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CT-MRI_metrics_validation_dataset

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3,400
CT Perfusion 1/7/2022 11:34 PM Clinical Information: Stroke. tia Comparison: None 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 < 2.0 ml/100g) in the color red. Patient weight: 260 lbs. IV contrast: Omnipaque 350, 40 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 0 sec Scan field of view: 244.20 mm. DLP: 1440 mGy cm. Findings: . Color parametric maps demonstrate prolonged Tmax and mean transit time throughout most of the left cerebral hemisphere and also the paramedian right frontal lobe.. There is no decreased R CBV and there appears to be increased R CBV within the left cerebral hemisphere white matter and portions of the cortex Prognostic maps demonstrate large area of increased Tmax involving the left frontal, left parietal, left temporal and left occipital lobes. There is also small amount of involvement of the right frontal lobe. Total volume measures 274 mL. There is no CBF less than 30%.. Conclusion: Large areas of delayed perfusion involving most of the left cerebral hemisphere and portions of the right frontal lobe. There is severe multifocal stenosis of the left petrous, cavernous and supraclinoid ICA and also proximal left M1 segment on accompanying CTA.. There is also severe narrowing of the proximal left A1 segment. There is severe hypoplasia of the right A1 segment indicating that the right ICA is significantly perfused by the left ICA as well.
Findings: . Color parametric maps demonstrate prolonged Tmax and mean transit time throughout most of the left cerebral hemisphere and also the paramedian right frontal lobe.. There is no decreased R CBV and there appears to be increased R CBV within the left cerebral hemisphere white matter and portions of the cortex Prognostic maps demonstrate large area of increased Tmax involving the left frontal, left parietal, left temporal and left occipital lobes. There is also small amount of involvement of the right frontal lobe. Total volume measures 274 mL. There is no CBF less than 30%..
FINDINGS: There is no acute intracranial hemorrhage. There are no abnormal areas of hypoattenuation to suggest acute infarction or remote infarction there are prominent perivascular spaces within the inferior basal ganglia bilaterally. There are small calcifications within the basal ganglia bilaterally.. 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.
3,401
RADIOLOGIC EXAM: CT Head wo contrast, CT Maxillofacial wo contrast CLINICAL INFORMATION: Head trauma, mod-severe COMPARISON: None. TECHNIQUE: CT Head wo contrast, CT Maxillofacial wo contrastScan field of view: 214 mm. DLP: 1164 mGy cm. (accession CT220004035), Scan field of view: 200 mm. DLP: 363 mGy cm. (accession CT220004036) STRUCTURED REPORT: CT Head and Maxillofacial Trauma FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. Age-appropriate predominantly frontoparietal parenchymal volume loss. EXTRA-AXIAL SPACES: Normal. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SKULL AND SKULL BASE: No fracture. Bilateral mastoid air cells are clear. Moderate mid frontal scalp hematoma, measuring up to 13 mm. FACIAL BONES: No fracture. MANDIBLE: No acute fracture. Bilateral temporomandibular joints are intact. SINONASAL CAVITIES: Paranasal sinuses are clear. OTHER: No acute fracture of the visualized upper cervical spine. There is chronic appearing grade 1 anterolisthesis of C3 on C4. Chronic multilevel discogenic degenerative changes with facet and uncovertebral hypertrophy. IMPRESSION: 1. No acute intracranial process or evidence of acute maxillofacial fractures. 2. Moderate mid frontal scalp hematoma, measuring up to 13 mm, without underlying calvarial fracture. 3. Partially visualized chronic multilevel degenerative changes with grade 1 anterolisthesis of C3 on C4. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. Age-appropriate predominantly frontoparietal parenchymal volume loss. EXTRA-AXIAL SPACES: Normal. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SKULL AND SKULL BASE: No fracture. Bilateral mastoid air cells are clear. Moderate mid frontal scalp hematoma, measuring up to 13 mm. FACIAL BONES: No fracture. MANDIBLE: No acute fracture. Bilateral temporomandibular joints are intact. SINONASAL CAVITIES: Paranasal sinuses are clear. OTHER: No acute fracture of the visualized upper cervical spine. There is chronic appearing grade 1 anterolisthesis of C3 on C4. Chronic multilevel discogenic degenerative changes with facet and uncovertebral hypertrophy.
FINDINGS: Redemonstrated punctate region hyperdensity in the right insular cortex, unchanged from the prior scan, measuring 5 x 6 mm with Hounsfield units in the mid 60s, nonspecific. No new region of parenchymal hemorrhage. No mass effect or edema. Gray white matter differentiation is maintained. Persistent encephalomalacia involving the inferior aspect of the right cerebellar hemisphere, remote right PICA territory infarct. Periventricular and subcortical white matter hypodensities are consistent with chronic microangiopathic ischemic changes. No extra axial collection. There is mild diffuse cerebral atrophy with prominence of the cortical sulci, sylvian fissures and compensatory dilatation of the ventricles. No fracture or aggressive osseous lesion. The paranasal sinuses, middle ears, and mastoid air cells are clear. The orbits are unremarkable. The visualized soft tissues are unremarkable. --------------------
3,402
RADIOLOGIC EXAM: CT Head wo contrast, CT Maxillofacial wo contrast CLINICAL INFORMATION: Head trauma, mod-severe COMPARISON: None. TECHNIQUE: CT Head wo contrast, CT Maxillofacial wo contrastScan field of view: 214 mm. DLP: 1164 mGy cm. (accession CT220004035), Scan field of view: 200 mm. DLP: 363 mGy cm. (accession CT220004036) STRUCTURED REPORT: CT Head and Maxillofacial Trauma FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. Age-appropriate predominantly frontoparietal parenchymal volume loss. EXTRA-AXIAL SPACES: Normal. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SKULL AND SKULL BASE: No fracture. Bilateral mastoid air cells are clear. Moderate mid frontal scalp hematoma, measuring up to 13 mm. FACIAL BONES: No fracture. MANDIBLE: No acute fracture. Bilateral temporomandibular joints are intact. SINONASAL CAVITIES: Paranasal sinuses are clear. OTHER: No acute fracture of the visualized upper cervical spine. There is chronic appearing grade 1 anterolisthesis of C3 on C4. Chronic multilevel discogenic degenerative changes with facet and uncovertebral hypertrophy. IMPRESSION: 1. No acute intracranial process or evidence of acute maxillofacial fractures. 2. Moderate mid frontal scalp hematoma, measuring up to 13 mm, without underlying calvarial fracture. 3. Partially visualized chronic multilevel degenerative changes with grade 1 anterolisthesis of C3 on C4. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. Age-appropriate predominantly frontoparietal parenchymal volume loss. EXTRA-AXIAL SPACES: Normal. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SKULL AND SKULL BASE: No fracture. Bilateral mastoid air cells are clear. Moderate mid frontal scalp hematoma, measuring up to 13 mm. FACIAL BONES: No fracture. MANDIBLE: No acute fracture. Bilateral temporomandibular joints are intact. SINONASAL CAVITIES: Paranasal sinuses are clear. OTHER: No acute fracture of the visualized upper cervical spine. There is chronic appearing grade 1 anterolisthesis of C3 on C4. Chronic multilevel discogenic degenerative changes with facet and uncovertebral hypertrophy.
FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Absent. PANCREAS: Normal. Vascular calcification in the splenic artery noted. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Bilateral nonobstructing nephrolithiasis with the largest stone in the interpolar region of the left kidney measuring 0.7 cm and largest stone in the upper pole of the right kidney measuring 1.0 cm. No hydronephrosis. No ureteral calculi. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Scattered uncomplicated colonic diverticula. Normal appendix. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Moderate atherosclerotic calcifications of the abdominal aorta and branch vessels. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Fat-containing umbilical hernia. MUSCULOSKELETAL: Chronic left-sided rib fractures.
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Radiologic Exam: CT Angio Neck, CT Angio Head wo+w contrast 1/7/2022 10:53 PM Clinical Information: L arm pain, HA, ho SAH. Comparison: Multiple prior CTA head and neck, most recently 7/8/2020. Multiple prior CT heads, most recently 8/26/2020. 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: 172 lbs. IV contrast: Omnipaque 350, 125 ml, per protocol. IV contrast injection rate: 4 ml per sec. Scan delay: bt sec. Scan field of view: 286 mm. DLP: 4481 mGy cm. (accession CT220004038), Patient weight: 172 lbs. IV contrast: Omnipaque 350, 125 ml, per protocol. IV contrast injection rate: 4 ml per sec. Scan delay: bt sec. Scan field of view: 217 mm. (accession CT220004037) 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. Normal cerebral cortical volume. Unchanged ventriculomegaly. There is no space occupying intracranial lesion.. No enhancing intracranial abnormality. Stable post surgical change status post left pterional craniotomy and left MCA aneurysm clipping. Normal appearance of the orbits. The paranasal sinuses and mastoid air cells are clear. CT angiogram of the brain: RIGHT CAROTID: Mild scattered calcified atherosclerosis of the carotid siphon. There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT CAROTID: Mild scattered calcified atherosclerosis of the carotid siphon. There is no evidence of stenosis, occlusion, or aneurysmal dilation. ANTERIOR, MIDDLE, AND POSTERIOR CEREBRAL ARTERIES: Stable postsurgical change from prior left MCA aneurysm clipping. No filling of the aneurysm or recurrent aneurysm identified. Tiny 3 mm outpouching from an M2 branch of the right MCA (image 103, series #606 and image 233, series #304), unchanged from CTA head and neck dated 6/28/2020. Normal appearance of the bilateral ACAs and PCAs. VERTEBROBASILAR ARTERIES: There is no evidence of stenosis, occlusion, or aneurysmal dilation. CT angiogram of the neck: AORTIC ARCH and PROXIMAL GREAT VESSELS: Unremarkable. Bovine arch. RIGHT CAROTID: Minimal calcified atherosclerosis of the proximal ICA. There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT CAROTID: Minimal calcified 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: Unchanged subcentimeter hypoattenuating lesions in the bilateral thyroid lobes. CERVICAL SPINE: No aggressive osseous lesions. Mild multilevel discogenic degenerative changes of the cervical spine. CONCLUSION: 1. No acute intracranial process. 2. Stable postsurgical change from prior left MCA aneurysm clipping. 3. Stable tiny 3 mm outpouching from an M2 branch of the right MCA, likely a small aneurysm. 4. No cervical arterial abnormality. 5. Other stable and incidental findings as above. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
FINDINGS: CT of the head with and without contrast: There is no acute infarction, hemorrhage, or cerebral edema. The gray-white matter differentiation is maintained. Normal cerebral cortical volume. Unchanged ventriculomegaly. There is no space occupying intracranial lesion.. No enhancing intracranial abnormality. Stable post surgical change status post left pterional craniotomy and left MCA aneurysm clipping. Normal appearance of the orbits. The paranasal sinuses and mastoid air cells are clear. CT angiogram of the brain: RIGHT CAROTID: Mild scattered calcified atherosclerosis of the carotid siphon. There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT CAROTID: Mild scattered calcified atherosclerosis of the carotid siphon. There is no evidence of stenosis, occlusion, or aneurysmal dilation. ANTERIOR, MIDDLE, AND POSTERIOR CEREBRAL ARTERIES: Stable postsurgical change from prior left MCA aneurysm clipping. No filling of the aneurysm or recurrent aneurysm identified. Tiny 3 mm outpouching from an M2 branch of the right MCA (image 103, series #606 and image 233, series #304), unchanged from CTA head and neck dated 6/28/2020. Normal appearance of the bilateral ACAs and PCAs. VERTEBROBASILAR ARTERIES: There is no evidence of stenosis, occlusion, or aneurysmal dilation. CT angiogram of the neck: AORTIC ARCH and PROXIMAL GREAT VESSELS: Unremarkable. Bovine arch. RIGHT CAROTID: Minimal calcified atherosclerosis of the proximal ICA. There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT CAROTID: Minimal calcified 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: Unchanged subcentimeter hypoattenuating lesions in the bilateral thyroid lobes. CERVICAL SPINE: No aggressive osseous lesions. Mild multilevel discogenic degenerative changes of the cervical spine.
The calculated liver volumes are as follows: Total liver volume: 1940 mL Left hepatic lobe volume: 653 mL (34%) Right hepatic lobe volume: 1287 mL (66%) Left hepatic lobe lateral segment volume: 370 mL (19%) Left hepatic lobe medial segment volume: 283 mL (15%) Right hepatic lobe anterior segment volume: 694 mL (36%) Right hepatic lobe posterior segment volume: 593 mL (31%)
3,404
Radiologic Exam: CT Angio Neck, CT Angio Head wo+w contrast 1/7/2022 10:53 PM Clinical Information: L arm pain, HA, ho SAH. Comparison: Multiple prior CTA head and neck, most recently 7/8/2020. Multiple prior CT heads, most recently 8/26/2020. 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: 172 lbs. IV contrast: Omnipaque 350, 125 ml, per protocol. IV contrast injection rate: 4 ml per sec. Scan delay: bt sec. Scan field of view: 286 mm. DLP: 4481 mGy cm. (accession CT220004038), Patient weight: 172 lbs. IV contrast: Omnipaque 350, 125 ml, per protocol. IV contrast injection rate: 4 ml per sec. Scan delay: bt sec. Scan field of view: 217 mm. (accession CT220004037) 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. Normal cerebral cortical volume. Unchanged ventriculomegaly. There is no space occupying intracranial lesion.. No enhancing intracranial abnormality. Stable post surgical change status post left pterional craniotomy and left MCA aneurysm clipping. Normal appearance of the orbits. The paranasal sinuses and mastoid air cells are clear. CT angiogram of the brain: RIGHT CAROTID: Mild scattered calcified atherosclerosis of the carotid siphon. There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT CAROTID: Mild scattered calcified atherosclerosis of the carotid siphon. There is no evidence of stenosis, occlusion, or aneurysmal dilation. ANTERIOR, MIDDLE, AND POSTERIOR CEREBRAL ARTERIES: Stable postsurgical change from prior left MCA aneurysm clipping. No filling of the aneurysm or recurrent aneurysm identified. Tiny 3 mm outpouching from an M2 branch of the right MCA (image 103, series #606 and image 233, series #304), unchanged from CTA head and neck dated 6/28/2020. Normal appearance of the bilateral ACAs and PCAs. VERTEBROBASILAR ARTERIES: There is no evidence of stenosis, occlusion, or aneurysmal dilation. CT angiogram of the neck: AORTIC ARCH and PROXIMAL GREAT VESSELS: Unremarkable. Bovine arch. RIGHT CAROTID: Minimal calcified atherosclerosis of the proximal ICA. There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT CAROTID: Minimal calcified 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: Unchanged subcentimeter hypoattenuating lesions in the bilateral thyroid lobes. CERVICAL SPINE: No aggressive osseous lesions. Mild multilevel discogenic degenerative changes of the cervical spine. CONCLUSION: 1. No acute intracranial process. 2. Stable postsurgical change from prior left MCA aneurysm clipping. 3. Stable tiny 3 mm outpouching from an M2 branch of the right MCA, likely a small aneurysm. 4. No cervical arterial abnormality. 5. Other stable and incidental findings as above. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
FINDINGS: CT of the head with and without contrast: There is no acute infarction, hemorrhage, or cerebral edema. The gray-white matter differentiation is maintained. Normal cerebral cortical volume. Unchanged ventriculomegaly. There is no space occupying intracranial lesion.. No enhancing intracranial abnormality. Stable post surgical change status post left pterional craniotomy and left MCA aneurysm clipping. Normal appearance of the orbits. The paranasal sinuses and mastoid air cells are clear. CT angiogram of the brain: RIGHT CAROTID: Mild scattered calcified atherosclerosis of the carotid siphon. There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT CAROTID: Mild scattered calcified atherosclerosis of the carotid siphon. There is no evidence of stenosis, occlusion, or aneurysmal dilation. ANTERIOR, MIDDLE, AND POSTERIOR CEREBRAL ARTERIES: Stable postsurgical change from prior left MCA aneurysm clipping. No filling of the aneurysm or recurrent aneurysm identified. Tiny 3 mm outpouching from an M2 branch of the right MCA (image 103, series #606 and image 233, series #304), unchanged from CTA head and neck dated 6/28/2020. Normal appearance of the bilateral ACAs and PCAs. VERTEBROBASILAR ARTERIES: There is no evidence of stenosis, occlusion, or aneurysmal dilation. CT angiogram of the neck: AORTIC ARCH and PROXIMAL GREAT VESSELS: Unremarkable. Bovine arch. RIGHT CAROTID: Minimal calcified atherosclerosis of the proximal ICA. There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT CAROTID: Minimal calcified 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: Unchanged subcentimeter hypoattenuating lesions in the bilateral thyroid lobes. CERVICAL SPINE: No aggressive osseous lesions. Mild multilevel discogenic degenerative changes of the cervical spine.
FINDINGS: No acute fracture or dislocation. Again noted is a large cartilaginous lesion involving the proximal humerus extending approximately 8.1 cm in the craniocaudal dimension, not significant changed from the prior studies. Small amount of endosteal scalloping is noted. No cortical disruption is seen. Cystic changes are noted at the insertion of the supraspinatus and infraspinatus tendons on the greater tuberosity. Mild degenerative changes of the glenohumeral and acromioclavicular joints. The soft tissues are unremarkable.
3,405
CT Orbit or Temporal Bones wo contrast, CT Head wo contrast 1/7/2022 9:28 PM Clinical Information: HEADACHE, BLURRY VISION Comparison: CT of the head without contrast dated 8/19/2021. Technique: Unenhanced axial brain and orbits CT. Bone and soft tissue windows were reviewed. Sagittal and coronal images were generated from the axial data. Scan field of view: 194 mm. DLP: 727 mGy cm. (accession CT220004041), Scan field of view: 226 mm. DLP: 1395.90 mGy cm. (accession CT220004040) 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. 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 right maxillary sinus mucous retention cysts and trace left maxillary sinus mucosal thickening. Otherwise, remain well aerated. Superficial soft tissues: Normal appearance. Globes: Intact and normal in appearance. Optic Nerves: Unchanged tortuosity of the bilateral intraconal optic nerves, with associated empty sella. Extraocular Muscles: Intact and normal in appearance. Retrobulbar soft tissues: No significant focal abnormality identified. Cavernous sinus and superior ophthalmic veins: Appear symmetric. IMPRESSION: 1. No acute intracranial process or significant interval change identified. 2. Persistent tortuosity of the bilateral intraconal optic nerves, with associated empty sella, which may represent sequela of idiopathic intracranial hypertension.
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. 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 right maxillary sinus mucous retention cysts and trace left maxillary sinus mucosal thickening. Otherwise, remain well aerated. Superficial soft tissues: Normal appearance. Globes: Intact and normal in appearance. Optic Nerves: Unchanged tortuosity of the bilateral intraconal optic nerves, with associated empty sella. Extraocular Muscles: Intact and normal in appearance. Retrobulbar soft tissues: No significant focal abnormality identified. Cavernous sinus and superior ophthalmic veins: Appear symmetric.
FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. No enlarged intrathoracic lymph nodes. Small hiatal hernia is seen with slight dilatation the mid to distal thoracic aorta. Calcific atherosclerosis is seen in the aorta and in the native coronary arteries. Post CABG findings with LIMA graft are present. Small amount of retrosternal fluid is seen measuring 18 x 31 mm on series 3 image 34. There is also some slight stranding and edema in the anterior mediastinal fat from the recent CABG. Calcification of mitral valve annulus and aortic valve leaflets is noted. The mediastinum and heart are slightly shifted to the left due to volume loss in the left hemithorax. Mild cardiomegaly is present. Noncontrast images the mediastinum are otherwise unremarkable. A large and loculated left pleural effusion is seen with considerable fluid trapped in the major fissure. Partial dependent and compressive atelectasis is seen in the left lower lobe and in the lingula. A few scattered calcified granuloma are identified bilaterally. Evidence of segmental atelectasis and scarring in the medial aspects of the RUL and RML. The lungs are otherwise normal. Cirrhotic liver is demonstrated. The gallbladder has been previously removed. The spleen is enlarged with the gastrohepatic varices noted consistent with portal hypertension. Left adrenal nodule measuring at most 1 cm is seen on image. This measures greater then 10 Hounsfield units. This appears unchanged from the abdomen CT on 11/18. Limited images of the upper abdomen are otherwise unremarkable. Poststernotomy changes are seen in the sternum with evidence of erosion in the manubrium on images 22-24. The first sternal wire does not have purchase in the bone of the right sternum. Anterior wedging is seen at T7 this appears to been present on the prior lateral chest radiograph on 11/18/2021. The bones are otherwise unremarkable.
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CT Orbit or Temporal Bones wo contrast, CT Head wo contrast 1/7/2022 9:28 PM Clinical Information: HEADACHE, BLURRY VISION Comparison: CT of the head without contrast dated 8/19/2021. Technique: Unenhanced axial brain and orbits CT. Bone and soft tissue windows were reviewed. Sagittal and coronal images were generated from the axial data. Scan field of view: 194 mm. DLP: 727 mGy cm. (accession CT220004041), Scan field of view: 226 mm. DLP: 1395.90 mGy cm. (accession CT220004040) 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. 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 right maxillary sinus mucous retention cysts and trace left maxillary sinus mucosal thickening. Otherwise, remain well aerated. Superficial soft tissues: Normal appearance. Globes: Intact and normal in appearance. Optic Nerves: Unchanged tortuosity of the bilateral intraconal optic nerves, with associated empty sella. Extraocular Muscles: Intact and normal in appearance. Retrobulbar soft tissues: No significant focal abnormality identified. Cavernous sinus and superior ophthalmic veins: Appear symmetric. IMPRESSION: 1. No acute intracranial process or significant interval change identified. 2. Persistent tortuosity of the bilateral intraconal optic nerves, with associated empty sella, which may represent sequela of idiopathic intracranial hypertension.
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. 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 right maxillary sinus mucous retention cysts and trace left maxillary sinus mucosal thickening. Otherwise, remain well aerated. Superficial soft tissues: Normal appearance. Globes: Intact and normal in appearance. Optic Nerves: Unchanged tortuosity of the bilateral intraconal optic nerves, with associated empty sella. Extraocular Muscles: Intact and normal in appearance. Retrobulbar soft tissues: No significant focal abnormality identified. Cavernous sinus and superior ophthalmic veins: Appear symmetric.
FINDINGS: The left upper lobe subpleural nodular density in image 65, series 2 is 14 x 13 mm, unchanged since December 2021 but increased since 2019 CT. Extensive bilateral multi lobar bronchiectasis much more severe in the left lung with significant left upper lobe volume loss. Increased airspace opacity surrounding the bronchiectatic cavities in the left upper lobe. The nodular cluster in the posterior segment of right upper lobe is also slightly more prominent near the fissure. Patient is status post left lower lobectomy. The previously noted right pleural and pericardial effusion have almost resolved. There are several minimally enlarged nodes in the mediastinum. The right hila also appear enlarged suggesting adenopathy although cannot accurately measure due to lack of contrast. There is no focal lytic or sclerotic bone lesion.
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RADIOLOGIC EXAM: CT Head wo contrast, CT Maxillofacial wo contrast CLINICAL INFORMATION: Trauma COMPARISON: None. TECHNIQUE: CT Head wo contrast, CT Maxillofacial wo contrastScan field of view: 230 mm. DLP: 1387 mGy cm. (accession CT220004042), Scan field of view: 220 mm. DLP: 1105 mGy cm. (accession CT220004048) STRUCTURED REPORT: CT Head and Maxillofacial Trauma 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 acute fracture. Bilateral mastoid air cells are clear. Small right frontal scalp laceration. FACIAL BONES: No acute fracture. Bilateral pterygoid plates are intact. MANDIBLE: No acute fracture. Bilateral temporomandibular joints are intact. SINONASAL CAVITIES: Paranasal sinuses are clear. CONCLUSION: No acute intracranial process or maxillofacial fracture. Small right frontal scalp laceration. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
FINDINGS: BRAIN PARENCHYMA: No hemorrhage, 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 acute fracture. Bilateral mastoid air cells are clear. Small right frontal scalp laceration. FACIAL BONES: No acute fracture. Bilateral pterygoid plates are intact. MANDIBLE: No acute fracture. Bilateral temporomandibular joints are intact. SINONASAL CAVITIES: Paranasal sinuses are clear.
FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: 5 mm nodule in the left lung base (axial series 4, image 21), grossly unchanged. No other significant abnormality. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Extensive parenchymal calcifications, compatible with chronic pancreatitis. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Bilateral renal scarring. Minute subcentimeter hypodensity within the left kidney is technically indeterminate but statistically likely a cyst. LYMPH NODES: Few prominent left external iliac and inguinal nodes. No other enlarged lymph nodes. Fluid collection along the left external iliac chain, as described below. STOMACH / SMALL BOWEL: Stomach is normal. Small periampullary duodenal diverticulum. Small bowel is otherwise unremarkable. COLON / APPENDIX: Uncomplicated diverticulosis. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Simple fluid collection along the left pelvic sidewall/external iliac vessels measuring 8.9 x 5.5 cm (axial series 101, image 229). Mild surrounding fat stranding. There is mass effect upon the left external iliac vein which otherwise grossly patent. This fluid partially extends through the left inguinal canal and into the spermatic cord. VESSELS: Mild calcific atherosclerosis of the abdominal aorta and its branch vessels. URINARY BLADDER: Small amount of intraluminal air, likely secondary to recent instrumentation. Cystogram images demonstrate Foley catheter in place which appears to the outside of the bladder lumen, partially inflated in the prostatic urethra extending into the extraperitoneal soft tissues. Small amount of contrast within the bladder lumen which may be secondary to physiologic excretion as there is contrast in bilateral ureters. Soft tissue gas surrounds the Foley catheter balloon. There is also gas seen extending posterior to the bladder, possibly within the periprostatectomy fat or seminal vesicles. REPRODUCTIVE ORGANS: Prostate is surgically absent. Moderate-sized left hydrocele. Diffuse scrotal edema. BODY WALL: Scattered soft tissue gas, predominantly in the ventral abdominal wall which may be secondary to recent postoperative changes and/or medication injection related changes. Tiny fat-containing periumbilical hernia. Mild diffuse lower body wall anasarca. There is a large left inguinal hernia containing fluid and fat. There is a suspected small fat-containing right inguinal hernia. MUSCULOSKELETAL: Sclerotic lesion in the right ilium is redemonstrated. Multilevel degenerative changes of the thoracolumbar spine.
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EXAM: CT Chest with contrast, CT Abdomen and Pelvis w contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat CLINICAL INFORMATION: Trauma, stabbing. COMPARISON: Prior same-day chest and pelvis radiographs. TECHNIQUE: CT Chest with contrast, CT Abdomen and Pelvis w contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat. Patient weight: 145 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bt sec. Scan field of view: 415 mm. DLP: 823 mGy cm. (accession CT220004043), Patient weight: 145 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bt sec. Scan field of view: 415 mm. (accession CT220004044) FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Central airways are patent. Large right and moderate left pneumothoraces. Small bilateral hemothoraces. Multiple pulmonary contusions and lacerations involving predominantly the right lung and left lower lobe. HEART / VESSELS: Heart size is normal. No significant abnormality. The aorta appears intact. MEDIASTINUM / ESOPHAGUS: There is an apparent defect in the right lateral wall of the distal thoracic esophagus (axial series 501, image 225). There is no evidence of an adjacent fluid collection. No pneumomediastinum. No other significant abnormality. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: Penetrating injury to the left anterior shoulder with underlying soft tissue emphysema extending to the left chest wall. Additional penetrating injuries to the upper back and right mid back with associated contusive changes and extensive underlying soft tissue emphysema. Emphysema extends along the right greater than left paraspinous musculature. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Bilateral renal hypodensities are too small to adequately characterize, but statistically represent simple cysts. No hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. Appendix is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal with small amount of excreted contrast. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No other significant abnormality. MUSCULOSKELETAL: Minimally displaced fracture of the right posterior sixth rib. Penetrating injury to the left scapular body with focal left scapular body fracture axial image 118 series 502 for example. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: No acute fracture. Bilateral chronic L5 pars defects. DISC SPACES AND FACET JOINTS: No acute injury. Small disc bulge at L5-S1 and mild to moderate bilateral foraminal narrowing. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: There is grade 1 spondylolisthesis of L5 on S1 in setting of pars defects. Posterior vertebral alignment is otherwise maintained. CONCLUSION: 1. Large right and moderate left pneumothoraces and small bilateral hemothoraces. Multiple pulmonary contusions and lung lacerations bilaterally. 2. Penetrating injuries to the left anterior shoulder as well as the upper and mid back with associated soft tissue injuries and underlying emphysema. 3. Apparent defect in the right lateral wall of the distal thoracic esophagus is concerning for an esophageal penetrating injury. CT esophagram can be obtained for further characterization if clinically warranted. 4. Minimally displaced fracture of the right posterior sixth rib. Penetrating injury to the left shoulder with subtle mildly displaced left scapular body fracture. 5. No acute traumatic findings in the abdomen or pelvis. No acute fracture or malalignment of the thoracolumbar spine. Preliminary findings were reported to Dr. Cody Tyson at 10:05 PM on 1/7/2022 by Dr. Dylan Bittles. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Central airways are patent. Large right and moderate left pneumothoraces. Small bilateral hemothoraces. Multiple pulmonary contusions and lacerations involving predominantly the right lung and left lower lobe. HEART / VESSELS: Heart size is normal. No significant abnormality. The aorta appears intact. MEDIASTINUM / ESOPHAGUS: There is an apparent defect in the right lateral wall of the distal thoracic esophagus (axial series 501, image 225). There is no evidence of an adjacent fluid collection. No pneumomediastinum. No other significant abnormality. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: Penetrating injury to the left anterior shoulder with underlying soft tissue emphysema extending to the left chest wall. Additional penetrating injuries to the upper back and right mid back with associated contusive changes and extensive underlying soft tissue emphysema. Emphysema extends along the right greater than left paraspinous musculature. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Bilateral renal hypodensities are too small to adequately characterize, but statistically represent simple cysts. No hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. Appendix is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal with small amount of excreted contrast. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No other significant abnormality. MUSCULOSKELETAL: Minimally displaced fracture of the right posterior sixth rib. Penetrating injury to the left scapular body with focal left scapular body fracture axial image 118 series 502 for example. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: No acute fracture. Bilateral chronic L5 pars defects. DISC SPACES AND FACET JOINTS: No acute injury. Small disc bulge at L5-S1 and mild to moderate bilateral foraminal narrowing. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: There is grade 1 spondylolisthesis of L5 on S1 in setting of pars defects. Posterior vertebral alignment is otherwise maintained.
FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: 5 mm nodule in the left lung base (axial series 4, image 21), grossly unchanged. No other significant abnormality. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Extensive parenchymal calcifications, compatible with chronic pancreatitis. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Bilateral renal scarring. Minute subcentimeter hypodensity within the left kidney is technically indeterminate but statistically likely a cyst. LYMPH NODES: Few prominent left external iliac and inguinal nodes. No other enlarged lymph nodes. Fluid collection along the left external iliac chain, as described below. STOMACH / SMALL BOWEL: Stomach is normal. Small periampullary duodenal diverticulum. Small bowel is otherwise unremarkable. COLON / APPENDIX: Uncomplicated diverticulosis. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Simple fluid collection along the left pelvic sidewall/external iliac vessels measuring 8.9 x 5.5 cm (axial series 101, image 229). Mild surrounding fat stranding. There is mass effect upon the left external iliac vein which otherwise grossly patent. This fluid partially extends through the left inguinal canal and into the spermatic cord. VESSELS: Mild calcific atherosclerosis of the abdominal aorta and its branch vessels. URINARY BLADDER: Small amount of intraluminal air, likely secondary to recent instrumentation. Cystogram images demonstrate Foley catheter in place which appears to the outside of the bladder lumen, partially inflated in the prostatic urethra extending into the extraperitoneal soft tissues. Small amount of contrast within the bladder lumen which may be secondary to physiologic excretion as there is contrast in bilateral ureters. Soft tissue gas surrounds the Foley catheter balloon. There is also gas seen extending posterior to the bladder, possibly within the periprostatectomy fat or seminal vesicles. REPRODUCTIVE ORGANS: Prostate is surgically absent. Moderate-sized left hydrocele. Diffuse scrotal edema. BODY WALL: Scattered soft tissue gas, predominantly in the ventral abdominal wall which may be secondary to recent postoperative changes and/or medication injection related changes. Tiny fat-containing periumbilical hernia. Mild diffuse lower body wall anasarca. There is a large left inguinal hernia containing fluid and fat. There is a suspected small fat-containing right inguinal hernia. MUSCULOSKELETAL: Sclerotic lesion in the right ilium is redemonstrated. Multilevel degenerative changes of the thoracolumbar spine.
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EXAM: CT Chest with contrast, CT Abdomen and Pelvis w contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat CLINICAL INFORMATION: Trauma, stabbing. COMPARISON: Prior same-day chest and pelvis radiographs. TECHNIQUE: CT Chest with contrast, CT Abdomen and Pelvis w contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat. Patient weight: 145 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bt sec. Scan field of view: 415 mm. DLP: 823 mGy cm. (accession CT220004043), Patient weight: 145 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bt sec. Scan field of view: 415 mm. (accession CT220004044) FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Central airways are patent. Large right and moderate left pneumothoraces. Small bilateral hemothoraces. Multiple pulmonary contusions and lacerations involving predominantly the right lung and left lower lobe. HEART / VESSELS: Heart size is normal. No significant abnormality. The aorta appears intact. MEDIASTINUM / ESOPHAGUS: There is an apparent defect in the right lateral wall of the distal thoracic esophagus (axial series 501, image 225). There is no evidence of an adjacent fluid collection. No pneumomediastinum. No other significant abnormality. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: Penetrating injury to the left anterior shoulder with underlying soft tissue emphysema extending to the left chest wall. Additional penetrating injuries to the upper back and right mid back with associated contusive changes and extensive underlying soft tissue emphysema. Emphysema extends along the right greater than left paraspinous musculature. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Bilateral renal hypodensities are too small to adequately characterize, but statistically represent simple cysts. No hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. Appendix is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal with small amount of excreted contrast. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No other significant abnormality. MUSCULOSKELETAL: Minimally displaced fracture of the right posterior sixth rib. Penetrating injury to the left scapular body with focal left scapular body fracture axial image 118 series 502 for example. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: No acute fracture. Bilateral chronic L5 pars defects. DISC SPACES AND FACET JOINTS: No acute injury. Small disc bulge at L5-S1 and mild to moderate bilateral foraminal narrowing. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: There is grade 1 spondylolisthesis of L5 on S1 in setting of pars defects. Posterior vertebral alignment is otherwise maintained. CONCLUSION: 1. Large right and moderate left pneumothoraces and small bilateral hemothoraces. Multiple pulmonary contusions and lung lacerations bilaterally. 2. Penetrating injuries to the left anterior shoulder as well as the upper and mid back with associated soft tissue injuries and underlying emphysema. 3. Apparent defect in the right lateral wall of the distal thoracic esophagus is concerning for an esophageal penetrating injury. CT esophagram can be obtained for further characterization if clinically warranted. 4. Minimally displaced fracture of the right posterior sixth rib. Penetrating injury to the left shoulder with subtle mildly displaced left scapular body fracture. 5. No acute traumatic findings in the abdomen or pelvis. No acute fracture or malalignment of the thoracolumbar spine. Preliminary findings were reported to Dr. Cody Tyson at 10:05 PM on 1/7/2022 by Dr. Dylan Bittles. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Central airways are patent. Large right and moderate left pneumothoraces. Small bilateral hemothoraces. Multiple pulmonary contusions and lacerations involving predominantly the right lung and left lower lobe. HEART / VESSELS: Heart size is normal. No significant abnormality. The aorta appears intact. MEDIASTINUM / ESOPHAGUS: There is an apparent defect in the right lateral wall of the distal thoracic esophagus (axial series 501, image 225). There is no evidence of an adjacent fluid collection. No pneumomediastinum. No other significant abnormality. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: Penetrating injury to the left anterior shoulder with underlying soft tissue emphysema extending to the left chest wall. Additional penetrating injuries to the upper back and right mid back with associated contusive changes and extensive underlying soft tissue emphysema. Emphysema extends along the right greater than left paraspinous musculature. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Bilateral renal hypodensities are too small to adequately characterize, but statistically represent simple cysts. No hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. Appendix is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal with small amount of excreted contrast. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No other significant abnormality. MUSCULOSKELETAL: Minimally displaced fracture of the right posterior sixth rib. Penetrating injury to the left scapular body with focal left scapular body fracture axial image 118 series 502 for example. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: No acute fracture. Bilateral chronic L5 pars defects. DISC SPACES AND FACET JOINTS: No acute injury. Small disc bulge at L5-S1 and mild to moderate bilateral foraminal narrowing. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: There is grade 1 spondylolisthesis of L5 on S1 in setting of pars defects. Posterior vertebral alignment is otherwise maintained.
Findings: Comparison: 12/15/2021 Vascular Findings: No PTE. Heart size is at the upper limits of normal. No dense coronary artery atherosclerotic calcifications or pericardial effusion. Chest Wall and Abdomen: Between the upper endplates of T3 and T5 a right paraspinal mass is again noted measuring approximately 3.5 x 2.0 cm image 31 series 3, previously 3.3 x 1.9 cm. During arterial phase this shows minimal contrast enhancement. During venous phase this shows peripheral enhancement with a central region of hypoenhancement. No direct communication with the spinal canal is seen. No destructive osseous lesions. Included portions of the upper abdomen have an unremarkable appearance. Lower Neck, Mediastinum, and Lymph Nodes: No axillary or mediastinal adenopathy. Lungs and Pleura: No pleural effusion. No suspicious appearing pulmonary nodules.
