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CT Angio Head wo+w contrast, CT Angio Neck 1/9/2022 10:51 AM Clinical Information: bilateral vision loss Comparison: Technique: 1.4 mm axial images were obtained during the early arterial phase of a rapid IV infusion of contrast, from the thoracic inlet through the circle of Willis. 3D post-processing was performed with additional MIP images obtained. 3D CT angiographic images were generated from the axial data set. "Sliding MIP" images were also generated and reviewed for interpretation. Patient weight: 173 lbs. IV contrast: Omnipaque 350, 125 ml, per protocol. Saline flush: 40 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 291 mm. DLP: 5804.40 mGy cm. (accession CT220004542), Patient weight: 173 lbs. IV contrast: Omnipaque 350, 125 ml, per protocol. Saline flush: 40 ml. IV contrast injection rate: 4 ml per sec. Scan delay: BT sec. Scan field of view: 291 mm. (accession CT220004543) Findings: Head CT: There is focal area of hypoattenuation within the right parietal-occipital region. There is also a smaller area of hypoattenuation within the superior left occipital region. There is also a well-defined area of hypoattenuation within the left cerebellum. There is mild patchy enhancement hyperdensity within the occipital lobe hypodensities representing small areas of enhancement and possibly small amount of underlying hemorrhage. Aortic arch: There is normal great vessel origin anatomy. There are no great vessel origin stenosis. Right carotid: There is atherosclerotic plaque within the right common carotid artery resulting in mild narrowing. There are mild atherosclerotic calcifications involving the right carotid bifurcation and proximal right cervical ICA resulting in mild narrowing. Left carotid: There are mild atherosclerotic plaques involving the left common carotid artery resulting in mild to moderate narrowing. There are also atherosclerotic calcifications involving the left carotid bifurcation and proximal left cervical ICA resulting in mild narrowing. Right vertebral artery: There are no flow-limiting cervical right vertebral artery stenoses. Left vertebral artery: There is nonvisualization of the proximal left vertebral artery suggesting occlusion. There is very faint opacification of the left vertebral artery beginning at approximately the C4 level probably representing retrograde filling. There are moderate atherosclerotic calcifications involving the left V4 segment resulting in focal narrowing. Both internal jugular veins are patent. There is hypoattenuation within the left jugular vein likely representing mixed filling. There is no mass lesion within the neck. Intracranial vessels: There is no significant narrowing of the intracranial vertebral arteries. There are mild atherosclerotic calcifications of both cavernous and supraclinoid ICAs. Both anterior cerebral arteries are patent without focal stenosis. Both middle cerebral arteries are also patent without focal stenosis. Within the posterior circulation there is atherosclerotic calcification of the left V4 segment resulting in moderate narrowing. There is also moderate is irregular narrowing of the distal most left vertebral artery . There is mild atherosclerotic narrowing of the right V4 segment. The basilar artery demonstrates no significant stenosis. Both proximal PCAs are patent. There is no aneurysm. Conclusion: 01. Subacute bilateral occipital lobe infarctions. There may be small amount of hemorrhagic conversion and also mild gyral enhancement. Right occipital lobe infarct is larger than the left. 02. Remote left cerebellar infarction. 03. Occlusion of proximal left vertebral artery. There is also significant irregular narrowing of the distalmost left vertebral artery. Thrombus may serve as an embolic source for bilateral occipital lobe infarctions. 04. No significant stenosis within the major intracranial vessels. The proximal PCAs are patent bilaterally . The distal PCAs are suboptimally evaluated..
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Findings: Head CT: There is focal area of hypoattenuation within the right parietal-occipital region. There is also a smaller area of hypoattenuation within the superior left occipital region. There is also a well-defined area of hypoattenuation within the left cerebellum. There is mild patchy enhancement hyperdensity within the occipital lobe hypodensities representing small areas of enhancement and possibly small amount of underlying hemorrhage. Aortic arch: There is normal great vessel origin anatomy. There are no great vessel origin stenosis. Right carotid: There is atherosclerotic plaque within the right common carotid artery resulting in mild narrowing. There are mild atherosclerotic calcifications involving the right carotid bifurcation and proximal right cervical ICA resulting in mild narrowing. Left carotid: There are mild atherosclerotic plaques involving the left common carotid artery resulting in mild to moderate narrowing. There are also atherosclerotic calcifications involving the left carotid bifurcation and proximal left cervical ICA resulting in mild narrowing. Right vertebral artery: There are no flow-limiting cervical right vertebral artery stenoses. Left vertebral artery: There is nonvisualization of the proximal left vertebral artery suggesting occlusion. There is very faint opacification of the left vertebral artery beginning at approximately the C4 level probably representing retrograde filling. There are moderate atherosclerotic calcifications involving the left V4 segment resulting in focal narrowing. Both internal jugular veins are patent. There is hypoattenuation within the left jugular vein likely representing mixed filling. There is no mass lesion within the neck. Intracranial vessels: There is no significant narrowing of the intracranial vertebral arteries. There are mild atherosclerotic calcifications of both cavernous and supraclinoid ICAs. Both anterior cerebral arteries are patent without focal stenosis. Both middle cerebral arteries are also patent without focal stenosis. Within the posterior circulation there is atherosclerotic calcification of the left V4 segment resulting in moderate narrowing. There is also moderate is irregular narrowing of the distal most left vertebral artery . There is mild atherosclerotic narrowing of the right V4 segment. The basilar artery demonstrates no significant stenosis. Both proximal PCAs are patent. There is no aneurysm.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: Chest findings to be dictated separately; please see separate chest CT report same day. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Bilateral nodular thickening, similar to the prior exam. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Small hiatal hernia. Small bowel loops are normal COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Severe aortic atherosclerosis without aneurysm URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Partially calcified uterine fibroid. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
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3,801
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EXAM: CT Angio Chest wo+w contrast CLINICAL INFORMATION: Pulmonary embolus seen on abdominal CT COMPARISON: None. TECHNIQUE: CT Angio Chest wo+w contrast Additional 3D image post-processing was performed to generate MIP and/or volume-rendered images. Patient weight: 195 lbs. IV contrast: Omnipaque 350, 60 ml, per protocol. Saline flush: 20 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bt sec. Scan field of view: 350 mm. KVP: 100 DLP: 446 mGy cm. FINDINGS: STRUCTURED REPORT: CT PE OVERALL DIAGNOSTIC QUALITY: Full diagnostic quality LOWER NECK: No abnormality. CHEST: PULMONARY ARTERIES: Subsegmental right lower lobe pulmonary emboli redemonstrated. No other emboli visualized. LUNGS / AIRWAYS / PLEURA: Tiny pleural effusions/basilar atelectasis. HEART / OTHER VESSELS: Extensive coronary calcification. Normal heart size. No evidence of right heart strain. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: See separate CT from same day. MUSCULOSKELETAL: Multiple healing right rib fractures. CONCLUSION: Right lower lobe subsegmental pulmonary emboli. No evidence of right heart strain.
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FINDINGS: STRUCTURED REPORT: CT PE OVERALL DIAGNOSTIC QUALITY: Full diagnostic quality LOWER NECK: No abnormality. CHEST: PULMONARY ARTERIES: Subsegmental right lower lobe pulmonary emboli redemonstrated. No other emboli visualized. LUNGS / AIRWAYS / PLEURA: Tiny pleural effusions/basilar atelectasis. HEART / OTHER VESSELS: Extensive coronary calcification. Normal heart size. No evidence of right heart strain. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: See separate CT from same day. MUSCULOSKELETAL: Multiple healing right rib fractures.
