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Lung Cancer Screening Clinical Information: Lung cancer screening Technique: Scan field of view: 360 mm. Height: 69 in. Patient weight: 189 lbs. CTDI vol: 0.83 mGy. DLP: 36.08 mGy cm. 0.60 mm images were obtained through the chest. The CT is jointly interpreted by Drs. Singh and Ahmed Smoking Status: Current If not current, quit years ago: 0 Pack Years: 35 Screen Year: 2 Comparison: Lung cancer screening chest CT dated 12/3/2019. Interpretation and recommendations are based on 2019 version of ACR LungRads recommendations Findings: No enlarged hilar or mediastinal nodes are present. The esophagus is mildly patulous with small amount of retained fluid. Mild upper lobe mixed centrilobular and paraseptal emphysema is again noted. Redemonstrated mild diffuse bronchial wall thickening which could be seen with bronchitis. A tiny noncalcified pulmonary nodule within the left upper lobe measuring up to 5 mm is unchanged (series 2, image 90). A triangular nodule within the left major fissure (series 2, image 110) fissural pulmonary parenchymal lymph node. Redemonstrated is a large central calcified granuloma within the anteromedial basal segment of the left lower lobe. A tiny calcified granuloma within the basal posterior left lower lobe (series 2, image 201) is also noted. No new suspicious pulmonary nodules or masses. No pleural or pericardial effusion Coronary artery calcification: The visual score of calcification is 2 (slightly increased calcification within the left anterior descending coronary artery). (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: Degenerative bony changes with similar appearance of the superior endplate compression of T6 vertebral body, however, with the new superior endplate compression with 50% anterior wedging of the L1 vertebral body, most likely degenerative. Impression: 1. Stable 5 mm noncalcified right upper lobe pulmonary nodule. 2. No new suspicious pulmonary nodules or mass. 3. Mild COPD changes with mild diffuse bronchial thickening and mild upper lobe predominant mixed emphysema is similar. 4. Mild worsening of the LAD coronary artery calcification. 5. Interval new superior endplate compression with 50% anterior wedging of the L1 vertebral body, most likely degenerative. LungRads category: 2S Lung-Rads Modifier S: Interval new superior endplate compression with 50% anterior vertebral body, most likely degenerative. Recommendation: Continued low dose annual lung cancer screening chest 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
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Findings: No enlarged hilar or mediastinal nodes are present. The esophagus is mildly patulous with small amount of retained fluid. Mild upper lobe mixed centrilobular and paraseptal emphysema is again noted. Redemonstrated mild diffuse bronchial wall thickening which could be seen with bronchitis. A tiny noncalcified pulmonary nodule within the left upper lobe measuring up to 5 mm is unchanged (series 2, image 90). A triangular nodule within the left major fissure (series 2, image 110) fissural pulmonary parenchymal lymph node. Redemonstrated is a large central calcified granuloma within the anteromedial basal segment of the left lower lobe. A tiny calcified granuloma within the basal posterior left lower lobe (series 2, image 201) is also noted. No new suspicious pulmonary nodules or masses. No pleural or pericardial effusion Coronary artery calcification: The visual score of calcification is 2 (slightly increased calcification within the left anterior descending coronary artery). (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: Degenerative bony changes with similar appearance of the superior endplate compression of T6 vertebral body, however, with the new superior endplate compression with 50% anterior wedging of the L1 vertebral body, most likely degenerative.
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FINDINGS: The study is mildly degraded by metallic streak artifacts from dental amalgam. CT temporal bones: RIGHT: The external auditory canal is normal. The tympanic membrane is intact. The right middle ear cavity is clear. The inner ear ossicles are normal. There is no scutal or ossicular erosion. There is normal development of the cochlea, vestibule, and semicircular canals. The otic capsule is normally mineralized. The vestibular and cochlear aqueducts are not enlarged. There are no variations in vascular or facial nerve anatomy. The internal auditory canal is normal in size and configuration. The mastoid air cells are well-developed and aerated. LEFT: The external auditory canal is normal. The tympanic membrane is intact. The left middle ear cavity is clear. The inner ear ossicles are normal. There is no scutal or ossicular erosion. There is normal development of the cochlea, vestibule, and semicircular canals. The otic capsule is normally mineralized. The vestibular and cochlear aqueducts are not enlarged. There are no variations in vascular or facial nerve anatomy. The internal auditory canal is normal in size and configuration. Trace left mastoid effusion. The mastoid air cells are otherwise well-developed and aerated. CT of the head without contrast: No acute intracranial hemorrhage, vascular territorial infarct, cerebral edema, space-occupying mass, or mass effect. Gray-white matter differentiation is maintained. Age-appropriate cerebral volume. Multifocal periventricular and subcortical white matter hypoattenuation bilaterally, likely chronic microangiopathic changes. No acute osseous or orbital abnormality. Incidental hyperostosis frontalis interna. Trace mucosal thickening of the bilateral maxillary sinus floors, bilateral ethmoid sinuses, and anterior sphenoid sinuses. The paranasal sinuses are otherwise clear. CT venogram of the head: There is no evidence of venous sinus thrombosis. There is normal asymmetric size of the right transverse sinus relative to the left. The deep cerebral veins also appear patent. Included portions of the internal jugular veins appear patent. No abnormal postcontrast enhancement. CT angiogram of the head: RIGHT CAROTID: Mild carotid siphon calcific atherosclerosis. There is no evidence of flow-limiting stenosis, occlusion, or aneurysmal dilation. LEFT CAROTID: Mild carotid siphon calcific atherosclerosis. There is no evidence of flow-limiting stenosis, occlusion, or aneurysmal dilation. ANTERIOR, MIDDLE, AND POSTERIOR CEREBRAL ARTERIES: Unremarkable. VERTEBROBASILAR ARTERIES: Bilateral V4 segment calcific atherosclerosis with mild right and severe left luminal stenosis. There is no evidence of occlusion or aneurysmal dilation. CT angiogram of the neck: AORTIC ARCH and PROXIMAL GREAT VESSELS: Conventional three-vessel branching pattern. Mild aortic arch and proximal great vessel calcific atherosclerosis RIGHT CAROTID: Mild carotid bifurcation calcific atherosclerosis. There is no evidence of flow-limiting stenosis, occlusion, or aneurysmal dilation. LEFT CAROTID: Retropharyngeal in course. Mild distal common carotid and carotid bifurcation calcific atherosclerosis. There is no evidence of flow-limiting stenosis, occlusion, or aneurysmal dilation. RIGHT VERTEBRAL ARTERY: The right vertebral artery is dominant. Mild atherosclerotic calcifications at the subclavian artery origin. There is no evidence of flow-limiting stenosis, occlusion, or aneurysmal dilation. LEFT VERTEBRAL ARTERY: Mild atherosclerotic calcifications at the subclavian artery origin. There is no evidence of flow-limiting stenosis, occlusion, or aneurysmal dilation. SOFT TISSUES: Right thyroid lobe 7 mm hypoattenuating nodule. The imaged lung apices demonstrate multifocal groundglass opacities, similar to prior CT from April 2021. CERVICAL SPINE: Multilevel mild to moderate degenerative discogenic disease and facet arthropathy. Bony ankylosis of the right C4-C5 facet joint. Prominent disc-osteophyte complex at C3-C4 results in moderate spinal canal stenosis and deformation of the ventral cord. Disc osteophyte complex with uncovertebral hypertrophy at C6-C7 results in severe left neuroforaminal stenosis. --------------------
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High resolution chest CT without contrast - Indication:Follow-up two cystic changes seen on chest radiograph. - Technique: 1.25 mm high resolution noncontrast helical images were obtained through the lungs with the patient in the prone position. Images were obtained in inspiration and expiration and reconstructed with bone algorithm. Coronal reconstructions were also obtained.Scan field of view: 283 mm. DLP: 313 mGy cm. - Findings:Compared to chest radiograph from 12/26/2021 and chest CT from 2013. - There is interval increase and centrilobular and paraseptal emphysema with upper lobe predominance since the 2013 exam. Mild subpleural reticulation is seen bilaterally without traction bronchiectasis or definitive honeycombing. Peribronchial groundglass opacities are seen along with groundglass densities in the areas of fibrosis. Bilateral mild bronchial wall thickening is seen. - Slight biapical pleural parenchymal scarring is unchanged. Scattered pulmonary nodules are seen including a new RUL nodule on series 2 image 57 and previously seen peri- fissural nodules on images 106 and 123. LLL nodule on image 110 and LUL nodule on image 73 are also unchanged from 2013. Some additional scattered nodules seen on the current exam or in the areas obscured by atelectasis on the prior exam. No pleural effusion. - No significant difference is seen in the degree of inspiration between the inspiratory and expiratory images. Cannot evaluate for air trapping or tracheobronchomalacia. - Low-attenuation nodule left thyroid node is 19 mm in longest dimension unchanged from 2013. Multiple enlarged mediastinal nodes are seen increased from the prior exam for example lower right paratracheal node measures 17 x 21 mm on image 84 and was 15 x 19 mm on the prior. The hila are difficult to evaluate without IV contrast. No axillary adenopathy is identified. A small hiatal hernia is seen with dilatation of the mid and upper esophagus. Calcific atherosclerosis is present in the aorta and coronary arteries. The main pulmonary artery is borderline enlarged at 31 mm. Within the limits of a noncontrast exam, the heart size and the mediastinum are otherwise normal. - There has been a previous cholecystectomy. Scattered calcified granuloma are seen in the liver. Limited noncontrast images of the upper abdomen are otherwise unremarkable. - No focal destructive osseous lesion. - Impression: 1. Interval increase in centrilobular and paraseptal emphysema with mild bilateral subpleural reticulation also noted. Borderline dilatation of main pulmonary artery. 2. Scattered tiny nodules are noted a few of which were present on the prior exam. Some are clearly new and others are in areas obscured by atelectasis on the prior. Attention on six month follow-up is suggested. 3. Mediastinal adenopathy with nodes increased in size from the 2013 exam.
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Findings:Compared to chest radiograph from 12/26/2021 and chest CT from 2013. - There is interval increase and centrilobular and paraseptal emphysema with upper lobe predominance since the 2013 exam. Mild subpleural reticulation is seen bilaterally without traction bronchiectasis or definitive honeycombing. Peribronchial groundglass opacities are seen along with groundglass densities in the areas of fibrosis. Bilateral mild bronchial wall thickening is seen. - Slight biapical pleural parenchymal scarring is unchanged. Scattered pulmonary nodules are seen including a new RUL nodule on series 2 image 57 and previously seen peri- fissural nodules on images 106 and 123. LLL nodule on image 110 and LUL nodule on image 73 are also unchanged from 2013. Some additional scattered nodules seen on the current exam or in the areas obscured by atelectasis on the prior exam. No pleural effusion. - No significant difference is seen in the degree of inspiration between the inspiratory and expiratory images. Cannot evaluate for air trapping or tracheobronchomalacia. - Low-attenuation nodule left thyroid node is 19 mm in longest dimension unchanged from 2013. Multiple enlarged mediastinal nodes are seen increased from the prior exam for example lower right paratracheal node measures 17 x 21 mm on image 84 and was 15 x 19 mm on the prior. The hila are difficult to evaluate without IV contrast. No axillary adenopathy is identified. A small hiatal hernia is seen with dilatation of the mid and upper esophagus. Calcific atherosclerosis is present in the aorta and coronary arteries. The main pulmonary artery is borderline enlarged at 31 mm. Within the limits of a noncontrast exam, the heart size and the mediastinum are otherwise normal. - There has been a previous cholecystectomy. Scattered calcified granuloma are seen in the liver. Limited noncontrast images of the upper abdomen are otherwise unremarkable. - No focal destructive osseous lesion. -
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Findings: Contrast bolus is suboptimal. Examination was triggered when contrast was in the pulmonary artery rather than the aorta. The aorta and other arterial vessels are poorly opacified. Aortic arch: There is shared origin of the brachiocephalic artery and left common carotid artery. Evaluation for focal stenoses is limited lack of contrast opacification. Right carotid: There are moderate atherosclerotic calcifications at the carotid bifurcation and proximal right ICA. Evaluation for focal stenoses is limited secondary to lack of contrast opacification. Left carotid: There are mild atherosclerotic calcifications at the carotid bifurcation and proximal left ICA. Evaluation for focal stenoses is limited secondary to lack of contrast opacification Right vertebral artery: Mild atherosclerotic calcifications at the origin. Evaluation for focal stenoses is limited secondary to lack of contrast opacification Left vertebral artery: Evaluation for focal stenoses is limited secondary to lack of contrast opacification Intracranial vessels: Intracranial vessels are only faintly opacified and proximal vessels appear patent. However evaluation for focal stenoses or aneurysms is severely limited. There does appear to be significant stenosis or occlusion of distal left MCA branch supplying anterior left frontal lobe
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EXAM: CT Neck Soft Tissue w contrast CLINICAL INFORMATION: Female patient 34 years with Neck mass, nonpulsatile, Q89.2 Congenital malformations of other endocrine glands Spec Inst: hx of infected thyroglossal duct cyst TECHNIQUE: 1.25 mm thick serial axial images were obtained through the neck after the intravenous administration of contrast. Sagittal and coronal reformatted views were also obtained. Technique: Patient weight: 189 lbs. IV contrast: Omnipaque 350, 100 ml, per protocol. Saline flush: 20 ml. IV contrast injection rate: 2 ml per sec. Scan delay: 45sec Scan field of view: 250 mm. DLP: 817.09 mGy cm. COMPARISON: None available. FINDINGS: The nasopharynx, oropharynx and hypopharynx appear unremarkable. Larynx appears normal. The parotid glands and submandibular glands appear within normal limits. Thyroid gland is unremarkable. There is mild patchy stranding along the upper left anterior strap muscles and also overlying platysma thickening. No focal lesion is identified and there is no focal fluid collection. There is a small borderline enlarged left submental lymph node. Measures approximately 10 x 8 mm in size. There there is no lymphadenopathy using CT size criteria within the internal jugular chains.. There is no significant vascular abnormality. There is no acute abnormality within the brain. Visualized lungs are unremarkable CONCLUSION: 01. Soft tissue stranding within the subcutaneous soft tissues of the upper left neck and also slight asymmetric thickening of the upper left anterior strap muscles with patchy enhancement is nonspecific, may represent mild soft tissue infection or could represent postsurgical changes in the common site for thyroglossal duct cyst.. However, No focal enhancing lesion is identified and there is no focal fluid collection 02. Borderline enlarged left submental lymph node, likely reactive
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FINDINGS: The nasopharynx, oropharynx and hypopharynx appear unremarkable. Larynx appears normal. The parotid glands and submandibular glands appear within normal limits. Thyroid gland is unremarkable. There is mild patchy stranding along the upper left anterior strap muscles and also overlying platysma thickening. No focal lesion is identified and there is no focal fluid collection. There is a small borderline enlarged left submental lymph node. Measures approximately 10 x 8 mm in size. There there is no lymphadenopathy using CT size criteria within the internal jugular chains.. There is no significant vascular abnormality. There is no acute abnormality within the brain. Visualized lungs are unremarkable
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Findings: Contrast bolus is suboptimal. Examination was triggered when contrast was in the pulmonary artery rather than the aorta. The aorta and other arterial vessels are poorly opacified. Aortic arch: There is shared origin of the brachiocephalic artery and left common carotid artery. Evaluation for focal stenoses is limited lack of contrast opacification. Right carotid: There are moderate atherosclerotic calcifications at the carotid bifurcation and proximal right ICA. Evaluation for focal stenoses is limited secondary to lack of contrast opacification. Left carotid: There are mild atherosclerotic calcifications at the carotid bifurcation and proximal left ICA. Evaluation for focal stenoses is limited secondary to lack of contrast opacification Right vertebral artery: Mild atherosclerotic calcifications at the origin. Evaluation for focal stenoses is limited secondary to lack of contrast opacification Left vertebral artery: Evaluation for focal stenoses is limited secondary to lack of contrast opacification Intracranial vessels: Intracranial vessels are only faintly opacified and proximal vessels appear patent. However evaluation for focal stenoses or aneurysms is severely limited. There does appear to be significant stenosis or occlusion of distal left MCA branch supplying anterior left frontal lobe
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CT angiogram of the neck with contrast - Indication: Takayasu arteritis, M31.4 Aortic arch syndrome [Takayasu]. - Comparison: CT angiogram neck 9/30/2020. - Technique: During the administration of IV contrast bolus, 2.5 mm images were obtained and reformatted in the 1.4 mm overlapping images. 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: 150 lbs. IV contrast: Omnipaque 350, 125 ml, per protocol. Saline flush: 20 ml. IV contrast injection rate: 4 ml per sec. Scan delay: Bolus Tracked. Scan field of view: 213 mm. DLP: 358 mGy cm. Findings: CT angiogram of the neck: Visualized portions of the brain appear unremarkable. Visualized portions of the intracranial arteries appear unremarkable. Mild wall thickening along the aortic arch and origin of the great vessels is also again noted. Most prominent circumferential wall thickening is seen involving the left common carotid artery with mild luminal narrowing which is similar to the prior exam. There is no flow-limiting stenosis. The left vertebral artery is dominant with no flow-limiting stenosis in either vertebral artery. The left subclavian artery distal to the vertebral origin is diminutive and occluded beyond approximately 1 cm, similar to the prior exam. There are several tortuous collaterals within the region extending to the axillary region as well, which is partially visualized. Mildly prominent cervical lymph nodes in levels II appear stable. Chest findings are reported separately. ---------------- Impression: 1. Unchanged circumferential wall thickening involving the aortic arch and great vessels, most prominently in the left common carotid artery with mild luminal narrowing, compatible with known vasculitis. No flow-limiting stenosis in the carotid arteries. 2. Occlusion of the left subclavian artery 1 cm distal to the vertebral origin with some collateral formation, unchanged.
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Findings: CT angiogram of the neck: Visualized portions of the brain appear unremarkable. Visualized portions of the intracranial arteries appear unremarkable. Mild wall thickening along the aortic arch and origin of the great vessels is also again noted. Most prominent circumferential wall thickening is seen involving the left common carotid artery with mild luminal narrowing which is similar to the prior exam. There is no flow-limiting stenosis. The left vertebral artery is dominant with no flow-limiting stenosis in either vertebral artery. The left subclavian artery distal to the vertebral origin is diminutive and occluded beyond approximately 1 cm, similar to the prior exam. There are several tortuous collaterals within the region extending to the axillary region as well, which is partially visualized. Mildly prominent cervical lymph nodes in levels II appear stable. Chest findings are reported separately. ----------------
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Findings: There is mild limitation due to motion artifact. Within this limitation, there is a moderate-sized area of loss of gray-white differentiation in the left frontal lobe extending to the frontal operculum. There is no superimposed hemorrhage or significant mass effect at this time. There is a faint calcification in the region, which could be vascular. There is no midline shift. There is a chronic small left cerebellar infarct. The visualized paranasal sinuses and mastoid air cells are clear. There is no acute osseous abnormality.
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EXAM: CT Angio Chest wo+w contrast CLINICAL INFORMATION: 37-year-old female with History of Takayasu arteritis. COMPARISON: CTA chest 9/30/2020 TECHNIQUE: CT Angio Chest wo+w contrast. Additional 3D image post-processing was performed to generate MIP and/or volume-rendered images. Patient weight: 150 lbs. IV contrast: Omnipaque 350, 125 ml, per protocol. Saline flush: 20 ml. IV contrast injection rate: 4 ml per sec. Scan delay: Bolus Tracked. Scan field of view: 267 mm. KVP: 110 DLP: 358 mGy cm. FINDINGS: STRUCTURED REPORT: CTA Chest VASCULATURE: CORONARY ARTERIES: There are no atherosclerotic calcifications of the native coronary arteries although this exam is not optimized for evaluation of the coronary arteries. PULMONARY ARTERIES: No central pulmonary embolus. Normal size. ASCENDING THORACIC AORTA: Normal caliber. AORTIC ARCH: Similar appearance of smooth circumferential wall thickening. ARCH VESSELS: Long segment, smooth circumferential wall thickening involving the proximal arch vessels is again seen, most prominent in the left common carotid artery, with associated minimal non-flow-limiting stenosis. The left subclavian artery remains occluded distal to the origin of the left vertebral artery. The right innominate, proximal right common carotid, and subclavian arteries are patent. DESCENDING THORACIC AORTA: Smooth circumferential wall thickening in the proximal descending thoracic aorta is also similar to prior. UPPER ABDOMINAL AORTA: No significant abnormality. ------------------------------------------------------------- LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: The central airways are patent. No focal airspace consolidation, pleural effusion, or pneumothorax. No suspicious nodules or masses. HEART / OTHER VESSELS: Cardiac chambers are normal in size. No pericardial effusion. MEDIASTINUM / ESOPHAGUS: Unremarkable. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Unremarkable. MUSCULOSKELETAL: No aggressive osseous lesion. Mild multilevel degenerative changes of the thoracic spine. Unchanged sclerotic lesion in the T5 vertebral body, likely bone island. CONCLUSION: 1. Similar appearance of smooth circumferential wall thickening involving the aortic arch, proximal descending thoracic aorta, and proximal arch vessels, most prominent in the left common carotid artery, with associated minimal non-flow-limiting stenosis. 2. Persistent occlusion of the left subclavian artery distal to the origin of the left vertebral artery. 3. Other incidental findings as described. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: STRUCTURED REPORT: CTA Chest VASCULATURE: CORONARY ARTERIES: There are no atherosclerotic calcifications of the native coronary arteries although this exam is not optimized for evaluation of the coronary arteries. PULMONARY ARTERIES: No central pulmonary embolus. Normal size. ASCENDING THORACIC AORTA: Normal caliber. AORTIC ARCH: Similar appearance of smooth circumferential wall thickening. ARCH VESSELS: Long segment, smooth circumferential wall thickening involving the proximal arch vessels is again seen, most prominent in the left common carotid artery, with associated minimal non-flow-limiting stenosis. The left subclavian artery remains occluded distal to the origin of the left vertebral artery. The right innominate, proximal right common carotid, and subclavian arteries are patent. DESCENDING THORACIC AORTA: Smooth circumferential wall thickening in the proximal descending thoracic aorta is also similar to prior. UPPER ABDOMINAL AORTA: No significant abnormality. ------------------------------------------------------------- LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: The central airways are patent. No focal airspace consolidation, pleural effusion, or pneumothorax. No suspicious nodules or masses. HEART / OTHER VESSELS: Cardiac chambers are normal in size. No pericardial effusion. MEDIASTINUM / ESOPHAGUS: Unremarkable. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Unremarkable. MUSCULOSKELETAL: No aggressive osseous lesion. Mild multilevel degenerative changes of the thoracic spine. Unchanged sclerotic lesion in the T5 vertebral body, likely bone island.
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Findings: The study is limited due to patient motion and inability to comply with instructions. RAPID images demonstrate CBF less than 30% volume: 0 mL and T. Max greater than 6seconds volume: 31 mL. Mismatch volume is 31 mL. There are areas of elevated T-max in bilateral frontal lobes, temporal lobes and left cerebellar hemisphere, which are likely artifactual.
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EXAM: CT Angio Abdomen and Pelvis CLINICAL INFORMATION: Bowel ischemia COMPARISON: CT 01/03/2022 TECHNIQUE: CT Angio Abdomen and Pelvis. Additional 3D image post-processing was performed to generate MIP and/or volume-rendered images. Patient weight: 329 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked, 45 sec Scan field of view: 441 mm. DLP: 3786.40 mGy cm. FINDINGS: STRUCTURED REPORT: CTA Abdomen Pelvis VASCULATURE: DISTAL DESCENDING THORACIC AORTA: Thoracic aortic dissection. ABDOMINAL AORTA: Stable abdominal aortic dissection extends caudally to the aortic bifurcation and further caudally into the left common iliac artery and external iliac artery. CELIAC AXIS: No significant abnormality. SMA: No significant abnormality. RIGHT RENAL: Mild atherosclerotic narrowing of right renal artery. LEFT RENAL: Mild atherosclerotic narrowing at left renal artery. 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: Increasing small volume bilateral pleural effusion. Persistent hyperdensity in the dependent right pleural effusion likely represent hemothorax. Persistent loculated hemothorax along the anterior right chest wall. Bibasilar compressive lung atelectasis.. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Multiple drainage catheter in the anterior mediastinum. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Evolving multifocal right renal cortical infarcts. Also seen small right renal cyst. No hydronephrosis. Nonspecific bilateral perinephric fat stranding. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Feeding tube or nasogastric tube within the stomach. No abnormal dilatation small bowel loops. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Persistent stable trace intraperitoneal free fluid in the pelvis. RETROPERITONEUM: Retroperitoneal stranding/edema in the lower abdomen and presacral region. OTHER VESSELS: Venous structures not opacified. URINARY BLADDER: Partially distended and contains Foleys catheter's catheter REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Diffuse body wall edema. MUSCULOSKELETAL: Lumbar fusion hardware. Lumbar vertebrae demonstrate normal height and multilevel degenerative changes. CONCLUSION: 1. Persistent, grossly unchanged thoracoabdominal and left iliac dissection. 2. Normal origin, course and caliber of superior mesenteric artery. No CT evidence of bowel ischemia. No bowel wall pneumatosis or portal venous gas. 3. Persistent small volume ascites and body wall edema likely related to volume overload. 4. Small volume bilateral pleural effusions hyperattenuating contents likely representing hemothorax. Loculated hemothorax in the anterior right lower chest. Small volume simple density left pleural effusion. 5. Other stable findings as described above.
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FINDINGS: STRUCTURED REPORT: CTA Abdomen Pelvis VASCULATURE: DISTAL DESCENDING THORACIC AORTA: Thoracic aortic dissection. ABDOMINAL AORTA: Stable abdominal aortic dissection extends caudally to the aortic bifurcation and further caudally into the left common iliac artery and external iliac artery. CELIAC AXIS: No significant abnormality. SMA: No significant abnormality. RIGHT RENAL: Mild atherosclerotic narrowing of right renal artery. LEFT RENAL: Mild atherosclerotic narrowing at left renal artery. 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: Increasing small volume bilateral pleural effusion. Persistent hyperdensity in the dependent right pleural effusion likely represent hemothorax. Persistent loculated hemothorax along the anterior right chest wall. Bibasilar compressive lung atelectasis.. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Multiple drainage catheter in the anterior mediastinum. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Evolving multifocal right renal cortical infarcts. Also seen small right renal cyst. No hydronephrosis. Nonspecific bilateral perinephric fat stranding. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Feeding tube or nasogastric tube within the stomach. No abnormal dilatation small bowel loops. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Persistent stable trace intraperitoneal free fluid in the pelvis. RETROPERITONEUM: Retroperitoneal stranding/edema in the lower abdomen and presacral region. OTHER VESSELS: Venous structures not opacified. URINARY BLADDER: Partially distended and contains Foleys catheter's catheter REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Diffuse body wall edema. MUSCULOSKELETAL: Lumbar fusion hardware. Lumbar vertebrae demonstrate normal height and multilevel degenerative changes.
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Findings: Frontal sinuses and frontoethmoidal recesses are clear. Mild mucosal thickening of the ethmoid air cells. Sphenoid sinuses are clear. Normal variant pneumatization of the left lateral lesser wing of the sphenoid (coronal series 6, image 344). Minimal mucosal thickening of the maxillary sinuses greater on the left. The middle ear and mastoid air cells are well-aerated. The nasal septum is in the midline without contact points. The olfactory grooves are symmetric in depth (Keros II). No periapical maxillary dental disease. Soft tissues appear normal. The visualized brain is normal. ---------------
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EXAM: CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: 49-year-old male with concern for ventral abdominal wall hernia COMPARISON: CT abdomen pelvis 10/16/2019 TECHNIQUE: CT Abdomen and Pelvis w contrast. Patient weight: 301 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. Saline flush: 10 ml. IV contrast injection rate: 2.50 ml per sec. Scan delay: 100 sec Scan field of view: 490 mm. DLP: 1341.24 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 for technique. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal for technique. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No abdominal wall hernia. Widening of the space between the rectus abdominis muscles noted, most pronounced near the level of the umbilicus (axial series 2, image 102) MUSCULOSKELETAL: Multilevel lumbar facet arthrosis. CONCLUSION: No ventral abdominal wall hernia. Mild rectus diastasis as described above.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal for technique. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal for technique. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No abdominal wall hernia. Widening of the space between the rectus abdominis muscles noted, most pronounced near the level of the umbilicus (axial series 2, image 102) MUSCULOSKELETAL: Multilevel lumbar facet arthrosis.
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FINDINGS: The elongated retrosternal anterior mediastinal soft tissue nodular density persist associated with minimal adjacent pericardial thickening and small pericardial effusion as before. The speckled calcification in the right hilar node is more prominent. No other nodes are present in the mediastinum. Small axillary nodes are seen in the left axilla as before. Small left upper lobe subpleural nodule along the fissure is 6 x 6 in image 29, series 3, unchanged. Few other tiny nodular changes are also noted in the perilymphatic distribution in both upper lobes right more than left. No pleural effusion is noted and visualized bones are unremarkable.
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EXAM: CT Shoulder from Reformat CLINICAL INFORMATION: Fracture. COMPARISON: Radiograph 12/14/2021 TECHNIQUE: CT Shoulder from Reformat FINDINGS: BONES/JOINTS: Comminuted impaction fracture of the humeral head with small associated joint effusion, not significantly changed since 12/14/2021. No other acute displaced fractures are seen. SOFT TISSUES: No large hematoma or fluid collection. Please see separately dictated and concurrently obtained CT chest for additional nonosseous findings. CONCLUSION: 1. Right humeral head comminuted impaction fracture involving the articular surface, not significantly changed since 12/14/2021. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: BONES/JOINTS: Comminuted impaction fracture of the humeral head with small associated joint effusion, not significantly changed since 12/14/2021. No other acute displaced fractures are seen. SOFT TISSUES: No large hematoma or fluid collection. Please see separately dictated and concurrently obtained CT chest for additional nonosseous findings.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: No focal consolidation, pleural effusion, or pneumothorax. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Unchanged scattered hepatic cysts. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Unchanged partially exophytic simple cyst in the upper pole of the right kidney. Scattered hypodensities throughout the left kidney are not significantly changed and are too small to characterize, but statistically represent cysts. No hydronephrosis or radiopaque renal calculus. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Unchanged postsurgical changes along the greater curvature of the stomach. The small bowel is otherwise unremarkable. COLON / APPENDIX: Postsurgical changes of right hemicolectomy. The appendix is absent. PERITONEUM / MESENTERY: No free fluid or intraperitoneal free air. RETROPERITONEUM: Normal. VESSELS: Moderate atherosclerotic calcifications of the abdominal aorta and its branches. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus is absent. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. Mild discogenic degenerative disease of the lumbar spine.
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Craniocervical CT angiogram 1/7/2022 7:38 PM Indication: hygroma, intracranial hypotension Spec Inst: eval for dural av fistula Comparison: CT head without contrast dated 1/6/2022. Technique: 1.4 mm axial images were obtained during the early arterial phase of a rapid IV infusion of contrast, from the thoracic inlet through the circle of Willis. 3-D CT angiographic images were generated from axial data set. "Sliding slab MIP" images were also generated. Patient weight: 177 lbs. IV contrast: Omnipaque 350, 100 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 220 mm. (accession CT220003915), Patient weight: 177 lbs. IV contrast: Omnipaque 350, 100 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked, 300 sec Scan field of view: 220 mm. DLP: 5501.10 mGy cm. (accession CT220003914). 3-D reconstructions were generated per the ordering physician's request from the axial data. This was performed under the supervision of the interpreting radiologist. Findings related to the 3-D reconstructions are included in this report. VASCULAR FINDINGS: Aortic arch: Patent without flow-limiting stenosis. Incidental four vessel aortic arch is noted, with the left vertebral artery originating directly from aortic arch. Right carotid: Patent without flow-limiting stenosis. Left carotid: Patent without flow-limiting stenosis. Right vertebral artery: Dominant. Patent without flow-limiting stenosis. Left vertebral artery: Patent without flow-limiting stenosis. Intracranial arteries: The bilateral ACAs, MCAs and PCAs appear patent, without flow-limiting stenoses or discrete aneurysms. The vertebrobasilar axis is mildly tortuous, without flow-limiting stenoses. Global distention of the bilateral dural venous sinuses is noted. NONVASCULAR FINDINGS: Unchanged small right frontal convexity subdural hygroma, measuring up to 4 mm in maximum thickness, without significant midline shift. Persistent 4.3 mm cerebellar tonsillar ectopia and partial obliteration of the quadrigeminal plate and ambient cisterns. The brain parenchyma volume appears normal. The white-gray matter differentiation is preserved. There is no abnormal enhancement, acute intracranial hemorrhage, or hydrocephalus. The visualized paranasal sinuses, mastoid air cells and orbits appear otherwise unremarkable. The oral cavity, nasopharynx, oropharynx, and laryngopharynx have normal appearance. No intrinsic abnormality is seen within the larynx or trachea. The true and false vocal cords are without focal abnormality. The superficial soft tissues of the neck have a normal appearance with no enhancing lesion identified. No enlarged lymph nodes are seen. The parotid and submandibular glands are normal in appearance. The thyroid gland is without focal abnormality. IMPRESSION: 1. Unchanged small right frontal convexity subdural hygroma, measuring up to 4 mm in maximum thickness, without significant midline shift. Persistent 4.3 mm cerebellar tonsillar ectopia and partial obliteration of the quadrigeminal plate and ambient cisterns, with global distention of the bilateral dural venous sinuses. Findings may represent sequela of intracranial hypotension. 2. Patent cervical and intracranial arteries, without evidence of acute vascular injury or flow-limiting stenosis.
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FINDINGS: Aortic arch: Patent without flow-limiting stenosis. Incidental four vessel aortic arch is noted, with the left vertebral artery originating directly from aortic arch. Right carotid: Patent without flow-limiting stenosis. Left carotid: Patent without flow-limiting stenosis. Right vertebral artery: Dominant. Patent without flow-limiting stenosis. Left vertebral artery: Patent without flow-limiting stenosis. Intracranial arteries: The bilateral ACAs, MCAs and PCAs appear patent, without flow-limiting stenoses or discrete aneurysms. The vertebrobasilar axis is mildly tortuous, without flow-limiting stenoses. Global distention of the bilateral dural venous sinuses is noted. NONVASCULAR FINDINGS: Unchanged small right frontal convexity subdural hygroma, measuring up to 4 mm in maximum thickness, without significant midline shift. Persistent 4.3 mm cerebellar tonsillar ectopia and partial obliteration of the quadrigeminal plate and ambient cisterns. The brain parenchyma volume appears normal. The white-gray matter differentiation is preserved. There is no abnormal enhancement, acute intracranial hemorrhage, or hydrocephalus. The visualized paranasal sinuses, mastoid air cells and orbits appear otherwise unremarkable. The oral cavity, nasopharynx, oropharynx, and laryngopharynx have normal appearance. No intrinsic abnormality is seen within the larynx or trachea. The true and false vocal cords are without focal abnormality. The superficial soft tissues of the neck have a normal appearance with no enhancing lesion identified. No enlarged lymph nodes are seen. The parotid and submandibular glands are normal in appearance. The thyroid gland is without focal abnormality.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: See separate chest CT report. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Tiny right renal cyst. Otherwise normal. LYMPH NODES: New hypodense nodule at aortic bifurcation measures 1.8 x 1.3 cm (image 205, series 2). There are adjacent surgical clips. A few mildly prominent left internal iliac node is present on image 302, series 2. Numerous new small nodes in the mesorectal fat are not pathologically enlarged. No other adenopathy. Previous left retroperitoneal cystic lesion near renal hilum is no longer seen. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Mild rectal wall thickening. The rectum is collapsed without focal mass. The rest of colon is unremarkable. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Surgical clips and the nodular abnormality as described above. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Absent left testis. Otherwise, normal. BODY WALL: Small umbilical hernia contains fat. Midline scarring. No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
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Craniocervical CT angiogram 1/7/2022 7:38 PM Indication: hygroma, intracranial hypotension Spec Inst: eval for dural av fistula Comparison: CT head without contrast dated 1/6/2022. Technique: 1.4 mm axial images were obtained during the early arterial phase of a rapid IV infusion of contrast, from the thoracic inlet through the circle of Willis. 3-D CT angiographic images were generated from axial data set. "Sliding slab MIP" images were also generated. Patient weight: 177 lbs. IV contrast: Omnipaque 350, 100 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 220 mm. (accession CT220003915), Patient weight: 177 lbs. IV contrast: Omnipaque 350, 100 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked, 300 sec Scan field of view: 220 mm. DLP: 5501.10 mGy cm. (accession CT220003914). 3-D reconstructions were generated per the ordering physician's request from the axial data. This was performed under the supervision of the interpreting radiologist. Findings related to the 3-D reconstructions are included in this report. VASCULAR FINDINGS: Aortic arch: Patent without flow-limiting stenosis. Incidental four vessel aortic arch is noted, with the left vertebral artery originating directly from aortic arch. Right carotid: Patent without flow-limiting stenosis. Left carotid: Patent without flow-limiting stenosis. Right vertebral artery: Dominant. Patent without flow-limiting stenosis. Left vertebral artery: Patent without flow-limiting stenosis. Intracranial arteries: The bilateral ACAs, MCAs and PCAs appear patent, without flow-limiting stenoses or discrete aneurysms. The vertebrobasilar axis is mildly tortuous, without flow-limiting stenoses. Global distention of the bilateral dural venous sinuses is noted. NONVASCULAR FINDINGS: Unchanged small right frontal convexity subdural hygroma, measuring up to 4 mm in maximum thickness, without significant midline shift. Persistent 4.3 mm cerebellar tonsillar ectopia and partial obliteration of the quadrigeminal plate and ambient cisterns. The brain parenchyma volume appears normal. The white-gray matter differentiation is preserved. There is no abnormal enhancement, acute intracranial hemorrhage, or hydrocephalus. The visualized paranasal sinuses, mastoid air cells and orbits appear otherwise unremarkable. The oral cavity, nasopharynx, oropharynx, and laryngopharynx have normal appearance. No intrinsic abnormality is seen within the larynx or trachea. The true and false vocal cords are without focal abnormality. The superficial soft tissues of the neck have a normal appearance with no enhancing lesion identified. No enlarged lymph nodes are seen. The parotid and submandibular glands are normal in appearance. The thyroid gland is without focal abnormality. IMPRESSION: 1. Unchanged small right frontal convexity subdural hygroma, measuring up to 4 mm in maximum thickness, without significant midline shift. Persistent 4.3 mm cerebellar tonsillar ectopia and partial obliteration of the quadrigeminal plate and ambient cisterns, with global distention of the bilateral dural venous sinuses. Findings may represent sequela of intracranial hypotension. 2. Patent cervical and intracranial arteries, without evidence of acute vascular injury or flow-limiting stenosis.
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FINDINGS: Aortic arch: Patent without flow-limiting stenosis. Incidental four vessel aortic arch is noted, with the left vertebral artery originating directly from aortic arch. Right carotid: Patent without flow-limiting stenosis. Left carotid: Patent without flow-limiting stenosis. Right vertebral artery: Dominant. Patent without flow-limiting stenosis. Left vertebral artery: Patent without flow-limiting stenosis. Intracranial arteries: The bilateral ACAs, MCAs and PCAs appear patent, without flow-limiting stenoses or discrete aneurysms. The vertebrobasilar axis is mildly tortuous, without flow-limiting stenoses. Global distention of the bilateral dural venous sinuses is noted. NONVASCULAR FINDINGS: Unchanged small right frontal convexity subdural hygroma, measuring up to 4 mm in maximum thickness, without significant midline shift. Persistent 4.3 mm cerebellar tonsillar ectopia and partial obliteration of the quadrigeminal plate and ambient cisterns. The brain parenchyma volume appears normal. The white-gray matter differentiation is preserved. There is no abnormal enhancement, acute intracranial hemorrhage, or hydrocephalus. The visualized paranasal sinuses, mastoid air cells and orbits appear otherwise unremarkable. The oral cavity, nasopharynx, oropharynx, and laryngopharynx have normal appearance. No intrinsic abnormality is seen within the larynx or trachea. The true and false vocal cords are without focal abnormality. The superficial soft tissues of the neck have a normal appearance with no enhancing lesion identified. No enlarged lymph nodes are seen. The parotid and submandibular glands are normal in appearance. The thyroid gland is without focal abnormality.
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FINDINGS: Prominent residual thymic tissue in the anterior mediastinum. There are no enlarged nodes in the mediastinum or either axilla. There is a 4 mm noncalcified left upper lobe nodule in image 53, series 2 was present before in April 2021 as well as December 2020. No other lung nodule/mass, airspace consolidation or interstitial abnormality. No pleural or pericardial effusion is seen and visualized bones are unremarkable.
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RADIOLOGIC EXAM: CT Head wo contrast CLINICAL INFORMATION: Trauma. Loss of consciousness. Scalp laceration. COMPARISON: None. TECHNIQUE: CT Head wo contrastScan field of view: 230 mm. DLP: 1416.20 mGy cm. STRUCTURED REPORT: CT Head Trauma FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. Right frontal scalp laceration with small amount of subcutaneous gas in contusive changes along the right frontal scalp are demonstrated. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal. CONCLUSION: 1. No acute intracranial abnormality evident. 2. Right frontal scalp laceration.
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FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. Right frontal scalp laceration with small amount of subcutaneous gas in contusive changes along the right frontal scalp are demonstrated. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal.
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FINDINGS: Right frontal craniotomy changes are again noted. There is decreasing size of extra-axial hemorrhage and fluid underlying the craniotomy defect. Packing material along the floor of the anterior cranial fossa within the surgical bed at site of recently resected meningioma demonstrates expected evolution. Surgical cavity within the floor of the anterior cranial fossa appears stable. There is no evidence of residual meningioma on this noncontrast examination There is no acute intracranial hemorrhage. There are no abnormal areas of hypoattenuation to suggest acute infarction. Ventricles are stable in size without hydrocephalus. There is a small air-fluid level within the right sphenoid sinus which has developed. There is mild mucosal thickening within the posterior right ethmoid air cells which are stable. The remaining visualized paranasal sinuses and mastoid air cells are clear. There is decreased opacification of the superior nasal cavities bilaterally but there is continued small amount of fluid within the superior most left nasal cavity. The orbits are unremarkable.
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EXAM: CT Angio Abdomen and or Pelvis w Runoff CLINICAL INFORMATION: DP pulses diminished. Pulse discrepancy in the left lower extremity. COMPARISON: CT abdomen and pelvis October 8, 2021. TECHNIQUE: CT Angio Abdomen and or Pelvis w Runoff. Additional 3D image post-processing was performed to generate MIP and/or volume-rendered images. Patient weight: 107 lbs. IV contrast: Omnipaque 350, 80 ml, per protocol. IV contrast injection rate: 3.50 ml per sec. Scan delay: bt sec. Scan field of view: 443 mm. DLP: 2385 mGy cm. FINDINGS: STRUCTURED REPORT: CTA Aorta Runoff VASCULATURE: There is nonocclusive PTE in a left lower lobe segmental pulmonary artery and some peripheral nonocclusive PTE in the right interlobar pulmonary artery and right lower lobe pulmonary artery. There is reflux of contrast into the IVC and hepatic veins. DISTAL DESCENDING THORACIC AORTA: No significant abnormality. ABDOMINAL AORTA: No significant abnormality. CELIAC AXIS: No significant abnormality. SMA: No significant abnormality. RIGHT RENAL: No significant abnormality. LEFT RENAL: No significant abnormality. IMA: Patent. RIGHT ILIAC ARTERIES: No significant abnormality. Mild atherosclerotic calcification of the origin of the right internal iliac artery and scattered within the internal iliac artery. RIGHT FEMORAL \T\ POPLITEAL ARTERIES: On the initial acquisition the scanner appears to outrun the bolus. On the delayed phase images of the distal SFA, popliteal, tibioperoneal trunk and proximal anterior tibial artery are well opacified within unopacified. RIGHT TIBIAL AND PERONEAL ARTERIES: On the delayed phase images the vessels are patent proximally but unopacified in the mid and distal aspect potentially related to diminished cardiac function. There are scattered atherosclerotic calcifications in the anterior tibial territory. RIGHT FOOT ARTERIES: Unopacified on all sequences. LEFT ILIAC ARTERIES: No significant abnormality. Mild atherosclerotic calcification in the internal iliac territories. LEFT FEMORAL \T\ POPLITEAL ARTERIES: Patent proximally on the initial acquisition within the CT scanner appears to run the bolus. The delayed images demonstrate good opacification of the distal SFA and popliteal artery and proximal anterior tibial, posterior tibial and peroneal arteries. LEFT TIBIAL AND PERONEAL ARTERIES: These vessels are unopacified on the initial arterial acquisition. Atherosclerotic calcification is visualized in the anterior tibial territory and on the delayed phase images the anterior tibial and posterior tibial as well as peroneal artery are patent but the mid and distal foreleg is vessels are unopacified.. LEFT FOOT ARTERIES: Unopacified on all sequences. ------------------------------------------------------------- LOWER CHEST: LUNG BASES / PLEURA: Right lower lobe linear scarring also with bronchiectasis. There is left lower lobe linear scarring and bronchiectasis. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: There is reflux of contrast into the IVC and hepatic veins and a mildly dilated appearance of the right heart. No septal flattening. ABDOMEN and PELVIS: LIVER: Previously demonstrated subcentimeter focus of parenchymal enhancement in the right hepatic dome is not obviously enhancing on this exam and may represent a perfusional anomaly or hemangioma. Simple cyst in the inferior right liver is unchanged. Scattered subtle subcentimeter hypodensities are indeterminate due to small size, unchanged. BILIARY TRACT: Normal. GALLBLADDER: Gallbladder sludge versus cholelithiasis. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: There are subcentimeter hypodensities in both kidneys which are indeterminate due to small size. There is a simple cyst in the upper/left mid left kidney. There is mild left urothelial thickening of the left renal pelvis. No hydronephrosis. Mild left pelvocaliectasis. No nephrolithiasis evident. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Small linear radiodensity in the ascending colon on axial image 122 series 301 there are represent a surgical clip or potentially an ingested small foreign body. The colon is otherwise unremarkable. There is a large amount of fecal material in the rectum. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: No significant abnormality. URINARY BLADDER: There is diffuse bladder wall thickening. REPRODUCTIVE ORGANS: Enlarged prostate indenting the bladder base. The testicles are high riding. BODY WALL: Normal. MUSCULOSKELETAL: Postoperative changes of a bipolar left hemiarthroplasty. Osteopenia/demineralization. There are degenerative changes in the spine. There is SI joint fusion bilaterally. There appears to be a healed left femoral fracture. Postoperative changes of left femoral hardware removal. There are degenerative changes at the knees. CONCLUSION: 1. Nonocclusive PTE. 2. Evaluation of the bilateral lower extremity arteries is limited even on delayed images as the mid and distal foreleg arteries and foot arteries are not opacified on all sequences. This may be secondary to diminished cardiac function. There are findings of reflux of contrast into the hepatic veins and IVC. Recommend correlation for right heart dysfunction. 3. Mild atherosclerotic disease related changes. 4. Diffuse bladder wall thickening which may be related to cystitis. Clinical correlation to exclude hematuria. 5. Left renal pelvic urothelial thickening, mild, potentially infectious/inflammatory. 6. Small linear radiodensity in the ascending colon is indeterminate and could represent a clip or possibly a small ingested foreign body. Michelle Brown, PA, notified by Dr. Spann via telephone at 5:25 PM January 7, 2022.
