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16,000	MR Breast Screening wo+w contrast CLINICAL INFORMATION: Other, Z80.3 Family history of malignant neoplasm of breast, D24.9 Benign neoplasm of unspecified breast, R92.2 Inconclusive mammogram Spec Inst: +family hx of breast cancer, personal hx of Intraductal papilloma, cat. D breast density, Gail LT risk >20%. TECHNIQUE: T1 axial, FSE T2 fat sat axial, pre and post contrast vibrant sequence with 3D reconstructions. Fast scan. A dedicated 8 channel breast imaging coil was utilized. Patient weight: 123 lbs. IV contrast: ProHance, 11 ml, per protocol. IV contrast injection rate: 2 ml per sec. COMPARISON: Prior studies including most recent MRI from 2021 FINDINGS: All measurements provided in the format AP, TV, CC dimensions Breast tissue is heterogeneous fibroglandular tissue. Postcontrast administration there is mild background enhancement. RIGHT BREAST: No suspicious mass, nonmass enhancement, or distortion is seen. LEFT BREAST: No suspicious mass, nonmass enhancement, or distortion is seen. BILATERAL Few scattered bilateral foci are similar in appearance. None stands out from background. These do limit detection of small invasive cancers. Internal mammary nodes are normal. Axillary lymph nodes are normal. EXTRAMAMMARY: There is no suspicious abnormality in the visualized lung fields. Visualized upper abdomen unremarkable. Marrow signal is normal. IMPRESSION: RIGHT BREAST: No MRI evidence of malignancy. BI-RADS 2: Benign LEFT BREAST: No MRI evidence of malignancy. BI-RADS 2: Benign Overall BI-RADS assessment: BI-RADS 2: Benign	FINDINGS: All measurements provided in the format AP, TV, CC dimensions Breast tissue is heterogeneous fibroglandular tissue. Postcontrast administration there is mild background enhancement. RIGHT BREAST: No suspicious mass, nonmass enhancement, or distortion is seen. LEFT BREAST: No suspicious mass, nonmass enhancement, or distortion is seen. BILATERAL Few scattered bilateral foci are similar in appearance. None stands out from background. These do limit detection of small invasive cancers. Internal mammary nodes are normal. Axillary lymph nodes are normal. EXTRAMAMMARY: There is no suspicious abnormality in the visualized lung fields. Visualized upper abdomen unremarkable. Marrow signal is normal.	FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Bilateral pleural effusions are slightly increased in size compared to 1/15/2022, with unchanged basilar atelectasis. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Reflux of intravenous contrast from the right atrium into the hepatic veins and IVC is compatible with low cardiac output. ABDOMEN and PELVIS: LIVER: Precontrast images demonstrate large sentinel clot adjacent to the right margin of the inferior liver. Active vascular extravasation is seen from the anterolateral hepatic capsule of segment V into the peritoneum, with large volume hemoperitoneum. No underlying focal lesion was present on the prior contrast-enhanced CT. BILIARY TRACT: No abnormality.DDER: Absent PANCRNormal.rmal. SPLEENormal.al. ADRENANormal.mal. KIDNEYS: None enlarged.NODES: None enlarged. STNo abnormality.OWEL: Postsurgical changes of sleeve gastrectomy are noted. No vascular extravasation into the GI tract lumen is identified. COLON / APPENDIX: No abnormality. PERNormal. / MESENTERY: A large amount of fluid is seen within the peritoneum, new compared to 1/15/2002 and with heterogeneous high density is consistent with hemoperitoneum. RETROPERITONEUM: Normal. VESSELS: The abdominal aorta is normal in caliber. No variant hepatic arterial anatomy is noted. In addition, nonocclusive thrombus is once again seen in the left femoral vein and common femoral vein, without extension into the external iliac or IVC. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: The uterus appears surgically absent. Neither ovary is identified. BODY WALL: No significant abnormality. MUSCULOSKELETAL: There isdegenerative change in the hips and lumbar facets. No aggressive osseous lesions are noted. No displaced rib fractures are identified.
16,001	MR Cervical Spine wo contrast 1/28/2022 2:57 PM Clinical Information: Evaluation for cervical radiculopathy Comparison: Cervical spine radiograph from 8/20/2021 Technique: Axial and sagittal T1, axial and sagittal T2, and sagittal STIR sequences were acquired of the cervical spine without the use of intravenous contrast. Patient weight: 150 lbs. Findings: Straightening of cervical lordosis is noted. The bone marrow is of normal signal intensity. The visualized portions of the posterior fossa and craniocervical junction appear normal. The cervical spinal cord is unremarkable. Degenerative changes of the cervical spine are described on a level by level basis below: C2-C3: Within normal limits. C3-C4: There is mild disc bulge without significant central canal or neural foraminal narrowing.. C4-C5: Within normal limits. C5-C6: Unremarkable. C6-C7: No evidence of spinal canal or neural foraminal narrowing is noted C7-T1: No evidence of a spinal canal or neural foraminal narrowing is noted. T1-T2: No evidence of spinal canal or foraminal narrowing is noted. The visualized prevertebral and paravertebral soft tissues are unremarkable. Impression: Straightening of the cervical lordosis without significant degenerative changes. There is no significant central canal or neural foraminal narrowing. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.	Findings: Straightening of cervical lordosis is noted. The bone marrow is of normal signal intensity. The visualized portions of the posterior fossa and craniocervical junction appear normal. The cervical spinal cord is unremarkable. Degenerative changes of the cervical spine are described on a level by level basis below: C2-C3: Within normal limits. C3-C4: There is mild disc bulge without significant central canal or neural foraminal narrowing.. C4-C5: Within normal limits. C5-C6: Unremarkable. C6-C7: No evidence of spinal canal or neural foraminal narrowing is noted C7-T1: No evidence of a spinal canal or neural foraminal narrowing is noted. T1-T2: No evidence of spinal canal or foraminal narrowing is noted. The visualized prevertebral and paravertebral soft tissues are unremarkable.	FINDINGS: STRUCTURED REPORT: CT PE OVERALL DIAGNOSTIC QUALITY: Full diagnostic quality LOWER NECK: No abnormality. CHEST: PULMONARY ARTERIES: Positive for pulmonary embolus. - Pulmonary Embolus Distribution: Small filling defects within segmental branches of the right lower lobe. - Pulmonary Artery Diameter: Normal. - Ascending Aortic Diameter: Normal. - RV:LV Ratio: Normal. - Interventricular Septum: Normal. - Contrast reflux into IVC: No significant abnormality. LUNGS / AIRWAYS / PLEURA: Inspissated secretions within the trachea. Multifocal mucus plugging involving the right middle lobe. Significant interval worsened aeration of the left lung with multiple consolidations and air bronchograms in both lobes. There is also worsened aeration of the right base with two focal consolidation. No significant pleural effusion or pneumothorax. HEART / OTHER VESSELS: The heart is enlarged. MEDIASTINUM / ESOPHAGUS: Redemonstrated large hiatal hernia. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Normal. MUSCULOSKELETAL: Redemonstrated severe dextroscoliosis. Partially visualized spinal fusion hardware. Sternotomy wires.
16,002	EXAM: MULTIPARAMETRIC MRI OF THE PROSTATE W AND WO IV CONTRAST CLINICAL INDICATION: Prostate cancer, initial staging, low risk, R97.20 Elevated prostate specific antigen [PSA] TECHNIQUE: Multiplanar T1-, T2-, and diffusion-weighted imaging of the pelvis were performed on a 3 Tesla scanner. Axial T1-weighted images were obtained before, during, and after administration of intravenous contrast. Patient weight: 222 lbs. IV contrast: ProHance, 20 ml, per protocol. IV contrast injection rate: 2.50 ml per sec. COMPARISON: None. FINDINGS: STRUCTURED REPORT: MRI Prostate PROSTATE: Measurement: 3.3 x 5.1 x 5.2 cm; estimated volume: 46 cc, PSA density 0.16 Focal lesion(s): Lesion # 1 (index lesion): - Key image: image 13; series 9 - Size: 23 x 14 mm - Location: left; apex to mid; anterior central gland this may extend inferiorly involving the apex on series 5 image 12. - T2WI: 5; DWI: 5; DCE (early and focal enhancement): positive - PI-RADS v2.1 score: 5 - Very high (clinically significant cancer is highly likely to be present) - Likelihood of extraprostatic extension: 3 - Indeterminate Lesion abuts both the capsule and the prostatic urethra. - Likelihood of seminal vesicle invasion: 1 - Highly unlikely Diffuse prostate abnormalities: Diffusely striated appearance of the peripheral zone on T2WI with abnormal contrast kinetics may reflect prostatitis Other prostate findings: None. VESSELS: No significant abnormality. LYMPH NODES: None enlarged. PERIRECTAL / PERIANAL REGION: Normal. Sigmoid diverticulosis without acute inflammation. BLADDER: Within normal limits. OTHER PELVIC FINDINGS: None. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. Note: For more details about the Prostate Imaging-Reporting and Data System (PI-RADS) version 2.1, please visit: http://www.acr.org/Quality-Safety/Resources/PIRADS CONCLUSION: T2 hypointense lesion within the mid-apex of the left apical central gland which demonstrates significant diffusion restriction is highly suspicious for prostate cancer (PIRADS 5). This lesion abuts with prostatic capsule and the urethra, indeterminate for extracapsular extension and urethral involvement. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.	FINDINGS: STRUCTURED REPORT: MRI Prostate PROSTATE: Measurement: 3.3 x 5.1 x 5.2 cm; estimated volume: 46 cc, PSA density 0.16 Focal lesion(s): Lesion # 1 (index lesion): - Key image: image 13; series 9 - Size: 23 x 14 mm - Location: left; apex to mid; anterior central gland this may extend inferiorly involving the apex on series 5 image 12. - T2WI: 5; DWI: 5; DCE (early and focal enhancement): positive - PI-RADS v2.1 score: 5 - Very high (clinically significant cancer is highly likely to be present) - Likelihood of extraprostatic extension: 3 - Indeterminate Lesion abuts both the capsule and the prostatic urethra. - Likelihood of seminal vesicle invasion: 1 - Highly unlikely Diffuse prostate abnormalities: Diffusely striated appearance of the peripheral zone on T2WI with abnormal contrast kinetics may reflect prostatitis Other prostate findings: None. VESSELS: No significant abnormality. LYMPH NODES: None enlarged. PERIRECTAL / PERIANAL REGION: Normal. Sigmoid diverticulosis without acute inflammation. BLADDER: Within normal limits. OTHER PELVIC FINDINGS: None. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. Note: For more details about the Prostate Imaging-Reporting and Data System (PI-RADS) version 2.1, please visit: http://www.acr.org/Quality-Safety/Resources/PIRADS	FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Bibasilar atelectasis. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Subcentimeter hypoattenuating lesions are indeterminate but grossly unchanged from prior exam. BILIARY TRACT: Normal. GALLBLADDER: Focal adenomyomatosis of the gallbladder fundus. PANCREAS: Small cystic lesion within the pancreatic head measures 5 mm on axial series 201 image 98. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Scattered subcentimeter hypoattenuating lesions are too small to characterize. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Stomach and small bowel are unremarkable aside from mild fecalization of the terminal ileum likely related to delayed transit and small duodenal diverticulum. COLON / APPENDIX: The appendix and colon are unremarkable aside from scattered diverticulosis. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Scattered vascular calcifications. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: The uterus is absent. No adnexal mass. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Multilevel discogenic degenerative change with lower lumbar spine facet arthropathy. There is also pubic symphysis and hip degenerative change. No acute osseous abnormality or focal aggressive osseous lesion.
16,003	RADIOLOGIC EXAM: MR Brain wo+w contrast CLINICAL INFORMATION: Seizure, nontraumatic, Spec Inst: Epilepsy Protocol, 3T. special attention to the occipital lobes. Per chart review, first-time witnessed convulsive seizure on 12/14/2021. EEG on 1/18/2022 with normal findings. COMPARISON: None available. TECHNIQUE: MR Brain wo+w contrast Patient weight: 175 lbs. IV contrast: ProHance, 10 ml, per protocol. Multiple T1 and T2-weighted MR sequence images of the brain were obtained in the sagittal axial and coronal planes pre- and post administration of intravenous contrast per departmental protocol. FINDINGS: INTRACRANIAL FINDINGS: Mild right hippocampal volume loss compared to the left without association of FLAIR hyperintensity. Asymmetric prominence of the right parieto-occipital and calcarine sulci. No convincing evidence of lissencephaly, neuronal migration disorder, vascular malformation, or encephalocele. No acute intraparenchymal infarct, hemorrhage, edema, hydrocephalus, space-occupying lesion, or mass effect. Postcontrast series demonstrates no focal enhancing lesion. Scattered bilateral frontal lobe subcortical and deep cerebral white matter T2/FLAIR hyperintense foci, likely mild chronic microangiopathic changes. The ventricular system is normal in caliber and configuration. The basal cisterns are clear. The visualized proximal cerebrovascular flow voids appear normal. EXTRACRANIAL FINDINGS: The visualized extracranial osseous and soft tissue structures demonstrate normal signal characteristics. Trace mucosal thickening the bilateral anterior ethmoid air cells. The paranasal sinuses and mastoid air cells are otherwise clear. Both orbits are unremarkable. CONCLUSION: 1. No acute intracranial process. No pathologic enhancement. 2. Asymmetric prominence of the right parieto-occipital and calcarine sulci. 3. Mild right hippocampal volume loss without evidence of mesial temporal sclerosis. 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: INTRACRANIAL FINDINGS: Mild right hippocampal volume loss compared to the left without association of FLAIR hyperintensity. Asymmetric prominence of the right parieto-occipital and calcarine sulci. No convincing evidence of lissencephaly, neuronal migration disorder, vascular malformation, or encephalocele. No acute intraparenchymal infarct, hemorrhage, edema, hydrocephalus, space-occupying lesion, or mass effect. Postcontrast series demonstrates no focal enhancing lesion. Scattered bilateral frontal lobe subcortical and deep cerebral white matter T2/FLAIR hyperintense foci, likely mild chronic microangiopathic changes. The ventricular system is normal in caliber and configuration. The basal cisterns are clear. The visualized proximal cerebrovascular flow voids appear normal. EXTRACRANIAL FINDINGS: The visualized extracranial osseous and soft tissue structures demonstrate normal signal characteristics. Trace mucosal thickening the bilateral anterior ethmoid air cells. The paranasal sinuses and mastoid air cells are otherwise clear. Both orbits are unremarkable.	FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Hepatic steatosis. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Nonobstructing 8 mm calculus in the lower pole of left kidney. Mild left renal atrophy. No hydronephrosis. Subcentimeter hypoattenuating lesion in the upper pole of the left kidney, likely a renal cyst. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: VP shunt catheter terminates in the anterior pelvis. No free intraperitoneal fluid or air. RETROPERITONEUM: Normal. VESSELS: Mild calcified atherosclerosis of the abdominal aorta. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Small fat-containing umbilical hernia. MUSCULOSKELETAL: No significant abnormality.
16,004	MRI face: History: Oral cancer, malignant neoplasm of the mouth Comparison: Prior study from 12/13/2021 technique: Axial DWI, axial T1, coronal T1, coronal T2, axial T2, sagittal T1, coronal T1, coronal T2, postcontrast axial T1, coronal and sagittal images of the brain and maxillofacial region were obtained. Findings: There are postsurgical changes in the left buccal space with graft placement. There is heterogeneously enhancing lesion in the medial aspect of the graft and extending into the oral cavity and lateral margin of the tongue, measures approximately 2 x 1 cm. There is also heterogeneously enhancing lesion along the anterolateral aspect of the left buccal space, concern for recurrent malignancy. Previously described lesions demonstrate restricted diffusion on DWI. There is atrophy of the left masticator muscles. There is right hemiglossectomy with fatty graft extending posteriorly to the submandibular space. There is mild heterogeneous enhancement of the left hemitongue. There is no definite significant cervical lymphadenopathy. There are posttreatment changes in the epiglottis and aryepiglottic folds. There is diffuse opacification of the right mastoid air cells. Visualized brain parenchyma is within normal limits. There is no hydrocephalus. Impression: Heterogeneously enhancing lesions in the medial and lateral aspect of the left buccal space graft and show restricted diffusion on DWI, highly concerning for malignancy. Recommended biopsy of the lesions. No definite significant cervical lymphadenopathy. Visualized brain parenchyma is within normal limits.. .	Findings: There are postsurgical changes in the left buccal space with graft placement. There is heterogeneously enhancing lesion in the medial aspect of the graft and extending into the oral cavity and lateral margin of the tongue, measures approximately 2 x 1 cm. There is also heterogeneously enhancing lesion along the anterolateral aspect of the left buccal space, concern for recurrent malignancy. Previously described lesions demonstrate restricted diffusion on DWI. There is atrophy of the left masticator muscles. There is right hemiglossectomy with fatty graft extending posteriorly to the submandibular space. There is mild heterogeneous enhancement of the left hemitongue. There is no definite significant cervical lymphadenopathy. There are posttreatment changes in the epiglottis and aryepiglottic folds. There is diffuse opacification of the right mastoid air cells. Visualized brain parenchyma is within normal limits. There is no hydrocephalus.	FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. Mild diffuse parenchymal volume loss. Periventricular white matter hypoattenuation consistent with chronic microangiopathic changes. No abnormal intracranial enhancement. EXTRA-AXIAL SPACES: Normal. VENTRICULAR SYSTEM: Normal. ORBITS: Large left and small right periorbital hematomas as below with associated severe bilateral eyelid edema. Bilateral pseudophakia. No fracture. SKULL AND SKULL BASE: No fracture. Trace bilateral mastoid air cell effusions, right greater than left. Large mixed density, predominantly hyperattenuating left greater than right frontal scalp hematoma extending to the left temporal, bilateral periorbital, and left zygomatic soft tissues. There are scattered foci of hyperenhancement within the hematoma concerning for active extravasation (image 24 and 29, series #701). FACIAL BONES: No fracture. Bilateral pterygoid plates are intact. MANDIBLE: No fracture. Bilateral temporomandibular joints are intact. SINONASAL CAVITIES: Mild mucosal thickening of the bilateral maxillary and sphenoid sinuses. Bilateral mastoid effusions. Cervical fixation hardware partially included at C6.