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FINDINGS: Scouts: No additional findings. Lines and tubes: None. Lungs and pleura: Interval decrease in previously noted areas of consolidation and surrounding groundglass densities and atelectasis bilaterally with increased linear scarring now seen. Subsegmental consolidation/atelectasis in the left lower lobe posteriorly (series 3 image 109), right lower lobe anteriorly (series 3 image 121) are new from prior. Spiculated nodule in the right upper lobe measures 12 x 7 mm, previously 19 x 10 mm. Stable right upper lobe nodule (series 3 image 66). Moderate to severe centrilobular emphysema bilaterally with bronchial wall thickening. No pleural effusion. No pneumothorax. Esophagus, Mediastinum and neck: Small hiatal hernia. No abnormality in the mediastinum. The thyroid gland shows few hypodense nodules in the right lobe.. Lymph Nodes: Stable R lymph node measuring 7 mm in short axis, unchanged from November 2021 CT, however increase from October 2021 CT. Stable bilateral hilar lymph nodes. Left hilar lymph node measures 9 mm in short axis. Right hilar lymph node measures 30 mm in short axis, unchanged. No lymphadenopathy by CT size criteria. Cardiovascular: No cardiomegaly or pericardial effusion. Atherosclerotic calcifications and plaques involving the thoracic aorta, aortic arch sidebranches Coronary artery atherosclerotic calcification: Large amount. Abdomen: Please refer to same day CT abdomen report for detailed findings below the diaphragm. Body Wall/Musculoskeletal: No soft tissue masses. No aggressive appearing skeletal lesions. Mild degenerative changes in spine.
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3,802
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EXAM: CT Chest with contrast, CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: 69-year-old male trauma follow-up. COMPARISON: Chest, abdomen radiographs 1/8/2022; CT chest 1/4/2022 TECHNIQUE: CT Chest with contrast, CT Abdomen and Pelvis w contrast. Patient weight: 254 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. Saline flush: 60 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 90 sec Scan field of view: 470 mm. DLP: 1172 mGy cm. (accession CT220004555), Patient weight: 254 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. Saline flush: 60 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 90 sec Scan field of view: 470 mm. (accession CT220004556) FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Partially visualized stranding/edema in the distal aspect of the left sternocleidomastoid muscle. CHEST: LUNGS / AIRWAYS / PLEURA: Subsegmental atelectasis in the posterior right lower lobe, increased from prior exam. Minimal atelectatic changes in the left lung base, also increased. There is otherwise no focal consolidation. Few calcified granulomas in the right lower lobe. No pneumothorax. Small right pleural effusion, new from prior. Trace left fissural fluid. HEART / VESSELS: No significant abnormality. Mild anterior pericardial thickening/fluid. Small amount of coronary artery calcifications. MEDIASTINUM / ESOPHAGUS: No significant abnormality. Decreased/nearly resolved retrosternal hemorrhage. DIAPHRAGM: Intact. LYMPH NODES: Few calcified right hilar and subcarinal lymph nodes. No enlarged lymphadenopathy. CHEST WALL: Mild soft tissue edema and contusive changes in the chest wall, likely secondary to seatbelt trauma, reduced from prior. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Distended. No cholelithiasis, gallbladder wall thickening or pericholecystic fluid. PANCREAS: Normal. SPLEEN: Few punctate calcified granulomas. Otherwise normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Stomach is unremarkable. Postsurgical changes from small bowel resection in the right lower quadrant. COLON / APPENDIX: Uncomplicated diverticulosis. No other significant abnormality. PERITONEUM / MESENTERY: Postsurgical changes in the right lower quadrant mesentery. Left lower abdominal surgical drain in place with catheter tip in the right lower quadrant. Moderate volume pneumoperitoneum, within expected postsurgical limits. Scattered mesenteric edema with small volume simple free fluid. Small focally peripherally thickened pocket of fluid in the right iliac fossa near the ileoileal anastomosis measuring approximately 4.6 x 1.9 cm (series 3 image 310) with internal focus of gas. RETROPERITONEUM: Normal. VESSELS: Mild calcific atherosclerosis of the abdominal aorta and its branch vessels. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No significant abnormality. BODY WALL: Postsurgical changes in the ventral midline abdominal wall. Moderate diffuse lower body wall anasarca. MUSCULOSKELETAL: Minimally displaced fracture of the proximal sternal body. Minimally displaced fractures of the right anterolateral 3rd-6th fractures. Multilevel discogenic degenerative changes of the visualized spine. CONCLUSION: 1. Postsurgical changes from midline laparotomy with partial small bowel resection and ileocolic anastomosis. Expected volume of pneumoperitoneum with small peripherally thickened pocket of fluid in the right lower quadrant, may be postsurgical. Small volume peritoneal fluid. 2. Minimally displaced fractures of the proximal sternal body and the anterolateral right 3rd-6th ribs. Previously seen retrosternal hemorrhage has nearly completely resolved. 3. Evolving contusive changes in the anterior chest wall, likely secondary to seatbelt trauma. Additional chronic and incidental findings as above. 4. Increased bilateral lower lobe atelectasis, greater on the right with small right pleural effusion, may be secondary to aspiration. Gallbladder hydrops without evidence of acute cholecystitis. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Partially visualized stranding/edema in the distal aspect of the left sternocleidomastoid muscle. CHEST: LUNGS / AIRWAYS / PLEURA: Subsegmental atelectasis in the posterior right lower lobe, increased from prior exam. Minimal atelectatic changes in the left lung base, also increased. There is otherwise no focal consolidation. Few calcified granulomas in the right lower lobe. No pneumothorax. Small right pleural effusion, new from prior. Trace left fissural fluid. HEART / VESSELS: No significant abnormality. Mild anterior pericardial thickening/fluid. Small amount of coronary artery calcifications. MEDIASTINUM / ESOPHAGUS: No significant abnormality. Decreased/nearly resolved retrosternal hemorrhage. DIAPHRAGM: Intact. LYMPH NODES: Few calcified right hilar and subcarinal lymph nodes. No enlarged lymphadenopathy. CHEST WALL: Mild soft tissue edema and contusive changes in the chest wall, likely secondary to seatbelt trauma, reduced from prior. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Distended. No cholelithiasis, gallbladder wall thickening or pericholecystic fluid. PANCREAS: Normal. SPLEEN: Few punctate calcified granulomas. Otherwise normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Stomach is unremarkable. Postsurgical changes from small bowel resection in the right lower quadrant. COLON / APPENDIX: Uncomplicated diverticulosis. No other significant abnormality. PERITONEUM / MESENTERY: Postsurgical changes in the right lower quadrant mesentery. Left lower abdominal surgical drain in place with catheter tip in the right lower quadrant. Moderate volume pneumoperitoneum, within expected postsurgical limits. Scattered mesenteric edema with small volume simple free fluid. Small focally peripherally thickened pocket of fluid in the right iliac fossa near the ileoileal anastomosis measuring approximately 4.6 x 1.9 cm (series 3 image 310) with internal focus of gas. RETROPERITONEUM: Normal. VESSELS: Mild calcific atherosclerosis of the abdominal aorta and its branch vessels. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No significant abnormality. BODY WALL: Postsurgical changes in the ventral midline abdominal wall. Moderate diffuse lower body wall anasarca. MUSCULOSKELETAL: Minimally displaced fracture of the proximal sternal body. Minimally displaced fractures of the right anterolateral 3rd-6th fractures. Multilevel discogenic degenerative changes of the visualized spine.