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FINDINGS: STRUCTURED REPORT: CTA Aorta Runoff VASCULATURE: There is nonocclusive PTE in a left lower lobe segmental pulmonary artery and some peripheral nonocclusive PTE in the right interlobar pulmonary artery and right lower lobe pulmonary artery. There is reflux of contrast into the IVC and hepatic veins. DISTAL DESCENDING THORACIC AORTA: No significant abnormality. ABDOMINAL AORTA: No significant abnormality. CELIAC AXIS: No significant abnormality. SMA: No significant abnormality. RIGHT RENAL: No significant abnormality. LEFT RENAL: No significant abnormality. IMA: Patent. RIGHT ILIAC ARTERIES: No significant abnormality. Mild atherosclerotic calcification of the origin of the right internal iliac artery and scattered within the internal iliac artery. RIGHT FEMORAL \T\ POPLITEAL ARTERIES: On the initial acquisition the scanner appears to outrun the bolus. On the delayed phase images of the distal SFA, popliteal, tibioperoneal trunk and proximal anterior tibial artery are well opacified within unopacified. RIGHT TIBIAL AND PERONEAL ARTERIES: On the delayed phase images the vessels are patent proximally but unopacified in the mid and distal aspect potentially related to diminished cardiac function. There are scattered atherosclerotic calcifications in the anterior tibial territory. RIGHT FOOT ARTERIES: Unopacified on all sequences. LEFT ILIAC ARTERIES: No significant abnormality. Mild atherosclerotic calcification in the internal iliac territories. LEFT FEMORAL \T\ POPLITEAL ARTERIES: Patent proximally on the initial acquisition within the CT scanner appears to run the bolus. The delayed images demonstrate good opacification of the distal SFA and popliteal artery and proximal anterior tibial, posterior tibial and peroneal arteries. LEFT TIBIAL AND PERONEAL ARTERIES: These vessels are unopacified on the initial arterial acquisition. Atherosclerotic calcification is visualized in the anterior tibial territory and on the delayed phase images the anterior tibial and posterior tibial as well as peroneal artery are patent but the mid and distal foreleg is vessels are unopacified.. LEFT FOOT ARTERIES: Unopacified on all sequences. ------------------------------------------------------------- LOWER CHEST: LUNG BASES / PLEURA: Right lower lobe linear scarring also with bronchiectasis. There is left lower lobe linear scarring and bronchiectasis. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: There is reflux of contrast into the IVC and hepatic veins and a mildly dilated appearance of the right heart. No septal flattening. ABDOMEN and PELVIS: LIVER: Previously demonstrated subcentimeter focus of parenchymal enhancement in the right hepatic dome is not obviously enhancing on this exam and may represent a perfusional anomaly or hemangioma. Simple cyst in the inferior right liver is unchanged. Scattered subtle subcentimeter hypodensities are indeterminate due to small size, unchanged. BILIARY TRACT: Normal. GALLBLADDER: Gallbladder sludge versus cholelithiasis. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: There are subcentimeter hypodensities in both kidneys which are indeterminate due to small size. There is a simple cyst in the upper/left mid left kidney. There is mild left urothelial thickening of the left renal pelvis. No hydronephrosis. Mild left pelvocaliectasis. No nephrolithiasis evident. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Small linear radiodensity in the ascending colon on axial image 122 series 301 there are represent a surgical clip or potentially an ingested small foreign body. The colon is otherwise unremarkable. There is a large amount of fecal material in the rectum. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: No significant abnormality. URINARY BLADDER: There is diffuse bladder wall thickening. REPRODUCTIVE ORGANS: Enlarged prostate indenting the bladder base. The testicles are high riding. BODY WALL: Normal. MUSCULOSKELETAL: Postoperative changes of a bipolar left hemiarthroplasty. Osteopenia/demineralization. There are degenerative changes in the spine. There is SI joint fusion bilaterally. There appears to be a healed left femoral fracture. Postoperative changes of left femoral hardware removal. There are degenerative changes at the knees.
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FINDINGS: There is a well-circumscribed lesion within the subcutaneous soft tissues of the upper thoracic spine. Lesion is at approximately the level of the T2 vertebral body. The lesion is nearly isodense to musculature and appears to contain several small calcifications. It measures 3.3 x 2.2 cm in the axial plane. There is no adjacent soft tissue stranding. There is no acute fracture subluxation or destructive osseous lesion. There are several Schmorl's nodes within the mid and inferior thoracic spine. There are no significant degenerative changes. There is no significant central canal narrowing or neural foraminal narrowing Visualized lungs are clear.
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EXAM: CT Abdomen and Pelvis wo+w contrast CLINICAL INFORMATION: Staging breast cancer with hilar and mediastinal lymph node concerning for recurrence. COMPARISON: Chest CT 12/27/2021. TECHNIQUE: CT Abdomen and Pelvis wo+w contrast. Patient weight: 162 lbs. IV contrast: Omnipaque 350, 143 ml, per protocol. IV contrast injection rate: 3.50 ml per sec. Scan delay: bt sec. Scan field of view: 333 mm. DLP: 785 mGy cm. FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Right lower lobe lung nodule is unchanged from recent chest CT DISTAL ESOPHAGUS: Normal. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: 4 mm nonobstructing right renal stone.. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: No ascites. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus and adnexa are unremarkable. Hypodensity in the left perivaginal tissues likely a Bartholin's duct cyst BODY WALL: Small soft tissue stranding/fluid collection is seen in the anterior abdominal wall subcutaneous tissues likely post reconstruction. Of note, some of the anterior left chest soft tissues is cut off the field-of-view due to body habitus. MUSCULOSKELETAL: No destructive osseous lesions seen. Subtle area of sclerosis in the midline sacrum corresponding to the nuclear medicine study is symmetric. CONCLUSION: 1. Subtle area of sclerosis in the midline sacrum corresponding to the nuclear medicine study is symmetric, and not likely to be metastasis but cannot be completely excluded. Recommend attention on follow-up. 2. Otherwise, no definite evidence of metastatic disease in the abdomen pelvis. 3. Right lower lobe lung nodule is unchanged from recent chest CT.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Right lower lobe lung nodule is unchanged from recent chest CT DISTAL ESOPHAGUS: Normal. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: 4 mm nonobstructing right renal stone.. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: No ascites. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus and adnexa are unremarkable. Hypodensity in the left perivaginal tissues likely a Bartholin's duct cyst BODY WALL: Small soft tissue stranding/fluid collection is seen in the anterior abdominal wall subcutaneous tissues likely post reconstruction. Of note, some of the anterior left chest soft tissues is cut off the field-of-view due to body habitus. MUSCULOSKELETAL: No destructive osseous lesions seen. Subtle area of sclerosis in the midline sacrum corresponding to the nuclear medicine study is symmetric.
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FINDINGS: STRUCTURED REPORT: CT HCC Follow-up IMAGE QUALITY: Satisfactory LOWER CHEST: LUNG BASES / PLEURA: No significant abnormality HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Cirrhotic. No steatosis. TREATED LIVER LESIONS: - Lesion Number: 1 - Description: Left hepatic lobe lesion along the falciform ligament - Location: Segment(s) 4A/B - Size of largest enhancing portion of the mass: No masslike enhancement - Enhancement: Treatment-specific expected enhancement pattern - 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): - Lesion Number: 1 - Description: Partially exophytic left hepatic lobe segment two lesion - Location: Segment(s) 2 - Size: 3.3 cm - Enhancement: Nonrim arterial phase hyperenhancement - Vascular invasion: No - Additional major features present: 3 - Enhancing "capsule": Present. - Nonperipheral "washout": Present. - Threshold growth (>= 50% in = 50% in <= 6 months): Present. - Other features: None. - LI-RADS: LR-5 LIVER VASCULATURE AND COLLATERALS: - Hepatic artery patency and anatomy: Patent with conventional anatomy. - Portal venous system: Nonocclusive thrombus in the left portal vein. - Hepatic veins: Patent right, middle and left hepatic veins. - Esophageal varices: Small (
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EXAM: CT Sinus wo contrast CLINICAL INFORMATION: Male patient 66 years with Sinonasal obstruction, J34.89 Other specified disorders of nose and nasal sinuses Spec Inst: facialsinus pressure despite antibiotic treatment TECHNIQUE: 0.6 mm thick serial axial images were obtained through the paranasal sinuses without intravenous contrast. Sagittal and coronal reformatted views were also obtained. Technique: Scan field of view: 180 mm. DLP: 727 mGy cm. COMPARISON: Brain MRI dated 8/26/2009 FINDINGS: There is minimal mucosal thickening within the left frontal sinus at the frontoethmoidal recess. The right frontal sinus is clear. There is also mild mucosal thickening within the anterior left greater than right ethmoid air cells. There is minimal mucosal thickening within the right sphenoid sinus and also within the left sphenoid sinus.. Both maxillary sinuses are clear. There is a density along the inferior aspect of the left maxillary sinus which appears to represent a unerupted tooth which appears mildly dysplastic. There are no air-fluid levels within the paranasal sinuses. Walls of the paranasal sinuses are intact. There is mild dehiscence of the left cribriform plate but there is no definite focal defect. Ostiomeatal complexes are patent bilaterally. Frontal sinus outflow tracts are patent bilaterally There is mild rightward deviation of the nasal septum. No mass lesion is identified within the nasal cavity. There is no acute abnormality of the orbits. Mastoid air cells are clear. CONCLUSION: 01. No evidence of acute or chronic sinusitis. No obstructing lesion is identified. 02. Mild dehiscence involving the left cribriform plate. However no definite defect/cephalocele is identified
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FINDINGS: There is minimal mucosal thickening within the left frontal sinus at the frontoethmoidal recess. The right frontal sinus is clear. There is also mild mucosal thickening within the anterior left greater than right ethmoid air cells. There is minimal mucosal thickening within the right sphenoid sinus and also within the left sphenoid sinus.. Both maxillary sinuses are clear. There is a density along the inferior aspect of the left maxillary sinus which appears to represent a unerupted tooth which appears mildly dysplastic. There are no air-fluid levels within the paranasal sinuses. Walls of the paranasal sinuses are intact. There is mild dehiscence of the left cribriform plate but there is no definite focal defect. Ostiomeatal complexes are patent bilaterally. Frontal sinus outflow tracts are patent bilaterally There is mild rightward deviation of the nasal septum. No mass lesion is identified within the nasal cavity. There is no acute abnormality of the orbits. Mastoid air cells are clear.
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FINDINGS: STRUCTURED REPORT: CT PE OVERALL DIAGNOSTIC QUALITY: Mildly suboptimal quality with incomplete evaluation of subsegmental pulmonary arteries. Motion artifact. LOWER NECK: No abnormality. CHEST: PULMONARY ARTERIES: Negative for pulmonary embolus LUNGS / AIRWAYS / PLEURA: Normal. 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.
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EXAM: CT Bone Pelvis wo contrast CLINICAL INFORMATION: Left hip pain. COMPARISON: CT abdomen and pelvis with contrast 4/24/2021. Progressive the pelvis and left hip 1/7/2022. TECHNIQUE: CT Bone Pelvis wo contrast Scan field of view: 360 mm. DLP: 618 mGy cm. STRUCTURED REPORT: CT Bone vDec2021 FINDINGS: BONES/JOINTS: Osseous mineralization is diffusely decreased. No acute displaced fracture or malalignment is identified. Unchanged sclerotic lesion in the posterior left ilium. Advanced degenerative changes at L5-S1 with posterior disc osteophyte complex and moderate osseous narrowing of the bilateral neural foramina. SOFT TISSUES: No large hematoma or fluid collection. Penile prosthesis is again noted with its reservoir in the anterior left hemipelvis. Advanced aortoiliac calcific atherosclerosis. Infrarenal abdominal aortic aneurysm measures 3.9 x 3.9 cm (series 301, image 12), similar to prior examination. Partially thrombosed saccular aneurysm arising from the left common iliac artery, measuring approximately 3.8 x 3.5 cm (series 301, image 49), unchanged by my measurements (series 301, image 235). No new abnormality in the visualized lower abdomen and pelvis. CONCLUSION: 1. No acute osseous abnormality identified. 2. Stable sclerotic lesion in the left posterior ilium, stable infrarenal abdominal aortic aneurysm and left common iliac artery saccular aneurysm, an additional unchanged findings as above. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: BONES/JOINTS: Osseous mineralization is diffusely decreased. No acute displaced fracture or malalignment is identified. Unchanged sclerotic lesion in the posterior left ilium. Advanced degenerative changes at L5-S1 with posterior disc osteophyte complex and moderate osseous narrowing of the bilateral neural foramina. SOFT TISSUES: No large hematoma or fluid collection. Penile prosthesis is again noted with its reservoir in the anterior left hemipelvis. Advanced aortoiliac calcific atherosclerosis. Infrarenal abdominal aortic aneurysm measures 3.9 x 3.9 cm (series 301, image 12), similar to prior examination. Partially thrombosed saccular aneurysm arising from the left common iliac artery, measuring approximately 3.8 x 3.5 cm (series 301, image 49), unchanged by my measurements (series 301, image 235). No new abnormality in the visualized lower abdomen and pelvis.
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Findings: Moderate to severe age-appropriate brain involution. Chronic encephalomalacia changes in the right frontoparietal, bilateral parieto-occipital, left posterior high frontal and left hemispheric cerebellar regions. Old lacunar infarcts in bilateral basal ganglia and thalami. Extensive periventricular white matter hypoattenuation in a pattern compatible with small vessel ischemic disease. No acute intracranial hemorrhage, intracranial mass, mass effect or midline shift. No evidence for brain edema. No evidence for large vascular territory acute stroke. Atherosclerotic calcifications in the intracranial vasculature. No hydrocephalus. Basal cisterns are patent. Chronic bilateral maxillary sinusitis. Left maxillary sinonasal surgery changes Scattered mucosal inflammatory changes in anterior right ethmoid and frontal sinuses. Small right mastoid effusion. Bilateral mastoid air cells and middle ear cavities are otherwise unremarkable. Bilateral pseudophakia. Otherwise visualized bilateral orbits are unremarkable. No acute osseous abnormalities.
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EXAM: CT Angio Abdomen and Pelvis CLINICAL INFORMATION: Preoperative for flap reconstruction. COMPARISON: CT abdomen pelvis dated 3/25/2019 TECHNIQUE: CT Angio Abdomen and Pelvis. Additional 3D image post-processing was performed to generate MIP and/or volume-rendered images. Patient weight: 194 lbs. IV contrast: Omnipaque 350, 143 ml, per protocol. Saline flush: 10 ml. IV contrast injection rate: 6 ml per sec. Scan delay: bolus track Scan field of view: 480 mm. DLP: 969.12 mGy cm. FINDINGS: STRUCTURED REPORT: CTA Abdomen Pelvis VASCULATURE: DISTAL DESCENDING THORACIC AORTA: No significant abnormality. ABDOMINAL AORTA: No significant abnormality. CELIAC AXIS: No significant abnormality. Accessory left hepatic artery arises from the left gastric artery. SMA: No significant abnormality. Right hepatic artery arises from the SMA. 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: Hypoattenuation of the liver, suggestive of steatosis. No focal hepatic lesion identified. 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. Appendix is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus is absent. BODY WALL: Postoperative changes of the anterior abdominal wall with mild rectus diastases. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: Preoperative planning CT for flap reconstruction. No evidence of vascular disease or abdominopelvic metastatic disease. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: STRUCTURED REPORT: CTA Abdomen Pelvis VASCULATURE: DISTAL DESCENDING THORACIC AORTA: No significant abnormality. ABDOMINAL AORTA: No significant abnormality. CELIAC AXIS: No significant abnormality. Accessory left hepatic artery arises from the left gastric artery. SMA: No significant abnormality. Right hepatic artery arises from the SMA. 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: Hypoattenuation of the liver, suggestive of steatosis. No focal hepatic lesion identified. 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. Appendix is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus is absent. BODY WALL: Postoperative changes of the anterior abdominal wall with mild rectus diastases. MUSCULOSKELETAL: No significant abnormality.
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FINDINGS: STRUCTURED REPORT: CTA Abdomen Pelvis VASCULATURE: DISTAL DESCENDING THORACIC AORTA: Wall calcifications and mural plaque are unchanged. ABDOMINAL AORTA: Diffuse arterial wall calcifications are unchanged. No aneurysm. CELIAC AXIS: Occluded. Hepatic arterial branches supplied by collaterals. SMA: No significant abnormalities. RIGHT RENAL: No significant abnormality. LEFT RENAL: No significant abnormality. IMA: No significant abnormality. RIGHT ILIAC / PROXIMAL FEMORAL ARTERIES: Diffusely calcified right common iliac artery with stent is patent, but there is arterial narrowing at the proximal margin of the stent on image 138 series 2. Right internal iliac artery bypass is patent with severe wall calcifications and luminal narrowing on image 144 series 2. No new abnormality. LEFT ILIAC / PROXIMAL FEMORAL ARTERIES: Left proximal internal iliac artery stenosis, unchanged. No new abnormality. ------------------------------------------------------------- LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal size and configuration. Tiny cysts are unchanged. BILIARY TRACT: Common bile duct dilatation and mild intrahepatic ductal dilatation are unchanged. GALLBLADDER: Surgically absent. PANCREAS: Pancreatic body cystic lesion measures 2.2 x 1.5 cm (image 56 series 4), previously 1.7 x 1.7 cm (series 4, image 71). Mild pancreatic duct dilatation is increased (image 87 series 4). No other pancreatic abnormality. SPLEEN: Normal. ADRENALS: Bilateral adrenal thickening, unchanged. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: Bilateral common iliac venous stents are unchanged. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterine fibroids. Bilateral enlarged periuterine veins are unchanged. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Lumbar degenerative changes and osteopenia are similar to prior study. No aggressive osseous lesions.
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CT lumbar spine without contrast Indication: Lower back pain Technique: Axial images of the lumbar spine were obtained without contrast. Coronal and sagittal reformats were reviewed. Scan field of view: 160 mm. DLP: 310 mGy cm. Comparison: Lumbar spine radiographs dated 12/7/2021 Findings: There is slight dextroscoliosis centered at T12 1. Remote compression deformity of T12. Post surgical changes from prior L5 right hemilaminectomy. Degenerative changes of the discussed level by level basis below. T12-L1: Mild spinal canal narrowing related to retropulsion of bony fragments associated with the T12 compression fracture. Mild bilateral facet arthropathy and retropulsed bony fragments result in moderate left neural foraminal narrowing. L1-L2: Mild bilateral facet arthropathy without significant spinal canal or neural foraminal narrowing. L2-L3: Mild broad-based disc bulge asymmetric to the left results in minimal spinal canal narrowing. There is also mild bilateral facet arthropathy without significant neuroforaminal narrowing. L3-L4: Broad-based disc bulge and moderate bilateral facet arthropathy results in mild spinal canal narrowing and mild bilateral neuroforaminal narrowing, right greater than left. Prominent degenerative changes of the endplates. L4-L5: Broad-based disc bulge results in mild spinal canal narrowing. Moderate facet arthropathy without significant neural foraminal narrowing. L5-S1: Post surgical changes from prior L5 right hemilaminectomy. Small amount of asymmetric soft tissue at the laminectomy site results in effacement of the dorsal aspect of the spinal canal, for example on image 166 series 4. Severe bilateral facet arthropathy with mild bilateral neuroforaminal narrowing. Limited images of the intra-abdominal and pelvic structures demonstrate moderate atherosclerotic calcifications of the abdominal aorta and branch vessels. Additionally there are partially imaged post surgical changes from prior bowel resection with anastomotic suture in the right hemiabdomen. ---------------- Conclusion: 1. Postsurgical changes from prior L5 right hemilaminectomy with asymmetric soft tissue in the laminectomy site resulting in effacement of the right dorsal aspect of the spinal canal. These findings could be related to surgical scarring and further evaluation with contrast enhanced MRI is recommended as clinically indicated. 2. Mild/moderate multilevel degenerative changes of the lumbar spine without CT evidence of neural impingement at any level. 3. Remote T12 compression deformity. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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Findings: There is slight dextroscoliosis centered at T12 1. Remote compression deformity of T12. Post surgical changes from prior L5 right hemilaminectomy. Degenerative changes of the discussed level by level basis below. T12-L1: Mild spinal canal narrowing related to retropulsion of bony fragments associated with the T12 compression fracture. Mild bilateral facet arthropathy and retropulsed bony fragments result in moderate left neural foraminal narrowing. L1-L2: Mild bilateral facet arthropathy without significant spinal canal or neural foraminal narrowing. L2-L3: Mild broad-based disc bulge asymmetric to the left results in minimal spinal canal narrowing. There is also mild bilateral facet arthropathy without significant neuroforaminal narrowing. L3-L4: Broad-based disc bulge and moderate bilateral facet arthropathy results in mild spinal canal narrowing and mild bilateral neuroforaminal narrowing, right greater than left. Prominent degenerative changes of the endplates. L4-L5: Broad-based disc bulge results in mild spinal canal narrowing. Moderate facet arthropathy without significant neural foraminal narrowing. L5-S1: Post surgical changes from prior L5 right hemilaminectomy. Small amount of asymmetric soft tissue at the laminectomy site results in effacement of the dorsal aspect of the spinal canal, for example on image 166 series 4. Severe bilateral facet arthropathy with mild bilateral neuroforaminal narrowing. Limited images of the intra-abdominal and pelvic structures demonstrate moderate atherosclerotic calcifications of the abdominal aorta and branch vessels. Additionally there are partially imaged post surgical changes from prior bowel resection with anastomotic suture in the right hemiabdomen. ----------------
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FINDINGS: STRUCTURED REPORT: CT Renal Mass LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN: KIDNEYS: RENAL MASS #1 BRIEF DESCRIPTION: Large heterogeneously enhancing mass arises from the left kidney. LOCATION: Left Kidney. SIZE IN 3 ORTHOGONAL DIMENSIONS (cm): 7.5 x 7.4 x 7.2 cm. COMPOSITION: Solid with >=50% to 75% nonenhancing. BOSNIAK CLASSIFICATION: Not applicable. MARGINS: Well-defined PRESENCE OF MACROSCOPIC FAT: No. ENHANCEMENT: Heterogenous enhancement. - Nonenhanced phase attenuation: 29 HU - Corticomedullary phase attenuation: 39 HU - Nephrographic phase attenuation: 50 HU NEPHROMETRY SCORE: - Radius: >=7 cm (3 points) - Exophytic extent: 50% of the mass is central (3 points) - Axial location: Anterior and Lateral. - Hilar extent: No hilar invasion. - Nephrometry Score (Points): 11 LOCAL EXTENT OF DISEASE: - Invades perirenal fat: Yes. - Contacts the perirenal (Gerota's) fascia: Yes. - Invades through the perirenal (Gerota's) fascia: No. - Invades central sinus fat: Yes. - Invades collecting system: No. - Invades ipsilateral adrenal: No. - Invades adjacent organs or structure: No. IPSILATERAL VESSELS: - Renal artery: Single ipsilateral renal artery without early branching. - Significant renal artery stenosis >70%: None. - Renal vein anatomy: Single ipsilateral renal vein with conventional anatomy. - Renal vein thrombus (describe extent of tumor and bland thrombus): No. - IVC thrombus (describe anatomy and extend of tumor and bland thrombus): No. OTHER RENAL FINDINGS: Tiny left superior calyceal nonobstructing calculus. ADRENALS: - Direct invasion by renal mass: No. - Adrenal nodule(s): Yes. Left adrenal nodule measuring 2.3 x 1.5 cm (series 900 image 80). This nodule measures 16 Hounsfield units on precontrast series. - Other findings: Right adrenal appears normal. LYMPH NODES: - Retroperitoneal / Pararenal lymph nodes: Not enlarged. - Other findings: Not enlarged. LIVER: Normal. No suspicious lesion. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. Appendix appears normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: Replaced left hepatic artery arises from the left gastric artery. Small accessory right hepatic artery arises from the SMA. No significant abnormality. URINARY BLADDER: Normal. Incidentally noted vesicourachal diverticulum (sagittal series 10 image 177). REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Small fat-containing umbilical hernia. MUSCULOSKELETAL: Right hip arthroplasty projects appropriately on scout image. Mild degenerative change of the left SI joint. There are degenerative changes of the lumbar spine. No aggressive osseous lesion.
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CT Head wo+w contrast 1/7/2022 7:38 PM Clinical Information: seizure, concern for mass Comparison: CT head without contrast dated 10/30/2021. Technique: Unenhanced and enhanced axial brain CT. Bone and soft tissue windows were reviewed. Sagittal and coronal images were generated from the axial data. Patient weight: 220 lbs. IV contrast: Omnipaque 350, 100 ml, per protocol. Saline flush: 75 ml. IV contrast injection rate: 2.80 ml per sec. Scan delay: 300sec Scan field of view: 247 mm. DLP: 2850 mGy cm. Findings: Brain parenchyma: Mild frontal age-appropriate brain parenchymal volume loss is again seen. The brain parenchyma has a normal appearance. The white-gray matter differentiation is preserved. No abnormal enhancement is identified. Ventricular system: Normal configuration. No hydrocephalus. Basal cisterns: There is no significant effacement of the basilar cisterns. Extra-axial spaces: Normal appearance. No abnormal extra-axial fluid collections. Hemorrhage: No intracranial hemorrhage is identified. Midline shift: No significant midline shift is seen. Vascular system: Persistent punctate atherosclerotic calcifications of the bilateral carotid siphons. Soft tissues: Unremarkable without discrete fluid collections. Orbits: Normal appearance. Calvarium and skull base: No acute fractures or suspicious osseous lesions identified. The bilateral mastoid air cell complexes are well-developed and clear. Paranasal sinuses: Unchanged trace right maxillary sinus mucosal thickening and left maxillary sinus mucous retention cyst. Otherwise, remain well aerated. IMPRESSION: No acute intracranial process, abnormal enhancement or significant interval change identified.
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Findings: Brain parenchyma: Mild frontal age-appropriate brain parenchymal volume loss is again seen. The brain parenchyma has a normal appearance. The white-gray matter differentiation is preserved. No abnormal enhancement is identified. Ventricular system: Normal configuration. No hydrocephalus. Basal cisterns: There is no significant effacement of the basilar cisterns. Extra-axial spaces: Normal appearance. No abnormal extra-axial fluid collections. Hemorrhage: No intracranial hemorrhage is identified. Midline shift: No significant midline shift is seen. Vascular system: Persistent punctate atherosclerotic calcifications of the bilateral carotid siphons. Soft tissues: Unremarkable without discrete fluid collections. Orbits: Normal appearance. Calvarium and skull base: No acute fractures or suspicious osseous lesions identified. The bilateral mastoid air cell complexes are well-developed and clear. Paranasal sinuses: Unchanged trace right maxillary sinus mucosal thickening and left maxillary sinus mucous retention cyst. Otherwise, remain well aerated.
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Findings: No acute infarction, hemorrhage, or cerebral edema. The gray-white matter differentiation is maintained. Subcortical and periventricular hypodensities likely representing chronic microangiopathy changes. The cerebral volume is appropriate for patient's age. There is no space occupying intracranial lesion, mass effect, or hydrocephalus. No abnormal intracranial enhancement. Bilateral lens replacements. The paranasal sinuses, middle ears, and mastoid air cells are clear. Subgaleal hematoma over the right parieto-occipital region measures 8 mm in maximum diameter.
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EXAM: CT Abdomen and Pelvis wo IV contrast CLINICAL INFORMATION: 38-year-old male with abdominal pain. COMPARISON: CT abdomen and pelvis 1/15/2020 TECHNIQUE: CT Abdomen and Pelvis wo IV contrast. Scan field of view: 389.60 mm. DLP: 556.70 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: Small left pleural effusion. Patchy peripheral predominant consolidation within the bilateral lower lungs. A couple of the lesions appear cavitary. Air bronchograms in the left lower lung. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Steatosis. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Unremarkable for technique SPLEEN: Splenomegaly. ADRENALS: Hyperplastic without discrete nodule KIDNEYS: No renal calculi or hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. The appendix is normal. 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: 1. No acute abnormality within the abdomen or pelvis. 2. Bilateral peripheral predominant consolidation, effusions cavitary lesions, with a small left pleural effusion, concerning for multifocal infectious etiology, possibly septic emboli. Differential considerations also include multifocal pneumonia or less likely viral pneumonia. 3. Splenomegaly. Additional chronic and incidental findings as described above. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Small left pleural effusion. Patchy peripheral predominant consolidation within the bilateral lower lungs. A couple of the lesions appear cavitary. Air bronchograms in the left lower lung. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Steatosis. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Unremarkable for technique SPLEEN: Splenomegaly. ADRENALS: Hyperplastic without discrete nodule KIDNEYS: No renal calculi or hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. The appendix is normal. 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.
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FINDINGS: Postsurgical appearance of prior cricoid cartilage resection. Interval enlargement of the soft tissue lesion at the right side of the first tracheal ring now with extension into the lumen and superiorly to the base of the vocal cords, measuring 1.6 x 0.8 x 1.8 cm (sagittal series 602, image 52, axial series 3, image 359 and coronal series 601 #41). No definite internal calcification or contrast enhancement. Multiple prominent lymph nodes throughout the neck without pathologic enlargement or abnormal morphology. The nasopharynx and oropharynx are normal. The base of the tongue and lymphoid tissue within Waldeyer's ring are unremarkable. The hypopharynx and larynx are normal. The parotid, submandibular, and thyroid glands are within normal limits. Esophagus is patulous suggesting reflux/dysmotility. Imaged portions of the brain and skull base are normal. Multilevel degenerative changes of the spine without acute fracture or aggressive lesions. -------------------
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EXAM: CT Chest with contrast, CT Thoracic Spine from Reformat, CT Lumbar Spine from Reformat, CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: Trauma, GSW. COMPARISON: None. TECHNIQUE: CT Chest with contrast, CT Thoracic Spine from Reformat, CT Lumbar Spine from Reformat, CT Abdomen and Pelvis w contrast. Patient weight: 219 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 80sec Scan field of view: 393.50 mm. (accession CT220003929), Patient weight: 219 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 80sec Scan field of view: 393.50 mm. DLP: 1116.50 mGy cm. (accession CT220003930), Patient weight: 219 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 80sec Scan field of view: 393.50 mm. (accession CT220003932), Patient weight: 219 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 80sec Scan field of view: 393.50 mm. (accession CT220003933) FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Central airways are patent. No focal airspace opacities, pneumothorax or pleural effusion. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. 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: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. Appendix is normal. PERITONEUM / MESENTERY: Normal. No free fluid. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. Small amount of hemorrhage is present about the right common femoral artery which may be iatrogenic. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Radiopaque markers are seen along the skin surface at the right mid back and left flank soft tissues. There are changes of penetrating injury to the left flank on axial image 271 series 201 and also at the right posterior flank with gas and hemorrhage tracking along the tract. There is evidence for injury to the posterior right paraspinous muscles with punctate focus of gas on axial image 286 series 201 and asymmetric mild swelling of the right paraspinous musculature compared with the left which may represent a small amount of intramuscular hemorrhage. No active extravasation evident. MUSCULOSKELETAL: No significant abnormality. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: No fracture. Incidental congenital nonunion of bilateral L1 transverse processes. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. CONCLUSION: 1. There are radiopaque markers along the right mid back and left flank superficial soft tissues with findings of subcutaneous gas and hemorrhage along penetrating injury tracks in the posterior back soft tissues. No active extravasation evident. There is subtle intramuscular hemorrhage and tiny focus of subcutaneous gas in the right paraspinous musculature posteriorly compatible with penetrating injury changes. No acute osseous abnormality. No associated intrathoracic or intra-abdominal injuries. 2. No other acute traumatic findings in the chest, abdomen or pelvis. 3. No acute fracture or malalignment of the thoracolumbar spine. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Central airways are patent. No focal airspace opacities, pneumothorax or pleural effusion. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. 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: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. Appendix is normal. PERITONEUM / MESENTERY: Normal. No free fluid. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. Small amount of hemorrhage is present about the right common femoral artery which may be iatrogenic. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Radiopaque markers are seen along the skin surface at the right mid back and left flank soft tissues. There are changes of penetrating injury to the left flank on axial image 271 series 201 and also at the right posterior flank with gas and hemorrhage tracking along the tract. There is evidence for injury to the posterior right paraspinous muscles with punctate focus of gas on axial image 286 series 201 and asymmetric mild swelling of the right paraspinous musculature compared with the left which may represent a small amount of intramuscular hemorrhage. No active extravasation evident. MUSCULOSKELETAL: No significant abnormality. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: No fracture. Incidental congenital nonunion of bilateral L1 transverse processes. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal.
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FINDINGS: There is large embolic coil mass in the region of the basilar apex at site of coiled aneurysm. Basilar artery stent is also noted. There is a right frontal approach VP shunt catheter with tip near the right foramen of Monro. There is been resolution of postprocedural gas within the right frontal horn. Ventricles are mildly decreased in size since prior exam. There is no extra-axial collection. There is expected evolution of right cerebellar infarction. There is no hemorrhagic conversion. Previously identified small superior left cerebellar infarction is not clearly visualized. No new areas of hypoattenuation are evident. There is no mass effect. The calvarium is intact. The visualized paranasal sinuses and mastoid air cells are clear. The orbits are unremarkable.
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3,320
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EXAM: CT Chest with contrast, CT Thoracic Spine from Reformat, CT Lumbar Spine from Reformat, CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: Trauma, GSW. COMPARISON: None. TECHNIQUE: CT Chest with contrast, CT Thoracic Spine from Reformat, CT Lumbar Spine from Reformat, CT Abdomen and Pelvis w contrast. Patient weight: 219 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 80sec Scan field of view: 393.50 mm. (accession CT220003929), Patient weight: 219 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 80sec Scan field of view: 393.50 mm. DLP: 1116.50 mGy cm. (accession CT220003930), Patient weight: 219 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 80sec Scan field of view: 393.50 mm. (accession CT220003932), Patient weight: 219 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 80sec Scan field of view: 393.50 mm. (accession CT220003933) FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Central airways are patent. No focal airspace opacities, pneumothorax or pleural effusion. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. 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: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. Appendix is normal. PERITONEUM / MESENTERY: Normal. No free fluid. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. Small amount of hemorrhage is present about the right common femoral artery which may be iatrogenic. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Radiopaque markers are seen along the skin surface at the right mid back and left flank soft tissues. There are changes of penetrating injury to the left flank on axial image 271 series 201 and also at the right posterior flank with gas and hemorrhage tracking along the tract. There is evidence for injury to the posterior right paraspinous muscles with punctate focus of gas on axial image 286 series 201 and asymmetric mild swelling of the right paraspinous musculature compared with the left which may represent a small amount of intramuscular hemorrhage. No active extravasation evident. MUSCULOSKELETAL: No significant abnormality. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: No fracture. Incidental congenital nonunion of bilateral L1 transverse processes. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. CONCLUSION: 1. There are radiopaque markers along the right mid back and left flank superficial soft tissues with findings of subcutaneous gas and hemorrhage along penetrating injury tracks in the posterior back soft tissues. No active extravasation evident. There is subtle intramuscular hemorrhage and tiny focus of subcutaneous gas in the right paraspinous musculature posteriorly compatible with penetrating injury changes. No acute osseous abnormality. No associated intrathoracic or intra-abdominal injuries. 2. No other acute traumatic findings in the chest, abdomen or pelvis. 3. No acute fracture or malalignment of the thoracolumbar spine. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Central airways are patent. No focal airspace opacities, pneumothorax or pleural effusion. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. 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: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. Appendix is normal. PERITONEUM / MESENTERY: Normal. No free fluid. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. Small amount of hemorrhage is present about the right common femoral artery which may be iatrogenic. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Radiopaque markers are seen along the skin surface at the right mid back and left flank soft tissues. There are changes of penetrating injury to the left flank on axial image 271 series 201 and also at the right posterior flank with gas and hemorrhage tracking along the tract. There is evidence for injury to the posterior right paraspinous muscles with punctate focus of gas on axial image 286 series 201 and asymmetric mild swelling of the right paraspinous musculature compared with the left which may represent a small amount of intramuscular hemorrhage. No active extravasation evident. MUSCULOSKELETAL: No significant abnormality. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: No fracture. Incidental congenital nonunion of bilateral L1 transverse processes. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal.
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FINDINGS: SOFT TISSUES: Stable postsurgical changes from left neck dissection. No focal masslike enhancement. Extensive left cervical subcutaneous fat stranding and pharyngeal edema, similar to prior, likely radiation posttreatment changes. LYMPH NODES: No pathologic adenopathy by imaging size criteria. AERODIGESTIVE STRUCTURES: No asymmetric contrast enhancement or asymmetric soft tissue nodularity. Small-volume air-fluid level in the midthoracic esophagus. PAROTID GLANDS: Normal right parotid gland. The left parotid is atrophic. SUBMANDIBULAR GLANDS: Normal right submandibular gland. The left is surgically absent. THYROID GLAND: Normal. VASCULAR STRUCTURES: Mild mixed calcified and noncalcified atherosclerotic plaque in the proximal left ICA without flow-limiting stenosis, unchanged. The right vertebral artery terminates as the PICA, incidental variant. The internal jugular veins are patent. MAXILLA/MANDIBLE: Stable postsurgical changes related to left partial mandibulectomy. Small periapical lucency adjacent to the left mandibular second and third molars, unchanged. No evidence of cortical breakthrough. REMAINING OSSEOUS STRUCTURES: No fracture, dislocation, or destructive lesion. Multilevel degenerative discogenic disease and facet arthropathy, most prominently spanning C4-C7. Trace degenerative anterolisthesis of C2 on C3. Complete right and partial left bony ankylosis of the bilateral C3-C4 facet joints. ORBITS: Normal. PARANASAL SINUSES AND MASTOID AIR CELLS: Trace mucosal thickening of the bilateral maxillary sinus floors and scattered bilateral ethmoid air cells. The remaining paranasal sinuses and mastoid air cells are otherwise clear. VISUALIZED INTRACRANIAL STRUCTURES: Normal. LUNG APICES: Accessory azygos lobe with dilated azygos vein. Left apical pleuroparenchymal scarring. The imaged lungs are otherwise clear. Mildly enlarged main pulmonary artery trunk up to 3.3 cm, previously 3.1 cm. --------------------
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3,321
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EXAM: CT Chest with contrast, CT Thoracic Spine from Reformat, CT Lumbar Spine from Reformat, CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: Trauma, GSW. COMPARISON: None. TECHNIQUE: CT Chest with contrast, CT Thoracic Spine from Reformat, CT Lumbar Spine from Reformat, CT Abdomen and Pelvis w contrast. Patient weight: 219 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 80sec Scan field of view: 393.50 mm. (accession CT220003929), Patient weight: 219 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 80sec Scan field of view: 393.50 mm. DLP: 1116.50 mGy cm. (accession CT220003930), Patient weight: 219 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 80sec Scan field of view: 393.50 mm. (accession CT220003932), Patient weight: 219 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 80sec Scan field of view: 393.50 mm. (accession CT220003933) FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Central airways are patent. No focal airspace opacities, pneumothorax or pleural effusion. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. 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: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. Appendix is normal. PERITONEUM / MESENTERY: Normal. No free fluid. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. Small amount of hemorrhage is present about the right common femoral artery which may be iatrogenic. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Radiopaque markers are seen along the skin surface at the right mid back and left flank soft tissues. There are changes of penetrating injury to the left flank on axial image 271 series 201 and also at the right posterior flank with gas and hemorrhage tracking along the tract. There is evidence for injury to the posterior right paraspinous muscles with punctate focus of gas on axial image 286 series 201 and asymmetric mild swelling of the right paraspinous musculature compared with the left which may represent a small amount of intramuscular hemorrhage. No active extravasation evident. MUSCULOSKELETAL: No significant abnormality. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: No fracture. Incidental congenital nonunion of bilateral L1 transverse processes. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. CONCLUSION: 1. There are radiopaque markers along the right mid back and left flank superficial soft tissues with findings of subcutaneous gas and hemorrhage along penetrating injury tracks in the posterior back soft tissues. No active extravasation evident. There is subtle intramuscular hemorrhage and tiny focus of subcutaneous gas in the right paraspinous musculature posteriorly compatible with penetrating injury changes. No acute osseous abnormality. No associated intrathoracic or intra-abdominal injuries. 2. No other acute traumatic findings in the chest, abdomen or pelvis. 3. No acute fracture or malalignment of the thoracolumbar spine. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Central airways are patent. No focal airspace opacities, pneumothorax or pleural effusion. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. 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: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. Appendix is normal. PERITONEUM / MESENTERY: Normal. No free fluid. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. Small amount of hemorrhage is present about the right common femoral artery which may be iatrogenic. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Radiopaque markers are seen along the skin surface at the right mid back and left flank soft tissues. There are changes of penetrating injury to the left flank on axial image 271 series 201 and also at the right posterior flank with gas and hemorrhage tracking along the tract. There is evidence for injury to the posterior right paraspinous muscles with punctate focus of gas on axial image 286 series 201 and asymmetric mild swelling of the right paraspinous musculature compared with the left which may represent a small amount of intramuscular hemorrhage. No active extravasation evident. MUSCULOSKELETAL: No significant abnormality. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: No fracture. Incidental congenital nonunion of bilateral L1 transverse processes. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal.
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FINDINGS: STRUCTURED REPORT: CT Chest LOWER NECK: Please see same-day CT neck for neck findings. CHEST: LUNGS / AIRWAYS / PLEURA: No suspicious pulmonary nodule is identified. No focal consolidation, pleural effusion, or pneumothorax. Central airways are patent. Incidental azygos lobe. HEART / VESSELS: Heart size is normal. No pericardial effusion. The ascending aorta is slightly dilated at 41 mm. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Normal. MUSCULOSKELETAL: No acute or aggressive appearing osseous abnormality. Mild to moderate multilevel degenerative changes of the mid to lower thoracic spine.
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3,322
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EXAM: CT Chest with contrast, CT Thoracic Spine from Reformat, CT Lumbar Spine from Reformat, CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: Trauma, GSW. COMPARISON: None. TECHNIQUE: CT Chest with contrast, CT Thoracic Spine from Reformat, CT Lumbar Spine from Reformat, CT Abdomen and Pelvis w contrast. Patient weight: 219 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 80sec Scan field of view: 393.50 mm. (accession CT220003929), Patient weight: 219 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 80sec Scan field of view: 393.50 mm. DLP: 1116.50 mGy cm. (accession CT220003930), Patient weight: 219 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 80sec Scan field of view: 393.50 mm. (accession CT220003932), Patient weight: 219 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 80sec Scan field of view: 393.50 mm. (accession CT220003933) FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Central airways are patent. No focal airspace opacities, pneumothorax or pleural effusion. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. 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: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. Appendix is normal. PERITONEUM / MESENTERY: Normal. No free fluid. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. Small amount of hemorrhage is present about the right common femoral artery which may be iatrogenic. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Radiopaque markers are seen along the skin surface at the right mid back and left flank soft tissues. There are changes of penetrating injury to the left flank on axial image 271 series 201 and also at the right posterior flank with gas and hemorrhage tracking along the tract. There is evidence for injury to the posterior right paraspinous muscles with punctate focus of gas on axial image 286 series 201 and asymmetric mild swelling of the right paraspinous musculature compared with the left which may represent a small amount of intramuscular hemorrhage. No active extravasation evident. MUSCULOSKELETAL: No significant abnormality. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: No fracture. Incidental congenital nonunion of bilateral L1 transverse processes. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. CONCLUSION: 1. There are radiopaque markers along the right mid back and left flank superficial soft tissues with findings of subcutaneous gas and hemorrhage along penetrating injury tracks in the posterior back soft tissues. No active extravasation evident. There is subtle intramuscular hemorrhage and tiny focus of subcutaneous gas in the right paraspinous musculature posteriorly compatible with penetrating injury changes. No acute osseous abnormality. No associated intrathoracic or intra-abdominal injuries. 2. No other acute traumatic findings in the chest, abdomen or pelvis. 3. No acute fracture or malalignment of the thoracolumbar spine. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Central airways are patent. No focal airspace opacities, pneumothorax or pleural effusion. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. 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: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. Appendix is normal. PERITONEUM / MESENTERY: Normal. No free fluid. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. Small amount of hemorrhage is present about the right common femoral artery which may be iatrogenic. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Radiopaque markers are seen along the skin surface at the right mid back and left flank soft tissues. There are changes of penetrating injury to the left flank on axial image 271 series 201 and also at the right posterior flank with gas and hemorrhage tracking along the tract. There is evidence for injury to the posterior right paraspinous muscles with punctate focus of gas on axial image 286 series 201 and asymmetric mild swelling of the right paraspinous musculature compared with the left which may represent a small amount of intramuscular hemorrhage. No active extravasation evident. MUSCULOSKELETAL: No significant abnormality. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: No fracture. Incidental congenital nonunion of bilateral L1 transverse processes. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal.