16,005	Brain MRI with and without contrast MR venogram of the dural venous sinuses. - Clinical indication: Headache, new or worsening, neuro deficit, R51.9 Headache, unspecified Spec Inst: PLEASE DO MRV. . . - Technique: Pre contrast sagittal and axial T1, axial FLAIR and T2 FSE with fat saturation, coronal gradient echo, postcontrast axial and coronal T1; 3-D time-of-flight images of the MR venogram were obtained including MIPS. Patient weight: 205 lbs. IV contrast: ProHance, 20 ml, per protocol. IV contrast injection rate: 1.80 ml per sec. - Comparison: No previous similar studies are available for comparison at this time. - Findings: Brain MRI: There is no restricted diffusion on DWI. Visualized cerebral parenchyma is within normal limits. There are scattered T-2/flair hyperintense focus in the right frontal and parietal subcortical location, likely microangiopathic changes.. There is no hydrocephalus. Postcontrast images demonstrate no abnormal enhancement in the brain parenchyma. - MR venogram: Superior sagittal sinus and deep cerebral veins are patent and unremarkable. Straight sinus is patent and unremarkable. Right transverse sinus is dominant and patent. Left transverse sinus appears small in caliber but patent. Bilateral internal jugular veins are patent. - Impression: No acute intracranial process is identified. No definite dural venous sinus thrombus or stenosis is identified. See comment for normal variants.	Findings: Brain MRI: There is no restricted diffusion on DWI. Visualized cerebral parenchyma is within normal limits. There are scattered T-2/flair hyperintense focus in the right frontal and parietal subcortical location, likely microangiopathic changes.. There is no hydrocephalus. Postcontrast images demonstrate no abnormal enhancement in the brain parenchyma. - MR venogram: Superior sagittal sinus and deep cerebral veins are patent and unremarkable. Straight sinus is patent and unremarkable. Right transverse sinus is dominant and patent. Left transverse sinus appears small in caliber but patent. Bilateral internal jugular veins are patent. -	FINDINGS: STRUCTURED REPORT: CT CAP LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Endotracheal tube distal tip terminates 3 cm superior to the carina. Extensive mucous plugging in the right lower lobe bronchi and new nodular opacities throughout the right lower lobe with peripheral and dependent regions of consolidation. New hyperdense foci within region of right lower lobe consolidation (series 201 image 26) has appearance highly concerning for active contrast extravasation and surrounding region of consolidation may be related to pulmonary hemorrhage. There are two probable pneumatoceles in the right upper and middle lobes with adjacent rib fractures. Patchy left apical groundglass opacities are unchanged from prior. Persistent subpulmonic left effusion with associated overlying atelectasis. HEART / VESSELS: The right internal jugular vein is atretic. Coronary artery stents are noted. Scattered vascular calcifications. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: Body wall edema. ABDOMEN and PELVIS: LIVER: A few subcentimeter hypodensities in the right hepatic lobe, technically indeterminate but most likely represent cysts. Liver is otherwise unremarkable. BILIARY TRACT: Mild intra and extrahepatic biliary ductal dilation, likely related to age and prior cholecystectomy. GALLBLADDER: Surgically absent. PANCREAS: Normal. SPLEEN: Heterogeneous enhancement of the spleen likely related to bolus timing. However wedge-shaped region of peripheral hypodensity could represent splenic infarct. ADRENALS: Normal. KIDNEYS: Severely atrophic bilateral kidneys with multiple scattered simple cysts. There are also multiple subcentimeter hypoattenuating lesions which are too small to characterize. The right kidney is partially obscured secondary to beam hardening artifact. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Esophagogastric tube distal tip terminates in the distal gastric body. Small amount of hyperdense material layering in the dependent stomach, possibly oral contrast. COLON / APPENDIX: The appendix is not identified. Colon is normal. PERITONEUM / MESENTERY: Small volume free fluid in the pelvis. RETROPERITONEUM: Normal. VESSELS: Postsurgical change and small amount of stranding adjacent to the left inguinal vessels. Extensive scattered vascular calcifications. Mild narrowing of the origin of the SMA. Extensive atherosclerotic disease of the origin of the renal arteries. URINARY BLADDER: Decompressed REPRODUCTIVE ORGANS: The uterus is absent. No adnexal mass. BODY WALL: Anasarca. Moderately sized hematoma in the anterior/inferior left abdominal wall measures approximately 8.2 x 2.5 cm on axial series 201 image 377 and measures 8.7 cm in cranial to caudal on sagittal series 204 image 84. No active extravasation. MUSCULOSKELETAL: Posterior fusion hardware with laminectomy spanning L4-S1. Partially visualized anterior cervical fusion hardware. Multiple bilateral anterior rib fractures are likely related to resuscitative measures and involve the second through eighth ribs on the right and the second through seventh ribs on the left. Comminuted sternal fracture.
16,006	Brain MRI with and without contrast MR venogram of the dural venous sinuses. - Clinical indication: Headache, new or worsening, neuro deficit, R51.9 Headache, unspecified Spec Inst: PLEASE DO MRV. . . - Technique: Pre contrast sagittal and axial T1, axial FLAIR and T2 FSE with fat saturation, coronal gradient echo, postcontrast axial and coronal T1; 3-D time-of-flight images of the MR venogram were obtained including MIPS. Patient weight: 205 lbs. IV contrast: ProHance, 20 ml, per protocol. IV contrast injection rate: 1.80 ml per sec. - Comparison: No previous similar studies are available for comparison at this time. - Findings: Brain MRI: There is no restricted diffusion on DWI. Visualized cerebral parenchyma is within normal limits. There are scattered T-2/flair hyperintense focus in the right frontal and parietal subcortical location, likely microangiopathic changes.. There is no hydrocephalus. Postcontrast images demonstrate no abnormal enhancement in the brain parenchyma. - MR venogram: Superior sagittal sinus and deep cerebral veins are patent and unremarkable. Straight sinus is patent and unremarkable. Right transverse sinus is dominant and patent. Left transverse sinus appears small in caliber but patent. Bilateral internal jugular veins are patent. - Impression: No acute intracranial process is identified. No definite dural venous sinus thrombus or stenosis is identified. See comment for normal variants.	Findings: Brain MRI: There is no restricted diffusion on DWI. Visualized cerebral parenchyma is within normal limits. There are scattered T-2/flair hyperintense focus in the right frontal and parietal subcortical location, likely microangiopathic changes.. There is no hydrocephalus. Postcontrast images demonstrate no abnormal enhancement in the brain parenchyma. - MR venogram: Superior sagittal sinus and deep cerebral veins are patent and unremarkable. Straight sinus is patent and unremarkable. Right transverse sinus is dominant and patent. Left transverse sinus appears small in caliber but patent. Bilateral internal jugular veins are patent. -	FINDINGS: STRUCTURED REPORT: CT CAP LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Endotracheal tube distal tip terminates 3 cm superior to the carina. Extensive mucous plugging in the right lower lobe bronchi and new nodular opacities throughout the right lower lobe with peripheral and dependent regions of consolidation. New hyperdense foci within region of right lower lobe consolidation (series 201 image 26) has appearance highly concerning for active contrast extravasation and surrounding region of consolidation may be related to pulmonary hemorrhage. There are two probable pneumatoceles in the right upper and middle lobes with adjacent rib fractures. Patchy left apical groundglass opacities are unchanged from prior. Persistent subpulmonic left effusion with associated overlying atelectasis. HEART / VESSELS: The right internal jugular vein is atretic. Coronary artery stents are noted. Scattered vascular calcifications. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: Body wall edema. ABDOMEN and PELVIS: LIVER: A few subcentimeter hypodensities in the right hepatic lobe, technically indeterminate but most likely represent cysts. Liver is otherwise unremarkable. BILIARY TRACT: Mild intra and extrahepatic biliary ductal dilation, likely related to age and prior cholecystectomy. GALLBLADDER: Surgically absent. PANCREAS: Normal. SPLEEN: Heterogeneous enhancement of the spleen likely related to bolus timing. However wedge-shaped region of peripheral hypodensity could represent splenic infarct. ADRENALS: Normal. KIDNEYS: Severely atrophic bilateral kidneys with multiple scattered simple cysts. There are also multiple subcentimeter hypoattenuating lesions which are too small to characterize. The right kidney is partially obscured secondary to beam hardening artifact. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Esophagogastric tube distal tip terminates in the distal gastric body. Small amount of hyperdense material layering in the dependent stomach, possibly oral contrast. COLON / APPENDIX: The appendix is not identified. Colon is normal. PERITONEUM / MESENTERY: Small volume free fluid in the pelvis. RETROPERITONEUM: Normal. VESSELS: Postsurgical change and small amount of stranding adjacent to the left inguinal vessels. Extensive scattered vascular calcifications. Mild narrowing of the origin of the SMA. Extensive atherosclerotic disease of the origin of the renal arteries. URINARY BLADDER: Decompressed REPRODUCTIVE ORGANS: The uterus is absent. No adnexal mass. BODY WALL: Anasarca. Moderately sized hematoma in the anterior/inferior left abdominal wall measures approximately 8.2 x 2.5 cm on axial series 201 image 377 and measures 8.7 cm in cranial to caudal on sagittal series 204 image 84. No active extravasation. MUSCULOSKELETAL: Posterior fusion hardware with laminectomy spanning L4-S1. Partially visualized anterior cervical fusion hardware. Multiple bilateral anterior rib fractures are likely related to resuscitative measures and involve the second through eighth ribs on the right and the second through seventh ribs on the left. Comminuted sternal fracture.
16,007	MR Angio Head wo contrast 1/28/2022 5:22 PM CLINICAL INFORMATION: Headache, chronic, new features or increased frequency, R51.9 Headache, unspecified, R41.3 Other amnesia Spec Inst: REQUEST MRV HEAD AND MRA head non contrast .br 66 yo F with cerebral microangioapthic disease with new onset headache head pressure refractory patient shares arose after J COMPARISON: Prior MR brain 11/17/2021. TECHNIQUE: Multiplanar, multisequence MR images of the brain were obtained without the administration of intravenous contrast. MRV protocol only performed. FINDINGS: Limited sequences show diffuse mild atrophy of the cerebral parenchyma, age-related, and unchanged. The pituitary and posterior fossa structures are within normal limits. MRV findings show patent bilateral superior sagittal sinus, internal cerebral veins, vein of Galen, straight sinus, bilateral transverse and sigmoid sinuses. Visualized portions of the internal jugular veins are also patent. CONCLUSION: Limited scan with MRV only performed. Normal MRV of the brain. 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: Limited sequences show diffuse mild atrophy of the cerebral parenchyma, age-related, and unchanged. The pituitary and posterior fossa structures are within normal limits. MRV findings show patent bilateral superior sagittal sinus, internal cerebral veins, vein of Galen, straight sinus, bilateral transverse and sigmoid sinuses. Visualized portions of the internal jugular veins are also patent.	FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. Mild diffuse parenchymal volume loss. Periventricular white matter hypoattenuation consistent with chronic microangiopathic changes. No abnormal intracranial enhancement. EXTRA-AXIAL SPACES: Normal. VENTRICULAR SYSTEM: Normal. ORBITS: Large left and small right periorbital hematomas as below with associated severe bilateral eyelid edema. Bilateral pseudophakia. No fracture. SKULL AND SKULL BASE: No fracture. Trace bilateral mastoid air cell effusions, right greater than left. Large mixed density, predominantly hyperattenuating left greater than right frontal scalp hematoma extending to the left temporal, bilateral periorbital, and left zygomatic soft tissues. There are scattered foci of hyperenhancement within the hematoma concerning for active extravasation (image 24 and 29, series #701). FACIAL BONES: No fracture. Bilateral pterygoid plates are intact. MANDIBLE: No fracture. Bilateral temporomandibular joints are intact. SINONASAL CAVITIES: Mild mucosal thickening of the bilateral maxillary and sphenoid sinuses. Bilateral mastoid effusions. Cervical fixation hardware partially included at C6.
16,008	EXAM: MR Brain wo+w contrast CLINICAL INFORMATION: Arachnoid cyst. COMPARISON: CT dated 7/30/2021. TECHNIQUE: MR Brain wo+w contrast. Patient weight: 128 lbs. IV contrast: ProHance, 12 ml, per protocol. FINDINGS: No abnormal restricted diffusion. No significant abnormal T2 or FLAIR signal. The ventricles are normal in size without midline shift. Basal cisterns are maintained. Expected vascular flow voids are unremarkable. The midline structures are unremarkable. No tonsillar ectopia or other herniation. No abnormal susceptibility signal dropout. Within the extra-axial space along the superior/anterior right frontal lobe a prominent cystic structure is noted which follows CSF signal on all sequences. No associated peripheral or internal enhancement. There is mild associated mass effect on the underlying parenchyma of the right frontal lobe. No abnormal marrow signal. The middle ears, mastoid air cells, and paranasal sinuses are clear. The orbits and globes are unremarkable. No significant soft tissue abnormality. CONCLUSION: Arachnoid cyst overlying the right frontal lobe with mild associated mass effect on the underlying parenchyma. Otherwise no acute intracranial process is identified. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.	FINDINGS: No abnormal restricted diffusion. No significant abnormal T2 or FLAIR signal. The ventricles are normal in size without midline shift. Basal cisterns are maintained. Expected vascular flow voids are unremarkable. The midline structures are unremarkable. No tonsillar ectopia or other herniation. No abnormal susceptibility signal dropout. Within the extra-axial space along the superior/anterior right frontal lobe a prominent cystic structure is noted which follows CSF signal on all sequences. No associated peripheral or internal enhancement. There is mild associated mass effect on the underlying parenchyma of the right frontal lobe. No abnormal marrow signal. The middle ears, mastoid air cells, and paranasal sinuses are clear. The orbits and globes are unremarkable. No significant soft tissue abnormality.	FINDINGS: BRAIN PARENCHYMA: No intraparenchymal hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. Confluent periventricular white matter hypoattenuation consistent with advanced degenerative change. Encephalomalacia in the anterior right temporal lobe. Remote infarcts in the bilateral basal ganglia. Advanced diffuse parenchymal volume loss. EXTRA-AXIAL SPACES: Small volume extra-axial hemorrhage in the right medial frontal, right temporal, and left inferior temporal convexities. Small extra-axial hemorrhage in the right cerebellar convexity. No mass effect or midline shift. VENTRICULAR SYSTEM: Asymmetric ex vacuo dilatation of the right lateral ventricle. ORBITS: Bilateral pseudophakia. No fracture. SKULL AND SKULL BASE: Nondisplaced obliquely oriented right occipital bone fracture extending to the petrous temporal bone. Bilateral mastoid air cells are clear. Moderate-sized left parietal scalp hematoma. FACIAL BONES: No fracture. Pterygoid plates are intact. MANDIBLE: No fracture. Bilateral temporomandibular joints are intact. SINONASAL CAVITIES: Moderate mucosal thickening of the right sphenoid sinus.
16,009	EXAM: MR Cervical Spine wo contrast 1/28/2022 4:28 PM CLINICAL INFORMATION: Cervical radiculopathy, no red flags, Cervicalgia. Spec Inst: Neck pain, abnormal NCVEMG. COMPARISON: MRI brain dated 7/19/2018. TECHNIQUE: T2 sagittal and axial fast spin spin echo, T1 sagittal spin echo, sagittal STIR, axial T2* gradient echo. FINDINGS: Multilevel mild to moderate degenerative discogenic disease and facet arthropathy, most prominently with moderate intervertebral disc space height loss at C3-C5 and C6-C7. Trace stepwise degenerative retrolisthesis of C3 on C4, mild at C4 on C5, trace at C5 on C6, and trace at C6 on C7. Vertebral body heights are preserved. There are no suspicious bone marrow signal abnormalities. The craniovertebral junction appears unremarkable. No definite cord signal abnormality is identified. Degenerative findings are discussed on a level by level basis: C2-3: Normal. C3-4: Mild disc osteophyte complex and mild bilateral facet arthropathy. Moderate spinal canal stenosis. Moderate right and severe left bilateral neuroforaminal stenosis. C4-5: Mild disc osteophyte complex and mild bilateral facet arthropathy. Mild spinal canal stenosis. Moderate bilateral neuroforaminal stenosis. C5-6: Normal. C6-7: Mild disc osteophyte complex and mild bilateral neuroforaminal stenosis. Mild spinal canal stenosis. Severe right and moderate left neuroforaminal stenosis. C7-T1: Normal. The visualized paraspinal structures appear otherwise within normal limits. The remaining visualized osseous and soft tissue structures demonstrate normal MR signal characteristics. CONCLUSION: 1. Multilevel mild to moderate degenerative discogenic disease and facet arthropathy, most prominently at C3-C5 and C6-C7. Moderate C3-C4 spinal canal stenosis. Multilevel moderate to severe bilateral neuroforaminal stenosis as detailed above. 2. Trace stepwise degenerative retrolisthesis of C3 on C4, mild at C4 on C5, trace at C5 on C6, and trace at C6 on C7. 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: Multilevel mild to moderate degenerative discogenic disease and facet arthropathy, most prominently with moderate intervertebral disc space height loss at C3-C5 and C6-C7. Trace stepwise degenerative retrolisthesis of C3 on C4, mild at C4 on C5, trace at C5 on C6, and trace at C6 on C7. Vertebral body heights are preserved. There are no suspicious bone marrow signal abnormalities. The craniovertebral junction appears unremarkable. No definite cord signal abnormality is identified. Degenerative findings are discussed on a level by level basis: C2-3: Normal. C3-4: Mild disc osteophyte complex and mild bilateral facet arthropathy. Moderate spinal canal stenosis. Moderate right and severe left bilateral neuroforaminal stenosis. C4-5: Mild disc osteophyte complex and mild bilateral facet arthropathy. Mild spinal canal stenosis. Moderate bilateral neuroforaminal stenosis. C5-6: Normal. C6-7: Mild disc osteophyte complex and mild bilateral neuroforaminal stenosis. Mild spinal canal stenosis. Severe right and moderate left neuroforaminal stenosis. C7-T1: Normal. The visualized paraspinal structures appear otherwise within normal limits. The remaining visualized osseous and soft tissue structures demonstrate normal MR signal characteristics.	FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: The trachea and central airways are patent. Biapical pleural-parenchymal scarring. Basilar predominant chronic lung changes including septal thickening, reticular opacities, and mild bronchiectasis. Dependent basilar atelectasis is also noted. HEART / VESSELS: Right atrial enlargement. Papillary muscle calcifications as well as coronary calcifications. MEDIASTINUM / ESOPHAGUS: Small hiatal hernia. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Simple hepatic cysts. Other scattered hypoattenuating lesions are too small to characterize. BILIARY TRACT: Mild central predominant intrahepatic and extrahepatic biliary ductal dilatation. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Increased attenuation involving the right renal middle lobe suggestive of medullary nephrocalcinosis. LYMPH NODES: Scattered prominent para-aortic lymph nodes. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Extensively redundant colon. The appendix is not visualized. Scattered diverticula. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Extensive vascular calcifications. Severe calcifications are noted at the origin of the SMA with high-grade near complete stenosis. Similar-appearing extensive calcifications are noted at the origin of both renal arteries, left worse than right with high-grade near complete stenoses. URINARY BLADDER: Mildly distended. REPRODUCTIVE ORGANS: The uterus is absent. No adnexal mass. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Mildly comminuted proximal left clavicular fracture. There is also deformity of the right proximal clavicle and a more chronic appearance. The posterior left ribs. Bilateral internal fixation of the proximal humerus. Chronic deformity of the right inferior rami. THORACIC: VERTEBRA: Multiple age-indeterminate anterior wedge deformity and endplate deformities involving the T1, T4, T7, and T11. Deformities at T7 and T11 appear chronic. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. Mild multilevel discogenic degenerative change. PREVERTEBRAL SOFT TISSUES: Unremarkable. LUMBAR: VERTEBRA: Irregularity of the superior endplate of L4, technically age indeterminate. Kyphoplasty changes at L1. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. Advanced discogenic degenerative change of lower lumbar spine facet arthropathy. PREVERTEBRAL SOFT TISSUES: Unremarkable.