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FINDINGS: Stable postoperative appearance of the distal fibular fixation hardware and type device spanning the distal tibiofibular syndesmosis. Erosive changes of the talar dome and tibial plafond with small joint effusion. Stable postoperative appearance of the midfoot fixation hardware spanning the comminuted fracture of the great toe metatarsal. No hardware complication. Disuse osteopenia. Extensive soft tissue swelling about the ankle.
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3,803
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EXAM: CT Chest with contrast, CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: 69-year-old male trauma follow-up. COMPARISON: Chest, abdomen radiographs 1/8/2022; CT chest 1/4/2022 TECHNIQUE: CT Chest with contrast, CT Abdomen and Pelvis w contrast. Patient weight: 254 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. Saline flush: 60 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 90 sec Scan field of view: 470 mm. DLP: 1172 mGy cm. (accession CT220004555), Patient weight: 254 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. Saline flush: 60 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 90 sec Scan field of view: 470 mm. (accession CT220004556) FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Partially visualized stranding/edema in the distal aspect of the left sternocleidomastoid muscle. CHEST: LUNGS / AIRWAYS / PLEURA: Subsegmental atelectasis in the posterior right lower lobe, increased from prior exam. Minimal atelectatic changes in the left lung base, also increased. There is otherwise no focal consolidation. Few calcified granulomas in the right lower lobe. No pneumothorax. Small right pleural effusion, new from prior. Trace left fissural fluid. HEART / VESSELS: No significant abnormality. Mild anterior pericardial thickening/fluid. Small amount of coronary artery calcifications. MEDIASTINUM / ESOPHAGUS: No significant abnormality. Decreased/nearly resolved retrosternal hemorrhage. DIAPHRAGM: Intact. LYMPH NODES: Few calcified right hilar and subcarinal lymph nodes. No enlarged lymphadenopathy. CHEST WALL: Mild soft tissue edema and contusive changes in the chest wall, likely secondary to seatbelt trauma, reduced from prior. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Distended. No cholelithiasis, gallbladder wall thickening or pericholecystic fluid. PANCREAS: Normal. SPLEEN: Few punctate calcified granulomas. Otherwise normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Stomach is unremarkable. Postsurgical changes from small bowel resection in the right lower quadrant. COLON / APPENDIX: Uncomplicated diverticulosis. No other significant abnormality. PERITONEUM / MESENTERY: Postsurgical changes in the right lower quadrant mesentery. Left lower abdominal surgical drain in place with catheter tip in the right lower quadrant. Moderate volume pneumoperitoneum, within expected postsurgical limits. Scattered mesenteric edema with small volume simple free fluid. Small focally peripherally thickened pocket of fluid in the right iliac fossa near the ileoileal anastomosis measuring approximately 4.6 x 1.9 cm (series 3 image 310) with internal focus of gas. RETROPERITONEUM: Normal. VESSELS: Mild calcific atherosclerosis of the abdominal aorta and its branch vessels. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No significant abnormality. BODY WALL: Postsurgical changes in the ventral midline abdominal wall. Moderate diffuse lower body wall anasarca. MUSCULOSKELETAL: Minimally displaced fracture of the proximal sternal body. Minimally displaced fractures of the right anterolateral 3rd-6th fractures. Multilevel discogenic degenerative changes of the visualized spine. CONCLUSION: 1. Postsurgical changes from midline laparotomy with partial small bowel resection and ileocolic anastomosis. Expected volume of pneumoperitoneum with small peripherally thickened pocket of fluid in the right lower quadrant, may be postsurgical. Small volume peritoneal fluid. 2. Minimally displaced fractures of the proximal sternal body and the anterolateral right 3rd-6th ribs. Previously seen retrosternal hemorrhage has nearly completely resolved. 3. Evolving contusive changes in the anterior chest wall, likely secondary to seatbelt trauma. Additional chronic and incidental findings as above. 4. Increased bilateral lower lobe atelectasis, greater on the right with small right pleural effusion, may be secondary to aspiration. Gallbladder hydrops without evidence of acute cholecystitis. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Partially visualized stranding/edema in the distal aspect of the left sternocleidomastoid muscle. CHEST: LUNGS / AIRWAYS / PLEURA: Subsegmental atelectasis in the posterior right lower lobe, increased from prior exam. Minimal atelectatic changes in the left lung base, also increased. There is otherwise no focal consolidation. Few calcified granulomas in the right lower lobe. No pneumothorax. Small right pleural effusion, new from prior. Trace left fissural fluid. HEART / VESSELS: No significant abnormality. Mild anterior pericardial thickening/fluid. Small amount of coronary artery calcifications. MEDIASTINUM / ESOPHAGUS: No significant abnormality. Decreased/nearly resolved retrosternal hemorrhage. DIAPHRAGM: Intact. LYMPH NODES: Few calcified right hilar and subcarinal lymph nodes. No enlarged lymphadenopathy. CHEST WALL: Mild soft tissue edema and contusive changes in the chest wall, likely secondary to seatbelt trauma, reduced from prior. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Distended. No cholelithiasis, gallbladder wall thickening or pericholecystic fluid. PANCREAS: Normal. SPLEEN: Few punctate calcified granulomas. Otherwise normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Stomach is unremarkable. Postsurgical changes from small bowel resection in the right lower quadrant. COLON / APPENDIX: Uncomplicated diverticulosis. No other significant abnormality. PERITONEUM / MESENTERY: Postsurgical changes in the right lower quadrant mesentery. Left lower abdominal surgical drain in place with catheter tip in the right lower quadrant. Moderate volume pneumoperitoneum, within expected postsurgical limits. Scattered mesenteric edema with small volume simple free fluid. Small focally peripherally thickened pocket of fluid in the right iliac fossa near the ileoileal anastomosis measuring approximately 4.6 x 1.9 cm (series 3 image 310) with internal focus of gas. RETROPERITONEUM: Normal. VESSELS: Mild calcific atherosclerosis of the abdominal aorta and its branch vessels. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No significant abnormality. BODY WALL: Postsurgical changes in the ventral midline abdominal wall. Moderate diffuse lower body wall anasarca. MUSCULOSKELETAL: Minimally displaced fracture of the proximal sternal body. Minimally displaced fractures of the right anterolateral 3rd-6th fractures. Multilevel discogenic degenerative changes of the visualized spine.
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FINDINGS: Status post left total hip arthroplasty with stable appearance of the methacrylate medial and cranial to the acetabular cup. Additionally, there is stable lucency at the inferomedial aspect most consistent with osteolysis. Progressive interval healing of the periprosthetic proximal femoral fracture fixated by multiple cerclage clamps. Persistent fracture lucencies are noted. Within the anterior soft tissues of the thigh, there is a peripheral enhancing hypoattenuation measuring approximately 3.6 x 4.1 x 10.2 cm (image 78, series 4; image 185, series 80589). This area appears contiguous with the veins proximally and distally. The veins of the distal to this lesion contained central filling defects consistent with nonocclusive thrombus within the popliteal vein. The common left iliac and external iliac veins as well as the proximal femoral venous vasculature is markedly dilated. Common femoral vein is difficult to evaluate secondary to artifact from the hip arthroplasty. Adjacent to the distal aspect of the periprosthetic femoral fracture, there is a small peripheral enhancing fluid collection measuring 1.5 x 0.8 cm (image 96, series 4), which appears contiguous with the bone. Within the distal lateral thigh, there is marked soft tissue thickening of the subcutaneous fat with numerous prominent vessels as well as enhancement. Large meningocele arising from the left L4-5 neuroforamen measuring approximately 6.3 x 5.0 cm. Left femoral hernia containing a portion of the urinary bladder.