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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: Subcentimeter hypoattenuating lesion in the right hepatic dome (series 301 image 35) is unchanged. Subcentimeter arterially hyperenhancing lesion in the right hepatic lobe segment 7/8 on series 301 image 50, not visualized on portal venous phase. This is unchanged and may reflect perfusion alteration. Reflux of contrast into the hepatic veins on the arterial phase may reflect right heart dysfunction. 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: More conspicuous small hypoattenuating focus in the lumbar spine as seen on series 606 image 129, seen in retrospect dating at least back to 2018 though was not well seen before that, however is probably enlarged compared to 2018.
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3,323
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EXAM: CT Chest wo contrast CLINICAL INFORMATION: 42-year-old female, for follow-up of lung nodules. COMPARISON: CT angiogram chest dated 12/11/2020. TECHNIQUE: CT Chest wo contrast. Scan field of view: 310 mm. DLP: 259.79 mGy cm. FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Central airways are patent. Mild bronchial wall thickening. A few predominantly right upper lobe nodules, all less than 6 mm, overall unchanged. No suspicious pulmonary nodule. A small peripheral groundglass nodule in the left lower lobe on axial image 123; series 2, overall unchanged. No pleural effusion. HEART / VESSELS: Normal sized cardiac chambers. No pericardial effusion. Normal caliber pulmonary artery and thoracic aorta. MEDIASTINUM / ESOPHAGUS: Esophagus is unremarkable for the technique. Residual thymic tissue is seen, unchanged. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Hepatic cyst in the posterior right hepatic lobe, unchanged. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. A few noncalcified pulmonary nodules in the peripheral right upper lobe, all less than 6 mm, overall unchanged. No new nodule. No follow-up is recommended, unless the patient is high risk. 2. Other incidental findings as above.
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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Central airways are patent. Mild bronchial wall thickening. A few predominantly right upper lobe nodules, all less than 6 mm, overall unchanged. No suspicious pulmonary nodule. A small peripheral groundglass nodule in the left lower lobe on axial image 123; series 2, overall unchanged. No pleural effusion. HEART / VESSELS: Normal sized cardiac chambers. No pericardial effusion. Normal caliber pulmonary artery and thoracic aorta. MEDIASTINUM / ESOPHAGUS: Esophagus is unremarkable for the technique. Residual thymic tissue is seen, unchanged. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Hepatic cyst in the posterior right hepatic lobe, unchanged. MUSCULOSKELETAL: No significant abnormality.
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FINDINGS: STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Interval decrease in size in the previously described right lower lobe pulmonary nodule today measuring 1.3 x 0.7 cm on series 307 image 76, previously 2.4 x 1.6 cm. Similar appearance of left upper lobe pulmonary scarring with surrounding tree-in-bud nodularity. Stable appearance of right upper lobe wedge resection. Additional scattered bilateral, less than 6 mm pulmonary nodules are overall stable in appearance. No focal consolidation, pleural effusion, pneumothorax. Central airways are patent. HEART / VESSELS: Heart size is normal. No pericardial effusion. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: Left chest wall Mediport is present, tip terminates at the superior cavoatrial junction. UPPER ABDOMEN: Please see same day CT abdomen for abdomen findings. MUSCULOSKELETAL: No acute or aggressive appearing osseous abnormality. Chronic deformities of the left fifth through seventh and right fifth ribs.
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EXAM: CT Chest wo contrast CLINICAL INFORMATION: Lung nodule greater than 8 mm COMPARISON: Images of the lower chest from the upper abdomen outside CT dated 6/22/2021. TECHNIQUE: CT Chest wo contrast with 1.25 mm axial reconstructions per super dimension protocol.. Scan field of view: 320 mm. DLP: 501.07 mGy cm. FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. Borderline enlarged right paratracheal nodes are seen but still less than a centimeter in short axis. Mildly enlarged right hilar node is 11 mm on series 4 image 128. No additional enlarged intrathoracic lymph nodes are identified. Small hiatal hernia is present with some dilatation of the mid and lower esophagus. Within the limits of a noncontrast exam, the heart size and the mediastinum are otherwise normal. No pleural effusion. Smooth bordered nodule in the anterior right upper lobe measures 7 x 8 mm on series 4 image 95. Adjacent nodule on image 96 measures 5 x 5 mm. The nodular density seen previously in the RLL has resolved. Slight linear atelectasis is seen in the lingula. The lungs are otherwise normal. Elevation of the right hemidiaphragm is seen. Limited, noncontrast images of the upper abdomen are otherwise unremarkable. No focal destructive osseous lesions. CONCLUSION: 1. Previously seen nodular density in the right lower lobe has resolved consistent with an infectious or inflammatory process. 2. Two adjacent solid noncalcified smooth bordered nodules are seen anteriorly in the RUL with the largest measuring just under 8 mm. Patient is at low risk for lung cancer then a follow-up CT in 6-12 months should be done and if unchanged and additional follow-up CT 18-24 months should be considered. If patient is at high risk then a follow-up CT in 6-12 months an additional follow-up at 18-24 months is recommended. 3. Mildly enlarged right hilar node which may be reactive.
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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. Borderline enlarged right paratracheal nodes are seen but still less than a centimeter in short axis. Mildly enlarged right hilar node is 11 mm on series 4 image 128. No additional enlarged intrathoracic lymph nodes are identified. Small hiatal hernia is present with some dilatation of the mid and lower esophagus. Within the limits of a noncontrast exam, the heart size and the mediastinum are otherwise normal. No pleural effusion. Smooth bordered nodule in the anterior right upper lobe measures 7 x 8 mm on series 4 image 95. Adjacent nodule on image 96 measures 5 x 5 mm. The nodular density seen previously in the RLL has resolved. Slight linear atelectasis is seen in the lingula. The lungs are otherwise normal. Elevation of the right hemidiaphragm is seen. Limited, noncontrast images of the upper abdomen are otherwise unremarkable. No focal destructive osseous lesions.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Minimal subsegmental atelectatic changes in bilateral lung bases. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Status post cholecystectomy. PANCREAS: Pancreatic duct is of normal caliber. No evidence for pancreatic duct stent in situ. Pancreas is otherwise unremarkable. SPLEEN: Normal. ADRENALS: Indeterminate left adrenal nodule measuring 1.4 x 1 cm (image 73, series 2). KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Extensive colonic diverticulosis. Mild thickening of the sigmoid colonic wall without significant adjacent fat stranding. Findings may relate to chronic colonic inflammation. No pericolonic free fluid or gas. Appendix is unremarkable. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Status post hysterectomy. No adnexal masses. BODY WALL: Small fat-containing uncomplicated umbilical and supraumbilical ventral hernia. Uncomplicated fat-containing bilateral inguinal hernias. MUSCULOSKELETAL: Degenerative changes in the lumbar spine. No acute osseous abnormalities.
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EXAM: CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: 56-year-old male with concern for colitis, rule out toxic megacolon. COMPARISON: CT abdomen pelvis 12/9/2021. TECHNIQUE: CT Abdomen and Pelvis w contrast. Patient weight: 195 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 75 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 80sec Scan field of view: 450 mm. DLP: 683 mGy cm. FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Mild coronary artery calcifications. ABDOMEN and PELVIS: LIVER: There are a few subtle subcentimeter hypodensities in the liver, one in the hepatic dome axial image 20 series 201 and another in the caudate, grossly unchanged from prior and likely representing perfusional anomalies or flash filling hemangiomas. No new abnormality. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: There is an obstructing calculi within the proximal right ureter measuring up to 6 mm (series 201 image 147) resulting in moderate upstream hydroureteronephrosis. Additional nonobstructing right upper pole renal calculi measuring up to 3 mm (series 201 image 97). There is mild right perinephric stranding. The left kidney is unremarkable without renal calculi or hydronephrosis. Bilateral renal sinus/parapelvic small cysts. Symmetric renal enhancement. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. The appendix is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Scattered atherosclerotic calcifications of the abdominal aorta which is normal in caliber. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Dystrophic prostate calcifications. BODY WALL: Small amount of gas and subcutaneous fat stranding within the superficial soft tissues of the left abdominal wall, potentially related to recent injection. MUSCULOSKELETAL: No acute osseous abnormality evident. CONCLUSION: 1. Obstructing proximal right ureteral calculi measuring approximately 6 mm resulting in moderate upstream hydroureteronephrosis. 2. Additional chronic and incidental findings as described above. These preliminary results were discussed with Dr. Evans at 7:16 PM on 1/7/2022 by Dr. Adrian Murray. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Mild coronary artery calcifications. ABDOMEN and PELVIS: LIVER: There are a few subtle subcentimeter hypodensities in the liver, one in the hepatic dome axial image 20 series 201 and another in the caudate, grossly unchanged from prior and likely representing perfusional anomalies or flash filling hemangiomas. No new abnormality. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: There is an obstructing calculi within the proximal right ureter measuring up to 6 mm (series 201 image 147) resulting in moderate upstream hydroureteronephrosis. Additional nonobstructing right upper pole renal calculi measuring up to 3 mm (series 201 image 97). There is mild right perinephric stranding. The left kidney is unremarkable without renal calculi or hydronephrosis. Bilateral renal sinus/parapelvic small cysts. Symmetric renal enhancement. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. The appendix is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Scattered atherosclerotic calcifications of the abdominal aorta which is normal in caliber. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Dystrophic prostate calcifications. BODY WALL: Small amount of gas and subcutaneous fat stranding within the superficial soft tissues of the left abdominal wall, potentially related to recent injection. MUSCULOSKELETAL: No acute osseous abnormality evident.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Bibasilar atelectasis. No pleural effusion or pneumothorax. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Subcentimeter hypodense lesion in the right anterior lobe, which is technically too small to characterize but statistically represents cyst. Focal fat adjacent to the falciform ligament. BILIARY TRACT: Mild intra and extra hepatic biliary dilatation, not significantly changed from prior, likely related to postcholecystectomy state. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. The appendix is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Mild atherosclerotic calcifications of the abdominal aorta and its branches. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Supracervical hysterectomy. BODY WALL: Redemonstrated large hernia of the right lateral abdominal wall which contains bowel. Small fat-containing left lateral abdominal wall hernia. MUSCULOSKELETAL: No acute displaced fracture. Thoracic and lumbar spinal fusion hardware shows no evidence of loosening or failure.
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Radiologic Exam: CT Venogram Head 1/7/2022 11:43 PM Clinical Information: headache. Comparison: None available. Technique: Helical CT images were obtained before and after the administration of contrast from the base of the skull to the vertex. Contrast enhanced CT angiographic images were obtained from the skull base to the vertex during the arterial phase. 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: 202 lbs. IV contrast: Omnipaque 350, 100 ml, per protocol. Saline flush: 90 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 210 mm. DLP: 5202.50 mGy cm. FINDINGS: CT of the head with and without contrast: There is no acute infarction, hemorrhage, or cerebral edema. The gray-white matter differentiation is maintained. The cerebral cortical volume is appropriate for patient's age. There is no space occupying intracranial lesion or hydrocephalus. No enhancing intracranial abnormality. There is no acute osseous or orbital abnormality. The paranasal sinuses and mastoid air cells are clear. CT angiogram of the brain: RIGHT CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. ANTERIOR, MIDDLE, AND POSTERIOR CEREBRAL ARTERIES: Unremarkable. VERTEBROBASILAR ARTERIES: There is no evidence of stenosis, occlusion, or aneurysmal dilation. CT venogram: There is no evidence of venous sinus thrombosis. The deep cerebral veins also appear patent. Included portions of the internal jugular veins appear patent. CONCLUSION: 1. No acute intracranial process. 2. No evidence of venous sinus thrombosis or intracranial arterial abnormality. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: CT of the head with and without contrast: There is no acute infarction, hemorrhage, or cerebral edema. The gray-white matter differentiation is maintained. The cerebral cortical volume is appropriate for patient's age. There is no space occupying intracranial lesion or hydrocephalus. No enhancing intracranial abnormality. There is no acute osseous or orbital abnormality. The paranasal sinuses and mastoid air cells are clear. CT angiogram of the brain: RIGHT CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. ANTERIOR, MIDDLE, AND POSTERIOR CEREBRAL ARTERIES: Unremarkable. VERTEBROBASILAR ARTERIES: There is no evidence of stenosis, occlusion, or aneurysmal dilation. CT venogram: There is no evidence of venous sinus thrombosis. The deep cerebral veins also appear patent. Included portions of the internal jugular veins appear patent.
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FINDINGS: No acute fracture or dislocation. Degenerative changes are noted involving the proximal tibiofibular joint with prominent marginal osteophytes inferiorly. No aggressive osseous lesions are seen. Os trigonum. Partially visualized knee joint effusion. Moderate popliteal cyst. The soft tissues are otherwise unremarkable.
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RADIOLOGIC EXAM: CT Head wo contrast CLINICAL INFORMATION: 77-year-old female with worsening headache. COMPARISON: CT head without contrast dated 10/11/2020. TECHNIQUE: CT Head wo contrastScan field of view: 218 mm. DLP: 1366 mGy cm. STRUCTURED REPORT: CT Head Trauma FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white differentiation is maintained. Scattered periventricular and subcortical white matter hypoattenuating foci are unchanged, compatible with mild chronic microangiopathic changes. Stable physiologic left basal ganglia calcifications. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. Hyperostosis frontalis interna and degenerative changes of the atlantoaxial joint with partial ossification of the transverse ligament. Persistent atherosclerotic calcifications of the bilateral carotid siphons and the right vertebral artery. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. Bilateral pseudophakia, stable. SINUSES: Normal. IMPRESSION: No acute intracranial process or significant interval change identified. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white differentiation is maintained. Scattered periventricular and subcortical white matter hypoattenuating foci are unchanged, compatible with mild chronic microangiopathic changes. Stable physiologic left basal ganglia calcifications. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. Hyperostosis frontalis interna and degenerative changes of the atlantoaxial joint with partial ossification of the transverse ligament. Persistent atherosclerotic calcifications of the bilateral carotid siphons and the right vertebral artery. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. Bilateral pseudophakia, stable. SINUSES: Normal.
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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT CAP Evaluation is mildly limited by motion. LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Motion limited evaluation. Scattered mosaic attenuation. Multiple scattered pulmonary nodules with largest index nodule in the superior segment of the right lower lobe measuring approximately 8 mm (image 141, series 302). No pleural effusion or pneumothorax. Trachea and central airways are patent. HEART / VESSELS: Mild calcified atherosclerosis, including three vessel coronary atherosclerosis. MEDIASTINUM / ESOPHAGUS: Moderate hiatal hernia. LYMPH NODES: Multiple prominent/mildly enlarged cervical/supraclavicular nodes, measuring up to 1.1 cm on the right (series 301 image 13) and 1.2 cm on the left (image 7). Multiple prominent/mildly enlarged mediastinal/hilar nodes, for example, a right hilar node measuring approximately 1.7 cm (image 112). Enlarged left axillary nodes measuring 1.6 cm (image 86) and 1.9 cm (image 122). CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Cholelithiasis. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Bilateral cysts with some lesions too small to characterize. Bilateral hilar calcifications are favored vascular. LYMPH NODES: Diffuse abdominopelvic lymphadenopathy, for example, a peripancreatic/mesenteric node measuring 1.5 cm (series 301 image 252), a right caval conglomerate measuring 3.2 x 2.3 cm (image 300), and bilateral obturator conglomerates measuring up to 5.1 x 3.2 cm on the left (image 445). STOMACH / SMALL BOWEL: Moderate hiatal hernia. No small bowel abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Severe calcified atherosclerosis. Infrarenal IVC filter. URINARY BLADDER: Decompressed by Foley catheter. Intraluminal gas, expected for Foley's placement. REPRODUCTIVE ORGANS: Uterus is absent. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Degenerative bilateral glenohumeral and spine changes. Grade 1 anterolisthesis of L4 on L5, grade 1 retrolisthesis of L3 on L4 and L5 on S1. No aggressive osseous lesion.
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EXAM: CT Angio Chest wo+w contrast CLINICAL INFORMATION: 40-year-old female with chest pain and elevated d-dimer, evaluation for pulmonary embolism. COMPARISON: Prior same-day chest radiograph; CT chest with contrast 10/12/2019 TECHNIQUE: CT Angio Chest wo+w contrast. Additional 3D image post-processing was performed to generate MIP and/or volume-rendered images. Patient weight: 195 lbs. IV contrast: Omnipaque 350, 60 ml, per protocol. Saline flush: 75 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bt sec. Scan field of view: 297 mm. KVP: 120 DLP: 355.70 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: Central airways are patent. Minimal posterior dependent atelectatic changes. No focal consolidation, pneumothorax or pleural effusion. HEART / OTHER VESSELS: Heart size is normal. Main pulmonary artery is normal in caliber. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: Bilateral breast implants in place. No significant abnormality. UPPER ABDOMEN: No significant abnormality. Gastric diverticulum is present. MUSCULOSKELETAL: Mild chronic degenerative changes of the thoracic spine. Chronic mild superior plate compression deformities of the T9-T11. CONCLUSION: No evidence of pulmonary embolism. No acute cardiopulmonary abnormality evident. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: STRUCTURED REPORT: CT PE OVERALL DIAGNOSTIC QUALITY: Full diagnostic quality LOWER NECK: No abnormality. CHEST: PULMONARY ARTERIES: Negative for pulmonary embolus LUNGS / AIRWAYS / PLEURA: Central airways are patent. Minimal posterior dependent atelectatic changes. No focal consolidation, pneumothorax or pleural effusion. HEART / OTHER VESSELS: Heart size is normal. Main pulmonary artery is normal in caliber. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: Bilateral breast implants in place. No significant abnormality. UPPER ABDOMEN: No significant abnormality. Gastric diverticulum is present. MUSCULOSKELETAL: Mild chronic degenerative changes of the thoracic spine. Chronic mild superior plate compression deformities of the T9-T11.
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Findings: Index lesions: Measured on series 2. 1. The right upper lobe nodule adjacent to the major fissure measures 15 x 16 mm on image 36 and was 12 x 13 mm on the prior. 2. Right lower lobe nodule measures 15 x 18 mm on image 61 and was 11 x 12 mm on the prior. New pulmonary nodules are identified such as in the RLL on image 72. Multiple additional prior nodules have also increased in size. Collapse of the left lower lobe is again seen with fiducial markers present within the collapsed lung. Difficult to separate neoplasm from compressed lung. No pleural effusion identified. Tip of the right-sided port catheter is at the SVC atrial junction. Low-attenuation left thyroid nodule is redemonstrated. An enlarged right hilar node is present No additional enlarged intrathoracic nodes are present. Small pericardial effusion has slightly increased. Coronary artery calcification is again seen. The heart size and mediastinum are otherwise normal. New osseous destruction is seen in the posterior and superior aspect of T1 destruction of the left side of the vertebral body at T2 including destruction of the left pedicle lytic lesion in the left posterior aspect of T3 involving part of the pedicle. Destruction of the posterior left third rib is new. Lytic lesion in the transverse process at T4 is suspected. Associated soft tissue mass is present in the left apex extending into the T2 left neural foramen this measures 21 x 48 mm on image 12. The mass measures 36 mm craniocaudal on coronal image 69. The tumor involves the anterior left side of the spinal canal. Limited images of the upper abdomen are unremarkable.
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EXAM: CT Angio Chest wo+w contrast CLINICAL INFORMATION: Shortness of breath. COMPARISON: None. TECHNIQUE: CT Angio Chest wo+w contrast. Additional 3D image post-processing was performed to generate MIP and/or volume-rendered images. Patient weight: 230 lbs. IV contrast: Omnipaque 350, 100 ml, per protocol. Saline flush: 75 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 381 mm. KVP: 100 DLP: 290 mGy cm. FINDINGS: STRUCTURED REPORT: CT PE OVERALL DIAGNOSTIC QUALITY: Mildly to moderately suboptimal quality with incomplete evaluation of segmental and subsegmental pulmonary arteries. Evaluation is limited due to suboptimal bolus timing and respiratory motion. LOWER NECK: No abnormality. CHEST: PULMONARY ARTERIES: Negative for central pulmonary embolus. Evaluation of the distal segmental and subsegmental pulmonary arteries is limited due to motion and suboptimal bolus timing. LUNGS / AIRWAYS / PLEURA: There is bilateral patchy but fairly diffuse groundglass opacities seen throughout both lungs with superimposed interlobular septal thickening. No pneumothorax or pleural effusion. HEART / OTHER VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Splenomegaly MUSCULOSKELETAL: Diffuse osseous sclerosis. CONCLUSION: 1. Limited exam. No central pulmonary thromboembolism is identified. 2. Bilateral diffuse groundglass opacities, concerning for multifocal pneumonia, particularly atypical viral pneumonia such as COVID 19. Pulmonary hemorrhage versus superimposed acute chest cannot be excluded, but thought less likely. 3. Osseous sclerosis suggestive of sickle cell disease. 4. Splenomegaly. Additional findings above.
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FINDINGS: STRUCTURED REPORT: CT PE OVERALL DIAGNOSTIC QUALITY: Mildly to moderately suboptimal quality with incomplete evaluation of segmental and subsegmental pulmonary arteries. Evaluation is limited due to suboptimal bolus timing and respiratory motion. LOWER NECK: No abnormality. CHEST: PULMONARY ARTERIES: Negative for central pulmonary embolus. Evaluation of the distal segmental and subsegmental pulmonary arteries is limited due to motion and suboptimal bolus timing. LUNGS / AIRWAYS / PLEURA: There is bilateral patchy but fairly diffuse groundglass opacities seen throughout both lungs with superimposed interlobular septal thickening. No pneumothorax or pleural effusion. HEART / OTHER VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Splenomegaly MUSCULOSKELETAL: Diffuse osseous sclerosis.
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FINDINGS: STRUCTURED REPORT: CT PE OVERALL DIAGNOSTIC QUALITY: Full diagnostic quality LOWER NECK: No abnormality. CHEST: PULMONARY ARTERIES: Negative for pulmonary embolus LUNGS / AIRWAYS / PLEURA: There is a 5 mm nodule seen in the right middle lobe. Bilateral pulmonary opacities are essentially unchanged. No new focal consolidation or pneumothorax. No pleural effusion. The HEART / OTHER VESSELS: The heart size is stable. No pericardial effusion. The main pulmonary artery is mildly dilated which could represent pulmonary arterial hypertension. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Right hemidiaphragmatic eventration again noted. Hepatic steatosis. There is an indeterminate partially visualized lesion arising from the left kidney measuring 2.1 cm on image 647, series 601. Additional low attenuated lesion within the left upper pole is likely a cyst. MUSCULOSKELETAL: No significant abnormality.
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CT Angio Head wo+w contrast 1/7/2022 10:22 PM Trauma. intracranial lesion Comparison: Head CT performed 1/4/2022 and MRI from 1/5/2022.. Technique: CT head with and without contrast was performed. CT angiography of the head with axial, sagittal and coronal and 3-D reconstructions was also performed. Findings: Brainstem and cerebellum appear unremarkable. There is hyperdensity within the anterior cranial fossa representing the meningioma seen better on the recent MRI. There is mild surrounding edema. No hydrocephalus. No intracranial hemorrhage. A small mucous retention cyst is present in the right posterior ethmoid air cells. No osseous abnormality. CT Angiogram: There is normal course and caliber of vertebral, basilar, superior cerebellar arteries and posterior cerebral arteries. There is a prominent right posterior communicating artery. Bilateral anterior cerebral arteries appear unremarkable. The intracranial fossa meningioma is in close proximity to the A2 segment of the anterior cerebral artery and derives vascular supply supply from the A2 segments but there is no compression of the anterior cerebral arteries. Bilateral middle cerebral arteries and intracranial internal carotid arteries appear unremarkable. Postcontrast images demonstrate 3.2 x 3.1 cm enhancing lesion in the anterior cranial fossa. No other abnormal intracranial enhancement. Impression: 1. Enhancing extra-axial lesion at the angiogram is likely meningioma with mild surrounding edema in bilateral frontal lobes. 2.. No intracranial vascular abnormality. The meningioma is in close proximity to the anterior cerebral arteries and receiving blood supply from the A2 segments of the anterior cerebral arteries. No compression of the anterior cerebral arteries.
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Findings: Brainstem and cerebellum appear unremarkable. There is hyperdensity within the anterior cranial fossa representing the meningioma seen better on the recent MRI. There is mild surrounding edema. No hydrocephalus. No intracranial hemorrhage. A small mucous retention cyst is present in the right posterior ethmoid air cells. No osseous abnormality. CT Angiogram: There is normal course and caliber of vertebral, basilar, superior cerebellar arteries and posterior cerebral arteries. There is a prominent right posterior communicating artery. Bilateral anterior cerebral arteries appear unremarkable. The intracranial fossa meningioma is in close proximity to the A2 segment of the anterior cerebral artery and derives vascular supply supply from the A2 segments but there is no compression of the anterior cerebral arteries. Bilateral middle cerebral arteries and intracranial internal carotid arteries appear unremarkable. Postcontrast images demonstrate 3.2 x 3.1 cm enhancing lesion in the anterior cranial fossa. No other abnormal intracranial enhancement.
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FINDINGS: A - THORACIC AORTA: Aortic valve morphology is trileaflet, and free from calcifications. 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. Aortic measurements are as follows: Aortic root at the level of the sinuses: 3.1 x 3.2 x 3.0 cm as measured from sinus to commissure. Mid-ascending thoracic aorta: 3.5 x 3.3 cm. Aortic arch: 2.9 x 2.6 cm. Proximal descending thoracic aorta: 2.9 x 2.8 cm. Mid descending thoracic aorta: 2.8 x 2.6 cm. Distal descending thoracic aorta: 2.6 x 2.5 cm. The cardiac chamber sizes are normal. The coronary arteries have normal origins and courses. There are mild to moderate coronary calcifications identified, though this study was not optimized for coronary artery evaluation. The pulmonary artery is normal in caliber. No pericardial effusion. B - OTHER CHEST FINDINGS: Lung and pleura: No focal consolidation. No suspicious pulmonary nodule. The trachea and main bronchi are patent. No pleural effusion. Mediastinum and lymph nodes: Shotty subcentimeter short axis mediastinal and hilar lymph nodes, probably reactive. The esophagus appears normal. Bones and chest wall: No aggressive bone lesion. Left chest wall dual chamber pacemaker with transvenous lead terminates at the right atrial appendage and right ventricular apex. The CT of the abdomen and pelvis will be reported separately.
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CT Head wo contrast 1/7/2022 8:37 PM Clinical Information: Encephalopathy Comparison: MRI brain without contrast dated 6/16/2021. 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: 230 mm. DLP: 1308 mGy cm. Findings: Brain parenchyma: Diffuse age-appropriate brain parenchymal volume loss is again seen, resulting in ex vacuo dilatation of the ventricular system. Scattered periventricular and subcortical white matter hypoattenuation is again noted, suggestive of mild chronic microvascular ischemic disease. The white-gray matter differentiation is preserved. Basal cisterns: There is no significant effacement of the basilar cisterns. Extra-axial spaces: Normal appearance. No abnormal extra-axial fluid collections. Hemorrhage: No intracranial hemorrhage is identified. Midline shift: No significant midline shift is seen. Vascular system: Unchanged dense atherosclerotic calcifications of the bilateral carotid siphons and vertebral arteries. Soft tissues: Unremarkable without discrete fluid collections. Orbits: Normal appearance. Unchanged bilateral lens replacements. Calvarium and skull base: Suggestion of fibrous dysplasia involving the central skull base, posterior inferior to the sphenoid sinuses. No acute fractures or suspicious osseous lesions identified. The bilateral mastoid air cell complexes are well-developed and clear. Paranasal sinuses: Persistent left greater than right maxillary sinus mucosal thickening. Otherwise, remain well aerated. IMPRESSION: 1. No acute intracranial process or significant interval change identified. 2. Persistent age-appropriate brain involution and mild chronic microvascular ischemic disease.
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Findings: Brain parenchyma: Diffuse age-appropriate brain parenchymal volume loss is again seen, resulting in ex vacuo dilatation of the ventricular system. Scattered periventricular and subcortical white matter hypoattenuation is again noted, suggestive of mild chronic microvascular ischemic disease. The white-gray matter differentiation is preserved. Basal cisterns: There is no significant effacement of the basilar cisterns. Extra-axial spaces: Normal appearance. No abnormal extra-axial fluid collections. Hemorrhage: No intracranial hemorrhage is identified. Midline shift: No significant midline shift is seen. Vascular system: Unchanged dense atherosclerotic calcifications of the bilateral carotid siphons and vertebral arteries. Soft tissues: Unremarkable without discrete fluid collections. Orbits: Normal appearance. Unchanged bilateral lens replacements. Calvarium and skull base: Suggestion of fibrous dysplasia involving the central skull base, posterior inferior to the sphenoid sinuses. No acute fractures or suspicious osseous lesions identified. The bilateral mastoid air cell complexes are well-developed and clear. Paranasal sinuses: Persistent left greater than right maxillary sinus mucosal thickening. Otherwise, remain well aerated.
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FINDINGS: STRUCTURED REPORT: CTA Abdomen Pelvis VASCULATURE: DISTAL DESCENDING THORACIC AORTA: No significant abnormality. ABDOMINAL AORTA: No significant abnormality. CELIAC AXIS: No significant abnormality. SMA: No significant abnormality. RIGHT RENAL: No significant abnormality. LEFT RENAL: No significant abnormality. IMA: No significant abnormality. RIGHT ILIAC / PROXIMAL FEMORAL ARTERIES: No significant abnormality. LEFT ILIAC / PROXIMAL FEMORAL ARTERIES: No significant abnormality. MEASUREMENTS: Suprarenal abdominal aorta: max = 24.5 mm, min = 22.1 mm, avg = 23.5 mm Juxtarenal abdominal aorta: max = 20.6 mm, min = 19.3 mm, avg = 20.0 mm Mid-infrarenal abdominal aorta: max = 21.0 mm, min = 19.3 mm, avg = 19.7 mm Aortic bifurcation: max = max = 19.2 mm, min = 15.7 mm, avg = 18.0 mm Right common iliac artery dimension: max = 12.2 mm, min = 11.5 mm, avg = 11.7 mm Right mid external iliac artery dimensions: max = 10.0 mm, min = 9.4 mm, avg = 9.6 mm Right distal external iliac artery dimensions: max = 11.0 mm, min = 8.8 mm, avg = 10.0 mm Left common iliac artery dimension: max = 12.3 mm, min = 11.5 mm, avg = 11.9 mm Left proximal external iliac artery dimensions: max = 10.5 mm, min = 9.5 mm, avg = 10.0 mm Left mid external iliac artery dimensions: max = 10.7 mm, min = 9.7 mm, avg = 10.3 mm Left distal external iliac artery dimensions: max = 10.4 mm, min = 9.5 mm, avg = 10.0 mm ------------------------------------------------------------- ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Small right renal cyst. Otherwise normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. No appendicitis. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Mild discogenic degenerative disease with facet arthropathy of the low lumbar spine. No suspicious osseous lesion.
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EXAM: CT Abdomen and Pelvis wo IV contrast CLINICAL INFORMATION: Ureteral stent evaluation. Per review of the EMR, the patient is COVID positive. COMPARISON: None available. TECHNIQUE: CT Abdomen and Pelvis wo IV contrast. Scan field of view: 442 mm. DLP: 1309 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: Patchy peripheral predominant consolidative opacities as well as the dependent areas of consolidation throughout the visualized lower lungs. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Partially visualized vascular catheter terminating in the right atrium. ABDOMEN and PELVIS: LIVER: Normal for technique. BILIARY TRACT: Normal. GALLBLADDER: Surgically absent. PANCREAS: Normal for technique. SPLEEN: Splenomegaly. ADRENALS: Normal. KIDNEYS: Nonobstructing 10 mm calculus in the lower pole of the right kidney. Double-J right ureteral stent with its proximal loop formed in the proximal to mid right ureter and its distal loop formed within the urinary bladder. Mild right periureteral stranding/edema. No significant hydroureteronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Esophagogastric catheter terminates in the distal stomach. No significant abnormality in the stomach or small bowel. COLON / APPENDIX: Rectal tube in place. Otherwise, no significant abnormality in the colon. The appendix is normal. PERITONEUM / MESENTERY: No free intraperitoneal fluid. No pneumoperitoneum. RETROPERITONEUM: Right periureteral stranding, as above. VESSELS: No significant abnormality within the limitations of noncontrast technique. URINARY BLADDER: Partially decompressed around a Foley catheter. REPRODUCTIVE ORGANS: No significant abnormality. BODY WALL: Postsurgical changes from recent Pfannenstiel incision. Focal defect in the caudal right rectus abdominis with herniation of intra-abdominal fat between the caudal right rectus abdominis and rectus sheath. MUSCULOSKELETAL: No aggressive osseous abnormality is identified. CONCLUSION: 1. Malpositioned double-J right ureteral stent, with its proximal loop in the proximal to mid ureter. The distal loop of the right ureteral stent is in expected position within the urinary bladder. 2. Nonobstructing right nephrolithiasis. 3. Patchy peripheral predominant consolidative opacities throughout the visualized lower lungs, consistent with patient's known COVID pneumonia. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Patchy peripheral predominant consolidative opacities as well as the dependent areas of consolidation throughout the visualized lower lungs. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Partially visualized vascular catheter terminating in the right atrium. ABDOMEN and PELVIS: LIVER: Normal for technique. BILIARY TRACT: Normal. GALLBLADDER: Surgically absent. PANCREAS: Normal for technique. SPLEEN: Splenomegaly. ADRENALS: Normal. KIDNEYS: Nonobstructing 10 mm calculus in the lower pole of the right kidney. Double-J right ureteral stent with its proximal loop formed in the proximal to mid right ureter and its distal loop formed within the urinary bladder. Mild right periureteral stranding/edema. No significant hydroureteronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Esophagogastric catheter terminates in the distal stomach. No significant abnormality in the stomach or small bowel. COLON / APPENDIX: Rectal tube in place. Otherwise, no significant abnormality in the colon. The appendix is normal. PERITONEUM / MESENTERY: No free intraperitoneal fluid. No pneumoperitoneum. RETROPERITONEUM: Right periureteral stranding, as above. VESSELS: No significant abnormality within the limitations of noncontrast technique. URINARY BLADDER: Partially decompressed around a Foley catheter. REPRODUCTIVE ORGANS: No significant abnormality. BODY WALL: Postsurgical changes from recent Pfannenstiel incision. Focal defect in the caudal right rectus abdominis with herniation of intra-abdominal fat between the caudal right rectus abdominis and rectus sheath. MUSCULOSKELETAL: No aggressive osseous abnormality is identified.
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FINDINGS: ALIGNMENT: Chronic appearing grade 1 retrolisthesis of L3 on L4, grade 1 anterolisthesis of L4 on L5 and grade 1 retrolisthesis of L5 on S1. VERTEBRAE: Transitional lumbosacral anatomy with partial lumbarization of S1. There is no acute fracture. Scattered Schmorl's nodes. Moderate degenerative changes within endplate sclerosis and subchondral cysts predominantly at L3-4. Severe facet arthropathy in the lower lumbar spine. DISCS: Moderate disc height loss at T12-L1, L3-4, and L4-L5. Multilevel vacuum disc phenomena, most prominent at L3-L4 and L4-L5. PARASPINAL SOFT TISSUES: Dense atherosclerotic calcification of the abdominal aorta and iliac vessels. Multiple indeterminate bilateral renal lesions are not appropriately evaluated on this exam. Infrarenal IVC filter is positioned appropriately. Enteric contrast opacifies the small bowel. Please refer to concurrently performed CT of the abdomen and pelvis report for further details. At L1-2, there is posterior central and bilateral foraminal disc bulge with bilateral facet joint arthropathy resulting in moderate bilateral neural foraminal stenosis and mild spinal canal stenosis. At L2-3, there is diffuse posterior disc bulge, ligamentum flavum hypertrophy and bilateral facet joint arthropathy resulting in moderate spinal canal stenosis, severe left neural foraminal stenosis and moderate right neural foraminal stenosis. At L3-4, there is diffuse posterior disc bulge bilateral facet joint arthropathy and ligamentum flavum hypertrophy resulting in moderate spinal canal stenosis and severe left greater than right neural foraminal stenosis. At L4-5, there is diffuse posterior disc bulge, bilateral facet arthropathy and ligamentum flavum hypertrophy resulting in severe spinal canal stenosis with moderate left and severe right neural foraminal stenosis. At L5-S1, there is diffuse posterior disc bulge and bilateral facet arthropathy without significant spinal canal stenosis and moderate right and severe left neural foraminal stenosis.
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EXAM: CT Angio Chest wo+w contrast CLINICAL INFORMATION: Rule out aortic dissection COMPARISON: CT 08/12/2015. TECHNIQUE: CT Angio Chest wo+w contrast. Additional 3D image post-processing was performed to generate MIP and/or volume-rendered images. Patient weight: 226 lbs. IV contrast: Omnipaque 350, 100 ml, per protocol. Saline flush: 80 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 364 mm. KVP: 120 DLP: 510 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: Mild scattered patchy ground glass opacities and interstitial septal thickening likely related to volume overload. No focal lung consolidation, pleural effusion or pneumothorax. Trachea is central. Tracheobronchial airways are patent. HEART / OTHER VESSELS: Heart is normal in size. Aortic prosthesis is in place. Thoracic aorta is nonaneurysmal. No evidence of aortic dissection. Origins of great vessels are unremarkable.. MEDIASTINUM / ESOPHAGUS: Small hiatal hernia. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: No acute findings in the imaged upper abdomen. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. No acute cardiopulmonary findings. Specifically no evidence of thoracic aortic aneurysm or dissection. 2. Changes of mild volume overload. Aortic prosthesis is in place. Other stable findings as described above.
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FINDINGS: STRUCTURED REPORT: CT PE OVERALL DIAGNOSTIC QUALITY: Full diagnostic quality LOWER NECK: No abnormality. CHEST: PULMONARY ARTERIES: Negative for pulmonary embolus LUNGS / AIRWAYS / PLEURA: Mild scattered patchy ground glass opacities and interstitial septal thickening likely related to volume overload. No focal lung consolidation, pleural effusion or pneumothorax. Trachea is central. Tracheobronchial airways are patent. HEART / OTHER VESSELS: Heart is normal in size. Aortic prosthesis is in place. Thoracic aorta is nonaneurysmal. No evidence of aortic dissection. Origins of great vessels are unremarkable.. MEDIASTINUM / ESOPHAGUS: Small hiatal hernia. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: No acute findings in the imaged upper abdomen. MUSCULOSKELETAL: No significant abnormality.
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Findings: CTA neck: There is stable appearance of the mural thrombus adherent to a plaque at the left carotid bifurcation measuring 5 x 13 mm (sagittal series 12#74), similar to the prior CTA on 12/24/2022. The right bifurcation is essentially negative. Both proximal cervical ICAs are retropharyngeal. The posterior arch and the brachiocephalic arteries have expected appearance. Both vertebral arteries are sizable with no apparent defect. CTA head: The cavernous and supraclinoid ICAs are unremarkable. The proximal ACAs, MCA's and PCAs also appear normal. The basilar artery and its branches are intact. The precontrast scan of the brain shows hypodensities in the left centrum semiovale appearance of subacute infarcts. The overlying cortices are spared. There is no mass, hemorrhage or extracerebral collection. Postcontrast scans show no abnormal enhancement. ----------------
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EXAM: CT Angio Chest wo+w contrast CLINICAL INFORMATION: 70-year-old male with hypoxia, evaluation for pulmonary embolism. COMPARISON: CT chest 11/25/2021. TECHNIQUE: CT Angio Chest wo+w contrast. Additional 3D image post-processing was performed to generate MIP and/or volume-rendered images. Patient weight: 215 lbs. IV contrast: Omnipaque 350, 100 ml, per protocol. Saline flush: 75 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 442 mm. KVP: 120 DLP: 524 mGy cm. FINDINGS: STRUCTURED REPORT: CT PE OVERALL DIAGNOSTIC QUALITY: Mildly suboptimal quality with incomplete evaluation of subsegmental pulmonary arteries. LOWER NECK: No abnormality. CHEST: PULMONARY ARTERIES: Negative for pulmonary embolus LUNGS / AIRWAYS / PLEURA: Central airways are patent. Small linear opacities within the trachea likely represents mucus secretions. Mild bibasilar atelectasis. No focal consolidation. Moderate right and small left pleural effusions. No pneumothorax. HEART / OTHER VESSELS: Mild cardiomegaly. Main pulmonary artery is normal in caliber. Trace pericardial effusion. Aortic valvular prosthesis in place. Atherosclerotic ossifications of the coronary arteries, thoracic aorta and proximal great vessels. MEDIASTINUM / ESOPHAGUS: No significant abnormality. LYMPH NODES: Slightly prominent paratracheal and subcarinal lymph nodes, likely reactive. CHEST WALL: Postsurgical changes in the midline anterior chest wall. UPPER ABDOMEN: Liver is cirrhotic in morphology. Splenomegaly. Calcified granulomas in the spleen. MUSCULOSKELETAL: Postsurgical changes from median sternotomy. CONCLUSION: 1. No evidence of pulmonary embolism. 2. Moderate right and small left pleural effusions with mild bibasilar atelectasis. 3. Cirrhosis with splenomegaly. 4. Mild cardiomegaly and additional chronic/incidental findings, as above. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: STRUCTURED REPORT: CT PE OVERALL DIAGNOSTIC QUALITY: Mildly suboptimal quality with incomplete evaluation of subsegmental pulmonary arteries. LOWER NECK: No abnormality. CHEST: PULMONARY ARTERIES: Negative for pulmonary embolus LUNGS / AIRWAYS / PLEURA: Central airways are patent. Small linear opacities within the trachea likely represents mucus secretions. Mild bibasilar atelectasis. No focal consolidation. Moderate right and small left pleural effusions. No pneumothorax. HEART / OTHER VESSELS: Mild cardiomegaly. Main pulmonary artery is normal in caliber. Trace pericardial effusion. Aortic valvular prosthesis in place. Atherosclerotic ossifications of the coronary arteries, thoracic aorta and proximal great vessels. MEDIASTINUM / ESOPHAGUS: No significant abnormality. LYMPH NODES: Slightly prominent paratracheal and subcarinal lymph nodes, likely reactive. CHEST WALL: Postsurgical changes in the midline anterior chest wall. UPPER ABDOMEN: Liver is cirrhotic in morphology. Splenomegaly. Calcified granulomas in the spleen. MUSCULOSKELETAL: Postsurgical changes from median sternotomy.
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Findings: CTA neck: There is stable appearance of the mural thrombus adherent to a plaque at the left carotid bifurcation measuring 5 x 13 mm (sagittal series 12#74), similar to the prior CTA on 12/24/2022. The right bifurcation is essentially negative. Both proximal cervical ICAs are retropharyngeal. The posterior arch and the brachiocephalic arteries have expected appearance. Both vertebral arteries are sizable with no apparent defect. CTA head: The cavernous and supraclinoid ICAs are unremarkable. The proximal ACAs, MCA's and PCAs also appear normal. The basilar artery and its branches are intact. The precontrast scan of the brain shows hypodensities in the left centrum semiovale appearance of subacute infarcts. The overlying cortices are spared. There is no mass, hemorrhage or extracerebral collection. Postcontrast scans show no abnormal enhancement. ----------------
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CT Head wo contrast Clinical Information: headache Spec Inst: headache, htn, vision loss, papilledema Technique: Axial thin slice unenhanced images of the brain were obtained. Multiplanar reformatted images were obtained from the thin slice data set. Scan field of view: 230 mm. DLP: 1311 mGy cm. Comparison: No prior head CT. Findings: No acute intracranial hemorrhage. No hydrocephalus, mass effect or midline shift. Scattered nonspecific areas of subcortical white matter hypoattenuation. The calvarium and skull base appear intact. The orbits are maintained. The paranasal sinuses are clear. Impression: 1. No acute intracranial hemorrhage. 2. Scattered subcortical regions of white matter hypoattenuation bilaterally are nonspecific. Recommend correlation with already ordered MRI brain.
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Findings: No acute intracranial hemorrhage. No hydrocephalus, mass effect or midline shift. Scattered nonspecific areas of subcortical white matter hypoattenuation. The calvarium and skull base appear intact. The orbits are maintained. The paranasal sinuses are clear.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Scattered consolidative and groundglass opacities with associated bronchiectatic changes, worsened from yesterday. Interval development of small left and trace right pleural effusion. DISTAL ESOPHAGUS: Markedly distended with fluid with small hiatal hernia. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Cirrhotic features with no definite focal lesion. Gastrohepatic collaterals are again seen. BILIARY TRACT: Normal. GALLBLADDER: Postcholecystectomy. PANCREAS: Normal. SPLEEN: Borderline splenomegaly with stable small hypodensity likely cyst. Redemonstrated peripheral low perfusion areas in the spleen. ADRENALS: Normal. KIDNEYS: Small bilateral kidneys with unchanged small right nonobstructive calculus. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Diverticulosis without diverticulitis. Appendix not well seen. PERITONEUM / MESENTERY: Mild bronchial wall thickening and enhancement. RETROPERITONEUM: Redemonstrated large amount of ascites with interval decrease in size of previously noted intermediate attenuation in the pelvis. VESSELS: Redemonstrated bilateral, similar thrombus extending to the external iliac veins bilaterally to the right common iliac vein, similar to prior. IVC filter is noted. The left common iliac vein is small. Redemonstrated prominent anterior abdominal wall veins. URINARY BLADDER: Collapsed. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Mild body wall edema. MUSCULOSKELETAL: Illustrated subacute right rib fractures. No aggressive bone lesion. Moderate T12 which deformity, similar to prior.