16,010	MR Brain wo contrast, MR Angio Head wo contrast 1/28/2022 4:56 PM Clinical Information: Benign intracranial hypertension, H93.A2 Pulsatile tinnitus, left ear Spec Inst: Left-sided pulsatile tinnitus Comparison: None. Technique: Axial FLAIR/T2, axial DWI, coronal T1, axial 3-D T2 SPACE images through the IAC and labyrinth. 3-D single slab time-of-flight MRA of the head with multiple MIP and 3-D SSD reconstruction. Findings: Prominent left AICA gives rise to multiple branches, which are looping around the left porus acusticus and crossing over the cisternal portion of the left vestibulocochlear nerve. The left superior petrosal sinus appears engorged. No intracranial aneurysm or large vessel steno-occlusive disease is noted. The left PCA is fetal origin. The IACs and cerebellopontine angle cisterns are symmetric with no space-occupying lesion. The cochlea and vestibule show no structural abnormalities. The bony coverage of the superior semicircular canal is intact. The cranial nerves VII, VIII, V, IX and X are normally visualized. The left mastoid antrum and air cells are opacified with effusion. There is no evidence of retrocochlear pathology or intracranial structural abnormality. No focal signal abnormality is seen in the brain and brainstem. Impression: Prominent left AICA branches looping around the porus acusticus and cisternal portion of the left vestibulocochlear nerve concerning for small dural aVF with neurovascular compression.	Findings: Prominent left AICA gives rise to multiple branches, which are looping around the left porus acusticus and crossing over the cisternal portion of the left vestibulocochlear nerve. The left superior petrosal sinus appears engorged. No intracranial aneurysm or large vessel steno-occlusive disease is noted. The left PCA is fetal origin. The IACs and cerebellopontine angle cisterns are symmetric with no space-occupying lesion. The cochlea and vestibule show no structural abnormalities. The bony coverage of the superior semicircular canal is intact. The cranial nerves VII, VIII, V, IX and X are normally visualized. The left mastoid antrum and air cells are opacified with effusion. There is no evidence of retrocochlear pathology or intracranial structural abnormality. No focal signal abnormality is seen in the brain and brainstem.	FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: The trachea and central airways are patent. Biapical pleural-parenchymal scarring. Basilar predominant chronic lung changes including septal thickening, reticular opacities, and mild bronchiectasis. Dependent basilar atelectasis is also noted. HEART / VESSELS: Right atrial enlargement. Papillary muscle calcifications as well as coronary calcifications. MEDIASTINUM / ESOPHAGUS: Small hiatal hernia. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Simple hepatic cysts. Other scattered hypoattenuating lesions are too small to characterize. BILIARY TRACT: Mild central predominant intrahepatic and extrahepatic biliary ductal dilatation. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Increased attenuation involving the right renal middle lobe suggestive of medullary nephrocalcinosis. LYMPH NODES: Scattered prominent para-aortic lymph nodes. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Extensively redundant colon. The appendix is not visualized. Scattered diverticula. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Extensive vascular calcifications. Severe calcifications are noted at the origin of the SMA with high-grade near complete stenosis. Similar-appearing extensive calcifications are noted at the origin of both renal arteries, left worse than right with high-grade near complete stenoses. URINARY BLADDER: Mildly distended. REPRODUCTIVE ORGANS: The uterus is absent. No adnexal mass. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Mildly comminuted proximal left clavicular fracture. There is also deformity of the right proximal clavicle and a more chronic appearance. The posterior left ribs. Bilateral internal fixation of the proximal humerus. Chronic deformity of the right inferior rami. THORACIC: VERTEBRA: Multiple age-indeterminate anterior wedge deformity and endplate deformities involving the T1, T4, T7, and T11. Deformities at T7 and T11 appear chronic. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. Mild multilevel discogenic degenerative change. PREVERTEBRAL SOFT TISSUES: Unremarkable. LUMBAR: VERTEBRA: Irregularity of the superior endplate of L4, technically age indeterminate. Kyphoplasty changes at L1. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. Advanced discogenic degenerative change of lower lumbar spine facet arthropathy. PREVERTEBRAL SOFT TISSUES: Unremarkable.
16,011	MR Brain wo contrast, MR Angio Head wo contrast 1/28/2022 4:56 PM Clinical Information: Benign intracranial hypertension, H93.A2 Pulsatile tinnitus, left ear Spec Inst: Left-sided pulsatile tinnitus Comparison: None. Technique: Axial FLAIR/T2, axial DWI, coronal T1, axial 3-D T2 SPACE images through the IAC and labyrinth. 3-D single slab time-of-flight MRA of the head with multiple MIP and 3-D SSD reconstruction. Findings: Prominent left AICA gives rise to multiple branches, which are looping around the left porus acusticus and crossing over the cisternal portion of the left vestibulocochlear nerve. The left superior petrosal sinus appears engorged. No intracranial aneurysm or large vessel steno-occlusive disease is noted. The left PCA is fetal origin. The IACs and cerebellopontine angle cisterns are symmetric with no space-occupying lesion. The cochlea and vestibule show no structural abnormalities. The bony coverage of the superior semicircular canal is intact. The cranial nerves VII, VIII, V, IX and X are normally visualized. The left mastoid antrum and air cells are opacified with effusion. There is no evidence of retrocochlear pathology or intracranial structural abnormality. No focal signal abnormality is seen in the brain and brainstem. Impression: Prominent left AICA branches looping around the porus acusticus and cisternal portion of the left vestibulocochlear nerve concerning for small dural aVF with neurovascular compression.	Findings: Prominent left AICA gives rise to multiple branches, which are looping around the left porus acusticus and crossing over the cisternal portion of the left vestibulocochlear nerve. The left superior petrosal sinus appears engorged. No intracranial aneurysm or large vessel steno-occlusive disease is noted. The left PCA is fetal origin. The IACs and cerebellopontine angle cisterns are symmetric with no space-occupying lesion. The cochlea and vestibule show no structural abnormalities. The bony coverage of the superior semicircular canal is intact. The cranial nerves VII, VIII, V, IX and X are normally visualized. The left mastoid antrum and air cells are opacified with effusion. There is no evidence of retrocochlear pathology or intracranial structural abnormality. No focal signal abnormality is seen in the brain and brainstem.	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 (
16,012	MR Breast Screening wo+w contrast CLINICAL INFORMATION: Hx of Triple negative breast cancer --pre menopausal patient with post-surgical lumpecotmy changes, C50.919 Malignant neoplasm of unspecified site of unspecified female breast, Z17.1 Estrogen receptor negative status [ER-] Spec Inst: Hx of Triple negative breast cancer --pre menopausal patient with post-surgical lumpecotmy changes. Annual fu. TECHNIQUE: T1 axial, FSE T2 fat sat axial, pre and post contrast vibrant sequence with 3D reconstructions and time intensity curves. Delayed post contrast sagittal. A dedicated 8 channel breast imaging coil was utilized. Patient weight: 170 lbs. IV contrast: ProHance, 16 ml, per protocol. IV contrast injection rate: 2 ml per sec. COMPARISON: Prior studies including most recent MRI from January 2021 FINDINGS: All measurements provided in the format AP, TV, CC dimensions Breast tissue is scattered fibroglandular tissue. Postcontrast administration there is mild background enhancement. RIGHT BREAST: No suspicious mass, nonmass enhancement, or distortion is seen. Continued decrease in trace enhancement at lumpectomy site consistent with benign evolving fat necrosis LEFT BREAST: No suspicious mass, nonmass enhancement, or distortion is seen. BILATERAL Internal mammary and axillary nodes unremarkable. EXTRAMAMMARY: There is no suspicious abnormality in the visualized lung fields. Visualized upper abdomen unremarkable. Marrow signal is normal. IMPRESSION: RIGHT BREAST: No MRI evidence of malignancy. BI-RADS 2: Benign LEFT BREAST: No MRI evidence of malignancy. BI-RADS 2: Benign Overall BI-RADS assessment: BI-RADS 2: Benign	FINDINGS: All measurements provided in the format AP, TV, CC dimensions Breast tissue is scattered fibroglandular tissue. Postcontrast administration there is mild background enhancement. RIGHT BREAST: No suspicious mass, nonmass enhancement, or distortion is seen. Continued decrease in trace enhancement at lumpectomy site consistent with benign evolving fat necrosis LEFT BREAST: No suspicious mass, nonmass enhancement, or distortion is seen. BILATERAL Internal mammary and axillary nodes unremarkable. EXTRAMAMMARY: There is no suspicious abnormality in the visualized lung fields. Visualized upper abdomen unremarkable. Marrow signal is normal.	FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: The trachea and central airways are patent. Biapical pleural-parenchymal scarring. Basilar predominant chronic lung changes including septal thickening, reticular opacities, and mild bronchiectasis. Dependent basilar atelectasis is also noted. HEART / VESSELS: Right atrial enlargement. Papillary muscle calcifications as well as coronary calcifications. MEDIASTINUM / ESOPHAGUS: Small hiatal hernia. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Simple hepatic cysts. Other scattered hypoattenuating lesions are too small to characterize. BILIARY TRACT: Mild central predominant intrahepatic and extrahepatic biliary ductal dilatation. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Increased attenuation involving the right renal middle lobe suggestive of medullary nephrocalcinosis. LYMPH NODES: Scattered prominent para-aortic lymph nodes. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Extensively redundant colon. The appendix is not visualized. Scattered diverticula. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Extensive vascular calcifications. Severe calcifications are noted at the origin of the SMA with high-grade near complete stenosis. Similar-appearing extensive calcifications are noted at the origin of both renal arteries, left worse than right with high-grade near complete stenoses. URINARY BLADDER: Mildly distended. REPRODUCTIVE ORGANS: The uterus is absent. No adnexal mass. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Mildly comminuted proximal left clavicular fracture. There is also deformity of the right proximal clavicle and a more chronic appearance. The posterior left ribs. Bilateral internal fixation of the proximal humerus. Chronic deformity of the right inferior rami. THORACIC: VERTEBRA: Multiple age-indeterminate anterior wedge deformity and endplate deformities involving the T1, T4, T7, and T11. Deformities at T7 and T11 appear chronic. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. Mild multilevel discogenic degenerative change. PREVERTEBRAL SOFT TISSUES: Unremarkable. LUMBAR: VERTEBRA: Irregularity of the superior endplate of L4, technically age indeterminate. Kyphoplasty changes at L1. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. Advanced discogenic degenerative change of lower lumbar spine facet arthropathy. PREVERTEBRAL SOFT TISSUES: Unremarkable.
16,013	EXAM: MR Knee Right wo contrast CLINICAL INFORMATION: Right knee pain after injury COMPARISON: 1/22/2022 TECHNIQUE: MR Knee Right wo contrast STRUCTURED REPORT: MRI Knee 1/2/2020 FINDINGS: BONES:No fracture, marrow replacement, or aggressive osseous lesion. ARTICULATIONS: Effusion:Moderate Patellofemoral compartment:No cartilage defect. Medial compartment:No cartilage defect. Lateral compartment:No cartilage defect. MENISCI: Medial meniscus:Intact. Lateral meniscus:Intact. LIGAMENTS: Cruciate ligaments:Complete tear of the ACL. PCL is intact. Medial collateral ligament:High-grade tear of the superficial and deep fibers of the MCL proximally. High-grade tear of the femoral attachment of the medial patellofemoral ligament. There is a large knee joint effusion but only a small amount of the fluid is extravasating through the MPFL. Lateral collateral ligament:Full-thickness tear through the lateral patellar retinaculum at the femoral attachment site. Posterolateral corner structures:Intact. EXTENSOR MECHANISM:The distal quadriceps and patellar tendons are intact. Moderate soft tissue edema about the knee. CONCLUSION: 1. Complete tear of the ACL. 2. High-grade tear of the superficial and deep fibers of the MCL proximally. 3. High-grade, probably complete tear through the femoral attachment of the medial patellofemoral ligament. 4. Complete tear of the lateral patellar retinaculum at the femoral epicondyle attachment. 5. Moderate suprapatellar joint effusion. 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:No fracture, marrow replacement, or aggressive osseous lesion. ARTICULATIONS: Effusion:Moderate Patellofemoral compartment:No cartilage defect. Medial compartment:No cartilage defect. Lateral compartment:No cartilage defect. MENISCI: Medial meniscus:Intact. Lateral meniscus:Intact. LIGAMENTS: Cruciate ligaments:Complete tear of the ACL. PCL is intact. Medial collateral ligament:High-grade tear of the superficial and deep fibers of the MCL proximally. High-grade tear of the femoral attachment of the medial patellofemoral ligament. There is a large knee joint effusion but only a small amount of the fluid is extravasating through the MPFL. Lateral collateral ligament:Full-thickness tear through the lateral patellar retinaculum at the femoral attachment site. Posterolateral corner structures:Intact. EXTENSOR MECHANISM:The distal quadriceps and patellar tendons are intact. Moderate soft tissue edema about the knee.	FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: The trachea and central airways are patent. Biapical pleural-parenchymal scarring. Basilar predominant chronic lung changes including septal thickening, reticular opacities, and mild bronchiectasis. Dependent basilar atelectasis is also noted. HEART / VESSELS: Right atrial enlargement. Papillary muscle calcifications as well as coronary calcifications. MEDIASTINUM / ESOPHAGUS: Small hiatal hernia. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Simple hepatic cysts. Other scattered hypoattenuating lesions are too small to characterize. BILIARY TRACT: Mild central predominant intrahepatic and extrahepatic biliary ductal dilatation. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Increased attenuation involving the right renal middle lobe suggestive of medullary nephrocalcinosis. LYMPH NODES: Scattered prominent para-aortic lymph nodes. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Extensively redundant colon. The appendix is not visualized. Scattered diverticula. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Extensive vascular calcifications. Severe calcifications are noted at the origin of the SMA with high-grade near complete stenosis. Similar-appearing extensive calcifications are noted at the origin of both renal arteries, left worse than right with high-grade near complete stenoses. URINARY BLADDER: Mildly distended. REPRODUCTIVE ORGANS: The uterus is absent. No adnexal mass. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Mildly comminuted proximal left clavicular fracture. There is also deformity of the right proximal clavicle and a more chronic appearance. The posterior left ribs. Bilateral internal fixation of the proximal humerus. Chronic deformity of the right inferior rami. THORACIC: VERTEBRA: Multiple age-indeterminate anterior wedge deformity and endplate deformities involving the T1, T4, T7, and T11. Deformities at T7 and T11 appear chronic. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. Mild multilevel discogenic degenerative change. PREVERTEBRAL SOFT TISSUES: Unremarkable. LUMBAR: VERTEBRA: Irregularity of the superior endplate of L4, technically age indeterminate. Kyphoplasty changes at L1. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. Advanced discogenic degenerative change of lower lumbar spine facet arthropathy. PREVERTEBRAL SOFT TISSUES: Unremarkable.