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3,804
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RADIOLOGIC EXAM: CT Head wo No Charge CLINICAL INFORMATION: Code stroke COMPARISON: 1/5/2022 TECHNIQUE: CT Head wo No ChargeScan field of view: 250 mm. DLP: 1293.80 mGy cm. FINDINGS: Exam somewhat limited by streak/motion artifact. BRAIN PARENCHYMA: No parenchymal hemorrhage, mass effect or edema. Global atrophy. EXTRA-AXIAL SPACES: Overall stable appearance of a thin anterior parafalcine subdural hematoma. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Left sphenoid mucous retention cysts. MASTOIDS: Clear. SOFT TISSUE: Unremarkable. CONCLUSION: Overall stable tiny anterior parafalcine subdural hematoma. No specific evidence for acute ischemia or detrimental interval change from 1/5/2022.
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FINDINGS: Exam somewhat limited by streak/motion artifact. BRAIN PARENCHYMA: No parenchymal hemorrhage, mass effect or edema. Global atrophy. EXTRA-AXIAL SPACES: Overall stable appearance of a thin anterior parafalcine subdural hematoma. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Left sphenoid mucous retention cysts. MASTOIDS: Clear. SOFT TISSUE: Unremarkable.
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FINDINGS: Postsurgical changes of the left parietal vertex is again seen for evacuation of the left hemispheric subdural hemorrhage. There is interval size decrease of the residual left hemispheric subdural hemorrhage with tiny residual hemorrhages/dural thickening measuring 3 mm in thickness previously 8 mm. There is no residual mass effect over the brain parenchyma at this location. Intracranial atherosclerosis is noted. There is mild diffuse cerebral volume loss. Ventriculomegaly appears to be excavatum dilation. The brain parenchyma appears normal without evidence for acute territorial infarct, mass lesion, mass effect, or recent hemorrhage. A 29 mm hypodensity structure in deep portion of left parotid gland is again noted in favor of a lipoma which is partially visualized. The calvarium is intact. Status post functional sinus surgery, bilateral uncinectomy, ethmoidectomy and bilateral sphenoidal osteotomy. Residual mucosal thickening in the maxillary, frontal and ethmoidal air cells is suggestive for residual sinusitis. There is a small focus of dehiscence in anterior portion of the right frontal lobe which is likely sequela of previous sinusitis/mucocele.. The orbits are normal.
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3,805
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Radiologic Exam: CT Angio Head Code Stroke, CT Angio Neck 1/9/2022 4:53 AM Clinical Information: left droop, unequl left facial movement Spec Inst: CODE STROKE: Acute Symptoms. Per chart review, history of AML. Comparison: Multiple prior CT heads, most recently same day. Technique: Helical CT images were obtained before and after the administration of contrast from the base of the skull to the vertex. Contrast enhanced CT angiographic images were obtained from the superior mediastinum to the vertex during the arterial phase. 3-D CT angiographic images were generated from the axial data set. "Sliding MIP" images were also generated in the sagittal, axial, and coronal planes. Patient weight: 170 lbs. IV contrast: Omnipaque 350, 100 ml, per protocol. Saline flush: 80 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 270 mm. DLP: 3037.40 mGy cm. (accession CT220004558), Patient weight: 170 lbs. Saline flush: 80 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 270 mm. (accession CT220004559) FINDINGS: CT of the head with and without contrast: Please see separately reported same day noncontrast CT head. No abnormal intracranial enhancement within the limitations of arterial phase exam. CT angiogram of the brain: RIGHT CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. ANTERIOR, MIDDLE, AND POSTERIOR CEREBRAL ARTERIES: Unremarkable. Fetal predominant circulation of the right PCA. VERTEBROBASILAR ARTERIES: There is no evidence of stenosis, occlusion, or aneurysmal dilation. CT angiogram of the neck: AORTIC ARCH and PROXIMAL GREAT VESSELS: Unremarkable. RIGHT CAROTID: Mild atherosclerosis of the carotid bulb. There is no evidence of flow-limiting stenosis, occlusion, or aneurysmal dilation. LEFT CAROTID: Moderate atherosclerosis of the carotid bulb. There is no evidence of flow-limiting stenosis, occlusion, or aneurysmal dilation. RIGHT VERTEBRAL ARTERY: There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT VERTEBRAL ARTERY: There is no evidence of stenosis, occlusion, or aneurysmal dilation. SOFT TISSUES: Bilateral cervical lymphadenopathy.Partially imaged left subclavian Mediport catheter. Visualized lung apices are clear. CERVICAL SPINE: No aggressive osseous lesions. Mild multilevel discogenic degenerative changes of the cervical spine, most prominent at C6-C7. CONCLUSION: 1. No acute intracranial process appreciated. 2. No evidence of cervical or intracranial arterial abnormality. 3. Bilateral cervical lymphadenopathy, consistent with patient's history of AML. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: CT of the head with and without contrast: Please see separately reported same day noncontrast CT head. No abnormal intracranial enhancement within the limitations of arterial phase exam. CT angiogram of the brain: RIGHT CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. ANTERIOR, MIDDLE, AND POSTERIOR CEREBRAL ARTERIES: Unremarkable. Fetal predominant circulation of the right PCA. VERTEBROBASILAR ARTERIES: There is no evidence of stenosis, occlusion, or aneurysmal dilation. CT angiogram of the neck: AORTIC ARCH and PROXIMAL GREAT VESSELS: Unremarkable. RIGHT CAROTID: Mild atherosclerosis of the carotid bulb. There is no evidence of flow-limiting stenosis, occlusion, or aneurysmal dilation. LEFT CAROTID: Moderate atherosclerosis of the carotid bulb. There is no evidence of flow-limiting stenosis, occlusion, or aneurysmal dilation. RIGHT VERTEBRAL ARTERY: There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT VERTEBRAL ARTERY: There is no evidence of stenosis, occlusion, or aneurysmal dilation. SOFT TISSUES: Bilateral cervical lymphadenopathy.Partially imaged left subclavian Mediport catheter. Visualized lung apices are clear. CERVICAL SPINE: No aggressive osseous lesions. Mild multilevel discogenic degenerative changes of the cervical spine, most prominent at C6-C7.
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FINDINGS: There is a stable left frontal approach intraventricular catheter which ends in the superior portion of the third ventricle, unchanged. Ventricular system remains the same and the left atrium measures 10 mm previously 10. Hypodensity along the left frontal catheter is again seen most consistent with postsurgical changes. There is persistent encephalomalacia of the right cerebellum. Postsurgical changes status post suboccipital craniectomy is again seen. The brain parenchyma appears normal without evidence for acute territorial infarct, mass lesion, mass effect, or recent hemorrhage. The ventricles are normal in size. There is no abnormal extra axial collection. The calvarium is intact. There is a small fluid and retention cyst in left maxillary sinus.. The orbits are normal.