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RADIOLOGIC EXAM: CT Head wo contrast CLINICAL INFORMATION: head injury COMPARISON: None. TECHNIQUE: CT Head wo contrastScan field of view: 250 mm. DLP: 1355 mGy cm. FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Global atrophy. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Mildly prominent in proportion to degree of atrophy. ORBITS: Normal. SINUSES: Normal. MASTOIDS: Clear. SOFT TISSUE: Unremarkable. CONCLUSION: No acute intracranial process.
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FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Global atrophy. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Mildly prominent in proportion to degree of atrophy. ORBITS: Normal. SINUSES: Normal. MASTOIDS: Clear. SOFT TISSUE: Unremarkable.
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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Bilateral groundglass density airspace opacities. No pleural effusion. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: The heart size is normal. Three-vessel coronary artery calcifications. ABDOMEN and PELVIS: LIVER: Two hypodensities within the right lobe, likely cysts. Calcified granuloma in the right lobe of liver. Hypertrophy of the left lateral segment of the liver, likely early cirrhotic morphology. BILIARY TRACT: Normal. GALLBLADDER: Multiple layering gallstones. No associated fat stranding or wall thickening. PANCREAS: Mild diffuse pancreatic atrophy. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: No hydronephrosis or renal calculus bilaterally. Redemonstrated benign cysts in the right kidney. Mild bilateral perinephric fat stranding. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Unremarkable. COLON / APPENDIX: Colonic diverticulosis without diverticulitis. The appendix is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Mild scattered atherosclerotic calcifications of the abdominal aorta and its branches. URINARY BLADDER: Decompressed around Foley catheter with intraluminal gas. REPRODUCTIVE ORGANS: Prostatomegaly. Metallic density material in the prostate. BODY WALL: Gynecomastia. MUSCULOSKELETAL: No acute displaced fracture. Mild levoscoliosis and discogenic degenerative changes of the lumbar spine.
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RADIOLOGIC EXAM: CT Cervical Spine wo contrast CLINICAL INFORMATION: Neck injury, fall. COMPARISON: None. TECHNIQUE: CT Cervical Spine wo contrastScan field of view: 239 mm. DLP: 517 mGy cm. Axial CT images are as vomiting without IV contrast. Coronal and sagittal reformats were obtained. STRUCTURED REPORT: CT Cervical Spine Trauma FINDINGS: Limited exam due to patient positioning and head rotation. SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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FINDINGS: Limited exam due to patient positioning and head rotation. SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: Refer to the concurrent dedicated CT chest report ABDOMEN and PELVIS: LIVER: A subcentimeter hypodensity is too small to further characterize in the left lobe. No other suspicious hepatic focal lesion is identified. BILIARY TRACT: Normal. GALLBLADDER: Contracted PANCREAS: A small enhancing cystic lesion measures 4 mm in the pancreatic head, likely represent sidebranch IPMN. The main pancreatic duct is nondilated. SPLEEN: Normal. ADRENALS: Mild thickening of the left adrenal gland. Otherwise, no nodular lesion in bilateral adrenal glands noted. KIDNEYS: Right kidney is slightly lower in position with lower pole extending into the right iliac fossa region. Otherwise, bilateral kidneys are normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Periampullary duodenal diverticulum is noted. Otherwise, stomach and small bowel are normal. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Atheromatous calcification the abdominal aorta and its branches without aneurysmal dilatation or significant stenosis. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus is absent. No adnexal masses identified. BODY WALL: There is small fascial defect in the right lateral wall near the iliac wing with partial herniation of a loop of ascending colon, the defect measures 1.7 cm. MUSCULOSKELETAL: No significant abnormality.
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RADIOLOGIC EXAM: CT Head wo contrast CLINICAL INFORMATION: Trauma. COMPARISON: None. TECHNIQUE: CT Head wo contrastScan field of view: 230 mm. DLP: 1383 mGy cm. STRUCTURED REPORT: CT Head Trauma FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. Mild predominantly frontoparietal cerebral volume loss. Physiologic punctate calcifications of the bilateral basal ganglia. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. VASCULAR: Punctate atherosclerosis of the bilateral carotid siphons. IMPRESSION: 1. No acute intracranial process. 2. Please refer to concomitant CT of the face for complete description of maxillofacial findings. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. Mild predominantly frontoparietal cerebral volume loss. Physiologic punctate calcifications of the bilateral basal ganglia. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. VASCULAR: Punctate atherosclerosis of the bilateral carotid siphons.
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FINDINGS: STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Mild interval increase in size in the left upper lobe pulmonary nodule today measuring 2.4 x 2.3 cm on series 2 image 50, previously 2.0 x 1.8 cm and 2.1 x 2.0 cm. Fiducial markers are stable in appearance. New area of patchy consolidation and tree-in-bud nodularity in the left lung base on series 2 image 89 and series 602 image 30. Additional scattered bilateral pulmonary nodules measuring less than 6 mm and irregular lobulated lesion in the right upper lobe are stable in appearance. Redemonstration of severe biapical centrilobular emphysema. Bilateral mild bronchial wall thickening is again noted. No focal consolidation, pleural effusion, or pneumothorax. Central airways are patent. HEART / VESSELS: Heart size is normal. Trace pericardial effusion, decreased from the prior. Moderate to severe atherosclerotic calcifications and noncalcified plaque of the thoracic aorta. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: Prominent mediastinal lymph nodes are overall stable in appearance. None significantly enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Please see same day CT abdomen for abdomen findings. MUSCULOSKELETAL: No acute or aggressive appearing osseous abnormality.
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EXAM: CT Abdomen and Pelvis w contrast, CT Thoracic Spine from Reformat, CT Lumbar Spine from Reformat, CT Chest with contrast CLINICAL INFORMATION: 64-year-old female with trauma COMPARISON: None available. TECHNIQUE: CT Abdomen and Pelvis w contrast, CT Thoracic Spine from Reformat, CT Lumbar Spine from Reformat, CT Chest with contrast. Patient weight: 185 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 30 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 80 secs Scan field of view: 415 mm. DLP: 931.90 mGy cm. (accession CT220003959), Patient weight: 185 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 30 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 80 secs Scan field of view: 415 mm. (accession CT220003958), Patient weight: 185 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 30 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 80 secs Scan field of view: 415 mm. DLP: 931.90 mGy cm. (accession CT220003961), Patient weight: 185 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 30 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 80 secs Scan field of view: 415 mm. DLP: 931.90 mGy cm. (accession CT220003962) FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Mild posterior predominant dependent groundglass opacities. And a region of groundglass opacity in the right lower lobe posterior medially on axial image 202 series 502 there is a small possible pneumatocele versus pulmonary cyst. Trace right posterior medial pneumothorax versus pneumomediastinum. No pleural effusion. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Moderate hiatal hernia with thickening of the distal esophagus. Trace pneumomediastinum versus trace pneumothorax on the right, as above. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Hepatic steatosis. Simple cyst within the superior liver measuring 2.0 x 2.0 cm (series 501 image 162). BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Bilateral subcentimeter hypodensities are too small to characterize; however, statistically representing cysts. No hydronephrosis bilaterally. There is scarring in the mid right kidney. There is scarring at the left mid kidney and lower pole of the left kidney. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Diverticulosis without evidence of diverticulitis. The appendix is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. No adnexal masses. BODY WALL: Small fat-containing umbilical hernia. There are some body wall contusive changes at the left lower anterior abdominal wall and left hip region. MUSCULOSKELETAL: Nondisplaced left posterior ninth through 11th rib fractures. There is a obliquely oriented split fracture of the left posterior 12th rib. Nondisplaced right anteromedial sixth rib fracture, subtle. Thoracic: VERTEBRA: No acute fracture evident. DISC SPACES AND FACET JOINTS: No acute injury. Multilevel endplate degenerative changes in the midthoracic spine. ALIGNMENT: Normal. Lumbar: VERTEBRA: No acute fracture evident. There are scattered sclerotic densities in the sacrum. Schmorl's nodes are present in the superior endplate of L3. DISC SPACES AND FACET JOINTS: No acute injury. Multilevel facet hypertrophy and discogenic degenerative changes resulting in moderate bilateral neural foramen narrowing at L3-L4. Disc bulge and osteophyte complex and severe facet DJD at L4-5 produce an appearance of mild to moderate spinal canal stenosis and moderate to severe bilateral foraminal stenosis. Disc bulge and osteophyte complex at L5-S1 produces an severe left foraminal narrowing and moderate to severe right foraminal narrowing ALIGNMENT: Grade 1 anterolisthesis of L4 on L5. Mild retrolisthesis of L2 on L3 and L3 on L4. CONCLUSION: 1. Mild posterior predominant dependent groundglass opacities, possibly representing mild pulmonary contusions in the setting of trauma. Suspected tiny pneumatocele in the right lower lobe region of pulmonary contusive change posterior medially. Additionally there are findings of trace right-sided pneumothorax versus trace pneumomediastinum. Nondisplaced left posterior ninth through 11th rib fractures and split fracture of the left 12th rib. Nondisplaced right anterior medial sixth rib fracture. 2. Body wall contusive changes at the left lower anterior abdomen and left hip. 3. No acute fracture evident in the thoracic or lumbar spine. Multilevel lumbar spondylosis. 4. Additional chronic incidental findings as described above. Dr. Tyson in the UAB trauma bay notified by Dr. Spann via telephone at 8:15 PM January 7, 2022. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Mild posterior predominant dependent groundglass opacities. And a region of groundglass opacity in the right lower lobe posterior medially on axial image 202 series 502 there is a small possible pneumatocele versus pulmonary cyst. Trace right posterior medial pneumothorax versus pneumomediastinum. No pleural effusion. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Moderate hiatal hernia with thickening of the distal esophagus. Trace pneumomediastinum versus trace pneumothorax on the right, as above. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Hepatic steatosis. Simple cyst within the superior liver measuring 2.0 x 2.0 cm (series 501 image 162). BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Bilateral subcentimeter hypodensities are too small to characterize; however, statistically representing cysts. No hydronephrosis bilaterally. There is scarring in the mid right kidney. There is scarring at the left mid kidney and lower pole of the left kidney. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Diverticulosis without evidence of diverticulitis. The appendix is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. No adnexal masses. BODY WALL: Small fat-containing umbilical hernia. There are some body wall contusive changes at the left lower anterior abdominal wall and left hip region. MUSCULOSKELETAL: Nondisplaced left posterior ninth through 11th rib fractures. There is a obliquely oriented split fracture of the left posterior 12th rib. Nondisplaced right anteromedial sixth rib fracture, subtle. Thoracic: VERTEBRA: No acute fracture evident. DISC SPACES AND FACET JOINTS: No acute injury. Multilevel endplate degenerative changes in the midthoracic spine. ALIGNMENT: Normal. Lumbar: VERTEBRA: No acute fracture evident. There are scattered sclerotic densities in the sacrum. Schmorl's nodes are present in the superior endplate of L3. DISC SPACES AND FACET JOINTS: No acute injury. Multilevel facet hypertrophy and discogenic degenerative changes resulting in moderate bilateral neural foramen narrowing at L3-L4. Disc bulge and osteophyte complex and severe facet DJD at L4-5 produce an appearance of mild to moderate spinal canal stenosis and moderate to severe bilateral foraminal stenosis. Disc bulge and osteophyte complex at L5-S1 produces an severe left foraminal narrowing and moderate to severe right foraminal narrowing ALIGNMENT: Grade 1 anterolisthesis of L4 on L5. Mild retrolisthesis of L2 on L3 and L3 on L4.
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FINDINGS: STRUCTURED REPORT: CTA Abdomen Pelvis Stent VASCULATURE: ENDOVASCULAR STENT: Thoracoabdominal aortic stent graft is again observed with a overlapping aortobiiliac stent graft. ENDOLEAK: Type II endoleak is observed in the inferior aspect of the native aortic sac (series 601 image 111). An additional small type II endoleak is observed superior to this in the posterior aspect of the graft (series 601 image 73). The previously observed endoleak adjacent to the stent graft is not visualized on the current exam. DISTAL DESCENDING THORACIC AORTA: Atherosclerotic disease without aneurysm ABDOMINAL AORTA: There is perhaps mild interval decrease in size of the native aneurysmal aortic sac, today measuring a maximum of 7.3 x 7.1 cm (series 502 image 75), previously measuring 7.8 x 7.4 cm using a similar measurement technique (on series 2 image 52 of the prior exam). CELIAC AXIS: Patent. Narrowing of the celiac origin with poststenotic dilatation, unchanged SMA: Patent with narrowing at the origin, similar to the prior exam RIGHT RENAL: Right renal artery stent appears chronically occluded. There is reconstitution of flow in the renal artery distal to this seen on the venous phase. LEFT RENAL: Patent stent IMA: Not well visualized RIGHT ILIAC / PROXIMAL FEMORAL ARTERIES: Patent stent LEFT ILIAC / PROXIMAL FEMORAL ARTERIES: Patent stent. Unchanged chronic short section dissection flap of the left common femoral artery. ------------------------------------------------------------- LOWER CHEST: LUNG BASES / PLEURA: Advanced emphysema DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Unchanged 1.6 cm rounded peripheral hypoenhancing lesion in the right hepatic lobe, indeterminate but unchanged from multiple prior examinations. There is an additional subcentimeter hypoattenuating lesion centrally in the right hepatic lobe on series 601 image 44 which is too small to characterize BILIARY TRACT: Mild intrahepatic biliary dilatation, similar to the prior exam GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Atrophic right kidney, similar to the prior examination. Small hypoattenuating lesions in the left kidney are unchanged, likely cysts. No hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Colonic diverticulosis PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: Bilateral enlarged gonadal veins with prominent parauterine vessels, consistent with pelvic congestion syndrome, unchanged from prior. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Diffuse osteopenia. Vertebral body compression deformity at L1 is unchanged. No acute osseous abnormality.
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EXAM: CT Abdomen and Pelvis w contrast, CT Thoracic Spine from Reformat, CT Lumbar Spine from Reformat, CT Chest with contrast CLINICAL INFORMATION: 64-year-old female with trauma COMPARISON: None available. TECHNIQUE: CT Abdomen and Pelvis w contrast, CT Thoracic Spine from Reformat, CT Lumbar Spine from Reformat, CT Chest with contrast. Patient weight: 185 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 30 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 80 secs Scan field of view: 415 mm. DLP: 931.90 mGy cm. (accession CT220003959), Patient weight: 185 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 30 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 80 secs Scan field of view: 415 mm. (accession CT220003958), Patient weight: 185 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 30 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 80 secs Scan field of view: 415 mm. DLP: 931.90 mGy cm. (accession CT220003961), Patient weight: 185 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 30 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 80 secs Scan field of view: 415 mm. DLP: 931.90 mGy cm. (accession CT220003962) FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Mild posterior predominant dependent groundglass opacities. And a region of groundglass opacity in the right lower lobe posterior medially on axial image 202 series 502 there is a small possible pneumatocele versus pulmonary cyst. Trace right posterior medial pneumothorax versus pneumomediastinum. No pleural effusion. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Moderate hiatal hernia with thickening of the distal esophagus. Trace pneumomediastinum versus trace pneumothorax on the right, as above. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Hepatic steatosis. Simple cyst within the superior liver measuring 2.0 x 2.0 cm (series 501 image 162). BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Bilateral subcentimeter hypodensities are too small to characterize; however, statistically representing cysts. No hydronephrosis bilaterally. There is scarring in the mid right kidney. There is scarring at the left mid kidney and lower pole of the left kidney. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Diverticulosis without evidence of diverticulitis. The appendix is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. No adnexal masses. BODY WALL: Small fat-containing umbilical hernia. There are some body wall contusive changes at the left lower anterior abdominal wall and left hip region. MUSCULOSKELETAL: Nondisplaced left posterior ninth through 11th rib fractures. There is a obliquely oriented split fracture of the left posterior 12th rib. Nondisplaced right anteromedial sixth rib fracture, subtle. Thoracic: VERTEBRA: No acute fracture evident. DISC SPACES AND FACET JOINTS: No acute injury. Multilevel endplate degenerative changes in the midthoracic spine. ALIGNMENT: Normal. Lumbar: VERTEBRA: No acute fracture evident. There are scattered sclerotic densities in the sacrum. Schmorl's nodes are present in the superior endplate of L3. DISC SPACES AND FACET JOINTS: No acute injury. Multilevel facet hypertrophy and discogenic degenerative changes resulting in moderate bilateral neural foramen narrowing at L3-L4. Disc bulge and osteophyte complex and severe facet DJD at L4-5 produce an appearance of mild to moderate spinal canal stenosis and moderate to severe bilateral foraminal stenosis. Disc bulge and osteophyte complex at L5-S1 produces an severe left foraminal narrowing and moderate to severe right foraminal narrowing ALIGNMENT: Grade 1 anterolisthesis of L4 on L5. Mild retrolisthesis of L2 on L3 and L3 on L4. CONCLUSION: 1. Mild posterior predominant dependent groundglass opacities, possibly representing mild pulmonary contusions in the setting of trauma. Suspected tiny pneumatocele in the right lower lobe region of pulmonary contusive change posterior medially. Additionally there are findings of trace right-sided pneumothorax versus trace pneumomediastinum. Nondisplaced left posterior ninth through 11th rib fractures and split fracture of the left 12th rib. Nondisplaced right anterior medial sixth rib fracture. 2. Body wall contusive changes at the left lower anterior abdomen and left hip. 3. No acute fracture evident in the thoracic or lumbar spine. Multilevel lumbar spondylosis. 4. Additional chronic incidental findings as described above. Dr. Tyson in the UAB trauma bay notified by Dr. Spann via telephone at 8:15 PM January 7, 2022. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Mild posterior predominant dependent groundglass opacities. And a region of groundglass opacity in the right lower lobe posterior medially on axial image 202 series 502 there is a small possible pneumatocele versus pulmonary cyst. Trace right posterior medial pneumothorax versus pneumomediastinum. No pleural effusion. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Moderate hiatal hernia with thickening of the distal esophagus. Trace pneumomediastinum versus trace pneumothorax on the right, as above. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Hepatic steatosis. Simple cyst within the superior liver measuring 2.0 x 2.0 cm (series 501 image 162). BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Bilateral subcentimeter hypodensities are too small to characterize; however, statistically representing cysts. No hydronephrosis bilaterally. There is scarring in the mid right kidney. There is scarring at the left mid kidney and lower pole of the left kidney. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Diverticulosis without evidence of diverticulitis. The appendix is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. No adnexal masses. BODY WALL: Small fat-containing umbilical hernia. There are some body wall contusive changes at the left lower anterior abdominal wall and left hip region. MUSCULOSKELETAL: Nondisplaced left posterior ninth through 11th rib fractures. There is a obliquely oriented split fracture of the left posterior 12th rib. Nondisplaced right anteromedial sixth rib fracture, subtle. Thoracic: VERTEBRA: No acute fracture evident. DISC SPACES AND FACET JOINTS: No acute injury. Multilevel endplate degenerative changes in the midthoracic spine. ALIGNMENT: Normal. Lumbar: VERTEBRA: No acute fracture evident. There are scattered sclerotic densities in the sacrum. Schmorl's nodes are present in the superior endplate of L3. DISC SPACES AND FACET JOINTS: No acute injury. Multilevel facet hypertrophy and discogenic degenerative changes resulting in moderate bilateral neural foramen narrowing at L3-L4. Disc bulge and osteophyte complex and severe facet DJD at L4-5 produce an appearance of mild to moderate spinal canal stenosis and moderate to severe bilateral foraminal stenosis. Disc bulge and osteophyte complex at L5-S1 produces an severe left foraminal narrowing and moderate to severe right foraminal narrowing ALIGNMENT: Grade 1 anterolisthesis of L4 on L5. Mild retrolisthesis of L2 on L3 and L3 on L4.
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Findings: Brain parenchyma: Mild frontal age-appropriate brain parenchymal volume loss is again seen. The brain parenchyma has a normal appearance. The white-gray matter differentiation is preserved. Unchanged 6 mm right cerebellar tonsillar ectopia. Ventricular system: Normal configuration. No hydrocephalus. Basal cisterns: There is no significant effacement of the basilar cisterns. Extra-axial spaces: Normal appearance. No abnormal extra-axial fluid collections. Hemorrhage: No intracranial hemorrhage is identified. Midline shift: No significant midline shift is seen. Vascular system: Punctate atherosclerotic calcifications of the bilateral carotid siphons. Soft tissues: Unremarkable without discrete fluid collections. Orbits: Normal appearance. Calvarium and skull base: No acute fractures or suspicious osseous lesions identified. The bilateral mastoid air cell complexes are well-developed and clear. Paranasal sinuses: Persistent trace bilateral maxillary sinus mucosal thickening with associated right greater than left chronic osteitis. Otherwise, remain well aerated.
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CT Cervical Spine From Reformat 1/7/2022 7:22 PM Clinical information: 64 years Female patient with Trauma Comparison: None available. Technique: Multiple, contiguous, axial CT images of the cervical spine were obtained from the base of the skull through the thoracic inlet without administration of intravenous contrast. Reformatted sagittal and coronal reconstructions were also performed. Findings: The sagittal images demonstrate mild dextrocurvature of the cervical spine, with preservation of the cervical lordosis, subtle grade 1 anterolisthesis of C4 on C5. The vertebral bodies maintain normal height, without acute fractures or suspicious osseous lesions. Mild intervertebral disc space loss with associated endplate sclerosis and early osteophytes at C5-C6. Mild predental space narrowing and spurring. The craniocervical junction appears unremarkable. Multilevel uncovertebral facet hypertrophy seen, resulting in mild left C5-C6 neuroforaminal narrowing, without significant spinal canal stenosis. Ossification of the nuchal ligament at C4, C5 and C6. The prevertebral and paraspinal soft tissues appear normal. IMPRESSION: 1. No evidence of acute cervical spine fracture or subluxation. 2. Chronic multilevel degenerative changes as described, most significant at C5-C6, resulting in mild left neuroforaminal narrowing, without significant spinal canal stenosis.
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Findings: The sagittal images demonstrate mild dextrocurvature of the cervical spine, with preservation of the cervical lordosis, subtle grade 1 anterolisthesis of C4 on C5. The vertebral bodies maintain normal height, without acute fractures or suspicious osseous lesions. Mild intervertebral disc space loss with associated endplate sclerosis and early osteophytes at C5-C6. Mild predental space narrowing and spurring. The craniocervical junction appears unremarkable. Multilevel uncovertebral facet hypertrophy seen, resulting in mild left C5-C6 neuroforaminal narrowing, without significant spinal canal stenosis. Ossification of the nuchal ligament at C4, C5 and C6. The prevertebral and paraspinal soft tissues appear normal.
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Findings: Hypodensity persists in the right pericallosal artery territory including the corpus callosum was slight swelling but no apparent hemorrhage. No new infarct is seen. The left hemisphere and posterior fossa contents retain normal appearance. ----------------
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EXAM: CT Abdomen and Pelvis w contrast, CT Thoracic Spine from Reformat, CT Lumbar Spine from Reformat, CT Chest with contrast CLINICAL INFORMATION: 64-year-old female with trauma COMPARISON: None available. TECHNIQUE: CT Abdomen and Pelvis w contrast, CT Thoracic Spine from Reformat, CT Lumbar Spine from Reformat, CT Chest with contrast. Patient weight: 185 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 30 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 80 secs Scan field of view: 415 mm. DLP: 931.90 mGy cm. (accession CT220003959), Patient weight: 185 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 30 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 80 secs Scan field of view: 415 mm. (accession CT220003958), Patient weight: 185 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 30 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 80 secs Scan field of view: 415 mm. DLP: 931.90 mGy cm. (accession CT220003961), Patient weight: 185 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 30 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 80 secs Scan field of view: 415 mm. DLP: 931.90 mGy cm. (accession CT220003962) FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Mild posterior predominant dependent groundglass opacities. And a region of groundglass opacity in the right lower lobe posterior medially on axial image 202 series 502 there is a small possible pneumatocele versus pulmonary cyst. Trace right posterior medial pneumothorax versus pneumomediastinum. No pleural effusion. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Moderate hiatal hernia with thickening of the distal esophagus. Trace pneumomediastinum versus trace pneumothorax on the right, as above. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Hepatic steatosis. Simple cyst within the superior liver measuring 2.0 x 2.0 cm (series 501 image 162). BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Bilateral subcentimeter hypodensities are too small to characterize; however, statistically representing cysts. No hydronephrosis bilaterally. There is scarring in the mid right kidney. There is scarring at the left mid kidney and lower pole of the left kidney. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Diverticulosis without evidence of diverticulitis. The appendix is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. No adnexal masses. BODY WALL: Small fat-containing umbilical hernia. There are some body wall contusive changes at the left lower anterior abdominal wall and left hip region. MUSCULOSKELETAL: Nondisplaced left posterior ninth through 11th rib fractures. There is a obliquely oriented split fracture of the left posterior 12th rib. Nondisplaced right anteromedial sixth rib fracture, subtle. Thoracic: VERTEBRA: No acute fracture evident. DISC SPACES AND FACET JOINTS: No acute injury. Multilevel endplate degenerative changes in the midthoracic spine. ALIGNMENT: Normal. Lumbar: VERTEBRA: No acute fracture evident. There are scattered sclerotic densities in the sacrum. Schmorl's nodes are present in the superior endplate of L3. DISC SPACES AND FACET JOINTS: No acute injury. Multilevel facet hypertrophy and discogenic degenerative changes resulting in moderate bilateral neural foramen narrowing at L3-L4. Disc bulge and osteophyte complex and severe facet DJD at L4-5 produce an appearance of mild to moderate spinal canal stenosis and moderate to severe bilateral foraminal stenosis. Disc bulge and osteophyte complex at L5-S1 produces an severe left foraminal narrowing and moderate to severe right foraminal narrowing ALIGNMENT: Grade 1 anterolisthesis of L4 on L5. Mild retrolisthesis of L2 on L3 and L3 on L4. CONCLUSION: 1. Mild posterior predominant dependent groundglass opacities, possibly representing mild pulmonary contusions in the setting of trauma. Suspected tiny pneumatocele in the right lower lobe region of pulmonary contusive change posterior medially. Additionally there are findings of trace right-sided pneumothorax versus trace pneumomediastinum. Nondisplaced left posterior ninth through 11th rib fractures and split fracture of the left 12th rib. Nondisplaced right anterior medial sixth rib fracture. 2. Body wall contusive changes at the left lower anterior abdomen and left hip. 3. No acute fracture evident in the thoracic or lumbar spine. Multilevel lumbar spondylosis. 4. Additional chronic incidental findings as described above. Dr. Tyson in the UAB trauma bay notified by Dr. Spann via telephone at 8:15 PM January 7, 2022. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Mild posterior predominant dependent groundglass opacities. And a region of groundglass opacity in the right lower lobe posterior medially on axial image 202 series 502 there is a small possible pneumatocele versus pulmonary cyst. Trace right posterior medial pneumothorax versus pneumomediastinum. No pleural effusion. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Moderate hiatal hernia with thickening of the distal esophagus. Trace pneumomediastinum versus trace pneumothorax on the right, as above. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Hepatic steatosis. Simple cyst within the superior liver measuring 2.0 x 2.0 cm (series 501 image 162). BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Bilateral subcentimeter hypodensities are too small to characterize; however, statistically representing cysts. No hydronephrosis bilaterally. There is scarring in the mid right kidney. There is scarring at the left mid kidney and lower pole of the left kidney. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Diverticulosis without evidence of diverticulitis. The appendix is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. No adnexal masses. BODY WALL: Small fat-containing umbilical hernia. There are some body wall contusive changes at the left lower anterior abdominal wall and left hip region. MUSCULOSKELETAL: Nondisplaced left posterior ninth through 11th rib fractures. There is a obliquely oriented split fracture of the left posterior 12th rib. Nondisplaced right anteromedial sixth rib fracture, subtle. Thoracic: VERTEBRA: No acute fracture evident. DISC SPACES AND FACET JOINTS: No acute injury. Multilevel endplate degenerative changes in the midthoracic spine. ALIGNMENT: Normal. Lumbar: VERTEBRA: No acute fracture evident. There are scattered sclerotic densities in the sacrum. Schmorl's nodes are present in the superior endplate of L3. DISC SPACES AND FACET JOINTS: No acute injury. Multilevel facet hypertrophy and discogenic degenerative changes resulting in moderate bilateral neural foramen narrowing at L3-L4. Disc bulge and osteophyte complex and severe facet DJD at L4-5 produce an appearance of mild to moderate spinal canal stenosis and moderate to severe bilateral foraminal stenosis. Disc bulge and osteophyte complex at L5-S1 produces an severe left foraminal narrowing and moderate to severe right foraminal narrowing ALIGNMENT: Grade 1 anterolisthesis of L4 on L5. Mild retrolisthesis of L2 on L3 and L3 on L4.
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FINDINGS: The quality of study is good for evaluation of aortic root and was not tailored for coronary artery evaluation. There is severe calcification of the tricuspid aortic leaflets with restricted opening during systole. The aortic root measurements done in systolic phase 30% are as follows (all using double oblique method): Annulus: 27 x 20 mm Approximate Annulus area: 435 mm2 Perimeter: 79 mm Distance of LM coronary artery from Annulus: 13 mm Distance of Right coronary artery from Annulus: 15 mm RCC height:22 mm LCC height: 22 mm Aortic sinuses: 33 x 33 x 32 mm Sinotubular junction: 31 x 29 mm Mid ascending aorta: 36 x 35 mm Annulus angulation: 47 degree Suitable Valve deployment angle: LAO 25, Cranial 16 Aortic valve calcification score: 2897 Cardiac chambers: The cardiac chamber sizes appear normal. Severe mitral annular calcification. No evidence of cardiac mass or thrombus on delayed images. Moderate pericardial effusion. Normal origin of coronary arteries. Severe scattered three-vessel coronary artery calcification, although this study is not optimized for coronary assessment. The main pulmonary artery is dilated, measures 3.8 cm. The thoracic aorta is normal in caliber with severe mixed atherosclerotic changes mainly involving the descending thoracic aorta. There is no acute aortic pathology, such as dissection, intramural hematoma, or contained rupture. Cardiac function: LVEF: 32% LVED volume: 200 ml LVES volume: 136 ml Stroke volume: 64 ml Lung: Moderate right and small left pleural effusion with adjacent opacities likely atelectasis. Diffuse hazy groundglass opacities in both lungs, likely related to pulmonary edema. The trachea and main bronchi are patent. Mediastinum: No thoracic lymphadenopathy. The esophagus is nondilated. Bones and soft tissues: Multiple sclerotic bony lesions involving mainly the spine and right ribs. No definite pathological fracture. Chest wall soft tissues are unremarkable. The CT of the abdomen and pelvis will be reported separately.
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EXAM: CT Abdomen and Pelvis w contrast, CT Thoracic Spine from Reformat, CT Lumbar Spine from Reformat, CT Chest with contrast CLINICAL INFORMATION: 64-year-old female with trauma COMPARISON: None available. TECHNIQUE: CT Abdomen and Pelvis w contrast, CT Thoracic Spine from Reformat, CT Lumbar Spine from Reformat, CT Chest with contrast. Patient weight: 185 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 30 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 80 secs Scan field of view: 415 mm. DLP: 931.90 mGy cm. (accession CT220003959), Patient weight: 185 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 30 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 80 secs Scan field of view: 415 mm. (accession CT220003958), Patient weight: 185 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 30 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 80 secs Scan field of view: 415 mm. DLP: 931.90 mGy cm. (accession CT220003961), Patient weight: 185 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 30 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 80 secs Scan field of view: 415 mm. DLP: 931.90 mGy cm. (accession CT220003962) FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Mild posterior predominant dependent groundglass opacities. And a region of groundglass opacity in the right lower lobe posterior medially on axial image 202 series 502 there is a small possible pneumatocele versus pulmonary cyst. Trace right posterior medial pneumothorax versus pneumomediastinum. No pleural effusion. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Moderate hiatal hernia with thickening of the distal esophagus. Trace pneumomediastinum versus trace pneumothorax on the right, as above. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Hepatic steatosis. Simple cyst within the superior liver measuring 2.0 x 2.0 cm (series 501 image 162). BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Bilateral subcentimeter hypodensities are too small to characterize; however, statistically representing cysts. No hydronephrosis bilaterally. There is scarring in the mid right kidney. There is scarring at the left mid kidney and lower pole of the left kidney. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Diverticulosis without evidence of diverticulitis. The appendix is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. No adnexal masses. BODY WALL: Small fat-containing umbilical hernia. There are some body wall contusive changes at the left lower anterior abdominal wall and left hip region. MUSCULOSKELETAL: Nondisplaced left posterior ninth through 11th rib fractures. There is a obliquely oriented split fracture of the left posterior 12th rib. Nondisplaced right anteromedial sixth rib fracture, subtle. Thoracic: VERTEBRA: No acute fracture evident. DISC SPACES AND FACET JOINTS: No acute injury. Multilevel endplate degenerative changes in the midthoracic spine. ALIGNMENT: Normal. Lumbar: VERTEBRA: No acute fracture evident. There are scattered sclerotic densities in the sacrum. Schmorl's nodes are present in the superior endplate of L3. DISC SPACES AND FACET JOINTS: No acute injury. Multilevel facet hypertrophy and discogenic degenerative changes resulting in moderate bilateral neural foramen narrowing at L3-L4. Disc bulge and osteophyte complex and severe facet DJD at L4-5 produce an appearance of mild to moderate spinal canal stenosis and moderate to severe bilateral foraminal stenosis. Disc bulge and osteophyte complex at L5-S1 produces an severe left foraminal narrowing and moderate to severe right foraminal narrowing ALIGNMENT: Grade 1 anterolisthesis of L4 on L5. Mild retrolisthesis of L2 on L3 and L3 on L4. CONCLUSION: 1. Mild posterior predominant dependent groundglass opacities, possibly representing mild pulmonary contusions in the setting of trauma. Suspected tiny pneumatocele in the right lower lobe region of pulmonary contusive change posterior medially. Additionally there are findings of trace right-sided pneumothorax versus trace pneumomediastinum. Nondisplaced left posterior ninth through 11th rib fractures and split fracture of the left 12th rib. Nondisplaced right anterior medial sixth rib fracture. 2. Body wall contusive changes at the left lower anterior abdomen and left hip. 3. No acute fracture evident in the thoracic or lumbar spine. Multilevel lumbar spondylosis. 4. Additional chronic incidental findings as described above. Dr. Tyson in the UAB trauma bay notified by Dr. Spann via telephone at 8:15 PM January 7, 2022. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Mild posterior predominant dependent groundglass opacities. And a region of groundglass opacity in the right lower lobe posterior medially on axial image 202 series 502 there is a small possible pneumatocele versus pulmonary cyst. Trace right posterior medial pneumothorax versus pneumomediastinum. No pleural effusion. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Moderate hiatal hernia with thickening of the distal esophagus. Trace pneumomediastinum versus trace pneumothorax on the right, as above. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Hepatic steatosis. Simple cyst within the superior liver measuring 2.0 x 2.0 cm (series 501 image 162). BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Bilateral subcentimeter hypodensities are too small to characterize; however, statistically representing cysts. No hydronephrosis bilaterally. There is scarring in the mid right kidney. There is scarring at the left mid kidney and lower pole of the left kidney. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Diverticulosis without evidence of diverticulitis. The appendix is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. No adnexal masses. BODY WALL: Small fat-containing umbilical hernia. There are some body wall contusive changes at the left lower anterior abdominal wall and left hip region. MUSCULOSKELETAL: Nondisplaced left posterior ninth through 11th rib fractures. There is a obliquely oriented split fracture of the left posterior 12th rib. Nondisplaced right anteromedial sixth rib fracture, subtle. Thoracic: VERTEBRA: No acute fracture evident. DISC SPACES AND FACET JOINTS: No acute injury. Multilevel endplate degenerative changes in the midthoracic spine. ALIGNMENT: Normal. Lumbar: VERTEBRA: No acute fracture evident. There are scattered sclerotic densities in the sacrum. Schmorl's nodes are present in the superior endplate of L3. DISC SPACES AND FACET JOINTS: No acute injury. Multilevel facet hypertrophy and discogenic degenerative changes resulting in moderate bilateral neural foramen narrowing at L3-L4. Disc bulge and osteophyte complex and severe facet DJD at L4-5 produce an appearance of mild to moderate spinal canal stenosis and moderate to severe bilateral foraminal stenosis. Disc bulge and osteophyte complex at L5-S1 produces an severe left foraminal narrowing and moderate to severe right foraminal narrowing ALIGNMENT: Grade 1 anterolisthesis of L4 on L5. Mild retrolisthesis of L2 on L3 and L3 on L4.
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FINDINGS: STRUCTURED REPORT: CTA TAVR Protocol VASCULATURE: ABDOMINAL AORTA: There is severe calcific atherosclerosis throughout the abdominal aorta. There is an infrarenal abdominal aorta aneurysm measuring up to 3.3 cm at L3-L4. The aneurysm starts approximately 3 cm below the left renal artery (lower renal artery). CELIAC AXIS: No significant abnormality. SMA: Calcific atherosclerotic plaque involving the ostium and proximal superior mesenteric artery resulting in severe stenosis proximally. RIGHT RENAL: Calcific atherosclerosis involving the proximal right renal artery resulting in at least moderate stenosis. LEFT RENAL: Calcific atherosclerosis of the left renal artery resulting in at least mild stenosis. IMA: No significant abnormality. RIGHT ILIAC ARTERIES: Severe calcific atherosclerosis of the common iliac artery. No aneurysms or dissection. There is moderate calcific atherosclerosis of the external and internal iliac arteries. RIGHT COMMON FEMORAL ARTERY: There is moderate calcific atherosclerosis of the common femoral artery resulting in moderate stenosis proximally LEFT ILIAC ARTERIES: There is moderate calcific atherosclerosis of the common, external and internal iliac arteries. No dissection or aneurysms. There is at least moderate stenosis of the proximal left external iliac artery. The LEFT COMMON FEMORAL ARTERY: There is mild to moderate calcific atherosclerosis resulting in mild stenosis. MEASUREMENTS: Right Common iliac dimensions: avg = 6.5, min = 4.6, max = 7.9 mm. Right External iliac dimensions: avg = 7.4, min = 6.4, max = 9.0 mm. Right Common femoral dimensions: avg = 4.6, min = 3.8, max = 5.1 mm. Left Common iliac dimensions: avg = 7.6, min = 4.4, max = 8.7 mm. Left External iliac dimensions: avg = 4.3, min = 3.1, max = 5.2 mm. Left Common femoral dimensions: avg = 7.3, min = 5.2, max = 8.8 mm. ------------------------------------------------------------- LOWER CHEST: A cardiac CTA was performed in conjunction with this examination and will be dictated in a separate report. Please see that report for all findings above the diaphragm. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: There is hyperdense material layering along the dependent portion of the gallbladder. Otherwise no pericholecystic inflammatory changes. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: There are a few diverticula along the sigmoid colon. The appendix is not visualized. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: No lymph node enlargement. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Small umbilical hernia. Small fat-containing left inguinal hernia. MUSCULOSKELETAL: There are multilevel multifactorial degenerative changes of the lumbar spine manifested by loss of the intervertebral disc space, facet joint arthropathy and endplate degenerative changes. Degenerative changes bilateral joints. There is very sclerotic vertebral bodies at T6, T12 and L1 levels. Other vessels: There is a inferior vena cava filter.
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CT Maxillofacial wo contrast 1/7/2022 7:14 PM Clinical information: 64 years Female patient with Trauma Comparison: None available. Technique: Multiple, contiguous, thin slice, axial CT images of the face were obtained without administration of intravenous contrast. Reformatted coronal reconstructions were also obtained. Scan field of view: 219.90 mm. DLP: 1009.80 mGy cm. FINDINGS: Soft tissues: No soft tissue swelling or lacerations identified. Incidental calcifications in the bilateral palatine tonsils, likely sequela of prior infections. Bones: No acute facial bone fractures are identified. No suspicious osseous lesions are seen. The visualized mandible is intact and the bilateral TMJs are congruent. Orbits: The bilateral globes and optic nerves are intact. The retrobulbar soft tissues have a normal appearance. Paranasal sinuses and mastoid air cells: Appear well aerated. IMPRESSION: No evidence of acute maxillofacial fractures.
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FINDINGS: Soft tissues: No soft tissue swelling or lacerations identified. Incidental calcifications in the bilateral palatine tonsils, likely sequela of prior infections. Bones: No acute facial bone fractures are identified. No suspicious osseous lesions are seen. The visualized mandible is intact and the bilateral TMJs are congruent. Orbits: The bilateral globes and optic nerves are intact. The retrobulbar soft tissues have a normal appearance. Paranasal sinuses and mastoid air cells: Appear well aerated.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Interval appearance of scattered groundglass airspace opacities in bilateral lung bases which may be infectious or inflammatory in etiology. DISTAL ESOPHAGUS: Diffuse thickening of the distal esophageal wall likely representing reflux esophagitis. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: 1.4 cm hepatic cyst in the right lobe of liver. Additional scattered hepatic hypodensities that are too small to further characterize. Diffuse hypoattenuation in the liver suggesting hepatic steatosis. BILIARY TRACT: Mild dilatation of the central bile ducts, likely related to postcholecystectomy status. Small cystic lesion adjacent to the cystic duct at the hepatic hilum which may be dilatation of the cystic duct remnant versus choledochal cyst measuring approximately 2.4 x 2.2 cm. This appearance is stable from prior study. GALLBLADDER: Surgically absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Mild nonspecific nodularity of the left adrenal gland. Right adrenal gland is unremarkable. KIDNEYS: Large right renal cyst measuring 9.5 x 7.8 cm. No hydronephrosis or 100 ureter. No obstructing urinary calculi. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Changes related to gastric banding procedure. Stomach, duodenum and other small bowel loops are otherwise unremarkable. COLON / APPENDIX: Appendix is not readily identified. Scattered noninflamed colonic diverticula. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Tiny calcifications in the intraluminal IVC proximal to the renal veins and iliac vein IVC confluence, likely small nonocclusive chronic clot, otherwise visualized vascular structures are unremarkable. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Status post hysterectomy and bilateral salpingo-oophorectomy. BODY WALL: Small fat-containing umbilical hernia. MUSCULOSKELETAL: No significant abnormality.
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CT Angio Neck 1/7/2022 7:22 PM Clinical information: 64 years Female patient with Trauma Comparison: None available. Technique: Intravenous iodinated contrast was then administered and multiple, contiguous, axial CT images of the neck were performed in the arterial phase using CT neck angiogram protocol. Postprocessing reformatted sagittal and coronal maximum intensity projections were also obtained. 3-D volume rendered and maximum intensity projection reconstructions were generated from the axial CT angiographic data set on an independent 3-D workstation per the ordering physician's request. These were created from the axial data. This process was performed under the supervision of the interpreting radiologist. Findings related to the 3-D reconstructions are included in this report. Patient weight: 185 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 30 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus track Scan field of view: 179.30 mm. DLP: 854.70 mGy cm. . FINDINGS: VASCULAR FINDINGS: Aortic arch: Patent with no hemodynamically significant stenosis. Incidental bovine origin of the great vessels from aortic arch. Common carotid arteries: Patent with no hemodynamically significant stenosis. Internal carotid arteries: Patent with no hemodynamically significant stenosis. Vertebral arteries: Dominant right vertebral artery. Patent with no hemodynamically significant stenosis. Aneurysm: No large aneurysm identified. NONVASCULAR FINDINGS: The oral cavity, nasopharynx, oropharynx, and laryngopharynx have normal appearance. No intrinsic abnormality is seen within the larynx or trachea. The true and false vocal cords are without focal abnormality. The superficial soft tissues of the neck have a normal appearance with no enhancing lesion identified. No enlarged lymph nodes are seen. The parotid and submandibular glands are normal in appearance. The thyroid gland is without focal abnormality. Groundglass opacities in the dependent portions of the bilateral lungs. IMPRESSION: Patent cervical arteries, without evidence of acute vascular injury or flow-limiting 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.
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FINDINGS: VASCULAR FINDINGS: Aortic arch: Patent with no hemodynamically significant stenosis. Incidental bovine origin of the great vessels from aortic arch. Common carotid arteries: Patent with no hemodynamically significant stenosis. Internal carotid arteries: Patent with no hemodynamically significant stenosis. Vertebral arteries: Dominant right vertebral artery. Patent with no hemodynamically significant stenosis. Aneurysm: No large aneurysm identified. NONVASCULAR FINDINGS: The oral cavity, nasopharynx, oropharynx, and laryngopharynx have normal appearance. No intrinsic abnormality is seen within the larynx or trachea. The true and false vocal cords are without focal abnormality. The superficial soft tissues of the neck have a normal appearance with no enhancing lesion identified. No enlarged lymph nodes are seen. The parotid and submandibular glands are normal in appearance. The thyroid gland is without focal abnormality. Groundglass opacities in the dependent portions of the bilateral lungs.
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FINDINGS: STRUCTURED REPORT: CT PE OVERALL DIAGNOSTIC QUALITY: Full diagnostic quality LOWER NECK: No abnormality. CHEST: PULMONARY ARTERIES: Pulmonary embolus in the right main pulmonary artery extending into the right middle lobar artery. The main pulmonary artery is normal in size. LUNGS / AIRWAYS / PLEURA: Wedge-shaped groundglass opacity in the right middle lobe. Bilateral septal thickening. No 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. UPPER ABDOMEN: Normal. MUSCULOSKELETAL: No significant abnormality.