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RADIOLOGIC EXAM: CT Angio Neck, CT Cervical Spine From Reformat CLINICAL INFORMATION: Trauma. COMPARISON: None. TECHNIQUE: CT Angio Neck, CT Cervical Spine From ReformatPatient weight: 145 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bt sec. Scan field of view: 220 mm. DLP: 1136 mGy cm. Following CT of the neck, reformatted images were produced to optimize visualization of the osseous structures of the cervical spine. 3-D CT MIP were generated in post processing. FINDINGS: CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
FINDINGS: CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
FINDINGS: Multifocal areas of groundglass density have decreased in density resolved with known diffuse mosaic attenuation seen. Subpleural reticulation has also decreased. Scattered calcified granuloma are noted. No noncalcified nodules or masses no focal airspace consolidation. No pleural effusion. - Mild air trapping is seen on expiratory images predominantly in the upper lobes. No tracheobronchomalacia. - Calcified nodes are seen in the left hilum. No enlarged intrathoracic lymph nodes are identified. Slight calcific atherosclerosis is seen in the aorta. Within the limits of a noncontrast exam, the heart size and the mediastinum are otherwise normal. - Limited noncontrast images of the upper abdomen are unremarkable. - No focal destructive osseous lesions. -
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EXAM: CT Chest with contrast, CT Abdomen and Pelvis w contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat CLINICAL INFORMATION: Trauma, stabbing. COMPARISON: Prior same-day chest and pelvis radiographs. TECHNIQUE: CT Chest with contrast, CT Abdomen and Pelvis w contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat. Patient weight: 145 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bt sec. Scan field of view: 415 mm. DLP: 823 mGy cm. (accession CT220004043), Patient weight: 145 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bt sec. Scan field of view: 415 mm. (accession CT220004044) FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Central airways are patent. Large right and moderate left pneumothoraces. Small bilateral hemothoraces. Multiple pulmonary contusions and lacerations involving predominantly the right lung and left lower lobe. HEART / VESSELS: Heart size is normal. No significant abnormality. The aorta appears intact. MEDIASTINUM / ESOPHAGUS: There is an apparent defect in the right lateral wall of the distal thoracic esophagus (axial series 501, image 225). There is no evidence of an adjacent fluid collection. No pneumomediastinum. No other significant abnormality. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: Penetrating injury to the left anterior shoulder with underlying soft tissue emphysema extending to the left chest wall. Additional penetrating injuries to the upper back and right mid back with associated contusive changes and extensive underlying soft tissue emphysema. Emphysema extends along the right greater than left paraspinous musculature. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Bilateral renal hypodensities are too small to adequately characterize, but statistically represent simple cysts. No hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. Appendix is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal with small amount of excreted contrast. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No other significant abnormality. MUSCULOSKELETAL: Minimally displaced fracture of the right posterior sixth rib. Penetrating injury to the left scapular body with focal left scapular body fracture axial image 118 series 502 for example. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: No acute fracture. Bilateral chronic L5 pars defects. DISC SPACES AND FACET JOINTS: No acute injury. Small disc bulge at L5-S1 and mild to moderate bilateral foraminal narrowing. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: There is grade 1 spondylolisthesis of L5 on S1 in setting of pars defects. Posterior vertebral alignment is otherwise maintained. CONCLUSION: 1. Large right and moderate left pneumothoraces and small bilateral hemothoraces. Multiple pulmonary contusions and lung lacerations bilaterally. 2. Penetrating injuries to the left anterior shoulder as well as the upper and mid back with associated soft tissue injuries and underlying emphysema. 3. Apparent defect in the right lateral wall of the distal thoracic esophagus is concerning for an esophageal penetrating injury. CT esophagram can be obtained for further characterization if clinically warranted. 4. Minimally displaced fracture of the right posterior sixth rib. Penetrating injury to the left shoulder with subtle mildly displaced left scapular body fracture. 5. No acute traumatic findings in the abdomen or pelvis. No acute fracture or malalignment of the thoracolumbar spine. Preliminary findings were reported to Dr. Cody Tyson at 10:05 PM on 1/7/2022 by Dr. Dylan Bittles. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Central airways are patent. Large right and moderate left pneumothoraces. Small bilateral hemothoraces. Multiple pulmonary contusions and lacerations involving predominantly the right lung and left lower lobe. HEART / VESSELS: Heart size is normal. No significant abnormality. The aorta appears intact. MEDIASTINUM / ESOPHAGUS: There is an apparent defect in the right lateral wall of the distal thoracic esophagus (axial series 501, image 225). There is no evidence of an adjacent fluid collection. No pneumomediastinum. No other significant abnormality. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: Penetrating injury to the left anterior shoulder with underlying soft tissue emphysema extending to the left chest wall. Additional penetrating injuries to the upper back and right mid back with associated contusive changes and extensive underlying soft tissue emphysema. Emphysema extends along the right greater than left paraspinous musculature. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Bilateral renal hypodensities are too small to adequately characterize, but statistically represent simple cysts. No hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. Appendix is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal with small amount of excreted contrast. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No other significant abnormality. MUSCULOSKELETAL: Minimally displaced fracture of the right posterior sixth rib. Penetrating injury to the left scapular body with focal left scapular body fracture axial image 118 series 502 for example. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: No acute fracture. Bilateral chronic L5 pars defects. DISC SPACES AND FACET JOINTS: No acute injury. Small disc bulge at L5-S1 and mild to moderate bilateral foraminal narrowing. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: There is grade 1 spondylolisthesis of L5 on S1 in setting of pars defects. Posterior vertebral alignment is otherwise maintained.
Findings: There are calcified plaques in the right common carotid artery at the plane of T1 with severe stenosis (axial series 3 #358, sagittal series 602 #41 and coronal series 601 #42). The residual lumen measures 3 mm and there may be additional atheromatous plaque and more severe stenosis.. The nasopharynx is unremarkable and the oral cavity and tongue base appear normal. No abnormal adenopathy is seen. The hypopharynx and larynx have normal appearance. The infraglottic visceral space appears normal. The remaining soft tissues of the neck are unremarkable. --------------
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EXAM: CT Chest with contrast, CT Abdomen and Pelvis w contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat CLINICAL INFORMATION: Trauma, stabbing. COMPARISON: Prior same-day chest and pelvis radiographs. TECHNIQUE: CT Chest with contrast, CT Abdomen and Pelvis w contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat. Patient weight: 145 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bt sec. Scan field of view: 415 mm. DLP: 823 mGy cm. (accession CT220004043), Patient weight: 145 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bt sec. Scan field of view: 415 mm. (accession CT220004044) FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Central airways are patent. Large right and moderate left pneumothoraces. Small bilateral hemothoraces. Multiple pulmonary contusions and lacerations involving predominantly the right lung and left lower lobe. HEART / VESSELS: Heart size is normal. No significant abnormality. The aorta appears intact. MEDIASTINUM / ESOPHAGUS: There is an apparent defect in the right lateral wall of the distal thoracic esophagus (axial series 501, image 225). There is no evidence of an adjacent fluid collection. No pneumomediastinum. No other significant abnormality. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: Penetrating injury to the left anterior shoulder with underlying soft tissue emphysema extending to the left chest wall. Additional penetrating injuries to the upper back and right mid back with associated contusive changes and extensive underlying soft tissue emphysema. Emphysema extends along the right greater than left paraspinous musculature. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Bilateral renal hypodensities are too small to adequately characterize, but statistically represent simple cysts. No hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. Appendix is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal with small amount of excreted contrast. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No other significant abnormality. MUSCULOSKELETAL: Minimally displaced fracture of the right posterior sixth rib. Penetrating injury to the left scapular body with focal left scapular body fracture axial image 118 series 502 for example. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: No acute fracture. Bilateral chronic L5 pars defects. DISC SPACES AND FACET JOINTS: No acute injury. Small disc bulge at L5-S1 and mild to moderate bilateral foraminal narrowing. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: There is grade 1 spondylolisthesis of L5 on S1 in setting of pars defects. Posterior vertebral alignment is otherwise maintained. CONCLUSION: 1. Large right and moderate left pneumothoraces and small bilateral hemothoraces. Multiple pulmonary contusions and lung lacerations bilaterally. 2. Penetrating injuries to the left anterior shoulder as well as the upper and mid back with associated soft tissue injuries and underlying emphysema. 3. Apparent defect in the right lateral wall of the distal thoracic esophagus is concerning for an esophageal penetrating injury. CT esophagram can be obtained for further characterization if clinically warranted. 4. Minimally displaced fracture of the right posterior sixth rib. Penetrating injury to the left shoulder with subtle mildly displaced left scapular body fracture. 5. No acute traumatic findings in the abdomen or pelvis. No acute fracture or malalignment of the thoracolumbar spine. Preliminary findings were reported to Dr. Cody Tyson at 10:05 PM on 1/7/2022 by Dr. Dylan Bittles. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Central airways are patent. Large right and moderate left pneumothoraces. Small bilateral hemothoraces. Multiple pulmonary contusions and lacerations involving predominantly the right lung and left lower lobe. HEART / VESSELS: Heart size is normal. No significant abnormality. The aorta appears intact. MEDIASTINUM / ESOPHAGUS: There is an apparent defect in the right lateral wall of the distal thoracic esophagus (axial series 501, image 225). There is no evidence of an adjacent fluid collection. No pneumomediastinum. No other significant abnormality. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: Penetrating injury to the left anterior shoulder with underlying soft tissue emphysema extending to the left chest wall. Additional penetrating injuries to the upper back and right mid back with associated contusive changes and extensive underlying soft tissue emphysema. Emphysema extends along the right greater than left paraspinous musculature. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Bilateral renal hypodensities are too small to adequately characterize, but statistically represent simple cysts. No hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. Appendix is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal with small amount of excreted contrast. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No other significant abnormality. MUSCULOSKELETAL: Minimally displaced fracture of the right posterior sixth rib. Penetrating injury to the left scapular body with focal left scapular body fracture axial image 118 series 502 for example. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: No acute fracture. Bilateral chronic L5 pars defects. DISC SPACES AND FACET JOINTS: No acute injury. Small disc bulge at L5-S1 and mild to moderate bilateral foraminal narrowing. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: There is grade 1 spondylolisthesis of L5 on S1 in setting of pars defects. Posterior vertebral alignment is otherwise maintained.
FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Few areas of subsegmental atelectasis and septal thickening in the right lung base. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Mild diffuse fatty atrophy. Pancreas is otherwise unremarkable. SPLEEN: Normal. ADRENALS: Multiple indeterminate left adrenal nodules, the largest of which measures 1.7 cm (axial series 202, image 94). KIDNEYS: Bilateral renal hypodensities are too small to adequately characterize, but statistically represent simple cysts. No hydronephrosis or renal calculi. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Colon is diffusely distended with an abrupt transition point in the sigmoid colon where there is focal irregular wall thickening and minimal surrounding inflammatory changes. The rectum is partially air filled and unremarkable. Irregular soft tissue stranding and focal peritoneal thickening adjacent to the sigmoid colon in the left lower quadrant. There is a small fecal material filled collection measuring 1.6 cm on image 258, series 201 which appears slightly eccentric to the expected colonic lumen. Questionable areas of pneumatosis in the cecum and ascending colon, though predominantly in dependent locations and may represent trapped gas/frothy secretions. Colonic diverticulosis. PERITONEUM / MESENTERY: Irregular peritoneal thickening with associated stranding and aggressive calcification in the left lower quadrant. This area appears associated with the irregular sigmoid colon thickening. No definite free fluid. No pneumoperitoneum. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Poorly visualized secondary to streak artifact. Visualized portions appear unremarkable. REPRODUCTIVE ORGANS: Uterus is present, though poorly evaluated due to streak artifact. BODY WALL: Tiny fat-containing periumbilical hernia. No other significant abnormality. MUSCULOSKELETAL: Postsurgical changes of bilateral hip arthroplasties. Sclerotic changes in the L4 and L5 vertebral bodies along with degenerative endplate changes which are most severe at this level. Additional multilevel chronic degenerative changes of the visualized thoracolumbar spine.
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RADIOLOGIC EXAM: CT Head wo contrast, CT Maxillofacial wo contrast CLINICAL INFORMATION: Trauma COMPARISON: None. TECHNIQUE: CT Head wo contrast, CT Maxillofacial wo contrastScan field of view: 230 mm. DLP: 1387 mGy cm. (accession CT220004042), Scan field of view: 220 mm. DLP: 1105 mGy cm. (accession CT220004048) STRUCTURED REPORT: CT Head and Maxillofacial Trauma 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 acute fracture. Bilateral mastoid air cells are clear. Small right frontal scalp laceration. FACIAL BONES: No acute fracture. Bilateral pterygoid plates are intact. MANDIBLE: No acute fracture. Bilateral temporomandibular joints are intact. SINONASAL CAVITIES: Paranasal sinuses are clear. CONCLUSION: No acute intracranial process or maxillofacial fracture. Small right frontal scalp laceration. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
FINDINGS: BRAIN PARENCHYMA: No hemorrhage, 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 acute fracture. Bilateral mastoid air cells are clear. Small right frontal scalp laceration. FACIAL BONES: No acute fracture. Bilateral pterygoid plates are intact. MANDIBLE: No acute fracture. Bilateral temporomandibular joints are intact. SINONASAL CAVITIES: Paranasal sinuses are clear.
Findings: No acute fracture or dislocation. Status post bilateral trapeziectomy with associated degenerative changes of the base of the thumb metacarpal. Advanced degenerative and erosive changes of the distal interphalangeal joints of the bilateral index and middle fingers possibly represents erosive osteoarthritis. No other significant degenerative or osseous erosive changes are noted. Mild bilateral negative ulnar variance. No evidence of monosodium urate deposition. The soft tissues are unremarkable.
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RADIOLOGIC EXAM: CT Angio Neck, CT Cervical Spine From Reformat CLINICAL INFORMATION: Trauma. COMPARISON: None. TECHNIQUE: CT Angio Neck, CT Cervical Spine From ReformatPatient weight: 145 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bt sec. Scan field of view: 220 mm. DLP: 1136 mGy cm. Following CT of the neck, reformatted images were produced to optimize visualization of the osseous structures of the cervical spine. 3-D CT MIP were generated in post processing. FINDINGS: CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
FINDINGS: CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
Findings: There is prominent mucosal thickening in the right maxillary sinus and slight thickening in the left. Both ostiomeatal complexes are narrow. There is slight mucosal thickening in ethmoid cells and in the frontal sinuses. Sphenoid sinuses are essentially negative the mastoids and middle ears are clear. The maxillofacial bones, orbits and orbital contents are unremarkable. No defect is seen in the anterior skull base or calvarium. ---------------
3,415
RADIOLOGIC EXAM: CT Head wo contrast, CT Maxillofacial wo contrast CLINICAL INFORMATION: Trauma COMPARISON: None. TECHNIQUE: CT Head wo contrast, CT Maxillofacial wo contrastScan field of view: 230 mm. DLP: 1396.80 mGy cm. (accession CT220004050), Scan field of view: 225.80 mm. DLP: 1098.80 mGy cm. (accession CT220004056) STRUCTURED REPORT: CT Head and Maxillofacial Trauma 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: Globes are intact. Small left periorbital hematoma. No retrobulbar hemorrhage or exophthalmos. No fracture. SKULL AND SKULL BASE: No acute fracture. Bilateral mastoid air cells are clear. Small right frontal and right occipital scalp hematomas. Diffuse scalp edema. FACIAL BONES: No fracture. Bilateral pterygoid plates are intact. MANDIBLE: No fracture. Bilateral temporomandibular joints are intact. SINONASAL CAVITIES: Small mucus retention cysts in the left maxillary sinus. Mild mucosal thickening of the bilateral maxillary sinuses. CONCLUSION: 1. No acute intracranial process or acute maxillofacial fracture evident. 2. Small right frontal and occipital scalp hematomas. Small left periorbital hematoma. Diffuse scalp soft tissue swelling. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. Cerebral cortical volume is normal. EXTRA-AXIAL SPACES: Normal. VENTRICULAR SYSTEM: Normal. ORBITS: Globes are intact. Small left periorbital hematoma. No retrobulbar hemorrhage or exophthalmos. No fracture. SKULL AND SKULL BASE: No acute fracture. Bilateral mastoid air cells are clear. Small right frontal and right occipital scalp hematomas. Diffuse scalp edema. FACIAL BONES: No fracture. Bilateral pterygoid plates are intact. MANDIBLE: No fracture. Bilateral temporomandibular joints are intact. SINONASAL CAVITIES: Small mucus retention cysts in the left maxillary sinus. Mild mucosal thickening of the bilateral maxillary sinuses.
FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Endotracheal tube in place with tip 2.5 cm above the carina. Small amount of layering secretions in the right main bronchus with interval obstruction of the right lower lobe posterior segmental bronchus. There is resultant partial right lower lobe obstructive atelectasis. Trace left basilar atelectasis. Small right pleural effusion. No pneumothorax. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Esophagogastric tube courses through the esophagus and terminates in the mid to distal stomach. No other significant abnormality. LYMPH NODES: None enlarged. CHEST WALL: Scattered ballistic fragments are seen in the posterior left upper back soft tissues. No other significant abnormality. UPPER ABDOMEN: Enteric contrast in the bowel. No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
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EXAM: CT Chest with contrast, CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: Trauma. COMPARISON: None. TECHNIQUE: CT Chest with contrast, CT Abdomen and Pelvis w contrast. Patient weight: 180 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: 455.10 mm. (accession CT220004051), Patient weight: 180 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: 455.10 mm. DLP: 752.90 mGy cm. (accession CT220004052) FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Trace secretions in the trachea, left mainstem bronchus, and bronchus intermedius. Mild dependent atelectatic changes. No pleural effusions or pneumothorax. HEART / VESSELS: No significant abnormality. The left vertebral artery arises strictly from the aortic arch between the origins of the left common carotid and left subclavian arteries, a normal anatomic variant. MEDIASTINUM / ESOPHAGUS: No significant abnormality. Residual thymic tissue is noted. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: Partially ossified deformity of the right seventh costal cartilage, likely chronic, with tiny focus of underlying gas, likely extrapleural (series 502, image 293). 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 significant abnormality in the colon. The appendix is not definitely visualized. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. Retroaortic left renal vein. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No aggressive osseous abnormality is identified. CONCLUSION: 1. No acute traumatic abnormality in the chest, abdomen, or pelvis. 2. Trace secretions scattered throughout the central tracheobronchial tree, likely related to aspiration. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Trace secretions in the trachea, left mainstem bronchus, and bronchus intermedius. Mild dependent atelectatic changes. No pleural effusions or pneumothorax. HEART / VESSELS: No significant abnormality. The left vertebral artery arises strictly from the aortic arch between the origins of the left common carotid and left subclavian arteries, a normal anatomic variant. MEDIASTINUM / ESOPHAGUS: No significant abnormality. Residual thymic tissue is noted. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: Partially ossified deformity of the right seventh costal cartilage, likely chronic, with tiny focus of underlying gas, likely extrapleural (series 502, image 293). 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 significant abnormality in the colon. The appendix is not definitely visualized. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. Retroaortic left renal vein. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No aggressive osseous abnormality is identified.
FINDINGS: STRUCTURED REPORT: CT Chest LOWER NECK: Heterogeneous thyroid without dominant nodule. CHEST: LUNGS / AIRWAYS / PLEURA: Diffuse bilateral groundglass and consolidative opacities with apical predominant interlobular septal thickening. Trace effusions. Endotracheal tube 4.7 cm above carina. Suspected right lateral diverticulum of the cervical trachea (series 3 image 7). Central airways are patent. The HEART / VESSELS: Trace calcified atherosclerosis. Right IJ CVL with tip in proximal right atrium. Small pericardial effusion. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: Overall stable mediastinal and bilateral hilar lymphadenopathy. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Subcentimeter hypoattenuating lesion in the lateral right hepatic lobe, too small to characterize. Foci of left renal scarring with parapelvic cysts. Gastrostomy with tip in gastric body lumen. MUSCULOSKELETAL: Degenerative spine changes. Previously noted cervicothoracic lytic lesions no longer seen. Slight decrease in prominence of the mixed sclerotic/lytic changes of the sternum.
3,417
EXAM: CT Chest with contrast, CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: Trauma. COMPARISON: None. TECHNIQUE: CT Chest with contrast, CT Abdomen and Pelvis w contrast. Patient weight: 180 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: 455.10 mm. (accession CT220004051), Patient weight: 180 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: 455.10 mm. DLP: 752.90 mGy cm. (accession CT220004052) FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Trace secretions in the trachea, left mainstem bronchus, and bronchus intermedius. Mild dependent atelectatic changes. No pleural effusions or pneumothorax. HEART / VESSELS: No significant abnormality. The left vertebral artery arises strictly from the aortic arch between the origins of the left common carotid and left subclavian arteries, a normal anatomic variant. MEDIASTINUM / ESOPHAGUS: No significant abnormality. Residual thymic tissue is noted. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: Partially ossified deformity of the right seventh costal cartilage, likely chronic, with tiny focus of underlying gas, likely extrapleural (series 502, image 293). 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 significant abnormality in the colon. The appendix is not definitely visualized. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. Retroaortic left renal vein. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No aggressive osseous abnormality is identified. CONCLUSION: 1. No acute traumatic abnormality in the chest, abdomen, or pelvis. 2. Trace secretions scattered throughout the central tracheobronchial tree, likely related to aspiration. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Trace secretions in the trachea, left mainstem bronchus, and bronchus intermedius. Mild dependent atelectatic changes. No pleural effusions or pneumothorax. HEART / VESSELS: No significant abnormality. The left vertebral artery arises strictly from the aortic arch between the origins of the left common carotid and left subclavian arteries, a normal anatomic variant. MEDIASTINUM / ESOPHAGUS: No significant abnormality. Residual thymic tissue is noted. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: Partially ossified deformity of the right seventh costal cartilage, likely chronic, with tiny focus of underlying gas, likely extrapleural (series 502, image 293). 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 significant abnormality in the colon. The appendix is not definitely visualized. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. Retroaortic left renal vein. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No aggressive osseous abnormality is identified.
Findings: There are extensive postsurgical changes following right orbital exenteration and resection of the medial orbital roof, right frontal and ethmoid sinuses and right turbinates. The right sphenoid sinus is opacified. The medial orbital floor and lateral wall of the right nasal passage is also resected. Fluid, air and packing materials fill the right nasal passage and ethmoid region. There is prominent pneumocephalus over the right frontal pole. No parenchymal abnormality is seen. There is moderate diffuse atrophy but the ventricles are not enlarged. There is no hypodensity in the white matter. There is no parenchymal mass or hemorrhage. The posterior fossa contents are unremarkable. ---------------
3,418
RADIOLOGIC EXAM: CT Cervical Spine From Reformat, CT Angio Neck CLINICAL INFORMATION: Trauma. COMPARISON: None. TECHNIQUE: CT Cervical Spine From Reformat, CT Angio Neck 3-D CT MIP images were generated in post processing. Patient weight: 180 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: 214.40 mm. DLP: 926.30 mGy cm. FINDINGS: CERVICAL SPINE: Craniocervical junction and odontoid are intact. No acute fracture or malalignment. Soft tissues are unremarkable. CTA NECK: No evidence of irregularity, narrowing, occlusion or flap to indicate acute arterial injury or dissection. CONCLUSION: No acute cervical spine fracture or vascular injury.
FINDINGS: CERVICAL SPINE: Craniocervical junction and odontoid are intact. No acute fracture or malalignment. Soft tissues are unremarkable. CTA NECK: No evidence of irregularity, narrowing, occlusion or flap to indicate acute arterial injury or dissection.
FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Minimal atelectatic changes in bilateral lung bases. DISTAL ESOPHAGUS: Small hiatal hernia. Minimal thickening of the distal esophageal wall, likely reflux esophagitis. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Mild intrahepatic and extrahepatic biliary ductal prominence, likely related to postcholecystectomy status. GALLBLADDER: Surgically removed. PANCREAS: Diffuse fatty atrophy of pancreas with related sparing of pancreatic tail. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Bilateral renal cysts. Mildly prominent bilateral renal collecting systems without distal obstructing etiology. LYMPH NODES: Multiple small sized mesenteric lymph nodes with adjacent mesenteric fat stranding suggesting mesenteric lymphadenitis/panniculitis. Multiple nonspecific prominent bilateral inguinal and pelvic lymph nodes. STOMACH / SMALL BOWEL: Mural fatty change in the stomach suggesting prior inflammation. No evidence for acute inflammation. Duodenum and small bowel loops are unremarkable. COLON / APPENDIX: Appendix is within normal limits. Scattered colonic diverticula without evidence for acute colonic diverticulitis. Stool distended rectum with mild rectal wall thickening and mild perirectal fat stranding suggesting stercoral proctitis. PERITONEUM / MESENTERY: See above. No free fluid or free air. RETROPERITONEUM: Normal. VESSELS: Scattered atherosclerosis. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Coarse prostatic calcifications. BODY WALL: Small fat-containing umbilical hernia. Omphalolith. MUSCULOSKELETAL: No significant acute abnormality. Old healed fractures posterior right ribs. Chronic wedge compression deformities of T12, L2 and L4 vertebral bodies.
3,419
RADIOLOGIC EXAM: CT Head wo contrast, CT Maxillofacial wo contrast CLINICAL INFORMATION: Trauma COMPARISON: None. TECHNIQUE: CT Head wo contrast, CT Maxillofacial wo contrastScan field of view: 230 mm. DLP: 1396.80 mGy cm. (accession CT220004050), Scan field of view: 225.80 mm. DLP: 1098.80 mGy cm. (accession CT220004056) STRUCTURED REPORT: CT Head and Maxillofacial Trauma 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: Globes are intact. Small left periorbital hematoma. No retrobulbar hemorrhage or exophthalmos. No fracture. SKULL AND SKULL BASE: No acute fracture. Bilateral mastoid air cells are clear. Small right frontal and right occipital scalp hematomas. Diffuse scalp edema. FACIAL BONES: No fracture. Bilateral pterygoid plates are intact. MANDIBLE: No fracture. Bilateral temporomandibular joints are intact. SINONASAL CAVITIES: Small mucus retention cysts in the left maxillary sinus. Mild mucosal thickening of the bilateral maxillary sinuses. CONCLUSION: 1. No acute intracranial process or acute maxillofacial fracture evident. 2. Small right frontal and occipital scalp hematomas. Small left periorbital hematoma. Diffuse scalp soft tissue swelling. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. Cerebral cortical volume is normal. EXTRA-AXIAL SPACES: Normal. VENTRICULAR SYSTEM: Normal. ORBITS: Globes are intact. Small left periorbital hematoma. No retrobulbar hemorrhage or exophthalmos. No fracture. SKULL AND SKULL BASE: No acute fracture. Bilateral mastoid air cells are clear. Small right frontal and right occipital scalp hematomas. Diffuse scalp edema. FACIAL BONES: No fracture. Bilateral pterygoid plates are intact. MANDIBLE: No fracture. Bilateral temporomandibular joints are intact. SINONASAL CAVITIES: Small mucus retention cysts in the left maxillary sinus. Mild mucosal thickening of the bilateral maxillary sinuses.
FINDINGS: There is no significant change in appearance of multiple hyperdense posterior fossa lesions and also the left parietal lobe lesion. There is stable vasogenic edema about the largest posterior fossa lesions resulting in mass effect upon the fourth ventricle. There is no hydrocephalus. There is no acute intracranial hemorrhage. There are no abnormal areas of hypoattenuation to suggest acute infarction. The calvarium is intact. The visualized paranasal sinuses and mastoid air cells are clear. There is no acute abnormality of the orbits. There is asymmetric enlargement of the left inferior rectus muscle raising possibility of involvement.
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RADIOLOGIC EXAM: CT Cervical Spine From Reformat, CT Angio Neck CLINICAL INFORMATION: Trauma. COMPARISON: None. TECHNIQUE: CT Cervical Spine From Reformat, CT Angio Neck 3-D CT MIP images were generated in post processing. Patient weight: 180 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: 214.40 mm. DLP: 926.30 mGy cm. FINDINGS: CERVICAL SPINE: Craniocervical junction and odontoid are intact. No acute fracture or malalignment. Soft tissues are unremarkable. CTA NECK: No evidence of irregularity, narrowing, occlusion or flap to indicate acute arterial injury or dissection. CONCLUSION: No acute cervical spine fracture or vascular injury.
FINDINGS: CERVICAL SPINE: Craniocervical junction and odontoid are intact. No acute fracture or malalignment. Soft tissues are unremarkable. CTA NECK: No evidence of irregularity, narrowing, occlusion or flap to indicate acute arterial injury or dissection.
Findings: Interval placement of endovascular coil in the cavernous right ICA aneurysm with extensive streak artifact in the right cavernous region limiting evaluation. Within this limitation, there is no acute intracranial hemorrhage, intracranial mass, mass effect or midline shift. No evidence for large vascular territory acute infarction. Basal cisterns are patent. No hydrocephalus. Cavum septum pellucidum and vergae. Bilateral orbits are unremarkable. Visualized paranasal sinuses, mastoid air cells and middle ear cavities are unremarkable. Right posterior parietal and vertex scalp laceration with tiny pockets of scalp gas and small volume scalp hemorrhage. No evidence for underlying acute calvarial fracture.
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RADIOLOGIC EXAM: CT Head wo contrast CLINICAL INFORMATION: Postoperative status post resection of cerebellar mass COMPARISON: None. TECHNIQUE: CT Head wo contrastScan field of view: 220 mm. DLP: 1385.20 mGy cm. STRUCTURED REPORT: CT Head Trauma FINDINGS: BRAIN PARENCHYMA: Post surgical changes status post resection of cerebellar mass. Trace hemorrhage within surgical bed. No herniation. Right frontal approach ventriculostomy catheter is stable with tip terminating in the anterior horn of the left lateral ventricle. Trace hemorrhage along the course of the right ventriculostomy catheter. No mass effect or midline shift. Minimal intraventricular hemorrhage in the left occipital horn EXTRA-AXIAL SPACES: Small moderate pneumocephalus. SKULL AND SKULL BASE: Post surgical changes of the posterior fossa VENTRICULAR SYSTEM: Moderate gas within the ventricles. ORBITS: Normal SINUSES: Mild mucosal thickening of the ethmoid sinuses. Trace left mastoid effusion. CONCLUSION: Expected postsurgical changes status post cerebellar mass resection with trace hemorrhage in the resection bed, trace intraventricular hemorrhage in left occipital horn and small moderate pneumocephalus. Stable appearance of right frontal approach ventriculostomy catheter. Please see same day MRI brain for further detail. Left frontal extra-axial lesion, likely meningioma better seen on the prior MRI. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
FINDINGS: BRAIN PARENCHYMA: Post surgical changes status post resection of cerebellar mass. Trace hemorrhage within surgical bed. No herniation. Right frontal approach ventriculostomy catheter is stable with tip terminating in the anterior horn of the left lateral ventricle. Trace hemorrhage along the course of the right ventriculostomy catheter. No mass effect or midline shift. Minimal intraventricular hemorrhage in the left occipital horn EXTRA-AXIAL SPACES: Small moderate pneumocephalus. SKULL AND SKULL BASE: Post surgical changes of the posterior fossa VENTRICULAR SYSTEM: Moderate gas within the ventricles. ORBITS: Normal SINUSES: Mild mucosal thickening of the ethmoid sinuses. Trace left mastoid effusion.
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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RADIOLOGIC EXAM: CT Head wo contrast CLINICAL INFORMATION: Trauma. COMPARISON: None. TECHNIQUE: CT Head wo contrastScan field of view: 230 mm. DLP: 1310 mGy cm. STRUCTURED REPORT: CT Head FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. No evidence of acute infarction. Normal cerebral cortical volume. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. Bilateral mastoid air cells are clear. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Paranasal sinuses are clear. VESSELS: Normal noncontrast appearance of the vessels. CONCLUSION: No acute intracranial process. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. No evidence of acute infarction. Normal cerebral cortical volume. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. Bilateral mastoid air cells are clear. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Paranasal sinuses are clear. VESSELS: Normal noncontrast appearance of the vessels.
FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Left lateral segment hypodensities, likely cysts. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Hypoattenuating pancreatic body lesion measuring 2.2 x 0.7 cm (series 201 image 83), previously 1.5 x 0.7 cm. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Right upper pole cyst with more superior subcentimeter hypodensity, too small to characterize. No hydronephrosis or nephrolithiasis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Mild mucosal hyperemia at the gastric antrum and pylorus suggesting acute gastritis. Small periampullary duodenal diverticulum. Otherwise duodenum is unremarkable. Scattered mural edema in the distal small bowel loops particularly seen in the distal ileum suggesting recent bowel inflammation. No definite evidence for small bowel mucosal hyperemia. No evidence for adjacent fat stranding, abscess or fistula formation. COLON / APPENDIX: Mural fatty change at the cecum and ascending colon likely related to prior colonic inflammation. Scattered colonic diverticula without evidence for acute colonic diverticulitis. High attenuation stool material in the colon. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Moderate calcified atherosclerosis. URINARY BLADDER: Nondistended. Mild thickening of the urinary bladder wall particularly on the anterior aspect, more than expected for nondistended state with mild mucosal hyperemia. Findings may suggest cystitis in the appropriate clinical setting. Correlation with urinalysis is suggested. REPRODUCTIVE ORGANS: Uterus is absent. BODY WALL: Partially visualized right breast implant. Fat-containing umbilical hernia. MUSCULOSKELETAL: Degenerative spine changes.
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EXAM: CT Chest with contrast, CT Abdomen and Pelvis w contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat CLINICAL INFORMATION: Trauma. COMPARISON: None. TECHNIQUE: CT Chest with contrast, CT Abdomen and Pelvis w contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat. Patient weight: 120 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bt sec. Scan field of view: 415 mm. DLP: 589 mGy cm. (accession CT220004060), Patient weight: 120 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bt sec. Scan field of view: 415 mm. (accession CT220004061) FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Normal. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: No significant abnormality. Residual thymic tissue is noted. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Focal fatty infiltration along the falciform. Otherwise, no significant abnormality. 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 significant abnormality in the colon. 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 aggressive osseous abnormality is identified. The patient is skeletally immature. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No spondylolisthesis. LUMBAR SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No spondylolisthesis. CONCLUSION: No acute traumatic abnormality in the chest, abdomen, or pelvis. No acute fracture or subluxation 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.
FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Normal. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: No significant abnormality. Residual thymic tissue is noted. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Focal fatty infiltration along the falciform. Otherwise, no significant abnormality. 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 significant abnormality in the colon. 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 aggressive osseous abnormality is identified. The patient is skeletally immature. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No spondylolisthesis. LUMBAR SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No spondylolisthesis.
Findings: There is stable appearance of the multiage subacute and acute loculated extracerebral collection over the left frontoparietal convexity at the vertex. There is stable slight diffuse atrophy and commensurate slight prominence of ventricles but no hydrocephalus per se. Posterior fossa contents are unremarkable. No defect is seen in the calvarium or skull base. ---------------
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EXAM: CT Chest with contrast, CT Abdomen and Pelvis w contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat CLINICAL INFORMATION: Trauma. COMPARISON: None. TECHNIQUE: CT Chest with contrast, CT Abdomen and Pelvis w contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat. Patient weight: 120 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bt sec. Scan field of view: 415 mm. DLP: 589 mGy cm. (accession CT220004060), Patient weight: 120 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bt sec. Scan field of view: 415 mm. (accession CT220004061) FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Normal. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: No significant abnormality. Residual thymic tissue is noted. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Focal fatty infiltration along the falciform. Otherwise, no significant abnormality. 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 significant abnormality in the colon. 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 aggressive osseous abnormality is identified. The patient is skeletally immature. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No spondylolisthesis. LUMBAR SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No spondylolisthesis. CONCLUSION: No acute traumatic abnormality in the chest, abdomen, or pelvis. No acute fracture or subluxation 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.
FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Normal. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: No significant abnormality. Residual thymic tissue is noted. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Focal fatty infiltration along the falciform. Otherwise, no significant abnormality. 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 significant abnormality in the colon. 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 aggressive osseous abnormality is identified. The patient is skeletally immature. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No spondylolisthesis. LUMBAR SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No spondylolisthesis.
FINDINGS: STRUCTURED REPORT: CT PE OVERALL DIAGNOSTIC QUALITY: Moderately suboptimal quality with incomplete evaluation of segmental and subsegmental pulmonary arteries due to respiratory motion and artifact from patient's arms. LOWER NECK: Anasarca. CHEST: PULMONARY ARTERIES: Negative for central or lobar pulmonary embolus LUNGS / AIRWAYS / PLEURA: Similar moderate bilateral pleural effusions. Redemonstration of extensive bilateral lower lobe consolidation with interval increase in number of cavitary components/cystic spaces bilaterally. Worsening consolidation and groundglass opacities in the right upper, right middle, and left upper lobes. Endotracheal tube terminates in mid thoracic trachea. HEART / OTHER VESSELS: Similar right atrial dilation. MEDIASTINUM / ESOPHAGUS: Enteric tubes course through the esophagus into the stomach beyond the field-of-view. LYMPH NODES: None enlarged. CHEST WALL: Anasarca. UPPER ABDOMEN: Unremarkable for technique. MUSCULOSKELETAL: Multilevel degenerative changes. Nondisplaced right anterior medial sixth rib fracture.
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RADIOLOGIC EXAM: CT Angio Neck, CT Cervical Spine From Reformat CLINICAL INFORMATION: Trauma. COMPARISON: None. TECHNIQUE: CT Angio Neck, CT Cervical Spine From ReformatPatient weight: 120 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bt sec. Scan field of view: 200 mm. DLP: 942 mGy cm. Following CT of the neck, reformatted images were produced to optimize visualization of the osseous structures of the cervical spine. 3-D CT MIP were generated in post processing. FINDINGS: CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. Incidental finding of bilateral paracondylar processes. ATLANTODENTAL INTERVAL: Normal (
FINDINGS: CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. Incidental finding of bilateral paracondylar processes. ATLANTODENTAL INTERVAL: Normal (
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 Chest with contrast, CT Abdomen and Pelvis w contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat CLINICAL INFORMATION: Trauma. COMPARISON: None. TECHNIQUE: CT Chest with contrast, CT Abdomen and Pelvis w contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat. Patient weight: 120 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bt sec. Scan field of view: 415 mm. DLP: 589 mGy cm. (accession CT220004060), Patient weight: 120 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bt sec. Scan field of view: 415 mm. (accession CT220004061) FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Normal. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: No significant abnormality. Residual thymic tissue is noted. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Focal fatty infiltration along the falciform. Otherwise, no significant abnormality. 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 significant abnormality in the colon. 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 aggressive osseous abnormality is identified. The patient is skeletally immature. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No spondylolisthesis. LUMBAR SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No spondylolisthesis. CONCLUSION: No acute traumatic abnormality in the chest, abdomen, or pelvis. No acute fracture or subluxation 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.
FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Normal. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: No significant abnormality. Residual thymic tissue is noted. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Focal fatty infiltration along the falciform. Otherwise, no significant abnormality. 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 significant abnormality in the colon. 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 aggressive osseous abnormality is identified. The patient is skeletally immature. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No spondylolisthesis. LUMBAR SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No spondylolisthesis.
FINDINGS: STRUCTURED REPORT: CT CAP LOWER NECK: Heterogeneous thyroid without dominant nodule. Right neck stranding/hematoma likely from vascular access. CHEST: LUNGS / AIRWAYS / PLEURA: Patchy bilateral ground glass and consolidative opacities. Trace bilateral pleural effusion with adjacent atelectasis. Endotracheal tube tip 4.8 cm above carina. HEART / VESSELS: Severe calcified atherosclerosis, including three-vessel coronary atherosclerosis. Multiple coronary stents. Aortic valve and mitral annular calcifications. Bilateral IJ CVLs with tips at cavoatrial junction. Main pulmonary artery is enlarged measuring 4.1 cm. MEDIASTINUM / ESOPHAGUS: Esophagus is fluid-filled, suggesting reflux, with feeeding tube in place. LYMPH NODES: Prominent mediastinal nodes, likely reactive. CHEST WALL: Median sternotomy wires. ABDOMEN and PELVIS: LIVER: Diffuse hepatic steatosis. No evidence of liver injury. Streak artifact through the inferior liver tip. BILIARY TRACT: Normal. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Postsurgical changes of right nephrectomy. Left kidney is atrophic with multiple cystic lesions, some too small to characterize. Nonobstructing left nephrolithiasis versus vascular calcifications. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Weighted feeding tube tip in region of pylorus. No small bowel abnormality. COLON / APPENDIX: Rectal tube in place. Colon and rectum are mostly collapsed. Appendix not seen. PERITONEUM / MESENTERY: Small volume ascites. RETROPERITONEUM: Normal. VESSELS: Severe calcified atherosclerosis. Right nephrectomy changes. Patent bilateral iliac artery stents. Postsurgical changes of the right femoral artery bypass. URINARY BLADDER: Collapsed. REPRODUCTIVE ORGANS: Uterus is absent. BODY WALL: Mild anasarca. Large cutaneous defect involving the right lower quadrant extending to the anterior right upper extremity, with extensive underlying edema and exposed proximal segment of the femoropopliteal bypass graft, similar to prior. Peripherally enhancing hypoattenuating lesion in the left psoas measuring approximately 0.9 x 1.3 x 3.0 cm (TR x AP x CC, axial series 5 image 131, sagittal series 23 image 141). MUSCULOSKELETAL: Mild degenerative spine changes. Diffuse demineralization. Healed right inferior pubic ramus fracture.