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3,806
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Radiologic Exam: CT Angio Head Code Stroke, CT Angio Neck 1/9/2022 4:53 AM Clinical Information: left droop, unequl left facial movement Spec Inst: CODE STROKE: Acute Symptoms. Per chart review, history of AML. Comparison: Multiple prior CT heads, most recently same day. Technique: Helical CT images were obtained before and after the administration of contrast from the base of the skull to the vertex. Contrast enhanced CT angiographic images were obtained from the superior mediastinum to the vertex during the arterial phase. 3-D CT angiographic images were generated from the axial data set. "Sliding MIP" images were also generated in the sagittal, axial, and coronal planes. Patient weight: 170 lbs. IV contrast: Omnipaque 350, 100 ml, per protocol. Saline flush: 80 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 270 mm. DLP: 3037.40 mGy cm. (accession CT220004558), Patient weight: 170 lbs. Saline flush: 80 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 270 mm. (accession CT220004559) FINDINGS: CT of the head with and without contrast: Please see separately reported same day noncontrast CT head. No abnormal intracranial enhancement within the limitations of arterial phase exam. CT angiogram of the brain: RIGHT CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. ANTERIOR, MIDDLE, AND POSTERIOR CEREBRAL ARTERIES: Unremarkable. Fetal predominant circulation of the right PCA. VERTEBROBASILAR ARTERIES: There is no evidence of stenosis, occlusion, or aneurysmal dilation. CT angiogram of the neck: AORTIC ARCH and PROXIMAL GREAT VESSELS: Unremarkable. RIGHT CAROTID: Mild atherosclerosis of the carotid bulb. There is no evidence of flow-limiting stenosis, occlusion, or aneurysmal dilation. LEFT CAROTID: Moderate atherosclerosis of the carotid bulb. There is no evidence of flow-limiting stenosis, occlusion, or aneurysmal dilation. RIGHT VERTEBRAL ARTERY: There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT VERTEBRAL ARTERY: There is no evidence of stenosis, occlusion, or aneurysmal dilation. SOFT TISSUES: Bilateral cervical lymphadenopathy.Partially imaged left subclavian Mediport catheter. Visualized lung apices are clear. CERVICAL SPINE: No aggressive osseous lesions. Mild multilevel discogenic degenerative changes of the cervical spine, most prominent at C6-C7. CONCLUSION: 1. No acute intracranial process appreciated. 2. No evidence of cervical or intracranial arterial abnormality. 3. Bilateral cervical lymphadenopathy, consistent with patient's history of AML. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: CT of the head with and without contrast: Please see separately reported same day noncontrast CT head. No abnormal intracranial enhancement within the limitations of arterial phase exam. CT angiogram of the brain: RIGHT CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. ANTERIOR, MIDDLE, AND POSTERIOR CEREBRAL ARTERIES: Unremarkable. Fetal predominant circulation of the right PCA. VERTEBROBASILAR ARTERIES: There is no evidence of stenosis, occlusion, or aneurysmal dilation. CT angiogram of the neck: AORTIC ARCH and PROXIMAL GREAT VESSELS: Unremarkable. RIGHT CAROTID: Mild atherosclerosis of the carotid bulb. There is no evidence of flow-limiting stenosis, occlusion, or aneurysmal dilation. LEFT CAROTID: Moderate atherosclerosis of the carotid bulb. There is no evidence of flow-limiting stenosis, occlusion, or aneurysmal dilation. RIGHT VERTEBRAL ARTERY: There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT VERTEBRAL ARTERY: There is no evidence of stenosis, occlusion, or aneurysmal dilation. SOFT TISSUES: Bilateral cervical lymphadenopathy.Partially imaged left subclavian Mediport catheter. Visualized lung apices are clear. CERVICAL SPINE: No aggressive osseous lesions. Mild multilevel discogenic degenerative changes of the cervical spine, most prominent at C6-C7.
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FINDINGS: STRUCTURED REPORT: CT Abdomen LOWER CHEST: LUNG BASES / PLEURA: Mild left basilar atelectasis and trace left pleural effusion. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Surgically absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Postoperative changes from Nissen fundoplication. Small focal outpouching is observed at the location of the previously observed leak (series 3 image 45). No leakage of oral contrast into the pleural space. COLON: No abnormality. PERITONEUM / MESENTERY: No ascites or free intraperitoneal air. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. BODY WALL: Tiny fat-containing umbilical hernia. Changes from prior gastric tube. MUSCULOSKELETAL: Degenerative changes of the thoracolumbar spine. Remote appearing deformity of the right iliac wing..
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3,807
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CT Perfusion 1/9/2022 4:24 AM Clinical Information: Stroke. left droop, unequl left facial movement Spec Inst: known SDH - concern for progression Comparison: None Technique: A CT perfusion study was performed during single pass of 50 cc contrast bolus. Axial images were acquired at 8 axial locations and time-attenuation curves generated from this dataset were utilized to calculate cerebral blood flow, mean transit time, time to peak, and cerebral blood volume maps as well as region of interest specific quantitative data. "Prognostic" color maps were also generated depicting areas of ischemia (voxel values for MTT > 1.4 times mirror image voxels on the contralateral "normal side") in the color green and areas predictive of infarction (CBV values < 2.0 ml/100g) in the color red. Patient weight: 170 lbs. IV contrast: Omnipaque 350, 80 ml, per protocol. Saline flush: 80 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 0 sec. Scan field of view: 250 mm. DLP: 1416 mGy cm. Findings: Color parametric maps demonstrate no areas of increased mean transit time or Tmax and no areas of decreased R CBF or R CBV. Prognostic maps demonstrate no area of increased Tmax greater than 6 seconds and no CBF less than 30%. Conclusion: No CT perfusion evidence of acute infarction
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Findings: Color parametric maps demonstrate no areas of increased mean transit time or Tmax and no areas of decreased R CBF or R CBV. Prognostic maps demonstrate no area of increased Tmax greater than 6 seconds and no CBF less than 30%.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Focal fat is seen adjacent to the intersegmental fissure. The liver is otherwise unremarkable. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Low attenuated lesion within the mid left kidney is technically indeterminate but likely a cyst. No radiopaque urinary calculus or hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: The appendix is normal. The colon is otherwise unremarkable. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Small fat-containing umbilical hernia. MUSCULOSKELETAL: No significant abnormality.
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3,808
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EXAM: CT Bone Pelvis w soft tissue no charge CLINICAL INFORMATION: Trauma COMPARISON: None. TECHNIQUE: CT Bone Pelvis w soft tissue no charge Scan field of view: 438 mm. FINDINGS/CONCLUSION: Severely comminuted fracture of the proximal right femur involving the intertrochanteric region and extending inferiorly out of the field of view. No acute fracture of the pelvis or left femur. Numerous foci of soft tissue gas and metallic densities are seen scattered throughout the fracture fragments consistent with ballistic injury. Contrast is seen within the urinary bladder. Please see separately dictated and concurrently obtained CT chest abdomen and pelvis for intra-abdominal findings..
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FINDINGS/CONCLUSION: Severely comminuted fracture of the proximal right femur involving the intertrochanteric region and extending inferiorly out of the field of view. No acute fracture of the pelvis or left femur. Numerous foci of soft tissue gas and metallic densities are seen scattered throughout the fracture fragments consistent with ballistic injury. Contrast is seen within the urinary bladder. Please see separately dictated and concurrently obtained CT chest abdomen and pelvis for intra-abdominal findings..