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EXAM: CT Angio Chest wo+w contrast, CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: Altered mental status. Possible recent assault. Polysubstance abuse. COMPARISON: None. TECHNIQUE: CT Angio Chest wo+w contrast, CT Abdomen and Pelvis w contrast. Additional 3D image post-processing was performed to generate MIP and/or volume-rendered images. Patient weight: 159 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 75 ml. IV contrast injection rate: 4 ml per sec. Scan delay: BT sec. Scan field of view: 340 mm. KVP: 100 DLP: 549.50 mGy cm. (accession CT220003965), Patient weight: 159 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 75 ml. IV contrast injection rate: 4 ml per sec. Scan delay: BT sec. Scan field of view: 340 mm. (accession CT220003971) FINDINGS: STRUCTURED REPORT: CT Chest PE and Abdomen Pelvis OVERALL DIAGNOSTIC QUALITY: Moderately suboptimal quality with incomplete evaluation of segmental and subsegmental pulmonary arteries. Evaluation limited due to respiratory motion and suboptimal bolus timing.. LOWER NECK: No abnormality. CHEST: PULMONARY ARTERIES: Negative for pulmonary embolus LUNGS / AIRWAYS / PLEURA: Patchy airspace opacities are seen within the right upper, right middle and right lower lobes. The left lung is clear. There is a trace right pleural effusion. No pneumothorax. There are secretions seen within the distal trachea and right mainstem bronchus. There is a small amount of superimposed subsegmental atelectasis in the right lower lobe.. HEART / OTHER VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: Subcutaneous edema and stranding seen along the anterior chest without drainable fluid collection. 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: Thick-walled and partially decompressed around a Foley catheter. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: There is asymmetrical subcutaneous stranding/edema along the right back chest wall and abdomen. There is a partially visualized area of indeterminate low attenuation seen within the right latissimus dorsi seen best on image four, series 601. Additional areas of irregular low-attenuation are seen involving the right gluteal musculature and extending inferior to the right hip and involving the adductor musculature and proximal hamstrings. There is subtle peripheral enhancement involving these lesions. A similar area of low-attenuation is also seen in the right supraspinatus musculature. There is an additional mild subcutaneous edema and swelling seen in the visualized right upper extremity. MUSCULOSKELETAL: Bilateral L5 pars defects are noted. No focal destructive osseous lesion is identified. CONCLUSION: 1. Moderately limited exam. No acute central pulmonary thromboembolism is identified. Evaluation of the segmental and subsegmental pulmonary arteries is limited. 2. Multifocal areas of intramuscular low-attenuation seen in the right shoulder and back, as well as involving the right gluteal and pelvic musculature, as described. There is overlying asymmetrical right chest and flank edema as well as edema involving the visualized right upper extremity. This is of uncertain etiology but could be secondary to evolving intramuscular hematoma/muscular injury, myonecrosis, or rhabdomyolysis. Superimposed infection/myositis is not excluded. No acute fracture is seen. 3. Multifocal airspace opacities within the right lung concerning for pneumonia and/or aspiration. Trace right pleural effusion. 4. Thick-walled urinary bladder. Correlation with urinalysis recommended to exclude cystitis. 5. Additional findings above. Final report findings discussed with Jane Miller, CRNP at 1/7/2022 9:51 PM by Dr. Little by telephone.
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FINDINGS: STRUCTURED REPORT: CT Chest PE and Abdomen Pelvis OVERALL DIAGNOSTIC QUALITY: Moderately suboptimal quality with incomplete evaluation of segmental and subsegmental pulmonary arteries. Evaluation limited due to respiratory motion and suboptimal bolus timing.. LOWER NECK: No abnormality. CHEST: PULMONARY ARTERIES: Negative for pulmonary embolus LUNGS / AIRWAYS / PLEURA: Patchy airspace opacities are seen within the right upper, right middle and right lower lobes. The left lung is clear. There is a trace right pleural effusion. No pneumothorax. There are secretions seen within the distal trachea and right mainstem bronchus. There is a small amount of superimposed subsegmental atelectasis in the right lower lobe.. HEART / OTHER VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: Subcutaneous edema and stranding seen along the anterior chest without drainable fluid collection. 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: Thick-walled and partially decompressed around a Foley catheter. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: There is asymmetrical subcutaneous stranding/edema along the right back chest wall and abdomen. There is a partially visualized area of indeterminate low attenuation seen within the right latissimus dorsi seen best on image four, series 601. Additional areas of irregular low-attenuation are seen involving the right gluteal musculature and extending inferior to the right hip and involving the adductor musculature and proximal hamstrings. There is subtle peripheral enhancement involving these lesions. A similar area of low-attenuation is also seen in the right supraspinatus musculature. There is an additional mild subcutaneous edema and swelling seen in the visualized right upper extremity. MUSCULOSKELETAL: Bilateral L5 pars defects are noted. No focal destructive osseous lesion is identified.
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FINDINGS: SOFT TISSUES: Postsurgical changes of prior right adenoid cystic carcinoma resection with associated free flap reconstruction. There is also associated increased fat within the right tongue. Postsurgical changes of prior resection of the right posterior neck masses are also noted. There is new increased soft tissue density, stranding, and skin thickening overlying the lateral aspect of the right mandibular eminence. This is associated with new osseous destructive change at the resection border with a small focus of gas internally (axial series 3 image 251 and coronal series 601 #31). Questionable cutaneous irregularity is noted overlying this region. Otherwise the masticator, parapharyngeal, retropharyngeal, and carotid spaces are unremarkable. LYMPH NODES: No pathologic adenopathy by imaging size criteria. AERODIGESTIVE STRUCTURES: No asymmetric contrast enhancement or asymmetric soft tissue nodularity. Tiny anterior tracheal diverticulum. PAROTID GLANDS/SUBMANDIBULAR GLANDS: The bilateral submandibular glands are absent. The parotid glands appear unchanged from prior. Redemonstrated small left parotid lymph nodes. THYROID GLAND: Unremarkable. VASCULAR STRUCTURES: No evidence of dissection, occlusion, or aneurysm. Redemonstrated mild atheromatous narrowing of the left common carotid artery just caudal to its bifurcation. OSSEOUS STRUCTURES: The erosive and destructive changes at the resection border of the right mandibular eminence with a small foci of gas internally as described above. ORBITS: Unremarkable. PARANASAL SINUSES AND MASTOID AIR CELLS: Mild mucosal thickening of the right maxillary sinus. PARTIALLY VISUALIZED INTRACRANIAL STRUCTURES: Unremarkable. LUNG APICES: Multiple lung nodules, some of which are cavitary, are unchanged. ----------------
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. Radiologic Exam: CT Angio Head wo+w contrast, CT Angio Neck 1/7/2022 9:20 PM Clinical Information: PUI for COVID ams. Comparison: None available. Technique: Helical CT images were obtained before and after the administration of contrast from the base of the skull to the vertex. Contrast enhanced CT angiographic images were obtained from the superior mediastinum to the vertex during the arterial phase. 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: 159 lbs. IV contrast: Omnipaque 350, 100 ml, per protocol. Saline flush: 75 ml. IV contrast injection rate: 4 ml per sec. Scan delay: BT sec. Scan field of view: 230 mm. DLP: 5659.80 mGy cm. (accession CT220003966), Patient weight: 159 lbs. IV contrast: Omnipaque 350, 100 ml, per protocol. Saline flush: 75 ml. IV contrast injection rate: 4 ml per sec. Scan delay: BT sec. Scan field of view: 230 mm. (accession CT220003967) FINDINGS: CT of the head with and without contrast: There is no acute infarction, hemorrhage, or cerebral edema. The gray-white matter differentiation is maintained. Mild frontal brain parenchymal volume loss is seen. There is no space occupying intracranial lesion or hydrocephalus. Incidentally noted cavum septum pellucidum and vergae. No enhancing intracranial abnormality. There is no acute osseous or orbital abnormality. The mastoid air cells are underpneumatized. Small mucus retention cyst and mild mucosal thickening in the left maxillary sinus. Tiny right maxillary sinus mucous retention cysts. Corticated lucencies of the bilateral nasal bones, likely sequela of remote injury, with mild 5 mm leftward nasal septal deviation, abutting the left middle nasal turbinate. CT angiogram of the brain: RIGHT CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. ANTERIOR, MIDDLE, AND POSTERIOR CEREBRAL ARTERIES: Unremarkable. Hypoplastic right A1 segment, normal variant. VERTEBROBASILAR ARTERIES: There is no evidence of stenosis, occlusion, or aneurysmal dilation. CT angiogram of the neck: Limited evaluation of the proximal vessels due to photon starvation and contrast injection artifact. AORTIC ARCH and PROXIMAL GREAT VESSELS: Three normal vessel aortic arch is noted. Limited evaluation of the proximal vessels as above. Unremarkable as visualized. 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: Slightly dominant. There is no evidence of stenosis, occlusion, or aneurysmal dilation. NONVASCULAR FINDINGS: The oral cavity, nasopharynx, oropharynx, and laryngopharynx have normal appearance. No intrinsic abnormality is seen within the larynx or trachea. The true and false vocal cords are without focal abnormality. The superficial soft tissues of the neck have a normal appearance with no enhancing lesion identified. No enlarged lymph nodes are seen. The parotid and submandibular glands are normal in appearance. The thyroid gland is without focal abnormality. Patchy groundglass opacities in the right upper lobe. No aggressive osseous lesions. Mild multilevel discogenic degenerative changes. IMPRESSION: 1. No acute intracranial process or abnormal enhancement identified. 2. No evidence of cervical or intracranial arterial abnormality. 3. Patchy ground glass opacities in the right upper lobe, likely infectious versus inflammatory. Please refer to concomitant CT of the chest for complete description of infraclavicular findings. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: CT of the head with and without contrast: There is no acute infarction, hemorrhage, or cerebral edema. The gray-white matter differentiation is maintained. Mild frontal brain parenchymal volume loss is seen. There is no space occupying intracranial lesion or hydrocephalus. Incidentally noted cavum septum pellucidum and vergae. No enhancing intracranial abnormality. There is no acute osseous or orbital abnormality. The mastoid air cells are underpneumatized. Small mucus retention cyst and mild mucosal thickening in the left maxillary sinus. Tiny right maxillary sinus mucous retention cysts. Corticated lucencies of the bilateral nasal bones, likely sequela of remote injury, with mild 5 mm leftward nasal septal deviation, abutting the left middle nasal turbinate. CT angiogram of the brain: RIGHT CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. ANTERIOR, MIDDLE, AND POSTERIOR CEREBRAL ARTERIES: Unremarkable. Hypoplastic right A1 segment, normal variant. VERTEBROBASILAR ARTERIES: There is no evidence of stenosis, occlusion, or aneurysmal dilation. CT angiogram of the neck: Limited evaluation of the proximal vessels due to photon starvation and contrast injection artifact. AORTIC ARCH and PROXIMAL GREAT VESSELS: Three normal vessel aortic arch is noted. Limited evaluation of the proximal vessels as above. Unremarkable as visualized. 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: Slightly dominant. There is no evidence of stenosis, occlusion, or aneurysmal dilation. NONVASCULAR FINDINGS: The oral cavity, nasopharynx, oropharynx, and laryngopharynx have normal appearance. No intrinsic abnormality is seen within the larynx or trachea. The true and false vocal cords are without focal abnormality. The superficial soft tissues of the neck have a normal appearance with no enhancing lesion identified. No enlarged lymph nodes are seen. The parotid and submandibular glands are normal in appearance. The thyroid gland is without focal abnormality. Patchy groundglass opacities in the right upper lobe. No aggressive osseous lesions. Mild multilevel discogenic degenerative changes.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma, CT Thoracic and Lumbar spine LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Normal. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. Residual thymus in the anterior mediastinum. DIAPHRAGM: Intact. LYMPH NODES: Mildly prominent reactive appearing bilateral axillary lymph nodes. No significant mediastinal or hilar lymphadenopathy. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Focal area of hypoattenuation in the medial mid left kidney measuring 1.4 x 1.1 cm (image 243, series 301), suggesting indeterminate renal lesion. No evidence for adjacent perinephric hemorrhage or fat stranding. No hydronephrosis or hydroureter ureter. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Appendix is not readily identified. Otherwise no significant abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Skeletal immaturity. No acute traumatic abnormality. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal.
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. Radiologic Exam: CT Angio Head wo+w contrast, CT Angio Neck 1/7/2022 9:20 PM Clinical Information: PUI for COVID ams. Comparison: None available. Technique: Helical CT images were obtained before and after the administration of contrast from the base of the skull to the vertex. Contrast enhanced CT angiographic images were obtained from the superior mediastinum to the vertex during the arterial phase. 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: 159 lbs. IV contrast: Omnipaque 350, 100 ml, per protocol. Saline flush: 75 ml. IV contrast injection rate: 4 ml per sec. Scan delay: BT sec. Scan field of view: 230 mm. DLP: 5659.80 mGy cm. (accession CT220003966), Patient weight: 159 lbs. IV contrast: Omnipaque 350, 100 ml, per protocol. Saline flush: 75 ml. IV contrast injection rate: 4 ml per sec. Scan delay: BT sec. Scan field of view: 230 mm. (accession CT220003967) FINDINGS: CT of the head with and without contrast: There is no acute infarction, hemorrhage, or cerebral edema. The gray-white matter differentiation is maintained. Mild frontal brain parenchymal volume loss is seen. There is no space occupying intracranial lesion or hydrocephalus. Incidentally noted cavum septum pellucidum and vergae. No enhancing intracranial abnormality. There is no acute osseous or orbital abnormality. The mastoid air cells are underpneumatized. Small mucus retention cyst and mild mucosal thickening in the left maxillary sinus. Tiny right maxillary sinus mucous retention cysts. Corticated lucencies of the bilateral nasal bones, likely sequela of remote injury, with mild 5 mm leftward nasal septal deviation, abutting the left middle nasal turbinate. CT angiogram of the brain: RIGHT CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. ANTERIOR, MIDDLE, AND POSTERIOR CEREBRAL ARTERIES: Unremarkable. Hypoplastic right A1 segment, normal variant. VERTEBROBASILAR ARTERIES: There is no evidence of stenosis, occlusion, or aneurysmal dilation. CT angiogram of the neck: Limited evaluation of the proximal vessels due to photon starvation and contrast injection artifact. AORTIC ARCH and PROXIMAL GREAT VESSELS: Three normal vessel aortic arch is noted. Limited evaluation of the proximal vessels as above. Unremarkable as visualized. 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: Slightly dominant. There is no evidence of stenosis, occlusion, or aneurysmal dilation. NONVASCULAR FINDINGS: The oral cavity, nasopharynx, oropharynx, and laryngopharynx have normal appearance. No intrinsic abnormality is seen within the larynx or trachea. The true and false vocal cords are without focal abnormality. The superficial soft tissues of the neck have a normal appearance with no enhancing lesion identified. No enlarged lymph nodes are seen. The parotid and submandibular glands are normal in appearance. The thyroid gland is without focal abnormality. Patchy groundglass opacities in the right upper lobe. No aggressive osseous lesions. Mild multilevel discogenic degenerative changes. IMPRESSION: 1. No acute intracranial process or abnormal enhancement identified. 2. No evidence of cervical or intracranial arterial abnormality. 3. Patchy ground glass opacities in the right upper lobe, likely infectious versus inflammatory. Please refer to concomitant CT of the chest for complete description of infraclavicular findings. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: CT of the head with and without contrast: There is no acute infarction, hemorrhage, or cerebral edema. The gray-white matter differentiation is maintained. Mild frontal brain parenchymal volume loss is seen. There is no space occupying intracranial lesion or hydrocephalus. Incidentally noted cavum septum pellucidum and vergae. No enhancing intracranial abnormality. There is no acute osseous or orbital abnormality. The mastoid air cells are underpneumatized. Small mucus retention cyst and mild mucosal thickening in the left maxillary sinus. Tiny right maxillary sinus mucous retention cysts. Corticated lucencies of the bilateral nasal bones, likely sequela of remote injury, with mild 5 mm leftward nasal septal deviation, abutting the left middle nasal turbinate. CT angiogram of the brain: RIGHT CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. ANTERIOR, MIDDLE, AND POSTERIOR CEREBRAL ARTERIES: Unremarkable. Hypoplastic right A1 segment, normal variant. VERTEBROBASILAR ARTERIES: There is no evidence of stenosis, occlusion, or aneurysmal dilation. CT angiogram of the neck: Limited evaluation of the proximal vessels due to photon starvation and contrast injection artifact. AORTIC ARCH and PROXIMAL GREAT VESSELS: Three normal vessel aortic arch is noted. Limited evaluation of the proximal vessels as above. Unremarkable as visualized. 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: Slightly dominant. There is no evidence of stenosis, occlusion, or aneurysmal dilation. NONVASCULAR FINDINGS: The oral cavity, nasopharynx, oropharynx, and laryngopharynx have normal appearance. No intrinsic abnormality is seen within the larynx or trachea. The true and false vocal cords are without focal abnormality. The superficial soft tissues of the neck have a normal appearance with no enhancing lesion identified. No enlarged lymph nodes are seen. The parotid and submandibular glands are normal in appearance. The thyroid gland is without focal abnormality. Patchy groundglass opacities in the right upper lobe. No aggressive osseous lesions. Mild multilevel discogenic degenerative changes.
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Findings: Comparison: 12/28/2020 Lungs and Pleura: The distribution of predominantly upper lobe bronchiectasis is mildly increased, for instance in the right upper lobe images 41-70 series 2. There are a few other regions showing slightly worsened peripheral bronchiectasis/bronchiolectasis. Micronodular disease is mildly increased in the lower lobes. No new air-fluid levels within the cylindrical and varicoid regions of bronchiectasis. Lymph Nodes, Mediastinum and Neck: A few partially calcified mediastinal lymph nodes have a similar appearance. No axillary adenopathy. Cardiovascular: Heart size is normal. No pericardial effusion or dense coronary artery atherosclerotic ossifications. Main pulmonary artery is mildly enlarged measuring 3.5 cm, previously 3.2 cm Body Wall and Abdomen: No destructive osseous lesions. Small hiatal hernia. The included portions of the upper abdomen have an unremarkable appearance.
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EXAM: CT Angio Chest wo+w contrast, CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: Altered mental status. Possible recent assault. Polysubstance abuse. COMPARISON: None. TECHNIQUE: CT Angio Chest wo+w contrast, CT Abdomen and Pelvis w contrast. Additional 3D image post-processing was performed to generate MIP and/or volume-rendered images. Patient weight: 159 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 75 ml. IV contrast injection rate: 4 ml per sec. Scan delay: BT sec. Scan field of view: 340 mm. KVP: 100 DLP: 549.50 mGy cm. (accession CT220003965), Patient weight: 159 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 75 ml. IV contrast injection rate: 4 ml per sec. Scan delay: BT sec. Scan field of view: 340 mm. (accession CT220003971) FINDINGS: STRUCTURED REPORT: CT Chest PE and Abdomen Pelvis OVERALL DIAGNOSTIC QUALITY: Moderately suboptimal quality with incomplete evaluation of segmental and subsegmental pulmonary arteries. Evaluation limited due to respiratory motion and suboptimal bolus timing.. LOWER NECK: No abnormality. CHEST: PULMONARY ARTERIES: Negative for pulmonary embolus LUNGS / AIRWAYS / PLEURA: Patchy airspace opacities are seen within the right upper, right middle and right lower lobes. The left lung is clear. There is a trace right pleural effusion. No pneumothorax. There are secretions seen within the distal trachea and right mainstem bronchus. There is a small amount of superimposed subsegmental atelectasis in the right lower lobe.. HEART / OTHER VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: Subcutaneous edema and stranding seen along the anterior chest without drainable fluid collection. 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: Thick-walled and partially decompressed around a Foley catheter. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: There is asymmetrical subcutaneous stranding/edema along the right back chest wall and abdomen. There is a partially visualized area of indeterminate low attenuation seen within the right latissimus dorsi seen best on image four, series 601. Additional areas of irregular low-attenuation are seen involving the right gluteal musculature and extending inferior to the right hip and involving the adductor musculature and proximal hamstrings. There is subtle peripheral enhancement involving these lesions. A similar area of low-attenuation is also seen in the right supraspinatus musculature. There is an additional mild subcutaneous edema and swelling seen in the visualized right upper extremity. MUSCULOSKELETAL: Bilateral L5 pars defects are noted. No focal destructive osseous lesion is identified. CONCLUSION: 1. Moderately limited exam. No acute central pulmonary thromboembolism is identified. Evaluation of the segmental and subsegmental pulmonary arteries is limited. 2. Multifocal areas of intramuscular low-attenuation seen in the right shoulder and back, as well as involving the right gluteal and pelvic musculature, as described. There is overlying asymmetrical right chest and flank edema as well as edema involving the visualized right upper extremity. This is of uncertain etiology but could be secondary to evolving intramuscular hematoma/muscular injury, myonecrosis, or rhabdomyolysis. Superimposed infection/myositis is not excluded. No acute fracture is seen. 3. Multifocal airspace opacities within the right lung concerning for pneumonia and/or aspiration. Trace right pleural effusion. 4. Thick-walled urinary bladder. Correlation with urinalysis recommended to exclude cystitis. 5. Additional findings above. Final report findings discussed with Jane Miller, CRNP at 1/7/2022 9:51 PM by Dr. Little by telephone.
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FINDINGS: STRUCTURED REPORT: CT Chest PE and Abdomen Pelvis OVERALL DIAGNOSTIC QUALITY: Moderately suboptimal quality with incomplete evaluation of segmental and subsegmental pulmonary arteries. Evaluation limited due to respiratory motion and suboptimal bolus timing.. LOWER NECK: No abnormality. CHEST: PULMONARY ARTERIES: Negative for pulmonary embolus LUNGS / AIRWAYS / PLEURA: Patchy airspace opacities are seen within the right upper, right middle and right lower lobes. The left lung is clear. There is a trace right pleural effusion. No pneumothorax. There are secretions seen within the distal trachea and right mainstem bronchus. There is a small amount of superimposed subsegmental atelectasis in the right lower lobe.. HEART / OTHER VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: Subcutaneous edema and stranding seen along the anterior chest without drainable fluid collection. 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: Thick-walled and partially decompressed around a Foley catheter. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: There is asymmetrical subcutaneous stranding/edema along the right back chest wall and abdomen. There is a partially visualized area of indeterminate low attenuation seen within the right latissimus dorsi seen best on image four, series 601. Additional areas of irregular low-attenuation are seen involving the right gluteal musculature and extending inferior to the right hip and involving the adductor musculature and proximal hamstrings. There is subtle peripheral enhancement involving these lesions. A similar area of low-attenuation is also seen in the right supraspinatus musculature. There is an additional mild subcutaneous edema and swelling seen in the visualized right upper extremity. MUSCULOSKELETAL: Bilateral L5 pars defects are noted. No focal destructive osseous lesion is identified.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma, CT Thoracic and Lumbar spine LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Normal. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. Residual thymus in the anterior mediastinum. DIAPHRAGM: Intact. LYMPH NODES: Mildly prominent reactive appearing bilateral axillary lymph nodes. No significant mediastinal or hilar lymphadenopathy. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Focal area of hypoattenuation in the medial mid left kidney measuring 1.4 x 1.1 cm (image 243, series 301), suggesting indeterminate renal lesion. No evidence for adjacent perinephric hemorrhage or fat stranding. No hydronephrosis or hydroureter ureter. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Appendix is not readily identified. Otherwise no significant abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Skeletal immaturity. No acute traumatic abnormality. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal.
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EXAM: CT Abdomen and Pelvis wo IV contrast CLINICAL INFORMATION: 37-year-old male with right flank pain and hematuria. COMPARISON: CT abdomen pelvis 3/25/2010. TECHNIQUE: CT Abdomen and Pelvis wo IV contrast. Scan field of view: 412 mm. DLP: 322 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 is a 7 mm nodule seen in the right lower lobe on image 25, series 2 (previously seen on prior CT from 2010 on image 7, series 2) likely benign. There is a stable 6 mm nodule in the left lower lobe, likely benign. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Unremarkable for technique BILIARY TRACT: Normal. GALLBLADDER: Surgically absent. PANCREAS: Normal. SPLEEN: Unremarkable for technique ADRENALS: Normal. KIDNEYS: Left lower pole nonobstructing calculus measuring up to 4 mm. Multiple right-sided punctate nonobstructing calculi. Obstructing 7 mm stone at the right ureterovesicular junction with mild upstream hydroureter ureter. There is an additional nonobstructing punctate stone in the dilated upstream right ureter measuring approximately 3 mm on image 334, series 2. No hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. Appendix is surgically absent. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Mild atherosclerotic calcification without aneurysmal dilatation URINARY BLADDER: Minimal circumferential bladder wall thickening probably due to lack distention. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. Obstructing 7 mm calculus at the right ureterovesicular junction. Mild upstream right hydroureter. There is an additional punctate 3 mm nonobstructing stone in the dilated distal right ureter. 2. Minimal bladder wall thickening, possibly due to lack distention, but should be correlated with urinalysis to exclude UTI. 3. Bilateral additional nonobstructing nephrolithiasis. No hydronephrosis. These findings were reported to Dr. Amanda Smith at 7:41 PM on 1/7/2022 by Dr. Dylan Bittles. Final report findings discussed with Dr. Amanda Smith at 1/7/2022 7:57 PM by Dr. Little by telephone. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: There is a 7 mm nodule seen in the right lower lobe on image 25, series 2 (previously seen on prior CT from 2010 on image 7, series 2) likely benign. There is a stable 6 mm nodule in the left lower lobe, likely benign. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Unremarkable for technique BILIARY TRACT: Normal. GALLBLADDER: Surgically absent. PANCREAS: Normal. SPLEEN: Unremarkable for technique ADRENALS: Normal. KIDNEYS: Left lower pole nonobstructing calculus measuring up to 4 mm. Multiple right-sided punctate nonobstructing calculi. Obstructing 7 mm stone at the right ureterovesicular junction with mild upstream hydroureter ureter. There is an additional nonobstructing punctate stone in the dilated upstream right ureter measuring approximately 3 mm on image 334, series 2. No hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. Appendix is surgically absent. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Mild atherosclerotic calcification without aneurysmal dilatation URINARY BLADDER: Minimal circumferential bladder wall thickening probably due to lack distention. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma, CT Thoracic and Lumbar spine LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Normal. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. Residual thymus in the anterior mediastinum. DIAPHRAGM: Intact. LYMPH NODES: Mildly prominent reactive appearing bilateral axillary lymph nodes. No significant mediastinal or hilar lymphadenopathy. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Focal area of hypoattenuation in the medial mid left kidney measuring 1.4 x 1.1 cm (image 243, series 301), suggesting indeterminate renal lesion. No evidence for adjacent perinephric hemorrhage or fat stranding. No hydronephrosis or hydroureter ureter. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Appendix is not readily identified. Otherwise no significant abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Skeletal immaturity. No acute traumatic abnormality. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal.
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RADIOLOGIC EXAM: CT Head wo contrast CLINICAL INFORMATION: Encephalopathy COMPARISON: 1/13/2017 TECHNIQUE: CT Head wo contrastScan field of view: 230 mm. DLP: 1236 mGy cm. FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Left frontoparietal and left basal ganglia/insular white matter encephalomalacia, related to prior hemorrhage. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Mild ex vacuo dilatation of the left lateral horn. ORBITS: Normal. SINUSES: Normal. MASTOIDS: Clear. SOFT TISSUE: Unremarkable. CONCLUSION: No acute intracranial process.
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FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Left frontoparietal and left basal ganglia/insular white matter encephalomalacia, related to prior hemorrhage. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Mild ex vacuo dilatation of the left lateral horn. ORBITS: Normal. SINUSES: Normal. MASTOIDS: Clear. SOFT TISSUE: Unremarkable.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma, CT Thoracic and Lumbar spine LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Normal. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. Residual thymus in the anterior mediastinum. DIAPHRAGM: Intact. LYMPH NODES: Mildly prominent reactive appearing bilateral axillary lymph nodes. No significant mediastinal or hilar lymphadenopathy. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Focal area of hypoattenuation in the medial mid left kidney measuring 1.4 x 1.1 cm (image 243, series 301), suggesting indeterminate renal lesion. No evidence for adjacent perinephric hemorrhage or fat stranding. No hydronephrosis or hydroureter ureter. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Appendix is not readily identified. Otherwise no significant abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Skeletal immaturity. No acute traumatic abnormality. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal.
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RADIOLOGIC EXAM: CT Head wo contrast CLINICAL INFORMATION: Encephalopathy. Recent diagnosis of GBM. COMPARISON: CT head without contrast 12/4/2021 TECHNIQUE: CT Head wo contrastScan field of view: 244 mm. DLP: 1534 mGy cm. FINDINGS: BRAIN PARENCHYMA: Interval enlargement of heterogeneous mass within the splenium of the corpus callosum is suggested with development of right frontoparietal lobe vasogenic edema with mild effacement of the occipital horn of the right lateral ventricle and right parietal cortical sulci. Left parieto-occipital lobe edema is similar to prior. Right frontal approach ventricular shunt catheter terminates within the frontal horn of the right ventricle. Ventricles appear similar in size when compared to prior. EXTRA-AXIAL SPACES: Small isoattenuating extra-axial collection along the posterior left occipital convexity is unchanged from prior. SKULL AND SKULL BASE: Left parietal craniotomy changes are redemonstrated. VENTRICULAR SYSTEM: Stable ventricular size with VP shunt as above. ORBITS: Normal. SINUSES: Bilateral mastoid effusions. Small mucous retention cyst within the right sphenoid sinus. Nearly complete opacification of middle and inferior nasal meatus in the setting of nasogastric tube. CONCLUSION: 1. Interval findings suggestive of enlargement of heterogeneous mass within the splenium of the corpus callosum with development of right frontoparietal lobe vasogenic edema with local mass effect. No midline shift or herniation. Consider further characterization with brain MRI with contrast if possible. 2. Stable VP shunt placement with similar ventricular size to prior. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: BRAIN PARENCHYMA: Interval enlargement of heterogeneous mass within the splenium of the corpus callosum is suggested with development of right frontoparietal lobe vasogenic edema with mild effacement of the occipital horn of the right lateral ventricle and right parietal cortical sulci. Left parieto-occipital lobe edema is similar to prior. Right frontal approach ventricular shunt catheter terminates within the frontal horn of the right ventricle. Ventricles appear similar in size when compared to prior. EXTRA-AXIAL SPACES: Small isoattenuating extra-axial collection along the posterior left occipital convexity is unchanged from prior. SKULL AND SKULL BASE: Left parietal craniotomy changes are redemonstrated. VENTRICULAR SYSTEM: Stable ventricular size with VP shunt as above. ORBITS: Normal. SINUSES: Bilateral mastoid effusions. Small mucous retention cyst within the right sphenoid sinus. Nearly complete opacification of middle and inferior nasal meatus in the setting of nasogastric tube.
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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Chest LOWER NECK: Redemonstrated subcutaneous gas. CHEST: LUNGS / AIRWAYS / PLEURA: Slight interval increase in size of the small left pneumothorax. Apparent resolution of right pneumothorax. The left-sided chest tube with intrapulmonary course along the major fissure has been retracted slightly since the prior CT and now terminates within the major fissure. The left hemothorax has increased in size since prior exam, now with a loculated component superiorly and overall small to moderate. Small right hemothorax is also increased in size. Similar bilateral pulmonary lacerations with gas, blood products, and associated contusion along the ballistic tract. Retained ballistic fragment in the right peripheral middle lobe posteriorly is unchanged producing beam hardening artifact. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Small pneumomediastinum decreased from the presentation CT. LYMPH NODES: None enlarged. CHEST WALL: Similar left chest subcutaneous gas. Ballistic trajectory through the left posterior chest wall through the left eighth rib and T8 vertebral body with ballistic fragment lodged in the right middle lobe laterally. UPPER ABDOMEN: Normal. MUSCULOSKELETAL: Similar appearance of the comminuted ballistic fractures involving the left inferior scapula, left posterior lateral eighth rib, and T8 vertebral body.
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EXAM: CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: Left lower quadrant pain COMPARISON: 10/23/2015 TECHNIQUE: CT Abdomen and Pelvis w contrast. Patient weight: 270 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. Saline flush: 75 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 90 sec. Scan field of view: 400 mm. DLP: 1290.90 mGy cm. FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Mild coronary artery vascular calcification. ABDOMEN and PELVIS: LIVER: Small subcentimeter hypodensity within the right hepatic lobe is technically indeterminate but statistically likely cysts. 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: A few scattered noninflamed colonic diverticula are seen. The appendix is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Left superior lumbar hernia is unchanged.. VESSELS: Mild aortoiliac atherosclerosis without aneurysmal dilatation. URINARY BLADDER: Partially decompressed REPRODUCTIVE ORGANS: Trace bilateral scrotal hydroceles are partially visualized. BODY WALL: Small fat-containing umbilical hernia. MUSCULOSKELETAL: Mild degenerative changes are seen within the spine. No focal destructive osseous lesion is identified. Schmorl's nodes are seen within the inferior L1 and superior L2 vertebral bodies.888 CONCLUSION: 1. No acute abnormality is identified within the abdomen or pelvis. 2. Stable incidental findings as above.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Mild coronary artery vascular calcification. ABDOMEN and PELVIS: LIVER: Small subcentimeter hypodensity within the right hepatic lobe is technically indeterminate but statistically likely cysts. 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: A few scattered noninflamed colonic diverticula are seen. The appendix is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Left superior lumbar hernia is unchanged.. VESSELS: Mild aortoiliac atherosclerosis without aneurysmal dilatation. URINARY BLADDER: Partially decompressed REPRODUCTIVE ORGANS: Trace bilateral scrotal hydroceles are partially visualized. BODY WALL: Small fat-containing umbilical hernia. MUSCULOSKELETAL: Mild degenerative changes are seen within the spine. No focal destructive osseous lesion is identified. Schmorl's nodes are seen within the inferior L1 and superior L2 vertebral bodies.888
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FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. Cerebral cortical volume is normal. EXTRA-AXIAL SPACES: Normal. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SKULL AND SKULL BASE: No fracture. FACIAL BONES: Normal. MANDIBLE: Normal. SINONASAL CAVITIES: Mild mucosal thickening of the bilateral frontal sinuses and small mucosal retention cyst in the left maxillary sinus. The left mastoid air cells are opacified. The remaining paranasal sinuses and right mastoid air cells are clear. SOFT TISSUES:Subgaleal hematoma over the left parieto-occipital regions.
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3,354
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EXAM: CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: Rectal bleeding. Left-sided abdominal pain COMPARISON: None. TECHNIQUE: CT Abdomen and Pelvis w contrast. Patient weight: 228 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. IV contrast injection rate: 3 ml per sec. Scan delay: 90 sec. Scan field of view: 412 mm. DLP: 1058 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: Surgically absent PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Minute subcentimeter hypodensity in the lower pole the left kidney is technically indeterminate. No hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Scattered noninflamed colonic diverticula are seen. The appendix is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Mild aortoiliac atherosclerosis without aneurysmal dilatation. URINARY BLADDER: Thick-walled and probably due to lack distention and/or chronic outlet obstruction REPRODUCTIVE ORGANS: Prostatomegaly. Clips within the scrotum, probably related to prior vasectomy. BODY WALL: Tiny periumbilical fat-containing hernia. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. No acute abnormality is identified within the abdomen or pelvis. 2. Diverticulosis without convincing CT evidence of diverticulitis. 3. Prostatomegaly with thick-walled urinary bladder, possibly due to chronic outlet obstruction. Correlation with urinalysis may be helpful to exclude cystitis/UTI. 4. Additional findings above.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Surgically absent PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Minute subcentimeter hypodensity in the lower pole the left kidney is technically indeterminate. No hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Scattered noninflamed colonic diverticula are seen. The appendix is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Mild aortoiliac atherosclerosis without aneurysmal dilatation. URINARY BLADDER: Thick-walled and probably due to lack distention and/or chronic outlet obstruction REPRODUCTIVE ORGANS: Prostatomegaly. Clips within the scrotum, probably related to prior vasectomy. BODY WALL: Tiny periumbilical fat-containing hernia. MUSCULOSKELETAL: No significant abnormality.
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FINDINGS: CERVICAL SPINE: Suboptimal study secondary to motion. SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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3,355
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EXAM: CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: 35-year-old male with abdominal pain. COMPARISON: CT abdomen and pelvis 8/23/2018 TECHNIQUE: CT Abdomen and Pelvis w contrast. Patient weight: 150 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 75 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 83 sec. Scan field of view: 374 mm. DLP: 466 mGy cm. FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Circumferential thickening of the distal esophagus, unchanged. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Subcentimeter hypodensity within the left hepatic lobe is too small to characterize (series 201 image 52); however, statistically representing a cyst. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal with adjacent splenule. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Questionable thickening of the distal stomach. The small bowel is otherwise normal in appearance. COLON / APPENDIX: No abnormality. The appendix is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Mild scattered atherosclerotic calcifications of the abdominal aorta which is normal in caliber. URINARY BLADDER: Collapsed with mild mucosal thickening and enhancement. REPRODUCTIVE ORGANS: Prostatomegaly BODY WALL: No significant abnormality. MUSCULOSKELETAL: Redemonstration of the ballistic fragment within the L1 vertebral body with irregularity of the superior L1 endplate. CONCLUSION: 1. Bladder wall thickening and enhancement, concerning for cystitis/UTI. 2. Questionable gastric wall thickening could suggest gastritis/peptic ulcer disease. Unchanged distal esophageal thickening could suggest reflux esophagitis. 3. Additional chronic and incidental findings as described above. Final report findings discussed with Dr. Jamie Miller at 1/7/2022 8:30 PM by Dr. Little by telephone. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Circumferential thickening of the distal esophagus, unchanged. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Subcentimeter hypodensity within the left hepatic lobe is too small to characterize (series 201 image 52); however, statistically representing a cyst. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal with adjacent splenule. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Questionable thickening of the distal stomach. The small bowel is otherwise normal in appearance. COLON / APPENDIX: No abnormality. The appendix is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Mild scattered atherosclerotic calcifications of the abdominal aorta which is normal in caliber. URINARY BLADDER: Collapsed with mild mucosal thickening and enhancement. REPRODUCTIVE ORGANS: Prostatomegaly BODY WALL: No significant abnormality. MUSCULOSKELETAL: Redemonstration of the ballistic fragment within the L1 vertebral body with irregularity of the superior L1 endplate.
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FINDINGS: CERVICAL SPINE: Suboptimal study secondary to motion. SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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3,356
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RADIOLOGIC EXAM: CT Head wo contrast CLINICAL INFORMATION: Trauma. COMPARISON: None. TECHNIQUE: CT Head wo contrastScan field of view: 214 mm. DLP: 1775 mGy cm. STRUCTURED REPORT: CT Head Trauma FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. The brain parenchyma volume appears normal. Gray-white matter differentiation is maintained. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal. Pneumatization of the left petrous apex. IMPRESSION: 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.
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FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. The brain parenchyma volume appears normal. Gray-white matter differentiation is maintained. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal. Pneumatization of the left petrous apex.
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FINDINGS: CERVICAL SPINE: Suboptimal study secondary to motion. SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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3,357
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EXAM: CT Chest with contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat, CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: Trauma, MVC. COMPARISON: None. TECHNIQUE: CT Chest with contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat, CT Abdomen and Pelvis w contrast. Patient weight: 125 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 30 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 80 secs Scan field of view: 415 mm. (accession CT220003987), Patient weight: 125 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 30 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 80 secs Scan field of view: 415 mm. DLP: 560.80 mGy cm. (accession CT220003988), Patient weight: 125 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 30 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 80 secs Scan field of view: 415 mm. (accession CT220003991), Patient weight: 125 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 30 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 80 secs Scan field of view: 415 mm. (accession CT220003990) FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Bilateral subcentimeter thyroid nodules. CHEST: LUNGS / AIRWAYS / PLEURA: Central airways are patent. There are subtle groundglass opacities in the left lower lobe which could represent pulmonary contusive change in the setting of trauma. There is no pneumothorax. The remainder of the lungs are clear. No effusion. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. Calcified right hilar lymph nodes compatible prior granulomatous disease.. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: No acute injury evident. Focal fatty infiltration along the intersegmental fissure. 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. Appendix is normal. PERITONEUM / MESENTERY: Trace free fluid in the pelvis, likely physiologic. No other significant abnormality. RETROPERITONEUM: Normal. VESSELS: Focal inflammatory changes/hemorrhage in the right groin which may be related to prior vascular access. No definite evidence of associated pseudoaneurysm formation. No other significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus and ovaries are normal. No adnexal mass. BODY WALL: No other significant abnormality. MUSCULOSKELETAL: Incomplete burst fractures of L1, L2 and L3 with mild height loss and subtle fracture extension into the posterior vertebral body. No significant retropulsion at L1 on L2. Very minimal retropulsion at L3 is demonstrated. No significant spinal canal narrowing. No additional fractures evident. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: Acute L3 superior endplate fracture deformity with less than 25% vertebral body height loss compatible with incomplete burst fracture with very minimal retropulsion and no significant spinal canal narrowing. Subtle sclerotic lines extending through the L1 and L2 superior endplates extending into the posterior vertebral wall associated with mild approximately 5-10% height loss. There is no bony retropulsion at L1 or L2. No additional fractures evident.. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Minimal prevertebral hemorrhage at the L3 fracture. ALIGNMENT: Posterior vertebral alignment is maintained.. CONCLUSION: 1. Acute L3 incomplete burst fracture deformity with less than 25% vertebral body height loss and subtle fracture extension into the posterior vertebral wall with very minimal osseous retropulsion but no spinal canal narrowing. Subtle acute incomplete burst fractures of L1 and L2 with minimal height loss and no bone retropulsion. 2. Subtle groundglass opacities in the left lower lobe are nonspecific and could represent pulmonary contusion in the setting of trauma and an infectious/inflammatory etiology is not excluded. Small amount of hemorrhage and inflammation associated with right femoral vascular access. 3. No other acute traumatic findings in the chest, abdomen or pelvis. 4. No evidence of acute fracture or posterior vertebral malalignment in the thoracic spine. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Bilateral subcentimeter thyroid nodules. CHEST: LUNGS / AIRWAYS / PLEURA: Central airways are patent. There are subtle groundglass opacities in the left lower lobe which could represent pulmonary contusive change in the setting of trauma. There is no pneumothorax. The remainder of the lungs are clear. No effusion. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. Calcified right hilar lymph nodes compatible prior granulomatous disease.. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: No acute injury evident. Focal fatty infiltration along the intersegmental fissure. 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. Appendix is normal. PERITONEUM / MESENTERY: Trace free fluid in the pelvis, likely physiologic. No other significant abnormality. RETROPERITONEUM: Normal. VESSELS: Focal inflammatory changes/hemorrhage in the right groin which may be related to prior vascular access. No definite evidence of associated pseudoaneurysm formation. No other significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus and ovaries are normal. No adnexal mass. BODY WALL: No other significant abnormality. MUSCULOSKELETAL: Incomplete burst fractures of L1, L2 and L3 with mild height loss and subtle fracture extension into the posterior vertebral body. No significant retropulsion at L1 on L2. Very minimal retropulsion at L3 is demonstrated. No significant spinal canal narrowing. No additional fractures evident. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: Acute L3 superior endplate fracture deformity with less than 25% vertebral body height loss compatible with incomplete burst fracture with very minimal retropulsion and no significant spinal canal narrowing. Subtle sclerotic lines extending through the L1 and L2 superior endplates extending into the posterior vertebral wall associated with mild approximately 5-10% height loss. There is no bony retropulsion at L1 or L2. No additional fractures evident.. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Minimal prevertebral hemorrhage at the L3 fracture. ALIGNMENT: Posterior vertebral alignment is maintained..
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FINDINGS: CERVICAL SPINE: Suboptimal study secondary to motion. SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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EXAM: CT Chest with contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat, CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: Trauma, MVC. COMPARISON: None. TECHNIQUE: CT Chest with contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat, CT Abdomen and Pelvis w contrast. Patient weight: 125 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 30 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 80 secs Scan field of view: 415 mm. (accession CT220003987), Patient weight: 125 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 30 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 80 secs Scan field of view: 415 mm. DLP: 560.80 mGy cm. (accession CT220003988), Patient weight: 125 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 30 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 80 secs Scan field of view: 415 mm. (accession CT220003991), Patient weight: 125 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 30 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 80 secs Scan field of view: 415 mm. (accession CT220003990) FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Bilateral subcentimeter thyroid nodules. CHEST: LUNGS / AIRWAYS / PLEURA: Central airways are patent. There are subtle groundglass opacities in the left lower lobe which could represent pulmonary contusive change in the setting of trauma. There is no pneumothorax. The remainder of the lungs are clear. No effusion. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. Calcified right hilar lymph nodes compatible prior granulomatous disease.. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: No acute injury evident. Focal fatty infiltration along the intersegmental fissure. 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. Appendix is normal. PERITONEUM / MESENTERY: Trace free fluid in the pelvis, likely physiologic. No other significant abnormality. RETROPERITONEUM: Normal. VESSELS: Focal inflammatory changes/hemorrhage in the right groin which may be related to prior vascular access. No definite evidence of associated pseudoaneurysm formation. No other significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus and ovaries are normal. No adnexal mass. BODY WALL: No other significant abnormality. MUSCULOSKELETAL: Incomplete burst fractures of L1, L2 and L3 with mild height loss and subtle fracture extension into the posterior vertebral body. No significant retropulsion at L1 on L2. Very minimal retropulsion at L3 is demonstrated. No significant spinal canal narrowing. No additional fractures evident. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: Acute L3 superior endplate fracture deformity with less than 25% vertebral body height loss compatible with incomplete burst fracture with very minimal retropulsion and no significant spinal canal narrowing. Subtle sclerotic lines extending through the L1 and L2 superior endplates extending into the posterior vertebral wall associated with mild approximately 5-10% height loss. There is no bony retropulsion at L1 or L2. No additional fractures evident.. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Minimal prevertebral hemorrhage at the L3 fracture. ALIGNMENT: Posterior vertebral alignment is maintained.. CONCLUSION: 1. Acute L3 incomplete burst fracture deformity with less than 25% vertebral body height loss and subtle fracture extension into the posterior vertebral wall with very minimal osseous retropulsion but no spinal canal narrowing. Subtle acute incomplete burst fractures of L1 and L2 with minimal height loss and no bone retropulsion. 2. Subtle groundglass opacities in the left lower lobe are nonspecific and could represent pulmonary contusion in the setting of trauma and an infectious/inflammatory etiology is not excluded. Small amount of hemorrhage and inflammation associated with right femoral vascular access. 3. No other acute traumatic findings in the chest, abdomen or pelvis. 4. No evidence of acute fracture or posterior vertebral malalignment in the thoracic spine. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Bilateral subcentimeter thyroid nodules. CHEST: LUNGS / AIRWAYS / PLEURA: Central airways are patent. There are subtle groundglass opacities in the left lower lobe which could represent pulmonary contusive change in the setting of trauma. There is no pneumothorax. The remainder of the lungs are clear. No effusion. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. Calcified right hilar lymph nodes compatible prior granulomatous disease.. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: No acute injury evident. Focal fatty infiltration along the intersegmental fissure. 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. Appendix is normal. PERITONEUM / MESENTERY: Trace free fluid in the pelvis, likely physiologic. No other significant abnormality. RETROPERITONEUM: Normal. VESSELS: Focal inflammatory changes/hemorrhage in the right groin which may be related to prior vascular access. No definite evidence of associated pseudoaneurysm formation. No other significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus and ovaries are normal. No adnexal mass. BODY WALL: No other significant abnormality. MUSCULOSKELETAL: Incomplete burst fractures of L1, L2 and L3 with mild height loss and subtle fracture extension into the posterior vertebral body. No significant retropulsion at L1 on L2. Very minimal retropulsion at L3 is demonstrated. No significant spinal canal narrowing. No additional fractures evident. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: Acute L3 superior endplate fracture deformity with less than 25% vertebral body height loss compatible with incomplete burst fracture with very minimal retropulsion and no significant spinal canal narrowing. Subtle sclerotic lines extending through the L1 and L2 superior endplates extending into the posterior vertebral wall associated with mild approximately 5-10% height loss. There is no bony retropulsion at L1 or L2. No additional fractures evident.. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Minimal prevertebral hemorrhage at the L3 fracture. ALIGNMENT: Posterior vertebral alignment is maintained..