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EXAM: CT Chest with contrast, CT Abdomen and Pelvis w contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat CLINICAL INFORMATION: Trauma. COMPARISON: None. TECHNIQUE: CT Chest with contrast, CT Abdomen and Pelvis w contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat. Patient weight: 120 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bt sec. Scan field of view: 415 mm. DLP: 589 mGy cm. (accession CT220004060), Patient weight: 120 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bt sec. Scan field of view: 415 mm. (accession CT220004061) FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Normal. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: No significant abnormality. Residual thymic tissue is noted. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Focal fatty infiltration along the falciform. Otherwise, no significant abnormality. 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 significant abnormality in the colon. 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 aggressive osseous abnormality is identified. The patient is skeletally immature. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No spondylolisthesis. LUMBAR SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No spondylolisthesis. CONCLUSION: No acute traumatic abnormality in the chest, abdomen, or pelvis. No acute fracture or subluxation 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.
FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Normal. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: No significant abnormality. Residual thymic tissue is noted. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Focal fatty infiltration along the falciform. Otherwise, no significant abnormality. 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 significant abnormality in the colon. 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 aggressive osseous abnormality is identified. The patient is skeletally immature. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No spondylolisthesis. LUMBAR SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No spondylolisthesis.
FINDINGS: STRUCTURED REPORT: CT CAP LOWER NECK: Heterogeneous thyroid without dominant nodule. Right neck stranding/hematoma likely from vascular access. CHEST: LUNGS / AIRWAYS / PLEURA: Patchy bilateral ground glass and consolidative opacities. Trace bilateral pleural effusion with adjacent atelectasis. Endotracheal tube tip 4.8 cm above carina. HEART / VESSELS: Severe calcified atherosclerosis, including three-vessel coronary atherosclerosis. Multiple coronary stents. Aortic valve and mitral annular calcifications. Bilateral IJ CVLs with tips at cavoatrial junction. Main pulmonary artery is enlarged measuring 4.1 cm. MEDIASTINUM / ESOPHAGUS: Esophagus is fluid-filled, suggesting reflux, with feeeding tube in place. LYMPH NODES: Prominent mediastinal nodes, likely reactive. CHEST WALL: Median sternotomy wires. ABDOMEN and PELVIS: LIVER: Diffuse hepatic steatosis. No evidence of liver injury. Streak artifact through the inferior liver tip. BILIARY TRACT: Normal. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Postsurgical changes of right nephrectomy. Left kidney is atrophic with multiple cystic lesions, some too small to characterize. Nonobstructing left nephrolithiasis versus vascular calcifications. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Weighted feeding tube tip in region of pylorus. No small bowel abnormality. COLON / APPENDIX: Rectal tube in place. Colon and rectum are mostly collapsed. Appendix not seen. PERITONEUM / MESENTERY: Small volume ascites. RETROPERITONEUM: Normal. VESSELS: Severe calcified atherosclerosis. Right nephrectomy changes. Patent bilateral iliac artery stents. Postsurgical changes of the right femoral artery bypass. URINARY BLADDER: Collapsed. REPRODUCTIVE ORGANS: Uterus is absent. BODY WALL: Mild anasarca. Large cutaneous defect involving the right lower quadrant extending to the anterior right upper extremity, with extensive underlying edema and exposed proximal segment of the femoropopliteal bypass graft, similar to prior. Peripherally enhancing hypoattenuating lesion in the left psoas measuring approximately 0.9 x 1.3 x 3.0 cm (TR x AP x CC, axial series 5 image 131, sagittal series 23 image 141). MUSCULOSKELETAL: Mild degenerative spine changes. Diffuse demineralization. Healed right inferior pubic ramus fracture.
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RADIOLOGIC EXAM: CT Angio Neck, CT Cervical Spine From Reformat CLINICAL INFORMATION: Trauma. COMPARISON: None. TECHNIQUE: CT Angio Neck, CT Cervical Spine From ReformatPatient weight: 120 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bt sec. Scan field of view: 200 mm. DLP: 942 mGy cm. Following CT of the neck, reformatted images were produced to optimize visualization of the osseous structures of the cervical spine. 3-D CT MIP were generated in post processing. FINDINGS: CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. Incidental finding of bilateral paracondylar processes. ATLANTODENTAL INTERVAL: Normal (
FINDINGS: CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. Incidental finding of bilateral paracondylar processes. ATLANTODENTAL INTERVAL: Normal (
FINDINGS: STRUCTURED REPORT: CTA Aorta Runoff VASCULATURE: DISTAL DESCENDING THORACIC AORTA: Severe calcified atherosclerotic disease. No dissection or aneurysm. ABDOMINAL AORTA: Severe calcified atherosclerotic disease. No dissection or aneurysm. CELIAC AXIS: Calcified atherosclerotic disease without flow-limiting stenosis or aneurysm. SMA: Calcified atherosclerotic disease without flow-limiting stenosis or aneurysm. RIGHT RENAL: Single right renal artery with severe ostial calcifications and poorly opacified, likely chronic. LEFT RENAL: Single left renal artery with scattered calcifications and poorly opacified, likely chronic. IMA: Patent with atherosclerotic calcifications. RIGHT ILIAC ARTERIES: Common iliac artery stent in place which appears patent. Severe multifocal calcified atherosclerotic disease with severe focal luminal narrowing of the common iliac artery just distal to the stent. Calcified atherosclerotic disease of the external and internal iliac arteries which otherwise appear patent. RIGHT FEMORAL \T\ POPLITEAL ARTERIES: Calcified and noncalcified atherosclerotic disease with suspected right mid femoral are small segment of severe stenosis, otherwise without definite flow-limiting stenosis. RIGHT TIBIAL AND PERONEAL ARTERIES: Diffuse atherosclerotic calcifications which limits evaluation of luminal filling. The anterior and posterior tibial arteries appear patent below the ankle. There is occlusion of the peroneal artery at its distal segment. RIGHT FOOT ARTERIES: Patent via flow primarily from the anterior and posterior tibial arteries. LEFT ILIAC ARTERIES: Common iliac artery stent in place which appears patent. Severe multifocal calcified atherosclerotic disease with without flow-limiting stenosis. Calcified atherosclerotic disease of the external and internal iliac arteries which otherwise appear patent. LEFT FEMORAL \T\ POPLITEAL ARTERIES: Calcified and noncalcified atherosclerotic disease without definite flow-limiting stenosis. LEFT TIBIAL AND PERONEAL ARTERIES: Distal tibioperoneal trunk is occluded. Peroneal and posterior tibial arteries are occluded proximally with reconstitution in the mid calf and patent below the ankle. Multifocal calcified atherosclerotic disease limits evaluation of luminal filling, however the posterior tibial artery appears patent below the ankle. Anterior tibial artery is occluded in the mid to distal leg. LEFT FOOT ARTERIES: Patent via flow primarily from the posterior tibial and peroneal arteries. ------------------------------------------------------------- LOWER CHEST: LUNG BASES / PLEURA: Scattered ground glass and tree-in-bud opacities in bilateral visualized lungs. Trace bibasilar atelectasis. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Mild cardiomegaly. Severe coronary artery calcifications. No pericardial effusion. ABDOMEN and PELVIS: LIVER: Hepatic granuloma. BILIARY TRACT: Common bile duct is dilated to 1.4 cm at the hepatic hilum with mild intrahepatic ductal dilatation. Calcified stone in the distal common bile duct near the ampulla (axial series 501, image 68). GALLBLADDER: Cholelithiasis. No gallbladder wall thickening or pericholecystic fluid. PANCREAS: Main pancreatic duct is dilated to 6 mm in the pancreatic head. No other significant abnormality. SPLEEN: Calcified granulomas. No other significant abnormality. ADRENALS: Normal. KIDNEYS: Severe bilateral cortical atrophy. Numerous cystic lesions bilaterally, multiple of which demonstrate peripheral wall calcifications and some of which with high attenuation. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Uncomplicated diverticulosis. Appendix is normal. Large colonic fecal burden. PERITONEUM / MESENTERY: No free fluid or pneumoperitoneum. RETROPERITONEUM: Calcification anterior to the left psoas muscle. OTHER VESSELS: No significant abnormality. URINARY BLADDER: No significant abnormality. REPRODUCTIVE ORGANS: Uterus is surgically absent. No adnexal mass. BODY WALL: Normal. MUSCULOSKELETAL: No significant abnormality.
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EXAM: CT Angio Chest wo+w contrast CLINICAL INFORMATION: COVID confirmed, increased oxygen demand, rule out pulmonary embolus 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: 209 lbs. IV contrast: Omnipaque 350, 80 ml, per protocol. Saline flush: 75 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 388 mm. KVP: 120 DLP: 216 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: Small right greater than left pleural effusions. Bibasilar consolidative opacities. Faint groundglass opacities in the lung apices. HEART / OTHER VESSELS: Cardiomegaly. Reflux of contrast into the hepatic veins and IVC. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: Anasarca. UPPER ABDOMEN: Normal. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. Negative for pulmonary embolus. 2. Small bilateral pleural effusions and soft tissue anasarca. 3. Bibasilar consolidative opacities may reflect atelectasis, but are concerning for component of pneumonia. 4. Cardiomegaly and features suggestive of right heart dysfunction.
FINDINGS: STRUCTURED REPORT: CT PE OVERALL DIAGNOSTIC QUALITY: Full diagnostic quality LOWER NECK: No abnormality. CHEST: PULMONARY ARTERIES: Negative for pulmonary embolus LUNGS / AIRWAYS / PLEURA: Small right greater than left pleural effusions. Bibasilar consolidative opacities. Faint groundglass opacities in the lung apices. HEART / OTHER VESSELS: Cardiomegaly. Reflux of contrast into the hepatic veins and IVC. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: Anasarca. UPPER ABDOMEN: Normal. MUSCULOSKELETAL: No significant abnormality.
FINDINGS: BRAIN PARENCHYMA: No intraparenchymal hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. Cerebral cortical volume is appropriate for patient's age. EXTRA-AXIAL SPACES: Trace fluid underlying the left skull flap measuring 2 mm in thickness. VENTRICULAR SYSTEM: Cavum septum pellucidum. VESSELS: Bilateral ICA calcifications within the cavernous sinus. SKULL AND SKULL BASE: Left pterional craniotomy with small amount of fluid overlying the skull flap measuring 5 mm in thickness. FACIAL BONES: No acute fracture. MANDIBLE: Intact. ORBITS: Normal. SINUSES: Layering fluid within the left maxillary sinus with associated mucosal thickening. Mild ethmoid air cell mucosal thickening. MASTOIDS: Left mastoidectomy postsurgical changes with fluid extending into the remaining mastoid air cells and middle ear. Right mastoid is clear. SOFT TISSUES: Mild postauricular soft tissue swelling likely postsurgical changes.
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CT Head wo contrast Clinical Information: HA, HTN 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: 206 mm. DLP: 1177 mGy cm. Comparison: None available Findings: No acute intracranial hemorrhage, hydrocephalus or large territorial acute infarct. No evidence of brain edema. There are minimal periventricular white matter hypoattenuation changes, nonspecific but likely representing minimal chronic microangiopathic change. Small right choroidal fissure cyst is incidentally noted. Bilateral basal ganglia calcifications. Mild hyperostosis frontalis interna. The orbits are maintained. Partially empty appearance of the sella. Intracranial ICA vascular calcifications are demonstrated. The visualized paranasal sinuses and mastoid air cells are clear except for small right maxillary sinus mucous retention cyst. Impression: No acute intracranial abnormality evident.
Findings: No acute intracranial hemorrhage, hydrocephalus or large territorial acute infarct. No evidence of brain edema. There are minimal periventricular white matter hypoattenuation changes, nonspecific but likely representing minimal chronic microangiopathic change. Small right choroidal fissure cyst is incidentally noted. Bilateral basal ganglia calcifications. Mild hyperostosis frontalis interna. The orbits are maintained. Partially empty appearance of the sella. Intracranial ICA vascular calcifications are demonstrated. The visualized paranasal sinuses and mastoid air cells are clear except for small right maxillary sinus mucous retention cyst.
Findings: 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. 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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RADIOLOGIC EXAM: CT Head wo contrast CLINICAL INFORMATION: PUI for COVID encephalopathy. Per chart review, history of multiple sclerosis. COMPARISON: Multiple prior CT heads, most recently 7/17/2021. MR brain 7/19/2021. TECHNIQUE: CT Head wo contrastScan field of view: 260.50 mm. DLP: 1424.80 mGy cm. STRUCTURED REPORT: CT Head FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. No evidence of acute infarction. Unchanged confluent periventricular and pericallosal white matter hypoattenuation consistent with demyelinating plaques and/or microangiopathic change. Mild diffuse parenchymal volume loss. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. Near complete opacification of the right mastoid air cells and small left mastoid air cell effusion, unchanged. VENTRICULAR SYSTEM: Ex vacuo dilatation. ORBITS: Normal. SINUSES: Paranasal sinuses are clear. VESSELS: Normal noncontrast appearance of the vessels. CONCLUSION: 1. No acute intracranial process. 2. Stable chronic findings as above. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. No evidence of acute infarction. Unchanged confluent periventricular and pericallosal white matter hypoattenuation consistent with demyelinating plaques and/or microangiopathic change. Mild diffuse parenchymal volume loss. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. Near complete opacification of the right mastoid air cells and small left mastoid air cell effusion, unchanged. VENTRICULAR SYSTEM: Ex vacuo dilatation. ORBITS: Normal. SINUSES: Paranasal sinuses are clear. VESSELS: Normal noncontrast appearance of the vessels.
FINDINGS/IMPRESSION: 1. Surgical skin staples are present in the upper anterior and posterior calf soft tissues. Extensive skin and subcutaneous edema, most pronounced in the mid and proximal anterior calf, where edema extends along the superficial and some deep soft tissue planes with muscle edema in the anterior compartment. Single focus of gas is present along the edematous superficial fascia at the level of the upper calf. The findings are consistent with cellulitis, myositis, and fasciitis. Single focus of gas does not have typical appearance of necrotizing fasciitis, however early gas-forming infection cannot be excluded. 2. No drainable fluid collection. No joint effusion. 3. No acute osseous finding.
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RADIOLOGIC EXAM: CT Cervical Spine wo contrast, CT Head wo contrast CLINICAL INFORMATION: MVC COMPARISON: None. TECHNIQUE: CT Cervical Spine wo contrast, CT Head wo contrastScan field of view: 160 mm. DLP: 768 mGy cm. (accession CT220004071), Scan field of view: 250 mm. DLP: 1039 mGy cm. (accession CT220004070) FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Trace scattered mucosal disease with probable tiny left maxillary retention cysts. MASTOIDS: Clear. SOFT TISSUE: Unremarkable. CERVICAL SPINE: Anterior fusion hardware and disc spacers spanning C5-7. Slight straightening of lordosis. Craniocervical junction and odontoid are intact. No acute fracture or malalignment. Soft tissues are grossly unremarkable. CONCLUSION: No acute intracranial process or cervical spine fracture.
FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Trace scattered mucosal disease with probable tiny left maxillary retention cysts. MASTOIDS: Clear. SOFT TISSUE: Unremarkable. CERVICAL SPINE: Anterior fusion hardware and disc spacers spanning C5-7. Slight straightening of lordosis. Craniocervical junction and odontoid are intact. No acute fracture or malalignment. Soft tissues are grossly unremarkable.
FINDINGS/IMPRESSION: 1. Surgical skin staples are present in the upper anterior and posterior calf soft tissues. Extensive skin and subcutaneous edema, most pronounced in the mid and proximal anterior calf, where edema extends along the superficial and some deep soft tissue planes with muscle edema in the anterior compartment. Single focus of gas is present along the edematous superficial fascia at the level of the upper calf. The findings are consistent with cellulitis, myositis, and fasciitis. Single focus of gas does not have typical appearance of necrotizing fasciitis, however early gas-forming infection cannot be excluded. 2. No drainable fluid collection. No joint effusion. 3. No acute osseous finding.
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RADIOLOGIC EXAM: CT Cervical Spine wo contrast, CT Head wo contrast CLINICAL INFORMATION: MVC COMPARISON: None. TECHNIQUE: CT Cervical Spine wo contrast, CT Head wo contrastScan field of view: 160 mm. DLP: 768 mGy cm. (accession CT220004071), Scan field of view: 250 mm. DLP: 1039 mGy cm. (accession CT220004070) FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Trace scattered mucosal disease with probable tiny left maxillary retention cysts. MASTOIDS: Clear. SOFT TISSUE: Unremarkable. CERVICAL SPINE: Anterior fusion hardware and disc spacers spanning C5-7. Slight straightening of lordosis. Craniocervical junction and odontoid are intact. No acute fracture or malalignment. Soft tissues are grossly unremarkable. CONCLUSION: No acute intracranial process or cervical spine fracture.
FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Trace scattered mucosal disease with probable tiny left maxillary retention cysts. MASTOIDS: Clear. SOFT TISSUE: Unremarkable. CERVICAL SPINE: Anterior fusion hardware and disc spacers spanning C5-7. Slight straightening of lordosis. Craniocervical junction and odontoid are intact. No acute fracture or malalignment. Soft tissues are grossly unremarkable.
FINDINGS: CT of the head with and without contrast: BRAIN PARENCHYMA: Scattered foci of hypoattenuation within right frontal lobe along the precentral gyrus superiorly, the left parieto-occipital white matter, and the right occipital white matter. Some of these may represent evolving acute stroke versus some representing chronic infarcts, given the provided history of recent hospital admission for stroke. No acute intraparenchymal hemorrhage or significant mass effect. EXTRA-AXIAL SPACES: No epidural, subdural, or subarachnoid hemorrhage. VENTRICULAR SYSTEM: Normal. SKULL AND SKULL BASE: No acute fracture. ORBITS: Normal. SINUSES: Bilateral maxillary antrostomies and bilateral partial ethmoidectomies.. Left maxillary sinus mucus retention cyst. Scattered residual ethmoid air cell mucosal thickening. MASTOIDS: Clear. SOFT TISSUES: Unremarkable. OTHER: Scattered tiny pulmonary nodules with the largest measuring 3 mm in the right upper lobe (series 501 image 138). Biapical emphysematous changes. CT angiogram of the brain: RIGHT INTRACRANIAL CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT INTRACRANIAL CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. ANTERIOR, MIDDLE, AND POSTERIOR CEREBRAL ARTERIES: : Mild narrowing of the P2 segments of the bilateral PCAs. Otherwise there is no evidence of significant stenosis, occlusion, or aneurysmal dilation. VERTEBROBASILAR ARTERIES: There is no evidence of stenosis, occlusion, or aneurysmal dilation. CT angiogram of the neck: AORTIC ARCH and PROXIMAL GREAT VESSELS: Conventional three vessel branching. RIGHT CAROTID: Calcific and noncalcific atherosclerosis within the carotid bulb without significant luminal narrowing. There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT CAROTID: Calcific and noncalcific atherosclerosis within the carotid bulb without significant luminal narrowing. 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.
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EXAM: CT Angio Chest wo+w contrast CLINICAL INFORMATION: 67-year-old female with shortness of breath. COMPARISON: Prior same-day chest radiograph. TECHNIQUE: CT Angio Chest wo+w contrast. Additional 3D image post-processing was performed to generate MIP and/or volume-rendered images. Patient weight: 155 lbs. IV contrast: Omnipaque 350, 60 ml, per protocol. Saline flush: 60 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bt sec. Scan field of view: 330 mm. KVP: 100 DLP: 156 mGy cm. FINDINGS: STRUCTURED REPORT: CT PE OVERALL DIAGNOSTIC QUALITY: Mildly suboptimal quality with incomplete evaluation of subsegmental pulmonary arteries. LOWER NECK: Heterogenous and enlarged right thyroid lobe with extension posteriorly into the mediastinum. CHEST: PULMONARY ARTERIES: Tiny right lower lobe subsegmental filling defect in the right lower lobe (axial slice 53 series 401). Right upper lobe segmental and subsegmental pulmonary arteries are narrowed and poorly evaluated. The left upper lobe pulmonary artery appears chronically narrowed and occluded secondary to adjacent fibrotic changes (axial series 401, image 40). The main pulmonary artery is normal in caliber. LUNGS / AIRWAYS / PLEURA: Extensive perilymphatic nodular thickening throughout bilateral lungs, no pneumothorax or large pleural effusion. Predominantly in their mid and upper portions. There are interstitial fibrotic changes involving the hila bilaterally with extension towards bilateral lung apices. Bullous changes in bilateral lung apices and the right lung base. Scattered groundglass opacities bilaterally. Innumerable tiny nodules are seen in a random distribution, predominantly throughout the left lung. No pneumothorax or large pleural effusion. HEART / OTHER VESSELS: Heart size is normal. Moderate atherosclerotic calcifications of the coronary arteries, thoracic aorta and proximal great vessels. MEDIASTINUM / ESOPHAGUS: Extensive fibrotic changes involving bilateral hila with narrowing of bilateral upper lobe pulmonary arteries and suspected chronic occlusion of the left upper lobe pulmonary artery, as above. LYMPH NODES: Enlarged paratracheal, subcarinal and bilateral hilar lymphadenopathy. Numerous enlarged lymph nodes are partially calcified. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Normal. MUSCULOSKELETAL: No acute osseous abnormality or aggressive osseous lesion. Increased thoracic kyphosis. CONCLUSION: 1. Tiny right lower lobe subsegmental pulmonary embolus. 2. Bilateral perilymphatic nodular thickening, scattered groundglass opacities, innumerable tiny pulmonary nodules and extensive fibrotic changes predominantly involving the hila bilaterally. Mediastinal and bilateral calcified hilar lymphadenopathy. Findings are compatible with patient's history of sarcoidosis. Superimposed infection is not excluded. 3. Narrowing of bilateral upper lobe pulmonary arteries with suspected chronic occlusion of the left upper lobe pulmonary artery secondary to adjacent fibrotic changes. 4. Large right thyroid nodule with substernal extension. Thyroid ultrasound may be indicated. Findings were discussed with Dr. Briana Miller by Dr. Dylan Bittles at 12:00 AM on 1/8/2022. *****IMPORTANT INCIDENTAL IMAGING FINDINGS REPORTED***** As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
FINDINGS: STRUCTURED REPORT: CT PE OVERALL DIAGNOSTIC QUALITY: Mildly suboptimal quality with incomplete evaluation of subsegmental pulmonary arteries. LOWER NECK: Heterogenous and enlarged right thyroid lobe with extension posteriorly into the mediastinum. CHEST: PULMONARY ARTERIES: Tiny right lower lobe subsegmental filling defect in the right lower lobe (axial slice 53 series 401). Right upper lobe segmental and subsegmental pulmonary arteries are narrowed and poorly evaluated. The left upper lobe pulmonary artery appears chronically narrowed and occluded secondary to adjacent fibrotic changes (axial series 401, image 40). The main pulmonary artery is normal in caliber. LUNGS / AIRWAYS / PLEURA: Extensive perilymphatic nodular thickening throughout bilateral lungs, no pneumothorax or large pleural effusion. Predominantly in their mid and upper portions. There are interstitial fibrotic changes involving the hila bilaterally with extension towards bilateral lung apices. Bullous changes in bilateral lung apices and the right lung base. Scattered groundglass opacities bilaterally. Innumerable tiny nodules are seen in a random distribution, predominantly throughout the left lung. No pneumothorax or large pleural effusion. HEART / OTHER VESSELS: Heart size is normal. Moderate atherosclerotic calcifications of the coronary arteries, thoracic aorta and proximal great vessels. MEDIASTINUM / ESOPHAGUS: Extensive fibrotic changes involving bilateral hila with narrowing of bilateral upper lobe pulmonary arteries and suspected chronic occlusion of the left upper lobe pulmonary artery, as above. LYMPH NODES: Enlarged paratracheal, subcarinal and bilateral hilar lymphadenopathy. Numerous enlarged lymph nodes are partially calcified. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Normal. MUSCULOSKELETAL: No acute osseous abnormality or aggressive osseous lesion. Increased thoracic kyphosis.
FINDINGS: CT of the head with and without contrast: BRAIN PARENCHYMA: Scattered foci of hypoattenuation within right frontal lobe along the precentral gyrus superiorly, the left parieto-occipital white matter, and the right occipital white matter. Some of these may represent evolving acute stroke versus some representing chronic infarcts, given the provided history of recent hospital admission for stroke. No acute intraparenchymal hemorrhage or significant mass effect. EXTRA-AXIAL SPACES: No epidural, subdural, or subarachnoid hemorrhage. VENTRICULAR SYSTEM: Normal. SKULL AND SKULL BASE: No acute fracture. ORBITS: Normal. SINUSES: Bilateral maxillary antrostomies and bilateral partial ethmoidectomies.. Left maxillary sinus mucus retention cyst. Scattered residual ethmoid air cell mucosal thickening. MASTOIDS: Clear. SOFT TISSUES: Unremarkable. OTHER: Scattered tiny pulmonary nodules with the largest measuring 3 mm in the right upper lobe (series 501 image 138). Biapical emphysematous changes. CT angiogram of the brain: RIGHT INTRACRANIAL CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT INTRACRANIAL CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. ANTERIOR, MIDDLE, AND POSTERIOR CEREBRAL ARTERIES: : Mild narrowing of the P2 segments of the bilateral PCAs. Otherwise there is no evidence of significant stenosis, occlusion, or aneurysmal dilation. VERTEBROBASILAR ARTERIES: There is no evidence of stenosis, occlusion, or aneurysmal dilation. CT angiogram of the neck: AORTIC ARCH and PROXIMAL GREAT VESSELS: Conventional three vessel branching. RIGHT CAROTID: Calcific and noncalcific atherosclerosis within the carotid bulb without significant luminal narrowing. There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT CAROTID: Calcific and noncalcific atherosclerosis within the carotid bulb without significant luminal narrowing. 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.
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EXAM: CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: Abdominal pain, history of stage III rectal cancer status post chemoradiation followed by LAR with DLI in 2015. Pelvic recurrence, currently undergoing chemotherapy. COMPARISON: CT abdomen and pelvis with contrast 9/6/2015, MRI pelvis without and with contrast 12/15/2021. TECHNIQUE: CT Abdomen and Pelvis w contrast. Patient weight: 167 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: 577.20 mGy cm. FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Mild dependent atelectatic changes. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Mild right atrial dilatation. ABDOMEN and PELVIS: LIVER: Focal fatty infiltration along the falciform. Mild interval increase in size in a few hypoattenuating lesions in the perihilar right hepatic lobe compared to examination in 2015, likely cysts. No new abnormality. BILIARY TRACT: Normal. GALLBLADDER: Hyperattenuating material layers in the gallbladder, likely vicarious excretion of contrast versus sludge. PANCREAS: Unchanged mild dilatation of the main pancreatic duct. No new abnormality. SPLEEN: Normal. ADRENALS: Unchanged mild nodular thickening of both adrenal glands. KIDNEYS: Simple bilateral renal cysts. Asymmetric delayed enhancement of the right kidney. Excreted contrast is visualized in the right renal collecting system and ureter with moderate hydroureteronephrosis and abrupt tapering at the level of the pelvic mass as below. No left hydroureteronephrosis. LYMPH NODES: Enlarged right common iliac lymph nodes. STOMACH / SMALL BOWEL: Patent enteroenteric anastomosis in the right mid abdomen. No evidence of small bowel obstruction. COLON / APPENDIX: Postsurgical changes from prior low anterior resection with rectosigmoid anastomosis. Focal endophytic area of relative hyperattenuation along the left anterolateral rectal wall, distal to the rectosigmoid anastomosis, measuring 0.7 x 0.6 cm (series 201, image 264). PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Redemonstration of heterogeneous cystic and solid presacral mass which measures 6.9 x 4.1 cm (series 201, image 225) and partially encases the rectosigmoid anastomosis as well as the proximal right external and internal iliac vasculature. The mass encases the distal right ureter with upstream right hydroureteronephrosis, as above, as well as abuts the cecum and a few loops of small bowel. A few foci of gas are noted within the cystic areas of the mass. Multiple adjacent surgical clips. Diffuse presacral edema and surrounding inflammatory stranding. VESSELS: Encasement of the right internal and external iliac musculature by the presacral mass, as above. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus is surgically absent. BODY WALL: Postsurgical changes to the ventral abdominal wall. MUSCULOSKELETAL: No aggressive osseous abnormality is identified. Partially visualized postsurgical changes from prior median sternotomy. CONCLUSION: 1. Redemonstration of lobulated, heterogeneous cystic and solid presacral mass which partially encases the rectosigmoid anastomosis, again concerning for pelvic recurrence of the patient's prior rectal cancer. No dilatation of the upstream colonic segments to suggest high-grade large bowel obstruction 2. Encasement of the distal right ureter by the pelvic mass, resulting in moderate right hydroureteronephrosis and obstructive uropathy. 3. A few punctate foci of gas within the mass could represent fistulous connection with an adjacent loop of bowel versus developing superimposed infection. 4. Enlarged right common iliac lymph nodes, concerning for nodal metastasis. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Mild dependent atelectatic changes. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Mild right atrial dilatation. ABDOMEN and PELVIS: LIVER: Focal fatty infiltration along the falciform. Mild interval increase in size in a few hypoattenuating lesions in the perihilar right hepatic lobe compared to examination in 2015, likely cysts. No new abnormality. BILIARY TRACT: Normal. GALLBLADDER: Hyperattenuating material layers in the gallbladder, likely vicarious excretion of contrast versus sludge. PANCREAS: Unchanged mild dilatation of the main pancreatic duct. No new abnormality. SPLEEN: Normal. ADRENALS: Unchanged mild nodular thickening of both adrenal glands. KIDNEYS: Simple bilateral renal cysts. Asymmetric delayed enhancement of the right kidney. Excreted contrast is visualized in the right renal collecting system and ureter with moderate hydroureteronephrosis and abrupt tapering at the level of the pelvic mass as below. No left hydroureteronephrosis. LYMPH NODES: Enlarged right common iliac lymph nodes. STOMACH / SMALL BOWEL: Patent enteroenteric anastomosis in the right mid abdomen. No evidence of small bowel obstruction. COLON / APPENDIX: Postsurgical changes from prior low anterior resection with rectosigmoid anastomosis. Focal endophytic area of relative hyperattenuation along the left anterolateral rectal wall, distal to the rectosigmoid anastomosis, measuring 0.7 x 0.6 cm (series 201, image 264). PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Redemonstration of heterogeneous cystic and solid presacral mass which measures 6.9 x 4.1 cm (series 201, image 225) and partially encases the rectosigmoid anastomosis as well as the proximal right external and internal iliac vasculature. The mass encases the distal right ureter with upstream right hydroureteronephrosis, as above, as well as abuts the cecum and a few loops of small bowel. A few foci of gas are noted within the cystic areas of the mass. Multiple adjacent surgical clips. Diffuse presacral edema and surrounding inflammatory stranding. VESSELS: Encasement of the right internal and external iliac musculature by the presacral mass, as above. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus is surgically absent. BODY WALL: Postsurgical changes to the ventral abdominal wall. MUSCULOSKELETAL: No aggressive osseous abnormality is identified. Partially visualized postsurgical changes from prior median sternotomy.
FINDINGS: BRAIN PARENCHYMA: No intraparenchymal hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. Cerebral cortical volume is appropriate for patient's age. EXTRA-AXIAL SPACES: Trace fluid underlying the left skull flap measuring 2 mm in thickness. VENTRICULAR SYSTEM: Cavum septum pellucidum. VESSELS: Bilateral ICA calcifications within the cavernous sinus. SKULL AND SKULL BASE: Left pterional craniotomy with small amount of fluid overlying the skull flap measuring 5 mm in thickness. FACIAL BONES: No acute fracture. MANDIBLE: Intact. ORBITS: Normal. SINUSES: Layering fluid within the left maxillary sinus with associated mucosal thickening. Mild ethmoid air cell mucosal thickening. MASTOIDS: Left mastoidectomy postsurgical changes with fluid extending into the remaining mastoid air cells and middle ear. Right mastoid is clear. SOFT TISSUES: Mild postauricular soft tissue swelling likely postsurgical changes.
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RADIOLOGIC EXAM: CT Head wo contrast CLINICAL INFORMATION: Trauma. COMPARISON: CT head 7/8/2021. TECHNIQUE: CT Head wo contrastScan field of view: 230 mm. DLP: 1330 mGy cm. STRUCTURED REPORT: CT Head FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. No evidence of acute infarction. Normal cerebral cortical volume for patient's age. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. Bilateral mastoid air cells are clear. Small hematoma with associated gas in the left temporal soft tissues. Small right frontal hematoma. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Small mucus retention cyst in the right maxillary sinus. VESSELS: Normal noncontrast appearance of the vessels. CONCLUSION: No acute intracranial process. Small hematoma with associated gas in the left temporal soft tissues. 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. Mildly displaced fracture of the left temporal bone involving the anteriormost aspect of the mastoid air cells with associated small amount of gas tracking to the adjacent soft tissues. Fracture of this type is less likely if only blunt injury is suspected, however if penetrating injury is suspected fracture is likely acute. COMMUNICATION: Stephanie Colvin, MD communicated preliminary findings by phone with Dr. Griesmer on 1/8/2022 1:11 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.
FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. No evidence of acute infarction. Normal cerebral cortical volume for patient's age. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. Bilateral mastoid air cells are clear. Small hematoma with associated gas in the left temporal soft tissues. Small right frontal hematoma. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Small mucus retention cyst in the right maxillary sinus. VESSELS: Normal noncontrast appearance of the vessels.
FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Similar moderate to large bilateral pleural effusions with adjacent atelectasis. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Small pericardial effusion. Normal heart size. Partially visualized central venous catheter tip terminates at the cavoatrial junction. ABDOMEN and PELVIS: Exam limited due to motion artifact and beam hardening artifact from patient's left hip arthroplasty. LIVER: Unremarkable for technique. BILIARY TRACT: Normal. GALLBLADDER: Distended, similar to prior exam. PANCREAS: Normal. SPLEEN: Calcified granulomata. ADRENALS: Normal. KIDNEYS: Status post ureteric diversion, ileal conduit with neobladder. Moderate left hydronephrosis, increased from prior exam. Similar left parenchymal thinning. Left perinephric stranding is overall decreased from prior. The proximal aspect of the left double-J ureteral stent coils in the proximal left ureter. The distal end of the ureteric stent has retracted since prior exam but still appears to be within the neobladder, although exact positioning is difficult to evaluate due to artifact from hip arthroplasty and the fact that the neobladder is decompressed. No right hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Stomach is unremarkable. Postsurgical changes of the small bowel again seen. No small bowel obstruction. COLON / APPENDIX: Grossly unremarkable for technique. PERITONEUM / MESENTERY: Similar scattered areas of free fluid in the abdomen and pelvis. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Neobladder is decompressed by Foley catheter. Evaluation is limited by artifact from left hip arthroplasty REPRODUCTIVE ORGANS: Uterus is absent. BODY WALL: Diffuse anasarca. MUSCULOSKELETAL: Left total hip arthroplasty. Interval decrease/apparent resolution of left iliopsoas hematoma. Old healed fractures of the bilateral ribs. Increased diffuse osseous sclerosis, may be secondary to renal osteodystrophy.
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EXAM: CT Chest wo contrast CLINICAL INFORMATION: Trauma. COMPARISON: CT chest with contrast 7/8/2021. TECHNIQUE: CT Chest wo contrast. Scan field of view: 360 mm. DLP: 742 mGy cm. FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Chest Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: The central tracheobronchial tree is patent. Mild dependent atelectatic changes. No pleural effusions or pneumothorax. HEART / VESSELS: No significant abnormality within the limitations of noncontrast technique. Common origin of the brachiocephalic trunk and left common carotid artery, a normal anatomic variant. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: Bilateral gynecomastia. A few foci of soft tissue gas are partially visualized tracking along the posterolateral aspects of the left deltoid and infraspinatus (series 204, image 1). Superficial laceration to the left upper back overlying the scapula (series 204, image 36). UPPER ABDOMEN: Normal. MUSCULOSKELETAL: No aggressive osseous abnormality is identified. CONCLUSION: 1. Superficial laceration to the left upper back. 2. No acute intrathoracic abnormality. 3. A few foci of gas tracking along the posterolateral aspects of the left deltoid and infraspinatus, partially visualized. This could be related to laceration/penetrating injury to the left shoulder/upper extremity outside of the field-of-view of the examination. Recommend correlation with physical examination. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Chest Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: The central tracheobronchial tree is patent. Mild dependent atelectatic changes. No pleural effusions or pneumothorax. HEART / VESSELS: No significant abnormality within the limitations of noncontrast technique. Common origin of the brachiocephalic trunk and left common carotid artery, a normal anatomic variant. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: Bilateral gynecomastia. A few foci of soft tissue gas are partially visualized tracking along the posterolateral aspects of the left deltoid and infraspinatus (series 204, image 1). Superficial laceration to the left upper back overlying the scapula (series 204, image 36). UPPER ABDOMEN: Normal. MUSCULOSKELETAL: No aggressive osseous abnormality is identified.
FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Chest LOWER NECK: Subcentimeter left thyroid lobe hypoattenuating lesion. CHEST: LUNGS / AIRWAYS / PLEURA: No focal consolidation. Mild centrilobular emphysema. Scattered bilateral small noncalcified nodules measuring less than 6 mm (for example, series 3 images 36, 64, 69). Small right effusion, unchanged. HEART / VESSELS: Moderate to severe calcified atherosclerosis, including three-vessel coronary atherosclerosis. Aortic and mitral valve calcifications. Right PICC with tip in proximal right atrium. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: Mildly enlarged subcarinal node measuring 1.1 cm (series 3 image 57) and right hilar lymph node, measures 1.1 cm (image 52) and probably reactive. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Gallbladder is absent. MUSCULOSKELETAL: Degenerative spine changes.
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RADIOLOGIC EXAM: CT Cervical Spine wo contrast CLINICAL INFORMATION: Trauma and fall, intoxicated. COMPARISON: CT cervical spine 7/8/2021. TECHNIQUE: CT Cervical Spine wo contrastScan field of view: 220 mm. DLP: 691 mGy cm. Axial CT images of the cervical spine were obtained without IV contrast. Coronal and sagittal reformats were obtained. 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. Incidental chip fracture of the left temporal bone, communicating with the mastoid air cells. ATLANTODENTAL INTERVAL: Normal (
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. Incidental chip fracture of the left temporal bone, communicating with the mastoid air cells. ATLANTODENTAL INTERVAL: Normal (
Findings: Brain parenchyma: Diffuse age-appropriate brain parenchymal volume loss is again seen, resulting in ex vacuo dilatation of the ventricular system. Periventricular and subcortical white matter hypoattenuation is unchanged, suggestive of mild chronic microvascular ischemic disease. The white-gray matter differentiation is preserved. Persistent physiologic bilateral basal ganglia calcifications. Basal cisterns: There is no significant effacement of the basilar cisterns. Extra-axial spaces: Evolving thin left posterior parieto-occipital convexity subdural hematoma demonstrates some redistribution to the posterior falx, measuring up to 3 mm in maximum thickness, without significant midline shift. Vascular system: Persistent dense atherosclerotic calcifications of the bilateral carotid siphons and vertebral arteries. Soft tissues: Unremarkable without discrete fluid collections. Orbits: Normal appearance. Calvarium and skull base: No acute fractures or suspicious osseous lesions identified. The bilateral mastoid air cell complexes are well-developed and clear. Paranasal sinuses: Well aerated.