16,014	RADIOLOGIC EXAM: MR Brain wo+w contrast CLINICAL INFORMATION: Epilepsy, unspecified, not intractable, without status epilepticus. Per chart review, posttraumatic epilepsy after major occipital pole, gated by intracranial hemorrhage requiring intervention in 2017. EEG on 11/8/2019 before epileptic form discharges persisting over the right hemisphere/central region, indicating cortical irritability and active ictal focus, as well as right hemispheric slowing. COMPARISON: MRI brain dated 3/16/2018. CT head dated 11/2/2019, 9/23/2019. TECHNIQUE: MR Brain wo+w contrast Patient weight: 145 lbs. IV contrast: ProHance, 10 ml, per protocol. Multiple T1 and T2-weighted MR sequence images of the brain were obtained in the sagittal axial and coronal planes pre- and post administration of intravenous contrast per departmental protocol. FINDINGS: INTRACRANIAL FINDINGS: Stable right greater than left bifrontal and right temporo-occipital chronic encephalomalacia/gliosis with extensive confluent T2/FLAIR hyperintense changes. Residual chronic blood products in the right frontal lobe as well as right frontotemporal and occipital sulci from prior intraparenchymal/subarachnoid hemorrhage, unchanged. Additional punctate focus of susceptibility artifact at the right temporal occipital junction, unchanged, likely chronic microhemorrhage. No acute intraparenchymal infarct, hemorrhage, edema, hydrocephalus, space-occupying lesion, or mass effect. Postcontrast series demonstrates no focal enhancing lesion. Age-appropriate, mild generalized cerebral volume loss. Additional confluent periventricular and scattered punctate deep cerebral T2/FLAIR hyperintensities, similar to prior, likely superimposed moderate chronic microangiopathic changes. Stable proportion ex vacuo ventricular dilatation of the right greater than left lateral ventricles secondary to focal atrophy and chronic encephalomalacia. Cavum septum pellucidum et vergae, incidental variant. The basal cisterns are clear. The visualized proximal cerebrovascular flow voids appear normal. EXTRACRANIAL FINDINGS: Right frontal calvarial burr hole, unchanged. The visualized extracranial osseous and soft tissue structures otherwise demonstrate normal signal characteristics. Trace bilateral maxillary, ethmoid, and frontal sinus mucosal thickening. Trace bilateral mastoid effusions. The paranasal sinuses are otherwise clear. Bilateral ocular lens replacements. CONCLUSION: 1. No acute intracranial process. No pathologic enhancement. 2. Stable right cerebral multiple encephalomalacia/gliosis. Stable residual chronic blood products from remote right frontal intraparenchymal hemorrhage as well as extensive right hemispheric subarachnoid hemorrhages. 3. Trace bilateral mastoid effusions. 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: INTRACRANIAL FINDINGS: Stable right greater than left bifrontal and right temporo-occipital chronic encephalomalacia/gliosis with extensive confluent T2/FLAIR hyperintense changes. Residual chronic blood products in the right frontal lobe as well as right frontotemporal and occipital sulci from prior intraparenchymal/subarachnoid hemorrhage, unchanged. Additional punctate focus of susceptibility artifact at the right temporal occipital junction, unchanged, likely chronic microhemorrhage. No acute intraparenchymal infarct, hemorrhage, edema, hydrocephalus, space-occupying lesion, or mass effect. Postcontrast series demonstrates no focal enhancing lesion. Age-appropriate, mild generalized cerebral volume loss. Additional confluent periventricular and scattered punctate deep cerebral T2/FLAIR hyperintensities, similar to prior, likely superimposed moderate chronic microangiopathic changes. Stable proportion ex vacuo ventricular dilatation of the right greater than left lateral ventricles secondary to focal atrophy and chronic encephalomalacia. Cavum septum pellucidum et vergae, incidental variant. The basal cisterns are clear. The visualized proximal cerebrovascular flow voids appear normal. EXTRACRANIAL FINDINGS: Right frontal calvarial burr hole, unchanged. The visualized extracranial osseous and soft tissue structures otherwise demonstrate normal signal characteristics. Trace bilateral maxillary, ethmoid, and frontal sinus mucosal thickening. Trace bilateral mastoid effusions. The paranasal sinuses are otherwise clear. Bilateral ocular lens replacements.	FINDINGS: BRAIN PARENCHYMA: No intraparenchymal hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. Confluent periventricular white matter hypoattenuation consistent with advanced degenerative change. Encephalomalacia in the anterior right temporal lobe. Remote infarcts in the bilateral basal ganglia. Advanced diffuse parenchymal volume loss. EXTRA-AXIAL SPACES: Small volume extra-axial hemorrhage in the right medial frontal, right temporal, and left inferior temporal convexities. Small extra-axial hemorrhage in the right cerebellar convexity. No mass effect or midline shift. VENTRICULAR SYSTEM: Asymmetric ex vacuo dilatation of the right lateral ventricle. ORBITS: Bilateral pseudophakia. No fracture. SKULL AND SKULL BASE: Nondisplaced obliquely oriented right occipital bone fracture extending to the petrous temporal bone. Bilateral mastoid air cells are clear. Moderate-sized left parietal scalp hematoma. FACIAL BONES: No fracture. Pterygoid plates are intact. MANDIBLE: No fracture. Bilateral temporomandibular joints are intact. SINONASAL CAVITIES: Moderate mucosal thickening of the right sphenoid sinus.
16,015	MR Lumbar Spine wo contrast 1/28/2022 4:55 PM CLINICAL INFORMATION: Lumbar radiculopathy, > 6 wks, M47.816 Spondylosis without myelopathy or radiculopathy, lumbar region, R20.8 Other disturbances of skin sensation, R20.2 Paresthesia of skin, M54.16 Radiculopathy, lumbar region, M54.50 Low back pain, unspecified COMPARISON: Lumbar spine MR, 1221. TECHNIQUE: Multiplanar, multisequence MR images of the lumbar spine were obtained without the administration of intravenous contrast. FINDINGS: The lumbar spine is normal in alignment. Again seen are Modic type II degenerative endplate changes at the superior and inferior endplates of the L5 vertebral body. There is progressive Schmorl's node formation noted at T12 and L1. Vertebral osseous hemangiomas are again seen at T12 and L1 in addition to T10. The conus appears normal terminating at the level T12-L1. Additional findings are given on a segmental basis: T12-L1: Mild facet arthropathy. No spinal canal stenosis or neural foraminal narrowing. L1-L2: No spinal canal stenosis or neural foraminal narrowing appreciated. L2-L3: There is a broad-based posterior disc bulge which results in mild narrowing of the thecal sac without appreciable nerve root compression. Bilateral facet arthropathy is noted, though there is no significant neural foraminal narrowing. L3-L4: There is a broad-based posterior disc bulge resulting in moderate spinal canal stenosis which is slightly worsened at this level compared to the prior examination, and is contributed to by bilateral facet arthropathy and ligamentum flavum hypertrophy additionally, there is mild bilateral neural foraminal narrowing. L4-L5: There is a broad-based posterior disc bulge at this level which results in mild to moderate spinal canal stenosis, contributed to by bilateral facet arthropathy and ligamentum flavum hypertrophy. These changes also result in mild bilateral neural foraminal stenosis. There is a left subarticular focal disc extrusion impinging left L5 nerve root. L5-S1: There is a broad-based posterior disc bulge which does not significantly narrow the thecal sac. Bilateral facet arthropathy is present resulting in mild right neural foraminal narrowing. Limited evaluation of the intra-abdominal structures shows a simple appearing right renal cyst, otherwise unremarkable. The paraspinal musculature is within normal limits. CONCLUSION: 1. Progressive degenerative changes of the lumbar spine with slight interval worsening of moderate spinal canal stenosis seen at L3-L4 and relatively unchanged mild to moderate spinal canal stenosis at L4-L5. 2. Left subarticular focal disc extrusion at L4-L5 impinging left L5 nerve root. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.	FINDINGS: The lumbar spine is normal in alignment. Again seen are Modic type II degenerative endplate changes at the superior and inferior endplates of the L5 vertebral body. There is progressive Schmorl's node formation noted at T12 and L1. Vertebral osseous hemangiomas are again seen at T12 and L1 in addition to T10. The conus appears normal terminating at the level T12-L1. Additional findings are given on a segmental basis: T12-L1: Mild facet arthropathy. No spinal canal stenosis or neural foraminal narrowing. L1-L2: No spinal canal stenosis or neural foraminal narrowing appreciated. L2-L3: There is a broad-based posterior disc bulge which results in mild narrowing of the thecal sac without appreciable nerve root compression. Bilateral facet arthropathy is noted, though there is no significant neural foraminal narrowing. L3-L4: There is a broad-based posterior disc bulge resulting in moderate spinal canal stenosis which is slightly worsened at this level compared to the prior examination, and is contributed to by bilateral facet arthropathy and ligamentum flavum hypertrophy additionally, there is mild bilateral neural foraminal narrowing. L4-L5: There is a broad-based posterior disc bulge at this level which results in mild to moderate spinal canal stenosis, contributed to by bilateral facet arthropathy and ligamentum flavum hypertrophy. These changes also result in mild bilateral neural foraminal stenosis. There is a left subarticular focal disc extrusion impinging left L5 nerve root. L5-S1: There is a broad-based posterior disc bulge which does not significantly narrow the thecal sac. Bilateral facet arthropathy is present resulting in mild right neural foraminal narrowing. Limited evaluation of the intra-abdominal structures shows a simple appearing right renal cyst, otherwise unremarkable. The paraspinal musculature is within normal limits.	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 (
16,016	MR Lumbar Spine wo+w contrast 1/28/2022 6:00 PM CLINICAL INFORMATION: Bone neoplasm, LS-spine, recurrence suspected, M51.26 Other intervertebral disc displacement, lumbar region, C67.9 Malignant neoplasm of bladder, unspecified COMPARISON: Prior MR lumbar spine 3/18/2005. TECHNIQUE: Multiplanar, multisequence MR images of the lumbar spine were obtained before and after the administration of intravenous contrast. Patient weight: 255 lbs. IV contrast injection rate: 0.50 ml per sec. FINDINGS: There is mild anterolisthesis of L3 over L4 and mild retrolisthesis of L5 over S1. These findings are new since the prior examination. Vertebral body heights are maintained. There is severe disc height loss at L5-S1. There are mixed Modic type III and Modic type I degenerative endplate changes at the level of L4-L5 mostly along the anterior and right lateral aspect, where there is a broad-based anterior disc bulge which is significantly progressed since the prior examination. This region also demonstrates enhancement along both vertebral endplates in a somewhat peripheral distribution, with some enhancement along the anterior longitudinal ligament. No other abnormal enhancing region is identified. No definite enhancement of the intervertebral disc. The conus is unremarkable, terminating at the level of L1. Additional findings given on a segmental basis as below: T12-L1: There is a broad-based posterior disc bulge, ligamentum flavum hypertrophy, and facet arthropathy which do not result in significant spinal canal stenosis at this level. No neural foraminal narrowing. L1-L2: There is a broad-based posterior disc bulge which preferentially narrows the left lateral recess. There is mild facet arthropathy, and these findings contribute to mild spinal canal stenosis at this level. Additionally, there is mild left neural foraminal narrowing. L2-L3: There is a broad-based posterior disc bulge, ligamentum flavum hypertrophy, and facet arthropathy which results in mild to moderate spinal canal stenosis. These findings also contribute to mild bilateral neural foraminal narrowing. L3-L4: Mild anterolisthesis of L3 over L4 is noted with a broad-based posterior disc bulge, ligamentum flavum hypertrophy, and facet arthropathy which results in moderate spinal canal stenosis at this level. Additionally, there is moderate neural foraminal narrowing bilaterally. L4-L5: There is a broad-based posterior disc bulge, facet arthropathy, and ligamenta flavum hypertrophy tilting and mild spinal canal stenosis. However, there is a severe right and moderate left neural foraminal narrowing secondary to these changes. L5-S1: Mild retrolisthesis of L5 over S1 is noted. However, there is no spinal canal stenosis at this level. Mild bilateral neural foraminal narrowing is noted. Limited evaluation of the intra-abdominal structures shows no significant abnormality. The paraspinal musculature is mildly atrophied. CONCLUSION: 1. Advanced degenerative changes of the lumbar spine most pronounced at L4-L5 where there is anterior disc bulging, mixed Modic type I and type III degenerative endplate changes, and associated enhancement near the vertebral endplates. Enhancement is most likely related to an acute degenerative process, and much less likely a neoplastic or infective process. 2. Moderate spinal canal stenosis at L3-L4, with additional areas of mild spinal canal narrowing as above. 3. Multilevel neural foraminal narrowing with severe right neural foraminal stenosis noted at L4-L5, likely contacting the exiting L4 nerve root. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.	FINDINGS: There is mild anterolisthesis of L3 over L4 and mild retrolisthesis of L5 over S1. These findings are new since the prior examination. Vertebral body heights are maintained. There is severe disc height loss at L5-S1. There are mixed Modic type III and Modic type I degenerative endplate changes at the level of L4-L5 mostly along the anterior and right lateral aspect, where there is a broad-based anterior disc bulge which is significantly progressed since the prior examination. This region also demonstrates enhancement along both vertebral endplates in a somewhat peripheral distribution, with some enhancement along the anterior longitudinal ligament. No other abnormal enhancing region is identified. No definite enhancement of the intervertebral disc. The conus is unremarkable, terminating at the level of L1. Additional findings given on a segmental basis as below: T12-L1: There is a broad-based posterior disc bulge, ligamentum flavum hypertrophy, and facet arthropathy which do not result in significant spinal canal stenosis at this level. No neural foraminal narrowing. L1-L2: There is a broad-based posterior disc bulge which preferentially narrows the left lateral recess. There is mild facet arthropathy, and these findings contribute to mild spinal canal stenosis at this level. Additionally, there is mild left neural foraminal narrowing. L2-L3: There is a broad-based posterior disc bulge, ligamentum flavum hypertrophy, and facet arthropathy which results in mild to moderate spinal canal stenosis. These findings also contribute to mild bilateral neural foraminal narrowing. L3-L4: Mild anterolisthesis of L3 over L4 is noted with a broad-based posterior disc bulge, ligamentum flavum hypertrophy, and facet arthropathy which results in moderate spinal canal stenosis at this level. Additionally, there is moderate neural foraminal narrowing bilaterally. L4-L5: There is a broad-based posterior disc bulge, facet arthropathy, and ligamenta flavum hypertrophy tilting and mild spinal canal stenosis. However, there is a severe right and moderate left neural foraminal narrowing secondary to these changes. L5-S1: Mild retrolisthesis of L5 over S1 is noted. However, there is no spinal canal stenosis at this level. Mild bilateral neural foraminal narrowing is noted. Limited evaluation of the intra-abdominal structures shows no significant abnormality. The paraspinal musculature is mildly atrophied.	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. Trace right mastoid air cell effusion. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Paranasal sinuses are clear. VESSELS: Scattered calcified atherosclerosis of the bilateral carotid siphons.
16,017	MR Breast Diagnostic Bil wo+w contrast CLINICAL INFORMATION: Multicentric Breast Cancer, C50.919 Malignant neoplasm of unspecified site of unspecified female breast Spec Inst: Evaluate extent of disease. TECHNIQUE: T1 axial, FSE T2 fat sat axial, pre and post contrast vibrant sequence with 3D reconstructions and time intensity curves. Delayed post contrast axials. A dedicated 8 channel breast imaging coil was utilized. Patient weight: 211 lbs. IV contrast: ProHance, 20 ml, per protocol. IV contrast injection rate: 2 ml per sec. COMPARISON: Prior studies including diagnostic evaluation from December 2021 FINDINGS: All measurements provided in the format AP, TV, CC dimensions Breast tissue is scattered fibroglandular tissue. Postcontrast administration there is minimal background enhancement. RIGHT BREAST: Please note, at least 4 different sites were identified on sonography, all now consistent with malignancy; however, the numerous sites described below are not well-seen with ultrasound. Total size measures approximately 59 x 47 x 67 mm. Finding 1: Conglomerate of irregular masses in the right breast lower inner quadrant anterior depth measures approximately 38 x 10 x 25 mm on series 400 image 169 and series 6 image 147. This extends to and involves the skin. This is biopsy-proven high-grade invasive ductal carcinoma. Additional sites of skin enhancement noted on series 400 image 165 in the lower outer Finding 2: Irregular mass approximately 4 mm posterior to Finding 1 measures 10 x 7 x 13 mm on series 400 image 164 and series 6 image 160. This is malignant until proven otherwise and consistent with satellite mass. Findings 3: Irregular mass measuring 10 x 16 x 9 mm on series 400 image 163 and series 6 image 156 with signal void representing biopsy clip is biopsy-proven invasive ductal carcinoma, high-grade. Finding 4: Extensive segmental nonmass enhancement spanning the lower inner quadrant and extending into the lower outer quadrant.. 2 separate groups, one measuring 46 x 16 mm and one measuring 39 x 23 mm on series 400 image is 162 and 158, respectively. These extend to site of malignancy. Additional linear nonmass enhancement extending from site of malignancy towards the lower outer quadrant noted on series 400 image 159 through 162. Finding 5:9 x 5 x 13 mm irregular mass in the lower outer quadrant middle depth. This has similar appearance to additional irregular masses throughout the right breast. LEFT BREAST: Focal nonmass enhancement lower outer quadrant middle depth measures 15 x 11 x 6 mm on series 400 image 142 and series 6 image 46. BILATERAL Internal mammary and axillary nodes are normal EXTRAMAMMARY: There is no suspicious abnormality in the visualized lung fields. Visualized upper abdomen unremarkable. Marrow signal is normal. IMPRESSION: RIGHT BREAST: Multicentric malignancy involving right lower inner and lower outer quadrants. See above for specific sites. This involves skin as discussed.: BI-RADS 6: Biopsy-proven malignancy. Surgical excision when clinically appropriate LEFT BREAST: Focal nonmass enhancement lower outer quadrant middle depth is suspicious. MRI guided biopsy recommended.: BI-RADS 4: Suspicious Overall BI-RADS assessment: BI-RADS 4: Suspicious	FINDINGS: All measurements provided in the format AP, TV, CC dimensions Breast tissue is scattered fibroglandular tissue. Postcontrast administration there is minimal background enhancement. RIGHT BREAST: Please note, at least 4 different sites were identified on sonography, all now consistent with malignancy; however, the numerous sites described below are not well-seen with ultrasound. Total size measures approximately 59 x 47 x 67 mm. Finding 1: Conglomerate of irregular masses in the right breast lower inner quadrant anterior depth measures approximately 38 x 10 x 25 mm on series 400 image 169 and series 6 image 147. This extends to and involves the skin. This is biopsy-proven high-grade invasive ductal carcinoma. Additional sites of skin enhancement noted on series 400 image 165 in the lower outer Finding 2: Irregular mass approximately 4 mm posterior to Finding 1 measures 10 x 7 x 13 mm on series 400 image 164 and series 6 image 160. This is malignant until proven otherwise and consistent with satellite mass. Findings 3: Irregular mass measuring 10 x 16 x 9 mm on series 400 image 163 and series 6 image 156 with signal void representing biopsy clip is biopsy-proven invasive ductal carcinoma, high-grade. Finding 4: Extensive segmental nonmass enhancement spanning the lower inner quadrant and extending into the lower outer quadrant.. 2 separate groups, one measuring 46 x 16 mm and one measuring 39 x 23 mm on series 400 image is 162 and 158, respectively. These extend to site of malignancy. Additional linear nonmass enhancement extending from site of malignancy towards the lower outer quadrant noted on series 400 image 159 through 162. Finding 5:9 x 5 x 13 mm irregular mass in the lower outer quadrant middle depth. This has similar appearance to additional irregular masses throughout the right breast. LEFT BREAST: Focal nonmass enhancement lower outer quadrant middle depth measures 15 x 11 x 6 mm on series 400 image 142 and series 6 image 46. BILATERAL Internal mammary and axillary nodes are normal EXTRAMAMMARY: There is no suspicious abnormality in the visualized lung fields. Visualized upper abdomen unremarkable. Marrow signal is normal.	FINDINGS: FACIAL BONES: No fracture. Bilateral pterygoid plates are intact. MANDIBLE: No fracture. Bilateral temporomandibular joints are intact. Small laceration/hematoma with associated small foci of gas in the left mandibular soft tissues. REMAINING VISUALIZED BONES: Normal. SINONASAL CAVITIES: Paranasal sinuses are clear. VISUALIZED INTRACRANIAL STRUCTURES: Normal. ORBITAL CONTENTS: Globes are intact. No fracture.