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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Minimal atelectatic changes at the left lung base and right middle lobe. 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: Tiny nonobstructing right renal calculus measuring less than 2 mm in size (image 70, series 2). No hydronephrosis. No hydroureter ureter. Stable appearance of previously described 2 mm calcification along the distal right ureter (image 210, series 2), likely a phlebolith. No obstructing ureteric calculi. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Small appendicoliths. Appendix is otherwise unremarkable. Colon is unremarkable. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Scattered vascular atherosclerosis. URINARY BLADDER: Partially distended and is unremarkable for degree of distention. REPRODUCTIVE ORGANS: Uterus and bilateral adnexa are unremarkable. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
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3,809
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EXAM: CT Abdomen and Pelvis wo IV contrast CLINICAL INFORMATION: Abdominal pain, history of diverticulitis. COMPARISON: CT abdomen pelvis without contrast 1/6/2022. TECHNIQUE: CT Abdomen and Pelvis wo IV contrast. Scan field of view: 358 mm. DLP: 461.90 mGy cm. FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Dense mitral annular calcifications. Partially visualized calcific atherosclerosis in the coronary arteries. Persistent moderate pericardial effusion. ABDOMEN and PELVIS: LIVER: Normal noncontrast appearance. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: The native pancreas is atrophic. The transplant pancreas is not well-visualized on this examination. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Symmetric atrophy of the native kidneys. Transplant kidney in the left iliac fossa with unchanged simple cyst and additional small hyperattenuating cysts. No radiopaque nephrolithiasis or transplant hydroureteronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Extensive colonic diverticulosis. Interval worsening mild wall thickening centered about the inflamed distal descending colonic diverticulum with worsening pericolonic stranding and edema tracking proximally to the splenic flexure. PERITONEUM / MESENTERY: No free intraperitoneal fluid. No pneumoperitoneum. Streak artifact from numerous surgical clips in the right lower quadrant of the abdomen obscures evaluation of the surrounding structures. RETROPERITONEUM: Stranding about the descending colon, as above. VESSELS: Advanced aortoiliac calcific atherosclerosis. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus is atrophic. BODY WALL: Postsurgical changes from ventral abdominal wall hernia repair with mesh. Pressure visualized left breast implant. MUSCULOSKELETAL: No aggressive osseous abnormality is identified. Multiple chronic bilateral rib fracture deformities. CONCLUSION: Redemonstration of acute diverticulitis of the distal descending colon with worsening colitis and surrounding inflammation involving the upstream descending colon. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Dense mitral annular calcifications. Partially visualized calcific atherosclerosis in the coronary arteries. Persistent moderate pericardial effusion. ABDOMEN and PELVIS: LIVER: Normal noncontrast appearance. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: The native pancreas is atrophic. The transplant pancreas is not well-visualized on this examination. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Symmetric atrophy of the native kidneys. Transplant kidney in the left iliac fossa with unchanged simple cyst and additional small hyperattenuating cysts. No radiopaque nephrolithiasis or transplant hydroureteronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Extensive colonic diverticulosis. Interval worsening mild wall thickening centered about the inflamed distal descending colonic diverticulum with worsening pericolonic stranding and edema tracking proximally to the splenic flexure. PERITONEUM / MESENTERY: No free intraperitoneal fluid. No pneumoperitoneum. Streak artifact from numerous surgical clips in the right lower quadrant of the abdomen obscures evaluation of the surrounding structures. RETROPERITONEUM: Stranding about the descending colon, as above. VESSELS: Advanced aortoiliac calcific atherosclerosis. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus is atrophic. BODY WALL: Postsurgical changes from ventral abdominal wall hernia repair with mesh. Pressure visualized left breast implant. MUSCULOSKELETAL: No aggressive osseous abnormality is identified. Multiple chronic bilateral rib fracture deformities.
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Findings/conclusion: Nondisplaced fracture of the anterior column of the right acetabulum. Comminuted fracture of the right inferior pubic ramus. No other acute displaced fracture is seen. Healed fracture deformity of the proximal right femur status post intramedullary fixation. Status post left hip arthroplasty. Diffuse decreased bone mineralization. The femoral heads are well-seated within their respective acetabula. No pubic symphyseal or SI joint diastasis. Please see separately dictated and concurrently obtained CT chest abdomen and pelvis for intra-abdominal findings..
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3,810
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RADIOLOGIC EXAM: CT Head wo contrast, CT Maxillofacial wo contrast CLINICAL INFORMATION: Trauma COMPARISON: None. TECHNIQUE: CT Head wo contrast, CT Maxillofacial wo contrastScan field of view: 242 mm. DLP: 1440.90 mGy cm. (accession CT220004564), Scan field of view: 220 mm. DLP: 1112.70 mGy cm. (accession CT220004570) STRUCTURED REPORT: CT Head and Maxillofacial Trauma FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. Cerebral cortical volume is normal. EXTRA-AXIAL SPACES: Normal. VENTRICULAR SYSTEM: Normal. ORBITS: Right orbital fractures as below. No muscle herniation. No evidence of retrobulbar hemorrhage or proptosis. Right malar and periorbital hematoma. SKULL AND SKULL BASE: Comminuted greater sphenoid wing and obliquely oriented right temporal bone fractures as described below. Moderate amount of fluid filling the right mastoid air cells, likely hemorrhage. Left mastoid air cells are clear. FACIAL BONES: Right ZMC fracture with comminuted fractures of the right zygomatic process, maxillary sinus, and inferior orbital rim. Fracture extends to the right greater sphenoid wing, squamous portion of the temporal bone, and right temporomandibular joint capsule. Hematoma anterior to the right zygomatic process extending down the cheek. Pterygoid plates are intact. MANDIBLE: Fracture extending to the right temporomandibular joint capsule as above. The bilateral temporomandibular joints are intact. No acute mandible fracture. SINONASAL CAVITIES: Moderate amount of hemorrhage in the right maxillary sinus. Tiny foci of gas in the right pterygopalatine fossa posterior to the maxillary sinus. CONCLUSION: 1. No acute intracranial process. 2. Comminuted right ZMC fracture extending to the right greater sphenoid wing, right squamous temporal bone, right temporomandibular joint capsule and right orbital floor as above. Moderate associated right maxillary intrasinus hemorrhage. COMMUNICATION: Stephanie Colvin, MD communicated preliminary findings by phone with Dr. Davis on 1/9/2022 5:34 AM. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. Cerebral cortical volume is normal. EXTRA-AXIAL SPACES: Normal. VENTRICULAR SYSTEM: Normal. ORBITS: Right orbital fractures as below. No muscle herniation. No evidence of retrobulbar hemorrhage or proptosis. Right malar and periorbital hematoma. SKULL AND SKULL BASE: Comminuted greater sphenoid wing and obliquely oriented right temporal bone fractures as described below. Moderate amount of fluid filling the right mastoid air cells, likely hemorrhage. Left mastoid air cells are clear. FACIAL BONES: Right ZMC fracture with comminuted fractures of the right zygomatic process, maxillary sinus, and inferior orbital rim. Fracture extends to the right greater sphenoid wing, squamous portion of the temporal bone, and right temporomandibular joint capsule. Hematoma anterior to the right zygomatic process extending down the cheek. Pterygoid plates are intact. MANDIBLE: Fracture extending to the right temporomandibular joint capsule as above. The bilateral temporomandibular joints are intact. No acute mandible fracture. SINONASAL CAVITIES: Moderate amount of hemorrhage in the right maxillary sinus. Tiny foci of gas in the right pterygopalatine fossa posterior to the maxillary sinus.