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FINDINGS: CERVICAL SPINE: Suboptimal study secondary to motion. SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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3,359
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CT Cervical Spine From Reformat 1/7/2022 8:03 PM Clinical information: 17 years Female patient with Trauma Comparison: None available. Technique: Multiple, contiguous, axial CT images of the cervical spine were obtained from the base of the skull through the thoracic inlet without administration of intravenous contrast. Reformatted sagittal and coronal reconstructions were also performed. Findings: The sagittal images demonstrate physiologic cervical lordosis, without subluxations. The vertebral bodies maintain normal height, without acute fractures or suspicious osseous lesions. No significant intervertebral disc space narrowing or extensive degenerative changes are identified. No significant neural foraminal narrowing or central spinal canal stenosis is seen. The craniocervical junction appears unremarkable. The prevertebral and paraspinal soft tissues appear normal. IMPRESSION: No evidence of acute cervical spine fracture or subluxation.
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Findings: The sagittal images demonstrate physiologic cervical lordosis, without subluxations. The vertebral bodies maintain normal height, without acute fractures or suspicious osseous lesions. No significant intervertebral disc space narrowing or extensive degenerative changes are identified. No significant neural foraminal narrowing or central spinal canal stenosis is seen. The craniocervical junction appears unremarkable. The prevertebral and paraspinal soft tissues appear normal.
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FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. Cerebral cortical volume is normal. EXTRA-AXIAL SPACES: Normal. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SKULL AND SKULL BASE: No fracture. FACIAL BONES: Normal. MANDIBLE: Normal. SINONASAL CAVITIES: Mild mucosal thickening of the bilateral frontal sinuses and small mucosal retention cyst in the left maxillary sinus. The left mastoid air cells are opacified. The remaining paranasal sinuses and right mastoid air cells are clear. SOFT TISSUES:Subgaleal hematoma over the left parieto-occipital regions.
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EXAM: CT Chest with contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat, CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: Trauma, MVC. COMPARISON: None. TECHNIQUE: CT Chest with contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat, CT Abdomen and Pelvis w contrast. Patient weight: 125 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 30 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 80 secs Scan field of view: 415 mm. (accession CT220003987), Patient weight: 125 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 30 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 80 secs Scan field of view: 415 mm. DLP: 560.80 mGy cm. (accession CT220003988), Patient weight: 125 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 30 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 80 secs Scan field of view: 415 mm. (accession CT220003991), Patient weight: 125 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 30 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 80 secs Scan field of view: 415 mm. (accession CT220003990) FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Bilateral subcentimeter thyroid nodules. CHEST: LUNGS / AIRWAYS / PLEURA: Central airways are patent. There are subtle groundglass opacities in the left lower lobe which could represent pulmonary contusive change in the setting of trauma. There is no pneumothorax. The remainder of the lungs are clear. No effusion. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. Calcified right hilar lymph nodes compatible prior granulomatous disease.. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: No acute injury evident. Focal fatty infiltration along the intersegmental fissure. 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. Appendix is normal. PERITONEUM / MESENTERY: Trace free fluid in the pelvis, likely physiologic. No other significant abnormality. RETROPERITONEUM: Normal. VESSELS: Focal inflammatory changes/hemorrhage in the right groin which may be related to prior vascular access. No definite evidence of associated pseudoaneurysm formation. No other significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus and ovaries are normal. No adnexal mass. BODY WALL: No other significant abnormality. MUSCULOSKELETAL: Incomplete burst fractures of L1, L2 and L3 with mild height loss and subtle fracture extension into the posterior vertebral body. No significant retropulsion at L1 on L2. Very minimal retropulsion at L3 is demonstrated. No significant spinal canal narrowing. No additional fractures evident. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: Acute L3 superior endplate fracture deformity with less than 25% vertebral body height loss compatible with incomplete burst fracture with very minimal retropulsion and no significant spinal canal narrowing. Subtle sclerotic lines extending through the L1 and L2 superior endplates extending into the posterior vertebral wall associated with mild approximately 5-10% height loss. There is no bony retropulsion at L1 or L2. No additional fractures evident.. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Minimal prevertebral hemorrhage at the L3 fracture. ALIGNMENT: Posterior vertebral alignment is maintained.. CONCLUSION: 1. Acute L3 incomplete burst fracture deformity with less than 25% vertebral body height loss and subtle fracture extension into the posterior vertebral wall with very minimal osseous retropulsion but no spinal canal narrowing. Subtle acute incomplete burst fractures of L1 and L2 with minimal height loss and no bone retropulsion. 2. Subtle groundglass opacities in the left lower lobe are nonspecific and could represent pulmonary contusion in the setting of trauma and an infectious/inflammatory etiology is not excluded. Small amount of hemorrhage and inflammation associated with right femoral vascular access. 3. No other acute traumatic findings in the chest, abdomen or pelvis. 4. No evidence of acute fracture or posterior vertebral malalignment in the thoracic spine. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Bilateral subcentimeter thyroid nodules. CHEST: LUNGS / AIRWAYS / PLEURA: Central airways are patent. There are subtle groundglass opacities in the left lower lobe which could represent pulmonary contusive change in the setting of trauma. There is no pneumothorax. The remainder of the lungs are clear. No effusion. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. Calcified right hilar lymph nodes compatible prior granulomatous disease.. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: No acute injury evident. Focal fatty infiltration along the intersegmental fissure. 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. Appendix is normal. PERITONEUM / MESENTERY: Trace free fluid in the pelvis, likely physiologic. No other significant abnormality. RETROPERITONEUM: Normal. VESSELS: Focal inflammatory changes/hemorrhage in the right groin which may be related to prior vascular access. No definite evidence of associated pseudoaneurysm formation. No other significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus and ovaries are normal. No adnexal mass. BODY WALL: No other significant abnormality. MUSCULOSKELETAL: Incomplete burst fractures of L1, L2 and L3 with mild height loss and subtle fracture extension into the posterior vertebral body. No significant retropulsion at L1 on L2. Very minimal retropulsion at L3 is demonstrated. No significant spinal canal narrowing. No additional fractures evident. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: Acute L3 superior endplate fracture deformity with less than 25% vertebral body height loss compatible with incomplete burst fracture with very minimal retropulsion and no significant spinal canal narrowing. Subtle sclerotic lines extending through the L1 and L2 superior endplates extending into the posterior vertebral wall associated with mild approximately 5-10% height loss. There is no bony retropulsion at L1 or L2. No additional fractures evident.. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Minimal prevertebral hemorrhage at the L3 fracture. ALIGNMENT: Posterior vertebral alignment is maintained..
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FINDINGS: CERVICAL SPINE: Suboptimal study secondary to motion. SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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EXAM: CT Chest with contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat, CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: Trauma, MVC. COMPARISON: None. TECHNIQUE: CT Chest with contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat, CT Abdomen and Pelvis w contrast. Patient weight: 125 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 30 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 80 secs Scan field of view: 415 mm. (accession CT220003987), Patient weight: 125 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 30 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 80 secs Scan field of view: 415 mm. DLP: 560.80 mGy cm. (accession CT220003988), Patient weight: 125 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 30 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 80 secs Scan field of view: 415 mm. (accession CT220003991), Patient weight: 125 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 30 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 80 secs Scan field of view: 415 mm. (accession CT220003990) FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Bilateral subcentimeter thyroid nodules. CHEST: LUNGS / AIRWAYS / PLEURA: Central airways are patent. There are subtle groundglass opacities in the left lower lobe which could represent pulmonary contusive change in the setting of trauma. There is no pneumothorax. The remainder of the lungs are clear. No effusion. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. Calcified right hilar lymph nodes compatible prior granulomatous disease.. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: No acute injury evident. Focal fatty infiltration along the intersegmental fissure. 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. Appendix is normal. PERITONEUM / MESENTERY: Trace free fluid in the pelvis, likely physiologic. No other significant abnormality. RETROPERITONEUM: Normal. VESSELS: Focal inflammatory changes/hemorrhage in the right groin which may be related to prior vascular access. No definite evidence of associated pseudoaneurysm formation. No other significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus and ovaries are normal. No adnexal mass. BODY WALL: No other significant abnormality. MUSCULOSKELETAL: Incomplete burst fractures of L1, L2 and L3 with mild height loss and subtle fracture extension into the posterior vertebral body. No significant retropulsion at L1 on L2. Very minimal retropulsion at L3 is demonstrated. No significant spinal canal narrowing. No additional fractures evident. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: Acute L3 superior endplate fracture deformity with less than 25% vertebral body height loss compatible with incomplete burst fracture with very minimal retropulsion and no significant spinal canal narrowing. Subtle sclerotic lines extending through the L1 and L2 superior endplates extending into the posterior vertebral wall associated with mild approximately 5-10% height loss. There is no bony retropulsion at L1 or L2. No additional fractures evident.. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Minimal prevertebral hemorrhage at the L3 fracture. ALIGNMENT: Posterior vertebral alignment is maintained.. CONCLUSION: 1. Acute L3 incomplete burst fracture deformity with less than 25% vertebral body height loss and subtle fracture extension into the posterior vertebral wall with very minimal osseous retropulsion but no spinal canal narrowing. Subtle acute incomplete burst fractures of L1 and L2 with minimal height loss and no bone retropulsion. 2. Subtle groundglass opacities in the left lower lobe are nonspecific and could represent pulmonary contusion in the setting of trauma and an infectious/inflammatory etiology is not excluded. Small amount of hemorrhage and inflammation associated with right femoral vascular access. 3. No other acute traumatic findings in the chest, abdomen or pelvis. 4. No evidence of acute fracture or posterior vertebral malalignment in the thoracic spine. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Bilateral subcentimeter thyroid nodules. CHEST: LUNGS / AIRWAYS / PLEURA: Central airways are patent. There are subtle groundglass opacities in the left lower lobe which could represent pulmonary contusive change in the setting of trauma. There is no pneumothorax. The remainder of the lungs are clear. No effusion. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. Calcified right hilar lymph nodes compatible prior granulomatous disease.. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: No acute injury evident. Focal fatty infiltration along the intersegmental fissure. 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. Appendix is normal. PERITONEUM / MESENTERY: Trace free fluid in the pelvis, likely physiologic. No other significant abnormality. RETROPERITONEUM: Normal. VESSELS: Focal inflammatory changes/hemorrhage in the right groin which may be related to prior vascular access. No definite evidence of associated pseudoaneurysm formation. No other significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus and ovaries are normal. No adnexal mass. BODY WALL: No other significant abnormality. MUSCULOSKELETAL: Incomplete burst fractures of L1, L2 and L3 with mild height loss and subtle fracture extension into the posterior vertebral body. No significant retropulsion at L1 on L2. Very minimal retropulsion at L3 is demonstrated. No significant spinal canal narrowing. No additional fractures evident. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: Acute L3 superior endplate fracture deformity with less than 25% vertebral body height loss compatible with incomplete burst fracture with very minimal retropulsion and no significant spinal canal narrowing. Subtle sclerotic lines extending through the L1 and L2 superior endplates extending into the posterior vertebral wall associated with mild approximately 5-10% height loss. There is no bony retropulsion at L1 or L2. No additional fractures evident.. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Minimal prevertebral hemorrhage at the L3 fracture. ALIGNMENT: Posterior vertebral alignment is maintained..
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Findings:Gray and white matter attenuation differentiation is maintained. No intracranial hemorrhage, intracranial mass, mass effect or midline shift. Periventricular white matter hypoattenuation of moderate severity in a pattern compatible with small vessel ischemic disease. Mild age-appropriate brain involution. No hydrocephalus. Basal cisterns are patent. Scattered bilateral basal ganglia mineralizations. Bilateral pseudophakia. Visualized bilateral orbits are otherwise unremarkable. Visualized mastoid air cells, middle ear cavities and paranasal sinuses are within normal limits. Hyperostosis frontalis interna. No acute calvarial abnormalities.
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CT MAXILLOFACIAL BONES WITHOUT CONTRAST CLINICAL INFORMATION: 17-year-old female, trauma evaluation TECHNIQUE: Helical CT images were obtained from the top of the frontal sinuses through the bottom of the mandible utilizing multislice helical technique. Reformatted coronal and sagittal images were also obtained. Scan field of view: 212 mm. DLP: 1085 mGy cm. COMPARISON EXAMINATION: None. FINDINGS: FACIAL BONES: No acute fracture. MANDIBLE: Intact. Left mandibular premolar and bilateral maxillary premolars are noted. REMAINING VISUALIZED BONES: No acute fracture. SINONASAL CAVITIES: Trace left maxillary sinus mucosal thickening. Otherwise, appear well aerated. VISUALIZED INTRACRANIAL STRUCTURES: Normal. ORBITAL CONTENTS: Normal. IMPRESSION: No evidence of acute maxillofacial fractures. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: FACIAL BONES: No acute fracture. MANDIBLE: Intact. Left mandibular premolar and bilateral maxillary premolars are noted. REMAINING VISUALIZED BONES: No acute fracture. SINONASAL CAVITIES: Trace left maxillary sinus mucosal thickening. Otherwise, appear well aerated. VISUALIZED INTRACRANIAL STRUCTURES: Normal. ORBITAL CONTENTS: Normal.
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FINDINGS: STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: There is a moderate, partially loculated left-sided pleural effusion with resulting partial compression atelectasis of the left lower lobe. There is extension into the fissure. No right pleural effusion is present. No pneumothorax. Stable appearance of right middle lobe 12 mm subpleural pulmonary nodule and another elongated nodule along the minor fissure in image 59, series 2 and right fissural nodules dating to 2018. Additional scattered less than 5 mm pulmonary nodules are present throughout the right lung. No new suspicious pulmonary nodule is identified. HEART / VESSELS: Left ventricle appears slightly dilated. No pericardial effusion. Mild atherosclerotic disease of the thoracic aorta and mild aortic valve calcifications. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: Multiple subcentimeter size mediastinal and bilateral hilar lymph nodes measuring up to 0.7 cm in diameter on series 2 image 53. Nonsignificantly enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Multiple renal cystic lesions, partially evaluated. Otherwise normal appearance of the imaged upper abdomen. MUSCULOSKELETAL: No acute or aggressive appearing osseous abnormality.
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CT Angio Neck 1/7/2022 8:03 PM Clinical information: 17 years Female patient with Trauma Comparison: None available. Technique: Intravenous iodinated contrast was then administered and multiple, contiguous, axial CT images of the neck were performed in the arterial phase using CT neck angiogram protocol. Postprocessing reformatted sagittal and coronal maximum intensity projections were also obtained. 3-D volume rendered and maximum intensity projection reconstructions were generated from the axial CT angiographic data set on an independent 3-D workstation per the ordering physician's request. These were created from the axial data. This process was performed under the supervision of the interpreting radiologist. Findings related to the 3-D reconstructions are included in this report. Patient weight: 125 lbs. Saline flush: 30 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus track Scan field of view: 208.60 mm. DLP: 911.60 mGy cm. . FINDINGS: VASCULAR FINDINGS: Aortic arch: Patent with no hemodynamically significant stenosis. Three normal vessel aortic arch is noted. Common carotid arteries: Patent with no hemodynamically significant stenosis. Internal carotid arteries: Patent with no hemodynamically significant stenosis. Vertebral arteries: Slightly dominant right vertebral artery. Patent with no hemodynamically significant stenosis. Aneurysm: No large aneurysm identified. NONVASCULAR FINDINGS: The oral cavity, nasopharynx, oropharynx, and laryngopharynx have normal appearance. No intrinsic abnormality is seen within the larynx or trachea. The true and false vocal cords are without focal abnormality. The superficial soft tissues of the neck have a normal appearance with no enhancing lesion identified. No enlarged lymph nodes are seen. The parotid and submandibular glands are normal in appearance. The thyroid gland is heterogeneous, with multiple tiny hypoattenuating nodules, likely colloid cysts. IMPRESSION: Patent cervical arteries, without evidence of acute vascular injury or flow-limiting stenosis.
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FINDINGS: VASCULAR FINDINGS: Aortic arch: Patent with no hemodynamically significant stenosis. Three normal vessel aortic arch is noted. Common carotid arteries: Patent with no hemodynamically significant stenosis. Internal carotid arteries: Patent with no hemodynamically significant stenosis. Vertebral arteries: Slightly dominant right vertebral artery. Patent with no hemodynamically significant stenosis. Aneurysm: No large aneurysm identified. NONVASCULAR FINDINGS: The oral cavity, nasopharynx, oropharynx, and laryngopharynx have normal appearance. No intrinsic abnormality is seen within the larynx or trachea. The true and false vocal cords are without focal abnormality. The superficial soft tissues of the neck have a normal appearance with no enhancing lesion identified. No enlarged lymph nodes are seen. The parotid and submandibular glands are normal in appearance. The thyroid gland is heterogeneous, with multiple tiny hypoattenuating nodules, likely colloid cysts.
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Findings: Bilateral cerebral hemispheres are symmetric in appearance. Gray and white matter attenuation differentiation is maintained. Bilateral basal ganglia mineralizations. No acute intracranial hemorrhage, intracranial mass, mass effect or midline shift. No abnormal extra-axial fluid collections. Ventricles are normal in configuration. No hydrocephalus. Basal cisterns are patent. Posterior fossa structures are unremarkable. Bilateral orbits are within normal limits. Visualized paranasal sinuses, mastoid air cells and middle ear cavities are unremarkable. No acute skull fractures.
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CT Head wo contrast 1/7/2022 7:40 PM Clinical Information: assault, head injury Comparison: None. 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: 212 mm. DLP: 1110 mGy cm. Findings: Brain parenchyma: The brain has normal morphology and volume. The brain parenchyma has a normal appearance. The white-gray matter differentiation is preserved. Ventricular system: Normal configuration. No hydrocephalus. Basal cisterns: There is no significant effacement of the basilar cisterns. Extra-axial spaces: Normal appearance. No abnormal extra-axial fluid collections. Hemorrhage: No intracranial hemorrhage is identified. Midline shift: No significant midline shift is seen. Vascular system: Normal noncontrast appearance. Soft tissues: Unremarkable without discrete fluid collections. Calvarium and skull base: No acute fractures or suspicious osseous lesions identified. The bilateral mastoid air cell complexes are well-developed and clear. IMPRESSION: 1. No acute intracranial process identified. 2. Please refer to concomitant CT of the face for complete description of maxillofacial findings.
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Findings: Brain parenchyma: The brain has normal morphology and volume. The brain parenchyma has a normal appearance. The white-gray matter differentiation is preserved. Ventricular system: Normal configuration. No hydrocephalus. Basal cisterns: There is no significant effacement of the basilar cisterns. Extra-axial spaces: Normal appearance. No abnormal extra-axial fluid collections. Hemorrhage: No intracranial hemorrhage is identified. Midline shift: No significant midline shift is seen. Vascular system: Normal noncontrast appearance. Soft tissues: Unremarkable without discrete fluid collections. Calvarium and skull base: No acute fractures or suspicious osseous lesions identified. The bilateral mastoid air cell complexes are well-developed and clear.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Moderate to large colorectal fecal burden is noted. Otherwise, colon and appendix are normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Multiple tortuous dilated veins in the diameter of the left side and dilated left gonadal vein measures 9 mm. Aorta and IVC are normal. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus is normal. There is small corpus luteal cyst and functional cyst in the left ovary. BODY WALL: Tiny fat-containing umbilical hernia. MUSCULOSKELETAL: No significant abnormality.
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CT Cervical Spine wo contrast 1/7/2022 7:40 PM Clinical information: 22 years Female patient with assault, head injury Comparison: None available. Technique: Multiple, contiguous, axial CT images of the cervical spine were obtained from the base of the skull through the thoracic inlet without administration of intravenous contrast. Reformatted sagittal and coronal reconstructions were also performed. Scan field of view: 165 mm. DLP: 880 mGy cm. Findings: The sagittal images demonstrate slight reversal of the cervical lordosis, centered at C4-C5, without subluxations. The vertebral bodies maintain normal height, without acute fractures or suspicious osseous lesions. No significant intervertebral disc space narrowing or extensive degenerative changes are identified. No significant neural foraminal narrowing or central spinal canal stenosis is seen. The craniocervical junction appears unremarkable. The prevertebral and paraspinal soft tissues appear normal. IMPRESSION: No evidence of acute cervical spine fracture or subluxation.
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Findings: The sagittal images demonstrate slight reversal of the cervical lordosis, centered at C4-C5, without subluxations. The vertebral bodies maintain normal height, without acute fractures or suspicious osseous lesions. No significant intervertebral disc space narrowing or extensive degenerative changes are identified. No significant neural foraminal narrowing or central spinal canal stenosis is seen. The craniocervical junction appears unremarkable. The prevertebral and paraspinal soft tissues appear normal.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Tiny nonobstructing renal calculus in the interpolar region of the left kidney (image two, series 301). No hydronephrosis bilaterally. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. The appendix is normal. PERITONEUM / MESENTERY: No free fluid or intraperitoneal free air. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Mildly thickened walls likely secondary to underdistention. REPRODUCTIVE ORGANS: Uterus is absent. BODY WALL: Small fat-containing umbilical hernia. MUSCULOSKELETAL: No significant abnormality.
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CT MAXILLOFACIAL BONES WITHOUT CONTRAST CLINICAL INFORMATION: 22-year-old female undergoing trauma evaluation TECHNIQUE: Helical CT images were obtained from the top of the frontal sinuses through the bottom of the mandible utilizing multislice helical technique. Reformatted coronal and sagittal images were also obtained. Scan field of view: 198 mm. DLP: 330 mGy cm. COMPARISON EXAMINATION: None. FINDINGS: FACIAL BONES: No acute fracture. MANDIBLE: Intact. REMAINING VISUALIZED BONES: No acute fracture. SINONASAL CAVITIES: Normal. VISUALIZED INTRACRANIAL STRUCTURES: Normal. ORBITAL CONTENTS: Normal. SOFT TISSUES: Jewelry noted within the superficial soft tissues of the right upper lip. IMPRESSION: No evidence of acute maxillofacial fractures. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: FACIAL BONES: No acute fracture. MANDIBLE: Intact. REMAINING VISUALIZED BONES: No acute fracture. SINONASAL CAVITIES: Normal. VISUALIZED INTRACRANIAL STRUCTURES: Normal. ORBITAL CONTENTS: Normal. SOFT TISSUES: Jewelry noted within the superficial soft tissues of the right upper lip.
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Findings: Mildly displaced fractures of the left zygomatic arch, left lateral and inferior orbital walls, including the left infraorbital foramen. There is a mildly displaced fracture of the posterior lateral wall of the left maxillary sinus. Incidental note is made of elongated styloid processes of the temporal bones bilaterally. There is trace left orbital gas without significant intraorbital hematoma. Bilateral lens placements are noted. The right maxillary sinus and right mastoid air cells are opacified. Air-fluid level within the left maxillary sinus. The remainder of the paranasal sinuses, and mastoid air cells are clear. There is extensive dental and periodontal disease with new porous periapical abscesses involving the mandibular teeth bilaterally.
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CLINICAL HISTORY: meningioam resection EXAM: CT Head wo contrast TECHNIQUE: 5 mm thick serial axial images were obtained throughout the head without intravenous contrast. Scan field of view: 217 mm. DLP: 974 mGy cm. COMPARISON: MRI dated 11/30/2021 FINDINGS: There has been interval left frontotemporal craniotomy. There has been resection of large left paraclinoid extra-axial mass and partial resection of the left anterior clinoid process. There is small amount of hemorrhage within the surgical cavity and also small adjacent parenchymal hemorrhage within the left temporal lobe. There is packing material and extra-axial gas underlying the craniotomy defect. There is continued large amount of vasogenic edema involving the left temporal lobe and also left parietal lobe as well as the left basal ganglia and left corona radiata. There is significant mass effect upon the left lateral ventricle which is nearly significantly effaced but improved since prior exam. There is continued left to right midline shift measuring approximately 13 mms. Previously measured 14 mms.. There is significant mass effect upon the left midbrain. There is a stable small right cerebellar infarction There is small left mastoid effusion The visualized paranasal sinuses and right mastoid air cells are clear. The orbits are unremarkable. CONCLUSION: 01. Interval left frontoparietal craniectomy and resection of large left paraclinoid extra-axial mass with small amount of hemorrhage within the surgical cavity and adjacent brain parenchyma. A small amount of extra-axial fluid/hemorrhage and gas within the extra-axial space underlying the craniotomy. There is no definite underlying lesion is identified on this noncontrast examination 02. Large amount of vasogenic edema resulting in significant mass effect with moderate left to right midline shift and also left uncal herniation not significantly changed since preoperative MRI
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FINDINGS: There has been interval left frontotemporal craniotomy. There has been resection of large left paraclinoid extra-axial mass and partial resection of the left anterior clinoid process. There is small amount of hemorrhage within the surgical cavity and also small adjacent parenchymal hemorrhage within the left temporal lobe. There is packing material and extra-axial gas underlying the craniotomy defect. There is continued large amount of vasogenic edema involving the left temporal lobe and also left parietal lobe as well as the left basal ganglia and left corona radiata. There is significant mass effect upon the left lateral ventricle which is nearly significantly effaced but improved since prior exam. There is continued left to right midline shift measuring approximately 13 mms. Previously measured 14 mms.. There is significant mass effect upon the left midbrain. There is a stable small right cerebellar infarction There is small left mastoid effusion The visualized paranasal sinuses and right mastoid air cells are clear. The orbits are unremarkable.
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FINDINGS: STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: There is a rounded appearing atelectasis in the right middle lobe and right lower lobe and dependent atelectatic changes in the setting of moderate partially loculated right-sided effusion which appears increased in attenuation with CT number approximately 72. Additionally the effusion appears increased in density compared to the January 25, 2022 CT study. Punctate calcified granuloma right upper lobe. The left lung is clear. Airways are patent. No pneumothorax. HEART / VESSELS: Mild to moderate coronary atherosclerotic calcifications. Heart size is normal. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: There is mild mediastinal and right hilar lymphadenopathy. A right paratracheal node measures 1.3 cm in the short axis image 39 series 201 for example. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Normal. MUSCULOSKELETAL: No acute osseous abnormality evident.
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EXAM: CT Head wo contrast, CT Maxillofacial wo contrast, CT Cervical Spine wo contrast CLINICAL INFORMATION: Trauma. Facial injury. COMPARISON: None. TECHNIQUE: CT Head wo contrast, CT Maxillofacial wo contrast, CT Cervical Spine wo contrast Scan field of view: 248.70 mm. DLP: 1393.70 mGy cm. (accession CT220003999), Scan field of view: 174.60 mm. DLP: 1072.60 mGy cm. (accession CT220004001), Scan field of view: 174.60 mm. DLP: 363.60 mGy cm. (accession CT220004000) FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. There is a posterior left parietal scalp hematoma extending to the midline. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Minimal mucosal thickening in the floor of the left maxillary sinus. MAXILLOFACIAL: There are no acute maxillofacial or mandibular fractures. There is no evidence of orbital soft tissue injury. The paranasal sinuses, middle ears, mastoid antra, and mastoid air cells are clear. CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. There is a posterior left parietal scalp hematoma extending to the midline. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Minimal mucosal thickening in the floor of the left maxillary sinus. MAXILLOFACIAL: There are no acute maxillofacial or mandibular fractures. There is no evidence of orbital soft tissue injury. The paranasal sinuses, middle ears, mastoid antra, and mastoid air cells are clear. CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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Findings: There is no pelvic fracture. The sacroiliac joints and symphysis pubis are intact. Femoral heads are properly positioned within the acetabula. A small benign bone island is present in the posterior left acetabulum. Anteversion of the coccyx appears developmental in nature.
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3,369
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EXAM: CT Head wo contrast, CT Maxillofacial wo contrast, CT Cervical Spine wo contrast CLINICAL INFORMATION: Trauma. Facial injury. COMPARISON: None. TECHNIQUE: CT Head wo contrast, CT Maxillofacial wo contrast, CT Cervical Spine wo contrast Scan field of view: 248.70 mm. DLP: 1393.70 mGy cm. (accession CT220003999), Scan field of view: 174.60 mm. DLP: 1072.60 mGy cm. (accession CT220004001), Scan field of view: 174.60 mm. DLP: 363.60 mGy cm. (accession CT220004000) FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. There is a posterior left parietal scalp hematoma extending to the midline. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Minimal mucosal thickening in the floor of the left maxillary sinus. MAXILLOFACIAL: There are no acute maxillofacial or mandibular fractures. There is no evidence of orbital soft tissue injury. The paranasal sinuses, middle ears, mastoid antra, and mastoid air cells are clear. CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. There is a posterior left parietal scalp hematoma extending to the midline. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Minimal mucosal thickening in the floor of the left maxillary sinus. MAXILLOFACIAL: There are no acute maxillofacial or mandibular fractures. There is no evidence of orbital soft tissue injury. The paranasal sinuses, middle ears, mastoid antra, and mastoid air cells are clear. CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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FINDINGS: Examination was obtained with puffed cheeks. There is focal buccal soft tissue thickening within the anterior upper buccal mucosa on the right. There appears to be a heterogeneously enhancing lesion in this location measuring approximately 3.5 x 1.1 x 0.8 cm. Remainder of the buccal mucosa and the gingival mucosa appear unremarkable. There is no destructive osseous lesion involving the mandible or the maxilla. The patient is noted to be edentulous. The nasopharynx is unremarkable. There is a cystic lesion within the right vallecula with mild peripheral enhancement likely representing small cysts on inflammatory basis. There are apparent entrapped secretions within the nasopharynx and upper oropharynx The remainder of the pharynx appears unremarkable. The larynx appears within normal limits. Thyroid gland is unremarkable. Both submandibular glands and parotid glands are unremarkable. There is no lymphadenopathy within the submental regions or internal jugular chains using CT size criteria. There are moderate atherosclerotic calcifications of both carotid bifurcations and proximal cervical ICAs, left worse than the right. There are also moderate atherosclerotic calcifications of the carotid siphons. There are also significant atherosclerotic calcifications of both intracranial vertebral arteries resulting in at least moderate focal stenosis. There is diffuse patchy sclerosis of the cervical vertebrae. There also multilevel moderate degenerative changes resulting in multilevel spinal canal narrowing, greatest at C3-C4 and C5-C6. Emphysematous changes are noted within the visualized lungs. Visualized brain appears unremarkable. There is a small right mastoid effusion. Left mastoid air cells are clear and paranasal sinuses are essentially clear. There is no acute abnormality of the orbits.
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3,370
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EXAM: CT Head wo contrast, CT Maxillofacial wo contrast, CT Cervical Spine wo contrast CLINICAL INFORMATION: Trauma. Facial injury. COMPARISON: None. TECHNIQUE: CT Head wo contrast, CT Maxillofacial wo contrast, CT Cervical Spine wo contrast Scan field of view: 248.70 mm. DLP: 1393.70 mGy cm. (accession CT220003999), Scan field of view: 174.60 mm. DLP: 1072.60 mGy cm. (accession CT220004001), Scan field of view: 174.60 mm. DLP: 363.60 mGy cm. (accession CT220004000) FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. There is a posterior left parietal scalp hematoma extending to the midline. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Minimal mucosal thickening in the floor of the left maxillary sinus. MAXILLOFACIAL: There are no acute maxillofacial or mandibular fractures. There is no evidence of orbital soft tissue injury. The paranasal sinuses, middle ears, mastoid antra, and mastoid air cells are clear. CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. There is a posterior left parietal scalp hematoma extending to the midline. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Minimal mucosal thickening in the floor of the left maxillary sinus. MAXILLOFACIAL: There are no acute maxillofacial or mandibular fractures. There is no evidence of orbital soft tissue injury. The paranasal sinuses, middle ears, mastoid antra, and mastoid air cells are clear. CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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Findings: The enlarged right hilar node measures 12 x 16 mm on series 2 image 65. Enlarged AP window node is 11 mm in short axis on image 50. Additional enlarged subcarinal node is present. No additional enlarged intrathoracic nodes are identified. Moderate to severe calcification is seen in the aorta and the native coronary arteries with noncalcified plaque in the descending thoracic aorta. Post CABG findings are noted. The ascending aorta is mildly ectatic at 41 mm. Dilated right atrium is present. The heart size and mediastinum are otherwise normal. No pleural effusion. Bilateral upper lobe predominant centrilobular emphysema is seen. Suture line is present posterior aspect of the right upper lobe. Scattered calcified granuloma are noted. There are areas of subpleural fibrosis and groundglass density such as in the right upper lobe on series 2 image 69, in the lingula and in the right lower lobe. Noncalcified nodule in the left lower lobe on series 2 image 103 measures 10 x 12 mm. No additional noncalcified nodules or masses are identified. The airways are patent. The mid pancreatic duct is dilated measuring up to 8 mm on series 2 image 130. Not all of the pancreatic head is visualized. There appear to be varices within the omentum. Limited images of the upper abdomen are otherwise unremarkable. Focal lipoma is seen within the left pectoralis major muscle. Previous sternotomy is seen. Previous fractures are postsurgical changes to the lateral left ribs. Marked degenerative changes seen in the lower cervical and upper thoracic spine. No suspicious destructive osseous lesions.
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3,371
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CT Head wo contrast 1/7/2022 8:39 PM Clinical Information: Trauma Comparison: None. 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: 230 mm. DLP: 1413 mGy cm. Findings: Brain parenchyma: Mild frontoparietal brain parenchymal volume loss is seen. The brain parenchyma has a normal appearance. The white-gray matter differentiation is preserved. Ventricular system: Normal configuration. No hydrocephalus. Basal cisterns: There is no significant effacement of the basilar cisterns. Extra-axial spaces: Normal appearance. No abnormal extra-axial fluid collections. Hemorrhage: No intracranial hemorrhage is identified. Midline shift: No significant midline shift is seen. Vascular system: Normal noncontrast appearance. Soft tissues: Unremarkable without discrete fluid collections. Calvarium and skull base: No acute fractures or suspicious osseous lesions identified. The bilateral mastoid air cell complexes are well-developed and clear. IMPRESSION: 1. No acute intracranial process identified. 2. Please refer to concomitant CT of the face for complete description of maxillofacial findings.
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Findings: Brain parenchyma: Mild frontoparietal brain parenchymal volume loss is seen. The brain parenchyma has a normal appearance. The white-gray matter differentiation is preserved. Ventricular system: Normal configuration. No hydrocephalus. Basal cisterns: There is no significant effacement of the basilar cisterns. Extra-axial spaces: Normal appearance. No abnormal extra-axial fluid collections. Hemorrhage: No intracranial hemorrhage is identified. Midline shift: No significant midline shift is seen. Vascular system: Normal noncontrast appearance. Soft tissues: Unremarkable without discrete fluid collections. Calvarium and skull base: No acute fractures or suspicious osseous lesions identified. The bilateral mastoid air cell complexes are well-developed and clear.
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FINDINGS/CONCLUSION: No acute fracture, specifically no fracture of the scaphoid is seen. Advanced degenerative changes of the thumb CMC joint with mild radial subluxation of the metacarpal in relation to the trapezium. Mild degenerative changes of the triscaphe joint with subchondral cystic changes within the distal scaphoid. The remaining joint spaces are unremarkable. The soft tissues are unremarkable.
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3,372
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EXAM: CT Chest with contrast, CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: Trauma, stabbing. COMPARISON: None. TECHNIQUE: CT Chest with contrast, CT Abdomen and Pelvis w contrast. Patient weight: 160 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 30 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 80 secs Scan field of view: 481.40 mm. (accession CT220004003), Patient weight: 160 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 30 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 80 secs Scan field of view: 481.40 mm. DLP: 878 mGy cm. (accession CT220004004) FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Focal hemorrhage edema relating to penetrating injury in the anterior right lower neck. Hemorrhage edema is seen within the right scalene musculature and tracking along the right sternocleidomastoid and subcutaneous gas tracks posterior to the right carotid space and anterior to the prevertebral soft tissues/prevertebral space. There is associated soft tissue emphysema extending from the superficial right lateral neck soft tissues to the adjacent prevertebral soft tissues. CHEST: LUNGS / AIRWAYS / PLEURA: Small amount of secretions in the trachea. Central airways are otherwise patent. 7 mm perifissural nodule in the right middle lobe (axial series 502, image 177), likely an intrapulmonary lymph node. 5 mm groundglass nodule in the posterior right lower lobe (axial image 194), likely infectious or inflammatory. Mild posterior dependent atelectatic changes bilaterally. No focal consolidation, pneumothorax or pleural effusion. HEART / VESSELS: Mild cardiomegaly. Trace pericardial effusion. MEDIASTINUM / ESOPHAGUS: Small hiatal hernia. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. Small accessory spleen. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. Appendix is normal. PERITONEUM / MESENTERY: Normal. No free fluid or pneumoperitoneum. RETROPERITONEUM: Small amount of intramuscular hemorrhage in the right psoas adjacent to L1 and tracking caudally. No active extravasation. VESSELS: Small amount of hemorrhage and inflammatory stranding associated with right femoral vascular access. Mild calcific atherosclerosis of the abdominal aorta and its branch vessels. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Moderate sized right hydrocele. Mild prostatomegaly. BODY WALL: Small penetrating injury to the right lower midline back with associated contusive changes and subcutaneous emphysema. Additional small penetrating injuries to the upper midline back with associated contusive changes and subcutaneous emphysema extending along the right greater than left paraspinous musculature and posterior chest wall. MUSCULOSKELETAL: There is a chip fracture of the right inferior lateral corner of L1 associated with the penetrating injury to the posterior back soft tissues and intramuscular hemorrhage in the right psoas and right paraspinous musculature. No active extravasation.. CONCLUSION: 1. Multiple small penetrating injuries to the right lower anterior neck, upper midline back and right lower back soft tissues with associated contusive changes and underlying soft tissue emphysema. There is a small chip fracture of the inferior right L1 vertebral body and intramuscular hemorrhage in the right psoas and right paraspinous musculature. No evidence for active extravasation. 2. Small amount of hemorrhage and inflammation associated with right femoral vascular access. 3. Chronic and incidental findings as above. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Focal hemorrhage edema relating to penetrating injury in the anterior right lower neck. Hemorrhage edema is seen within the right scalene musculature and tracking along the right sternocleidomastoid and subcutaneous gas tracks posterior to the right carotid space and anterior to the prevertebral soft tissues/prevertebral space. There is associated soft tissue emphysema extending from the superficial right lateral neck soft tissues to the adjacent prevertebral soft tissues. CHEST: LUNGS / AIRWAYS / PLEURA: Small amount of secretions in the trachea. Central airways are otherwise patent. 7 mm perifissural nodule in the right middle lobe (axial series 502, image 177), likely an intrapulmonary lymph node. 5 mm groundglass nodule in the posterior right lower lobe (axial image 194), likely infectious or inflammatory. Mild posterior dependent atelectatic changes bilaterally. No focal consolidation, pneumothorax or pleural effusion. HEART / VESSELS: Mild cardiomegaly. Trace pericardial effusion. MEDIASTINUM / ESOPHAGUS: Small hiatal hernia. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. Small accessory spleen. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. Appendix is normal. PERITONEUM / MESENTERY: Normal. No free fluid or pneumoperitoneum. RETROPERITONEUM: Small amount of intramuscular hemorrhage in the right psoas adjacent to L1 and tracking caudally. No active extravasation. VESSELS: Small amount of hemorrhage and inflammatory stranding associated with right femoral vascular access. Mild calcific atherosclerosis of the abdominal aorta and its branch vessels. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Moderate sized right hydrocele. Mild prostatomegaly. BODY WALL: Small penetrating injury to the right lower midline back with associated contusive changes and subcutaneous emphysema. Additional small penetrating injuries to the upper midline back with associated contusive changes and subcutaneous emphysema extending along the right greater than left paraspinous musculature and posterior chest wall. MUSCULOSKELETAL: There is a chip fracture of the right inferior lateral corner of L1 associated with the penetrating injury to the posterior back soft tissues and intramuscular hemorrhage in the right psoas and right paraspinous musculature. No active extravasation..
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FINDINGS/CONCLUSION: No acute fracture or dislocation. Irregularity of the coronoid process possibly reflects degenerative changes versus sequela of remote trauma. No elbow joint effusion. Soft tissue swelling over the olecranon which can be seen with olecranon bursitis.
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3,373
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EXAM: CT Chest with contrast, CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: Trauma, stabbing. COMPARISON: None. TECHNIQUE: CT Chest with contrast, CT Abdomen and Pelvis w contrast. Patient weight: 160 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 30 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 80 secs Scan field of view: 481.40 mm. (accession CT220004003), Patient weight: 160 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 30 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 80 secs Scan field of view: 481.40 mm. DLP: 878 mGy cm. (accession CT220004004) FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Focal hemorrhage edema relating to penetrating injury in the anterior right lower neck. Hemorrhage edema is seen within the right scalene musculature and tracking along the right sternocleidomastoid and subcutaneous gas tracks posterior to the right carotid space and anterior to the prevertebral soft tissues/prevertebral space. There is associated soft tissue emphysema extending from the superficial right lateral neck soft tissues to the adjacent prevertebral soft tissues. CHEST: LUNGS / AIRWAYS / PLEURA: Small amount of secretions in the trachea. Central airways are otherwise patent. 7 mm perifissural nodule in the right middle lobe (axial series 502, image 177), likely an intrapulmonary lymph node. 5 mm groundglass nodule in the posterior right lower lobe (axial image 194), likely infectious or inflammatory. Mild posterior dependent atelectatic changes bilaterally. No focal consolidation, pneumothorax or pleural effusion. HEART / VESSELS: Mild cardiomegaly. Trace pericardial effusion. MEDIASTINUM / ESOPHAGUS: Small hiatal hernia. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. Small accessory spleen. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. Appendix is normal. PERITONEUM / MESENTERY: Normal. No free fluid or pneumoperitoneum. RETROPERITONEUM: Small amount of intramuscular hemorrhage in the right psoas adjacent to L1 and tracking caudally. No active extravasation. VESSELS: Small amount of hemorrhage and inflammatory stranding associated with right femoral vascular access. Mild calcific atherosclerosis of the abdominal aorta and its branch vessels. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Moderate sized right hydrocele. Mild prostatomegaly. BODY WALL: Small penetrating injury to the right lower midline back with associated contusive changes and subcutaneous emphysema. Additional small penetrating injuries to the upper midline back with associated contusive changes and subcutaneous emphysema extending along the right greater than left paraspinous musculature and posterior chest wall. MUSCULOSKELETAL: There is a chip fracture of the right inferior lateral corner of L1 associated with the penetrating injury to the posterior back soft tissues and intramuscular hemorrhage in the right psoas and right paraspinous musculature. No active extravasation.. CONCLUSION: 1. Multiple small penetrating injuries to the right lower anterior neck, upper midline back and right lower back soft tissues with associated contusive changes and underlying soft tissue emphysema. There is a small chip fracture of the inferior right L1 vertebral body and intramuscular hemorrhage in the right psoas and right paraspinous musculature. No evidence for active extravasation. 2. Small amount of hemorrhage and inflammation associated with right femoral vascular access. 3. Chronic and incidental findings as above. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Focal hemorrhage edema relating to penetrating injury in the anterior right lower neck. Hemorrhage edema is seen within the right scalene musculature and tracking along the right sternocleidomastoid and subcutaneous gas tracks posterior to the right carotid space and anterior to the prevertebral soft tissues/prevertebral space. There is associated soft tissue emphysema extending from the superficial right lateral neck soft tissues to the adjacent prevertebral soft tissues. CHEST: LUNGS / AIRWAYS / PLEURA: Small amount of secretions in the trachea. Central airways are otherwise patent. 7 mm perifissural nodule in the right middle lobe (axial series 502, image 177), likely an intrapulmonary lymph node. 5 mm groundglass nodule in the posterior right lower lobe (axial image 194), likely infectious or inflammatory. Mild posterior dependent atelectatic changes bilaterally. No focal consolidation, pneumothorax or pleural effusion. HEART / VESSELS: Mild cardiomegaly. Trace pericardial effusion. MEDIASTINUM / ESOPHAGUS: Small hiatal hernia. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. Small accessory spleen. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. Appendix is normal. PERITONEUM / MESENTERY: Normal. No free fluid or pneumoperitoneum. RETROPERITONEUM: Small amount of intramuscular hemorrhage in the right psoas adjacent to L1 and tracking caudally. No active extravasation. VESSELS: Small amount of hemorrhage and inflammatory stranding associated with right femoral vascular access. Mild calcific atherosclerosis of the abdominal aorta and its branch vessels. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Moderate sized right hydrocele. Mild prostatomegaly. BODY WALL: Small penetrating injury to the right lower midline back with associated contusive changes and subcutaneous emphysema. Additional small penetrating injuries to the upper midline back with associated contusive changes and subcutaneous emphysema extending along the right greater than left paraspinous musculature and posterior chest wall. MUSCULOSKELETAL: There is a chip fracture of the right inferior lateral corner of L1 associated with the penetrating injury to the posterior back soft tissues and intramuscular hemorrhage in the right psoas and right paraspinous musculature. No active extravasation..