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CT Esophagram wo IV contrast Clinical Information: Trauma follow-up, concern for esophageal injury. Comparison: CT chest with contrast from earlier the same day, 1/7/2022. Technique: Multiple contiguous axial CT images of the chest without intravenous contrast were obtained after the patient drank enteric contrast, per departmental CT esophagram protocol. Axial MIPS as well as coronal/sagittal reformatted images were also obtained. Scan field of view: 350 mm. DLP: 291.60 mGy cm. Findings: Small amount of enteric contrast is visualized layering in the mid to distal thoracic esophagus as well as in the stomach. No frank extraluminal contrast leak is identified. No free fluid or gas in the paraesophageal soft tissues. Left thoracostomy tube with its tip terminating anterior to the left lung apex. Right thoracostomy tube with its tip terminating at the right hilum, adjacent to the posterolateral aspect of the mid thoracic esophagus. Focal kinking of the right thoracostomy tube at its proximal side port, corresponding to the apparent discontinuity of the radiopaque stripe seen on prior radiograph. Interval decrease in size of bilateral pneumothoraces, now small volume. Associated worsening subcutaneous emphysema in the bilateral chest wall. Redemonstration of multiple bilateral pulmonary contusions and lacerations. Minimally displaced fracture of the posterior right sixth rib. Left scapular body fracture. Penetrating injuries to the anterior left shoulder and upper back. No new traumatic abnormality. Impression: 1. No evidence of extraluminal contrast leak to suggest esophageal injury. 2. Bilateral thoracostomy tubes with interval reduction in volume of bilateral pneumothoraces, now small. 3. Focal kinking of the right thoracostomy tube at its proximal side port, consistent with the apparent discontinuity of the radiopaque stripe seen on recent chest radiograph. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
Findings: Small amount of enteric contrast is visualized layering in the mid to distal thoracic esophagus as well as in the stomach. No frank extraluminal contrast leak is identified. No free fluid or gas in the paraesophageal soft tissues. Left thoracostomy tube with its tip terminating anterior to the left lung apex. Right thoracostomy tube with its tip terminating at the right hilum, adjacent to the posterolateral aspect of the mid thoracic esophagus. Focal kinking of the right thoracostomy tube at its proximal side port, corresponding to the apparent discontinuity of the radiopaque stripe seen on prior radiograph. Interval decrease in size of bilateral pneumothoraces, now small volume. Associated worsening subcutaneous emphysema in the bilateral chest wall. Redemonstration of multiple bilateral pulmonary contusions and lacerations. Minimally displaced fracture of the posterior right sixth rib. Left scapular body fracture. Penetrating injuries to the anterior left shoulder and upper back. No new traumatic abnormality.
Findings: Brain parenchyma: Prominently frontoparietal brain parenchymal volume loss is seen, resulting in mild exvacuo dilatation of the lateral ventricles. Periventricular and subcortical white matter hypoattenuation is 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: Acute left cerebral convexity subdural hematoma is seen measuring up to 15.5 mm in maximum thickness, resulting in mild mass effect upon the left lateral ventricle, with associated 4 mm rightward midline shift, without basal cistern effacement. Vascular system: Trace atherosclerotic calcifications of the bilateral carotid siphons. 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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RADIOLOGIC EXAM: CT Head wo contrast CLINICAL INFORMATION: PUI for COVID, fall. COMPARISON: CT head 2/23/2021. TECHNIQUE: CT Head wo contrastScan field of view: 290.30 mm. DLP: 1492.20 mGy cm. STRUCTURED REPORT: CT Head FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. No evidence of acute infarction. Confluent periventricular white matter hypoattenuation consistent with microangiopathic change. Mild diffuse parenchymal volume loss. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. Bilateral mastoid air cells are clear. VENTRICULAR SYSTEM: Normal. ORBITS: Bilateral pseudophakia. SINUSES: Small mucus retention cyst in the left maxillary sinus. VESSELS: Scattered mild atherosclerosis of the intracranial vessels. CONCLUSION: 1. No acute intracranial process. 2. Other chronic stable findings as above. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. No evidence of acute infarction. Confluent periventricular white matter hypoattenuation consistent with microangiopathic change. Mild diffuse parenchymal volume loss. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. Bilateral mastoid air cells are clear. VENTRICULAR SYSTEM: Normal. ORBITS: Bilateral pseudophakia. SINUSES: Small mucus retention cyst in the left maxillary sinus. VESSELS: Scattered mild atherosclerosis of the intracranial vessels.
FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Endotracheal tube in place with tip 3.2 cm above the carina. Biapical pleural parenchymal scarring. Pleural calcification right apex. Trace atelectasis in the right lung base. Severe upper lobe predominant centrilobular emphysematous changes. No focal consolidation, pneumothorax or pleural effusion. HEART / VESSELS: Heart size is normal. Mild atherosclerotic calcifications of the thoracic aorta and proximal great vessels. Trace intravascular air, likely secondary to power injection. MEDIASTINUM / ESOPHAGUS: Esophagogastric tube coursing through the esophagus. Mediastinum and esophagus are otherwise unremarkable. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Moderate intra and extrahepatic biliary ductal dilatation. The common bile duct measures 1.6 cm in the hepatic hilum, tapering to normal size at the pancreatic head. GALLBLADDER: Distended. No cholelithiasis, gallbladder wall thickening or pericholecystic fluid. PANCREAS: Main pancreatic duct is mildly dilated in the pancreatic head to 5 mm. Pancreas is otherwise unremarkable. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Esophagogastric tube in place, terminating in the mid stomach. Stomach and small bowel are otherwise unremarkable. COLON / APPENDIX: Uncomplicated diverticulosis. PERITONEUM / MESENTERY: Normal. No free fluid. RETROPERITONEUM: Normal. VESSELS: Infrarenal abdominal aneurysm/ectasia with focal contrast-filled outpouching in the infrarenal abdominal aorta measuring 0.9 x 1.0 cm (axial series 501, image 287). The abdominal aorta is tortuous. Moderate calcific atherosclerosis of the abdominal aorta and its branch vessels. URINARY BLADDER: Distended, otherwise unremarkable. REPRODUCTIVE ORGANS: Uterus is surgically absent. No adnexal mass. BODY WALL: Small fat-containing supraumbilical hernia. MUSCULOSKELETAL: Chronic degenerative changes of bilateral hips. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. Mild multilevel discogenic changes. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. Multilevel discogenic degenerative changes and facet arthropathy, most severe at L2-L3 and L4-L5. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Grade 1 anterolisthesis of L3 on L4. Grade 1 retrolisthesis of L5 on S1.
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RADIOLOGIC EXAM: CT Cervical Spine wo contrast CLINICAL INFORMATION: PUI for COVID Fall COMPARISON: CT cervical spine 2/23/2021. TECHNIQUE: CT Cervical Spine wo contrastScan field of view: 192.30 mm. DLP: 452.50 mGy cm. Axial CT images of the cervical spine were obtained without IV contrast. Coronal and sagittal reformats were obtained. 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 (
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 (
FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Endotracheal tube in place with tip 3.2 cm above the carina. Biapical pleural parenchymal scarring. Pleural calcification right apex. Trace atelectasis in the right lung base. Severe upper lobe predominant centrilobular emphysematous changes. No focal consolidation, pneumothorax or pleural effusion. HEART / VESSELS: Heart size is normal. Mild atherosclerotic calcifications of the thoracic aorta and proximal great vessels. Trace intravascular air, likely secondary to power injection. MEDIASTINUM / ESOPHAGUS: Esophagogastric tube coursing through the esophagus. Mediastinum and esophagus are otherwise unremarkable. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Moderate intra and extrahepatic biliary ductal dilatation. The common bile duct measures 1.6 cm in the hepatic hilum, tapering to normal size at the pancreatic head. GALLBLADDER: Distended. No cholelithiasis, gallbladder wall thickening or pericholecystic fluid. PANCREAS: Main pancreatic duct is mildly dilated in the pancreatic head to 5 mm. Pancreas is otherwise unremarkable. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Esophagogastric tube in place, terminating in the mid stomach. Stomach and small bowel are otherwise unremarkable. COLON / APPENDIX: Uncomplicated diverticulosis. PERITONEUM / MESENTERY: Normal. No free fluid. RETROPERITONEUM: Normal. VESSELS: Infrarenal abdominal aneurysm/ectasia with focal contrast-filled outpouching in the infrarenal abdominal aorta measuring 0.9 x 1.0 cm (axial series 501, image 287). The abdominal aorta is tortuous. Moderate calcific atherosclerosis of the abdominal aorta and its branch vessels. URINARY BLADDER: Distended, otherwise unremarkable. REPRODUCTIVE ORGANS: Uterus is surgically absent. No adnexal mass. BODY WALL: Small fat-containing supraumbilical hernia. MUSCULOSKELETAL: Chronic degenerative changes of bilateral hips. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. Mild multilevel discogenic changes. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. Multilevel discogenic degenerative changes and facet arthropathy, most severe at L2-L3 and L4-L5. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Grade 1 anterolisthesis of L3 on L4. Grade 1 retrolisthesis of L5 on S1.
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EXAM: CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: Recent diverticulitis, evaluate for abscess or perforation. COMPARISON: None available. TECHNIQUE: CT Abdomen and Pelvis w contrast. Patient weight: 171 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 75 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 78 sec. Scan field of view: 411 mm. DLP: 718.30 mGy cm. FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Linear subsegmental atelectatic changes at both lung bases. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Simple cysts in the left upper pole. Otherwise, no significant abnormality. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: A few dilated loops of small bowel in the mid and upper abdomen abutting the pericolonic mesenteric abscess and containing fecalized material. COLON / APPENDIX: Colonic diverticulosis. Short segment colonic wall thickening and submucosal edema centered around a perforated sigmoid diverticulum (series 402, image 42) with surrounding inflammatory stranding/edema. Thick-walled, peripherally enhancing gas and fluid filled collection in the adjacent mesocolon, measuring 6.9 x 5.9 x 5.2 cm (AP by TR by CC on series 401, image 193 and series 403, image 72). PERITONEUM / MESENTERY: Small volume pneumoperitoneum, predominantly in the upper abdomen. Stranding and edema in the mesentery adjacent to the above pericolonic collection. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Partially decompressed, limiting evaluation. REPRODUCTIVE ORGANS: Large right and small left hydroceles. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No aggressive osseous abnormalities identified. Multilevel degenerative changes in the visualized thoracolumbar spine. CONCLUSION: 1. Perforated sigmoid diverticulitis with large abscess in the adjacent mesentery and small volume pneumoperitoneum. 2. Multiple dilated loops small bowel material in the mid and upper abdomen containing fecalized material with apparent change in caliber adjacent to the pericolonic abscess, concerning for at least partial small bowel obstruction. Note: Preliminary findings were discussed with Dr. Kessler by Dr. Cook at 1/8/2022 1:17 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.
FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Linear subsegmental atelectatic changes at both lung bases. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Simple cysts in the left upper pole. Otherwise, no significant abnormality. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: A few dilated loops of small bowel in the mid and upper abdomen abutting the pericolonic mesenteric abscess and containing fecalized material. COLON / APPENDIX: Colonic diverticulosis. Short segment colonic wall thickening and submucosal edema centered around a perforated sigmoid diverticulum (series 402, image 42) with surrounding inflammatory stranding/edema. Thick-walled, peripherally enhancing gas and fluid filled collection in the adjacent mesocolon, measuring 6.9 x 5.9 x 5.2 cm (AP by TR by CC on series 401, image 193 and series 403, image 72). PERITONEUM / MESENTERY: Small volume pneumoperitoneum, predominantly in the upper abdomen. Stranding and edema in the mesentery adjacent to the above pericolonic collection. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Partially decompressed, limiting evaluation. REPRODUCTIVE ORGANS: Large right and small left hydroceles. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No aggressive osseous abnormalities identified. Multilevel degenerative changes in the visualized thoracolumbar spine.
Findings: The sagittal images demonstrate dextroscoliosis of the cervical spine centered at C4-C5, with preservation of the cervical lordosis, and grade 1 anterolisthesis of C7 on T1. Postsurgical anterior spinal fusion at C4-C5, C5-C6 and C6-C7, with moderate bony callus formation, without perihardware lucencies, malpositioning or hardware fractures. The vertebral bodies otherwise maintain normal height, without acute fractures or suspicious osseous lesions. Multilevel intervertebral disc space loss, endplate sclerosis and osteophytosis, moderate at C7-T1. The craniocervical junction appears unremarkable. Multilevel uncovertebral and facet hypertrophy seen, resulting in severe left C3-C4/bilateral C6-C7 neuroforaminal narrowing, with moderate C6-7 spinal canal stenosis. The prevertebral and paraspinal soft tissues appear normal.
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RADIOLOGIC EXAM: CT Head wo contrast CLINICAL INFORMATION: VP shunt, seizure. COMPARISON: CT head 2/27/2013. MR brain 7/18/2014. TECHNIQUE: CT Head wo contrastScan field of view: 210 mm. DLP: 1278 mGy cm. STRUCTURED REPORT: CT Head FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. No evidence of acute infarction. Normal cerebral cortical volume for patient's age. Minimal interval increased size of the well-circumscribed, partially calcified, dural based lesion in the right parietal lobe measuring 3.0 x 2.1 cm (image 47, series #201), previously 2.7 x 1.9 cm. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: Stable postsurgical change from prior right parietal craniotomy. Mastoid air cells are clear. No acute fracture. VENTRICULAR SYSTEM: Normal sized ventricles. No VP shunt catheter present. ORBITS: Normal. SINUSES: Paranasal sinuses are clear. VESSELS: Normal noncontrast appearance of the vessels. CONCLUSION: 1. No acute intracranial process. 2. Normal size ventricles. No VP shunt catheter present. 3. Minimal interval increased size of the partially calcified right parietal lobe dural based lesion, likely meningioma. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. No evidence of acute infarction. Normal cerebral cortical volume for patient's age. Minimal interval increased size of the well-circumscribed, partially calcified, dural based lesion in the right parietal lobe measuring 3.0 x 2.1 cm (image 47, series #201), previously 2.7 x 1.9 cm. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: Stable postsurgical change from prior right parietal craniotomy. Mastoid air cells are clear. No acute fracture. VENTRICULAR SYSTEM: Normal sized ventricles. No VP shunt catheter present. ORBITS: Normal. SINUSES: Paranasal sinuses are clear. VESSELS: Normal noncontrast appearance of the vessels.
FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Endotracheal tube in place with tip 3.2 cm above the carina. Biapical pleural parenchymal scarring. Pleural calcification right apex. Trace atelectasis in the right lung base. Severe upper lobe predominant centrilobular emphysematous changes. No focal consolidation, pneumothorax or pleural effusion. HEART / VESSELS: Heart size is normal. Mild atherosclerotic calcifications of the thoracic aorta and proximal great vessels. Trace intravascular air, likely secondary to power injection. MEDIASTINUM / ESOPHAGUS: Esophagogastric tube coursing through the esophagus. Mediastinum and esophagus are otherwise unremarkable. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Moderate intra and extrahepatic biliary ductal dilatation. The common bile duct measures 1.6 cm in the hepatic hilum, tapering to normal size at the pancreatic head. GALLBLADDER: Distended. No cholelithiasis, gallbladder wall thickening or pericholecystic fluid. PANCREAS: Main pancreatic duct is mildly dilated in the pancreatic head to 5 mm. Pancreas is otherwise unremarkable. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Esophagogastric tube in place, terminating in the mid stomach. Stomach and small bowel are otherwise unremarkable. COLON / APPENDIX: Uncomplicated diverticulosis. PERITONEUM / MESENTERY: Normal. No free fluid. RETROPERITONEUM: Normal. VESSELS: Infrarenal abdominal aneurysm/ectasia with focal contrast-filled outpouching in the infrarenal abdominal aorta measuring 0.9 x 1.0 cm (axial series 501, image 287). The abdominal aorta is tortuous. Moderate calcific atherosclerosis of the abdominal aorta and its branch vessels. URINARY BLADDER: Distended, otherwise unremarkable. REPRODUCTIVE ORGANS: Uterus is surgically absent. No adnexal mass. BODY WALL: Small fat-containing supraumbilical hernia. MUSCULOSKELETAL: Chronic degenerative changes of bilateral hips. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. Mild multilevel discogenic changes. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. Multilevel discogenic degenerative changes and facet arthropathy, most severe at L2-L3 and L4-L5. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Grade 1 anterolisthesis of L3 on L4. Grade 1 retrolisthesis of L5 on S1.
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CT Angio Neck Clinical Information: Trauma, seatbelt sign. Comparison: None available. Technique: Exam prematurely terminated due to IV infiltration. Patient evaluated by Gardendale ED physician. Findings/Conclusion: Partial nondiagnostic study. No obvious abnormality visualized on scout images. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
Findings/Conclusion: Partial nondiagnostic study. No obvious abnormality visualized on scout images. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Endotracheal tube in place with tip 3.2 cm above the carina. Biapical pleural parenchymal scarring. Pleural calcification right apex. Trace atelectasis in the right lung base. Severe upper lobe predominant centrilobular emphysematous changes. No focal consolidation, pneumothorax or pleural effusion. HEART / VESSELS: Heart size is normal. Mild atherosclerotic calcifications of the thoracic aorta and proximal great vessels. Trace intravascular air, likely secondary to power injection. MEDIASTINUM / ESOPHAGUS: Esophagogastric tube coursing through the esophagus. Mediastinum and esophagus are otherwise unremarkable. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Moderate intra and extrahepatic biliary ductal dilatation. The common bile duct measures 1.6 cm in the hepatic hilum, tapering to normal size at the pancreatic head. GALLBLADDER: Distended. No cholelithiasis, gallbladder wall thickening or pericholecystic fluid. PANCREAS: Main pancreatic duct is mildly dilated in the pancreatic head to 5 mm. Pancreas is otherwise unremarkable. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Esophagogastric tube in place, terminating in the mid stomach. Stomach and small bowel are otherwise unremarkable. COLON / APPENDIX: Uncomplicated diverticulosis. PERITONEUM / MESENTERY: Normal. No free fluid. RETROPERITONEUM: Normal. VESSELS: Infrarenal abdominal aneurysm/ectasia with focal contrast-filled outpouching in the infrarenal abdominal aorta measuring 0.9 x 1.0 cm (axial series 501, image 287). The abdominal aorta is tortuous. Moderate calcific atherosclerosis of the abdominal aorta and its branch vessels. URINARY BLADDER: Distended, otherwise unremarkable. REPRODUCTIVE ORGANS: Uterus is surgically absent. No adnexal mass. BODY WALL: Small fat-containing supraumbilical hernia. MUSCULOSKELETAL: Chronic degenerative changes of bilateral hips. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. Mild multilevel discogenic changes. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. Multilevel discogenic degenerative changes and facet arthropathy, most severe at L2-L3 and L4-L5. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Grade 1 anterolisthesis of L3 on L4. Grade 1 retrolisthesis of L5 on S1.
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RADIOLOGIC EXAM: CT Head wo contrast CLINICAL INFORMATION: Blurry vision, SCC. Per chart review, history of sickle cell disease. COMPARISON: None. TECHNIQUE: CT Head wo contrastScan field of view: 250 mm. DLP: 1290.20 mGy cm. STRUCTURED REPORT: CT Head FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. No evidence of acute infarction. Normal cerebral cortical volume for patient's age. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. Bilateral mastoid air cells are clear. VENTRICULAR SYSTEM: Normal. ORBITS: Right pseudophakia. SINUSES: Mild mucosal thickening of the left maxillary and ethmoid sinuses. VESSELS: Mild atherosclerosis of the bilateral carotid siphons and vertebral arteries. CONCLUSION: No acute intracranial process. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. No evidence of acute infarction. Normal cerebral cortical volume for patient's age. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. Bilateral mastoid air cells are clear. VENTRICULAR SYSTEM: Normal. ORBITS: Right pseudophakia. SINUSES: Mild mucosal thickening of the left maxillary and ethmoid sinuses. VESSELS: Mild atherosclerosis of the bilateral carotid siphons and vertebral arteries.
FINDINGS: Soft tissues: Mild prefrontal scalp soft tissue contusion. Bones: Acute comminuted fractures of the bilateral nasal bones, extending into the bilateral frontal process of the maxilla and anterior nasal septum, with partial opacification of the anterior nasal cavity. No suspicious osseous lesions are seen. The visualized mandible is intact and the bilateral TMJs are congruent. Orbits: Incidental bilateral lens replacements. The bilateral globes and optic nerves are intact. The retrobulbar soft tissues have a normal appearance. Paranasal sinuses and mastoid air cells: Right greater than left maxillary sinus mucous retention cysts. Minimal dependent bilateral mastoid effusions. Otherwise, appear well aerated.
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CT Angio Head wo+w contrast 1/8/2022 8:58 AM Clinical Information: Intracranial aneurysm. Comparison: Outside CTA head 1/7/2022 Technique: 5 mm axial images were obtained without contrast from the base of the skull to the vertex. During the IV infusion of contrast, 1.4 mm images were obtained from skull base to the skull vertex. 3-D CT angiographic images were generated from the axial data set from an independent workstation. "Sliding MIP" images were also generated in the sagittal, axial, and coronal planes. Delayed contrast enhanced 5 mm axial images were then performed from the base of the skull to the vertex. Patient weight: 125 lbs. IV contrast: Omnipaque 350, 100 ml, per protocol. Saline flush: 60 ml. IV contrast injection rate: 4 ml per sec. Scan delay: Bolus Tracked. Scan field of view: 209 mm. DLP: 2847 mGy cm. Findings: CT head: Postsurgical changes status post right pterional craniotomy. There is a subdural fluid collection with intermixed gas measuring up to 5 mm in thickness. Right frontal approach surgical drain is present coursing through the right frontal lobe and terminating in the anterior right lateral ventricle. There is moderate pneumocephalus and moderate gas within the ventricles. There is hemorrhage within the basal cisterns extending along the bilateral sylvian fissures and intraparenchymal contusion/edema along the right frontal lobe. There is no midline shift or herniation. Paranasal sinuses and mastoid air cells are clear. Orbits appear normal. CTA head: Interval clipping of the anterior to indicating artery aneurysm evaluation is limited due to metallic streak artifacts, however no residual filling of the aneurysm sac is appreciated. The bilateral ACAs are patent. The intracranial ICAs, vertebral arteries, basilar artery, MCAs, and PCAs are normal in caliber..No flow limiting stenosis or aneurysm is identified. No evidence of extravasation. Impression: Expected postsurgical changes status post pterional craniotomy and anterior communicating artery aneurysm clipping with residual subarachnoid and pneumocephalus. No residual filling of the aneurysm sac is identified, no evidence of acute arterial injury, symmetric in stenosis, or occlusion of the major intracranial arteries. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
Findings: CT head: Postsurgical changes status post right pterional craniotomy. There is a subdural fluid collection with intermixed gas measuring up to 5 mm in thickness. Right frontal approach surgical drain is present coursing through the right frontal lobe and terminating in the anterior right lateral ventricle. There is moderate pneumocephalus and moderate gas within the ventricles. There is hemorrhage within the basal cisterns extending along the bilateral sylvian fissures and intraparenchymal contusion/edema along the right frontal lobe. There is no midline shift or herniation. Paranasal sinuses and mastoid air cells are clear. Orbits appear normal. CTA head: Interval clipping of the anterior to indicating artery aneurysm evaluation is limited due to metallic streak artifacts, however no residual filling of the aneurysm sac is appreciated. The bilateral ACAs are patent. The intracranial ICAs, vertebral arteries, basilar artery, MCAs, and PCAs are normal in caliber..No flow limiting stenosis or aneurysm is identified. No evidence of extravasation.
FINDINGS: VASCULAR FINDINGS: Aortic arch: Patent with no hemodynamically significant stenosis. Three normal vessel aortic arch with scattered nonflow limiting atherosclerotic calcifications. Common carotid arteries: Patent with no hemodynamically significant stenosis. Internal carotid arteries: Minimal luminal irregularities and atherosclerotic calcifications are seen involving the bilateral proximal ICAs. Otherwise, remain patent with no hemodynamically significant stenosis. Vertebral arteries: Dominant right vertebral artery. Diminutive left vertebral artery. Punctate atherosclerotic calcification at the origin of the right vertebral artery, resulting in mild focal luminal narrowing. Otherwise, remain 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 atrophic. Partially visualized emphysematous changes in the lung apices.
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EXAM: CT Angio Chest wo+w contrast CLINICAL INFORMATION: Concern for pulmonary embolus 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: 165 lbs. IV contrast: Omnipaque 350, 60 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 4 ml per sec. Scan delay: boluis tracked Scan field of view: 318.50 mm. KVP: 100 DLP: 153.60 mGy cm. FINDINGS: STRUCTURED REPORT: CT PE OVERALL DIAGNOSTIC QUALITY: Full diagnostic quality LOWER NECK: No abnormality. CHEST: PULMONARY ARTERIES: Negative for pulmonary embolus LUNGS / AIRWAYS / PLEURA: 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. CONCLUSION: Negative for pulmonary embolus or other acute process.
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: 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.
FINDINGS: Aortic arch: Patent without flow-limiting stenosis. Normal three vessel aortic arch is noted. Dense nonflow limiting atherosclerotic calcifications and fibrofatty plaques of the bilateral carotid bifurcations. Right carotid: Otherwise, remain patent without flow-limiting stenosis. Left carotid: Otherwise, remain patent without flow-limiting stenosis. Right vertebral artery: Filiform flow. Patent without flow-limiting stenosis. Left vertebral artery: Dominant. Patent without flow-limiting stenosis. Intracranial arteries: Hypoplastic right A1 segment. The bilateral ACAs, MCAs and PCAs appear patent, without flow-limiting stenoses or discrete aneurysms. The vertebrobasilar axis is mildly tortuous, without flow-limiting stenoses. NONVASCULAR FINDINGS: Brain parenchyma volume appears normal. Questionable hypoattenuation involving the right frontal centrum semiovale may represent early chronic microvascular ischemic disease. The white-gray matter differentiation is preserved. There is no abnormal enhancement, acute intracranial hemorrhage, midline shift, basal cistern effacement, hydrocephalus or abnormal extra-axial fluid collections. Incidental hyperostosis frontalis interna. 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 mildly heterogeneous.
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RADIOLOGIC EXAM: CT Head wo contrast, CT Maxillofacial wo contrast CLINICAL INFORMATION: PUI for COVID Trauma COMPARISON: CT head 11/26/2020 and multiple priors. TECHNIQUE: CT Head wo contrast, CT Maxillofacial wo contrastScan field of view: 257.80 mm. DLP: 1444.10 mGy cm. (accession CT220004100), Scan field of view: 180.50 mm. DLP: 1141.80 mGy cm. (accession CT220004106) STRUCTURED REPORT: CT Head and Maxillofacial Trauma 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: Small right periorbital hematoma. The globes are intact. No exophthalmos or retrobulbar hemorrhage identified. SKULL AND SKULL BASE: No fracture. Bilateral mastoid air cells are clear. FACIAL BONES: No acute fracture. Bilateral pterygoid plates are intact. Small hematoma of the nasal soft tissues containing tiny foci of gas. MANDIBLE: No acute fracture. Bilateral temporomandibular joints are intact. SINONASAL CAVITIES: Paranasal sinuses are clear. CONCLUSION: 1. No acute intracranial process or maxillofacial fracture. 2. Small right periorbital and nasal soft tissue hematomas. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. Cerebral cortical volume is normal. EXTRA-AXIAL SPACES: Normal. VENTRICULAR SYSTEM: Normal. ORBITS: Small right periorbital hematoma. The globes are intact. No exophthalmos or retrobulbar hemorrhage identified. SKULL AND SKULL BASE: No fracture. Bilateral mastoid air cells are clear. FACIAL BONES: No acute fracture. Bilateral pterygoid plates are intact. Small hematoma of the nasal soft tissues containing tiny foci of gas. MANDIBLE: No acute fracture. Bilateral temporomandibular joints are intact. SINONASAL CAVITIES: Paranasal sinuses are clear.
FINDINGS: Aortic arch: Patent without flow-limiting stenosis. Normal three vessel aortic arch is noted. Dense nonflow limiting atherosclerotic calcifications and fibrofatty plaques of the bilateral carotid bifurcations. Right carotid: Otherwise, remain patent without flow-limiting stenosis. Left carotid: Otherwise, remain patent without flow-limiting stenosis. Right vertebral artery: Filiform flow. Patent without flow-limiting stenosis. Left vertebral artery: Dominant. Patent without flow-limiting stenosis. Intracranial arteries: Hypoplastic right A1 segment. The bilateral ACAs, MCAs and PCAs appear patent, without flow-limiting stenoses or discrete aneurysms. The vertebrobasilar axis is mildly tortuous, without flow-limiting stenoses. NONVASCULAR FINDINGS: Brain parenchyma volume appears normal. Questionable hypoattenuation involving the right frontal centrum semiovale may represent early chronic microvascular ischemic disease. The white-gray matter differentiation is preserved. There is no abnormal enhancement, acute intracranial hemorrhage, midline shift, basal cistern effacement, hydrocephalus or abnormal extra-axial fluid collections. Incidental hyperostosis frontalis interna. 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 mildly heterogeneous.
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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 COMPARISON: 9/27/2020 TECHNIQUE: CT Chest with contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat, CT Abdomen and Pelvis w contrast Patient weight: 165 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 70 sec Scan field of view: 415.40 mm. DLP: 948.70 mGy cm. (accession CT220004101), Patient weight: 165 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 70 sec Scan field of view: 415.40 mm. (accession CT220004102), Patient weight: 165 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 70 sec Scan field of view: 415.40 mm. DLP: 948.70 mGy cm. (accession CT220004105), Patient weight: 165 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 70 sec Scan field of view: 415.40 mm. DLP: 948.70 mGy cm. (accession CT220004104) FINDINGS: LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Several scattered cysts. No pulmonary contusion or pneumothorax. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Steatotic with more prominent focal fatty infiltration along the falciform ligament. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Small left renal cyst. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Mild scattered calcific atherosclerosis. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Comminuted right humeral neck fracture. THORACIC SPINE: No acute fracture or malalignment. LUMBAR SPINE: No acute fracture or malalignment. CONCLUSION: 1. Acute comminuted right humeral neck fracture. 2. No other acute or posttraumatic finding in the chest, abdomen, pelvis or thoracolumbar spine. 3. Additional findings above.
FINDINGS: LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Several scattered cysts. No pulmonary contusion or pneumothorax. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Steatotic with more prominent focal fatty infiltration along the falciform ligament. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Small left renal cyst. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Mild scattered calcific atherosclerosis. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Comminuted right humeral neck fracture. THORACIC SPINE: No acute fracture or malalignment. LUMBAR SPINE: No acute fracture or malalignment.
FINDINGS/CONCLUSION: Displaced fracture of the lateral malleolus. Comminuted, displaced fracture of the posterior malleolus as well as the anterolateral aspect of the tibial plafond. Partially visualized fracture of the distal fibula. Minimally displaced avulsion fracture of the lateral talar process. There is lateral translation of the talus in respect to the tibia with widening of the medial ankle mortise and distal tibiofibular syndesmosis. Severely comminuted fracture of the calcaneus involving the anterior, middle, and posterior facets of the subtalar joint as well as the calcaneocuboid joint. Nondisplaced fracture of the navicular extending into the talonavicular joint. External fixation hardware is noted with screws within the calcaneus and cuneiforms. Soft tissue gas is noted about the ankle consistent with open fractures. Extensive soft tissue swelling is noted about the ankle and hindfoot.
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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 COMPARISON: 9/27/2020 TECHNIQUE: CT Chest with contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat, CT Abdomen and Pelvis w contrast Patient weight: 165 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 70 sec Scan field of view: 415.40 mm. DLP: 948.70 mGy cm. (accession CT220004101), Patient weight: 165 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 70 sec Scan field of view: 415.40 mm. (accession CT220004102), Patient weight: 165 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 70 sec Scan field of view: 415.40 mm. DLP: 948.70 mGy cm. (accession CT220004105), Patient weight: 165 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 70 sec Scan field of view: 415.40 mm. DLP: 948.70 mGy cm. (accession CT220004104) FINDINGS: LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Several scattered cysts. No pulmonary contusion or pneumothorax. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Steatotic with more prominent focal fatty infiltration along the falciform ligament. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Small left renal cyst. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Mild scattered calcific atherosclerosis. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Comminuted right humeral neck fracture. THORACIC SPINE: No acute fracture or malalignment. LUMBAR SPINE: No acute fracture or malalignment. CONCLUSION: 1. Acute comminuted right humeral neck fracture. 2. No other acute or posttraumatic finding in the chest, abdomen, pelvis or thoracolumbar spine. 3. Additional findings above.
FINDINGS: LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Several scattered cysts. No pulmonary contusion or pneumothorax. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Steatotic with more prominent focal fatty infiltration along the falciform ligament. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Small left renal cyst. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Mild scattered calcific atherosclerosis. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Comminuted right humeral neck fracture. THORACIC SPINE: No acute fracture or malalignment. LUMBAR SPINE: No acute fracture or malalignment.
Findings: Brain parenchyma: Mild frontal brain parenchymal volume loss is again 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. 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 circumferential mucosal thickening of the bilateral sphenoid sinuses and right frontal sinus mucous retention cyst. Otherwise, remain well aerated.
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RADIOLOGIC EXAM: CT Cervical Spine From Reformat, CT Angio Neck CLINICAL INFORMATION: Trauma. COMPARISON: Multiple prior CT cervical spine 9/27/2020. TECHNIQUE: CT Cervical Spine From Reformat, CT Angio NeckPatient weight: 165 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: 253.60 mm. DLP: 877.20 mGy cm. Following CT of the neck, reformatted images were produced to optimize visualization of the osseous structures of the cervical spine. 3-D CT MIP were generated in post processing. FINDINGS: CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
FINDINGS: CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
FINDINGS: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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EXAM: CT Chest with contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat, CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: Trauma COMPARISON: 9/27/2020 TECHNIQUE: CT Chest with contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat, CT Abdomen and Pelvis w contrast Patient weight: 165 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 70 sec Scan field of view: 415.40 mm. DLP: 948.70 mGy cm. (accession CT220004101), Patient weight: 165 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 70 sec Scan field of view: 415.40 mm. (accession CT220004102), Patient weight: 165 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 70 sec Scan field of view: 415.40 mm. DLP: 948.70 mGy cm. (accession CT220004105), Patient weight: 165 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 70 sec Scan field of view: 415.40 mm. DLP: 948.70 mGy cm. (accession CT220004104) FINDINGS: LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Several scattered cysts. No pulmonary contusion or pneumothorax. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Steatotic with more prominent focal fatty infiltration along the falciform ligament. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Small left renal cyst. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Mild scattered calcific atherosclerosis. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Comminuted right humeral neck fracture. THORACIC SPINE: No acute fracture or malalignment. LUMBAR SPINE: No acute fracture or malalignment. CONCLUSION: 1. Acute comminuted right humeral neck fracture. 2. No other acute or posttraumatic finding in the chest, abdomen, pelvis or thoracolumbar spine. 3. Additional findings above.
FINDINGS: LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Several scattered cysts. No pulmonary contusion or pneumothorax. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Steatotic with more prominent focal fatty infiltration along the falciform ligament. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Small left renal cyst. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Mild scattered calcific atherosclerosis. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Comminuted right humeral neck fracture. THORACIC SPINE: No acute fracture or malalignment. LUMBAR SPINE: No acute fracture or malalignment.
FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Trace bilateral pleural effusions. There is mild peribronchial thickening with subsegmental atelectasis and groundglass opacities which could represent mild pulmonary edema.. DISTAL ESOPHAGUS: Small hiatal hernia. HEART / VESSELS: Cardiomegaly with small pericardial effusion. ABDOMEN and PELVIS: LIVER: Unremarkable for technique BILIARY TRACT: Mild intra and extrahepatic biliary duct dilatation, probably related to post cholecystectomy state. GALLBLADDER: Surgically absent PANCREAS: Unremarkable for technique SPLEEN: Unremarkable for technique ADRENALS: Normal. KIDNEYS: Bilateral low attenuated lesions are seen within both kidneys, likely representing renal cysts of varying size and complexity. There are scattered calcifications, probably parenchymal. There is an indeterminant hyperdense mass seen in the mid right kidney which is difficult to fully visualize which measures approximately 4.4 x 4.5 cm on image 151, series 2. This may have internal hemorrhage. There is an additional hyperdense lesion in the lower pole the left kidney measuring 2.1 x 2.4 cm on image 193, series 2. There is an additional hyperdense lesion in the mid left kidney measuring 2.5 cm on image 154, series 2. No radiopaque urinary calculus or hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Scattered noninflamed colonic diverticula. The appendix is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Mild aortoiliac atherosclerosis. There is a right groin arteriovenous graft. Otherwise unremarkable without intravenous contrast. URINARY BLADDER: Collapsed and poorly visualized REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Fat-containing umbilical hernia possibly subincisional. Mild body wall anasarca. MUSCULOSKELETAL: There is diffuse osseous sclerosis compatible with renal osteodystrophy. No focal destructive osseous lesion is identified.
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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 COMPARISON: 9/27/2020 TECHNIQUE: CT Chest with contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat, CT Abdomen and Pelvis w contrast Patient weight: 165 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 70 sec Scan field of view: 415.40 mm. DLP: 948.70 mGy cm. (accession CT220004101), Patient weight: 165 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 70 sec Scan field of view: 415.40 mm. (accession CT220004102), Patient weight: 165 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 70 sec Scan field of view: 415.40 mm. DLP: 948.70 mGy cm. (accession CT220004105), Patient weight: 165 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 70 sec Scan field of view: 415.40 mm. DLP: 948.70 mGy cm. (accession CT220004104) FINDINGS: LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Several scattered cysts. No pulmonary contusion or pneumothorax. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Steatotic with more prominent focal fatty infiltration along the falciform ligament. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Small left renal cyst. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Mild scattered calcific atherosclerosis. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Comminuted right humeral neck fracture. THORACIC SPINE: No acute fracture or malalignment. LUMBAR SPINE: No acute fracture or malalignment. CONCLUSION: 1. Acute comminuted right humeral neck fracture. 2. No other acute or posttraumatic finding in the chest, abdomen, pelvis or thoracolumbar spine. 3. Additional findings above.
FINDINGS: LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Several scattered cysts. No pulmonary contusion or pneumothorax. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Steatotic with more prominent focal fatty infiltration along the falciform ligament. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Small left renal cyst. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Mild scattered calcific atherosclerosis. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Comminuted right humeral neck fracture. THORACIC SPINE: No acute fracture or malalignment. LUMBAR SPINE: No acute fracture or malalignment.
Findings: There is an apparent right wall down's mastoidectomy defect and there are soft tissue densities and air filling the mastoidectomy bowl. There is absence of the ossicles. Soft tissue bulges into the external ear canal, granulation tissue and possibly cholesteatoma. There is a drainage tube in the central aspect of the mastoidectomy bowl. There is dehiscence of the tegmen tympani and there is erosion into the otic capsule. There is dehiscence of the superior and lateral semicircular canals. The left petrous bone, mastoids, middle ear structures and inner ear structures which are visible have expected appearance. There is a retention cyst in the left maxillary sinus. The remainder of the paranasal sinuses are clear. ----------------
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RADIOLOGIC EXAM: CT Head wo contrast, CT Maxillofacial wo contrast CLINICAL INFORMATION: PUI for COVID Trauma COMPARISON: CT head 11/26/2020 and multiple priors. TECHNIQUE: CT Head wo contrast, CT Maxillofacial wo contrastScan field of view: 257.80 mm. DLP: 1444.10 mGy cm. (accession CT220004100), Scan field of view: 180.50 mm. DLP: 1141.80 mGy cm. (accession CT220004106) STRUCTURED REPORT: CT Head and Maxillofacial Trauma 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: Small right periorbital hematoma. The globes are intact. No exophthalmos or retrobulbar hemorrhage identified. SKULL AND SKULL BASE: No fracture. Bilateral mastoid air cells are clear. FACIAL BONES: No acute fracture. Bilateral pterygoid plates are intact. Small hematoma of the nasal soft tissues containing tiny foci of gas. MANDIBLE: No acute fracture. Bilateral temporomandibular joints are intact. SINONASAL CAVITIES: Paranasal sinuses are clear. CONCLUSION: 1. No acute intracranial process or maxillofacial fracture. 2. Small right periorbital and nasal soft tissue hematomas. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. Cerebral cortical volume is normal. EXTRA-AXIAL SPACES: Normal. VENTRICULAR SYSTEM: Normal. ORBITS: Small right periorbital hematoma. The globes are intact. No exophthalmos or retrobulbar hemorrhage identified. SKULL AND SKULL BASE: No fracture. Bilateral mastoid air cells are clear. FACIAL BONES: No acute fracture. Bilateral pterygoid plates are intact. Small hematoma of the nasal soft tissues containing tiny foci of gas. MANDIBLE: No acute fracture. Bilateral temporomandibular joints are intact. SINONASAL CAVITIES: Paranasal sinuses are clear.
FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Trace bilateral pleural effusions with associated subsegmental atelectasis. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Hepatomegaly. BILIARY TRACT: Mild biliary duct dilatation is likely related to prior cholecystectomy, unchanged GALLBLADDER: Surgically absent PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Appendectomy changes are noted. There is suspected mild thickening and pericolonic stranding seen in the descending colon. There are few scattered noninflamed diverticula. No inflamed diverticula is seen. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Subtle pericolonic stranding seen adjacent to the descending colon VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Mild degenerative changes are seen within the spine. No focal destructive osseous lesion is identified.
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RADIOLOGIC EXAM: CT Cervical Spine From Reformat, CT Angio Neck CLINICAL INFORMATION: Trauma. COMPARISON: Multiple prior CT cervical spine 9/27/2020. TECHNIQUE: CT Cervical Spine From Reformat, CT Angio NeckPatient weight: 165 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: 253.60 mm. DLP: 877.20 mGy cm. Following CT of the neck, reformatted images were produced to optimize visualization of the osseous structures of the cervical spine. 3-D CT MIP were generated in post processing. FINDINGS: CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
FINDINGS: CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
Findings: Brain parenchyma: Diffuse 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: Postsurgical right suboccipital burr whole is seen. No acute fractures or suspicious osseous lesions identified. The left mastoid air cells appear underpneumatized. The right mastoid air cell complex is well-developed and clear.
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CLINICAL HISTORY: tSAH EXAM: CT Head wo contrast TECHNIQUE: 5 mm thick serial axial images were obtained throughout the head without intravenous contrast. Scan field of view: 220 mm. DLP: 958.60 mGy cm. COMPARISON: 1/7/2022 FINDINGS: There is no significant change in small amount of subarachnoid hemorrhage along the anterior inferior left frontal lobe. There is also small amount of subdural hemorrhage along the floor of the left anterior cranial fossa and also the left frontal pole. There is questionable trace of dural hemorrhage along the left cerebellar tentorium. There is no acute intracranial hemorrhage. There are no abnormal areas of hypoattenuation to suggest acute infarction or contusion. The ventricles are unremarkable. There is no mass effect. There are bilateral nasal bone fractures with overlying soft tissue swelling. Calvarium is otherwise intact. There is left periorbital soft tissue swelling. There is small amount of hemorrhage/fluid within the anterior right ethmoid air cells and right maxillary sinus. The remaining visualized paranasal sinuses and mastoid air cells are clear. The orbits are unremarkable. CONCLUSION: 01. Stable small subarachnoid hemorrhage along the floor of the left anterior cranial fossa. Small subdural hemorrhages within the left anterior cranial fossa also unchanged. 02. Stable suggest a trace left cerebellar tentorium subdural hemorrhage 03. Left nasal bone fractures and overlying soft tissue contusions as described above
FINDINGS: There is no significant change in small amount of subarachnoid hemorrhage along the anterior inferior left frontal lobe. There is also small amount of subdural hemorrhage along the floor of the left anterior cranial fossa and also the left frontal pole. There is questionable trace of dural hemorrhage along the left cerebellar tentorium. There is no acute intracranial hemorrhage. There are no abnormal areas of hypoattenuation to suggest acute infarction or contusion. The ventricles are unremarkable. There is no mass effect. There are bilateral nasal bone fractures with overlying soft tissue swelling. Calvarium is otherwise intact. There is left periorbital soft tissue swelling. There is small amount of hemorrhage/fluid within the anterior right ethmoid air cells and right maxillary sinus. The remaining visualized paranasal sinuses and mastoid air cells are clear. The orbits are unremarkable.
FINDINGS: LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: No focal consolidation, pneumothorax, or pleural effusion. Subsegmental bibasilar atelectasis. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: Prominent paraesophageal node measuring 0.8 cm (series 501 image 151), nonspecific CHEST WALL: Subcutaneous cutaneous stranding along the left upper chest wall, likely seatbelt sign. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Mild intrahepatic and extrahepatic biliary dilation, likely related to cholecystectomy. GALLBLADDER: Absent. PANCREAS: Two cystic lesions in the region of the tail, the larger more inferior lesion measuring 1.7 x 1.2 cm (series 501 image 268). SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Bilateral subcentimeter hypodensities, likely cysts. LYMPH NODES: Prominent bilateral inguinal lymph nodes with index lymph node in the left inguinal region measuring approximately 1 cm in short axis. No abdominal or pelvic lymphadenopathy. 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: Subcutaneous stranding of the right lower quadrant, likely seatbelt sign. MUSCULOSKELETAL: Acute minimally displaced left posterior column fracture with posterior acetabular wall component. THORACIC SPINE: VERTEBRA: Mild anterior wedging of T6 with prominent Schmorl's node. T9 vertebral body hemangioma. DISC SPACES AND FACET JOINTS: No acute injury. Mild degenerative changes. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: No fracture. L5 vertebral body hemangioma. DISC SPACES AND FACET JOINTS: No acute injury. Mild degenerative changes. ALIGNMENT: Normal.
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EXAM: CT Abdomen and Pelvis wo IV contrast CLINICAL INFORMATION: Known ulcerative colitis/Crohn's disease with protuberant abdomen. Concern for small bowel obstruction. COMPARISON: None. TECHNIQUE: CT Abdomen and Pelvis wo IV contrast. Scan field of view: 445 mm. Oral contrast Omnipaque: 16.9 oz. DLP: 1018 mGy cm. FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Trace pericardial effusion. The heart is normal in size. ABDOMEN and PELVIS: LIVER: Normal for technique. BILIARY TRACT: Normal. GALLBLADDER: Surgically absent. PANCREAS: Normal for technique. SPLEEN: Scattered calcified granulomas. ADRENALS: Normal. KIDNEYS: The bilateral native kidneys are atrophied. Subcentimeter hypoattenuating lesion in the left interpolar region. The right lower quadrant transplant kidney is unremarkable without peritransplant collection or hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: The stomach is unremarkable. Multiple mildly dilated loops of small bowel in the anterior abdomen with gas and fluid without distinct transition point. Oral contrast progresses to the distal small bowel. COLON / APPENDIX: Colonic diverticulosis. Nondependent gas is seen in the proximal colon.. PERITONEUM / MESENTERY: No free air or free fluid. Ventriculoperitoneal shunt catheter terminates in the central abdomen. No adjacent fluid collection. RETROPERITONEUM: Circumscribed fluid collection in the right pelvis adjacent to the iliac vessels measuring 11.5 x 7.9 cm (series 3, image 262) displacing the reproductive organs to the left. VESSELS: No significant abnormality. URINARY BLADDER: The urinary bladder is displaced anteriorly and laterally to the left. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Tiny fat-containing umbilical and right inguinal hernias. Right lower quadrant incision scar. MUSCULOSKELETAL: No aggressive osseous lesion. CONCLUSION: 1. Mildly dilated loops of small bowel in the central abdomen without definite transition point. Gas is seen throughout the proximal colon. This pattern favors adynamic ileus. 2. No bowel wall thickening or mesenteric congestion to suggest active inflammatory bowel disease, but evaluation is limited without intravenous contrast. 3. Circumscribed fluid collection in the right pelvis adjacent to the iliac vessels. In patient with history of renal transplant, this may represent lymphocele or other postoperative fluid collection. 4. Additional findings as above. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Trace pericardial effusion. The heart is normal in size. ABDOMEN and PELVIS: LIVER: Normal for technique. BILIARY TRACT: Normal. GALLBLADDER: Surgically absent. PANCREAS: Normal for technique. SPLEEN: Scattered calcified granulomas. ADRENALS: Normal. KIDNEYS: The bilateral native kidneys are atrophied. Subcentimeter hypoattenuating lesion in the left interpolar region. The right lower quadrant transplant kidney is unremarkable without peritransplant collection or hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: The stomach is unremarkable. Multiple mildly dilated loops of small bowel in the anterior abdomen with gas and fluid without distinct transition point. Oral contrast progresses to the distal small bowel. COLON / APPENDIX: Colonic diverticulosis. Nondependent gas is seen in the proximal colon.. PERITONEUM / MESENTERY: No free air or free fluid. Ventriculoperitoneal shunt catheter terminates in the central abdomen. No adjacent fluid collection. RETROPERITONEUM: Circumscribed fluid collection in the right pelvis adjacent to the iliac vessels measuring 11.5 x 7.9 cm (series 3, image 262) displacing the reproductive organs to the left. VESSELS: No significant abnormality. URINARY BLADDER: The urinary bladder is displaced anteriorly and laterally to the left. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Tiny fat-containing umbilical and right inguinal hernias. Right lower quadrant incision scar. MUSCULOSKELETAL: No aggressive osseous lesion.
FINDINGS: LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: No focal consolidation, pneumothorax, or pleural effusion. Subsegmental bibasilar atelectasis. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: Prominent paraesophageal node measuring 0.8 cm (series 501 image 151), nonspecific CHEST WALL: Subcutaneous cutaneous stranding along the left upper chest wall, likely seatbelt sign. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Mild intrahepatic and extrahepatic biliary dilation, likely related to cholecystectomy. GALLBLADDER: Absent. PANCREAS: Two cystic lesions in the region of the tail, the larger more inferior lesion measuring 1.7 x 1.2 cm (series 501 image 268). SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Bilateral subcentimeter hypodensities, likely cysts. LYMPH NODES: Prominent bilateral inguinal lymph nodes with index lymph node in the left inguinal region measuring approximately 1 cm in short axis. No abdominal or pelvic lymphadenopathy. 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: Subcutaneous stranding of the right lower quadrant, likely seatbelt sign. MUSCULOSKELETAL: Acute minimally displaced left posterior column fracture with posterior acetabular wall component. THORACIC SPINE: VERTEBRA: Mild anterior wedging of T6 with prominent Schmorl's node. T9 vertebral body hemangioma. DISC SPACES AND FACET JOINTS: No acute injury. Mild degenerative changes. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: No fracture. L5 vertebral body hemangioma. DISC SPACES AND FACET JOINTS: No acute injury. Mild degenerative changes. ALIGNMENT: Normal.
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RADIOLOGIC EXAM: CT Maxillofacial wo contrast, CT Head wo contrast CLINICAL INFORMATION: fall COMPARISON: None. TECHNIQUE: CT Maxillofacial wo contrast, CT Head wo contrastScan field of view: 200 mm. DLP: 330 mGy cm. (accession CT220004118), Scan field of view: 250 mm. DLP: 1107 mGy cm. (accession CT220004112) STRUCTURED REPORT: CT Head and Maxillofacial Trauma 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 appearance of the globes. No fracture. SKULL AND SKULL BASE: No fracture. Bilateral mastoid air cells are clear. FACIAL BONES: No fracture. Bilateral pterygoid plates are intact. MANDIBLE: No fracture. Bilateral temporomandibular joints are intact. SINONASAL CAVITIES: Mild mucosal thickening and tiny mucus retention cysts in the bilateral maxillary sinuses. CONCLUSION: No acute intracranial process or maxillofacial fracture. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
FINDINGS: 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 appearance of the globes. No fracture. SKULL AND SKULL BASE: No fracture. Bilateral mastoid air cells are clear. FACIAL BONES: No fracture. Bilateral pterygoid plates are intact. MANDIBLE: No fracture. Bilateral temporomandibular joints are intact. SINONASAL CAVITIES: Mild mucosal thickening and tiny mucus retention cysts in the bilateral maxillary sinuses.
Findings: The sagittal images demonstrate physiologic cervical lordosis, without subluxations. Mild chronic anterior wedging of the C3 vertebral body is noted, without retropulsion into the spinal canal. The vertebral bodies otherwise maintain normal height, without acute fractures or suspicious osseous lesions. Suspected C2 vertebral body intraosseous hemangioma. Mild intervertebral disc space loss, endplate sclerosis and prominent bridging anterior osteophytes are noted at C4-C5 and C5-C6. Mild predental space narrowing and spurring. The craniocervical junction appears unremarkable. Multilevel disc osteophytes complexes and uncovertebral hypertrophy, resulting in mild right C5-C6 neuroforaminal narrowing with partial effacement of the right lateral recess, without significant spinal canal stenosis. The prevertebral and paraspinal soft tissues appear normal.
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EXAM: CT Chest wo contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat, CT Abdomen and Pelvis wo IV contrast CLINICAL INFORMATION: Trauma. COMPARISON: None available. TECHNIQUE: CT Chest wo contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat, CT Abdomen and Pelvis wo IV contrast. Scan field of view: 500 mm. DLP: 941 mGy cm. FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: The central tracheobronchial tree is patent. Tiny calcified granuloma in the right lower lobe. No focal consolidation, pleural effusions, or pneumothorax. HEART / VESSELS: No significant abnormality within the limitations of noncontrast technique. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. Calcified right hilar and mediastinal lymph nodes are likely sequela of prior granulomatous disease. CHEST WALL: Bilateral gynecomastia. ABDOMEN and PELVIS: LIVER: Normal noncontrast appearance. BILIARY TRACT: Normal. GALLBLADDER: Cholelithiasis. PANCREAS: Normal noncontrast appearance. SPLEEN: Normal in size. Scattered tiny calcified granulomata. ADRENALS: Normal. KIDNEYS: Normal noncontrast appearance. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No significant abnormality in the colon. The appendix is not definitely visualized. PERITONEUM / MESENTERY: No free intracranial fluid. No pneumoperitoneum. RETROPERITONEUM: Normal. VESSELS: No significant abnormality within the limitations of noncontrast technique. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Hematoma in the soft tissues overlying the caudal sacrum and right gluteal musculature, measuring 1.0 x 6.3 x 5.8 cm (AP by TR by CC on series 2, image 431 and series 602, image 245), with surrounding contusive changes. Calcified granuloma in the soft tissues overlying the lateral aspect of the left hip. MUSCULOSKELETAL: No aggressive osseous abnormality is identified. Enostoses in the right ischium and L4 vertebral body. 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. Mild multilevel discogenic degenerative changes and facet joint arthrosis. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No spondylolisthesis. CONCLUSION: 1. Small hematoma in the soft tissues overlying the caudal sacrum and right gluteal musculature with surrounding contusive changes. 2. Otherwise, no acute traumatic abnormality in the chest, abdomen, or pelvis. No acute fracture or subluxation 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.
FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: The central tracheobronchial tree is patent. Tiny calcified granuloma in the right lower lobe. No focal consolidation, pleural effusions, or pneumothorax. HEART / VESSELS: No significant abnormality within the limitations of noncontrast technique. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. Calcified right hilar and mediastinal lymph nodes are likely sequela of prior granulomatous disease. CHEST WALL: Bilateral gynecomastia. ABDOMEN and PELVIS: LIVER: Normal noncontrast appearance. BILIARY TRACT: Normal. GALLBLADDER: Cholelithiasis. PANCREAS: Normal noncontrast appearance. SPLEEN: Normal in size. Scattered tiny calcified granulomata. ADRENALS: Normal. KIDNEYS: Normal noncontrast appearance. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No significant abnormality in the colon. The appendix is not definitely visualized. PERITONEUM / MESENTERY: No free intracranial fluid. No pneumoperitoneum. RETROPERITONEUM: Normal. VESSELS: No significant abnormality within the limitations of noncontrast technique. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Hematoma in the soft tissues overlying the caudal sacrum and right gluteal musculature, measuring 1.0 x 6.3 x 5.8 cm (AP by TR by CC on series 2, image 431 and series 602, image 245), with surrounding contusive changes. Calcified granuloma in the soft tissues overlying the lateral aspect of the left hip. MUSCULOSKELETAL: No aggressive osseous abnormality is identified. Enostoses in the right ischium and L4 vertebral body. 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. Mild multilevel discogenic degenerative changes and facet joint arthrosis. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No spondylolisthesis.
FINDINGS: LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: No focal consolidation, pneumothorax, or pleural effusion. Subsegmental bibasilar atelectasis. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: Prominent paraesophageal node measuring 0.8 cm (series 501 image 151), nonspecific CHEST WALL: Subcutaneous cutaneous stranding along the left upper chest wall, likely seatbelt sign. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Mild intrahepatic and extrahepatic biliary dilation, likely related to cholecystectomy. GALLBLADDER: Absent. PANCREAS: Two cystic lesions in the region of the tail, the larger more inferior lesion measuring 1.7 x 1.2 cm (series 501 image 268). SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Bilateral subcentimeter hypodensities, likely cysts. LYMPH NODES: Prominent bilateral inguinal lymph nodes with index lymph node in the left inguinal region measuring approximately 1 cm in short axis. No abdominal or pelvic lymphadenopathy. 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: Subcutaneous stranding of the right lower quadrant, likely seatbelt sign. MUSCULOSKELETAL: Acute minimally displaced left posterior column fracture with posterior acetabular wall component. THORACIC SPINE: VERTEBRA: Mild anterior wedging of T6 with prominent Schmorl's node. T9 vertebral body hemangioma. DISC SPACES AND FACET JOINTS: No acute injury. Mild degenerative changes. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: No fracture. L5 vertebral body hemangioma. DISC SPACES AND FACET JOINTS: No acute injury. Mild degenerative changes. ALIGNMENT: Normal.
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EXAM: CT Chest wo contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat, CT Abdomen and Pelvis wo IV contrast CLINICAL INFORMATION: Trauma. COMPARISON: None available. TECHNIQUE: CT Chest wo contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat, CT Abdomen and Pelvis wo IV contrast. Scan field of view: 500 mm. DLP: 941 mGy cm. FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: The central tracheobronchial tree is patent. Tiny calcified granuloma in the right lower lobe. No focal consolidation, pleural effusions, or pneumothorax. HEART / VESSELS: No significant abnormality within the limitations of noncontrast technique. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. Calcified right hilar and mediastinal lymph nodes are likely sequela of prior granulomatous disease. CHEST WALL: Bilateral gynecomastia. ABDOMEN and PELVIS: LIVER: Normal noncontrast appearance. BILIARY TRACT: Normal. GALLBLADDER: Cholelithiasis. PANCREAS: Normal noncontrast appearance. SPLEEN: Normal in size. Scattered tiny calcified granulomata. ADRENALS: Normal. KIDNEYS: Normal noncontrast appearance. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No significant abnormality in the colon. The appendix is not definitely visualized. PERITONEUM / MESENTERY: No free intracranial fluid. No pneumoperitoneum. RETROPERITONEUM: Normal. VESSELS: No significant abnormality within the limitations of noncontrast technique. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Hematoma in the soft tissues overlying the caudal sacrum and right gluteal musculature, measuring 1.0 x 6.3 x 5.8 cm (AP by TR by CC on series 2, image 431 and series 602, image 245), with surrounding contusive changes. Calcified granuloma in the soft tissues overlying the lateral aspect of the left hip. MUSCULOSKELETAL: No aggressive osseous abnormality is identified. Enostoses in the right ischium and L4 vertebral body. 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. Mild multilevel discogenic degenerative changes and facet joint arthrosis. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No spondylolisthesis. CONCLUSION: 1. Small hematoma in the soft tissues overlying the caudal sacrum and right gluteal musculature with surrounding contusive changes. 2. Otherwise, no acute traumatic abnormality in the chest, abdomen, or pelvis. No acute fracture or subluxation 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.
FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: The central tracheobronchial tree is patent. Tiny calcified granuloma in the right lower lobe. No focal consolidation, pleural effusions, or pneumothorax. HEART / VESSELS: No significant abnormality within the limitations of noncontrast technique. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. Calcified right hilar and mediastinal lymph nodes are likely sequela of prior granulomatous disease. CHEST WALL: Bilateral gynecomastia. ABDOMEN and PELVIS: LIVER: Normal noncontrast appearance. BILIARY TRACT: Normal. GALLBLADDER: Cholelithiasis. PANCREAS: Normal noncontrast appearance. SPLEEN: Normal in size. Scattered tiny calcified granulomata. ADRENALS: Normal. KIDNEYS: Normal noncontrast appearance. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No significant abnormality in the colon. The appendix is not definitely visualized. PERITONEUM / MESENTERY: No free intracranial fluid. No pneumoperitoneum. RETROPERITONEUM: Normal. VESSELS: No significant abnormality within the limitations of noncontrast technique. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Hematoma in the soft tissues overlying the caudal sacrum and right gluteal musculature, measuring 1.0 x 6.3 x 5.8 cm (AP by TR by CC on series 2, image 431 and series 602, image 245), with surrounding contusive changes. Calcified granuloma in the soft tissues overlying the lateral aspect of the left hip. MUSCULOSKELETAL: No aggressive osseous abnormality is identified. Enostoses in the right ischium and L4 vertebral body. 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. Mild multilevel discogenic degenerative changes and facet joint arthrosis. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No spondylolisthesis.
FINDINGS: LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: No focal consolidation, pneumothorax, or pleural effusion. Subsegmental bibasilar atelectasis. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: Prominent paraesophageal node measuring 0.8 cm (series 501 image 151), nonspecific CHEST WALL: Subcutaneous cutaneous stranding along the left upper chest wall, likely seatbelt sign. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Mild intrahepatic and extrahepatic biliary dilation, likely related to cholecystectomy. GALLBLADDER: Absent. PANCREAS: Two cystic lesions in the region of the tail, the larger more inferior lesion measuring 1.7 x 1.2 cm (series 501 image 268). SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Bilateral subcentimeter hypodensities, likely cysts. LYMPH NODES: Prominent bilateral inguinal lymph nodes with index lymph node in the left inguinal region measuring approximately 1 cm in short axis. No abdominal or pelvic lymphadenopathy. 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: Subcutaneous stranding of the right lower quadrant, likely seatbelt sign. MUSCULOSKELETAL: Acute minimally displaced left posterior column fracture with posterior acetabular wall component. THORACIC SPINE: VERTEBRA: Mild anterior wedging of T6 with prominent Schmorl's node. T9 vertebral body hemangioma. DISC SPACES AND FACET JOINTS: No acute injury. Mild degenerative changes. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: No fracture. L5 vertebral body hemangioma. DISC SPACES AND FACET JOINTS: No acute injury. Mild degenerative changes. ALIGNMENT: Normal.
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RADIOLOGIC EXAM: CT Cervical Spine wo contrast CLINICAL INFORMATION: Fall. COMPARISON: None. TECHNIQUE: CT Cervical Spine wo contrastScan field of view: 204 mm. DLP: 937 mGy cm. Axial CT images of cervical spine were obtained without IV contrast. Coronal and sagittal reformats were obtained. 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 (
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 (
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. Under pneumatization of the left mastoid tip. Otherwise, appear well aerated.
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EXAM: CT Chest wo contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat, CT Abdomen and Pelvis wo IV contrast CLINICAL INFORMATION: Trauma. COMPARISON: None available. TECHNIQUE: CT Chest wo contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat, CT Abdomen and Pelvis wo IV contrast. Scan field of view: 500 mm. DLP: 941 mGy cm. FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: The central tracheobronchial tree is patent. Tiny calcified granuloma in the right lower lobe. No focal consolidation, pleural effusions, or pneumothorax. HEART / VESSELS: No significant abnormality within the limitations of noncontrast technique. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. Calcified right hilar and mediastinal lymph nodes are likely sequela of prior granulomatous disease. CHEST WALL: Bilateral gynecomastia. ABDOMEN and PELVIS: LIVER: Normal noncontrast appearance. BILIARY TRACT: Normal. GALLBLADDER: Cholelithiasis. PANCREAS: Normal noncontrast appearance. SPLEEN: Normal in size. Scattered tiny calcified granulomata. ADRENALS: Normal. KIDNEYS: Normal noncontrast appearance. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No significant abnormality in the colon. The appendix is not definitely visualized. PERITONEUM / MESENTERY: No free intracranial fluid. No pneumoperitoneum. RETROPERITONEUM: Normal. VESSELS: No significant abnormality within the limitations of noncontrast technique. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Hematoma in the soft tissues overlying the caudal sacrum and right gluteal musculature, measuring 1.0 x 6.3 x 5.8 cm (AP by TR by CC on series 2, image 431 and series 602, image 245), with surrounding contusive changes. Calcified granuloma in the soft tissues overlying the lateral aspect of the left hip. MUSCULOSKELETAL: No aggressive osseous abnormality is identified. Enostoses in the right ischium and L4 vertebral body. 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. Mild multilevel discogenic degenerative changes and facet joint arthrosis. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No spondylolisthesis. CONCLUSION: 1. Small hematoma in the soft tissues overlying the caudal sacrum and right gluteal musculature with surrounding contusive changes. 2. Otherwise, no acute traumatic abnormality in the chest, abdomen, or pelvis. No acute fracture or subluxation 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.
FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: The central tracheobronchial tree is patent. Tiny calcified granuloma in the right lower lobe. No focal consolidation, pleural effusions, or pneumothorax. HEART / VESSELS: No significant abnormality within the limitations of noncontrast technique. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. Calcified right hilar and mediastinal lymph nodes are likely sequela of prior granulomatous disease. CHEST WALL: Bilateral gynecomastia. ABDOMEN and PELVIS: LIVER: Normal noncontrast appearance. BILIARY TRACT: Normal. GALLBLADDER: Cholelithiasis. PANCREAS: Normal noncontrast appearance. SPLEEN: Normal in size. Scattered tiny calcified granulomata. ADRENALS: Normal. KIDNEYS: Normal noncontrast appearance. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No significant abnormality in the colon. The appendix is not definitely visualized. PERITONEUM / MESENTERY: No free intracranial fluid. No pneumoperitoneum. RETROPERITONEUM: Normal. VESSELS: No significant abnormality within the limitations of noncontrast technique. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Hematoma in the soft tissues overlying the caudal sacrum and right gluteal musculature, measuring 1.0 x 6.3 x 5.8 cm (AP by TR by CC on series 2, image 431 and series 602, image 245), with surrounding contusive changes. Calcified granuloma in the soft tissues overlying the lateral aspect of the left hip. MUSCULOSKELETAL: No aggressive osseous abnormality is identified. Enostoses in the right ischium and L4 vertebral body. 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. Mild multilevel discogenic degenerative changes and facet joint arthrosis. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No spondylolisthesis.
FINDINGS: VASCULAR FINDINGS: Aortic arch: Patent with no hemodynamically significant stenosis. Three normal vessel aortic arch is noted. Common carotid arteries: Mild nonflow limiting fibrofatty plaques of the bilateral carotid bifurcations. 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: 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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EXAM: CT Chest wo contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat, CT Abdomen and Pelvis wo IV contrast CLINICAL INFORMATION: Trauma. COMPARISON: None available. TECHNIQUE: CT Chest wo contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat, CT Abdomen and Pelvis wo IV contrast. Scan field of view: 500 mm. DLP: 941 mGy cm. FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: The central tracheobronchial tree is patent. Tiny calcified granuloma in the right lower lobe. No focal consolidation, pleural effusions, or pneumothorax. HEART / VESSELS: No significant abnormality within the limitations of noncontrast technique. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. Calcified right hilar and mediastinal lymph nodes are likely sequela of prior granulomatous disease. CHEST WALL: Bilateral gynecomastia. ABDOMEN and PELVIS: LIVER: Normal noncontrast appearance. BILIARY TRACT: Normal. GALLBLADDER: Cholelithiasis. PANCREAS: Normal noncontrast appearance. SPLEEN: Normal in size. Scattered tiny calcified granulomata. ADRENALS: Normal. KIDNEYS: Normal noncontrast appearance. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No significant abnormality in the colon. The appendix is not definitely visualized. PERITONEUM / MESENTERY: No free intracranial fluid. No pneumoperitoneum. RETROPERITONEUM: Normal. VESSELS: No significant abnormality within the limitations of noncontrast technique. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Hematoma in the soft tissues overlying the caudal sacrum and right gluteal musculature, measuring 1.0 x 6.3 x 5.8 cm (AP by TR by CC on series 2, image 431 and series 602, image 245), with surrounding contusive changes. Calcified granuloma in the soft tissues overlying the lateral aspect of the left hip. MUSCULOSKELETAL: No aggressive osseous abnormality is identified. Enostoses in the right ischium and L4 vertebral body. 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. Mild multilevel discogenic degenerative changes and facet joint arthrosis. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No spondylolisthesis. CONCLUSION: 1. Small hematoma in the soft tissues overlying the caudal sacrum and right gluteal musculature with surrounding contusive changes. 2. Otherwise, no acute traumatic abnormality in the chest, abdomen, or pelvis. No acute fracture or subluxation 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.
FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: The central tracheobronchial tree is patent. Tiny calcified granuloma in the right lower lobe. No focal consolidation, pleural effusions, or pneumothorax. HEART / VESSELS: No significant abnormality within the limitations of noncontrast technique. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. Calcified right hilar and mediastinal lymph nodes are likely sequela of prior granulomatous disease. CHEST WALL: Bilateral gynecomastia. ABDOMEN and PELVIS: LIVER: Normal noncontrast appearance. BILIARY TRACT: Normal. GALLBLADDER: Cholelithiasis. PANCREAS: Normal noncontrast appearance. SPLEEN: Normal in size. Scattered tiny calcified granulomata. ADRENALS: Normal. KIDNEYS: Normal noncontrast appearance. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No significant abnormality in the colon. The appendix is not definitely visualized. PERITONEUM / MESENTERY: No free intracranial fluid. No pneumoperitoneum. RETROPERITONEUM: Normal. VESSELS: No significant abnormality within the limitations of noncontrast technique. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Hematoma in the soft tissues overlying the caudal sacrum and right gluteal musculature, measuring 1.0 x 6.3 x 5.8 cm (AP by TR by CC on series 2, image 431 and series 602, image 245), with surrounding contusive changes. Calcified granuloma in the soft tissues overlying the lateral aspect of the left hip. MUSCULOSKELETAL: No aggressive osseous abnormality is identified. Enostoses in the right ischium and L4 vertebral body. 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. Mild multilevel discogenic degenerative changes and facet joint arthrosis. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No spondylolisthesis.
FINDINGS: BRAIN PARENCHYMA: Moderate bilateral periventricular deep white matter hypoattenuation in keeping with moderate chronic microangiopathic changes are similar to prior with continued findings of small areas of chronic encephalomalacia in the left frontal lobe. No hemorrhage, mass effect or edema. EXTRA-AXIAL SPACES: No acute hemorrhage. Atherosclerotic ICA and vertebrobasilar artery calcifications are again demonstrated.. SKULL AND SKULL BASE: No fracture. Right frontal scalp lipoma unchanged. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal.
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RADIOLOGIC EXAM: CT Maxillofacial wo contrast, CT Head wo contrast CLINICAL INFORMATION: fall COMPARISON: None. TECHNIQUE: CT Maxillofacial wo contrast, CT Head wo contrastScan field of view: 200 mm. DLP: 330 mGy cm. (accession CT220004118), Scan field of view: 250 mm. DLP: 1107 mGy cm. (accession CT220004112) STRUCTURED REPORT: CT Head and Maxillofacial Trauma 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 appearance of the globes. No fracture. SKULL AND SKULL BASE: No fracture. Bilateral mastoid air cells are clear. FACIAL BONES: No fracture. Bilateral pterygoid plates are intact. MANDIBLE: No fracture. Bilateral temporomandibular joints are intact. SINONASAL CAVITIES: Mild mucosal thickening and tiny mucus retention cysts in the bilateral maxillary sinuses. CONCLUSION: No acute intracranial process or maxillofacial fracture. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
FINDINGS: 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 appearance of the globes. No fracture. SKULL AND SKULL BASE: No fracture. Bilateral mastoid air cells are clear. FACIAL BONES: No fracture. Bilateral pterygoid plates are intact. MANDIBLE: No fracture. Bilateral temporomandibular joints are intact. SINONASAL CAVITIES: Mild mucosal thickening and tiny mucus retention cysts in the bilateral maxillary sinuses.
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: Punctate atherosclerotic calcifications of the bilateral carotid siphons and the vertebrobasilar axis. 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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EXAM: CT Abdomen and Pelvis w contrast, CT Chest with contrast CLINICAL INFORMATION: Concern for metastatic disease. COMPARISON: 2/6/2019 TECHNIQUE: CT Abdomen and Pelvis w contrast, CT Chest with contrast. Patient weight: 170 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 60 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 78 sec Scan field of view: 500 mm. DLP: 1191 mGy cm FINDINGS: STRUCTURED REPORT: CT CAP LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Interval development of a 6.9 x 5 7cm mass in the right lower lobe which abuts the major fissure (series 3, image 123). There are patchy adjacent tree-in-bud opacities. Biapical scarring is noted. No additional suspicious pulmonary nodule. Trace bilateral pleural effusions. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Moderate hiatal hernia. Otherwise normal. LYMPH NODES: Several mildly enlarged right hilar lymph nodes are noted (for example, a right hilar lymph node measuring 1.6 x 1.1 cm on series 3, image 122). No mediastinal or axillary. CHEST WALL: Bilateral breast implants. Otherwise normal. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Mild intrahepatic and extrahepatic biliary ductal dilation is likely due to postcholecystectomy change. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: No significant change in the left adrenal nodule, measuring approximately 1.2 cm. Mild thickening of the right adrenal gland appears similar. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Postsurgical changes from sigmoidectomy without suspicious anastomotic thickening. Appendix is absent. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Moderate atherosclerosis without aneurysm. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: Right lower lobe mass is suspicious for a metastasis from the patient's prior rectal cancer with adjacent right hilar adenopathy. No additional evidence of metastatic disease.
FINDINGS: STRUCTURED REPORT: CT CAP LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Interval development of a 6.9 x 5 7cm mass in the right lower lobe which abuts the major fissure (series 3, image 123). There are patchy adjacent tree-in-bud opacities. Biapical scarring is noted. No additional suspicious pulmonary nodule. Trace bilateral pleural effusions. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Moderate hiatal hernia. Otherwise normal. LYMPH NODES: Several mildly enlarged right hilar lymph nodes are noted (for example, a right hilar lymph node measuring 1.6 x 1.1 cm on series 3, image 122). No mediastinal or axillary. CHEST WALL: Bilateral breast implants. Otherwise normal. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Mild intrahepatic and extrahepatic biliary ductal dilation is likely due to postcholecystectomy change. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: No significant change in the left adrenal nodule, measuring approximately 1.2 cm. Mild thickening of the right adrenal gland appears similar. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Postsurgical changes from sigmoidectomy without suspicious anastomotic thickening. Appendix is absent. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Moderate atherosclerosis without aneurysm. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Central airways are patent. No focal consolidation, pneumothorax or pleural effusion. Minimal posterior dependent atelectatic changes. HEART / VESSELS: There is coronary artery atherosclerotic calcification. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: Asymmetrical stranding within the left breast may represent a breast contusion. ABDOMEN and PELVIS: LIVER: Hepatic steatosis. The liver is borderline cirrhotic. There is a linear hypodensity seen in the inferior right hepatic lobe measuring 2.2 cm on image 261, series 501. This lesion is seen on sagittal image 134, series 501, likely a grade 2 liver injury. BILIARY TRACT: Mild biliary duct dilatation, probably related to prior cholecystectomy. GALLBLADDER: Surgically absent. PANCREAS: Normal. SPLEEN: Tiny amount of fluid is seen adjacent to the inferior splenic tip such as on image 261, series 501.. ADRENALS: Normal. KIDNEYS: Subcentimeter hypoatt1enuating lesion in the left lower renal pole, too small to characterize but likely a renal cyst. No hydronephrosis or renal calculi. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. Appendix is normal. PERITONEUM / MESENTERY: There is a small amount stranding adjacent to the gastric antrum on image 286 seven, series 501, possibly a small mesenteric contusion.. RETROPERITONEUM: Soft tissue stranding along the left pelvic sidewall, likely a small hematoma VESSELS: There is stranding around the left femoral vasculature which is probably due to vascular access attempts. There is fat seen within the left common femoral vein on image 508, series 501, possibly a fat embolus. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus is normal. Subcentimeter peripherally calcified lesion in the left ovary, likely a calcified cyst. No other significant abnormality. BODY WALL: Tiny fat-containing periumbilical hernia. Small amount of focal fluid/stranding in the right ventral abdominal wall, possibly secondary to medication injection related changes. There is a rectus diastases. MUSCULOSKELETAL: Severely comminuted fracture of the left acetabulum involving the posterior column with superior and posterior dislocation of the femoral head. Displaced transcervical fracture of the left femoral neck. Impaction fracture of the femoral head No definite sacroiliac or pubic symphyseal diastasis. There is extensive soft tissue edema. A small focus of hyperdensity within the left hip joint on image 274, series 501, possibly a fracture fragment Minimally displaced fracture of the right anterior third rib. Nondisplaced buckle fractures of the right fourth-ninth ribs. Displaced fractures of the left posterior 1st and 11th ribs. Minimally displaced fracture of the left lateral 6th rib. Nondisplaced buckle fracture of the left seventh through ninth ribs. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. Multilevel discogenic degenerative changes. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: Displaced fractures of the left L1-L4 transverse processes. 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: Acute encephalopathy COMPARISON: 5/9/2018 TECHNIQUE: CT Head wo contrastScan field of view: 212 mm. DLP: 1711 mGy cm. STRUCTURED REPORT: CT Head Trauma FINDINGS: Evaluation is moderate to severely limited due to motion artifact. BRAIN PARENCHYMA: No discrete hemorrhage, mass effect or edema. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Left pseudophakia. Right globe appears normal. SINUSES: Opacification of the frontal, ethmoid, and sphenoid sinuses. Mucosal thickening of the bilateral maxillary sinuses. Right greater than left mastoid effusions. Other: Atherosclerotic disease of the bilateral intracranial ICAs. All CONCLUSION: 1. Paranasal sinus disease and bilateral, right greater than left mastoid effusions. Otherwise no acute intracranial abnormality. 2. Atherosclerotic disease. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
FINDINGS: Evaluation is moderate to severely limited due to motion artifact. BRAIN PARENCHYMA: No discrete hemorrhage, mass effect or edema. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Left pseudophakia. Right globe appears normal. SINUSES: Opacification of the frontal, ethmoid, and sphenoid sinuses. Mucosal thickening of the bilateral maxillary sinuses. Right greater than left mastoid effusions. Other: Atherosclerotic disease of the bilateral intracranial ICAs. All
FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Central airways are patent. No focal consolidation, pneumothorax or pleural effusion. Minimal posterior dependent atelectatic changes. HEART / VESSELS: There is coronary artery atherosclerotic calcification. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: Asymmetrical stranding within the left breast may represent a breast contusion. ABDOMEN and PELVIS: LIVER: Hepatic steatosis. The liver is borderline cirrhotic. There is a linear hypodensity seen in the inferior right hepatic lobe measuring 2.2 cm on image 261, series 501. This lesion is seen on sagittal image 134, series 501, likely a grade 2 liver injury. BILIARY TRACT: Mild biliary duct dilatation, probably related to prior cholecystectomy. GALLBLADDER: Surgically absent. PANCREAS: Normal. SPLEEN: Tiny amount of fluid is seen adjacent to the inferior splenic tip such as on image 261, series 501.. ADRENALS: Normal. KIDNEYS: Subcentimeter hypoatt1enuating lesion in the left lower renal pole, too small to characterize but likely a renal cyst. No hydronephrosis or renal calculi. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. Appendix is normal. PERITONEUM / MESENTERY: There is a small amount stranding adjacent to the gastric antrum on image 286 seven, series 501, possibly a small mesenteric contusion.. RETROPERITONEUM: Soft tissue stranding along the left pelvic sidewall, likely a small hematoma VESSELS: There is stranding around the left femoral vasculature which is probably due to vascular access attempts. There is fat seen within the left common femoral vein on image 508, series 501, possibly a fat embolus. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus is normal. Subcentimeter peripherally calcified lesion in the left ovary, likely a calcified cyst. No other significant abnormality. BODY WALL: Tiny fat-containing periumbilical hernia. Small amount of focal fluid/stranding in the right ventral abdominal wall, possibly secondary to medication injection related changes. There is a rectus diastases. MUSCULOSKELETAL: Severely comminuted fracture of the left acetabulum involving the posterior column with superior and posterior dislocation of the femoral head. Displaced transcervical fracture of the left femoral neck. Impaction fracture of the femoral head No definite sacroiliac or pubic symphyseal diastasis. There is extensive soft tissue edema. A small focus of hyperdensity within the left hip joint on image 274, series 501, possibly a fracture fragment Minimally displaced fracture of the right anterior third rib. Nondisplaced buckle fractures of the right fourth-ninth ribs. Displaced fractures of the left posterior 1st and 11th ribs. Minimally displaced fracture of the left lateral 6th rib. Nondisplaced buckle fracture of the left seventh through ninth ribs. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. Multilevel discogenic degenerative changes. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: Displaced fractures of the left L1-L4 transverse processes. 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: Follow-up CT head. COMPARISON: None. TECHNIQUE: CT Head wo contrastScan field of view: 250 mm. DLP: 1165 mGy cm. STRUCTURED REPORT: CT Head FINDINGS: Stable size of the intraparenchymal hematoma in the left periatrial white matter measuring 2.7 x 1.9 x 2.3 cm (image 32, series #2 and image 58, series #602). Stable mild surrounding edema. Partial effacement of the adjacent left lateral ventricle atrium. No hydrocephalus or midline shift. No new areas of intracranial hemorrhage. Gray-white matter differentiation is maintained. No evidence of acute infarction. Periventricular white matter hypoattenuation consistent with chronic microangiopathic changes. Remote infarct in the left basal ganglia. Mild diffuse parenchymal volume loss with ex vacuo dilatation of the ventricles. Normal appearance of the orbits. No acute osseous abnormality. Bilateral mastoid air cells and paranasal sinuses are clear. CONCLUSION: 1. Stable intraparenchymal hematoma in the left periatrial white matter with mild surrounding edema. 2. Partial effacement of the adjacent left lateral ventricle atrium. No hydrocephalus. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
FINDINGS: Stable size of the intraparenchymal hematoma in the left periatrial white matter measuring 2.7 x 1.9 x 2.3 cm (image 32, series #2 and image 58, series #602). Stable mild surrounding edema. Partial effacement of the adjacent left lateral ventricle atrium. No hydrocephalus or midline shift. No new areas of intracranial hemorrhage. Gray-white matter differentiation is maintained. No evidence of acute infarction. Periventricular white matter hypoattenuation consistent with chronic microangiopathic changes. Remote infarct in the left basal ganglia. Mild diffuse parenchymal volume loss with ex vacuo dilatation of the ventricles. Normal appearance of the orbits. No acute osseous abnormality. Bilateral mastoid air cells and paranasal sinuses are clear.