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FINDINGS: STRUCTURED REPORT: CT HCC Follow-up IMAGE QUALITY: Satisfactory LOWER CHEST: LUNG BASES / PLEURA: Bibasilar subpleural reticulation. Subpleural cystic change along the periphery of the partially imaged right upper lobe. HEART / VESSELS: Calcifications of the aortic valve and coronary arteries. ABDOMEN: LIVER: Normal liver surface and morphology. No steatosis. Subcentimeter hypoattenuating lesion in the hepatic dome on image 48 series 301, likely small cyst. TREATED LIVER LESIONS: - Lesion Number: 1 - Description: TACE lesion in the caudate. - Location: Segment(s) 1 - Size of largest enhancing portion of the mass: 2.7 x 2.3 cm on image 58 series 301 - Enhancement: Nodular, masslike, or thick irregular tissue in or along the treated lesion - Additional features: - Arterial phase hyperenhancement: Present. - Washout: Present. - Enhancement similar to pretreatment: N/A - Vascular invasion: No - LI-RADS: LR-TR Viable UNTREATED OR NEW LIVER LESION(S): None. LIVER VASCULATURE AND COLLATERALS: - Hepatic artery patency and anatomy: Patent with conventional anatomy. - Portal venous system: Patent intra- and extra-hepatic portal venous system. - Hepatic veins: The centrally located tumor contacts the middle and right hepatic veins and IVC and likely focally invades the middle hepatic vein and IVC. - Esophageal varices: None. - Other varices or collaterals: None. LIVER RELATED FINDINGS: BILIARY DUCTS: No biliary dilatation. GALLBLADDER: Absent. LYMPH NODES: None enlarged. SPLEEN: Normal size and appearance. PERITONEUM / ASCITES: No ascites. OTHER FINDINGS: PANCREAS: Normal. ADRENALS: Normal. KIDNEYS: Subcentimeter focus of hypoattenuation in the right lower pole is too small for accurate characterization. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Scattered noninflamed colonic diverticula. Normal appendix. MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: Advanced atherosclerotic calcifications of the abdominal aorta and branch vessels. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Prostate gland is enlarged. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Post surgical changes from left lateral fixation of L3-L4 with intervertebral disc device in place. No mature bridging ossification across the disc space. Post surgical changes from L4-L5 laminectomy.
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3,811
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EXAM: CT Chest with contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat, CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: Trauma. COMPARISON: None available. TECHNIQUE: CT Chest with contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat, CT Abdomen and Pelvis w contrast. Patient weight: 140 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 450 mm. DLP: 834.30 mGy cm. (accession CT220004565), Patient weight: 140 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 450 mm. DLP: 834.30 mGy cm. (accession CT220004568), Patient weight: 140 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 450 mm. DLP: 834.30 mGy cm. (accession CT220004569), Patient weight: 140 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 450 mm. (accession CT220004566) FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: The central tracheobronchial tree is patent. Mild dependent atelectatic changes. No focal consolidation, pleural effusion, or pneumothorax. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: No significant abnormality. Residual thymic tissue is noted. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No significant abnormality in the colon. The appendix is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Subtle asymmetric widening of the right acromioclavicular joint. Multiple chronic left rib fracture deformities. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. Mild multilevel discogenic degenerative changes. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No spondylolisthesis. LUMBAR SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No spondylolisthesis. CONCLUSION: 1. Subtle asymmetric widening of the right acromioclavicular joint, suggestive of a grade 1 AC joint injury. 2. No other acute traumatic abnormality in the abdomen or pelvis. No acute fracture or subluxation in the thoracolumbar spine. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: The central tracheobronchial tree is patent. Mild dependent atelectatic changes. No focal consolidation, pleural effusion, or pneumothorax. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: No significant abnormality. Residual thymic tissue is noted. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No significant abnormality in the colon. The appendix is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Subtle asymmetric widening of the right acromioclavicular joint. Multiple chronic left rib fracture deformities. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. Mild multilevel discogenic degenerative changes. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No spondylolisthesis. LUMBAR SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No spondylolisthesis.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: Please see separate CT chest report. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Unchanged tiny renal cysts. Otherwise normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. Contrast within the stomach and small bowel. COLON / APPENDIX: Colonic diverticulosis PERITONEUM / MESENTERY: Mesenteric nodularity in the anterior pelvis is unchanged (series 3 image 313). Peritoneal nodularity within the superior ventral abdominal hernia is similar to the prior exam (series 3 image 222, 223 and 233). RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Partially collapsed. REPRODUCTIVE ORGANS: Surgically absent uterus. Left adnexal lesion measures 1.8 x 1.1 cm (series 3, image 298), previously 1.6 x 1.3 cm. BODY WALL: Persistent supraumbilical ventral midline abdominal wall hernias containing loops of nondilated bowel. MUSCULOSKELETAL: Degenerative changes in lumbar spine. No suspicious osseous lesion.
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3,812
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EXAM: CT Chest with contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat, CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: Trauma. COMPARISON: None available. TECHNIQUE: CT Chest with contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat, CT Abdomen and Pelvis w contrast. Patient weight: 140 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 450 mm. DLP: 834.30 mGy cm. (accession CT220004565), Patient weight: 140 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 450 mm. DLP: 834.30 mGy cm. (accession CT220004568), Patient weight: 140 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 450 mm. DLP: 834.30 mGy cm. (accession CT220004569), Patient weight: 140 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 450 mm. (accession CT220004566) FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: The central tracheobronchial tree is patent. Mild dependent atelectatic changes. No focal consolidation, pleural effusion, or pneumothorax. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: No significant abnormality. Residual thymic tissue is noted. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No significant abnormality in the colon. The appendix is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Subtle asymmetric widening of the right acromioclavicular joint. Multiple chronic left rib fracture deformities. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. Mild multilevel discogenic degenerative changes. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No spondylolisthesis. LUMBAR SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No spondylolisthesis. CONCLUSION: 1. Subtle asymmetric widening of the right acromioclavicular joint, suggestive of a grade 1 AC joint injury. 2. No other acute traumatic abnormality in the abdomen or pelvis. No acute fracture or subluxation in the thoracolumbar spine. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: The central tracheobronchial tree is patent. Mild dependent atelectatic changes. No focal consolidation, pleural effusion, or pneumothorax. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: No significant abnormality. Residual thymic tissue is noted. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No significant abnormality in the colon. The appendix is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Subtle asymmetric widening of the right acromioclavicular joint. Multiple chronic left rib fracture deformities. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. Mild multilevel discogenic degenerative changes. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No spondylolisthesis. LUMBAR SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No spondylolisthesis.
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FINDINGS: Scouts: No additional findings. Lines and tubes: Left chest wall port catheter tip is in the mid SVC. Lungs and pleura: Scattered noncalcified pulmonary nodules bilaterally are unchanged (series 3 image 44, 87, 89, 100, 109, 111). Increase in conspicuity of one of the nodules in the right middle lobe laterally (series 3 image 87). No pulmonary consolidation. No pleural effusion. No pneumothorax. Esophagus, Mediastinum and neck: Small hiatal hernia. No abnormality in the mediastinum. The thyroid gland is enlarged, more on the left, with multiple hypodense nodules as before.. Lymph Nodes: None enlarged. Cardiovascular: No cardiomegaly or pericardial effusion. Coronary artery atherosclerotic calcification: None detected. Abdomen: Please refer to same day CT abdomen report for detailed findings below the diaphragm. Body Wall/Musculoskeletal: No soft tissue masses. Calcific focus in the right breast. No aggressive appearing skeletal lesions. Degenerative changes in spine.