16,018	Stroke protocol MRI without contrast. 1/28/2022 8:17 PM Indication: dizziness, vertigo Comparison: Similar examination is not available for comparison Technique: Sagittal T1, SWI, axial diffusion, T2, FLAIR sequences were obtained. MR angiogram of head, MR angiogram of neck without contrast were also obtained; multiple MIPs were generated from the MR angiogram data set which were reviewed for interpretation. Findings: The brain is normal in appearance. There is no evidence of acute infarction, acute intracranial hemorrhage, mass, evidence of demyelinating disease, hydrocephalus or abnormal extra-axial fluid collection. There are mild white matter microangiopathic changes and mild diffuse brain volume loss. MR angiogram of head: There is no flow-limiting stenosis involving the intracranial segments of the internal carotid, basilar artery, arteries of the circle of Willis and proximal branches of anterior, middle and posterior cerebral arteries. There is no evidence of aneurysm or AVM. MR angiogram of neck: There is no flow-limiting stenosis involving the carotid bifurcation or the proximal internal carotid arteries. Forward flow is maintained in both the vertebral arteries. There is no evidence of flow-limiting stenosis. Impression: 1. No acute intracranial abnormality. 2. No flow-limiting cervical or intracranial arterial stenosis.	Findings: The brain is normal in appearance. There is no evidence of acute infarction, acute intracranial hemorrhage, mass, evidence of demyelinating disease, hydrocephalus or abnormal extra-axial fluid collection. There are mild white matter microangiopathic changes and mild diffuse brain volume loss. MR angiogram of head: There is no flow-limiting stenosis involving the intracranial segments of the internal carotid, basilar artery, arteries of the circle of Willis and proximal branches of anterior, middle and posterior cerebral arteries. There is no evidence of aneurysm or AVM. MR angiogram of neck: There is no flow-limiting stenosis involving the carotid bifurcation or the proximal internal carotid arteries. Forward flow is maintained in both the vertebral arteries. There is no evidence of flow-limiting stenosis.	FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. Moderate loculated right hydropneumothorax with pigtail thoracostomy tube in place. Mild right pleural thickening and enhancement. Right middle lobe atelectasis. Left lower lobe dependent consolidation. DISTAL ESOPHAGUS: Significantly distended and fluid-filled secondary to reflux. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Hepatic cirrhosis. No suspicious liver lesions. BILIARY TRACT: Normal. GALLBLADDER: Cholelithiasis. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Subcentimeter foci of hypoattenuation are too small for accurate characterization. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Stomach is moderately distended. Small bowel is normal in caliber. No evidence of active intraluminal hemorrhage. COLON / APPENDIX: Colonic wall edema most pronounced in the ascending colon. No evidence of active intraluminal hemorrhage. PERITONEUM / MESENTERY: Large volume low attenuating ascites. No evidence of hemoperitoneum. RETROPERITONEUM: Normal. VESSELS: Direct origin of the left gastric artery from the aortic arch with replaced left hepatic artery arising from left gastric artery. Upper abdominal varices and collaterals including left splenorenal shunt. Advanced atherosclerotic calcifications of the abdominal aorta and branch vessels. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Moderate right inguinal hernia containing ascites. Subcutaneous gas likely associated with right sided chest tube placement. MUSCULOSKELETAL: Chronic ballistic injury to the left ilium.
16,019	MR Brain wo+w contrast 1/28/2022 6:51 PM Clinical Information: frontal brain tumor Spec Inst: stealth Comparison: None available Technique: Axial diffusion, axial FLAIR, sagittal 3-D FLAIR, sagittal T1, axial T2, SWI, post contrast axial and 3-D sagittal T1 with axial and coronal reformats and DSC perfusion series. Patient weight: 152 lbs. IV contrast: ProHance, 7 ml, per protocol. IV contrast injection rate: 3 ml per sec. Findings: There is a large abscess in the right frontal lobe measuring 4.8 x 5.1 x 4.1 cm which shows restricted diffusion and peripheral enhancement. This abscess is contiguous with the abscess in the right frontal sinus. There is restricted diffusion throughout the paranasal sinuses. There is significant vasogenic edema and mass effect resulting in effacement of the frontal horns of both lateral ventricles with subfalcine herniation and extension of edema into the left frontal lobe across the corpus callosum. Susceptibility is noted along the periphery of the abscess in the inferior frontal region. Postcontrast images also demonstrate enhancement of the right frontotemporal dura with subperiosteal abscess along the posterior wall of the right frontal sinus. There is small amount of extra-axial fluid along the right frontal and temporal convexities which does not show restricted diffusion. Diffuse peripheral mucosal enhancement is seen throughout the paranasal sinuses with exception of the left posterior ethmoid air cells and the left sphenoid sinus. Perfusion images have not been processed at the time of dictation. There are findings of increased intracranial pressure with prominence of optic nerve sheaths bilaterally and flattening of the posterior globes as well as bulging of optic discs. There is increased FLAIR signal adjacent to the occipital horns of both lateral ventricles. Both orbits appear normal no abnormal enhancement within the orbits. Impression: 1. Large abscess within the right frontal lobe with significant associated mass effect and midline shift and features of elevated intracranial pressure. Abscess is contiguous with the right frontal sinus. Associated small subperiosteal abscess along the posterior wall of the right frontal sinus and dural enhancement in the right frontal and temporal regions. No evidence of brain tumor. 2. Diffuse enhancement throughout the paranasal sinuses with associated diffusion restriction. These results were discussed with Abigail Croft RN by Dr. Atif Haneef at 7:45 PM on 1/28/2022.	Findings: There is a large abscess in the right frontal lobe measuring 4.8 x 5.1 x 4.1 cm which shows restricted diffusion and peripheral enhancement. This abscess is contiguous with the abscess in the right frontal sinus. There is restricted diffusion throughout the paranasal sinuses. There is significant vasogenic edema and mass effect resulting in effacement of the frontal horns of both lateral ventricles with subfalcine herniation and extension of edema into the left frontal lobe across the corpus callosum. Susceptibility is noted along the periphery of the abscess in the inferior frontal region. Postcontrast images also demonstrate enhancement of the right frontotemporal dura with subperiosteal abscess along the posterior wall of the right frontal sinus. There is small amount of extra-axial fluid along the right frontal and temporal convexities which does not show restricted diffusion. Diffuse peripheral mucosal enhancement is seen throughout the paranasal sinuses with exception of the left posterior ethmoid air cells and the left sphenoid sinus. Perfusion images have not been processed at the time of dictation. There are findings of increased intracranial pressure with prominence of optic nerve sheaths bilaterally and flattening of the posterior globes as well as bulging of optic discs. There is increased FLAIR signal adjacent to the occipital horns of both lateral ventricles. Both orbits appear normal no abnormal enhancement within the orbits.	FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Central airways are patent. A focal groundglass opacity in the superior segment of the right lower lobe crossing over into the right upper lobe is similar in appearance, measuring approximately 1.4 x 1.4 cm (axial image 291) and 1.4 x 1.2 cm at its inferior aspect (axial image 306, previously 1.3 x 1.3 cm). This measures 1.8cm in maximal craniocaudad dimension. An additional unchanged focal groundglass nodule in the right lower lobe measures 0.5 cm (axial image 439). No other suspicious pulmonary nodule or opacity. Biapical pleural parenchymal scarring. Tiny left upper lobe nodular opacity best seen on series #201 image #271 which may be artifactual in nature and unchanged. No pneumothorax or pleural effusion. HEART / VESSELS: Heart size is normal. Mild atherosclerotic calcifications of the coronary arteries and thoracic aorta. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: No significant abnormality. MUSCULOSKELETAL: Mild multilevel discogenic degenerative changes of the thoracic spine. No aggressive osseous lesion.
16,020	MR Brain wo+w contrast 1/28/2022 5:08 PM CLINICAL INFORMATION: Small cell lung cancer treatment response evaluation, M19.90 Unspecified osteoarthritis, unspecified site COMPARISON: Prior MR brain 8/12/2021. TECHNIQUE: Multiplanar, multisequence MR images of the brain were obtained before and after the administration of intravenous contrast. Patient weight: 135 lbs. IV contrast: ProHance, 13 ml, per protocol. IV contrast injection rate: 1 ml per sec. FINDINGS: There is no restricted diffusion. Increased, T2/FLAIR signal is again seen within the central pons, likely microangiopathy. The ventricles are unchanged in size, there is no midline shift. Appropriate major flow voids are present. On postcontrast images there is no focal or abnormal enhancement seen. No intracranial hemorrhage identified. The bilateral orbits are within normal limits. The paranasal sinuses and the mastoid air cells are clear. CONCLUSION: No acute intracranial abnormality, and no evidence of metastatic disease. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.	FINDINGS: There is no restricted diffusion. Increased, T2/FLAIR signal is again seen within the central pons, likely microangiopathy. The ventricles are unchanged in size, there is no midline shift. Appropriate major flow voids are present. On postcontrast images there is no focal or abnormal enhancement seen. No intracranial hemorrhage identified. The bilateral orbits are within normal limits. The paranasal sinuses and the mastoid air cells are clear.	Findings: There is diffuse cerebral volume loss due to atrophic changes. Prominent extra-axial spaces is secondary to volume loss. There is also diffuse deep white matter and periventricular hypodensity due to microangiopathic changes. Evidence of encephalomalacia is noted anterior to the frontal horn of right lateral ventricle associated with asymmetric ex vacuo dilatation of right lateral ventricle. There are areas of extra-axial hyperattenuation in right medial frontal lobe, right medial temporal lobe and lateral aspect of right cerebellar hemisphere, suggesting of a small volume of extra-axial hemorrhage, unchanged since prior study. There is a tiny new subdural hemorrhage in posterior portion of falx cerebri. Calcified atherosclerosis of bilateral vertebral arteries, basilar artery, both ICAs are seen. Ord lacunar infarction of the left aspect of pons and the right caudate head is seen. No intracranial mass, mass effect, edema, or hydrocephalus is seen. No acute infarction seen. Mild mucosal thickening of bilateral maxillary sinuses is seen. There is a stable linear right occipital bone fracture with extension to the right petrosal bone. There is a small subcutaneous hematoma in posterior portion of the vertex. The visualized parts of other paranasal sinuses and mastoid air cells are clear. No acute soft tissue abnormality seen.
16,021	MR Thoracic Spine wo contrast, MR Cervical Spine wo contrast 1/28/2022 7:21 PM Clinical information: PUI for COVID neck injury, right hand weakness Comparison: CT C-spine from earlier today Technique: Multiplanar multisequence images of the cervicothoracic spine without contrast Findings: MR cervical spine: Image quality is degraded motion artifacts, limiting utility of this exam. Cervical intervertebral alignment is maintained. No evidence of fracture or marrow edema. C2-C3: No disc herniation, spinal canal or neural foramen narrowing. C3-C4: There is central disc protrusion resulting in effacement of the ventral CSF and indenting the cord without cord signal abnormalities. There is uncovertebral DJD resulting in right greater than left moderate neural foraminal narrowing at this level. C4-C5: Broad-based central disc bulge without significant spinal canal or neural foramen narrowing. There is mild effacement of ventral CSF. C5-C6: There is disc/osteophyte complex with a broad-based central disc protrusion resulting in effacement of ventral CSF and indenting the cord without definite cord signal right. There is mild left neural from narrowing. C6-C7 and C7-T1: No significant disc herniation, spinal canal or neural from narrowing. Major cervical arterial flow voids are maintained. Paraspinal soft tissues appear normal. MR thoracic spine: Thoracic intervertebral alignment is maintained. There is no bone marrow edema. Hemangioma noted within the T6 vertebral body. Mild wedging of the superior endplates of T2 and T3, likely chronic. Thoracic spinal cord appears normal. No disc herniation, spinal canal or neural foramen narrowing at any level. Impression: 1. No acute abnormality of the cervical or thoracic spine. 2. Multilevel degenerative changes of the cervical spine most significant at C3-C4 and C5-C6, indenting the cord without cord signal abnormality. There is moderate right greater than left neural foraminal narrowing at C3-C4.	Findings: MR cervical spine: Image quality is degraded motion artifacts, limiting utility of this exam. Cervical intervertebral alignment is maintained. No evidence of fracture or marrow edema. C2-C3: No disc herniation, spinal canal or neural foramen narrowing. C3-C4: There is central disc protrusion resulting in effacement of the ventral CSF and indenting the cord without cord signal abnormalities. There is uncovertebral DJD resulting in right greater than left moderate neural foraminal narrowing at this level. C4-C5: Broad-based central disc bulge without significant spinal canal or neural foramen narrowing. There is mild effacement of ventral CSF. C5-C6: There is disc/osteophyte complex with a broad-based central disc protrusion resulting in effacement of ventral CSF and indenting the cord without definite cord signal right. There is mild left neural from narrowing. C6-C7 and C7-T1: No significant disc herniation, spinal canal or neural from narrowing. Major cervical arterial flow voids are maintained. Paraspinal soft tissues appear normal. MR thoracic spine: Thoracic intervertebral alignment is maintained. There is no bone marrow edema. Hemangioma noted within the T6 vertebral body. Mild wedging of the superior endplates of T2 and T3, likely chronic. Thoracic spinal cord appears normal. No disc herniation, spinal canal or neural foramen narrowing at any level.	FINDINGS: LINES AND TUBES: Endotracheal tube terminates in mid thoracic trachea. Bilateral chest tubes are visualized. Esophagogastric drainage catheter terminates in the gastric body. LOWER NECK: Similar of subcutaneous gas within the supraclavicular region. A small hematoma is noted along the medial aspect of the left clavicle. CHEST: LUNGS / AIRWAYS / PLEURA: Small left greater than and right pneumothoraces are relatively unchanged. Small dependent consolidations have minimally increased. Several scattered pulmonary contusions with index contusion within the inferolateral aspect of the right upper lobe. A small pulmonary laceration is again visualized underneath the fifth rib laterally adjacent to a displaced rib fracture. HEART / VESSELS: Mild coronary artery calcifications. The aorta is normal in caliber. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: Prominent right paratracheal and subcarinal lymph nodes, likely reactive. CHEST WALL: Minimal expansion of the intramuscular hematoma within the lateral aspect of the left pectoralis muscle. Hematoma extends along the left chest wall posterior laterally with hematoma and gas adjacent to the left scapula. Subcutaneous gas is noted along the left greater than right chest wall. UPPER ABDOMEN: See separate abdominal dictation. MUSCULOSKELETAL: Comminuted medial left clavicle fracture, comminuted left scapula fracture. Multiple displaced and nondisplaced first through sixth rib fractures, some of which are segmental. Metallic foreign bodies are again seen in the proximal upper arm.