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Findings: Brain parenchyma: Diffuse age-appropriate brain parenchymal volume loss is again seen, resulting in ex vacuo dilatation of the ventricular system. The white-gray matter differentiation is preserved. Basal cisterns: There is no significant effacement of the basilar cisterns. Extra-axial spaces: Normal appearance. No abnormal extra-axial fluid collections. Hemorrhage: No intracranial hemorrhage is identified. Midline shift: No significant midline shift is seen. Vascular system: Persistent punctate atherosclerotic calcifications of the bilateral carotid siphons and the right vertebral artery. Soft tissues: Unremarkable without discrete fluid collections. Orbits: Normal appearance. Calvarium and skull base: Partially visualized interval postsurgical fixation of the known upper cervical spine fractures. No suspicious osseous lesions identified. The bilateral mastoid air cell complexes are well-developed and clear. Paranasal sinuses: Persistent left greater than right frontal, scattered ethmoid and bilateral maxillary sinus mucosal thickening. Otherwise, remain well aerated.
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3,374
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RADIOLOGIC EXAM: CT Cervical Spine From Reformat CLINICAL INFORMATION: Trauma. COMPARISON: None. TECHNIQUE: CT Cervical Spine From Reformat Following CT of the neck, reformatted images were produced to optimize visualization of the osseous structures of the cervical spine. STRUCTURED REPORT: CT Cervical Spine Trauma FINDINGS: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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FINDINGS: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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FINDINGS: STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Redemonstration of bilateral, basilar and peripheral predominant subpleural reticulations with bronchiectasis and volume loss. There is no definitive honeycombing. No pleural effusion or pneumothorax. With expiration, there is no significant air trapping. There is no tracheobronchomalacia. Central airways are patent. HEART / VESSELS: Heart size is normal. No pericardial effusion. Moderate to severe native coronary artery calcifications. MEDIASTINUM / ESOPHAGUS: Esophagus is fluid-filled and dilated to the level of the thoracic inlet. LYMPH NODES: Multiple calcified lymph nodes throughout the mediastinum and bilateral hila. CHEST WALL: Poststernotomy changes, stable. UPPER ABDOMEN: Cholelithiasis. MUSCULOSKELETAL: No acute or aggressive appearing osseous abnormality.
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3,375
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RADIOLOGIC EXAM: CT Thoracic Spine from Reformat, CT Lumbar Spine from Reformat CLINICAL INFORMATION: Trauma. COMPARISON: None. TECHNIQUE: CT Thoracic Spine from Reformat, CT Lumbar Spine from Reformat Following CT of the chest, abdomen and pelvis, reformatted images were produced to optimize visualization of the osseous structures of the thoracic and lumbar spine. STRUCTURED REPORT: CT Lumbar Spine Trauma; CT Thoracic Spine Trauma FINDINGS: THORACIC SPINE: Subcutaneous gas tracks along the right posterior chest wall. VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. Minimal multilevel degenerative changes. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: There are findings of penetrating injury at the right posterior body wall with subcutaneous gas and hemorrhage edemaa superficial to the right posterior paraspinous musculature, hemorrhage edema in the right paraspinous musculature and a small chip fracture of the inferior lateral right L1 vertebral body endplate and adjacent intramuscular hemorrhage in the right psoas muscle. No active extravasation evident. DISC SPACES AND FACET JOINTS: No acute injury. There is disc bulge at L4-L5 and mild bilateral foraminal narrowing. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. CONCLUSION: 1. Findings of penetrating injury to the right posterior back at the L1 level with mildly displaced chip fracture of the inferior right L1 endplate and surrounding hemorrhage edema in the right psoas and right paraspinous musculature. No evidence for active extravasation. 2. No fracture or malalignment evident in the thoracic spine.
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FINDINGS: THORACIC SPINE: Subcutaneous gas tracks along the right posterior chest wall. VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. Minimal multilevel degenerative changes. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: There are findings of penetrating injury at the right posterior body wall with subcutaneous gas and hemorrhage edemaa superficial to the right posterior paraspinous musculature, hemorrhage edema in the right paraspinous musculature and a small chip fracture of the inferior lateral right L1 vertebral body endplate and adjacent intramuscular hemorrhage in the right psoas muscle. No active extravasation evident. DISC SPACES AND FACET JOINTS: No acute injury. There is disc bulge at L4-L5 and mild bilateral foraminal narrowing. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal.
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Findings: Focal area of hypoattenuation in the genu left internal capsule, likely age indeterminate lacunar infarct. Small subdural hygromas along bilateral frontal regions and along the right hemicerebellum. Age-appropriate mild brain involution. Otherwise, bilateral cerebral hemispheres are symmetric in appearance. Gray and white matter attenuation differentiation is maintained. No acute intracranial hemorrhage, intracranial mass, mass effect or midline shift. No abnormal extra-axial fluid collections. Ventricles are normal in configuration. No hydrocephalus. Basal cisterns are patent. Posterior fossa structures are unremarkable. Partial empty sella. Bilateral pseudophakia. Otherwise bilateral orbits are within normal limits. Visualized paranasal sinuses, mastoid air cells and middle ear cavities are unremarkable. No acute skull fractures.
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3,376
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RADIOLOGIC EXAM: CT Thoracic Spine from Reformat, CT Lumbar Spine from Reformat CLINICAL INFORMATION: Trauma. COMPARISON: None. TECHNIQUE: CT Thoracic Spine from Reformat, CT Lumbar Spine from Reformat Following CT of the chest, abdomen and pelvis, reformatted images were produced to optimize visualization of the osseous structures of the thoracic and lumbar spine. STRUCTURED REPORT: CT Lumbar Spine Trauma; CT Thoracic Spine Trauma FINDINGS: THORACIC SPINE: Subcutaneous gas tracks along the right posterior chest wall. VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. Minimal multilevel degenerative changes. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: There are findings of penetrating injury at the right posterior body wall with subcutaneous gas and hemorrhage edemaa superficial to the right posterior paraspinous musculature, hemorrhage edema in the right paraspinous musculature and a small chip fracture of the inferior lateral right L1 vertebral body endplate and adjacent intramuscular hemorrhage in the right psoas muscle. No active extravasation evident. DISC SPACES AND FACET JOINTS: No acute injury. There is disc bulge at L4-L5 and mild bilateral foraminal narrowing. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. CONCLUSION: 1. Findings of penetrating injury to the right posterior back at the L1 level with mildly displaced chip fracture of the inferior right L1 endplate and surrounding hemorrhage edema in the right psoas and right paraspinous musculature. No evidence for active extravasation. 2. No fracture or malalignment evident in the thoracic spine.
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FINDINGS: THORACIC SPINE: Subcutaneous gas tracks along the right posterior chest wall. VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. Minimal multilevel degenerative changes. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: There are findings of penetrating injury at the right posterior body wall with subcutaneous gas and hemorrhage edemaa superficial to the right posterior paraspinous musculature, hemorrhage edema in the right paraspinous musculature and a small chip fracture of the inferior lateral right L1 vertebral body endplate and adjacent intramuscular hemorrhage in the right psoas muscle. No active extravasation evident. DISC SPACES AND FACET JOINTS: No acute injury. There is disc bulge at L4-L5 and mild bilateral foraminal narrowing. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal.
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FINDINGS/CONCLUSION: Status post right shoulder reverse arthroplasty. No hardware complication. No acute osseous abnormality. The soft tissues about the shoulders are unremarkable. Centrilobular emphysematous changes are noted within the visualized right lung. Paraseptal bullae are also noted.
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3,377
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CT Maxillofacial wo contrast 1/7/2022 8:39 PM Clinical information: 142 years Unknown patient with Trauma Comparison: None available. Technique: Multiple, contiguous, thin slice, axial CT images of the face were obtained without administration of intravenous contrast. Reformatted coronal reconstructions were also obtained. Scan field of view: 214 mm. DLP: 1043.60 mGy cm. FINDINGS: Soft tissues: No soft tissue swelling or lacerations identified. Bones: No acute facial bone fractures are identified. No suspicious osseous lesions are seen. The visualized mandible is intact and the bilateral TMJs are congruent. Orbits: The bilateral globes and optic nerves are intact. The retrobulbar soft tissues have a normal appearance. Paranasal sinuses and mastoid air cells: Trace bilateral maxillary sinus mucosal thickening. Otherwise, appear well well aerated. IMPRESSION: No evidence of acute maxillofacial fractures.
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FINDINGS: Soft tissues: No soft tissue swelling or lacerations identified. Bones: No acute facial bone fractures are identified. No suspicious osseous lesions are seen. The visualized mandible is intact and the bilateral TMJs are congruent. Orbits: The bilateral globes and optic nerves are intact. The retrobulbar soft tissues have a normal appearance. Paranasal sinuses and mastoid air cells: Trace bilateral maxillary sinus mucosal thickening. Otherwise, appear well well aerated.
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FINDINGS: Minimal subpleural reticulations are present in the lingula with eccentric pleural calcification without associated pleural effusion. Rest of the lungs are clear. No enlarged nodes in the mediastinum or either axilla. Atherosclerotic disease changes in the thoracic aorta with dense eccentric calcification and slightly caliber change in the proximal descending thoracic aorta. A densely calcified ductus is also noted.. The origin of both right innominate artery and left subclavian artery are aneurysmal measuring approximately 18 mm each in image 29, series 2. Dense mitral annular calcification is also seen. There is no pericardial effusion No focal lytic or sclerotic bone lesion.
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3,378
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CT Angio Neck 1/7/2022 8:49 PM Clinical information: 142 years Unknown patient with Trauma Comparison: None available. Technique: Intravenous iodinated contrast was then administered and multiple, contiguous, axial CT images of the neck were performed in the arterial phase using CT neck angiogram protocol. Postprocessing reformatted sagittal and coronal maximum intensity projections were also obtained. 3-D volume rendered and maximum intensity projection reconstructions were generated from the axial CT angiographic data set on an independent 3-D workstation per the ordering physician's request. These were created from the axial data. This process was performed under the supervision of the interpreting radiologist. Findings related to the 3-D reconstructions are included in this report. Patient weight: 160 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 30 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus track Scan field of view: 232.10 mm. DLP: 925.60 mGy cm. . FINDINGS: VASCULAR FINDINGS: Aortic arch: Patent with no hemodynamically significant stenosis. Three normal vessel aortic arch is noted. Common carotid arteries: Patent with no hemodynamically significant stenosis. Internal carotid arteries: Patent with no hemodynamically significant stenosis. Vertebral arteries: Dominant left vertebral artery. Patent with no hemodynamically significant stenosis. Aneurysm: No large aneurysm identified. NONVASCULAR FINDINGS: Subcutaneous emphysema is noted within the right inferior lateral neck soft tissues, posterior to the right sternocleidomastoid muscle, extending into the vascular/visceral spaces and the right posterior paraspinal soft tissues. The oral cavity, nasopharynx, oropharynx, and laryngopharynx have normal appearance. No intrinsic abnormality is seen within the larynx or trachea. The true and false vocal cords are without focal abnormality. No enlarged lymph nodes are seen. The parotid and submandibular glands are normal in appearance. The thyroid gland is without focal abnormality. IMPRESSION: 1. Subcutaneous emphysema within the right inferior lateral neck soft tissues, posterior to the right sternocleidomastoid muscle, extending into the vascular/visceral spaces and the right posterior paraspinal soft tissues. 2. Patent cervical arteries, without evidence of acute vascular injury or flow-limiting stenosis.
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FINDINGS: VASCULAR FINDINGS: Aortic arch: Patent with no hemodynamically significant stenosis. Three normal vessel aortic arch is noted. Common carotid arteries: Patent with no hemodynamically significant stenosis. Internal carotid arteries: Patent with no hemodynamically significant stenosis. Vertebral arteries: Dominant left vertebral artery. Patent with no hemodynamically significant stenosis. Aneurysm: No large aneurysm identified. NONVASCULAR FINDINGS: Subcutaneous emphysema is noted within the right inferior lateral neck soft tissues, posterior to the right sternocleidomastoid muscle, extending into the vascular/visceral spaces and the right posterior paraspinal soft tissues. The oral cavity, nasopharynx, oropharynx, and laryngopharynx have normal appearance. No intrinsic abnormality is seen within the larynx or trachea. The true and false vocal cords are without focal abnormality. No enlarged lymph nodes are seen. The parotid and submandibular glands are normal in appearance. The thyroid gland is without focal abnormality.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: Please see separate CT chest report. ABDOMEN and PELVIS: LIVER: Redemonstration of several small hypoattenuating lesions, unchanged. Index lesion in the inferior right hepatic lobe measures 1.1 x 1.0 cm (series 304, image 115), previously 1.2 x 1.1 cm. BILIARY TRACT: Normal. GALLBLADDER: Surgically absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Atrophic left kidney. Small hypodense enhancing left renal lesion measures 8 x 9 mm (series 304, image 115), previously 9 x 9 mm. Right kidney demonstrates normal size and enhancement. No hydronephrosis. LYMPH NODES: Multiple mildly enlarged retroperitoneal and pelvic lymph nodes measuring up to 1.2 cm in short axis.. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. No appendicitis. PERITONEUM / MESENTERY: No ascites. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Limited evaluation due to streak artifact from left hip prosthesis. Mild thickening of the partially distended bladder. No focal mass is noted. REPRODUCTIVE ORGANS: Limited evaluation due to streak artifacts from left hip prosthesis Surgically absent uterus. No adnexal masses identified. BODY WALL: Small ventral fat-containing hernia. MUSCULOSKELETAL: Chronic extensive pelvic osseous remodeling involving the bilateral hips. Interval revision of left hip arthroplasty. No new suspicious osseous lesion. There is fluid collection along the lateral aspect of the left hip deep to the incision with peripheral enhancement measuring 5.6 x 2.7 cm image #354 series #209.
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3,379
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CT angio neck 1/7/2022 11:52 PM Indication: Diffuse large B-cell lymphoma with possible pseudoaneurysm of the proximal left external carotid artery Comparison: CT neck 1/6/2022 Technique: Thin slice axial images were obtained during the early arterial phase of a rapid IV infusion of contrast, from the thoracic inlet through the skull vertex. MIP images were generated. 3-D reformatted images were also provided. Patient weight: 199 lbs. IV contrast: Omnipaque 350, 125 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4.50 ml per sec. Scan delay: bolus track Scan field of view: 220 mm. DLP: 5902 mGy cm. (accession CT220004012), Patient weight: 199 lbs. IV contrast: Omnipaque 350, 125 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4.50 ml per sec. Scan delay: bolus track Scan field of view: 230 mm. (accession CT220004010) Findings: CT head: No acute hemorrhage, mass, or area suspicious for acute infarction is identified. The ventricles are normal in size and symmetric. There is no midline shift or mass effect. The visualized paranasal sinuses and mastoid air cells are clear. No acute osseous abnormality is identified. CTA head: No flow limiting stenosis or aneurysm of the bilateral intracranial ICAs, Vertebral arteries, basilar artery, ACAs, MCAs, or PCAs. No evidence of extravasation. CTA neck: Redemonstration of large left supraclavicular mass with heterogenous attenuation and dystrophic calcifications and posterior changes of the subcutaneous soft tissues overlying the mass. The mass encases the left common carotid artery and exerts mass effect on the trachea with rightward tracheal deviation. Mass measures approximately 6.4 x 9.1 x 8.3 cm on series 502 image 116 and series 505 image 85. The mass causes diffuse narrowing of the common carotid artery. The proximal ECA is prominent with fusiform dilatation measuring up to 1.2 cm in diameter on series 502 image 179 and tapering to approximately 0.5 cm on series 502 image 191 this appearance is stable compared to prior examination and is also redemonstrated on CT neck dated 12/9/2021 performed at an outside institution. The left common carotid artery and cervical internal carotid artery are patent and normal in caliber. There is however mild dilation of the distal left common carotid artery and proximal left internal carotid artery compared to the rest of the left common carotid artery which is mildly compressed. The right common carotid artery, cervical internal carotid artery, bilateral vertebral arteries, aortic arch, and great vessel origins appear within normal limits. Impression: 1. Mild prominent caliber of the distal left common carotid artery and proximal left internal carotid artery could be normal finding given that the remainder of the proximal left common carotid artery is mildly compressed by the mass. This is unlikely to represent any pseudoaneurysm, true aneurysm or ectasia. 2. Redemonstration of large left supraclavicular mass encompassing the left common carotid artery and exerting mass effect on the trachea with rightward tracheal deviation better appreciated on recent prior CT neck. . As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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Findings: CT head: No acute hemorrhage, mass, or area suspicious for acute infarction is identified. The ventricles are normal in size and symmetric. There is no midline shift or mass effect. The visualized paranasal sinuses and mastoid air cells are clear. No acute osseous abnormality is identified. CTA head: No flow limiting stenosis or aneurysm of the bilateral intracranial ICAs, Vertebral arteries, basilar artery, ACAs, MCAs, or PCAs. No evidence of extravasation. CTA neck: Redemonstration of large left supraclavicular mass with heterogenous attenuation and dystrophic calcifications and posterior changes of the subcutaneous soft tissues overlying the mass. The mass encases the left common carotid artery and exerts mass effect on the trachea with rightward tracheal deviation. Mass measures approximately 6.4 x 9.1 x 8.3 cm on series 502 image 116 and series 505 image 85. The mass causes diffuse narrowing of the common carotid artery. The proximal ECA is prominent with fusiform dilatation measuring up to 1.2 cm in diameter on series 502 image 179 and tapering to approximately 0.5 cm on series 502 image 191 this appearance is stable compared to prior examination and is also redemonstrated on CT neck dated 12/9/2021 performed at an outside institution. The left common carotid artery and cervical internal carotid artery are patent and normal in caliber. There is however mild dilation of the distal left common carotid artery and proximal left internal carotid artery compared to the rest of the left common carotid artery which is mildly compressed. The right common carotid artery, cervical internal carotid artery, bilateral vertebral arteries, aortic arch, and great vessel origins appear within normal limits.
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FINDINGS: STRUCTURED REPORT: CT Chest LOWER NECK: Normal CHEST: LUNGS / AIRWAYS / PLEURA: There is bilateral subsegmental linear and dependent atelectasis. No focal consolidation, pleural effusion, or pneumothorax. No suspicious pulmonary nodule is identified. HEART / VESSELS: Heart size is normal. No pericardial effusion. Mild coronary artery calcifications. Mild atherosclerotic calcifications of the thoracic aorta and great vessel origins. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: Prominent right paratracheal lymph node measuring 1.2 cm in short axis diameter on series 3 image 41, previously 1.2 cm. Additional prominent mediastinal lymph nodes, none pathologically enlarged. CHEST WALL: Left chest wall port is stable, tip terminates at the superior cavoatrial junction. UPPER ABDOMEN: Please see same day CT abdomen for abdomen findings. MUSCULOSKELETAL: No acute or aggressive appearing osseous abnormality. Chronic deformity of the right clavicle and right posterior sixth rib, stable.
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3,380
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CT angio neck 1/7/2022 11:52 PM Indication: Diffuse large B-cell lymphoma with possible pseudoaneurysm of the proximal left external carotid artery Comparison: CT neck 1/6/2022 Technique: Thin slice axial images were obtained during the early arterial phase of a rapid IV infusion of contrast, from the thoracic inlet through the skull vertex. MIP images were generated. 3-D reformatted images were also provided. Patient weight: 199 lbs. IV contrast: Omnipaque 350, 125 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4.50 ml per sec. Scan delay: bolus track Scan field of view: 220 mm. DLP: 5902 mGy cm. (accession CT220004012), Patient weight: 199 lbs. IV contrast: Omnipaque 350, 125 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4.50 ml per sec. Scan delay: bolus track Scan field of view: 230 mm. (accession CT220004010) Findings: CT head: No acute hemorrhage, mass, or area suspicious for acute infarction is identified. The ventricles are normal in size and symmetric. There is no midline shift or mass effect. The visualized paranasal sinuses and mastoid air cells are clear. No acute osseous abnormality is identified. CTA head: No flow limiting stenosis or aneurysm of the bilateral intracranial ICAs, Vertebral arteries, basilar artery, ACAs, MCAs, or PCAs. No evidence of extravasation. CTA neck: Redemonstration of large left supraclavicular mass with heterogenous attenuation and dystrophic calcifications and posterior changes of the subcutaneous soft tissues overlying the mass. The mass encases the left common carotid artery and exerts mass effect on the trachea with rightward tracheal deviation. Mass measures approximately 6.4 x 9.1 x 8.3 cm on series 502 image 116 and series 505 image 85. The mass causes diffuse narrowing of the common carotid artery. The proximal ECA is prominent with fusiform dilatation measuring up to 1.2 cm in diameter on series 502 image 179 and tapering to approximately 0.5 cm on series 502 image 191 this appearance is stable compared to prior examination and is also redemonstrated on CT neck dated 12/9/2021 performed at an outside institution. The left common carotid artery and cervical internal carotid artery are patent and normal in caliber. There is however mild dilation of the distal left common carotid artery and proximal left internal carotid artery compared to the rest of the left common carotid artery which is mildly compressed. The right common carotid artery, cervical internal carotid artery, bilateral vertebral arteries, aortic arch, and great vessel origins appear within normal limits. Impression: 1. Mild prominent caliber of the distal left common carotid artery and proximal left internal carotid artery could be normal finding given that the remainder of the proximal left common carotid artery is mildly compressed by the mass. This is unlikely to represent any pseudoaneurysm, true aneurysm or ectasia. 2. Redemonstration of large left supraclavicular mass encompassing the left common carotid artery and exerting mass effect on the trachea with rightward tracheal deviation better appreciated on recent prior CT neck. . As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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Findings: CT head: No acute hemorrhage, mass, or area suspicious for acute infarction is identified. The ventricles are normal in size and symmetric. There is no midline shift or mass effect. The visualized paranasal sinuses and mastoid air cells are clear. No acute osseous abnormality is identified. CTA head: No flow limiting stenosis or aneurysm of the bilateral intracranial ICAs, Vertebral arteries, basilar artery, ACAs, MCAs, or PCAs. No evidence of extravasation. CTA neck: Redemonstration of large left supraclavicular mass with heterogenous attenuation and dystrophic calcifications and posterior changes of the subcutaneous soft tissues overlying the mass. The mass encases the left common carotid artery and exerts mass effect on the trachea with rightward tracheal deviation. Mass measures approximately 6.4 x 9.1 x 8.3 cm on series 502 image 116 and series 505 image 85. The mass causes diffuse narrowing of the common carotid artery. The proximal ECA is prominent with fusiform dilatation measuring up to 1.2 cm in diameter on series 502 image 179 and tapering to approximately 0.5 cm on series 502 image 191 this appearance is stable compared to prior examination and is also redemonstrated on CT neck dated 12/9/2021 performed at an outside institution. The left common carotid artery and cervical internal carotid artery are patent and normal in caliber. There is however mild dilation of the distal left common carotid artery and proximal left internal carotid artery compared to the rest of the left common carotid artery which is mildly compressed. The right common carotid artery, cervical internal carotid artery, bilateral vertebral arteries, aortic arch, and great vessel origins appear within normal limits.
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FINDINGS: STRUCTURED REPORT: CT Abdomen LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. No focal mass or abnormal ductal dilatation noted. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. BODY WALL: Small fat-containing umbilical hernia noted. MUSCULOSKELETAL: Multilevel degenerative changes and spondylolysis on the left side at L4
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3,381
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EXAM: CT Foot Right wo contrast, CT Ankle Right wo contrast CLINICAL INFORMATION: Ankle fracture. COMPARISON: Earlier same day radiograph. TECHNIQUE: CT Foot Right wo contrast, CT Ankle Right wo contrast Scan field of view: 306 mm. DLP: 254 mGy cm. (accession CT220004015), Scan field of view: 223 mm. DLP: 247 mGy cm. (accession CT220004013) FINDINGS: BONES/JOINTS: Right Ankle: Comminuted fracture of the distal fibular metadiaphysis. Minimally displaced avulsion fracture of the distal fibula. Comminuted comminuted fracture of the medial malleolus with extension to the tibiotalar joint. The ankle mortise is maintained. Right Foot: No other acute fracture or dislocation. Joint spaces are maintained. SOFT TISSUES: No large hematoma or fluid collection. Subcutaneous edema about the fracture sites. CONCLUSION: 1. Medial malleolus minimally displaced fracture. 2. Comminuted distal fibular fractures. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: BONES/JOINTS: Right Ankle: Comminuted fracture of the distal fibular metadiaphysis. Minimally displaced avulsion fracture of the distal fibula. Comminuted comminuted fracture of the medial malleolus with extension to the tibiotalar joint. The ankle mortise is maintained. Right Foot: No other acute fracture or dislocation. Joint spaces are maintained. SOFT TISSUES: No large hematoma or fluid collection. Subcutaneous edema about the fracture sites.
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FINDINGS: Previously noted subpleural lingular 8 mm nodule has regressed with a residual thin tiny linear density noted in image 114, series 201. Right upper lobe partly calcified subpleural soft tissue mass appears stable. Multi lobar bronchiectasis is again noted along with multiple cystic changes especially in the lower lobes and to a lesser degree lingula. There are multifocal new patchy groundglass parenchymal opacities somewhat peripheral distribution especially in the upper lobes and to a lesser degree right middle lobe. Mostly calcified nodes in the mediastinum and both hila are again noted. The pulmonary artery appears normal in size. There is no pleural or pericardial effusion and visualized bones are unremarkable.
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EXAM: CT Foot Right wo contrast, CT Ankle Right wo contrast CLINICAL INFORMATION: Ankle fracture. COMPARISON: Earlier same day radiograph. TECHNIQUE: CT Foot Right wo contrast, CT Ankle Right wo contrast Scan field of view: 306 mm. DLP: 254 mGy cm. (accession CT220004015), Scan field of view: 223 mm. DLP: 247 mGy cm. (accession CT220004013) FINDINGS: BONES/JOINTS: Right Ankle: Comminuted fracture of the distal fibular metadiaphysis. Minimally displaced avulsion fracture of the distal fibula. Comminuted comminuted fracture of the medial malleolus with extension to the tibiotalar joint. The ankle mortise is maintained. Right Foot: No other acute fracture or dislocation. Joint spaces are maintained. SOFT TISSUES: No large hematoma or fluid collection. Subcutaneous edema about the fracture sites. CONCLUSION: 1. Medial malleolus minimally displaced fracture. 2. Comminuted distal fibular fractures. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: BONES/JOINTS: Right Ankle: Comminuted fracture of the distal fibular metadiaphysis. Minimally displaced avulsion fracture of the distal fibula. Comminuted comminuted fracture of the medial malleolus with extension to the tibiotalar joint. The ankle mortise is maintained. Right Foot: No other acute fracture or dislocation. Joint spaces are maintained. SOFT TISSUES: No large hematoma or fluid collection. Subcutaneous edema about the fracture sites.
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FINDINGS: Streak artifact from dental hardware limits evaluation. Large subtly enhancing right peritonsillar mass measuring 3.1 x 4.5 x 4.2 cm (series 301 image 202, series 302 image 198). Mass appears to involve the right base of the tongue structures, extends into the right parapharyngeal space along with extension into the right vallecula. There is significant mass effect with narrowing of the oropharyngeal airway predominantly on the right. Additionally there are multiple pathologically enlarged lymph nodes within the right cervical lymph nodes with index right level 2A lymph node measuring approximately 1.2 cm in short axis (image 201, series 201). Oral cavity incompletely visualized secondary to extensive dental amalgam artifact. Otherwise visualized supraglottic larynx, glottic larynx and infraglottic larynx are unremarkable. Hypopharynx is unremarkable. The parotid and submandibular glands are unremarkable. Large thyroid nodule versus level IV lymph node measuring approximately 1.5 cm in diameter. Advise further evaluation with thyroid ultrasound. Additional small multiple subcentimeter hypoattenuating thyroid nodules. The visualized paranasal sinuses are clear. The included intracranial contents and orbits are grossly unremarkable. Scalp soft tissue swelling in the right posterior parieto-occipital region with subtle decreased osseous density of the underlying calvarium without definite osseous erosion. Otherwise, visualized osseous structures demonstrate no suspicious lytic or blastic lesions. For chest findings see separately dictated report.
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CT Head wo contrast 1/7/2022 9:18 PM Clinical Information: Trauma Comparison: None. 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: 214 mm. DLP: 1472 mGy cm. Findings: Brain parenchyma: The brain has normal morphology and volume. The brain parenchyma has a normal appearance. The white-gray matter differentiation is preserved. Ventricular system: Normal configuration. No hydrocephalus. Basal cisterns: There is no significant effacement of the basilar cisterns. Extra-axial spaces: Acute extra-axial hematoma along the left inferior frontal convexity, with suggestion of associated scant subarachnoid hemorrhage. Small amount of posterior parafalcine subdural hematoma, extending into the bilateral tentorium. Midline shift: No significant midline shift is seen. Vascular system: Normal noncontrast appearance. Soft tissues: Moderate left frontal scalp hematoma extending into the left preseptal/periorbital and bilateral perinasal soft tissues. Small right frontal scalp hematoma and laceration. Calvarium and skull base: No acute fractures or suspicious osseous lesions identified. The bilateral mastoid air cell complexes are well-developed and clear. IMPRESSION: 1. Acute extra-axial hematoma along the left inferior frontal convexity, with suggestion of associated scant subarachnoid hemorrhage. Small amount of posterior parafalcine subdural hematoma, extending into the bilateral tentorium. 2. Moderate left frontal scalp hematoma extending into the left preseptal/periorbital and bilateral perinasal soft tissues. Small right frontal scalp hematoma and laceration. Please refer to concomitant CT of the face for complete description of maxillofacial findings.
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Findings: Brain parenchyma: The brain has normal morphology and volume. The brain parenchyma has a normal appearance. The white-gray matter differentiation is preserved. Ventricular system: Normal configuration. No hydrocephalus. Basal cisterns: There is no significant effacement of the basilar cisterns. Extra-axial spaces: Acute extra-axial hematoma along the left inferior frontal convexity, with suggestion of associated scant subarachnoid hemorrhage. Small amount of posterior parafalcine subdural hematoma, extending into the bilateral tentorium. Midline shift: No significant midline shift is seen. Vascular system: Normal noncontrast appearance. Soft tissues: Moderate left frontal scalp hematoma extending into the left preseptal/periorbital and bilateral perinasal soft tissues. Small right frontal scalp hematoma and laceration. Calvarium and skull base: No acute fractures or suspicious osseous lesions identified. The bilateral mastoid air cell complexes are well-developed and clear.
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FINDINGS: There is no airspace consolidation or interstitial lung parenchymal abnormality. No expiratory air trapping or tracheobronchomalacia is seen. No enlarged nodes are present in the mediastinum. The main pulmonary artery measures 30 mm in diameter in image 83, series 2. There is no pleural or pericardial and visualized bones are unremarkable. Multiple splenules are present in the left upper quadrant of the abdomen. Visualized liver, both adrenal glands and kidneys are unremarkable.
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EXAM: CT Chest with contrast, CT Abdomen and Pelvis w contrast, CT Thoracic Spine from Reformat, CT Lumbar Spine from Reformat CLINICAL INFORMATION: Trauma. COMPARISON: None available. TECHNIQUE: CT Chest with contrast, CT Abdomen and Pelvis w contrast, CT Thoracic Spine from Reformat, CT Lumbar Spine from Reformat. Patient weight: 270 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. Saline flush: 30 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 80 secs Scan field of view: 482.60 mm. (accession CT220004017), Patient weight: 270 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. Saline flush: 30 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 80 secs Scan field of view: 482.60 mm. DLP: 1924.90 mGy cm. (accession CT220004018) FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: The central tracheobronchial tree is patent and clear. Mild dependent atelectatic changes. No focal parenchymal consolidation or suspicious nodule or mass. No pleural effusions or pneumothorax. HEART / VESSELS: Heart size is normal. No pericardial effusion. Borderline dilatation of the main pulmonary artery, measuring 31 mm in diameter. The thoracic aorta is normal in caliber. The left vertebral artery arises directly from the aortic arch between the left common carotid and left subclavian arteries, a normal anatomic variant. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. A few prominent bilateral axillary lymph nodes, not meeting size criteria for pathologic enlargement. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Symmetric contrast enhancement. No radiopaque nephrolithiasis. No hydroureteronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Scattered colonic diverticulosis. The appendix is normal. PERITONEUM / MESENTERY: No free intraperitoneal fluid. No pneumoperitoneum. RETROPERITONEUM: Normal. VESSELS: A few scattered punctate atherosclerotic calcifications in the bilateral common iliac arteries. Stranding around the right common femoral vasculature is likely related to recent vascular access. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Small fat-containing umbilical hernia. MUSCULOSKELETAL: No aggressive osseous abnormality is identified. Bilateral os acromiale. Geographic area of sclerosis in the left ilium likely represents a bone island. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. Mild multilevel discogenic degenerative changes. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No spondylolisthesis. LUMBAR SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. Moderate discogenic degenerative changes at L5-S1. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No spondylolisthesis. CONCLUSION: No acute traumatic abnormality in the chest, abdomen, pelvis. No acute fracture or malalignment in the thoracolumbar spine. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: The central tracheobronchial tree is patent and clear. Mild dependent atelectatic changes. No focal parenchymal consolidation or suspicious nodule or mass. No pleural effusions or pneumothorax. HEART / VESSELS: Heart size is normal. No pericardial effusion. Borderline dilatation of the main pulmonary artery, measuring 31 mm in diameter. The thoracic aorta is normal in caliber. The left vertebral artery arises directly from the aortic arch between the left common carotid and left subclavian arteries, a normal anatomic variant. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. A few prominent bilateral axillary lymph nodes, not meeting size criteria for pathologic enlargement. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Symmetric contrast enhancement. No radiopaque nephrolithiasis. No hydroureteronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Scattered colonic diverticulosis. The appendix is normal. PERITONEUM / MESENTERY: No free intraperitoneal fluid. No pneumoperitoneum. RETROPERITONEUM: Normal. VESSELS: A few scattered punctate atherosclerotic calcifications in the bilateral common iliac arteries. Stranding around the right common femoral vasculature is likely related to recent vascular access. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Small fat-containing umbilical hernia. MUSCULOSKELETAL: No aggressive osseous abnormality is identified. Bilateral os acromiale. Geographic area of sclerosis in the left ilium likely represents a bone island. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. Mild multilevel discogenic degenerative changes. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No spondylolisthesis. LUMBAR SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. Moderate discogenic degenerative changes at L5-S1. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No spondylolisthesis.
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FINDINGS: Asymmetric upper lobe dominant centrilobular emphysema with diffuse increased peribronchial thickening. There are few tiny scattered nodules and ill-defined subtle groundglass changes in both upper lobes without any calcifications. Only minimal dependent lung air trapping is noted in the expiration images. There is no tracheobronchomalacia. Only small subcentimeter size nodes are seen in the mediastinum and both axilla. The main pulmonary arteries 34 mm in diameter in image 77, series 3. There is no pleural or pericardial effusion and visualized bones are unremarkable.
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3,385
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EXAM: CT Chest with contrast, CT Abdomen and Pelvis w contrast, CT Thoracic Spine from Reformat, CT Lumbar Spine from Reformat CLINICAL INFORMATION: Trauma. COMPARISON: None available. TECHNIQUE: CT Chest with contrast, CT Abdomen and Pelvis w contrast, CT Thoracic Spine from Reformat, CT Lumbar Spine from Reformat. Patient weight: 270 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. Saline flush: 30 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 80 secs Scan field of view: 482.60 mm. (accession CT220004017), Patient weight: 270 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. Saline flush: 30 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 80 secs Scan field of view: 482.60 mm. DLP: 1924.90 mGy cm. (accession CT220004018) FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: The central tracheobronchial tree is patent and clear. Mild dependent atelectatic changes. No focal parenchymal consolidation or suspicious nodule or mass. No pleural effusions or pneumothorax. HEART / VESSELS: Heart size is normal. No pericardial effusion. Borderline dilatation of the main pulmonary artery, measuring 31 mm in diameter. The thoracic aorta is normal in caliber. The left vertebral artery arises directly from the aortic arch between the left common carotid and left subclavian arteries, a normal anatomic variant. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. A few prominent bilateral axillary lymph nodes, not meeting size criteria for pathologic enlargement. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Symmetric contrast enhancement. No radiopaque nephrolithiasis. No hydroureteronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Scattered colonic diverticulosis. The appendix is normal. PERITONEUM / MESENTERY: No free intraperitoneal fluid. No pneumoperitoneum. RETROPERITONEUM: Normal. VESSELS: A few scattered punctate atherosclerotic calcifications in the bilateral common iliac arteries. Stranding around the right common femoral vasculature is likely related to recent vascular access. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Small fat-containing umbilical hernia. MUSCULOSKELETAL: No aggressive osseous abnormality is identified. Bilateral os acromiale. Geographic area of sclerosis in the left ilium likely represents a bone island. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. Mild multilevel discogenic degenerative changes. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No spondylolisthesis. LUMBAR SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. Moderate discogenic degenerative changes at L5-S1. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No spondylolisthesis. CONCLUSION: No acute traumatic abnormality in the chest, abdomen, pelvis. No acute fracture or malalignment in the thoracolumbar spine. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: The central tracheobronchial tree is patent and clear. Mild dependent atelectatic changes. No focal parenchymal consolidation or suspicious nodule or mass. No pleural effusions or pneumothorax. HEART / VESSELS: Heart size is normal. No pericardial effusion. Borderline dilatation of the main pulmonary artery, measuring 31 mm in diameter. The thoracic aorta is normal in caliber. The left vertebral artery arises directly from the aortic arch between the left common carotid and left subclavian arteries, a normal anatomic variant. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. A few prominent bilateral axillary lymph nodes, not meeting size criteria for pathologic enlargement. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Symmetric contrast enhancement. No radiopaque nephrolithiasis. No hydroureteronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Scattered colonic diverticulosis. The appendix is normal. PERITONEUM / MESENTERY: No free intraperitoneal fluid. No pneumoperitoneum. RETROPERITONEUM: Normal. VESSELS: A few scattered punctate atherosclerotic calcifications in the bilateral common iliac arteries. Stranding around the right common femoral vasculature is likely related to recent vascular access. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Small fat-containing umbilical hernia. MUSCULOSKELETAL: No aggressive osseous abnormality is identified. Bilateral os acromiale. Geographic area of sclerosis in the left ilium likely represents a bone island. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. Mild multilevel discogenic degenerative changes. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No spondylolisthesis. LUMBAR SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. Moderate discogenic degenerative changes at L5-S1. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No spondylolisthesis.
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Findings: There is an enlarged perivascular space in the left caudate head. The parenchyma otherwise appears normal with no mass, hemorrhage, visible infarct or extracerebral collection. The ventricles are small with normal appearance. The posterior fossa contents appear normal. The paranasal sinuses mastoids and middle ears are clear. No defect is seen in the calvarium or skull base. ----------------
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3,386
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RADIOLOGIC EXAM: CT Cervical Spine From Reformat CLINICAL INFORMATION: Trauma. COMPARISON: None. TECHNIQUE: CT Cervical Spine From Reformat Following CT of the neck, reformatted images were produced to optimize visualization of the osseous structures of the cervical spine. STRUCTURED REPORT: CT Cervical Spine Trauma FINDINGS: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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FINDINGS: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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FINDINGS: STRUCTURED REPORT: CT HCC Screening IMAGE QUALITY: Satisfactory LOWER CHEST: LUNG BASES / PLEURA: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Cirrhotic. Mild hepatic steatosis. LIVER LESIONS: Geographic hypodense lesion involves the anterior and medial hepatic segments with geographic hyperenhancement on portal venous phase and hypodense appearance on delayed images but no areas of arterial enhancement, measuring approximately 5.9 x 3.1 cm (image 34 series 13). The hepatic capsule appears retracted in this region. No other focal hepatic lesions. No arterial hyperenhancing lesions. LIVER VASCULATURE AND COLLATERALS: - Hepatic artery patency and anatomy: Patent with conventional anatomy. - Portal venous system: Patent intra- and extra-hepatic portal venous system. - Hepatic veins: Patent right, middle and left hepatic veins. - Esophageal varices: Small (
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3,387
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EXAM: CT Chest with contrast, CT Abdomen and Pelvis w contrast, CT Thoracic Spine from Reformat, CT Lumbar Spine from Reformat CLINICAL INFORMATION: Trauma. COMPARISON: None available. TECHNIQUE: CT Chest with contrast, CT Abdomen and Pelvis w contrast, CT Thoracic Spine from Reformat, CT Lumbar Spine from Reformat. Patient weight: 270 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. Saline flush: 30 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 80 secs Scan field of view: 482.60 mm. (accession CT220004017), Patient weight: 270 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. Saline flush: 30 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 80 secs Scan field of view: 482.60 mm. DLP: 1924.90 mGy cm. (accession CT220004018) FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: The central tracheobronchial tree is patent and clear. Mild dependent atelectatic changes. No focal parenchymal consolidation or suspicious nodule or mass. No pleural effusions or pneumothorax. HEART / VESSELS: Heart size is normal. No pericardial effusion. Borderline dilatation of the main pulmonary artery, measuring 31 mm in diameter. The thoracic aorta is normal in caliber. The left vertebral artery arises directly from the aortic arch between the left common carotid and left subclavian arteries, a normal anatomic variant. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. A few prominent bilateral axillary lymph nodes, not meeting size criteria for pathologic enlargement. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Symmetric contrast enhancement. No radiopaque nephrolithiasis. No hydroureteronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Scattered colonic diverticulosis. The appendix is normal. PERITONEUM / MESENTERY: No free intraperitoneal fluid. No pneumoperitoneum. RETROPERITONEUM: Normal. VESSELS: A few scattered punctate atherosclerotic calcifications in the bilateral common iliac arteries. Stranding around the right common femoral vasculature is likely related to recent vascular access. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Small fat-containing umbilical hernia. MUSCULOSKELETAL: No aggressive osseous abnormality is identified. Bilateral os acromiale. Geographic area of sclerosis in the left ilium likely represents a bone island. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. Mild multilevel discogenic degenerative changes. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No spondylolisthesis. LUMBAR SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. Moderate discogenic degenerative changes at L5-S1. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No spondylolisthesis. CONCLUSION: No acute traumatic abnormality in the chest, abdomen, pelvis. No acute fracture or malalignment in the thoracolumbar spine. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: The central tracheobronchial tree is patent and clear. Mild dependent atelectatic changes. No focal parenchymal consolidation or suspicious nodule or mass. No pleural effusions or pneumothorax. HEART / VESSELS: Heart size is normal. No pericardial effusion. Borderline dilatation of the main pulmonary artery, measuring 31 mm in diameter. The thoracic aorta is normal in caliber. The left vertebral artery arises directly from the aortic arch between the left common carotid and left subclavian arteries, a normal anatomic variant. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. A few prominent bilateral axillary lymph nodes, not meeting size criteria for pathologic enlargement. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Symmetric contrast enhancement. No radiopaque nephrolithiasis. No hydroureteronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Scattered colonic diverticulosis. The appendix is normal. PERITONEUM / MESENTERY: No free intraperitoneal fluid. No pneumoperitoneum. RETROPERITONEUM: Normal. VESSELS: A few scattered punctate atherosclerotic calcifications in the bilateral common iliac arteries. Stranding around the right common femoral vasculature is likely related to recent vascular access. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Small fat-containing umbilical hernia. MUSCULOSKELETAL: No aggressive osseous abnormality is identified. Bilateral os acromiale. Geographic area of sclerosis in the left ilium likely represents a bone island. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. Mild multilevel discogenic degenerative changes. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No spondylolisthesis. LUMBAR SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. Moderate discogenic degenerative changes at L5-S1. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No spondylolisthesis.
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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. Limitations: None. Chest: Lines, tubes, and devices: None. Lung parenchyma and pleura: There has been interval development of patchy consolidative and groundglass opacities in both lungs with associated septal thickening. There has been interval development of consolidative opacities with air bronchogram and a near total opacification of both lower lobes with associated low-attenuation areas. Small bilateral pleural effusions, slightly increased from prior. The previously noted right lower lobe nodule now obscured by the consolidation. Retained secretions in the trachea and right main bronchus. Thoracic inlet, heart, and mediastinum: No new or enlarging thoracic lymphadenopathy. The esophagus is nondilated. Thoracic aorta is normal in caliber. Main pulmonary artery is normal in caliber. Mild cardiomegaly. Aortic valve and coronary arterial calcification. No pericardial effusion. Blood appears hypodense relative to the interventricular septum, a finding which could be seen with anemia. Bones and soft tissues: Bilateral gynecomastia. Abdominal wall edema. No aggressive bone lesion. Redemonstrated diffuse sclerosis of the visualized bones. Upper abdomen: Mild mesenteric edema. Partially visualized small kidneys.