Findings: Please note evaluation is limited due to quantum mottle artifact from patient's body habitus. The sagittal images demonstrate straightening of the cervical lordosis, without subluxations. Partially visualized acute comminuted fractures of the right T1 transverse process and left first posterior rib. 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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RADIOLOGIC EXAM: CT Head wo contrast, CT Maxillofacial wo contrast CLINICAL INFORMATION: Trauma COMPARISON: None. TECHNIQUE: CT Head wo contrast, CT Maxillofacial wo contrastScan field of view: 230 mm. DLP: 1400 mGy cm. (accession CT220004122), Scan field of view: 220 mm. DLP: 1015 mGy cm. (accession CT220004128) STRUCTURED REPORT: CT Head and Maxillofacial Trauma FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. Cerebral cortical volume is normal. EXTRA-AXIAL SPACES: No extra-axial collections. VENTRICULAR SYSTEM: Normal. ORBITS: Normal appearance of the globes. No fracture. SKULL AND SKULL BASE: No fracture identified. Near-complete opacification of the right mastoid air cells. FACIAL BONES: No acute fracture. Bilateral pterygoid plates are intact. Diffuse dental disease with multiple dental caries and periapical lucency. The right parotid gland is asymmetrically enlarged. MANDIBLE: No acute fracture. Bilateral temporomandibular joints are intact. SINONASAL CAVITIES: Paranasal sinuses are clear. CONCLUSION: 1. No acute intracranial process or maxillofacial fracture. 2. Large right mastoid air cell effusion. No acute skull base fracture identified. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. Cerebral cortical volume is normal. EXTRA-AXIAL SPACES: No extra-axial collections. VENTRICULAR SYSTEM: Normal. ORBITS: Normal appearance of the globes. No fracture. SKULL AND SKULL BASE: No fracture identified. Near-complete opacification of the right mastoid air cells. FACIAL BONES: No acute fracture. Bilateral pterygoid plates are intact. Diffuse dental disease with multiple dental caries and periapical lucency. The right parotid gland is asymmetrically enlarged. MANDIBLE: No acute fracture. Bilateral temporomandibular joints are intact. SINONASAL CAVITIES: Paranasal sinuses are clear.
FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Central airways are patent. No focal consolidation, pneumothorax or pleural effusion. Minimal posterior dependent atelectatic changes. HEART / VESSELS: There is coronary artery atherosclerotic calcification. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: Asymmetrical stranding within the left breast may represent a breast contusion. ABDOMEN and PELVIS: LIVER: Hepatic steatosis. The liver is borderline cirrhotic. There is a linear hypodensity seen in the inferior right hepatic lobe measuring 2.2 cm on image 261, series 501. This lesion is seen on sagittal image 134, series 501, likely a grade 2 liver injury. BILIARY TRACT: Mild biliary duct dilatation, probably related to prior cholecystectomy. GALLBLADDER: Surgically absent. PANCREAS: Normal. SPLEEN: Tiny amount of fluid is seen adjacent to the inferior splenic tip such as on image 261, series 501.. ADRENALS: Normal. KIDNEYS: Subcentimeter hypoatt1enuating lesion in the left lower renal pole, too small to characterize but likely a renal cyst. No hydronephrosis or renal calculi. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. Appendix is normal. PERITONEUM / MESENTERY: There is a small amount stranding adjacent to the gastric antrum on image 286 seven, series 501, possibly a small mesenteric contusion.. RETROPERITONEUM: Soft tissue stranding along the left pelvic sidewall, likely a small hematoma VESSELS: There is stranding around the left femoral vasculature which is probably due to vascular access attempts. There is fat seen within the left common femoral vein on image 508, series 501, possibly a fat embolus. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus is normal. Subcentimeter peripherally calcified lesion in the left ovary, likely a calcified cyst. No other significant abnormality. BODY WALL: Tiny fat-containing periumbilical hernia. Small amount of focal fluid/stranding in the right ventral abdominal wall, possibly secondary to medication injection related changes. There is a rectus diastases. MUSCULOSKELETAL: Severely comminuted fracture of the left acetabulum involving the posterior column with superior and posterior dislocation of the femoral head. Displaced transcervical fracture of the left femoral neck. Impaction fracture of the femoral head No definite sacroiliac or pubic symphyseal diastasis. There is extensive soft tissue edema. A small focus of hyperdensity within the left hip joint on image 274, series 501, possibly a fracture fragment Minimally displaced fracture of the right anterior third rib. Nondisplaced buckle fractures of the right fourth-ninth ribs. Displaced fractures of the left posterior 1st and 11th ribs. Minimally displaced fracture of the left lateral 6th rib. Nondisplaced buckle fracture of the left seventh through ninth ribs. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. Multilevel discogenic degenerative changes. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: Displaced fractures of the left L1-L4 transverse processes. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal.
3,469
EXAM: CT Chest with contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat, CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: Trauma. 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: 200 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bt sec. Scan field of view: 415 mm. DLP: 1067 mGy cm. (accession CT220004123), Patient weight: 415 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 70 sec Scan field of view: 415 mm. (accession CT220004124), Patient weight: 200 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bt sec. Scan field of view: 415 mm. DLP: 1067 mGy cm. (accession CT220004127), Patient weight: 200 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bt sec. Scan field of view: 415 mm. DLP: 1067 mGy cm. (accession CT220004126) FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Small volume of secretions are dependently in the distal trachea and right mainstem bronchus. Biapical pleural-parenchymal scarring. A few noncalcified subpleural nodules in the right upper lobe, the largest of which measures 4 mm (series 502, image 111). Small mesenteric nodules along the left major fissure, likely representing perifissural lymph nodes. No pleural effusions or pneumothorax. HEART / VESSELS: Heart size is normal. No pericardial effusion. Mild calcific atherosclerosis in the coronary arteries. The main pulmonary artery and thoracic aorta are normal in caliber. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Hepatic steatosis. BILIARY TRACT: Mild central intrahepatic and extrahepatic biliary ductal dilatation with smooth tapering to the ampulla. No radiopaque choledocholithiasis or definite obstructing lesion is identified. GALLBLADDER: Distended. No radiopaque cholelithiasis, wall thickening, or pericholecystic stranding. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Symmetric contrast enhancement. Simple cysts in the left upper pole. Additional hypoattenuating lesion in the interpolar left kidney is too small to characterize, but is statistically likely a cyst. No radiopaque nephrolithiasis. No hydroureteronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Moderate-sized hiatal hernia. No significant abnormality in the remainder the stomach or small bowel. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Colonic diverticulosis. The appendix is normal. RETROPERITONEUM: Normal. VESSELS: Mild aortoiliac calcific atherosclerosis. Retroaortic left renal vein. URINARY BLADDER: No significant abnormality. Excreted contrast layers in the urinary bladder. REPRODUCTIVE ORGANS: Prostatomegaly. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Comminuted, impacted right intertrochanteric femoral fracture with extension into the greater trochanter. THORACIC SPINE: VERTEBRA: No fracture. Hemangioma in the T2 vertebral body. DISC SPACES AND FACET JOINTS: No acute injury. Moderate 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 multilevel discogenic degenerative changes. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No spondylolisthesis. CONCLUSION: 1. Comminuted, impacted right intertrochanteric femoral fracture with extension into the greater trochanter. 2. Otherwise, no acute traumatic abnormality in the chest, abdomen, or pelvis. No acute fracture or subluxation in the thoracolumbar spine. 3. Mild central intrahepatic and extrahepatic biliary ductal dilatation without radiopaque choledocholithiasis or definite obstructing lesion identified. Recommend correlation with biochemical profile. 4. A few noncalcified subpleural nodules in the right upper lobe may be related to the adjacent pleural parenchymal scarring, although if there are risk factors for lung malignancy, a follow-up chest CT exam could be obtained in 12 months. 5. Prostatomegaly, correlate with PSA. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Small volume of secretions are dependently in the distal trachea and right mainstem bronchus. Biapical pleural-parenchymal scarring. A few noncalcified subpleural nodules in the right upper lobe, the largest of which measures 4 mm (series 502, image 111). Small mesenteric nodules along the left major fissure, likely representing perifissural lymph nodes. No pleural effusions or pneumothorax. HEART / VESSELS: Heart size is normal. No pericardial effusion. Mild calcific atherosclerosis in the coronary arteries. The main pulmonary artery and thoracic aorta are normal in caliber. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Hepatic steatosis. BILIARY TRACT: Mild central intrahepatic and extrahepatic biliary ductal dilatation with smooth tapering to the ampulla. No radiopaque choledocholithiasis or definite obstructing lesion is identified. GALLBLADDER: Distended. No radiopaque cholelithiasis, wall thickening, or pericholecystic stranding. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Symmetric contrast enhancement. Simple cysts in the left upper pole. Additional hypoattenuating lesion in the interpolar left kidney is too small to characterize, but is statistically likely a cyst. No radiopaque nephrolithiasis. No hydroureteronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Moderate-sized hiatal hernia. No significant abnormality in the remainder the stomach or small bowel. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Colonic diverticulosis. The appendix is normal. RETROPERITONEUM: Normal. VESSELS: Mild aortoiliac calcific atherosclerosis. Retroaortic left renal vein. URINARY BLADDER: No significant abnormality. Excreted contrast layers in the urinary bladder. REPRODUCTIVE ORGANS: Prostatomegaly. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Comminuted, impacted right intertrochanteric femoral fracture with extension into the greater trochanter. THORACIC SPINE: VERTEBRA: No fracture. Hemangioma in the T2 vertebral body. DISC SPACES AND FACET JOINTS: No acute injury. Moderate 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 multilevel discogenic degenerative changes. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No spondylolisthesis.
FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Central airways are patent. No focal consolidation, pneumothorax or pleural effusion. Minimal posterior dependent atelectatic changes. HEART / VESSELS: There is coronary artery atherosclerotic calcification. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: Asymmetrical stranding within the left breast may represent a breast contusion. ABDOMEN and PELVIS: LIVER: Hepatic steatosis. The liver is borderline cirrhotic. There is a linear hypodensity seen in the inferior right hepatic lobe measuring 2.2 cm on image 261, series 501. This lesion is seen on sagittal image 134, series 501, likely a grade 2 liver injury. BILIARY TRACT: Mild biliary duct dilatation, probably related to prior cholecystectomy. GALLBLADDER: Surgically absent. PANCREAS: Normal. SPLEEN: Tiny amount of fluid is seen adjacent to the inferior splenic tip such as on image 261, series 501.. ADRENALS: Normal. KIDNEYS: Subcentimeter hypoatt1enuating lesion in the left lower renal pole, too small to characterize but likely a renal cyst. No hydronephrosis or renal calculi. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. Appendix is normal. PERITONEUM / MESENTERY: There is a small amount stranding adjacent to the gastric antrum on image 286 seven, series 501, possibly a small mesenteric contusion.. RETROPERITONEUM: Soft tissue stranding along the left pelvic sidewall, likely a small hematoma VESSELS: There is stranding around the left femoral vasculature which is probably due to vascular access attempts. There is fat seen within the left common femoral vein on image 508, series 501, possibly a fat embolus. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus is normal. Subcentimeter peripherally calcified lesion in the left ovary, likely a calcified cyst. No other significant abnormality. BODY WALL: Tiny fat-containing periumbilical hernia. Small amount of focal fluid/stranding in the right ventral abdominal wall, possibly secondary to medication injection related changes. There is a rectus diastases. MUSCULOSKELETAL: Severely comminuted fracture of the left acetabulum involving the posterior column with superior and posterior dislocation of the femoral head. Displaced transcervical fracture of the left femoral neck. Impaction fracture of the femoral head No definite sacroiliac or pubic symphyseal diastasis. There is extensive soft tissue edema. A small focus of hyperdensity within the left hip joint on image 274, series 501, possibly a fracture fragment Minimally displaced fracture of the right anterior third rib. Nondisplaced buckle fractures of the right fourth-ninth ribs. Displaced fractures of the left posterior 1st and 11th ribs. Minimally displaced fracture of the left lateral 6th rib. Nondisplaced buckle fracture of the left seventh through ninth ribs. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. Multilevel discogenic degenerative changes. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: Displaced fractures of the left L1-L4 transverse processes. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal.
3,470
EXAM: CT Chest with contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat, CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: Trauma. 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: 200 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bt sec. Scan field of view: 415 mm. DLP: 1067 mGy cm. (accession CT220004123), Patient weight: 415 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 70 sec Scan field of view: 415 mm. (accession CT220004124), Patient weight: 200 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bt sec. Scan field of view: 415 mm. DLP: 1067 mGy cm. (accession CT220004127), Patient weight: 200 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bt sec. Scan field of view: 415 mm. DLP: 1067 mGy cm. (accession CT220004126) FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Small volume of secretions are dependently in the distal trachea and right mainstem bronchus. Biapical pleural-parenchymal scarring. A few noncalcified subpleural nodules in the right upper lobe, the largest of which measures 4 mm (series 502, image 111). Small mesenteric nodules along the left major fissure, likely representing perifissural lymph nodes. No pleural effusions or pneumothorax. HEART / VESSELS: Heart size is normal. No pericardial effusion. Mild calcific atherosclerosis in the coronary arteries. The main pulmonary artery and thoracic aorta are normal in caliber. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Hepatic steatosis. BILIARY TRACT: Mild central intrahepatic and extrahepatic biliary ductal dilatation with smooth tapering to the ampulla. No radiopaque choledocholithiasis or definite obstructing lesion is identified. GALLBLADDER: Distended. No radiopaque cholelithiasis, wall thickening, or pericholecystic stranding. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Symmetric contrast enhancement. Simple cysts in the left upper pole. Additional hypoattenuating lesion in the interpolar left kidney is too small to characterize, but is statistically likely a cyst. No radiopaque nephrolithiasis. No hydroureteronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Moderate-sized hiatal hernia. No significant abnormality in the remainder the stomach or small bowel. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Colonic diverticulosis. The appendix is normal. RETROPERITONEUM: Normal. VESSELS: Mild aortoiliac calcific atherosclerosis. Retroaortic left renal vein. URINARY BLADDER: No significant abnormality. Excreted contrast layers in the urinary bladder. REPRODUCTIVE ORGANS: Prostatomegaly. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Comminuted, impacted right intertrochanteric femoral fracture with extension into the greater trochanter. THORACIC SPINE: VERTEBRA: No fracture. Hemangioma in the T2 vertebral body. DISC SPACES AND FACET JOINTS: No acute injury. Moderate 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 multilevel discogenic degenerative changes. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No spondylolisthesis. CONCLUSION: 1. Comminuted, impacted right intertrochanteric femoral fracture with extension into the greater trochanter. 2. Otherwise, no acute traumatic abnormality in the chest, abdomen, or pelvis. No acute fracture or subluxation in the thoracolumbar spine. 3. Mild central intrahepatic and extrahepatic biliary ductal dilatation without radiopaque choledocholithiasis or definite obstructing lesion identified. Recommend correlation with biochemical profile. 4. A few noncalcified subpleural nodules in the right upper lobe may be related to the adjacent pleural parenchymal scarring, although if there are risk factors for lung malignancy, a follow-up chest CT exam could be obtained in 12 months. 5. Prostatomegaly, correlate with PSA. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Small volume of secretions are dependently in the distal trachea and right mainstem bronchus. Biapical pleural-parenchymal scarring. A few noncalcified subpleural nodules in the right upper lobe, the largest of which measures 4 mm (series 502, image 111). Small mesenteric nodules along the left major fissure, likely representing perifissural lymph nodes. No pleural effusions or pneumothorax. HEART / VESSELS: Heart size is normal. No pericardial effusion. Mild calcific atherosclerosis in the coronary arteries. The main pulmonary artery and thoracic aorta are normal in caliber. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Hepatic steatosis. BILIARY TRACT: Mild central intrahepatic and extrahepatic biliary ductal dilatation with smooth tapering to the ampulla. No radiopaque choledocholithiasis or definite obstructing lesion is identified. GALLBLADDER: Distended. No radiopaque cholelithiasis, wall thickening, or pericholecystic stranding. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Symmetric contrast enhancement. Simple cysts in the left upper pole. Additional hypoattenuating lesion in the interpolar left kidney is too small to characterize, but is statistically likely a cyst. No radiopaque nephrolithiasis. No hydroureteronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Moderate-sized hiatal hernia. No significant abnormality in the remainder the stomach or small bowel. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Colonic diverticulosis. The appendix is normal. RETROPERITONEUM: Normal. VESSELS: Mild aortoiliac calcific atherosclerosis. Retroaortic left renal vein. URINARY BLADDER: No significant abnormality. Excreted contrast layers in the urinary bladder. REPRODUCTIVE ORGANS: Prostatomegaly. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Comminuted, impacted right intertrochanteric femoral fracture with extension into the greater trochanter. THORACIC SPINE: VERTEBRA: No fracture. Hemangioma in the T2 vertebral body. DISC SPACES AND FACET JOINTS: No acute injury. Moderate 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 multilevel discogenic degenerative changes. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No spondylolisthesis.
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 left lateral maxillary sinus mucosal thickening. Otherwise, appear well aerated.
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RADIOLOGIC EXAM: CT Cervical Spine From Reformat, CT Angio Neck CLINICAL INFORMATION: Trauma. COMPARISON: None. TECHNIQUE: CT Cervical Spine From Reformat, CT Angio NeckPatient weight: 200 lbs. IV contrast: Omnipaque 350, 200 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bt sec. Scan field of view: 220 mm. DLP: 1175 mGy cm. Following CT of the neck, reformatted images were produced to optimize visualization of the osseous structures of the cervical spine. 3-D CT MIP were generated in post processing. FINDINGS: Exam is limited due to motion artifact. CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
FINDINGS: Exam is limited due to motion artifact. CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
FINDINGS: VASCULAR FINDINGS: Aortic arch: Patent with no hemodynamically significant stenosis. Three normal vessel aortic arch is noted. Common carotid arteries: Mild fibrofatty plaques of the bilateral carotid bifurcations, with superimposed punctate nonflow limiting atherosclerotic calcification of the left carotid bifurcation. 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: 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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EXAM: CT Chest with contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat, CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: Trauma. 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: 200 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bt sec. Scan field of view: 415 mm. DLP: 1067 mGy cm. (accession CT220004123), Patient weight: 415 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 70 sec Scan field of view: 415 mm. (accession CT220004124), Patient weight: 200 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bt sec. Scan field of view: 415 mm. DLP: 1067 mGy cm. (accession CT220004127), Patient weight: 200 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bt sec. Scan field of view: 415 mm. DLP: 1067 mGy cm. (accession CT220004126) FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Small volume of secretions are dependently in the distal trachea and right mainstem bronchus. Biapical pleural-parenchymal scarring. A few noncalcified subpleural nodules in the right upper lobe, the largest of which measures 4 mm (series 502, image 111). Small mesenteric nodules along the left major fissure, likely representing perifissural lymph nodes. No pleural effusions or pneumothorax. HEART / VESSELS: Heart size is normal. No pericardial effusion. Mild calcific atherosclerosis in the coronary arteries. The main pulmonary artery and thoracic aorta are normal in caliber. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Hepatic steatosis. BILIARY TRACT: Mild central intrahepatic and extrahepatic biliary ductal dilatation with smooth tapering to the ampulla. No radiopaque choledocholithiasis or definite obstructing lesion is identified. GALLBLADDER: Distended. No radiopaque cholelithiasis, wall thickening, or pericholecystic stranding. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Symmetric contrast enhancement. Simple cysts in the left upper pole. Additional hypoattenuating lesion in the interpolar left kidney is too small to characterize, but is statistically likely a cyst. No radiopaque nephrolithiasis. No hydroureteronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Moderate-sized hiatal hernia. No significant abnormality in the remainder the stomach or small bowel. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Colonic diverticulosis. The appendix is normal. RETROPERITONEUM: Normal. VESSELS: Mild aortoiliac calcific atherosclerosis. Retroaortic left renal vein. URINARY BLADDER: No significant abnormality. Excreted contrast layers in the urinary bladder. REPRODUCTIVE ORGANS: Prostatomegaly. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Comminuted, impacted right intertrochanteric femoral fracture with extension into the greater trochanter. THORACIC SPINE: VERTEBRA: No fracture. Hemangioma in the T2 vertebral body. DISC SPACES AND FACET JOINTS: No acute injury. Moderate 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 multilevel discogenic degenerative changes. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No spondylolisthesis. CONCLUSION: 1. Comminuted, impacted right intertrochanteric femoral fracture with extension into the greater trochanter. 2. Otherwise, no acute traumatic abnormality in the chest, abdomen, or pelvis. No acute fracture or subluxation in the thoracolumbar spine. 3. Mild central intrahepatic and extrahepatic biliary ductal dilatation without radiopaque choledocholithiasis or definite obstructing lesion identified. Recommend correlation with biochemical profile. 4. A few noncalcified subpleural nodules in the right upper lobe may be related to the adjacent pleural parenchymal scarring, although if there are risk factors for lung malignancy, a follow-up chest CT exam could be obtained in 12 months. 5. Prostatomegaly, correlate with PSA. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Small volume of secretions are dependently in the distal trachea and right mainstem bronchus. Biapical pleural-parenchymal scarring. A few noncalcified subpleural nodules in the right upper lobe, the largest of which measures 4 mm (series 502, image 111). Small mesenteric nodules along the left major fissure, likely representing perifissural lymph nodes. No pleural effusions or pneumothorax. HEART / VESSELS: Heart size is normal. No pericardial effusion. Mild calcific atherosclerosis in the coronary arteries. The main pulmonary artery and thoracic aorta are normal in caliber. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Hepatic steatosis. BILIARY TRACT: Mild central intrahepatic and extrahepatic biliary ductal dilatation with smooth tapering to the ampulla. No radiopaque choledocholithiasis or definite obstructing lesion is identified. GALLBLADDER: Distended. No radiopaque cholelithiasis, wall thickening, or pericholecystic stranding. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Symmetric contrast enhancement. Simple cysts in the left upper pole. Additional hypoattenuating lesion in the interpolar left kidney is too small to characterize, but is statistically likely a cyst. No radiopaque nephrolithiasis. No hydroureteronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Moderate-sized hiatal hernia. No significant abnormality in the remainder the stomach or small bowel. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Colonic diverticulosis. The appendix is normal. RETROPERITONEUM: Normal. VESSELS: Mild aortoiliac calcific atherosclerosis. Retroaortic left renal vein. URINARY BLADDER: No significant abnormality. Excreted contrast layers in the urinary bladder. REPRODUCTIVE ORGANS: Prostatomegaly. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Comminuted, impacted right intertrochanteric femoral fracture with extension into the greater trochanter. THORACIC SPINE: VERTEBRA: No fracture. Hemangioma in the T2 vertebral body. DISC SPACES AND FACET JOINTS: No acute injury. Moderate 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 multilevel discogenic degenerative changes. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No spondylolisthesis.
Findings: Brain parenchyma: Predominantly biparietal age-appropriate brain parenchymal volume loss is again seen. Please note evaluation of the brain parenchyma is significantly limited due to motion and beam hardening artifacts. 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 atherosclerotic calcifications of the bilateral carotid siphons and the left vertebral artery. Soft tissues: Unremarkable without discrete fluid collections. Orbits: Normal appearance. Unchanged bilateral lens replacements. Calvarium and skull base: Unchanged empty sella and diffuse hyperostosis. No acute fractures or suspicious osseous lesions identified. The bilateral mastoid air cell complexes are well-developed and clear. Paranasal sinuses: Well aerated.
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EXAM: CT Chest with contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat, CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: Trauma. 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: 200 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bt sec. Scan field of view: 415 mm. DLP: 1067 mGy cm. (accession CT220004123), Patient weight: 415 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 70 sec Scan field of view: 415 mm. (accession CT220004124), Patient weight: 200 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bt sec. Scan field of view: 415 mm. DLP: 1067 mGy cm. (accession CT220004127), Patient weight: 200 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bt sec. Scan field of view: 415 mm. DLP: 1067 mGy cm. (accession CT220004126) FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Small volume of secretions are dependently in the distal trachea and right mainstem bronchus. Biapical pleural-parenchymal scarring. A few noncalcified subpleural nodules in the right upper lobe, the largest of which measures 4 mm (series 502, image 111). Small mesenteric nodules along the left major fissure, likely representing perifissural lymph nodes. No pleural effusions or pneumothorax. HEART / VESSELS: Heart size is normal. No pericardial effusion. Mild calcific atherosclerosis in the coronary arteries. The main pulmonary artery and thoracic aorta are normal in caliber. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Hepatic steatosis. BILIARY TRACT: Mild central intrahepatic and extrahepatic biliary ductal dilatation with smooth tapering to the ampulla. No radiopaque choledocholithiasis or definite obstructing lesion is identified. GALLBLADDER: Distended. No radiopaque cholelithiasis, wall thickening, or pericholecystic stranding. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Symmetric contrast enhancement. Simple cysts in the left upper pole. Additional hypoattenuating lesion in the interpolar left kidney is too small to characterize, but is statistically likely a cyst. No radiopaque nephrolithiasis. No hydroureteronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Moderate-sized hiatal hernia. No significant abnormality in the remainder the stomach or small bowel. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Colonic diverticulosis. The appendix is normal. RETROPERITONEUM: Normal. VESSELS: Mild aortoiliac calcific atherosclerosis. Retroaortic left renal vein. URINARY BLADDER: No significant abnormality. Excreted contrast layers in the urinary bladder. REPRODUCTIVE ORGANS: Prostatomegaly. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Comminuted, impacted right intertrochanteric femoral fracture with extension into the greater trochanter. THORACIC SPINE: VERTEBRA: No fracture. Hemangioma in the T2 vertebral body. DISC SPACES AND FACET JOINTS: No acute injury. Moderate 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 multilevel discogenic degenerative changes. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No spondylolisthesis. CONCLUSION: 1. Comminuted, impacted right intertrochanteric femoral fracture with extension into the greater trochanter. 2. Otherwise, no acute traumatic abnormality in the chest, abdomen, or pelvis. No acute fracture or subluxation in the thoracolumbar spine. 3. Mild central intrahepatic and extrahepatic biliary ductal dilatation without radiopaque choledocholithiasis or definite obstructing lesion identified. Recommend correlation with biochemical profile. 4. A few noncalcified subpleural nodules in the right upper lobe may be related to the adjacent pleural parenchymal scarring, although if there are risk factors for lung malignancy, a follow-up chest CT exam could be obtained in 12 months. 5. Prostatomegaly, correlate with PSA. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Small volume of secretions are dependently in the distal trachea and right mainstem bronchus. Biapical pleural-parenchymal scarring. A few noncalcified subpleural nodules in the right upper lobe, the largest of which measures 4 mm (series 502, image 111). Small mesenteric nodules along the left major fissure, likely representing perifissural lymph nodes. No pleural effusions or pneumothorax. HEART / VESSELS: Heart size is normal. No pericardial effusion. Mild calcific atherosclerosis in the coronary arteries. The main pulmonary artery and thoracic aorta are normal in caliber. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Hepatic steatosis. BILIARY TRACT: Mild central intrahepatic and extrahepatic biliary ductal dilatation with smooth tapering to the ampulla. No radiopaque choledocholithiasis or definite obstructing lesion is identified. GALLBLADDER: Distended. No radiopaque cholelithiasis, wall thickening, or pericholecystic stranding. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Symmetric contrast enhancement. Simple cysts in the left upper pole. Additional hypoattenuating lesion in the interpolar left kidney is too small to characterize, but is statistically likely a cyst. No radiopaque nephrolithiasis. No hydroureteronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Moderate-sized hiatal hernia. No significant abnormality in the remainder the stomach or small bowel. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Colonic diverticulosis. The appendix is normal. RETROPERITONEUM: Normal. VESSELS: Mild aortoiliac calcific atherosclerosis. Retroaortic left renal vein. URINARY BLADDER: No significant abnormality. Excreted contrast layers in the urinary bladder. REPRODUCTIVE ORGANS: Prostatomegaly. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Comminuted, impacted right intertrochanteric femoral fracture with extension into the greater trochanter. THORACIC SPINE: VERTEBRA: No fracture. Hemangioma in the T2 vertebral body. DISC SPACES AND FACET JOINTS: No acute injury. Moderate 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 multilevel discogenic degenerative changes. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No spondylolisthesis.
FINDINGS/IMPRESSION: 1. Comminuted tricolumn, bicondylar fracture of the left proximal tibia with diametaphyseal separation. The fracture involves articular surface of the lateral tibial plateau and obliquely extends to the proximal tibial diaphysis and tibial tubercle. Distal quadriceps and patellar tendon appear to be intact. Fracture lines extend to the base of the tibial eminence/attachment of the ACL. 2. Slightly comminuted avulsion fracture of the left fibular head. 3. Comminuted fracture of the left patella in anatomic alignment, extends to the patellar articular surface. There is no distraction of the fracture fragments. 4.Lipohemarthrosis. No intra-articular fragments or gas.
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RADIOLOGIC EXAM: CT Head wo contrast, CT Maxillofacial wo contrast CLINICAL INFORMATION: Trauma COMPARISON: None. TECHNIQUE: CT Head wo contrast, CT Maxillofacial wo contrastScan field of view: 230 mm. DLP: 1400 mGy cm. (accession CT220004122), Scan field of view: 220 mm. DLP: 1015 mGy cm. (accession CT220004128) STRUCTURED REPORT: CT Head and Maxillofacial Trauma FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. Cerebral cortical volume is normal. EXTRA-AXIAL SPACES: No extra-axial collections. VENTRICULAR SYSTEM: Normal. ORBITS: Normal appearance of the globes. No fracture. SKULL AND SKULL BASE: No fracture identified. Near-complete opacification of the right mastoid air cells. FACIAL BONES: No acute fracture. Bilateral pterygoid plates are intact. Diffuse dental disease with multiple dental caries and periapical lucency. The right parotid gland is asymmetrically enlarged. MANDIBLE: No acute fracture. Bilateral temporomandibular joints are intact. SINONASAL CAVITIES: Paranasal sinuses are clear. CONCLUSION: 1. No acute intracranial process or maxillofacial fracture. 2. Large right mastoid air cell effusion. No acute skull base fracture identified. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. Cerebral cortical volume is normal. EXTRA-AXIAL SPACES: No extra-axial collections. VENTRICULAR SYSTEM: Normal. ORBITS: Normal appearance of the globes. No fracture. SKULL AND SKULL BASE: No fracture identified. Near-complete opacification of the right mastoid air cells. FACIAL BONES: No acute fracture. Bilateral pterygoid plates are intact. Diffuse dental disease with multiple dental caries and periapical lucency. The right parotid gland is asymmetrically enlarged. MANDIBLE: No acute fracture. Bilateral temporomandibular joints are intact. SINONASAL CAVITIES: Paranasal sinuses are clear.
FINDINGS/IMPRESSION: 1. Comminuted, mildly displaced fracture of the distal tibial diaphysis, extending to the metaphysis and exiting at the tibial plafond. There is no significant depression of the articular surface. The fracture lines extends to the medial malleolus. 2. Mildly comminuted, mildly displaced predominantly transverse fracture of the distal fibula diaphysis. 3. Mildly comminuted, nondisplaced fractures of the inferior medial navicular. Lisfranc interval is normal. 4. No tendon entrapment.
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RADIOLOGIC EXAM: CT Cervical Spine From Reformat, CT Angio Neck CLINICAL INFORMATION: Trauma. COMPARISON: None. TECHNIQUE: CT Cervical Spine From Reformat, CT Angio NeckPatient weight: 200 lbs. IV contrast: Omnipaque 350, 200 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bt sec. Scan field of view: 220 mm. DLP: 1175 mGy cm. Following CT of the neck, reformatted images were produced to optimize visualization of the osseous structures of the cervical spine. 3-D CT MIP were generated in post processing. FINDINGS: Exam is limited due to motion artifact. CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
FINDINGS: Exam is limited due to motion artifact. CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
FINDINGS/CONCLUSION: Comminuted fracture of the posterior malleolus. Slight lateral translation of the talus in relation to the tibia with lateral talar tilt. Small ossific fragment is present within the medial ankle mortise likely representing an avulsion fracture. Additional small osseous fragments are present anterior to the lateral malleolus likely representing an avulsion fracture. Scattered foci of gas are noted in the anterior ankle soft tissues concerning for open fracture. Soft tissue swelling about the ankle.
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EXAM: CT Pelvis with contrast CLINICAL INFORMATION: Buttock abscess COMPARISON: None. TECHNIQUE: CT Pelvis with contrast. Patient weight: 260 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. Saline flush: 10 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 100 sec. Scan field of view: 455 mm. DLP: 683 mGy cm. FINDINGS: Visualized intrapelvic structures are unremarkable. Contrast noted in the visualized ureters and bladder. Mild inflammatory change along the gluteal cleft without discrete fluid collection. No soft tissue gas is evident. Osseous structures are unremarkable. CONCLUSION: Mild nonspecific inflammatory change along the gluteal cleft without discrete fluid collection to suggest abscess. However, exam is limited without IV contrast.
FINDINGS: Visualized intrapelvic structures are unremarkable. Contrast noted in the visualized ureters and bladder. Mild inflammatory change along the gluteal cleft without discrete fluid collection. No soft tissue gas is evident. Osseous structures are unremarkable.
FINDINGS: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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EXAM: CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: Diffuse abdominal pain, concern for mesenteric ischemia. Back pain. COMPARISON: CT abdomen and pelvis without contrast 1/7/2022. TECHNIQUE: CT Abdomen and Pelvis w contrast. Patient weight: 169 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 75 ml. IV contrast injection rate: 3 ml per sec. Scan delay: bolus tracking Scan field of view: 399 mm. DLP: 1105.30 mGy cm. FINDINGS: Examination is mildly limited by motion artifact. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Small left pleural effusion. Evolving patchy peribronchovascular and peripheral nodular groundglass and consolidative opacities, several which appear cavitary, with areas of more confluent consolidation in the left lower lobe. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Hepatic steatosis. Calcified granuloma in the right hepatic lobe. No focal enhancing lesion. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Unchanged splenomegaly. ADRENALS: Hypoplasia without discrete lesion. KIDNEYS: Symmetric contrast enhancement. No radiopaque nephrolithiasis. No hydroureteronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No significant abnormality in the colon. The appendix is normal. PERITONEUM / MESENTERY: No free intraperitoneal fluid. No pneumoperitoneum. RETROPERITONEUM: Normal. VESSELS: No significant abnormality in the proximal SMA or its branch vessels. Evaluation of the mid to distal SMA is limited secondary to motion artifact. No significant abnormality in the remainder of the visualized abdominal vasculature. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No aggressive osseous abnormality is identified. CONCLUSION: 1., Limited examination secondary to motion artifact, without evidence of acute mesenteric ischemia or discrete filling defect in the proximal SMA. 2. Redemonstration of patchy groundglass and nodular consolidative opacities, some of which are cavitary, in the visualized bilateral lower lungs. Findings again raise suspicion for septic pulmonary emboli versus atypical/multifocal infection. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
FINDINGS: Examination is mildly limited by motion artifact. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Small left pleural effusion. Evolving patchy peribronchovascular and peripheral nodular groundglass and consolidative opacities, several which appear cavitary, with areas of more confluent consolidation in the left lower lobe. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Hepatic steatosis. Calcified granuloma in the right hepatic lobe. No focal enhancing lesion. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Unchanged splenomegaly. ADRENALS: Hypoplasia without discrete lesion. KIDNEYS: Symmetric contrast enhancement. No radiopaque nephrolithiasis. No hydroureteronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No significant abnormality in the colon. The appendix is normal. PERITONEUM / MESENTERY: No free intraperitoneal fluid. No pneumoperitoneum. RETROPERITONEUM: Normal. VESSELS: No significant abnormality in the proximal SMA or its branch vessels. Evaluation of the mid to distal SMA is limited secondary to motion artifact. No significant abnormality in the remainder of the visualized abdominal vasculature. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No aggressive osseous abnormality is identified.