16,022	MR Thoracic Spine wo contrast, MR Cervical Spine wo contrast 1/28/2022 7:21 PM Clinical information: PUI for COVID neck injury, right hand weakness Comparison: CT C-spine from earlier today Technique: Multiplanar multisequence images of the cervicothoracic spine without contrast Findings: MR cervical spine: Image quality is degraded motion artifacts, limiting utility of this exam. Cervical intervertebral alignment is maintained. No evidence of fracture or marrow edema. C2-C3: No disc herniation, spinal canal or neural foramen narrowing. C3-C4: There is central disc protrusion resulting in effacement of the ventral CSF and indenting the cord without cord signal abnormalities. There is uncovertebral DJD resulting in right greater than left moderate neural foraminal narrowing at this level. C4-C5: Broad-based central disc bulge without significant spinal canal or neural foramen narrowing. There is mild effacement of ventral CSF. C5-C6: There is disc/osteophyte complex with a broad-based central disc protrusion resulting in effacement of ventral CSF and indenting the cord without definite cord signal right. There is mild left neural from narrowing. C6-C7 and C7-T1: No significant disc herniation, spinal canal or neural from narrowing. Major cervical arterial flow voids are maintained. Paraspinal soft tissues appear normal. MR thoracic spine: Thoracic intervertebral alignment is maintained. There is no bone marrow edema. Hemangioma noted within the T6 vertebral body. Mild wedging of the superior endplates of T2 and T3, likely chronic. Thoracic spinal cord appears normal. No disc herniation, spinal canal or neural foramen narrowing at any level. Impression: 1. No acute abnormality of the cervical or thoracic spine. 2. Multilevel degenerative changes of the cervical spine most significant at C3-C4 and C5-C6, indenting the cord without cord signal abnormality. There is moderate right greater than left neural foraminal narrowing at C3-C4.	Findings: MR cervical spine: Image quality is degraded motion artifacts, limiting utility of this exam. Cervical intervertebral alignment is maintained. No evidence of fracture or marrow edema. C2-C3: No disc herniation, spinal canal or neural foramen narrowing. C3-C4: There is central disc protrusion resulting in effacement of the ventral CSF and indenting the cord without cord signal abnormalities. There is uncovertebral DJD resulting in right greater than left moderate neural foraminal narrowing at this level. C4-C5: Broad-based central disc bulge without significant spinal canal or neural foramen narrowing. There is mild effacement of ventral CSF. C5-C6: There is disc/osteophyte complex with a broad-based central disc protrusion resulting in effacement of ventral CSF and indenting the cord without definite cord signal right. There is mild left neural from narrowing. C6-C7 and C7-T1: No significant disc herniation, spinal canal or neural from narrowing. Major cervical arterial flow voids are maintained. Paraspinal soft tissues appear normal. MR thoracic spine: Thoracic intervertebral alignment is maintained. There is no bone marrow edema. Hemangioma noted within the T6 vertebral body. Mild wedging of the superior endplates of T2 and T3, likely chronic. Thoracic spinal cord appears normal. No disc herniation, spinal canal or neural foramen narrowing at any level.	FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: Chest CT is reported separately. ABDOMEN and PELVIS: LIVER: Cirrhotic liver morphology. BILIARY TRACT: Normal. GALLBLADDER: Gallbladder wall edema and pericholecystic fluid. PANCREAS: Mildly atrophic pancreas. Diffuse peripancreatic edema without any discrete fluid collection. Pancreatic duct is nondilated. SPLEEN: Stable splenomegaly. ADRENALS: Normal. KIDNEYS: Kidneys demonstrates symmetric enhancement. No hydronephrosis. LYMPH NODES: Several mildly enlarged periportal/gastrohepatic and retroperitoneal lymph nodes, likely related to liver cirrhosis. STOMACH / SMALL BOWEL: Stomach is partially distended. Esophagogastric tube is seen within the mid stomach. No abnormal dilatation of small bowel loops. COLON / APPENDIX: Moderate circumferential thickening of the ascending colon, transverse colon sigmoid colon and rectum . PERITONEUM / MESENTERY: Trace perihepatic free fluid. No pneumoperitoneum. There is diffuse peripancreatic stranding/edema. RETROPERITONEUM: No retroperitoneal fluid collection. VESSELS: Aorta is nonaneurysmal and demonstrates moderate calcifications. Main portal, splenic and superior mesenteric veins and hepatic veins are patent. A few tiny perigastric and mesenteric collaterals. Femoral vascular catheters are seen in place. URINARY BLADDER: Partially distended and contains Foleys catheter. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Soft tissue emphysema in the left posterior back as seen before. MUSCULOSKELETAL: Stable osseous structures. Lumbar vertebrae demonstrate normal height and multilevel degenerative changes predominantly at L2-L3.
16,023	MR Brain wo+w contrast 1/28/2022 9:15 PM Clinical Information: lesion on ct Spec Inst: radiologist recc pituitary protocol Comparison: CT head from earlier today Technique: Axial T2, FLAIR, diffusion, contrast enhanced T1 weighted images, and sagittal T1 were obtained through the whole brain. Dedicated imaging of the sella was performed including the following sequences: Coronal T1 noncontrast, T1 Dynamic post contrast, and T1 post contrast with fat saturation, sagittal T1 post contrast with fat saturation, and coronal T2. Patient weight: 162 lbs. IV contrast: ProHance, 15 ml, per protocol. IV contrast injection rate: 1 ml per sec. Findings: There is a nonenhancing T1 hyperintense lesion within the sella eccentric to the right measuring 8.2 x 7.5 x 7.5 mm. There is no mass effect on the optic chiasm. Infundibulum is midline. Lesion mildly contacts the right supraclinoid ICA.Flow voids of bilateral ICAs appear normal. Rest of the pituitary gland and visualized sections of the brain show normal enhancement. Impression: Rounded T1 hyperintense lesion within the sella eccentric to the right without local mass effect is most consistent with Rathke cleft cyst.	Findings: There is a nonenhancing T1 hyperintense lesion within the sella eccentric to the right measuring 8.2 x 7.5 x 7.5 mm. There is no mass effect on the optic chiasm. Infundibulum is midline. Lesion mildly contacts the right supraclinoid ICA.Flow voids of bilateral ICAs appear normal. Rest of the pituitary gland and visualized sections of the brain show normal enhancement.	FINDINGS: Redemonstrated punctate intraparenchymal hemorrhages in the right parietal lobe is slightly decreased in size when compared to prior now measuring 8 x 5 mm on axial series 208 image 49. No new region of hemorrhage is noted. The gray white matter differentiation is maintained. Redemonstrated right basal ganglia or infarct. No extra axial collections. There is mild diffuse cerebral volume loss with prominence of the cortical sulci, sylvian fissures and compensatory dilatation of the ventricles. No acute osseous abnormality. The paranasal sinuses, middle ears, and mastoid air cells are clear. The orbits are unremarkable. Redemonstrated small right parietal scalp hematoma.
16,024	MR scan of the brain before and after contrast. Outside scan for interpretation only. Clinical: Right maxillary carcinoma status post resection. Findings: The residual mass in the region of the right zygoma measures 2.1 x 2.3 cm x 2.9 with sharp margins. Postcontrast scans show faint homogeneous enhancement. Extension into the anterior aspect of the orbit and involvement of the lateral rectus muscle is again noted. The medial margin of the mass is near the right ocular globe. Resection of the lateral and posterior walls of the right maxillary sinus and right orbital floor with prosthesis is again noted. There is new enhancing soft tissue in the upper nasal passages and ethmoid region, not present on prior scans on 7/14/2021, possible tumor extension. There is soft tissue fullness and enhancement in the pterygomaxillary region. The brain parenchyma has normal appearance with no mass, hemorrhage, infarct or extracerebral collection. The ventricles are small with normal appearance. There is no abnormal parenchymal enhancement. --------------- Conclusion: Slight enlargement of the apparent residual tumor in the right zygoma, invading the contralateral orbit and involving the lateral rectus muscle. New soft tissue enhancement, possible tumor in the upper posterior right nasal passage, in the ethmoid region and pterygomaxillary fossa region.	Findings: The residual mass in the region of the right zygoma measures 2.1 x 2.3 cm x 2.9 with sharp margins. Postcontrast scans show faint homogeneous enhancement. Extension into the anterior aspect of the orbit and involvement of the lateral rectus muscle is again noted. The medial margin of the mass is near the right ocular globe. Resection of the lateral and posterior walls of the right maxillary sinus and right orbital floor with prosthesis is again noted. There is new enhancing soft tissue in the upper nasal passages and ethmoid region, not present on prior scans on 7/14/2021, possible tumor extension. There is soft tissue fullness and enhancement in the pterygomaxillary region. The brain parenchyma has normal appearance with no mass, hemorrhage, infarct or extracerebral collection. The ventricles are small with normal appearance. There is no abnormal parenchymal enhancement. ---------------	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 tip terminates 5.3 cm from the carina. Interval decrease in a left pleural effusion with trace residual. Resolution of right pleural effusion. No pneumothorax. Progressive decrease in bilateral consolidations most improved in the posterior segment of the right upper lobe. Similar appearance of bilateral scattered interlobular septal thickening and groundglass opacities. HEART / VESSELS: Cardiac device leads terminating in unchanged position. Interval placement of right IJ CVL with tip terminating at the cavoatrial junction. Right upper extremity PICC tip terminates within the mid SVC. Mild cardiomegaly. Trace pericardial effusion. Severe coronary artery calcifications. Interval removal of intra-aortic balloon pump. MEDIASTINUM / ESOPHAGUS: Esophagogastric tube and feeding tube seen within the esophagus terminating below the diaphragm. LYMPH NODES: Unchanged prominent mediastinal nodes. CHEST WALL: Left chest wall subcutaneous AICD/pacer device. Minimal fluid density/thickening along the left substernal anterior mediastinum. MUSCULOSKELETAL: T4 vertebral body hemangioma. No aggressive osseous lesion. Median sternotomy changes with well opposed bone fragments.
16,025	Interpretation of Outside Films CT Chest Clinical Information: 61-year-old female with provided history of endometrial cancer. Spec Inst: ENDOMETRIAL CANCERCT CHEST 122821 CARMICHAEL IMAGING CTR. REC 122921 Study reviewed: CT of chest with contrast performed at Carmichael imaging Center on 12/20/2021, The images are available in PACS. Comparison: Chest CT 9/15/2021 Findings: Chest: Lines, tubes, and devices: A right IJ port catheter with tip at right atrium. Lung parenchyma and pleura: Mild diffuse mosaic attenuation in both lungs. Scattered calcified granulomas. No new or enlarging suspicious pulmonary nodule. The trachea and main bronchi are patent. No pleural effusion. Thoracic inlet, heart, and mediastinum: Few subcentimeter short axis right paratracheal and subcarinal lymph nodes. No supraclavicular lymphadenopathy within the field of view. No axillary lymphadenopathy The thoracic aorta is normal in caliber. Main pulmonary artery is dilated, measures 3.2 cm. The overall heart size normal. No pericardial effusion. Moderate coronary calcification. Bones and soft tissues: No destructive bone lesion. Chest wall is unremarkable. Upper abdomen: Reported separately. Conclusion: No convincing evidence of metastatic disease in the chest.	Findings: Chest: Lines, tubes, and devices: A right IJ port catheter with tip at right atrium. Lung parenchyma and pleura: Mild diffuse mosaic attenuation in both lungs. Scattered calcified granulomas. No new or enlarging suspicious pulmonary nodule. The trachea and main bronchi are patent. No pleural effusion. Thoracic inlet, heart, and mediastinum: Few subcentimeter short axis right paratracheal and subcarinal lymph nodes. No supraclavicular lymphadenopathy within the field of view. No axillary lymphadenopathy The thoracic aorta is normal in caliber. Main pulmonary artery is dilated, measures 3.2 cm. The overall heart size normal. No pericardial effusion. Moderate coronary calcification. Bones and soft tissues: No destructive bone lesion. Chest wall is unremarkable. Upper abdomen: Reported separately.	FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: Chest CT is reported separately. ABDOMEN and PELVIS: LIVER: Normal unenhanced appearance of liver. No focal hepatic lesions. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Atrophic pancreas. Pancreatic duct is nondilated. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Feeding and esophagogastric tube are seen within the stomach. Stomach is collapsed. Multiple diverticula are seen along the anterior aspect of second and third portion of duodenum. There is no abnormal dilatation of small bowel loops. Oral contrast has progressed to the distal small bowel loops. COLON / APPENDIX: There is moderate amount of colonic stool. Scattered uncomplicated colonic diverticulosis. PERITONEUM / MESENTERY: No ascites or pneumoperitoneum. RETROPERITONEUM: Normal. VESSELS: Moderate aortic calcifications. Mild ectasia of infrarenal aorta.. URINARY BLADDER: Collapsed and contains Foleys catheter REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Tiny fat-containing umbilical hernia MUSCULOSKELETAL: No acute osseous findings. Lumbar vertebrae demonstrate normal height.
16,026	Interpretation of Outside Films CT Chest Clinical Information: 70-year-old female with history of breast cancer. Spec Inst: BREAST CANCER METASTASESCT CHEST 121321 SOUTHVIEW MED. GROUP REC 122921 Study reviewed: CT of chest without contrast performed at Southview mid group on 12/13/2021, The images are available in PACS. Findings: Limitations: Noncontrasted study. Chest: Lines, tubes, and devices: None. Lung parenchyma and pleura: There are multiple innumerable scattered pulmonary nodules and masses in both lungs. Index lesions measured at series 401: 1. Left lower lobe 3.6 x 2.3 cm mass (image 18). 2. Right lower lobe 1.6 x 1.6 cm nodule (image 18). No focal consolidation. The trachea and main bronchi are patent. No pleural effusion. Thoracic inlet, heart, and mediastinum: No lymphadenopathy in the axillary, mediastinal, or hilar regions based on this noncontrasted study. Small hiatal hernia. The thoracic aorta and main pulmonary artery are normal in caliber. The cardiac chambers are normal in size. Mild coronary artery atherosclerotic calcifications are noted, although the study is not optimized for coronary assessment. No pericardial effusion. Hypoattenuation blood relative to the interventricular septum, likely related to anemia. Bones and soft tissues: Postsurgical changes in the left breast. Hazy sclerosis and lucency in the left lateral eighth rib. Left posterior 11th rib subacute to chronic fracture. Focal area of sclerosis in the right scapula. Focal lucent lesion of T12 vertebral body. Upper abdomen: Multiple scattered innumerable low-attenuation hepatic focal lesions. Conclusion: 1. Multiple innumerable pulmonary nodules and masses as well as hepatic focal lesions, likely related to metastases. Osseous sclerotic and lucent lesions are also noted, likely related to metastases. 2. Other findings as described.	Findings: Limitations: Noncontrasted study. Chest: Lines, tubes, and devices: None. Lung parenchyma and pleura: There are multiple innumerable scattered pulmonary nodules and masses in both lungs. Index lesions measured at series 401: 1. Left lower lobe 3.6 x 2.3 cm mass (image 18). 2. Right lower lobe 1.6 x 1.6 cm nodule (image 18). No focal consolidation. The trachea and main bronchi are patent. No pleural effusion. Thoracic inlet, heart, and mediastinum: No lymphadenopathy in the axillary, mediastinal, or hilar regions based on this noncontrasted study. Small hiatal hernia. The thoracic aorta and main pulmonary artery are normal in caliber. The cardiac chambers are normal in size. Mild coronary artery atherosclerotic calcifications are noted, although the study is not optimized for coronary assessment. No pericardial effusion. Hypoattenuation blood relative to the interventricular septum, likely related to anemia. Bones and soft tissues: Postsurgical changes in the left breast. Hazy sclerosis and lucency in the left lateral eighth rib. Left posterior 11th rib subacute to chronic fracture. Focal area of sclerosis in the right scapula. Focal lucent lesion of T12 vertebral body. Upper abdomen: Multiple scattered innumerable low-attenuation hepatic focal lesions.	FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Few scattered subpleural mild groundglass densities in the posterior right lung bases. No definite lung consolidation, pleural effusion or pneumothorax. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Heart is normal in size. There is no pericardial effusion. ABDOMEN and PELVIS: LIVER: Diffuse hepatic steatosis and cirrhosis. No definite hepatic lesions, however this examination is not tailored for evaluation of HCC. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Stable splenomegaly. ADRENALS: Normal. KIDNEYS: Kidneys are normal in size and demonstrate symmetric enhancement. No hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Stomach is partially distended. There is abnormal dilatation of small bowel loops. COLON / APPENDIX: Large bowel loops are nondilated. Persistent, mildly improved mild pericolonic stranding around the ascending and descending colon without any discrete fluid collection. Hyperdense contents within the ascending colon. PERITONEUM / MESENTERY: No discrete intra-abdominal fluid collection. RETROPERITONEUM: Normal. VESSELS: Aorta is nonaneurysmal. Aorta, IVC, iliac vasculature portal, splenic and superior mesenteric veins are patent. No large paraesophageal venous collaterals. Hepatic veins are not well opacified. URINARY BLADDER: Partially distended REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Stable osseous structures
16,027	EXAM: Outside MR Image Interpretation CLINICAL INFORMATION: 83-year-old male to evaluate for pancreatitis COMPARISON: None. TECHNIQUE: Outside MR images without and with IV contrast dated 11/11/2021 were submitted for interpretation. The MRI acquisition was performed outside of UAB protocol, monitoring and oversight. Interpretation may have reduced accuracy, which should be considered prior to implementation of clinical decisions. FINDINGS: STRUCTURED REPORT: MRI Abdomen LOWER CHEST: LUNG BASES / PLEURA: No significant abnormality. DISTAL ESOPHAGUS: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Normal morphology and signal intensity. A tiny cyst in the left lobe is noted. Few tiny enhancing foci in the right lobe, likely vascular shunt. No suspicious hepatic focal disease is identified. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal parenchymal morphology and enhancement. No focal lesion is identified. The main pancreatic duct is mildly dilated in the head region measures 5 mm. There is no peripancreatic soft tissue stranding or fluid collection. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Proteinaceous/hemorrhagic cyst measures 1.6 cm at the upper pole of the right kidney. There is a large exophytic hemorrhagic/proteinaceous cyst measures 7.9 x 6.5 cm an additional tiny hemorrhagic proteinaceous cysts at the lower pole of the left kidney but few simple cysts in bilateral kidneys are also noted. No hydronephrosis or suspicious mass noted. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Mild to moderate degenerative changes in the abdominal aorta and infrarenal fusiform aortic aneurysm measures 3.5 cm. There is narrowing of the celiac axis just distal to the ostium and distal aneurysmal dilatation measuring 1.5 cm in diameter. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Scattered degenerative changes in the spine. There is focal enhancement adjacent to the inferior endplate of L3 and L4, nonspecific and likely secondary to degenerative changes. CONCLUSION: 1. No MR evidence of acute abnormality in the abdomen. In particular, no evidence of pancreatitis or focal pancreatic mass. Borderline prominent main pancreatic duct in the head region without obstructing lesion. 2. Bilateral renal simple and hemorrhage/proteinaceous cysts as above. 3. Infrarenal abdominal aortic fusiform aneurysm measures 3.5 cm. 4. Moderate to severe narrowing in the proximal segment of the celiac axis with distal dilatation, concerning for median arcuate ligament syndrome. Correlate clinically.	FINDINGS: STRUCTURED REPORT: MRI Abdomen LOWER CHEST: LUNG BASES / PLEURA: No significant abnormality. DISTAL ESOPHAGUS: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Normal morphology and signal intensity. A tiny cyst in the left lobe is noted. Few tiny enhancing foci in the right lobe, likely vascular shunt. No suspicious hepatic focal disease is identified. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal parenchymal morphology and enhancement. No focal lesion is identified. The main pancreatic duct is mildly dilated in the head region measures 5 mm. There is no peripancreatic soft tissue stranding or fluid collection. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Proteinaceous/hemorrhagic cyst measures 1.6 cm at the upper pole of the right kidney. There is a large exophytic hemorrhagic/proteinaceous cyst measures 7.9 x 6.5 cm an additional tiny hemorrhagic proteinaceous cysts at the lower pole of the left kidney but few simple cysts in bilateral kidneys are also noted. No hydronephrosis or suspicious mass noted. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Mild to moderate degenerative changes in the abdominal aorta and infrarenal fusiform aortic aneurysm measures 3.5 cm. There is narrowing of the celiac axis just distal to the ostium and distal aneurysmal dilatation measuring 1.5 cm in diameter. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Scattered degenerative changes in the spine. There is focal enhancement adjacent to the inferior endplate of L3 and L4, nonspecific and likely secondary to degenerative changes.	FINDINGS: Limited evaluation due to noncontrasted study STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Absent1 GALLBLADDER: No abnormality. PANCREAS: Poorly seen cluster of cysts in the pancreas head grossly measures 1.2 x 1.1 cm on image 29 series 201, previously 1.1 x 1.1 cm on image 301 image 23. SPLEEN: Enlarged measuring 17.3 cm, with a splenic volume of 1522 cubic cm, similar to prior of 1512. ADRENALS: Normal. KIDNEYS: Left renal cysts are grossly unchanged from prior MRI, with limited evaluation due to the noncontrasted study. LYMPH NODES: None enlarged. Visualized STOMACH / SMALL BOWEL: No abnormality. Visualized COLON: Surgical staples noted in the region of the cecum PERITONEUM / MESENTERY: No ascites. RETROPERITONEUM: Normal. VESSELS: Moderate atherosclerotic disease URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No destructive osseous lesions seen.