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3,388
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EXAM: CT Chest with contrast, CT Abdomen and Pelvis w contrast, CT Thoracic Spine from Reformat, CT Lumbar Spine from Reformat CLINICAL INFORMATION: Trauma. COMPARISON: None available. TECHNIQUE: CT Chest with contrast, CT Abdomen and Pelvis w contrast, CT Thoracic Spine from Reformat, CT Lumbar Spine from Reformat. Patient weight: 270 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. Saline flush: 30 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 80 secs Scan field of view: 482.60 mm. (accession CT220004017), Patient weight: 270 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. Saline flush: 30 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 80 secs Scan field of view: 482.60 mm. DLP: 1924.90 mGy cm. (accession CT220004018) FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: The central tracheobronchial tree is patent and clear. Mild dependent atelectatic changes. No focal parenchymal consolidation or suspicious nodule or mass. No pleural effusions or pneumothorax. HEART / VESSELS: Heart size is normal. No pericardial effusion. Borderline dilatation of the main pulmonary artery, measuring 31 mm in diameter. The thoracic aorta is normal in caliber. The left vertebral artery arises directly from the aortic arch between the left common carotid and left subclavian arteries, a normal anatomic variant. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. A few prominent bilateral axillary lymph nodes, not meeting size criteria for pathologic enlargement. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Symmetric contrast enhancement. No radiopaque nephrolithiasis. No hydroureteronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Scattered colonic diverticulosis. The appendix is normal. PERITONEUM / MESENTERY: No free intraperitoneal fluid. No pneumoperitoneum. RETROPERITONEUM: Normal. VESSELS: A few scattered punctate atherosclerotic calcifications in the bilateral common iliac arteries. Stranding around the right common femoral vasculature is likely related to recent vascular access. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Small fat-containing umbilical hernia. MUSCULOSKELETAL: No aggressive osseous abnormality is identified. Bilateral os acromiale. Geographic area of sclerosis in the left ilium likely represents a bone island. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. Mild multilevel discogenic degenerative changes. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No spondylolisthesis. LUMBAR SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. Moderate discogenic degenerative changes at L5-S1. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No spondylolisthesis. CONCLUSION: No acute traumatic abnormality in the chest, abdomen, pelvis. No acute fracture or malalignment in the thoracolumbar spine. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: The central tracheobronchial tree is patent and clear. Mild dependent atelectatic changes. No focal parenchymal consolidation or suspicious nodule or mass. No pleural effusions or pneumothorax. HEART / VESSELS: Heart size is normal. No pericardial effusion. Borderline dilatation of the main pulmonary artery, measuring 31 mm in diameter. The thoracic aorta is normal in caliber. The left vertebral artery arises directly from the aortic arch between the left common carotid and left subclavian arteries, a normal anatomic variant. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. A few prominent bilateral axillary lymph nodes, not meeting size criteria for pathologic enlargement. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Symmetric contrast enhancement. No radiopaque nephrolithiasis. No hydroureteronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Scattered colonic diverticulosis. The appendix is normal. PERITONEUM / MESENTERY: No free intraperitoneal fluid. No pneumoperitoneum. RETROPERITONEUM: Normal. VESSELS: A few scattered punctate atherosclerotic calcifications in the bilateral common iliac arteries. Stranding around the right common femoral vasculature is likely related to recent vascular access. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Small fat-containing umbilical hernia. MUSCULOSKELETAL: No aggressive osseous abnormality is identified. Bilateral os acromiale. Geographic area of sclerosis in the left ilium likely represents a bone island. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. Mild multilevel discogenic degenerative changes. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No spondylolisthesis. LUMBAR SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. Moderate discogenic degenerative changes at L5-S1. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No spondylolisthesis.
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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Cyst in the right hepatic lobe. No other significant abnormality. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: 7 mm stone in the right lower renal pole. Additional punctate calculus in the right lower renal pole. No hydronephrosis. Multiple subtle hyperdensities in bilateral kidneys which may represent hemorrhagic or proteinaceous components of renal cysts. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No significant abnormality. COLON / APPENDIX: Large colorectal fecal burden. Appendix is normal. PERITONEUM / MESENTERY: Normal. No free fluid or pneumoperitoneum. RETROPERITONEUM: Normal. VESSELS: Mild calcific atherosclerosis of the abdominal aorta and its branch vessels. URINARY BLADDER: Partially decompressed with resultant wall thickening, otherwise unremarkable. REPRODUCTIVE ORGANS: Uterus is unremarkable. 3.1 cm simple left ovarian cyst. BODY WALL: Injection changes in the ventral abdominal wall. Tiny fat-containing periumbilical hernia. MUSCULOSKELETAL: Mild degenerative changes of the spine. No aggressive osseous lesion.
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3,389
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CT Maxillofacial wo contrast 1/7/2022 9:20 PM Clinical information: 142 years Unknown patient with Trauma Comparison: None available. Technique: Multiple, contiguous, thin slice, axial CT images of the face were obtained without administration of intravenous contrast. Reformatted coronal reconstructions were also obtained. Scan field of view: 227.80 mm. DLP: 1091.10 mGy cm. FINDINGS: Soft tissues: Moderate left frontal scalp hematoma extending into the left preseptal/periorbital and bilateral perinasal soft tissues. Small right frontal scalp hematoma and laceration. Bones: Acute comminuted displaced fractures of the bilateral nasal bones extending into the right frontal process of the maxilla and anterior nasal septum, resulting in opacification of the anterior nasal cavity. No suspicious osseous lesions are seen. The visualized mandible is intact and the bilateral TMJs are congruent. Orbits: The bilateral globes and optic nerves are intact. The retrobulbar soft tissues have a normal appearance. Paranasal sinuses and mastoid air cells: Small dependent air-fluid levels of the right frontal sinus, scattered ethmoid air cells and right maxillary sinus. Minimal bilateral sphenoid sinus mucosal thickening. IMPRESSION: 1. Acute comminuted displaced fractures of the bilateral nasal bones extending into the right frontal process of the maxilla and anterior nasal septum, resulting in opacification of the anterior nasal cavity. 2. Moderate left frontal scalp hematoma extending into the left preseptal/periorbital and bilateral perinasal soft tissues. Small right frontal scalp hematoma and laceration.
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FINDINGS: Soft tissues: Moderate left frontal scalp hematoma extending into the left preseptal/periorbital and bilateral perinasal soft tissues. Small right frontal scalp hematoma and laceration. Bones: Acute comminuted displaced fractures of the bilateral nasal bones extending into the right frontal process of the maxilla and anterior nasal septum, resulting in opacification of the anterior nasal cavity. No suspicious osseous lesions are seen. The visualized mandible is intact and the bilateral TMJs are congruent. Orbits: The bilateral globes and optic nerves are intact. The retrobulbar soft tissues have a normal appearance. Paranasal sinuses and mastoid air cells: Small dependent air-fluid levels of the right frontal sinus, scattered ethmoid air cells and right maxillary sinus. Minimal bilateral sphenoid sinus mucosal thickening.
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FINDINGS: STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Right middle lobe 7 mm pulmonary nodule on series 10 image 123 corresponds to the pulmonary nodule noted on prior breast MRI. The nodules along the minor fissure is reniform in shape. Additional tiny, less than 5 mm pulmonary nodules are present in the both lungs. No focal consolidation, pleural effusion, or pneumothorax. Central airways are patent. HEART / VESSELS: Heart size is normal. No pericardial effusion. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: Prominent mediastinal lymph nodes are present measuring up to 0.8 cm in diameter on series 10 image 91. CHEST WALL: Irregular enhancement in the upper outer right breast corresponds to biopsy-proven malignancy. UPPER ABDOMEN: Please see same day CT abdomen for abdomen findings. MUSCULOSKELETAL: No acute or aggressive appearing osseous abnormality.
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3,390
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CT Angio Neck 1/7/2022 9:26 PM Clinical information: 142 years Unknown patient with Trauma Comparison: None available. Technique: Intravenous iodinated contrast was then administered and multiple, contiguous, axial CT images of the neck were performed in the arterial phase using CT neck angiogram protocol. Postprocessing reformatted sagittal and coronal maximum intensity projections were also obtained. 3-D volume rendered and maximum intensity projection reconstructions were generated from the axial CT angiographic data set on an independent 3-D workstation per the ordering physician's request. These were created from the axial data. This process was performed under the supervision of the interpreting radiologist. Findings related to the 3-D reconstructions are included in this report. Patient weight: 270 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. Saline flush: 30 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus track Scan field of view: 237.10 mm. DLP: 956.70 mGy cm. . FINDINGS: VASCULAR FINDINGS: Aortic arch: Patent with no hemodynamically significant stenosis. Four vessel aortic arch is noted, with the left vertebral artery originating directly from the aortic arch. Common carotid arteries: Patent with no hemodynamically significant stenosis. Internal carotid arteries: Patent with no hemodynamically significant stenosis. Vertebral arteries: Dominant right vertebral artery. Patent with no hemodynamically significant stenosis. Aneurysm: No large aneurysm identified. NONVASCULAR FINDINGS: The oral cavity, nasopharynx, oropharynx, and laryngopharynx have normal appearance. No intrinsic abnormality is seen within the larynx or trachea. The true and false vocal cords are without focal abnormality. The superficial soft tissues of the neck have a normal appearance with no enhancing lesion identified. No enlarged lymph nodes are seen. The parotid and submandibular glands are normal in appearance. The thyroid gland is without focal abnormality. IMPRESSION: Patent cervical arteries, without evidence of acute vascular injury or flow-limiting stenosis.
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FINDINGS: VASCULAR FINDINGS: Aortic arch: Patent with no hemodynamically significant stenosis. Four vessel aortic arch is noted, with the left vertebral artery originating directly from the aortic arch. Common carotid arteries: Patent with no hemodynamically significant stenosis. Internal carotid arteries: Patent with no hemodynamically significant stenosis. Vertebral arteries: Dominant right vertebral artery. Patent with no hemodynamically significant stenosis. Aneurysm: No large aneurysm identified. NONVASCULAR FINDINGS: The oral cavity, nasopharynx, oropharynx, and laryngopharynx have normal appearance. No intrinsic abnormality is seen within the larynx or trachea. The true and false vocal cords are without focal abnormality. The superficial soft tissues of the neck have a normal appearance with no enhancing lesion identified. No enlarged lymph nodes are seen. The parotid and submandibular glands are normal in appearance. The thyroid gland is without focal abnormality.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: Refer to the concurrent dedicated CT chest report. ABDOMEN and PELVIS: LIVER: Hypodense lesion with peripheral enhancement measures 7.2 cm in the medial segment of the left lobe, likely represent hematoma. Subcentimeter hypodensity near the dome of the right lobe measures 5 mm, too small to further characterize. No other suspicious hepatic focal lesion is identified BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Nonobstructing stone measures 7 mm in the interpolar calyx of the right kidney otherwise, bilateral kidneys 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: Uterus is absent. No adnexal mass identified. BODY WALL: Tiny fat-containing umbilical hernia is noted. MUSCULOSKELETAL: No lytic or sclerotic bony lesion is identified scattered degenerative changes spine.
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3,391
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Craniocervical CT angiogram 1/7/2022 8:48 PM Indication: stroke Comparison: None. Technique: 1.4 mm axial images were obtained during the early arterial phase of a rapid IV infusion of contrast, from the thoracic inlet through the circle of Willis. 3-D CT angiographic images were generated from axial data set. "Sliding slab MIP" images were also generated. Patient weight: 280 lbs. IV contrast: Omnipaque 350, 125 ml, per protocol. IV contrast injection rate: 3.50 ml per sec. Scan delay: bt sec. Scan field of view: 262 mm. (accession CT220004025), Patient weight: 280 lbs. IV contrast: Omnipaque 350, 125 ml, per protocol. IV contrast injection rate: 3.50 ml per sec. Scan delay: bt sec. Scan field of view: 262 mm. DLP: 3445 mGy cm. (accession CT220004024). 3-D reconstructions were generated per the ordering physician's request from the axial data. This was performed under the supervision of the interpreting radiologist. Findings related to the 3-D reconstructions are included in this report. VASCULAR FINDINGS: Aortic arch: Patent without flow-limiting stenosis. Normal three vessel aortic arch is noted. Right carotid: Patent without flow-limiting stenosis. Short retropharyngeal course of the right ICA. Left carotid: Punctate nonflow limiting atherosclerotic calcifications and fibrofatty plaques of the proximal left ICA. Patent without flow-limiting stenosis. Right vertebral artery: Dominant. Patent without flow-limiting stenosis. Left vertebral artery: Patent without flow-limiting stenosis. Intracranial arteries: Punctate nonflow limiting atherosclerotic calcifications of the bilateral cavernous/paraclinoid ICAs. The bilateral ACAs, MCAs and PCAs appear patent, without flow-limiting stenoses or discrete aneurysms. The vertebrobasilar axis is mildly tortuous, without flow-limiting stenoses. NONVASCULAR FINDINGS: Please refer to concomitant CT of the head for complete description of intracranial findings. Punctate calcifications of the bilateral palatine tonsils, likely sequela of prior infections. The oral cavity, nasopharynx, oropharynx, and laryngopharynx have otherwise normal appearance. No intrinsic abnormality is seen within the larynx or trachea. The true and false vocal cords are without focal abnormality. The superficial soft tissues of the neck have a normal appearance with no enhancing lesion identified. No enlarged lymph nodes are seen. The parotid and submandibular glands are normal in appearance. The thyroid gland is without focal abnormality. IMPRESSION: 1. Patent cervical and intracranial arteries, without evidence of acute vascular injury, flow-limiting stenoses or discrete aneurysms. 2. Mild multifocal atherosclerosis as described. Requesting provider was paged on 1/7/2022 at 9:05 PM to communicate findings directly.
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FINDINGS: Aortic arch: Patent without flow-limiting stenosis. Normal three vessel aortic arch is noted. Right carotid: Patent without flow-limiting stenosis. Short retropharyngeal course of the right ICA. Left carotid: Punctate nonflow limiting atherosclerotic calcifications and fibrofatty plaques of the proximal left ICA. Patent without flow-limiting stenosis. Right vertebral artery: Dominant. Patent without flow-limiting stenosis. Left vertebral artery: Patent without flow-limiting stenosis. Intracranial arteries: Punctate nonflow limiting atherosclerotic calcifications of the bilateral cavernous/paraclinoid ICAs. The bilateral ACAs, MCAs and PCAs appear patent, without flow-limiting stenoses or discrete aneurysms. The vertebrobasilar axis is mildly tortuous, without flow-limiting stenoses. NONVASCULAR FINDINGS: Please refer to concomitant CT of the head for complete description of intracranial findings. Punctate calcifications of the bilateral palatine tonsils, likely sequela of prior infections. The oral cavity, nasopharynx, oropharynx, and laryngopharynx have otherwise normal appearance. No intrinsic abnormality is seen within the larynx or trachea. The true and false vocal cords are without focal abnormality. The superficial soft tissues of the neck have a normal appearance with no enhancing lesion identified. No enlarged lymph nodes are seen. The parotid and submandibular glands are normal in appearance. The thyroid gland is without focal abnormality.
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FINDINGS: Normal basal cisterns. Normal ventricles. Calcified atherosclerosis of the carotid siphons. No visible infarct and no hemorrhage or mass. No significant hypodensity in the white matter. Paranasal sinuses are well-aerated. Bilateral mastoid air cells are clear. Normal soft tissues. No acute fractures or suspicious osseous lesions. Chronic posttraumatic appearance of the left lamina papyracea (series 4, image 15). ---------------
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Craniocervical CT angiogram 1/7/2022 8:48 PM Indication: stroke Comparison: None. Technique: 1.4 mm axial images were obtained during the early arterial phase of a rapid IV infusion of contrast, from the thoracic inlet through the circle of Willis. 3-D CT angiographic images were generated from axial data set. "Sliding slab MIP" images were also generated. Patient weight: 280 lbs. IV contrast: Omnipaque 350, 125 ml, per protocol. IV contrast injection rate: 3.50 ml per sec. Scan delay: bt sec. Scan field of view: 262 mm. (accession CT220004025), Patient weight: 280 lbs. IV contrast: Omnipaque 350, 125 ml, per protocol. IV contrast injection rate: 3.50 ml per sec. Scan delay: bt sec. Scan field of view: 262 mm. DLP: 3445 mGy cm. (accession CT220004024). 3-D reconstructions were generated per the ordering physician's request from the axial data. This was performed under the supervision of the interpreting radiologist. Findings related to the 3-D reconstructions are included in this report. VASCULAR FINDINGS: Aortic arch: Patent without flow-limiting stenosis. Normal three vessel aortic arch is noted. Right carotid: Patent without flow-limiting stenosis. Short retropharyngeal course of the right ICA. Left carotid: Punctate nonflow limiting atherosclerotic calcifications and fibrofatty plaques of the proximal left ICA. Patent without flow-limiting stenosis. Right vertebral artery: Dominant. Patent without flow-limiting stenosis. Left vertebral artery: Patent without flow-limiting stenosis. Intracranial arteries: Punctate nonflow limiting atherosclerotic calcifications of the bilateral cavernous/paraclinoid ICAs. The bilateral ACAs, MCAs and PCAs appear patent, without flow-limiting stenoses or discrete aneurysms. The vertebrobasilar axis is mildly tortuous, without flow-limiting stenoses. NONVASCULAR FINDINGS: Please refer to concomitant CT of the head for complete description of intracranial findings. Punctate calcifications of the bilateral palatine tonsils, likely sequela of prior infections. The oral cavity, nasopharynx, oropharynx, and laryngopharynx have otherwise normal appearance. No intrinsic abnormality is seen within the larynx or trachea. The true and false vocal cords are without focal abnormality. The superficial soft tissues of the neck have a normal appearance with no enhancing lesion identified. No enlarged lymph nodes are seen. The parotid and submandibular glands are normal in appearance. The thyroid gland is without focal abnormality. IMPRESSION: 1. Patent cervical and intracranial arteries, without evidence of acute vascular injury, flow-limiting stenoses or discrete aneurysms. 2. Mild multifocal atherosclerosis as described. Requesting provider was paged on 1/7/2022 at 9:05 PM to communicate findings directly.
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FINDINGS: Aortic arch: Patent without flow-limiting stenosis. Normal three vessel aortic arch is noted. Right carotid: Patent without flow-limiting stenosis. Short retropharyngeal course of the right ICA. Left carotid: Punctate nonflow limiting atherosclerotic calcifications and fibrofatty plaques of the proximal left ICA. Patent without flow-limiting stenosis. Right vertebral artery: Dominant. Patent without flow-limiting stenosis. Left vertebral artery: Patent without flow-limiting stenosis. Intracranial arteries: Punctate nonflow limiting atherosclerotic calcifications of the bilateral cavernous/paraclinoid ICAs. The bilateral ACAs, MCAs and PCAs appear patent, without flow-limiting stenoses or discrete aneurysms. The vertebrobasilar axis is mildly tortuous, without flow-limiting stenoses. NONVASCULAR FINDINGS: Please refer to concomitant CT of the head for complete description of intracranial findings. Punctate calcifications of the bilateral palatine tonsils, likely sequela of prior infections. The oral cavity, nasopharynx, oropharynx, and laryngopharynx have otherwise normal appearance. No intrinsic abnormality is seen within the larynx or trachea. The true and false vocal cords are without focal abnormality. The superficial soft tissues of the neck have a normal appearance with no enhancing lesion identified. No enlarged lymph nodes are seen. The parotid and submandibular glands are normal in appearance. The thyroid gland is without focal abnormality.
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Findings/conclusion: AP and lateral scout images of the abdomen and pelvis were obtained. The exam was subsequently terminated due to a positive pregnancy test. No gross abnormality is identified.
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CT Head wo contrast 1/7/2022 8:46 PM Clinical Information: stroke Comparison: None. 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: 229 mm. DLP: 1165 mGy cm. Findings: Brain parenchyma: Acute intraparenchymal hematoma is noted within the left periatrial white matter, measuring approximately 27 x 23 x 21 mm, with surrounding edema extending into the left splenium of the corpus callosum. Diffuse age-appropriate brain parenchymal volume loss is seen, resulting in ex vacuo dilatation of the ventricular system. Periventricular and subcortical white matter hypoattenuation is noted, suggestive of mild chronic microvascular ischemic disease, with remote lacunar infarcts along the posterior limb of the left internal capsule. Basal cisterns: There is no significant effacement of the basilar cisterns. Extra-axial spaces: Normal appearance. No abnormal extra-axial fluid collections. Midline shift: No significant midline shift is seen. Vascular system: Punctate atherosclerotic calcifications of the bilateral carotid siphons. Soft tissues: Unremarkable without discrete fluid collections. Orbits: Normal appearance. Calvarium and skull base: No acute fractures or suspicious osseous lesions identified. The bilateral mastoid air cell complexes are well-developed and clear. Paranasal sinuses: Small right maxillary sinus mucous retention cysts. Otherwise, appear well aerated. IMPRESSION: 1. Acute intraparenchymal hematoma within the left periatrial white matter, measuring approximately 27 x 23 x 21 mm, with surrounding edema extending into the left splenium of the corpus callosum. 2. Age-appropriate brain involution and mild chronic microvascular ischemic disease, with remote posterior limb of the left internal capsule lacunar infarcts.
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Findings: Brain parenchyma: Acute intraparenchymal hematoma is noted within the left periatrial white matter, measuring approximately 27 x 23 x 21 mm, with surrounding edema extending into the left splenium of the corpus callosum. Diffuse age-appropriate brain parenchymal volume loss is seen, resulting in ex vacuo dilatation of the ventricular system. Periventricular and subcortical white matter hypoattenuation is noted, suggestive of mild chronic microvascular ischemic disease, with remote lacunar infarcts along the posterior limb of the left internal capsule. Basal cisterns: There is no significant effacement of the basilar cisterns. Extra-axial spaces: Normal appearance. No abnormal extra-axial fluid collections. Midline shift: No significant midline shift is seen. Vascular system: Punctate atherosclerotic calcifications of the bilateral carotid siphons. Soft tissues: Unremarkable without discrete fluid collections. Orbits: Normal appearance. Calvarium and skull base: No acute fractures or suspicious osseous lesions identified. The bilateral mastoid air cell complexes are well-developed and clear. Paranasal sinuses: Small right maxillary sinus mucous retention cysts. Otherwise, appear well aerated.
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Findings: Aortic arch: There is normal great vessel origin anatomy. There are no great vessel origin stenosis. Right carotid: No evidence of flow-limiting cervical right carotid stenoses. There is mild luminal irregularity of the distal right cervical ICA probably representing fibromuscular dysplasia. Left carotid: No evidence of flow-limiting cervical left carotid stenoses. There are mild atherosclerotic calcifications of the proximal left cervical ICA resulting in focal approximately 50% stenosis. Vessel returns to normal caliber distally. There is mild luminal irregularity of the distal left cervical ICA likely representing fibromuscular dysplasia. Right vertebral artery: There are no flow-limiting cervical right vertebral artery stenoses. Left vertebral artery: No cervical left vertebral artery stenoses are evident. Intracranial vessels: There are mild atherosclerotic calcifications of the right ICA carotid siphon and supraclinoid segment without significant narrowing. The right ACA and MCA appear within normal limits. There are only minimal atherosclerotic calcifications of the distal left ICA with no narrowing. The left MCA and left ACA appear within normal limits. Within the posterior circulation there is no focal stenosis involving the distal vertebral arteries. There is mild tortuosity of the basilar artery without focal narrowing. There is fetal origin of the left PCA. There is no focal stenosis of either PCA. No aneurysm is identified. Major dural venous sinuses are patent. Both internal jugular veins are patent.
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CT Perfusion 1/7/2022 8:47 PM Clinical information: Code stroke Comparison: None available. Technique: A CT perfusion study was performed during single pass of 50 cc contrast bolus. Axial images were acquired at 8 axial locations and time-attenuation curves generated from this dataset were utilized to calculate cerebral blood flow, mean transit time, time to peak, and cerebral blood volume maps as well as region of interest specific quantitative data. "Prognostic" color maps were also generated depicting areas of ischemia (voxel values for MTT > 1.4 times mirror image voxels on the contralateral "normal side") in the color green and areas predictive of infarction (CBV values 6.0s volume of 11 mm, giving a mismatch volume of 7 mL.
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A CT perfusion study was performed during single pass of 50 cc contrast bolus. Axial images were acquired at 8 axial locations and time-attenuation curves generated from this dataset were utilized to calculate cerebral blood flow, mean transit time, time to peak, and cerebral blood volume maps as well as region of interest specific quantitative data. "Prognostic" color maps were also generated depicting areas of ischemia (voxel values for MTT > 1.4 times mirror image voxels on the contralateral "normal side") in the color green and areas predictive of infarction (CBV values 6.0s volume of 11 mm, giving a mismatch volume of 7 mL.
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Findings: Aortic arch: There is normal great vessel origin anatomy. There are no great vessel origin stenosis. Right carotid: No evidence of flow-limiting cervical right carotid stenoses. There is mild luminal irregularity of the distal right cervical ICA probably representing fibromuscular dysplasia. Left carotid: No evidence of flow-limiting cervical left carotid stenoses. There are mild atherosclerotic calcifications of the proximal left cervical ICA resulting in focal approximately 50% stenosis. Vessel returns to normal caliber distally. There is mild luminal irregularity of the distal left cervical ICA likely representing fibromuscular dysplasia. Right vertebral artery: There are no flow-limiting cervical right vertebral artery stenoses. Left vertebral artery: No cervical left vertebral artery stenoses are evident. Intracranial vessels: There are mild atherosclerotic calcifications of the right ICA carotid siphon and supraclinoid segment without significant narrowing. The right ACA and MCA appear within normal limits. There are only minimal atherosclerotic calcifications of the distal left ICA with no narrowing. The left MCA and left ACA appear within normal limits. Within the posterior circulation there is no focal stenosis involving the distal vertebral arteries. There is mild tortuosity of the basilar artery without focal narrowing. There is fetal origin of the left PCA. There is no focal stenosis of either PCA. No aneurysm is identified. Major dural venous sinuses are patent. Both internal jugular veins are patent.
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3,395
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EXAM: CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: Abdominal pain. Per review of the EMR, the patient has a history of partial small bowel resection and sigmoid colectomy in 2019. COMPARISON: CT abdomen and pelvis with contrast 5/20/2017. TECHNIQUE: CT Abdomen and Pelvis w contrast. Patient weight: 140 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 80 sec Scan field of view: 360 mm. DLP: 419.90 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 size. Tiny calcified splenic granulomata. ADRENALS: Normal. KIDNEYS: Symmetric contrast enhancement. Hypoattenuating lesion in the lower pole the right kidney is too small to characterize, but is statistically likely to represent a cyst. No radiopaque nephrolithiasis. No hydroureteronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Postsurgical changes from partial small bowel resection with patent enteroenteric anastomosis in the left mid abdomen. Multiple dilated loops of small bowel throughout the abdomen with apparent transition point in the mid abdomen (series 2 and one, image 177). Swirling of the adjacent mesentery with eccentric filling defect in an associated mesenteric vessel (series 201, image 190). Decompressed distal loops of small bowel. COLON / APPENDIX: Postsurgical changes from sigmoid colectomy with patent colocolonic anastomosis. Fecal material is noted throughout the ascending, transverse, and descending colon with relative collapse of the distal descending colon and rectum. Normal retrocecal appendix. PERITONEUM / MESENTERY: Trace free fluid in the pelvis. No pneumoperitoneum. RETROPERITONEUM: Normal. VESSELS: Eccentric filling defect in a mesenteric branch vessel in the midabdomen, as above. URINARY BLADDER: Decompressed, limiting evaluation. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No aggressive osseous abnormality is identified. CONCLUSION: High-grade mechanical small bowel obstruction with apparent transition point in the mid abdomen. Swirling of the adjacent mesentery with questionable eccentric filling defect in an associated mesenteric vessel, although it is difficult to determine if this is in an arterial or venous branch vessel. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report. Note: Preliminary findings were discussed with Dr. Booth by Dr. Cook at 1/8/2022 12:09 AM. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal size. Tiny calcified splenic granulomata. ADRENALS: Normal. KIDNEYS: Symmetric contrast enhancement. Hypoattenuating lesion in the lower pole the right kidney is too small to characterize, but is statistically likely to represent a cyst. No radiopaque nephrolithiasis. No hydroureteronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Postsurgical changes from partial small bowel resection with patent enteroenteric anastomosis in the left mid abdomen. Multiple dilated loops of small bowel throughout the abdomen with apparent transition point in the mid abdomen (series 2 and one, image 177). Swirling of the adjacent mesentery with eccentric filling defect in an associated mesenteric vessel (series 201, image 190). Decompressed distal loops of small bowel. COLON / APPENDIX: Postsurgical changes from sigmoid colectomy with patent colocolonic anastomosis. Fecal material is noted throughout the ascending, transverse, and descending colon with relative collapse of the distal descending colon and rectum. Normal retrocecal appendix. PERITONEUM / MESENTERY: Trace free fluid in the pelvis. No pneumoperitoneum. RETROPERITONEUM: Normal. VESSELS: Eccentric filling defect in a mesenteric branch vessel in the midabdomen, as above. URINARY BLADDER: Decompressed, limiting evaluation. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No aggressive osseous abnormality is identified.
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FINDINGS: There is no acute intracranial hemorrhage. There are no abnormal areas of hypoattenuation to suggest acute infarction. There are mild periventricular hypodensities likely reflecting microangiopathic changes. Gray-white junction is maintained. There are mild atherosclerotic calcifications of the distal ICAs. The ventricles, cisterns and sulci are unremarkable. There is no mass effect. The calvarium is intact. The visualized paranasal sinuses and mastoid air cells are clear. The orbits are unremarkable.
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EXAM: CT Angio Chest wo+w contrast CLINICAL INFORMATION: 59-year-old male with chest pain, evaluation of ascending aortic aneurysm, rule out dissection. COMPARISON: Chest radiograph 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: 189 lbs. IV contrast: Omnipaque 350, 60 ml, per protocol. Saline flush: 75 ml. IV contrast injection rate: 3.50 ml per sec. Scan delay: BT sec. Scan field of view: 340 mm. KVP: 100 DLP: 456.60 mGy cm. 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: Aneurysmal dilatation of the ascending aorta to 4.8 cm (axial series 501, image 347). No dissection. AORTIC ARCH: No significant abnormality. ARCH VESSELS: No significant abnormality. DESCENDING THORACIC AORTA: No significant abnormality. UPPER ABDOMINAL AORTA: No significant abnormality. --------------------------------------1----------------------- LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Normal. HEART / OTHER VESSELS: Heart size is normal. No other significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: No significant abnormality. MUSCULOSKELETAL: Chronic degenerative changes of the thoracic spine. Multilevel bridging anterior syndesmophytes, compatible with DISH. CONCLUSION: 1. Ascending aortic aneurysm measuring up to 4.8 cm. 2. No evidence of aortic dissection or other acute cardiopulmonary findings. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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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: Aneurysmal dilatation of the ascending aorta to 4.8 cm (axial series 501, image 347). No dissection. AORTIC ARCH: No significant abnormality. ARCH VESSELS: No significant abnormality. DESCENDING THORACIC AORTA: No significant abnormality. UPPER ABDOMINAL AORTA: No significant abnormality. --------------------------------------1----------------------- LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Normal. HEART / OTHER VESSELS: Heart size is normal. No other significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: No significant abnormality. MUSCULOSKELETAL: Chronic degenerative changes of the thoracic spine. Multilevel bridging anterior syndesmophytes, compatible with DISH.
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Findings: Color parametric maps demonstrate mild increased Tmax within the right parietal and occipital lobes. Suggestion of increased Tmax within the right cerebellum and right temporal lobe appears to be artifactual. There is no corresponding increased mean transit time and no areas of decreased R CBV or our CBF. Prognostic maps demonstrate areas of Tmax greater than six seconds within the right cerebellum and right temporal lobe and right occipital lobe and right parietal lobe. Total volume measures 25 mL. There are no areas of CBF less than 30%.
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RADIOLOGIC EXAM: CT Head wo contrast CLINICAL INFORMATION: Pain behind left eye COMPARISON: None. TECHNIQUE: CT Head wo contrastScan field of view: 221 mm. DLP: 1163 mGy cm. STRUCTURED REPORT: CT Head Trauma FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Mucosal thickening of the bilateral dependent frontal, sphenoid, ethmoid, and maxillary sinuses. Postsurgical changes of bilateral maxillary antrostomies/uncinectomies and middle turbinectomies. Pneumatization the right greater than left petrous apices. IMPRESSION: 1. No acute intracranial process. 2. Inflammatory paranasal sinus disease as described. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Mucosal thickening of the bilateral dependent frontal, sphenoid, ethmoid, and maxillary sinuses. Postsurgical changes of bilateral maxillary antrostomies/uncinectomies and middle turbinectomies. Pneumatization the right greater than left petrous apices.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: There is atelectasis versus scarring in the right lower lung. There is a trace bilateral pleural effusion. There is a patchy airspace opacity in the right lower lobe with associated nonspecific groundglass opacities. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Trace pericardial effusion. There is a very prominent right pericardial lymph node. Calcified subcarinal lymph node. ABDOMEN and PELVIS: LIVER: Hepatomegaly and hepatic steatosis. Posterior right hepatic lobe metastasis measures 2.7 cm on image 110, series 2 and one, grossly unchanged from prior chest CT from 1/11/2021. Additional subcentimeter indeterminate hypodensities within liver are technically indeterminate but unchanged. There is a suspected additional metastasis measuring 2.4 cm on image 64, series 201, not definitely seen on the prior exam although the prior exam was suboptimal due to technique. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Minute subcentimeter hypodensities in both kidneys are technically indeterminate but statistically likely cysts. LYMPH NODES: Multiple enlarged periaortic lymph nodes in the upper abdomen, probably metastatic STOMACH / SMALL BOWEL: The small bowel is normal in caliber. There is areas of suspected thickening adjacent to the pelvic small bowel, probably serosal implants COLON / APPENDIX: The appendix is not well-visualized although there are no convincing signs of appendicitis. There are multiple pericolonic soft tissue nodules, likely related to carcinomatosis. The colon is collapsed. There are few inflamed colonic diverticula. PERITONEUM / MESENTERY: The necrotic soft tissue implant in the left upper quadrant measures 3.7 x 3.1 cm on image 125, series 2 and one (previously 3.4 x 3.1 cm, unchanged. Additional peritoneal nodularity is seen anterior to the liver and along the diaphragm which appears better appreciated given the increase in ascites which is now moderate to large volume. There is extensive omental caking along the anterior abdomen. RETROPERITONEUM: Normal. VESSELS: There is a nonocclusive thrombus seen within the right superficial and profunda femoral vein extending into the right common femoral where it becomes occlusive in the right external iliac vein. URINARY BLADDER: Collapsed REPRODUCTIVE ORGANS: Large bilateral adnexal solid and cystic masses, likely metastatic related to carcinomatosis. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
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3,398
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Radiologic Exam: CT Angio Neck, CT Angio Head wo+w contrast 1/7/2022 11:53 PM Clinical Information: tia and weakness. Comparison: Multiple prior CT heads, most recently 7/20/2021. MR brain 7/14/2021. CT perfusion 2/25/2020. Technique: Helical CT images were obtained before and after the administration of contrast from the base of the skull to the vertex. Contrast enhanced CT angiographic images were obtained from the superior mediastinum to the vertex during the arterial phase. 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: 230 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 259.40 mm. (accession CT220004033), Patient weight: 230 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 259.40 mm. DLP: 5320 mGy cm. (accession CT220004032) FINDINGS: CT of the head with and without contrast: There is no acute infarction, hemorrhage, or cerebral edema. The gray-white matter differentiation is maintained. The cerebral cortical volume is appropriate for patient's age. There is no space occupying intracranial lesion or hydrocephalus. No enhancing intracranial abnormality. There is no acute osseous or orbital abnormality. The mastoid air cells are clear. Mild mucosal thickening in bilateral maxillary and right sphenoid sinuses. CT angiogram of the brain: RIGHT CAROTID: Unchanged severe atherosclerotic calcification resulting in moderate narrowing of the distal petrous ICA. Dense calcified atherosclerosis of the cavernous ICA with mild irregular narrowing. No aneurysm. LEFT CAROTID: Unchanged severe irregular narrowing of the left petrous ICA, likely secondary to atherosclerosis. Dense calcified atherosclerosis of the cavernous ICA with mild irregular narrowing. Severe stenosis of the supraclinoid ICA, unchanged. Interval post angioplasty and stent changes of the left supraclinoid ICA in the area of previously noted severe stenosis with similar-appearing severe irregular narrowing just distal to the stent. No aneurysm. ANTERIOR, MIDDLE, AND POSTERIOR CEREBRAL ARTERIES: Hypoplastic right A1 segment, unchanged. No significant abnormality of the bilateral ACAs, MCAs, or PCAs. Unchanged prominent artery draining into the right transverse sinus which demonstrates asymmetric increased opacification (image 191, series #407), likely dural AV fistula. VERTEBROBASILAR ARTERIES: There is no evidence of stenosis, occlusion, or aneurysmal dilation. CT angiogram of the neck: AORTIC ARCH and PROXIMAL GREAT VESSELS: Limited evaluation the proximal vessels due to photon starvation artifact. Previously noted left vertebral ostial stenosis is not well evaluated due to adjacent contrast artifact. RIGHT CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT CAROTID: Mild atherosclerosis of the proximal ICA. 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: There is no evidence of stenosis, occlusion, or aneurysmal dilation. SOFT TISSUES: No soft tissue abnormality within the neck. CERVICAL SPINE: No aggressive osseous lesions. Mild multilevel discogenic degenerative change. CONCLUSION: 1. No acute intracranial process appreciated. 2. Interval stenting of the left supraclinoid ICA in the area of severe stenosis with similar-appearing severe irregular narrowing just distal to the stent. 3. Unchanged severe calcified atherosclerosis of the cavernous ICAs and severe irregular narrowing of the distal right petrous and majority of the left petrous ICAs. 4. Suspected right dural AV fistula as above, unchanged. 5. No acute cervical arterial abnormality within the limitations of exam. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: CT of the head with and without contrast: There is no acute infarction, hemorrhage, or cerebral edema. The gray-white matter differentiation is maintained. The cerebral cortical volume is appropriate for patient's age. There is no space occupying intracranial lesion or hydrocephalus. No enhancing intracranial abnormality. There is no acute osseous or orbital abnormality. The mastoid air cells are clear. Mild mucosal thickening in bilateral maxillary and right sphenoid sinuses. CT angiogram of the brain: RIGHT CAROTID: Unchanged severe atherosclerotic calcification resulting in moderate narrowing of the distal petrous ICA. Dense calcified atherosclerosis of the cavernous ICA with mild irregular narrowing. No aneurysm. LEFT CAROTID: Unchanged severe irregular narrowing of the left petrous ICA, likely secondary to atherosclerosis. Dense calcified atherosclerosis of the cavernous ICA with mild irregular narrowing. Severe stenosis of the supraclinoid ICA, unchanged. Interval post angioplasty and stent changes of the left supraclinoid ICA in the area of previously noted severe stenosis with similar-appearing severe irregular narrowing just distal to the stent. No aneurysm. ANTERIOR, MIDDLE, AND POSTERIOR CEREBRAL ARTERIES: Hypoplastic right A1 segment, unchanged. No significant abnormality of the bilateral ACAs, MCAs, or PCAs. Unchanged prominent artery draining into the right transverse sinus which demonstrates asymmetric increased opacification (image 191, series #407), likely dural AV fistula. VERTEBROBASILAR ARTERIES: There is no evidence of stenosis, occlusion, or aneurysmal dilation. CT angiogram of the neck: AORTIC ARCH and PROXIMAL GREAT VESSELS: Limited evaluation the proximal vessels due to photon starvation artifact. Previously noted left vertebral ostial stenosis is not well evaluated due to adjacent contrast artifact. RIGHT CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT CAROTID: Mild atherosclerosis of the proximal ICA. 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: There is no evidence of stenosis, occlusion, or aneurysmal dilation. SOFT TISSUES: No soft tissue abnormality within the neck. CERVICAL SPINE: No aggressive osseous lesions. Mild multilevel discogenic degenerative change.
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FINDINGS: Index lesions are measured in series 2. A slightly lobular noncalcified subpleural nodule in the right lower lobe in image 73 measures 12 x 10 mm it was approximately 11 x 10 mm in image nine, series 2 of abdominal CT dated October 19, 2021. No other nodule or mass, airspace consolidation or interstitial abnormality seen. Only small subcentimeter size nodes are seen in the mediastinum. There is no pleural or pericardial effusion and no focal lytic or sclerotic bone lesion is seen..
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3,399
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Radiologic Exam: CT Angio Neck, CT Angio Head wo+w contrast 1/7/2022 11:53 PM Clinical Information: tia and weakness. Comparison: Multiple prior CT heads, most recently 7/20/2021. MR brain 7/14/2021. CT perfusion 2/25/2020. Technique: Helical CT images were obtained before and after the administration of contrast from the base of the skull to the vertex. Contrast enhanced CT angiographic images were obtained from the superior mediastinum to the vertex during the arterial phase. 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: 230 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 259.40 mm. (accession CT220004033), Patient weight: 230 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 259.40 mm. DLP: 5320 mGy cm. (accession CT220004032) FINDINGS: CT of the head with and without contrast: There is no acute infarction, hemorrhage, or cerebral edema. The gray-white matter differentiation is maintained. The cerebral cortical volume is appropriate for patient's age. There is no space occupying intracranial lesion or hydrocephalus. No enhancing intracranial abnormality. There is no acute osseous or orbital abnormality. The mastoid air cells are clear. Mild mucosal thickening in bilateral maxillary and right sphenoid sinuses. CT angiogram of the brain: RIGHT CAROTID: Unchanged severe atherosclerotic calcification resulting in moderate narrowing of the distal petrous ICA. Dense calcified atherosclerosis of the cavernous ICA with mild irregular narrowing. No aneurysm. LEFT CAROTID: Unchanged severe irregular narrowing of the left petrous ICA, likely secondary to atherosclerosis. Dense calcified atherosclerosis of the cavernous ICA with mild irregular narrowing. Severe stenosis of the supraclinoid ICA, unchanged. Interval post angioplasty and stent changes of the left supraclinoid ICA in the area of previously noted severe stenosis with similar-appearing severe irregular narrowing just distal to the stent. No aneurysm. ANTERIOR, MIDDLE, AND POSTERIOR CEREBRAL ARTERIES: Hypoplastic right A1 segment, unchanged. No significant abnormality of the bilateral ACAs, MCAs, or PCAs. Unchanged prominent artery draining into the right transverse sinus which demonstrates asymmetric increased opacification (image 191, series #407), likely dural AV fistula. VERTEBROBASILAR ARTERIES: There is no evidence of stenosis, occlusion, or aneurysmal dilation. CT angiogram of the neck: AORTIC ARCH and PROXIMAL GREAT VESSELS: Limited evaluation the proximal vessels due to photon starvation artifact. Previously noted left vertebral ostial stenosis is not well evaluated due to adjacent contrast artifact. RIGHT CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT CAROTID: Mild atherosclerosis of the proximal ICA. 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: There is no evidence of stenosis, occlusion, or aneurysmal dilation. SOFT TISSUES: No soft tissue abnormality within the neck. CERVICAL SPINE: No aggressive osseous lesions. Mild multilevel discogenic degenerative change. CONCLUSION: 1. No acute intracranial process appreciated. 2. Interval stenting of the left supraclinoid ICA in the area of severe stenosis with similar-appearing severe irregular narrowing just distal to the stent. 3. Unchanged severe calcified atherosclerosis of the cavernous ICAs and severe irregular narrowing of the distal right petrous and majority of the left petrous ICAs. 4. Suspected right dural AV fistula as above, unchanged. 5. No acute cervical arterial abnormality within the limitations of exam. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: CT of the head with and without contrast: There is no acute infarction, hemorrhage, or cerebral edema. The gray-white matter differentiation is maintained. The cerebral cortical volume is appropriate for patient's age. There is no space occupying intracranial lesion or hydrocephalus. No enhancing intracranial abnormality. There is no acute osseous or orbital abnormality. The mastoid air cells are clear. Mild mucosal thickening in bilateral maxillary and right sphenoid sinuses. CT angiogram of the brain: RIGHT CAROTID: Unchanged severe atherosclerotic calcification resulting in moderate narrowing of the distal petrous ICA. Dense calcified atherosclerosis of the cavernous ICA with mild irregular narrowing. No aneurysm. LEFT CAROTID: Unchanged severe irregular narrowing of the left petrous ICA, likely secondary to atherosclerosis. Dense calcified atherosclerosis of the cavernous ICA with mild irregular narrowing. Severe stenosis of the supraclinoid ICA, unchanged. Interval post angioplasty and stent changes of the left supraclinoid ICA in the area of previously noted severe stenosis with similar-appearing severe irregular narrowing just distal to the stent. No aneurysm. ANTERIOR, MIDDLE, AND POSTERIOR CEREBRAL ARTERIES: Hypoplastic right A1 segment, unchanged. No significant abnormality of the bilateral ACAs, MCAs, or PCAs. Unchanged prominent artery draining into the right transverse sinus which demonstrates asymmetric increased opacification (image 191, series #407), likely dural AV fistula. VERTEBROBASILAR ARTERIES: There is no evidence of stenosis, occlusion, or aneurysmal dilation. CT angiogram of the neck: AORTIC ARCH and PROXIMAL GREAT VESSELS: Limited evaluation the proximal vessels due to photon starvation artifact. Previously noted left vertebral ostial stenosis is not well evaluated due to adjacent contrast artifact. RIGHT CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT CAROTID: Mild atherosclerosis of the proximal ICA. 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: There is no evidence of stenosis, occlusion, or aneurysmal dilation. SOFT TISSUES: No soft tissue abnormality within the neck. CERVICAL SPINE: No aggressive osseous lesions. Mild multilevel discogenic degenerative change.
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Findings: Brain parenchyma: Diffuse age-appropriate brain parenchymal volume loss is again seen, resulting in ex vacuo dilatation of the ventricular system. Unchanged multifocal left temporal and right parietal encephalomalacia. Persistent mild periventricular white matter hypoattenuation, suggestive of mild chronic microvascular ischemic disease. The white-gray matter differentiation is preserved. Basal cisterns: There is no significant effacement of the basilar cisterns. Extra-axial spaces: Normal appearance. No abnormal extra-axial fluid collections. Hemorrhage: No intracranial hemorrhage is identified. Midline shift: No significant midline shift is seen. Vascular system: Punctate atherosclerotic calcifications of the bilateral carotid siphons. Soft tissues: Small mid parietal scalp granulation tissue with associated underlying remote corticated fracture of the right parietal calvarium. Orbits: Normal appearance. Calvarium and skull base: No definitive acute fractures or suspicious osseous lesions identified. The bilateral mastoid air cell complexes are well-developed and clear. Paranasal sinuses: Well aerated.
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