FINDINGS/IMPRESSION: 1. Severely comminuted, tricolumn bicondylar fracture of the right proximal tibia with diametaphyseal separation. 2. Severely comminuted patellar fracture. 3. Comminuted fracture of the medial femoral condyle, predominantly in coronal plane. 4. Hemarthrosis with multiple intra-articular fragments.
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EXAM: CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: Epigastric pain, leukocytosis COMPARISON: Same day ultrasound. TECHNIQUE: CT Abdomen and Pelvis w contrast Patient weight: 163 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 75 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 78 sec. Scan field of view: 425 mm. DLP: 600.60 mGy cm. FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Bibasilar atelectasis. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Gallbladder is mildly distended with equivocal wall thickening and mild pericholecystic inflammatory change. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Mild inflammatory change in region of the vertical segment of the duodenum. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Inflammatory change surrounding the gallbladder and vertical segment of the duodenum. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Small right ovarian dermoid cyst measuring 2.2 cm. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: Mild gallbladder distention/equivocal wall thickening with inflammatory change surrounding the gallbladder and vertical segment of the duodenum. Differential considerations include cholecystitis and peptic ulcer disease/duodenitis. HIDA scan may be of benefit given lack of convincing evidence for cholecystitis on same-day ultrasound.
FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Bibasilar atelectasis. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Gallbladder is mildly distended with equivocal wall thickening and mild pericholecystic inflammatory change. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Mild inflammatory change in region of the vertical segment of the duodenum. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Inflammatory change surrounding the gallbladder and vertical segment of the duodenum. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Small right ovarian dermoid cyst measuring 2.2 cm. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Geographic area of low-attenuation adjacent to the intersegmental fissure, likely focal fat. There is an additional area of low-attenuation near the hepatic hilum on image 60, series 301 which is indeterminate. Minute subcentimeter hypodensity within the right hepatic lobe is technically indeterminate but statistically likely a cyst. 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 colonic diverticula are seen. The appendix is normal. There is thickening of the sigmoid colon which is thought to be most likely secondary to lack distention. No definite CT evidence of colitis. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Mild aortoiliac atherosclerosis without aneurysmal dilatation. There is a retroaortic left renal vein. URINARY BLADDER: Mildly thick-walled which may be due to lack of distention or chronic outlet obstruction. REPRODUCTIVE ORGANS: Prostatomegaly. Trace right scrotal hydrocele. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Moderate multilevel discogenic degenerative changes are seen within the spine. No focal destructive osseous lesion.
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EXAM: CT Hand Right with contrast, CT Wrist Right with contrast CLINICAL INFORMATION: Infection COMPARISON: 1/8/2022 TECHNIQUE: Helical CT images of the right hand and wrist were obtained following the intravenous administration of contrast. Axial, coronal, sagittal reconstructions were obtained. Patient weight: 210 lbs. Saline flush: 75 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 180 sec. Scan field of view: 303 mm. DLP: 303.80 mGy cm. (accession CT220004135), Patient weight: 210 lbs. Saline flush: 75 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 180 sec. Scan field of view: 252 mm. (accession CT220004134) FINDINGS: No acute fracture or dislocation of the right hand or wrist. There is a peripherally enhancing fluid collection within the dorsal and ulnar soft tissues of the distal index finger with apparent communication with the DIP joint. The collection measures approximately 1.4 x 1.1 cm (image 365, series 202) There are questionable erosive changes of the articular surface of the distal phalanx. Increased fluid is seen extending along the flexor tendon of the index finger to the level of the mid metacarpal. There is a second peripherally enhancing fluid collection extending into the first interweb space measuring approximately 1.2 x 3.8 cm (image 195, series 202). The remaining flexor tendons are unremarkable. The extensor tendons are unremarkable. There is extensive soft tissue swelling of the index finger and dorsum of the hand. CONCLUSION: 1. Soft tissue abscess of the distal index finger with extension to the DIP joint concerning for septic arthritis. Additionally, there are questionable erosive changes of the index finger distal phalanx concerning for osteomyelitis. 2. Tenosynovitis of the index finger flexor tendon with associated peripheral enhancing fluid collection within the volar aspect of the first interweb space of the hand.
FINDINGS: No acute fracture or dislocation of the right hand or wrist. There is a peripherally enhancing fluid collection within the dorsal and ulnar soft tissues of the distal index finger with apparent communication with the DIP joint. The collection measures approximately 1.4 x 1.1 cm (image 365, series 202) There are questionable erosive changes of the articular surface of the distal phalanx. Increased fluid is seen extending along the flexor tendon of the index finger to the level of the mid metacarpal. There is a second peripherally enhancing fluid collection extending into the first interweb space measuring approximately 1.2 x 3.8 cm (image 195, series 202). The remaining flexor tendons are unremarkable. The extensor tendons are unremarkable. There is extensive soft tissue swelling of the index finger and dorsum of the hand.
Findings: The sagittal images demonstrate persistent dextroscoliosis of the upper thoracic spine, with exaggeration of the thoracic kyphosis, without subluxations. Multiple chronic anterior wedging deformities, most pronounced from T8 to T11 are again seen, with associated prominent Schmorl nodes and scattered vacuum phenomenon, suggestive of Scheuermann's disease. The remaining vertebral bodies maintain normal height, without acute fractures or suspicious osseous lesions. A developmentally narrowed spinal canal is again seen. The bilateral neuroforamina remain otherwise patent. The prevertebral and paraspinal soft tissues appear normal.
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EXAM: CT Hand Right with contrast, CT Wrist Right with contrast CLINICAL INFORMATION: Infection COMPARISON: 1/8/2022 TECHNIQUE: Helical CT images of the right hand and wrist were obtained following the intravenous administration of contrast. Axial, coronal, sagittal reconstructions were obtained. Patient weight: 210 lbs. Saline flush: 75 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 180 sec. Scan field of view: 303 mm. DLP: 303.80 mGy cm. (accession CT220004135), Patient weight: 210 lbs. Saline flush: 75 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 180 sec. Scan field of view: 252 mm. (accession CT220004134) FINDINGS: No acute fracture or dislocation of the right hand or wrist. There is a peripherally enhancing fluid collection within the dorsal and ulnar soft tissues of the distal index finger with apparent communication with the DIP joint. The collection measures approximately 1.4 x 1.1 cm (image 365, series 202) There are questionable erosive changes of the articular surface of the distal phalanx. Increased fluid is seen extending along the flexor tendon of the index finger to the level of the mid metacarpal. There is a second peripherally enhancing fluid collection extending into the first interweb space measuring approximately 1.2 x 3.8 cm (image 195, series 202). The remaining flexor tendons are unremarkable. The extensor tendons are unremarkable. There is extensive soft tissue swelling of the index finger and dorsum of the hand. CONCLUSION: 1. Soft tissue abscess of the distal index finger with extension to the DIP joint concerning for septic arthritis. Additionally, there are questionable erosive changes of the index finger distal phalanx concerning for osteomyelitis. 2. Tenosynovitis of the index finger flexor tendon with associated peripheral enhancing fluid collection within the volar aspect of the first interweb space of the hand.
FINDINGS: No acute fracture or dislocation of the right hand or wrist. There is a peripherally enhancing fluid collection within the dorsal and ulnar soft tissues of the distal index finger with apparent communication with the DIP joint. The collection measures approximately 1.4 x 1.1 cm (image 365, series 202) There are questionable erosive changes of the articular surface of the distal phalanx. Increased fluid is seen extending along the flexor tendon of the index finger to the level of the mid metacarpal. There is a second peripherally enhancing fluid collection extending into the first interweb space measuring approximately 1.2 x 3.8 cm (image 195, series 202). The remaining flexor tendons are unremarkable. The extensor tendons are unremarkable. There is extensive soft tissue swelling of the index finger and dorsum of the hand.
FINDINGS: Aortic arch: Patent without flow-limiting stenosis. Normal three vessel aortic arch is noted. Right carotid: Patent without flow-limiting stenosis. Left carotid: Patent without flow-limiting stenosis. Punctate nonflow limiting atherosclerotic calcification of the proximal left ICA. Short retropharyngeal course of the bilateral common carotid and right internal carotid arteries. Right vertebral artery: Patent without flow-limiting stenosis. Left vertebral artery: Patent without flow-limiting stenosis. Codominant vertebral arteries. Intracranial arteries: Dense atherosclerotic calcifications of the bilateral cavernous and supraclinoid ICAs, resulting in moderate focal supraclinoid luminal narrowing respectively. The bilateral ACAs, MCAs and PCAs appear patent, without flow-limiting stenoses or discrete aneurysms. The vertebrobasilar axis is mildly tortuous, without flow-limiting stenoses. NONVASCULAR FINDINGS: Mild frontal age-appropriate brain parenchymal volume loss is seen. Mild periventricular frontal white matter hypoattenuation is noted, suggestive of mild chronic ischemic microvascular disease. The white-gray matter differentiation is preserved. Ventriculomegaly is slightly out of proportion to the parenchymal volume loss and may represent a component of mild communicating hydrocephalus. There is no abnormal enhancement, acute intracranial hemorrhage, midline shift, basal cistern effacement, or abnormal extra-axial fluid collections. Incidental bilateral lens replacements. 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 mildly heterogeneous.
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EXAM: CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: Epigastric abdominal pain. COMPARISON: Abdominal ultrasound 10/15/2021. TECHNIQUE: CT Abdomen and Pelvis w contrast. Patient weight: 150 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 60 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 80sec Scan field of view: 360 mm. DLP: 426 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: Moderate intrahepatic biliary ductal dilatation. The common bile duct is dilated, measuring up to 12 mm in diameter at the porta hepatis and tapering distally, and is filled with relatively hyperattenuating material. No radiopaque choledocholithiasis is identified. GALLBLADDER: No abnormality. PANCREAS: Edematous with mild pancreatic ductal dilatation in the head and proximal body, tapering distally. Small ill-defined fluid collections within and adjacent to the pancreatic tail. Moderate peripancreatic stranding/edema. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Symmetric contrast enhancement. Simple bilateral renal cysts. Additional hypoattenuating lesions in both kidneys are too small to characterize, but are statistically likely to represent cysts. No radiopaque nephrolithiasis or hydroureteronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No significant abnormality in the colon. The appendix is normal. PERITONEUM / MESENTERY: No free intraperitoneal fluid. No pneumoperitoneum. Edema along the hepatoduodenal ligament. RETROPERITONEUM: Moderate peripancreatic stranding/edema and mildly heterogeneous fluid collection adjacent to the pancreatic tail, as above. VESSELS: Moderate aortoiliac calcific atherosclerosis. Occlusion of the splenic vein with multiple perisplenic and perigastric venous collaterals. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Prostatomegaly. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No aggressive osseous abnormalities identified. Eight shaped vertebral bodies. CONCLUSION: 1. Acute pancreatitis with several ill-defined fluid collections within and adjacent the pancreatic tail, which may reflect acute peripancreatic collections or pseudocysts depending upon chronicity. Component of necrotizing pancreatitis is difficult to exclude. 2. Moderate intrahepatic and extrahepatic biliary ductal dilatation without radiopaque choledocholithiasis or discrete obstructing lesion identified. Homogenously hyperattenuating material fills the extrahepatic biliary tree, and may represent biliary sludge. Recommend correlation with biochemical profile and further evaluation with abdominal ultrasound. 3. Occlusion of the splenic vein with perisplenic and perigastric venous collaterals. 4. Prostatomegaly, correlate with PSA. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Moderate intrahepatic biliary ductal dilatation. The common bile duct is dilated, measuring up to 12 mm in diameter at the porta hepatis and tapering distally, and is filled with relatively hyperattenuating material. No radiopaque choledocholithiasis is identified. GALLBLADDER: No abnormality. PANCREAS: Edematous with mild pancreatic ductal dilatation in the head and proximal body, tapering distally. Small ill-defined fluid collections within and adjacent to the pancreatic tail. Moderate peripancreatic stranding/edema. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Symmetric contrast enhancement. Simple bilateral renal cysts. Additional hypoattenuating lesions in both kidneys are too small to characterize, but are statistically likely to represent cysts. No radiopaque nephrolithiasis or hydroureteronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No significant abnormality in the colon. The appendix is normal. PERITONEUM / MESENTERY: No free intraperitoneal fluid. No pneumoperitoneum. Edema along the hepatoduodenal ligament. RETROPERITONEUM: Moderate peripancreatic stranding/edema and mildly heterogeneous fluid collection adjacent to the pancreatic tail, as above. VESSELS: Moderate aortoiliac calcific atherosclerosis. Occlusion of the splenic vein with multiple perisplenic and perigastric venous collaterals. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Prostatomegaly. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No aggressive osseous abnormalities identified. Eight shaped vertebral bodies.
FINDINGS: Aortic arch: Patent without flow-limiting stenosis. Normal three vessel aortic arch is noted. Right carotid: Patent without flow-limiting stenosis. Left carotid: Patent without flow-limiting stenosis. Punctate nonflow limiting atherosclerotic calcification of the proximal left ICA. Short retropharyngeal course of the bilateral common carotid and right internal carotid arteries. Right vertebral artery: Patent without flow-limiting stenosis. Left vertebral artery: Patent without flow-limiting stenosis. Codominant vertebral arteries. Intracranial arteries: Dense atherosclerotic calcifications of the bilateral cavernous and supraclinoid ICAs, resulting in moderate focal supraclinoid luminal narrowing respectively. The bilateral ACAs, MCAs and PCAs appear patent, without flow-limiting stenoses or discrete aneurysms. The vertebrobasilar axis is mildly tortuous, without flow-limiting stenoses. NONVASCULAR FINDINGS: Mild frontal age-appropriate brain parenchymal volume loss is seen. Mild periventricular frontal white matter hypoattenuation is noted, suggestive of mild chronic ischemic microvascular disease. The white-gray matter differentiation is preserved. Ventriculomegaly is slightly out of proportion to the parenchymal volume loss and may represent a component of mild communicating hydrocephalus. There is no abnormal enhancement, acute intracranial hemorrhage, midline shift, basal cistern effacement, or abnormal extra-axial fluid collections. Incidental bilateral lens replacements. 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 mildly heterogeneous.
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. RADIOLOGIC EXAM: CT Head wo contrast CLINICAL INFORMATION: Fall, headache. COMPARISON: CT sinus 5/16/2008. TECHNIQUE: CT Head wo contrastScan field of view: 255 mm. DLP: 1448.30 mGy cm. STRUCTURED REPORT: CT Head FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. No evidence of acute infarction. Mild diffuse age-appropriate parenchymal volume loss. Periventricular white matter hypoattenuation consistent with chronic microangiopathic changes. Remote infarct in the right corona radiata. Physiologic calcifications of the basal ganglia. EXTRA-AXIAL SPACES: No extra-axial collections. SKULL AND SKULL BASE: No fracture. Bilateral mastoid air cells are clear. Small right parietal scalp contusion. VENTRICULAR SYSTEM: Normal. ORBITS: Bilateral pseudophakia. SINUSES: Paranasal sinuses are clear. VESSELS: Moderate calcified atherosclerosis of the carotid siphons and vertebrobasilar arteries. CONCLUSION: 1. No acute intracranial process. Small right parietal scalp contusion. 2. Other chronic and incidental findings as above. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. No evidence of acute infarction. Mild diffuse age-appropriate parenchymal volume loss. Periventricular white matter hypoattenuation consistent with chronic microangiopathic changes. Remote infarct in the right corona radiata. Physiologic calcifications of the basal ganglia. EXTRA-AXIAL SPACES: No extra-axial collections. SKULL AND SKULL BASE: No fracture. Bilateral mastoid air cells are clear. Small right parietal scalp contusion. VENTRICULAR SYSTEM: Normal. ORBITS: Bilateral pseudophakia. SINUSES: Paranasal sinuses are clear. VESSELS: Moderate calcified atherosclerosis of the carotid siphons and vertebrobasilar arteries.
Findings: There is slight diffuse atrophy and there is commensurate slight prominence of ventricles but no hydrocephalus per se. There is no mass, hemorrhage, visible infarct or extracerebral collection. The posterior fossa contents are unremarkable. No defect is seen in the calvarium or skull base. ----------------
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RADIOLOGIC EXAM: CT Cervical Spine wo contrast CLINICAL INFORMATION: Fall, head injury Spec Inst: Fall COMPARISON: None. TECHNIQUE: CT Cervical Spine wo contrastScan field of view: 298 mm. DLP: 389 mGy cm. Axial CT images of the cervical spine were obtained without IV contrast. Coronal and sagittal reformats were obtained. 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 (
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 (
Findings/conclusion: Comminuted fracture of the navicular involving the talonavicular and naviculocuneiform joints. Mildly displaced fracture of the medial cuneiform extending into the navicular cuneiform joint. Diffuse decreased bone mineralization. The joint spaces are maintained. Haglund deformity of the posterior calcaneus is noted. The distal Achilles tendon is thickened and heterogeneous representing tendinosis. The Lisfranc joint is unremarkable. Soft tissue swelling of the foot. Dorsal and plantar calcaneal enthesopathy.
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EXAM: CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: Peripancreatic fluid collection, chronic pancreatitis. COMPARISON: 12/24/21 TECHNIQUE: CT Abdomen and Pelvis w contrast. Patient weight: 128 lbs. IV contrast: Omnipaque 350, 80 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 3.50 ml per sec. Scan delay: 62 sec Scan field of view: 440 mm. DLP: 668 mGy cm. FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: New ground glass opacities scattered throughout both lower lungs. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Intrahepatic and extra hepatic biliary duct dilation with caliber change at the periampullary distal common bile duct is similar to prior. GALLBLADDER: No abnormality. PANCREAS: Sequela of chronic pancreatitis. Interval decreased size of peripancreatic fluid collections including the collection along the gallbladder fossa now measuring 4.3 x 3.8 cm, previously 4.7 x 4.8 cm. Previously visualized fluid collection extending cranially from the region of the pancreaticoduodenal groove region has nearly resolved. Few additional tiny peripancreatic gas and fluid containing collections are noted. A few foci of refluxed gas within the main pancreatic duct. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Right renal cyst. Obstructing 7 mm stone at the right UPJ with mild right hydroureteronephrosis and LYMPH NODES: Stable mildly enlarged peripancreatic and retroperitoneal nodes. STOMACH / SMALL BOWEL: Mild wall thickening of the peripancreatic descending duodenum in the region of previously visualized fluid collection. Fluid collection visualized prior to this region is largely resolved. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Large volume ascites. Diffuse mesenteric edema. RETROPERITONEUM: Normal. VESSELS: Stable narrowing of the main portal vein at the porta hepatis. Portal vein is patent. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No acute fracture or destructive osseous lesion. CONCLUSION: 1. Mild interval decrease size of gas and fluid containing collection along the gallbladder fossa. Few additional small gas and fluid containing peripancreatic collections have also decreased in size including the collection extending cranially from the pancreaticoduodenal groove region. 2. Obstructing 7 mm stone at the right UPJ with mild right hydronephrosis. 3. New groundglass opacities within both lower lungs highly suggestive of atypical/viral pneumonia. 4. Large volume ascites. 4. Additional stable findings as above.
FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: New ground glass opacities scattered throughout both lower lungs. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Intrahepatic and extra hepatic biliary duct dilation with caliber change at the periampullary distal common bile duct is similar to prior. GALLBLADDER: No abnormality. PANCREAS: Sequela of chronic pancreatitis. Interval decreased size of peripancreatic fluid collections including the collection along the gallbladder fossa now measuring 4.3 x 3.8 cm, previously 4.7 x 4.8 cm. Previously visualized fluid collection extending cranially from the region of the pancreaticoduodenal groove region has nearly resolved. Few additional tiny peripancreatic gas and fluid containing collections are noted. A few foci of refluxed gas within the main pancreatic duct. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Right renal cyst. Obstructing 7 mm stone at the right UPJ with mild right hydroureteronephrosis and LYMPH NODES: Stable mildly enlarged peripancreatic and retroperitoneal nodes. STOMACH / SMALL BOWEL: Mild wall thickening of the peripancreatic descending duodenum in the region of previously visualized fluid collection. Fluid collection visualized prior to this region is largely resolved. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Large volume ascites. Diffuse mesenteric edema. RETROPERITONEUM: Normal. VESSELS: Stable narrowing of the main portal vein at the porta hepatis. Portal vein is patent. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No acute fracture or destructive osseous lesion.
Findings: The left frontoparietal convexity epidural fluid collection is larger, now measuring 1.5 x 6.7 cm with air loculated anteriorly and posteriorly. There is also air in the subgaleal space. There is similar mass effect and subfalcine herniation to the right. The right hemisphere and posterior fossa contents are essentially negative. ----------------
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RADIOLOGIC EXAM: CT Orbit or Temporal Bones with contrast, CT Head wo+w contrast CLINICAL INFORMATION: PUI for COVID, scalp laceration, evaluate for left mastoiditis. COMPARISON: None. TECHNIQUE: CT Orbit or Temporal Bones with contrast, CT Head wo+w contrastPatient weight: 150 lbs. IV contrast: Omnipaque 350, 100 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 300 sec Scan field of view: 141 mm. DLP: 617.10 mGy cm. (accession CT220004141), Patient weight: 150 lbs. Saline flush: 70 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 300 sec Scan field of view: 262.20 mm. DLP: 2675.60 mGy cm. (accession CT220004140) FINDINGS: CT HEAD: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. No evidence of acute infarction. Normal cerebral cortical volume for patient's age. No abnormal intracranial enhancement. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. Bilateral mastoid air cells are clear. There is an organized, peripherally enhancing fluid collection in the mid frontal scalp measuring 2.5 x 1.2 x 3.9 cm (image 50, series #201 and image 29, series #205). VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Mucous retention cyst left maxillary sinus. Mild mucosal thickening of the bilateral ethmoid and bilateral maxillary sinuses. VESSELS: No significant abnormality. CT TEMPORAL BONE: The mastoid air cells are clear bilaterally. There is mild superficial skin thickening and stranding surrounding the left postauricular soft tissues (image 19, series #302). No focal fluid collection. The middle and inner ear structures are normal in appearance bilaterally. There is no evidence of internal auditory canal enlargement, labyrinthine obliteration, or inflammatory changes or soft tissue masses within the middle ears. There is close approximation of the left semicircular canal with the arcuate eminence without definite evidence of dehiscence. CONCLUSION: 1. Small peripherally enhancing fluid collection in the mid frontal scalp, likely abscess. 2. Mild skin thickening and stranding at the left postauricular region without fluid collection. 3. Other incidental findings as above. Mastoids are clear. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
FINDINGS: CT HEAD: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. No evidence of acute infarction. Normal cerebral cortical volume for patient's age. No abnormal intracranial enhancement. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. Bilateral mastoid air cells are clear. There is an organized, peripherally enhancing fluid collection in the mid frontal scalp measuring 2.5 x 1.2 x 3.9 cm (image 50, series #201 and image 29, series #205). VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Mucous retention cyst left maxillary sinus. Mild mucosal thickening of the bilateral ethmoid and bilateral maxillary sinuses. VESSELS: No significant abnormality. CT TEMPORAL BONE: The mastoid air cells are clear bilaterally. There is mild superficial skin thickening and stranding surrounding the left postauricular soft tissues (image 19, series #302). No focal fluid collection. The middle and inner ear structures are normal in appearance bilaterally. There is no evidence of internal auditory canal enlargement, labyrinthine obliteration, or inflammatory changes or soft tissue masses within the middle ears. There is close approximation of the left semicircular canal with the arcuate eminence without definite evidence of dehiscence.
FINDINGS/CONCLUSION: Posterior dislocation of the left hip with a severely comminuted fracture of the left acetabulum involving the posterior column. There is a transcervical left femoral neck fracture with impaction fracture of the anterior humeral head. Nondisplaced fracture of the posterior left ilium extending into the SI joint. No pubic symphyseal or SI joint diastasis. Please see separately dictated and concurrently obtained CT chest abdomen and pelvis for intra-abdominal findings.
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RADIOLOGIC EXAM: CT Orbit or Temporal Bones with contrast, CT Head wo+w contrast CLINICAL INFORMATION: PUI for COVID, scalp laceration, evaluate for left mastoiditis. COMPARISON: None. TECHNIQUE: CT Orbit or Temporal Bones with contrast, CT Head wo+w contrastPatient weight: 150 lbs. IV contrast: Omnipaque 350, 100 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 300 sec Scan field of view: 141 mm. DLP: 617.10 mGy cm. (accession CT220004141), Patient weight: 150 lbs. Saline flush: 70 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 300 sec Scan field of view: 262.20 mm. DLP: 2675.60 mGy cm. (accession CT220004140) FINDINGS: CT HEAD: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. No evidence of acute infarction. Normal cerebral cortical volume for patient's age. No abnormal intracranial enhancement. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. Bilateral mastoid air cells are clear. There is an organized, peripherally enhancing fluid collection in the mid frontal scalp measuring 2.5 x 1.2 x 3.9 cm (image 50, series #201 and image 29, series #205). VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Mucous retention cyst left maxillary sinus. Mild mucosal thickening of the bilateral ethmoid and bilateral maxillary sinuses. VESSELS: No significant abnormality. CT TEMPORAL BONE: The mastoid air cells are clear bilaterally. There is mild superficial skin thickening and stranding surrounding the left postauricular soft tissues (image 19, series #302). No focal fluid collection. The middle and inner ear structures are normal in appearance bilaterally. There is no evidence of internal auditory canal enlargement, labyrinthine obliteration, or inflammatory changes or soft tissue masses within the middle ears. There is close approximation of the left semicircular canal with the arcuate eminence without definite evidence of dehiscence. CONCLUSION: 1. Small peripherally enhancing fluid collection in the mid frontal scalp, likely abscess. 2. Mild skin thickening and stranding at the left postauricular region without fluid collection. 3. Other incidental findings as above. Mastoids are clear. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
FINDINGS: CT HEAD: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. No evidence of acute infarction. Normal cerebral cortical volume for patient's age. No abnormal intracranial enhancement. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. Bilateral mastoid air cells are clear. There is an organized, peripherally enhancing fluid collection in the mid frontal scalp measuring 2.5 x 1.2 x 3.9 cm (image 50, series #201 and image 29, series #205). VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Mucous retention cyst left maxillary sinus. Mild mucosal thickening of the bilateral ethmoid and bilateral maxillary sinuses. VESSELS: No significant abnormality. CT TEMPORAL BONE: The mastoid air cells are clear bilaterally. There is mild superficial skin thickening and stranding surrounding the left postauricular soft tissues (image 19, series #302). No focal fluid collection. The middle and inner ear structures are normal in appearance bilaterally. There is no evidence of internal auditory canal enlargement, labyrinthine obliteration, or inflammatory changes or soft tissue masses within the middle ears. There is close approximation of the left semicircular canal with the arcuate eminence without definite evidence of dehiscence.
FINDINGS: BRAIN PARENCHYMA: No intraparenchymal hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. Cerebral cortical volume is appropriate for patient's age. No evidence for abnormal intracranial enhancement. EXTRA-AXIAL SPACES: No hemorrhage or abnormal enhancement evident at CT. VENTRICULAR SYSTEM: Normal. VESSELS: No significant vascular abnormality. SKULL AND SKULL BASE: No acute fracture. ORBITS: Normal. SINUSES: Minimal bilateral maxillary mucosal thickening also with small mucus retention cysts. MASTOIDS: Clear. SOFT TISSUES: Unremarkable.
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RADIOLOGIC EXAM: CT Cervical Spine wo contrast CLINICAL INFORMATION: MVC COMPARISON: None. TECHNIQUE: CT Cervical Spine wo contrastScan field of view: 158 mm. DLP: 784 mGy cm. Axial CT images of the cervical spine were obtained without IV contrast. Coronal and sagittal reformats were obtained. 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 (
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 (
FINDINGS: STRUCTURED REPORT: CTA CAP VASCULATURE: CORONARY ARTERIES: There are no atherosclerotic calcifications of the native coronary arteries. PULMONARY ARTERIES: No central pulmonary embolus. Normal size. ASCENDING THORACIC AORTA: Postsurgical changes of ascending aortic graft repair. No dissection. AORTIC ARCH: Postsurgical changes of the proximal hemiarch repair. No dissection. ARCH VESSELS: Patent. No dissection. DESCENDING THORACIC AORTA: Dissection flap is visualized just distal to the takeoff of the left subclavian artery. The true lumen is smaller than the false lumen in the distal descending thoracic aorta (image 98 series 501). Fenestration is present in the dissection flap in the descending thoracic aorta allowing for communication with the false lumen. The proximal descending thoracic aorta remains dilated/aneurysmal at 44 mm, unchanged from prior. ABDOMINAL AORTA: Dissection extends throughout the course of the abdominal aorta and terminates just distal to the take off of the bilateral renal arteries. CELIAC AXIS: Patent and arises from true lumen. SMA: Patent and arises from true lumen. RIGHT RENAL: Patent and arises from false lumen. Dissection flap partially extends into the proximal right renal artery. LEFT RENAL: Patent and arises from true lumen. IMA: No significant abnormality. RIGHT ILIAC / PROXIMAL FEMORAL ARTERIES: No significant abnormality. LEFT ILIAC / PROXIMAL FEMORAL ARTERIES: No significant abnormality. ------------------------------------------------------------- LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Similar small left pleural effusion with adjacent atelectasis. HEART / OTHER VESSELS: Similar cardiomegaly and small pericardial effusion. Reflux of contrast into the IVC and hepatic veins.. MEDIASTINUM / ESOPHAGUS: Redemonstration of periaortic gas and fluid collection, measuring 7.9 x 6.3 cm (image 62 series 501), previously 7.8 x 5.9 cm, grossly similar accounting for differences in technique. LYMPH NODES: There is mild upper anterior mediastinal lymphadenopathy and mild AP window and right paratracheal lymphadenopathy, unchanged. CHEST WALL: Poststernotomy changes. Persistent stranding anterior to the sternotomy wires without drainable fluid collection. Diffuse anasarca. Similar increased sternal separation at the level of the top two sternotomy wires. Erosive changes of the upper sternum are noted, most prominently at the sternal manubrium (for instance image 16 series 201). Small left breast nodule is unchanged. ABDOMEN and PELVIS: LIVER: Unremarkable for technique. BILIARY TRACT: Normal. GALLBLADDER: Dependent gallbladder sludge or microlithiasis. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: No hydronephrosis. Cyst in the right kidney is unchanged. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Diverticulosis without acute diverticulitis. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: Distended IVC. URINARY BLADDER: Underdistended. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Diffuse anasarca, worsened from prior. MUSCULOSKELETAL: Degenerative changes of thoracolumbar spine. There are sternotomy is ununited at the upper margin with some erosive changes, particularly at the manubrium. The mediastinal fluid collection abuts the sternotomy.
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RADIOLOGIC EXAM: CT Head wo contrast CLINICAL INFORMATION: MVC. COMPARISON: None. TECHNIQUE: CT Head wo contrastScan field of view: 250 mm. DLP: 1080 mGy cm. STRUCTURED REPORT: CT Head FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. No evidence of acute infarction. Normal cerebral cortical volume for patient's age. Cerebellar tonsillar ectopia. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. Bilateral mastoid air cells are clear. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Paranasal sinuses are clear. VESSELS: Normal noncontrast appearance of the vessels. CONCLUSION: No acute intracranial process. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. No evidence of acute infarction. Normal cerebral cortical volume for patient's age. Cerebellar tonsillar ectopia. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. Bilateral mastoid air cells are clear. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Paranasal sinuses are clear. VESSELS: Normal noncontrast appearance of the vessels.
FINDINGS: STRUCTURED REPORT: CTA CAP VASCULATURE: CORONARY ARTERIES: There are no atherosclerotic calcifications of the native coronary arteries. PULMONARY ARTERIES: No central pulmonary embolus. Normal size. ASCENDING THORACIC AORTA: Postsurgical changes of ascending aortic graft repair. No dissection. AORTIC ARCH: Postsurgical changes of the proximal hemiarch repair. No dissection. ARCH VESSELS: Patent. No dissection. DESCENDING THORACIC AORTA: Dissection flap is visualized just distal to the takeoff of the left subclavian artery. The true lumen is smaller than the false lumen in the distal descending thoracic aorta (image 98 series 501). Fenestration is present in the dissection flap in the descending thoracic aorta allowing for communication with the false lumen. The proximal descending thoracic aorta remains dilated/aneurysmal at 44 mm, unchanged from prior. ABDOMINAL AORTA: Dissection extends throughout the course of the abdominal aorta and terminates just distal to the take off of the bilateral renal arteries. CELIAC AXIS: Patent and arises from true lumen. SMA: Patent and arises from true lumen. RIGHT RENAL: Patent and arises from false lumen. Dissection flap partially extends into the proximal right renal artery. LEFT RENAL: Patent and arises from true lumen. IMA: No significant abnormality. RIGHT ILIAC / PROXIMAL FEMORAL ARTERIES: No significant abnormality. LEFT ILIAC / PROXIMAL FEMORAL ARTERIES: No significant abnormality. ------------------------------------------------------------- LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Similar small left pleural effusion with adjacent atelectasis. HEART / OTHER VESSELS: Similar cardiomegaly and small pericardial effusion. Reflux of contrast into the IVC and hepatic veins.. MEDIASTINUM / ESOPHAGUS: Redemonstration of periaortic gas and fluid collection, measuring 7.9 x 6.3 cm (image 62 series 501), previously 7.8 x 5.9 cm, grossly similar accounting for differences in technique. LYMPH NODES: There is mild upper anterior mediastinal lymphadenopathy and mild AP window and right paratracheal lymphadenopathy, unchanged. CHEST WALL: Poststernotomy changes. Persistent stranding anterior to the sternotomy wires without drainable fluid collection. Diffuse anasarca. Similar increased sternal separation at the level of the top two sternotomy wires. Erosive changes of the upper sternum are noted, most prominently at the sternal manubrium (for instance image 16 series 201). Small left breast nodule is unchanged. ABDOMEN and PELVIS: LIVER: Unremarkable for technique. BILIARY TRACT: Normal. GALLBLADDER: Dependent gallbladder sludge or microlithiasis. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: No hydronephrosis. Cyst in the right kidney is unchanged. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Diverticulosis without acute diverticulitis. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: Distended IVC. URINARY BLADDER: Underdistended. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Diffuse anasarca, worsened from prior. MUSCULOSKELETAL: Degenerative changes of thoracolumbar spine. There are sternotomy is ununited at the upper margin with some erosive changes, particularly at the manubrium. The mediastinal fluid collection abuts the sternotomy.
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EXAM: CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: Pelvic fluid collection, evaluate for rectovaginal fistula or abscess. COMPARISON: None available. TECHNIQUE: CT Abdomen and Pelvis w contrast. Patient weight: 225 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 80 sec Scan field of view: 436.90 mm. DLP: 1120.50 mGy cm. FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Scattered hypoattenuating lesions are too small to characterize, but are statistically likely to represent cysts. BILIARY TRACT: Normal. GALLBLADDER: Nondistended. Layering hyperattenuating material, which may represent vicarious excretion of contrast versus sludge. PANCREAS: Normal. SPLEEN: Normal size. Multiple splenic cysts. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Patent end-to-side rectosigmoid anastomosis. No significant abnormality in the remainder of the colon. The appendix is normal. PERITONEUM / MESENTERY: Small volume free fluid in the rectouterine pouch. RETROPERITONEUM: Normal. VESSELS: Duplicated IVC. URINARY BLADDER: Excreted contrast is noted in the urinary bladder. REPRODUCTIVE ORGANS: Thick-walled, enhancing distended tubular structure in the right adnexa with surrounding inflammatory stranding/edema and fluid in the rectouterine pouch. No significant abnormality in the uterus. No convincing evidence of rectovaginal fistula. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No aggressive osseous abnormality is identified. CONCLUSION: Thick-walled, enhancing dilated tubular structure in the right adnexa with surrounding inflammatory stranding and small volume of free fluid in the rectouterine pouch. Findings are concerning for pelvic inflammatory disease with pyosalpinx. No definite tubo-ovarian abscess is identified, although this could be further evaluated with pelvic ultrasound as clinically indicated. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Scattered hypoattenuating lesions are too small to characterize, but are statistically likely to represent cysts. BILIARY TRACT: Normal. GALLBLADDER: Nondistended. Layering hyperattenuating material, which may represent vicarious excretion of contrast versus sludge. PANCREAS: Normal. SPLEEN: Normal size. Multiple splenic cysts. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Patent end-to-side rectosigmoid anastomosis. No significant abnormality in the remainder of the colon. The appendix is normal. PERITONEUM / MESENTERY: Small volume free fluid in the rectouterine pouch. RETROPERITONEUM: Normal. VESSELS: Duplicated IVC. URINARY BLADDER: Excreted contrast is noted in the urinary bladder. REPRODUCTIVE ORGANS: Thick-walled, enhancing distended tubular structure in the right adnexa with surrounding inflammatory stranding/edema and fluid in the rectouterine pouch. No significant abnormality in the uterus. No convincing evidence of rectovaginal fistula. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No aggressive osseous abnormality is identified.
Findings: Brain parenchyma: Mild diffuse brain parenchymal volume loss is seen, resulting in mild exvacuo dilatation of the lateral ventricles. Scattered periventricular and subcortical white matter hypoattenuation is 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: Atherosclerotic calcifications of the bilateral carotid siphons and the vertebrobasilar axis. 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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EXAM: CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: Abdominal pain and constipation. History of multiple abdominal surgeries following GSW, including distal pancreatectomy, splenectomy, distal transverse and descending colectomy with end colostomy, and appendectomy. The appendix has been was notable for low-grade mucinous neoplasm. The patient subsequently underwent colostomy takedown 2/26/2021. COMPARISON: CT abdomen and pelvis with contrast 2/11/2021. TECHNIQUE: CT Abdomen and Pelvis w contrast. Patient weight: 150 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: 346.20 mm. DLP: 430 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: Postsurgical changes from distal pancreatectomy. No significant abnormality in the remaining pancreatic parenchyma. SPLEEN: Surgically absent. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No significant abnormality. No evidence of small bowel obstruction. COLON / APPENDIX: Postsurgical changes from partial left colectomy with patent colocolonic anastomosis in the left upper quadrant. The appendix is surgically absent. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Postsurgical changes in the right upper quadrant ventral abdominal wall from prior ostomy site. Otherwise, no significant abnormality. MUSCULOSKELETAL: No aggressive osseous abnormality is identified. CONCLUSION: No acute abdominopelvic abnormality. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
FINDINGS: 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: Postsurgical changes from distal pancreatectomy. No significant abnormality in the remaining pancreatic parenchyma. SPLEEN: Surgically absent. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No significant abnormality. No evidence of small bowel obstruction. COLON / APPENDIX: Postsurgical changes from partial left colectomy with patent colocolonic anastomosis in the left upper quadrant. The appendix is surgically absent. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Postsurgical changes in the right upper quadrant ventral abdominal wall from prior ostomy site. Otherwise, no significant abnormality. MUSCULOSKELETAL: No aggressive osseous abnormality is identified.
FINDINGS: LOWER NECK: Enlarged, heterogeneous thyroid, with largest hypoattenuating lesion measuring 1.1 cm in the left lobe (series 501 image 63). CHEST: LUNGS / AIRWAYS / PLEURA: Small left hemopneumothorax. Mild paraseptal emphysema. Bibasilar atelectasis. HEART / VESSELS: Mild calcified atherosclerosis including three-vessel coronary atherosclerosis. There is a ascending aortic ectasia measuring 4.3 cm MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: Displaced left lateral seventh through 10th rib fractures, with additional displaced posterior fracture of the 10th rib. ABDOMEN and PELVIS: LIVER: Diffuse focal fat along the falciform. Steatosis. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Scattered parenchymal calcifications compatible with chronic calcific pancreatitis. No acute pancreatitis is seen. There is perhaps slightly dilated biliary duct dilatation in the pancreatic tail. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Punctate right nonobstructive nephrolithiasis. No acute injury. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Diverticulosis. Appendix is absent. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Severe mixed atherosclerosis. Fusiform infrarenal aortic aneurysm measuring 3.2 x 2.8 cm (series 501 image 366). URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Prostatomegaly. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No additional fracture or dislocation. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. Moderate degenerative changes. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. Moderate degenerative changes. ALIGNMENT: Mild levocurvature, likely positional.