16,028	Interpretation of Outside Films CT Chest Clinical Information: 33-year-old female with provided history of pelvic mass. Spec Inst: CT CHEST 122821 REC 123021 FLOWERS HOSPITAL Study reviewed: CT of chest with contrast performed at flowers Hospital on 12/20/2021, The images are available in PACS. Findings: Chest: Lines, tubes, and devices: None. Lung parenchyma and pleura: Few small (less than 6 mm) pulmonary nodules are seen. For reference, a 3 mm right middle lobe nodule (image 111, series 4), and a 2 mm right lung apex nodule (image 33). No focal consolidation. Mild diffuse mosaic attenuation in both lungs with diffuse bronchial wall thickening. Retained secretions the trachea and main bronchi, otherwise patent central airways. No pleural effusion. Thoracic inlet, heart, and mediastinum: No lymphadenopathy in the axillary, mediastinal, or hilar regions. The esophagus is nondilated. The thoracic aorta and main pulmonary artery are normal in caliber. The cardiac chambers are normal in size. No coronary artery atherosclerotic calcifications are noted, although the study is not optimized for coronary assessment. No pericardial effusion. Bones and soft tissues: No destructive bone lesion. Chest wall is unremarkable. Upper abdomen: Reported separately. Conclusion: Few tiny pulmonary nodules, otherwise no convincing evidence of metastatic disease in the chest.	Findings: Chest: Lines, tubes, and devices: None. Lung parenchyma and pleura: Few small (less than 6 mm) pulmonary nodules are seen. For reference, a 3 mm right middle lobe nodule (image 111, series 4), and a 2 mm right lung apex nodule (image 33). No focal consolidation. Mild diffuse mosaic attenuation in both lungs with diffuse bronchial wall thickening. Retained secretions the trachea and main bronchi, otherwise patent central airways. No pleural effusion. Thoracic inlet, heart, and mediastinum: No lymphadenopathy in the axillary, mediastinal, or hilar regions. The esophagus is nondilated. The thoracic aorta and main pulmonary artery are normal in caliber. The cardiac chambers are normal in size. No coronary artery atherosclerotic calcifications are noted, although the study is not optimized for coronary assessment. No pericardial effusion. Bones and soft tissues: No destructive bone lesion. Chest wall is unremarkable. Upper abdomen: Reported separately.	Findings: There is diffuse cerebral volume loss due to atrophic changes. There is periventricular and deep white matter hypodensities due to mild chronic microangiopathic changes. Small bilateral chronic basal ganglia lacunar infarcts are again noted. No definite evidence of intracranial hemorrhage or infarction is noted. Soft tissue hematoma in the left parietal cortex is noted. There is no evidence of fracture in the underlying calvarium. The visualized paranasal sinuses and mastoid air cells are clear. No acute osseous or soft tissue abnormality seen.
16,029	EXAM: Outside CT Image Interpretation CLINICAL INFORMATION: History of thrombotic thrombocytopenic purpura. COMPARISON: None. TECHNIQUE: Outside CT images of the abdomen and pelvis with contrast and coronal and sagittal reformats dated 12/26/2021 were submitted for interpretation. The CT acquisition was performed outside of UAB protocol, monitoring and oversight. Interpretation may have reduced accuracy, which should be considered prior to implementation of clinical decisions. FINDINGS: IMAGE QUALITY: Satisfactory. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Focal area of hypodensity measuring 2.6 x 1.2 cm is seen along the periphery of the spleen (series 7 image 51). There is an additional focal area of hypodensity involving a more inferior portion of the spleen, measuring approximately 2.8 x 1.7 cm (series 7 image 79). Additional hypodensity along the anterior portion the spleen, measuring approximately 2.0 x 1.1 cm (series 7 image 66). ADRENALS: Normal. KIDNEYS: Mild left-sided pelviectasis with hyperenhancement of the urothelium. Bilateral kidneys are otherwise normal. No obstructing mass or stone is visualized. Significant, bilateral perinephric stranding. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus is normal. There is a small left ovarian cyst. Right adnexa is within normal limits. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No acute or aggressive osseous abnormality. There is a bony fragment adjacent to the anterior aspect of L1 superior endplate, likely sequela of prior trauma. This could also represent degenerative osteophyte. CONCLUSION: Multifocal hypodense lesions within the spleen, likely representing splenic infarcts in the setting of known thrombotic thrombocytopenic purpura. Perinephric stranding and urothelial enhancement are nonspecific. There are no other findings of pyelonephritis, such as focal patchy enhancement of the kidneys. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.	FINDINGS: IMAGE QUALITY: Satisfactory. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Focal area of hypodensity measuring 2.6 x 1.2 cm is seen along the periphery of the spleen (series 7 image 51). There is an additional focal area of hypodensity involving a more inferior portion of the spleen, measuring approximately 2.8 x 1.7 cm (series 7 image 79). Additional hypodensity along the anterior portion the spleen, measuring approximately 2.0 x 1.1 cm (series 7 image 66). ADRENALS: Normal. KIDNEYS: Mild left-sided pelviectasis with hyperenhancement of the urothelium. Bilateral kidneys are otherwise normal. No obstructing mass or stone is visualized. Significant, bilateral perinephric stranding. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus is normal. There is a small left ovarian cyst. Right adnexa is within normal limits. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No acute or aggressive osseous abnormality. There is a bony fragment adjacent to the anterior aspect of L1 superior endplate, likely sequela of prior trauma. This could also represent degenerative osteophyte.	FINDINGS: Limited evaluation due to noncontrasted study STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Absent1 GALLBLADDER: No abnormality. PANCREAS: Poorly seen cluster of cysts in the pancreas head grossly measures 1.2 x 1.1 cm on image 29 series 201, previously 1.1 x 1.1 cm on image 301 image 23. SPLEEN: Enlarged measuring 17.3 cm, with a splenic volume of 1522 cubic cm, similar to prior of 1512. ADRENALS: Normal. KIDNEYS: Left renal cysts are grossly unchanged from prior MRI, with limited evaluation due to the noncontrasted study. LYMPH NODES: None enlarged. Visualized STOMACH / SMALL BOWEL: No abnormality. Visualized COLON: Surgical staples noted in the region of the cecum PERITONEUM / MESENTERY: No ascites. RETROPERITONEUM: Normal. VESSELS: Moderate atherosclerotic disease URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No destructive osseous lesions seen.
16,030	EXAM: Outside CT Image Interpretation CLINICAL INFORMATION: 65-year-old patient with ascites and hepatomegaly COMPARISON: CT dated 8/13/2019 TECHNIQUE: Outside CT images without intravenous contrast dated 12/2/2021 were submitted for interpretation. The CT acquisition was performed outside of UAB protocol, monitoring and oversight. Interpretation may have reduced accuracy, which should be considered prior to implementation of clinical decisions. FINDINGS: IMAGE QUALITY: Satisfactory. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Small bilateral pleural effusions DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Cardiomegaly and coronary artery atherosclerosis with evidence of prior midline sternotomy. CHEST WALL: Mild gynecomastia ABDOMEN and PELVIS: LIVER: Not enlarged. GALLBLADDER: Radiopaque cholelithiasis. PANCREAS: Glandular atrophy SPLEEN: Normal size. ADRENALS: Normal. KIDNEYS: Native kidneys are atrophic. Mild dilatation of the collecting system of the right native kidney to the proximal half of the ureter. Right lower quadrant transplant with upper pole cyst versus dilated calyx with communication with the renal pelvis. This cystic area measures approximately 4.6 cm. No peritransplant fluid collections. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No gastric outlet or small bowel obstruction. COLON / APPENDIX: Diverticulosis without diverticulitis. Appendix is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Advanced arterial atherosclerotic disease. URINARY BLADDER: Decompressed. REPRODUCTIVE ORGANS: Prostate is grossly unremarkable. BODY WALL: Right lower quadrant incisional hernia containing small and large bowel loops without evidence of obstruction, slightly larger compared to 2019. MUSCULOSKELETAL: Osseous demineralization with spinal degenerative changes. CONCLUSION: 1. No ascites. No hepatomegaly. 2. Right lower quadrant transplant kidney with large cyst versus dilated calyx communicating with the renal pelvis. Mildly worsening uncomplicated right lower quadrant incisional hernia. 3. Other findings as described. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.	FINDINGS: IMAGE QUALITY: Satisfactory. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Small bilateral pleural effusions DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Cardiomegaly and coronary artery atherosclerosis with evidence of prior midline sternotomy. CHEST WALL: Mild gynecomastia ABDOMEN and PELVIS: LIVER: Not enlarged. GALLBLADDER: Radiopaque cholelithiasis. PANCREAS: Glandular atrophy SPLEEN: Normal size. ADRENALS: Normal. KIDNEYS: Native kidneys are atrophic. Mild dilatation of the collecting system of the right native kidney to the proximal half of the ureter. Right lower quadrant transplant with upper pole cyst versus dilated calyx with communication with the renal pelvis. This cystic area measures approximately 4.6 cm. No peritransplant fluid collections. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No gastric outlet or small bowel obstruction. COLON / APPENDIX: Diverticulosis without diverticulitis. Appendix is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Advanced arterial atherosclerotic disease. URINARY BLADDER: Decompressed. REPRODUCTIVE ORGANS: Prostate is grossly unremarkable. BODY WALL: Right lower quadrant incisional hernia containing small and large bowel loops without evidence of obstruction, slightly larger compared to 2019. MUSCULOSKELETAL: Osseous demineralization with spinal degenerative changes.	FINDINGS: BONES/JOINTS: Interval insertion of three fixation pins through the right femoral neck fracture with near anatomic alignment of the right femoral neck and head. Interval reduction of the right femoral head which now is well-seated within the acetabulum. Small impaction fracture along the anterolateral femoral head (series 204 image 187). Comminuted acetabular fractures involving the posterior wall, roof, and puboacetabular junction have improved in position but there is continued posterior and superior displacement. Improved alignment of the right inferior pubic ramus oblique fracture (series 204 image 214). The sacroiliac joints are symmetric. No pubic symphysis diastasis. The left femoral head is well-seated within the acetabulum. SOFT TISSUES: Soft tissue hematoma and stranding overlying the right hip. Numerous foci of gas are seen within the soft tissues.
16,031	EXAM: Outside MR Image Interpretation CLINICAL INFORMATION: 74 old male with colon polyp COMPARISON: None. TECHNIQUE: Outside MR images without IV contrast dated 12/7/2021 were submitted for interpretation. The MRI acquisition was performed outside of UAB protocol, monitoring and oversight. Interpretation may have reduced accuracy, which should be considered prior to implementation of clinical decisions. FINDINGS: STRUCTURED REPORT: MRI Pelvis LOWER ABDOMEN: BOWEL: Extensive sigmoid colonic diverticulosis is observed. No overt colon polyp is identified PERITONEUM: A collapsed reservoir device is observed in the left lower quadrant, presumably from prior penile prosthesis. OTHER: No other abnormality. PELVIS: VESSELS: No significant abnormality. LYMPH NODES: None enlarged. PERIRECTAL / PERIANAL REGION: Normal. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Bilateral small fat-containing inguinal hernias.. MUSCULOSKELETAL: Bilateral hip prosthesis with susceptibility artifact is observed. Multilevel degenerative changes in the visualized lower lumbar spine. CONCLUSION: Extensive sigmoid colonic diverticulosis. An overt colonic polyp is not visualized on the available images however the study was protocoled with sequences optimized for evaluation of the musculoskeletal structures. Further evaluation with age-appropriate colon cancer screening is recommended. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.	FINDINGS: STRUCTURED REPORT: MRI Pelvis LOWER ABDOMEN: BOWEL: Extensive sigmoid colonic diverticulosis is observed. No overt colon polyp is identified PERITONEUM: A collapsed reservoir device is observed in the left lower quadrant, presumably from prior penile prosthesis. OTHER: No other abnormality. PELVIS: VESSELS: No significant abnormality. LYMPH NODES: None enlarged. PERIRECTAL / PERIANAL REGION: Normal. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Bilateral small fat-containing inguinal hernias.. MUSCULOSKELETAL: Bilateral hip prosthesis with susceptibility artifact is observed. Multilevel degenerative changes in the visualized lower lumbar spine.	FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis ABDOMEN and PELVIS: LIVER: Extensive laceration seen in the right lobe is similar to prior. Extensive laceration in the the caudate extending to the IVC is similar to prior. No evidence of active extravasation. BILIARY TRACT: Normal. GALLBLADDER: High attenuation in the gallbladder with cholelithiasis, likely vicarious excretion. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Soft tissue stranding around both adrenal glands is again seen, extending to the left anterior pararenal fascia and lateral conal fascia, decreased slightly from prior. No definite active extravasation. KIDNEYS: Previously seen left upper pole cortical lacerations are not identified. Both kidneys are grossly unremarkable with a small amount of left perirenal fluid. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: NG tube is seen with distal tip in the stomach COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Trace ascites. Mild soft tissue stranding. RETROPERITONEUM: See above. VESSELS: Mild atherosclerotic disease. Tortuous ovarian veins again noted. URINARY BLADDER: Foley catheter within a mildly dilated urinary bladder. REPRODUCTIVE ORGANS: Fibroid uterus. Left ovary and right adnexa are unremarkable. BODY WALL: Soft tissue stranding is seen in the right groin, likely from vascular access MUSCULOSKELETAL: L1-4 transverse process fractures again seen
16,032	EXAM:Interpretation of Outside Films MR MSK CLINICAL INFORMATION:55-year-old female with right ankle pain and instability. COMPARISON: Right ankle and foot radiographs 12/17/2021 TECHNIQUE: Interpretation of Outside Films MR MSK STRUCTURED REPORT: MRI ANKLE 1/2/2020 FINDINGS: BONES:No fracture, marrow replacement, or aggressive osseous lesion. Edema is noted in the posteromedial medial malleolus articular surface of the talus, at the insertion of the posterior tibiotalar ligaments.. ARTICULATIONS: Effusion: Moderate sized anterior tibiotalar and subtalar joint effusions. Tibiotalar joint:Normal. Subtalar joint:Normal. Tarsal joints:Normal. MEDIAL COMPARTMENT: Medial malleolus:Normal. Posterior tibial tendon:Normal. Flexor digitorum longus tendon:Normal. Deltoid ligament complex: Intact with increased T2 signal within the deltoid ligament complex, most prominent posteriorly in the deep posterior tibiotalar ligament with loss of fatty striations, and underlying edema in the posterior medial talus. LATERAL COMPARTMENT: Lateral malleolus:Normal. Peroneus longus tendon:Normal. Peroneus brevis tendon:Normal. Anterior tibiofibular ligament:Thickened without discreet tear. Posterior tibiofibular ligament:Normal. Anterior talofibular ligament:Normal. Calcaneofibular ligament:Normal. POSTERIOR COMPARTMENT: Flexor hallucis longus:Normal. Achilles tendon:Normal. Plantar fascia:Normal. ANTERIOR COMPARTMENT: Anterior tibial tendon:Normal. Extensor hallucis longus:Normal. Extensor digitorum longus:Normal. TARSAL TUNNEL:Normal. SINUS TARSI:Normal. SOFT TISSUES: Subcutaneous soft tissue edema in the medial ankle. CONCLUSION: 1. Grade 1 sprain of the deep posterior tibiotalar ligament with associated edema/contusion of the posterior medial talus. No associated tear or fracture. 2. Thickening of the anterior tibiofibular ligament suggests sequela of remote injury. 3. Anterior tibiotalar and subtalar joint effusions with edema in the medial malleolar 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.	FINDINGS: BONES:No fracture, marrow replacement, or aggressive osseous lesion. Edema is noted in the posteromedial medial malleolus articular surface of the talus, at the insertion of the posterior tibiotalar ligaments.. ARTICULATIONS: Effusion: Moderate sized anterior tibiotalar and subtalar joint effusions. Tibiotalar joint:Normal. Subtalar joint:Normal. Tarsal joints:Normal. MEDIAL COMPARTMENT: Medial malleolus:Normal. Posterior tibial tendon:Normal. Flexor digitorum longus tendon:Normal. Deltoid ligament complex: Intact with increased T2 signal within the deltoid ligament complex, most prominent posteriorly in the deep posterior tibiotalar ligament with loss of fatty striations, and underlying edema in the posterior medial talus. LATERAL COMPARTMENT: Lateral malleolus:Normal. Peroneus longus tendon:Normal. Peroneus brevis tendon:Normal. Anterior tibiofibular ligament:Thickened without discreet tear. Posterior tibiofibular ligament:Normal. Anterior talofibular ligament:Normal. Calcaneofibular ligament:Normal. POSTERIOR COMPARTMENT: Flexor hallucis longus:Normal. Achilles tendon:Normal. Plantar fascia:Normal. ANTERIOR COMPARTMENT: Anterior tibial tendon:Normal. Extensor hallucis longus:Normal. Extensor digitorum longus:Normal. TARSAL TUNNEL:Normal. SINUS TARSI:Normal. SOFT TISSUES: Subcutaneous soft tissue edema in the medial ankle.	FINDINGS: STRUCTURED REPORT: CTA Chest VASCULATURE: Limited evaluation due to poor intravenous contrast opacification. CORONARY ARTERIES: There are mild atherosclerotic calcifications of the native coronary arteries. PULMONARY ARTERIES: No central pulmonary embolus. Enlarged main pulmonary artery measuring up to 4.3 cm. ASCENDING THORACIC AORTA: No significant abnormality. AORTIC ARCH: No significant abnormality. ARCH VESSELS: No significant abnormality. DESCENDING THORACIC AORTA: No significant abnormality. UPPER ABDOMINAL AORTA: No significant abnormality. ------------------------------------------------------------- LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Central airways are patent. Diffuse mosaic attenuation. No focal consolidation, pneumothorax or pleural effusion. HEART / OTHER VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: Enlarged paratracheal node measuring up to 1.3 cm (axial series 5, image 50), likely reactive. No other enlarged lymphadenopathy. CHEST WALL: No significant abnormality. UPPER ABDOMEN: No significant abnormality. MUSCULOSKELETAL: Multilevel chronic degenerative changes of the thoracic spine. No aggressive osseous lesion. -------------------
16,033	EXAM: Interpretation of Outside Films MR MSK CLINICAL INFORMATION: Femoral mass. COMPARISON: None. TECHNIQUE: Interpretation of Outside Films MR MSK STRUCTURED REPORT: MRI Knee 1/2/2020 FINDINGS: BONES:Diffusely enhancing well-defined expansile mass measuring approximately 6.7 x 8.1 x 10.0 cm involving the distal femur. The mass demonstrates low T1 signal and heterogenous T2 signal. There is extension of the mass into the patellofemoral compartment. Mild periosteal enhancement anterolaterally. There is mild surrounding marrow edema. ARTICULATIONS: Effusion:None. Patellofemoral compartment:Destruction of medial femoral trochlear cartilage secondary to anterior erosion by the femoral mass. Medial compartment:No cartilage defect. Lateral compartment:No cartilage defect. MENISCI: Medial meniscus:Intact. Lateral meniscus:Intact. LIGAMENTS: Cruciate ligaments:Intact. Medial collateral ligament:Intact. Lateral collateral ligament:Intact. Posterolateral corner structures:Intact. EXTENSOR MECHANISM:The distal quadriceps and patellar tendons are intact. CONCLUSION: Large distal femoral expansile mass which erodes anteriorly into the patellofemoral compartment with associated femoral articular surface collapse. This is most consistent with a giant cell neoplasm. 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:Diffusely enhancing well-defined expansile mass measuring approximately 6.7 x 8.1 x 10.0 cm involving the distal femur. The mass demonstrates low T1 signal and heterogenous T2 signal. There is extension of the mass into the patellofemoral compartment. Mild periosteal enhancement anterolaterally. There is mild surrounding marrow edema. ARTICULATIONS: Effusion:None. Patellofemoral compartment:Destruction of medial femoral trochlear cartilage secondary to anterior erosion by the femoral mass. Medial compartment:No cartilage defect. Lateral compartment:No cartilage defect. MENISCI: Medial meniscus:Intact. Lateral meniscus:Intact. LIGAMENTS: Cruciate ligaments:Intact. Medial collateral ligament:Intact. Lateral collateral ligament:Intact. Posterolateral corner structures:Intact. EXTENSOR MECHANISM:The distal quadriceps and patellar tendons are intact.	Findings: Cervical spine alignment is normal. There are no fractures. There is no significant degenerative abnormality with resultant spinal canal or foraminal narrowing. There is heterogeneous enlargement of the right greater than left thyroid lobe. The larger nodule on the right approximately measures 2.3 cm.
16,034	EXAM: Outside MR Image Interpretation CLINICAL INFORMATION: 61-year-old male with liver mass. COMPARISON: None. TECHNIQUE: Outside MR images of the abdomen without and with IV contrast dated 12/10/2021 were submitted for interpretation. The MRI acquisition was performed outside of UAB protocol, monitoring and oversight. Interpretation may have reduced accuracy, which should be considered prior to implementation of clinical decisions. FINDINGS: STRUCTURED REPORT: MRI Abdomen LOWER CHEST: LUNG BASES / PLEURA: No significant abnormality. DISTAL ESOPHAGUS: No significant abnormality. HEART / VESSELS: There is a 4.5 x 3.3 cm moderately T2 hyperintense lesion with heterogenous enhancement in the lower anterior mediastinum and subtle mass effect on the right ventricle. ABDOMEN: LIVER: Cirrhotic morphology with mild steatosis. There is a mildly T2 hyperintense segment 8 hepatic lesion with heterogeneous enhancement and predominantly peripheral enhancement on all phases which measures 5.5 x 5.4 x 5.4 cm (image 95 series 1003, image 23 series 4). BILIARY TRACT: Normal. GALLBLADDER: Cholelithiasis. PANCREAS: Normal. SPLEEN: Mildly enlarged measuring 15 cm.. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON: No abnormality in the visualized portions. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. Cirrhosis with mild steatosis. Solitary mass with heterogeneous predominantly peripheral enhancement and mild increased enhancement on the delayed sequence, LR-M. The differential consideration is cholangiocarcinoma and metastasis. Recommend imaging guided biopsy for further evaluation. 2. Lower anterior mediastinal nodular mass anterior to the right ventricle, concerning for metastasis. 3. Mild splenomegaly, could be secondary to portal hypertension. 4. Cholelithiasis. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.	FINDINGS: STRUCTURED REPORT: MRI Abdomen LOWER CHEST: LUNG BASES / PLEURA: No significant abnormality. DISTAL ESOPHAGUS: No significant abnormality. HEART / VESSELS: There is a 4.5 x 3.3 cm moderately T2 hyperintense lesion with heterogenous enhancement in the lower anterior mediastinum and subtle mass effect on the right ventricle. ABDOMEN: LIVER: Cirrhotic morphology with mild steatosis. There is a mildly T2 hyperintense segment 8 hepatic lesion with heterogeneous enhancement and predominantly peripheral enhancement on all phases which measures 5.5 x 5.4 x 5.4 cm (image 95 series 1003, image 23 series 4). BILIARY TRACT: Normal. GALLBLADDER: Cholelithiasis. PANCREAS: Normal. SPLEEN: Mildly enlarged measuring 15 cm.. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON: No abnormality in the visualized portions. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.	Findings: There is no evidence of acute infarction, hemorrhage or hydrocephalus. There is no vasogenic edema or mass effect. There is diffuse cerebral volume loss with ventricular prominence. There are areas of low attenuation in the periventricular and subcortical white matter, likely microangiopathic changes. Atherosclerotic calcifications are noted. The visualized paranasal sinuses and mastoid air cells are clear. There is no acute osseous abnormality.
16,035	EXAM: Outside CT Image Interpretation CLINICAL INFORMATION: Renal mass. COMPARISON: 12/3/2021. TECHNIQUE: Outside CT images without and with IV contrast dated 12/20/2021 were submitted for interpretation. The CT acquisition was performed outside of UAB protocol, monitoring and oversight. Interpretation may have reduced accuracy, which should be considered prior to implementation of clinical decisions. FINDINGS: IMAGE QUALITY: Satisfactory. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Heterogeneously enhancing left renal mass is seen arising from the interpolar region. This measures 6.4 x 5.8 x 5.8 cm (series 3, image 32; series 552, image 68), previously 6.2 x 5.7 cm. This is in close proximally to the posterior cirrhosis fascia but does not appear to abut or invade. This abuts the renal sinus fat without involvement of the collecting system. The renal vein is patent. The right kidney is normal. There is no hydronephrosis bilaterally. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Scattered diverticulosis without evidence of diverticulitis. Otherwise, the included colon, including the appendix, is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. Left renal mass is similar in size when compared to prior again concerning for renal cell carcinoma. No involvement of the collecting system is visualized. The left renal vein is patent. 2. No definite abdominal metastases. Incidental findings as above.	FINDINGS: IMAGE QUALITY: Satisfactory. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Heterogeneously enhancing left renal mass is seen arising from the interpolar region. This measures 6.4 x 5.8 x 5.8 cm (series 3, image 32; series 552, image 68), previously 6.2 x 5.7 cm. This is in close proximally to the posterior cirrhosis fascia but does not appear to abut or invade. This abuts the renal sinus fat without involvement of the collecting system. The renal vein is patent. The right kidney is normal. There is no hydronephrosis bilaterally. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Scattered diverticulosis without evidence of diverticulitis. Otherwise, the included colon, including the appendix, is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.	Findings: The right frontal sinus is not pneumatized. The remaining visualized paranasal sinuses and mastoid air cells are clear of acute process. No acute maxillofacial fracture is noted. The mandibles are intact. The globes are intact. The orbital soft tissues appear unremarkable. The patient is edentulous. There appears to be mild frontal scalp soft tissue swelling.
16,036	Right shoulder MRI: Indication: Interpretation outside study Images: Images are submitted from SEHMC. The images are dated 12/1/2021. Multiplanar multisequence images through the shoulder are provided both pre and post intravenous contrast administration. Findings: There is a large amount of fluid and synovial thickening in the subacromial/subdeltoid bursa with extension into the subcoracoid bursa. There is diffuse hyperenhancement of the thickened synovium after contrast administration. There is patchy red marrow reconversion in the visualized bones. There is a low-grade bursal surface tear of the supraspinatus extending from the insertion through the critical zone. There is a moderate amount of fluid around the long head biceps tendon within the bicipital groove. No thickened synovium is seen within the biceps tendon sheath. Impression: 1. Subacromial/subdeltoid bursitis with diffuse synovial thickening. 2. Biceps tenosynovitis within the bicipital groove. 3. Low-grade articular surface tear of the supraspinatus tendon.	Findings: There is a large amount of fluid and synovial thickening in the subacromial/subdeltoid bursa with extension into the subcoracoid bursa. There is diffuse hyperenhancement of the thickened synovium after contrast administration. There is patchy red marrow reconversion in the visualized bones. There is a low-grade bursal surface tear of the supraspinatus extending from the insertion through the critical zone. There is a moderate amount of fluid around the long head biceps tendon within the bicipital groove. No thickened synovium is seen within the biceps tendon sheath.	FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Hypodense nodule in the right thyroid, which measures 3.1 x 2.1 cm (image 39, series 501). CHEST: LUNGS / AIRWAYS / PLEURA: Left basilar atelectasis. Small calcified granuloma in the left lower lobe. No pleural effusion or pneumothorax. Central airways are patent. HEART / VESSELS: Calcification of the coronary arteries. Trace pericardial effusion. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Hypoattenuating lesion in the lower pole of the left kidney measuring approximately 2.0 cm and showing fluid attenuation, likely a cyst. No hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Mild to moderate scattered calcific atherosclerosis of the abdominal aorta and its branches. URINARY BLADDER: Distended. REPRODUCTIVE ORGANS: Uterus is absent. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Chronic deformities of the third through fifth right ribs. THORACIC AND LUMBAR SPINE: Age-indeterminate compression deformity of the L1 vertebral body with approximately 25% height loss. The rest of the vertebral body heights are preserved. No evidence of malalignment. Mild multilevel degenerative changes of the spine.
16,037	Interpretation of Outside Films MR Head 1/1/2022 11:00 AM Clinical Information: Nonpulsatile tinnitus, lightheadedness Comparison: CT head without contrast dated 9/24/2021, outside MRI images of the brain without and with contrast dated 6/6/2019 Technique: Limited examination provided from outside institution, open upright magnet 0.60 Tesla. Multiplanar multisequence images of the brain were provided without and with contrast. Findings: The available images of the brain demonstrate no discrete intracranial mass, mass effect, edema, hemorrhage, hydrocephalus, or evidence of acute infarction. Examination is not protocoled for evaluation of the inner ear. Minimal microangiopathic changes. The visualized paranasal sinuses and mastoid air cells are unremarkable. No acute osseous or soft tissue abnormality. Impression: Limited Outside Images of the brain demonstrate no MRI abnormality explain patient's symptoms. 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: The available images of the brain demonstrate no discrete intracranial mass, mass effect, edema, hemorrhage, hydrocephalus, or evidence of acute infarction. Examination is not protocoled for evaluation of the inner ear. Minimal microangiopathic changes. The visualized paranasal sinuses and mastoid air cells are unremarkable. No acute osseous or soft tissue abnormality.	FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Hypodense nodule in the right thyroid, which measures 3.1 x 2.1 cm (image 39, series 501). CHEST: LUNGS / AIRWAYS / PLEURA: Left basilar atelectasis. Small calcified granuloma in the left lower lobe. No pleural effusion or pneumothorax. Central airways are patent. HEART / VESSELS: Calcification of the coronary arteries. Trace pericardial effusion. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Hypoattenuating lesion in the lower pole of the left kidney measuring approximately 2.0 cm and showing fluid attenuation, likely a cyst. No hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Mild to moderate scattered calcific atherosclerosis of the abdominal aorta and its branches. URINARY BLADDER: Distended. REPRODUCTIVE ORGANS: Uterus is absent. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Chronic deformities of the third through fifth right ribs. THORACIC AND LUMBAR SPINE: Age-indeterminate compression deformity of the L1 vertebral body with approximately 25% height loss. The rest of the vertebral body heights are preserved. No evidence of malalignment. Mild multilevel degenerative changes of the spine.
16,038	EXAM: Outside MR Image Interpretation CLINICAL INFORMATION: 44-year-old female with history of anal cancer, status post chemoradiation. COMPARISON: Abdomen pelvis CT 10/8/2021. TECHNIQUE: Outside MR images without and with IV contrast dated 12/8/2021 were submitted for interpretation. The MRI acquisition was performed outside of UAB protocol, monitoring and oversight. Interpretation may have reduced accuracy, which should be considered prior to implementation of clinical decisions. FINDINGS: STRUCTURED REPORT: MRI Pelvis LOWER ABDOMEN: BOWEL: No abnormality. PERITONEUM: Normal. OTHER: No other abnormality. PELVIS: VESSELS: No significant abnormality. LYMPH NODES: None enlarged. PERIRECTAL / PERIANAL REGION: There is a small broad-based focal outpouching in the lower rectum wall posteriorly just above the level of the anorectal junction without inflammatory changes in the adjacent puborectalis muscle or in the ischiorectal/ischioanal fat, likely chronic contained perforation posttreatment related given patient history. Mucosal hyperenhancement in the region of the anorectal junction is likely inflammatory/posttreatment related (series 12 image 33). No overt evidence of residual or recurrent disease is appreciated. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus is surgically absent BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. No overt findings of residual or recurrent disease. No metastatic disease is visualized in the pelvis. 2. Chronic contained perforation of the lower rectum posteriorly near the anorectal junction 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: MRI Pelvis LOWER ABDOMEN: BOWEL: No abnormality. PERITONEUM: Normal. OTHER: No other abnormality. PELVIS: VESSELS: No significant abnormality. LYMPH NODES: None enlarged. PERIRECTAL / PERIANAL REGION: There is a small broad-based focal outpouching in the lower rectum wall posteriorly just above the level of the anorectal junction without inflammatory changes in the adjacent puborectalis muscle or in the ischiorectal/ischioanal fat, likely chronic contained perforation posttreatment related given patient history. Mucosal hyperenhancement in the region of the anorectal junction is likely inflammatory/posttreatment related (series 12 image 33). No overt evidence of residual or recurrent disease is appreciated. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus is surgically absent BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.	FINDINGS: STRUCTURED REPORT: CT AP Trauma LOWER CHEST: LUNG BASES: Clear ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Intrauterine] device with T arms appearing to invade into the myometrium superiorly. BODY WALL: Soft tissue stranding in the lower anterior abdominal wall and right anterior thigh likely represents soft tissue contusion. Small fat-containing umbilical hernia. MUSCULOSKELETAL: No significant abnormality. LUMBAR SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Trace retrolisthesis of L5 on S1, likely degenerative.
16,039	Interpretation of Outside Films CT Chest Clinical Information: 71-year-old female with provided history of breast cancer Spec Inst: CT CHEST 122321 REC 010122 NORTHWEST FLORIDA Study reviewed: CT of chest with contrast performed at Northwest Florida community Hospital on 12/23/2021, The images are available in PACS. Comparison: CT chest done later on 1/1/2022 Findings/Conclusion: Attention to the most recent CT done 1/1/2022, unchanged postradiation changes in the left anterior chest wall and left upper lobe with left mastectomy changes. Enlarged bilateral hilar, right axillary, and subcarinal lymph nodes.	Findings/Conclusion: Attention to the most recent CT done 1/1/2022, unchanged postradiation changes in the left anterior chest wall and left upper lobe with left mastectomy changes. Enlarged bilateral hilar, right axillary, and subcarinal lymph nodes.	FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. Cerebral volume is normal. Focal chronic encephalomalacia along the ventriculostomy catheter tract at the caudate head, unchanged. Status post left PCOM aneurysm embolization with extensive streak artifacts from the coil mass.. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. Right frontal ventriculostomy burr hole. VENTRICULAR SYSTEM: Interval removal of right frontal approach ventriculostomy catheter. No periventricular hypoattenuation to suggest transependymal edema. ORBITS: Bilateral lens replacements. SINUSES: Right maxillary sinus mucus retention cyst and trace mucosal thickening. Right sphenoid sinus mucous retention cyst. Small right posterior ethmoid sinolith. The paranasal sinuses and mastoid air cells are otherwise clear.