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EXAM: CT Femur Left with contrast CLINICAL INFORMATION: History of left above knee amputation with dehiscence and hematoma at the lateral aspect of the amputation site. COMPARISON: Bilateral femurs CT 12/15/2021 TECHNIQUE: CT Femur Left with contrast Patient weight: 300 lbs. IV contrast: Omnipaque 350, 100 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 180 sec Scan field of view: 358 mm. DLP: 2528.20 mGy cm. STRUCTURED REPORT: CT Bone vDec2021 FINDINGS: BONES/JOINTS: Postsurgical changes from left above knee amputation with reactive bone formation at the distal femur. Mild degenerative changes of the left femoroacetabular joint. No acute fracture or malalignment. SOFT TISSUES: Postsurgical changes from left above knee amputation with skin thickening and edema at the distal left AKA stump. Soft tissue defect consistent with dehiscence of the stump incision. Poorly organized fluid collection measuring 11.3 x 3.4 cm (series 202, image 831) in the soft tissues abutting and just distal to the femoral resection site with locules of gas and areas of peripheral enhancement. Surrounding fat stranding. The femoral vessels are ligated in the distal thigh. Left inguinal lymphadenopathy, likely reactive. Small fat-containing left inguinal hernia. CONCLUSION: 1. Postsurgical changes from above-knee amputation with dehiscence of the distal thigh incision. 2. Poorly organized gas and fluid collection within the soft tissues of the distal left thigh at and distal to the femoral resection site concerning for developing abscess. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
FINDINGS: BONES/JOINTS: Postsurgical changes from left above knee amputation with reactive bone formation at the distal femur. Mild degenerative changes of the left femoroacetabular joint. No acute fracture or malalignment. SOFT TISSUES: Postsurgical changes from left above knee amputation with skin thickening and edema at the distal left AKA stump. Soft tissue defect consistent with dehiscence of the stump incision. Poorly organized fluid collection measuring 11.3 x 3.4 cm (series 202, image 831) in the soft tissues abutting and just distal to the femoral resection site with locules of gas and areas of peripheral enhancement. Surrounding fat stranding. The femoral vessels are ligated in the distal thigh. Left inguinal lymphadenopathy, likely reactive. Small fat-containing left inguinal hernia.
FINDINGS: LOWER NECK: Enlarged, heterogeneous thyroid, with largest hypoattenuating lesion measuring 1.1 cm in the left lobe (series 501 image 63). CHEST: LUNGS / AIRWAYS / PLEURA: Small left hemopneumothorax. Mild paraseptal emphysema. Bibasilar atelectasis. HEART / VESSELS: Mild calcified atherosclerosis including three-vessel coronary atherosclerosis. There is a ascending aortic ectasia measuring 4.3 cm MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: Displaced left lateral seventh through 10th rib fractures, with additional displaced posterior fracture of the 10th rib. ABDOMEN and PELVIS: LIVER: Diffuse focal fat along the falciform. Steatosis. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Scattered parenchymal calcifications compatible with chronic calcific pancreatitis. No acute pancreatitis is seen. There is perhaps slightly dilated biliary duct dilatation in the pancreatic tail. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Punctate right nonobstructive nephrolithiasis. No acute injury. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Diverticulosis. Appendix is absent. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Severe mixed atherosclerosis. Fusiform infrarenal aortic aneurysm measuring 3.2 x 2.8 cm (series 501 image 366). URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Prostatomegaly. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No additional fracture or dislocation. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. Moderate degenerative changes. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. Moderate degenerative changes. ALIGNMENT: Mild levocurvature, likely positional.
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EXAM: CT Angio Lower Ext Left wo+w contrast CLINICAL INFORMATION: Concern for osteomyelitis versus necrotizing fasciitis. COMPARISON: Left foot radiographs on 1/7/2022, US lower extremity 1/8/2022. TECHNIQUE: CT Angio Lower Ext Left wo+w contrast. Additional 3D image post-processing was performed to generate MIP and/or volume-rendered images. Patient weight: 102 lbs. IV contrast: Omnipaque 350, 80 ml, per protocol. Saline flush: 75 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracking Scan field of view: 293 mm. DLP: 813.20 mGy cm. FINDINGS: STRUCTURED REPORT: CTA Lower Extremities VASCULATURE: ABDOMINAL AORTA: Moderate atherosclerosis of the infrarenal abdominal aorta. LEFT ILIAC ARTERIES: Patent without significant stenosis. Scattered mild calcified atherosclerosis of the common, internal, and external iliac arteries. LEFT FEMORAL \T\ POPLITEAL ARTERIES: Patent through the popliteal artery. Moderate calcified atherosclerosis without significant stenosis. LEFT TIBIAL AND PERONEAL ARTERIES: Multifocal irregular narrowing of the anterior tibial, posterior tibial, and peroneal arteries secondary to severe calcified atherosclerosis. Overall patency is difficult to assess given extensive calcification. However, the anterior and posterior tibial arteries appear to be opacified at the ankle. The peroneal artery is occluded at the ankle, but reconstitutes distally. LEFT FOOT ARTERIES: The dorsalis pedis artery appears patent but is narrowed proximally. Plantar arteries appear patent. ------------------------------------------------------------- LOWER ABDOMEN: BOWEL: No abnormality. PERITONEUM: Normal. OTHER: Left pelvic transplant kidney is present without significant abnormality. PELVIS: OTHER VESSELS: No significant abnormality. LYMPH NODES: None enlarged. PERIRECTAL / PERIANAL REGION: Normal as visualized. URINARY BLADDER: Normal as visualized. REPRODUCTIVE ORGANS: Uterus is present. No left adnexal mass. BODY WALL: Diffuse body wall anasarca. MUSCULOSKELETAL: There is gas in the plantar surface of the left foot, predominantly at the level of the great toe. There is a diffuse edema involving the left foot soft tissues. Redemonstrated erosive changes and periosteal reaction involving the great toe distal phalanx consistent with acute osteomyelitis. Heterotopic ossification and surgical clips are present in the left medial soft tissues at the level of the knee. CONCLUSION: 1. Extensive lower extremity atherosclerosis/Monckeberg calcification as above with thready two-vessel runoff to the left ankle. The peroneal artery is occluded at the ankle, but reconstitutes distally. 2. Acute osteomyelitis of the left great toe distal phalanx. 3. Gas and edema in the plantar surface of the left foot underlying the great toe could feasibly reflect necrotizing infection. COMMUNICATION: Stephanie Colvin, MD communicated preliminary findings by phone with Dr. Choudry on 1/8/2022 4:37 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.
FINDINGS: STRUCTURED REPORT: CTA Lower Extremities VASCULATURE: ABDOMINAL AORTA: Moderate atherosclerosis of the infrarenal abdominal aorta. LEFT ILIAC ARTERIES: Patent without significant stenosis. Scattered mild calcified atherosclerosis of the common, internal, and external iliac arteries. LEFT FEMORAL \T\ POPLITEAL ARTERIES: Patent through the popliteal artery. Moderate calcified atherosclerosis without significant stenosis. LEFT TIBIAL AND PERONEAL ARTERIES: Multifocal irregular narrowing of the anterior tibial, posterior tibial, and peroneal arteries secondary to severe calcified atherosclerosis. Overall patency is difficult to assess given extensive calcification. However, the anterior and posterior tibial arteries appear to be opacified at the ankle. The peroneal artery is occluded at the ankle, but reconstitutes distally. LEFT FOOT ARTERIES: The dorsalis pedis artery appears patent but is narrowed proximally. Plantar arteries appear patent. ------------------------------------------------------------- LOWER ABDOMEN: BOWEL: No abnormality. PERITONEUM: Normal. OTHER: Left pelvic transplant kidney is present without significant abnormality. PELVIS: OTHER VESSELS: No significant abnormality. LYMPH NODES: None enlarged. PERIRECTAL / PERIANAL REGION: Normal as visualized. URINARY BLADDER: Normal as visualized. REPRODUCTIVE ORGANS: Uterus is present. No left adnexal mass. BODY WALL: Diffuse body wall anasarca. MUSCULOSKELETAL: There is gas in the plantar surface of the left foot, predominantly at the level of the great toe. There is a diffuse edema involving the left foot soft tissues. Redemonstrated erosive changes and periosteal reaction involving the great toe distal phalanx consistent with acute osteomyelitis. Heterotopic ossification and surgical clips are present in the left medial soft tissues at the level of the knee.
Findings: The sagittal images demonstrate preservation of the cervical lordosis, with subtle grade 1 anterolisthesis of C4 on C5. The vertebral bodies maintain normal height, without acute fractures or suspicious osseous lesions. Multilevel intervertebral disc space loss, end plate sclerosis and osteophytosis, moderate at C6-C7, mild at C3-C4. Predental space obliteration and spurring. The craniocervical junction appears unremarkable. Multilevel discogenic complexes, uncovertebral and facet hypertrophy, resulting in severe left C3-C4/right C4-C5, and moderate right C3-C4 neuroforaminal narrowing, with associated moderate C3-C4 spinal canal stenosis. The prevertebral and paraspinal soft tissues appear normal. Partially visualized multinodular goiter.
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EXAM: CT Angio Upper Ext Right wo+w contrast CLINICAL INFORMATION: Right hand and wrist pain, concern for arterial stenosis or occlusion. COMPARISON: None. TECHNIQUE: CT Angio Upper Ext Right wo+w contrast. Additional 3D image post-processing was performed to generate MIP and/or volume-rendered images. Patient weight: 290 lbs. Saline flush: 75 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracking Scan field of view: 378 mm. DLP: 783.80 mGy cm. FINDINGS: STRUCTURED REPORT: CTA Upper Extremity FINDINGS: VASCULATURE: AORTIC ARCH: No significant abnormality in the visualized aortic arch. PROXIMAL ASPECT OF ARCH VESSELS: No significant abnormality. RIGHT SUBCLAVIAN ARTERY: No significant abnormality. RIGHT AXILLARY ARTERY: No significant abnormality. RIGHT BRACHIAL ARTERY: No significant abnormality. RIGHT RADIAL ARTERY: Suboptimal opacification secondary to contrast bolus timing. RIGHT ULNAR ARTERY: Suboptimal opacification secondary to contrast bolus timing. RIGHT HAND ARTERIES: Suboptimal opacification secondary to contrast bolus timing. OTHER VASCULATURE: No significant abnormality. PARTIALLY IMAGED HEAD AND NECK: No abnormality. PARTIALLY IMAGED CHEST: No abnormality. SUPERFICIAL SOFT TISSUES: No abnormality. MUSCULOSKELETAL: No aggressive osseous abnormality is identified. Degenerative changes at the right elbow joint and scattered about the right wrist. Mild soft tissue swelling/edema about the wrist. CONCLUSION: 1. No hemodynamically significant stenosis in the proximal right upper extremity arterial vasculature. Limited evaluation of the arterial vasculature of the right forearm and hand secondary to contrast bolus timing. 2. Mild soft tissue swelling/edema about the right wrist without acute displaced fracture identified. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
FINDINGS: STRUCTURED REPORT: CTA Upper Extremity FINDINGS: VASCULATURE: AORTIC ARCH: No significant abnormality in the visualized aortic arch. PROXIMAL ASPECT OF ARCH VESSELS: No significant abnormality. RIGHT SUBCLAVIAN ARTERY: No significant abnormality. RIGHT AXILLARY ARTERY: No significant abnormality. RIGHT BRACHIAL ARTERY: No significant abnormality. RIGHT RADIAL ARTERY: Suboptimal opacification secondary to contrast bolus timing. RIGHT ULNAR ARTERY: Suboptimal opacification secondary to contrast bolus timing. RIGHT HAND ARTERIES: Suboptimal opacification secondary to contrast bolus timing. OTHER VASCULATURE: No significant abnormality. PARTIALLY IMAGED HEAD AND NECK: No abnormality. PARTIALLY IMAGED CHEST: No abnormality. SUPERFICIAL SOFT TISSUES: No abnormality. MUSCULOSKELETAL: No aggressive osseous abnormality is identified. Degenerative changes at the right elbow joint and scattered about the right wrist. Mild soft tissue swelling/edema about the wrist.
FINDINGS: LOWER NECK: Enlarged, heterogeneous thyroid, with largest hypoattenuating lesion measuring 1.1 cm in the left lobe (series 501 image 63). CHEST: LUNGS / AIRWAYS / PLEURA: Small left hemopneumothorax. Mild paraseptal emphysema. Bibasilar atelectasis. HEART / VESSELS: Mild calcified atherosclerosis including three-vessel coronary atherosclerosis. There is a ascending aortic ectasia measuring 4.3 cm MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: Displaced left lateral seventh through 10th rib fractures, with additional displaced posterior fracture of the 10th rib. ABDOMEN and PELVIS: LIVER: Diffuse focal fat along the falciform. Steatosis. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Scattered parenchymal calcifications compatible with chronic calcific pancreatitis. No acute pancreatitis is seen. There is perhaps slightly dilated biliary duct dilatation in the pancreatic tail. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Punctate right nonobstructive nephrolithiasis. No acute injury. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Diverticulosis. Appendix is absent. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Severe mixed atherosclerosis. Fusiform infrarenal aortic aneurysm measuring 3.2 x 2.8 cm (series 501 image 366). URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Prostatomegaly. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No additional fracture or dislocation. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. Moderate degenerative changes. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. Moderate degenerative changes. ALIGNMENT: Mild levocurvature, likely positional.
3,494
EXAM: CT Bone Pelvis w soft tissue no charge CLINICAL INFORMATION: Trauma. COMPARISON: Earlier same day radiograph. TECHNIQUE: CT Bone Pelvis w soft tissue no charge Scan field of view: 380 mm. FINDINGS: BONES/JOINTS: Comminuted basicervical femoral neck fracture with extension to the greater trochanter. The left hip is intact with mild degenerative changes. No pubic symphysis diastasis or SI joint widening. SOFT TISSUES: No large hematoma or fluid collection. Please see separately dictated and concurrently obtained CT chest abdomen and pelvis for intra-abdominal findings. CONCLUSION: 1. Comminuted basicervical femoral neck fracture with extension to the greater trochanter. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
FINDINGS: BONES/JOINTS: Comminuted basicervical femoral neck fracture with extension to the greater trochanter. The left hip is intact with mild degenerative changes. No pubic symphysis diastasis or SI joint widening. SOFT TISSUES: No large hematoma or fluid collection. Please see separately dictated and concurrently obtained CT chest abdomen and pelvis for intra-abdominal findings.
FINDINGS: LOWER NECK: Enlarged, heterogeneous thyroid, with largest hypoattenuating lesion measuring 1.1 cm in the left lobe (series 501 image 63). CHEST: LUNGS / AIRWAYS / PLEURA: Small left hemopneumothorax. Mild paraseptal emphysema. Bibasilar atelectasis. HEART / VESSELS: Mild calcified atherosclerosis including three-vessel coronary atherosclerosis. There is a ascending aortic ectasia measuring 4.3 cm MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: Displaced left lateral seventh through 10th rib fractures, with additional displaced posterior fracture of the 10th rib. ABDOMEN and PELVIS: LIVER: Diffuse focal fat along the falciform. Steatosis. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Scattered parenchymal calcifications compatible with chronic calcific pancreatitis. No acute pancreatitis is seen. There is perhaps slightly dilated biliary duct dilatation in the pancreatic tail. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Punctate right nonobstructive nephrolithiasis. No acute injury. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Diverticulosis. Appendix is absent. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Severe mixed atherosclerosis. Fusiform infrarenal aortic aneurysm measuring 3.2 x 2.8 cm (series 501 image 366). URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Prostatomegaly. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No additional fracture or dislocation. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. Moderate degenerative changes. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. Moderate degenerative changes. ALIGNMENT: Mild levocurvature, likely positional.
3,495
RADIOLOGIC EXAM: CT Head wo contrast, CT Maxillofacial wo contrast CLINICAL INFORMATION: Trauma COMPARISON: Multiple prior CT heads, most recently 3/3/2021. TECHNIQUE: CT Head wo contrast, CT Maxillofacial wo contrastScan field of view: 243.60 mm. DLP: 1444.10 mGy cm. (accession CT220004150), Scan field of view: 198.20 mm. DLP: 1155.80 mGy cm. (accession CT220004156) STRUCTURED REPORT: CT Head and Maxillofacial Trauma FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. Periventricular white matter hypoattenuation consistent with chronic microangiopathic changes. Progressive encephalomalacia in the right occipital lobe, likely from prior infarct. Mild diffuse parenchymal volume loss. EXTRA-AXIAL SPACES: Normal. VENTRICULAR SYSTEM: Ex vacuo dilatation, predominantly involving the right occipital horn in the region of encephalomalacia. ORBITS: Large right periorbital hematoma. No retrobulbar hemorrhage. Bilateral pseudophakia. SKULL AND SKULL BASE: No fracture. Trace left mastoid air cell effusion. Large right frontal scalp hematoma. FACIAL BONES: No fracture. Bilateral pterygoid plates are intact. MANDIBLE: No fracture. Bilateral temporomandibular joints are intact. SINONASAL CAVITIES: Paranasal sinuses are clear. CONCLUSION: 1. No acute intracranial process or maxillofacial fracture. 2. Large right frontal scalp and periorbital hematoma. 3. Other chronic and incidental findings as above. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. Periventricular white matter hypoattenuation consistent with chronic microangiopathic changes. Progressive encephalomalacia in the right occipital lobe, likely from prior infarct. Mild diffuse parenchymal volume loss. EXTRA-AXIAL SPACES: Normal. VENTRICULAR SYSTEM: Ex vacuo dilatation, predominantly involving the right occipital horn in the region of encephalomalacia. ORBITS: Large right periorbital hematoma. No retrobulbar hemorrhage. Bilateral pseudophakia. SKULL AND SKULL BASE: No fracture. Trace left mastoid air cell effusion. Large right frontal scalp hematoma. FACIAL BONES: No fracture. Bilateral pterygoid plates are intact. MANDIBLE: No fracture. Bilateral temporomandibular joints are intact. SINONASAL CAVITIES: Paranasal sinuses are clear.
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: Incidental left scleral banding. 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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EXAM: CT Chest with contrast, CT Abdomen and Pelvis w contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat CLINICAL INFORMATION: Trauma. COMPARISON: CT chest without contrast 6/22/2020, CT abdomen pelvis with bilateral lower external ear of 11/1/2021. TECHNIQUE: CT Chest with contrast, CT Abdomen and Pelvis w contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat. Patient weight: 140 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 70 sec Scan field of view: 415.40 mm. DLP: 660.50 mGy cm. (accession CT220004151), Patient weight: 140 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 70 sec Scan field of view: 415.40 mm. (accession CT220004152), Patient weight: 140 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 70 sec Scan field of view: 415.40 mm. DLP: 660.50 mGy cm. (accession CT220004155), Patient weight: 140 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 70 sec Scan field of view: 415.40 mm. DLP: 660.50 mGy cm. (accession CT220004154) FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Hypoattenuating 2 mm nodule in the right thyroid lobe. CHEST: LUNGS / AIRWAYS / PLEURA: The central tracheobronchial tree is patent. Dependent atelectatic changes. No pleural effusions or pneumothorax. HEART / VESSELS: Mild four-chamber cardiomegaly. Dense mitral annular calcifications. Advanced calcific atherosclerosis in the coronary arteries. Mild dilatation the main pulmonary artery, measuring 32 mm in diameter. The thoracic aorta is normal in caliber. Thrombosed right upper extremity HeRO graft with its tip terminating at the superior cavoatrial junction. Small amount of thrombus adherent to the graft tip. Left external jugular vein approach tunneled vascular catheter with its tip terminating at the superior cavoatrial junction. Short segment of nonocclusive thrombus in the left external jugular vein cranial to the vascular catheter. Irregular eccentric filling defects in the right atrium (series 501, images 149 and 73). Partially visualized left upper extremity vascular graft. MEDIASTINUM / ESOPHAGUS: The esophagus is diffusely distended with gas. Circumferential thickening of the distal thoracic esophageal wall, likely related to reflux esophagitis. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Cirrhotic morphology. Focal fatty infiltration along the falciform. Slightly mottled enhancement, likely representing congestive hepatopathy in the setting of cardiomegaly. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Unchanged mild prominence of the ventral and dorsal pancreatic ducts with smooth tapering distally. No focal enhancing lesion within the limitations of single phase technique. ADRENALS: Normal. KIDNEYS: Symmetric atrophy and enhancement. Scattered hypoattenuating lesions in both kidneys are too small to characterize, but are statistically likely to represent cysts. Similar appearance of the right lower pole hyperdense cyst. No radiopaque nephrolithiasis. No hydroureteronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Moderate-sized hiatal hernia. COLON / APPENDIX: Colonic diverticulosis. The appendix is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Mild presacral stranding/edema. VESSELS: Advanced aortoiliac calcific atherosclerosis. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus is surgically absent. BODY WALL: Mild body wall edema. Unchanged small fluid containing left inguinal hernia. MUSCULOSKELETAL: Osseous mineralization is diffusely decreased. Comminuted fracture through the medial right clavicle without extension into the sternoclavicular joint. Chondrocalcinosis involving the pubic symphysis. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No spondylolisthesis. LUMBAR SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. Advanced multilevel discogenic degenerative changes. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No spondylolisthesis. CONCLUSION: 1. Comminuted fracture through the medial aspect of the right clavicle without extension into the sternoclavicular joint. 2. No acute traumatic abnormality in the abdomen or pelvis. No acute fracture or subluxation in the thoracolumbar spine. 3. Chronically occluded right upper extremity hero graft with its wall thrombus adherent to the catheter tip. Additional eccentric filling defects in the right atrium may represent small intracardiac thrombi, less likely to be related to a prominent crista terminalis. Additional small nonocclusive thrombus in the left external jugular vein associated with a left chest tunneled dialysis catheter. Note: Preliminary findings were discussed with Dr. Miller by Dr. Cook at 1/8/2022 6:42 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.
FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Hypoattenuating 2 mm nodule in the right thyroid lobe. CHEST: LUNGS / AIRWAYS / PLEURA: The central tracheobronchial tree is patent. Dependent atelectatic changes. No pleural effusions or pneumothorax. HEART / VESSELS: Mild four-chamber cardiomegaly. Dense mitral annular calcifications. Advanced calcific atherosclerosis in the coronary arteries. Mild dilatation the main pulmonary artery, measuring 32 mm in diameter. The thoracic aorta is normal in caliber. Thrombosed right upper extremity HeRO graft with its tip terminating at the superior cavoatrial junction. Small amount of thrombus adherent to the graft tip. Left external jugular vein approach tunneled vascular catheter with its tip terminating at the superior cavoatrial junction. Short segment of nonocclusive thrombus in the left external jugular vein cranial to the vascular catheter. Irregular eccentric filling defects in the right atrium (series 501, images 149 and 73). Partially visualized left upper extremity vascular graft. MEDIASTINUM / ESOPHAGUS: The esophagus is diffusely distended with gas. Circumferential thickening of the distal thoracic esophageal wall, likely related to reflux esophagitis. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Cirrhotic morphology. Focal fatty infiltration along the falciform. Slightly mottled enhancement, likely representing congestive hepatopathy in the setting of cardiomegaly. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Unchanged mild prominence of the ventral and dorsal pancreatic ducts with smooth tapering distally. No focal enhancing lesion within the limitations of single phase technique. ADRENALS: Normal. KIDNEYS: Symmetric atrophy and enhancement. Scattered hypoattenuating lesions in both kidneys are too small to characterize, but are statistically likely to represent cysts. Similar appearance of the right lower pole hyperdense cyst. No radiopaque nephrolithiasis. No hydroureteronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Moderate-sized hiatal hernia. COLON / APPENDIX: Colonic diverticulosis. The appendix is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Mild presacral stranding/edema. VESSELS: Advanced aortoiliac calcific atherosclerosis. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus is surgically absent. BODY WALL: Mild body wall edema. Unchanged small fluid containing left inguinal hernia. MUSCULOSKELETAL: Osseous mineralization is diffusely decreased. Comminuted fracture through the medial right clavicle without extension into the sternoclavicular joint. Chondrocalcinosis involving the pubic symphysis. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No spondylolisthesis. LUMBAR SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. Advanced multilevel discogenic degenerative changes. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No spondylolisthesis.
FINDINGS: VASCULAR FINDINGS: Aortic arch: Patent with no hemodynamically significant stenosis. Three normal vessel aortic arch is noted, with scattered nonflow limiting atherosclerotic calcifications. Common/Internal carotid arteries: Dense atherosclerotic calcifications involving the bilateral carotid bifurcations, resulting in short segment high-grade stenoses of the respective proximal ICAs. Otherwise, remain patent with no hemodynamically significant stenosis. Short retropharyngeal course of the right internal carotid artery. Vertebral arteries: Dominant left vertebral artery. Punctate atherosclerotic calcification at the origin of the right vertebral artery, resulting in moderate focal luminal narrowing. Otherwise, remain 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 diffusely enlarged and heterogeneous in appearance, with multiple internal hypodense nodules and scattered calcifications, suggestive of multinodular goiter.
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EXAM: CT Chest with contrast, CT Abdomen and Pelvis w contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat CLINICAL INFORMATION: Trauma. COMPARISON: CT chest without contrast 6/22/2020, CT abdomen pelvis with bilateral lower external ear of 11/1/2021. TECHNIQUE: CT Chest with contrast, CT Abdomen and Pelvis w contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat. Patient weight: 140 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 70 sec Scan field of view: 415.40 mm. DLP: 660.50 mGy cm. (accession CT220004151), Patient weight: 140 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 70 sec Scan field of view: 415.40 mm. (accession CT220004152), Patient weight: 140 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 70 sec Scan field of view: 415.40 mm. DLP: 660.50 mGy cm. (accession CT220004155), Patient weight: 140 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 70 sec Scan field of view: 415.40 mm. DLP: 660.50 mGy cm. (accession CT220004154) FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Hypoattenuating 2 mm nodule in the right thyroid lobe. CHEST: LUNGS / AIRWAYS / PLEURA: The central tracheobronchial tree is patent. Dependent atelectatic changes. No pleural effusions or pneumothorax. HEART / VESSELS: Mild four-chamber cardiomegaly. Dense mitral annular calcifications. Advanced calcific atherosclerosis in the coronary arteries. Mild dilatation the main pulmonary artery, measuring 32 mm in diameter. The thoracic aorta is normal in caliber. Thrombosed right upper extremity HeRO graft with its tip terminating at the superior cavoatrial junction. Small amount of thrombus adherent to the graft tip. Left external jugular vein approach tunneled vascular catheter with its tip terminating at the superior cavoatrial junction. Short segment of nonocclusive thrombus in the left external jugular vein cranial to the vascular catheter. Irregular eccentric filling defects in the right atrium (series 501, images 149 and 73). Partially visualized left upper extremity vascular graft. MEDIASTINUM / ESOPHAGUS: The esophagus is diffusely distended with gas. Circumferential thickening of the distal thoracic esophageal wall, likely related to reflux esophagitis. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Cirrhotic morphology. Focal fatty infiltration along the falciform. Slightly mottled enhancement, likely representing congestive hepatopathy in the setting of cardiomegaly. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Unchanged mild prominence of the ventral and dorsal pancreatic ducts with smooth tapering distally. No focal enhancing lesion within the limitations of single phase technique. ADRENALS: Normal. KIDNEYS: Symmetric atrophy and enhancement. Scattered hypoattenuating lesions in both kidneys are too small to characterize, but are statistically likely to represent cysts. Similar appearance of the right lower pole hyperdense cyst. No radiopaque nephrolithiasis. No hydroureteronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Moderate-sized hiatal hernia. COLON / APPENDIX: Colonic diverticulosis. The appendix is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Mild presacral stranding/edema. VESSELS: Advanced aortoiliac calcific atherosclerosis. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus is surgically absent. BODY WALL: Mild body wall edema. Unchanged small fluid containing left inguinal hernia. MUSCULOSKELETAL: Osseous mineralization is diffusely decreased. Comminuted fracture through the medial right clavicle without extension into the sternoclavicular joint. Chondrocalcinosis involving the pubic symphysis. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No spondylolisthesis. LUMBAR SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. Advanced multilevel discogenic degenerative changes. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No spondylolisthesis. CONCLUSION: 1. Comminuted fracture through the medial aspect of the right clavicle without extension into the sternoclavicular joint. 2. No acute traumatic abnormality in the abdomen or pelvis. No acute fracture or subluxation in the thoracolumbar spine. 3. Chronically occluded right upper extremity hero graft with its wall thrombus adherent to the catheter tip. Additional eccentric filling defects in the right atrium may represent small intracardiac thrombi, less likely to be related to a prominent crista terminalis. Additional small nonocclusive thrombus in the left external jugular vein associated with a left chest tunneled dialysis catheter. Note: Preliminary findings were discussed with Dr. Miller by Dr. Cook at 1/8/2022 6:42 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.
FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Hypoattenuating 2 mm nodule in the right thyroid lobe. CHEST: LUNGS / AIRWAYS / PLEURA: The central tracheobronchial tree is patent. Dependent atelectatic changes. No pleural effusions or pneumothorax. HEART / VESSELS: Mild four-chamber cardiomegaly. Dense mitral annular calcifications. Advanced calcific atherosclerosis in the coronary arteries. Mild dilatation the main pulmonary artery, measuring 32 mm in diameter. The thoracic aorta is normal in caliber. Thrombosed right upper extremity HeRO graft with its tip terminating at the superior cavoatrial junction. Small amount of thrombus adherent to the graft tip. Left external jugular vein approach tunneled vascular catheter with its tip terminating at the superior cavoatrial junction. Short segment of nonocclusive thrombus in the left external jugular vein cranial to the vascular catheter. Irregular eccentric filling defects in the right atrium (series 501, images 149 and 73). Partially visualized left upper extremity vascular graft. MEDIASTINUM / ESOPHAGUS: The esophagus is diffusely distended with gas. Circumferential thickening of the distal thoracic esophageal wall, likely related to reflux esophagitis. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Cirrhotic morphology. Focal fatty infiltration along the falciform. Slightly mottled enhancement, likely representing congestive hepatopathy in the setting of cardiomegaly. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Unchanged mild prominence of the ventral and dorsal pancreatic ducts with smooth tapering distally. No focal enhancing lesion within the limitations of single phase technique. ADRENALS: Normal. KIDNEYS: Symmetric atrophy and enhancement. Scattered hypoattenuating lesions in both kidneys are too small to characterize, but are statistically likely to represent cysts. Similar appearance of the right lower pole hyperdense cyst. No radiopaque nephrolithiasis. No hydroureteronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Moderate-sized hiatal hernia. COLON / APPENDIX: Colonic diverticulosis. The appendix is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Mild presacral stranding/edema. VESSELS: Advanced aortoiliac calcific atherosclerosis. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus is surgically absent. BODY WALL: Mild body wall edema. Unchanged small fluid containing left inguinal hernia. MUSCULOSKELETAL: Osseous mineralization is diffusely decreased. Comminuted fracture through the medial right clavicle without extension into the sternoclavicular joint. Chondrocalcinosis involving the pubic symphysis. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No spondylolisthesis. LUMBAR SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. Advanced multilevel discogenic degenerative changes. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No spondylolisthesis.
FINDINGS/IMPRESSION: 1. No localizing history provided. No acute osseous finding. Slight asymmetrical widening of the lateral aspect of the tibiotalar joint may be due to sequela of sequela of remote injury. 2. Bipartite accessory navicular. Chronic posttraumatic ossifications, adjacent to the medial malleolus and lateral talus. 3. Bimalleolar soft tissue swelling.
3,498
RADIOLOGIC EXAM: CT Angio Neck, CT Cervical Spine From Reformat CLINICAL INFORMATION: Trauma. COMPARISON: CT neck 3/3/2021. TECHNIQUE: CT Angio Neck, CT Cervical Spine From ReformatPatient weight: 140 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: 246.90 mm. DLP: 935.90 mGy cm. Following CT of the neck, reformatted images were produced to optimize visualization of the osseous structures of the cervical spine. 3-D CT MIP were generated in post processing. FINDINGS: CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
FINDINGS: CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
FINDINGS/IMPRESSION: 1. No localizing history provided. No acute osseous finding. Slight asymmetrical widening of the lateral aspect of the tibiotalar joint may be due to sequela of sequela of remote injury. 2. Bipartite accessory navicular. Chronic posttraumatic ossifications, adjacent to the medial malleolus and lateral talus. 3. Bimalleolar soft tissue swelling.
3,499
EXAM: CT Chest with contrast, CT Abdomen and Pelvis w contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat CLINICAL INFORMATION: Trauma. COMPARISON: CT chest without contrast 6/22/2020, CT abdomen pelvis with bilateral lower external ear of 11/1/2021. TECHNIQUE: CT Chest with contrast, CT Abdomen and Pelvis w contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat. Patient weight: 140 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 70 sec Scan field of view: 415.40 mm. DLP: 660.50 mGy cm. (accession CT220004151), Patient weight: 140 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 70 sec Scan field of view: 415.40 mm. (accession CT220004152), Patient weight: 140 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 70 sec Scan field of view: 415.40 mm. DLP: 660.50 mGy cm. (accession CT220004155), Patient weight: 140 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 70 sec Scan field of view: 415.40 mm. DLP: 660.50 mGy cm. (accession CT220004154) FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Hypoattenuating 2 mm nodule in the right thyroid lobe. CHEST: LUNGS / AIRWAYS / PLEURA: The central tracheobronchial tree is patent. Dependent atelectatic changes. No pleural effusions or pneumothorax. HEART / VESSELS: Mild four-chamber cardiomegaly. Dense mitral annular calcifications. Advanced calcific atherosclerosis in the coronary arteries. Mild dilatation the main pulmonary artery, measuring 32 mm in diameter. The thoracic aorta is normal in caliber. Thrombosed right upper extremity HeRO graft with its tip terminating at the superior cavoatrial junction. Small amount of thrombus adherent to the graft tip. Left external jugular vein approach tunneled vascular catheter with its tip terminating at the superior cavoatrial junction. Short segment of nonocclusive thrombus in the left external jugular vein cranial to the vascular catheter. Irregular eccentric filling defects in the right atrium (series 501, images 149 and 73). Partially visualized left upper extremity vascular graft. MEDIASTINUM / ESOPHAGUS: The esophagus is diffusely distended with gas. Circumferential thickening of the distal thoracic esophageal wall, likely related to reflux esophagitis. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Cirrhotic morphology. Focal fatty infiltration along the falciform. Slightly mottled enhancement, likely representing congestive hepatopathy in the setting of cardiomegaly. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Unchanged mild prominence of the ventral and dorsal pancreatic ducts with smooth tapering distally. No focal enhancing lesion within the limitations of single phase technique. ADRENALS: Normal. KIDNEYS: Symmetric atrophy and enhancement. Scattered hypoattenuating lesions in both kidneys are too small to characterize, but are statistically likely to represent cysts. Similar appearance of the right lower pole hyperdense cyst. No radiopaque nephrolithiasis. No hydroureteronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Moderate-sized hiatal hernia. COLON / APPENDIX: Colonic diverticulosis. The appendix is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Mild presacral stranding/edema. VESSELS: Advanced aortoiliac calcific atherosclerosis. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus is surgically absent. BODY WALL: Mild body wall edema. Unchanged small fluid containing left inguinal hernia. MUSCULOSKELETAL: Osseous mineralization is diffusely decreased. Comminuted fracture through the medial right clavicle without extension into the sternoclavicular joint. Chondrocalcinosis involving the pubic symphysis. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No spondylolisthesis. LUMBAR SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. Advanced multilevel discogenic degenerative changes. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No spondylolisthesis. CONCLUSION: 1. Comminuted fracture through the medial aspect of the right clavicle without extension into the sternoclavicular joint. 2. No acute traumatic abnormality in the abdomen or pelvis. No acute fracture or subluxation in the thoracolumbar spine. 3. Chronically occluded right upper extremity hero graft with its wall thrombus adherent to the catheter tip. Additional eccentric filling defects in the right atrium may represent small intracardiac thrombi, less likely to be related to a prominent crista terminalis. Additional small nonocclusive thrombus in the left external jugular vein associated with a left chest tunneled dialysis catheter. Note: Preliminary findings were discussed with Dr. Miller by Dr. Cook at 1/8/2022 6:42 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.
FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Hypoattenuating 2 mm nodule in the right thyroid lobe. CHEST: LUNGS / AIRWAYS / PLEURA: The central tracheobronchial tree is patent. Dependent atelectatic changes. No pleural effusions or pneumothorax. HEART / VESSELS: Mild four-chamber cardiomegaly. Dense mitral annular calcifications. Advanced calcific atherosclerosis in the coronary arteries. Mild dilatation the main pulmonary artery, measuring 32 mm in diameter. The thoracic aorta is normal in caliber. Thrombosed right upper extremity HeRO graft with its tip terminating at the superior cavoatrial junction. Small amount of thrombus adherent to the graft tip. Left external jugular vein approach tunneled vascular catheter with its tip terminating at the superior cavoatrial junction. Short segment of nonocclusive thrombus in the left external jugular vein cranial to the vascular catheter. Irregular eccentric filling defects in the right atrium (series 501, images 149 and 73). Partially visualized left upper extremity vascular graft. MEDIASTINUM / ESOPHAGUS: The esophagus is diffusely distended with gas. Circumferential thickening of the distal thoracic esophageal wall, likely related to reflux esophagitis. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Cirrhotic morphology. Focal fatty infiltration along the falciform. Slightly mottled enhancement, likely representing congestive hepatopathy in the setting of cardiomegaly. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Unchanged mild prominence of the ventral and dorsal pancreatic ducts with smooth tapering distally. No focal enhancing lesion within the limitations of single phase technique. ADRENALS: Normal. KIDNEYS: Symmetric atrophy and enhancement. Scattered hypoattenuating lesions in both kidneys are too small to characterize, but are statistically likely to represent cysts. Similar appearance of the right lower pole hyperdense cyst. No radiopaque nephrolithiasis. No hydroureteronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Moderate-sized hiatal hernia. COLON / APPENDIX: Colonic diverticulosis. The appendix is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Mild presacral stranding/edema. VESSELS: Advanced aortoiliac calcific atherosclerosis. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus is surgically absent. BODY WALL: Mild body wall edema. Unchanged small fluid containing left inguinal hernia. MUSCULOSKELETAL: Osseous mineralization is diffusely decreased. Comminuted fracture through the medial right clavicle without extension into the sternoclavicular joint. Chondrocalcinosis involving the pubic symphysis. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No spondylolisthesis. LUMBAR SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. Advanced multilevel discogenic degenerative changes. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No spondylolisthesis.
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: Small subcentimeter hypodensity within the right hepatic lobe is unchanged and while technically indeterminate, probably represents a cyst. Otherwise unremarkable for technique BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Unremarkable for technique SPLEEN: Unremarkable for technique ADRENALS: Left adrenal gland is normal. Right adrenal gland is poorly evaluated due to streak artifact, though likely surgically absent. KIDNEYS: Postsurgical changes from right nephrectomy. Left kidney is grossly unremarkable. No radiopaque urinary calculus or hydronephrosis. 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. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus is again somewhat enlarged and heterogeneous likely related to uterine fibroids. Otherwise unremarkable for technique. No adnexal mass. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Chronic degenerative changes of the visualized spine. No aggressive osseous lesion.