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3,813
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RADIOLOGIC EXAM: CT Angio Neck, CT Cervical Spine From Reformat CLINICAL INFORMATION: Trauma. COMPARISON: None. TECHNIQUE: CT Angio Neck, CT Cervical Spine From ReformatPatient weight: 140 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 247 mm. DLP: 1010.80 mGy cm. Following CT of the neck, reformatted images were produced to optimize visualization of the osseous structures of the cervical spine. 3-D CT MIP were generated in post processing. FINDINGS: CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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FINDINGS: CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Bilateral lower lobe subsegmental atelectasis. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Right upper pole renal cyst. LYMPH NODES: Scattered prominent but nonenlarged retroperitoneal lymph nodes and mesenteric lymph nodes. STOMACH / SMALL BOWEL: Enteric contrast material extends to the patient's diverting loop ileostomy. No extra luminal contrast. Small gas-filled duodenal diverticulum. Right lower quadrant diverting loop ileostomy COLON / APPENDIX: Post surgical changes from distal colonic resection with colorectal anastomosis. Decreasing gas along the cranial and anterior margins of the anastomosis, for example on images 283, 296, and 324. Most of the colon is collapsed with evolving adjacent inflammatory changes. PERITONEUM / MESENTERY: Near-complete resolution of the ascites seen throughout the abdomen and pelvis with a small amount of residual ascites along the hepatic dome and stomach. Extensive pericolonic inflammatory changes appear similar in distribution. Left hemiabdomen surgical drain terminates in the right hemipelvis. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Urinary bladder wall thickening may be due to under distention, though there is also persistent perivesicular fat stranding. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Increasing peripherally enhancing fluid deep to the cranial aspect of the surgical incision, for example measuring up to 3.0 x 2.7 cm on image 209 series 2. This appears to communicate with the skin. Similar dehiscence of the caudal aspect of the surgical wound. Right lower quadrant diverting loop ileostomy with associated parastomal hernia. MUSCULOSKELETAL: L5-S1 degenerative changes.
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3,814
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EXAM: CT Chest with contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat, CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: Trauma. COMPARISON: None available. TECHNIQUE: CT Chest with contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat, CT Abdomen and Pelvis w contrast. Patient weight: 140 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 450 mm. DLP: 834.30 mGy cm. (accession CT220004565), Patient weight: 140 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 450 mm. DLP: 834.30 mGy cm. (accession CT220004568), Patient weight: 140 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 450 mm. DLP: 834.30 mGy cm. (accession CT220004569), Patient weight: 140 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 450 mm. (accession CT220004566) FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: The central tracheobronchial tree is patent. Mild dependent atelectatic changes. No focal consolidation, pleural effusion, or pneumothorax. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: No significant abnormality. Residual thymic tissue is noted. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No significant abnormality in the colon. The appendix is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Subtle asymmetric widening of the right acromioclavicular joint. Multiple chronic left rib fracture deformities. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. Mild multilevel discogenic degenerative changes. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No spondylolisthesis. LUMBAR SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No spondylolisthesis. CONCLUSION: 1. Subtle asymmetric widening of the right acromioclavicular joint, suggestive of a grade 1 AC joint injury. 2. No other acute traumatic abnormality in the abdomen or pelvis. No acute fracture or subluxation in the thoracolumbar spine. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: The central tracheobronchial tree is patent. Mild dependent atelectatic changes. No focal consolidation, pleural effusion, or pneumothorax. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: No significant abnormality. Residual thymic tissue is noted. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No significant abnormality in the colon. The appendix is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Subtle asymmetric widening of the right acromioclavicular joint. Multiple chronic left rib fracture deformities. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. Mild multilevel discogenic degenerative changes. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No spondylolisthesis. LUMBAR SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No spondylolisthesis.
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Findings: CT angiogram of the brain: Early branching of the left PCA. Severe short segment narrowing/ occlusion of the anterior P2 branch. Atherosclerotic calcifications and luminal irregularity of both intracranial vertebral arteries, greater on the right. The left vertebral artery is dominant. The visualized portions of the ICAs and vertebrobasilar system appear within normal limits. The visualized portions of the ACAs, MCAs, and right PCAs appear within normal limits. - CT angiogram of the neck: Limited evaluation of the proximal neck vessels due to photon starvation/ streak artifacts. Calcific Atherosclerotic changes at the right carotid artery bifurcation and proximal right ICA with about 50% luminal narrowing of the right ICA, but 1.5 cm from its origin. Small amount of calcific atherosclerotic changes at the left carotid bifurcation with no evidence of luminal stenosis or occlusion. The left vertebral artery is dominant. There is a normal three great vessel arch. The visualized portions of the common, as well as cervical portions of the internal, and external carotid arteries appear within normal limits. The visualized vertebral arteries appear within normal limits. -
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3,815
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EXAM: CT Chest with contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat, CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: Trauma. COMPARISON: None available. TECHNIQUE: CT Chest with contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat, CT Abdomen and Pelvis w contrast. Patient weight: 140 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 450 mm. DLP: 834.30 mGy cm. (accession CT220004565), Patient weight: 140 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 450 mm. DLP: 834.30 mGy cm. (accession CT220004568), Patient weight: 140 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 450 mm. DLP: 834.30 mGy cm. (accession CT220004569), Patient weight: 140 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 450 mm. (accession CT220004566) FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: The central tracheobronchial tree is patent. Mild dependent atelectatic changes. No focal consolidation, pleural effusion, or pneumothorax. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: No significant abnormality. Residual thymic tissue is noted. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No significant abnormality in the colon. The appendix is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Subtle asymmetric widening of the right acromioclavicular joint. Multiple chronic left rib fracture deformities. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. Mild multilevel discogenic degenerative changes. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No spondylolisthesis. LUMBAR SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No spondylolisthesis. CONCLUSION: 1. Subtle asymmetric widening of the right acromioclavicular joint, suggestive of a grade 1 AC joint injury. 2. No other acute traumatic abnormality in the abdomen or pelvis. No acute fracture or subluxation in the thoracolumbar spine. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: The central tracheobronchial tree is patent. Mild dependent atelectatic changes. No focal consolidation, pleural effusion, or pneumothorax. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: No significant abnormality. Residual thymic tissue is noted. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No significant abnormality in the colon. The appendix is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Subtle asymmetric widening of the right acromioclavicular joint. Multiple chronic left rib fracture deformities. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. Mild multilevel discogenic degenerative changes. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No spondylolisthesis. LUMBAR SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No spondylolisthesis.
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Findings: CT angiogram of the brain: Early branching of the left PCA. Severe short segment narrowing/ occlusion of the anterior P2 branch. Atherosclerotic calcifications and luminal irregularity of both intracranial vertebral arteries, greater on the right. The left vertebral artery is dominant. The visualized portions of the ICAs and vertebrobasilar system appear within normal limits. The visualized portions of the ACAs, MCAs, and right PCAs appear within normal limits. - CT angiogram of the neck: Limited evaluation of the proximal neck vessels due to photon starvation/ streak artifacts. Calcific Atherosclerotic changes at the right carotid artery bifurcation and proximal right ICA with about 50% luminal narrowing of the right ICA, but 1.5 cm from its origin. Small amount of calcific atherosclerotic changes at the left carotid bifurcation with no evidence of luminal stenosis or occlusion. The left vertebral artery is dominant. There is a normal three great vessel arch. The visualized portions of the common, as well as cervical portions of the internal, and external carotid arteries appear within normal limits. The visualized vertebral arteries appear within normal limits. -
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3,816
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RADIOLOGIC EXAM: CT Head wo contrast, CT Maxillofacial wo contrast CLINICAL INFORMATION: Trauma COMPARISON: None. TECHNIQUE: CT Head wo contrast, CT Maxillofacial wo contrastScan field of view: 242 mm. DLP: 1440.90 mGy cm. (accession CT220004564), Scan field of view: 220 mm. DLP: 1112.70 mGy cm. (accession CT220004570) STRUCTURED REPORT: CT Head and Maxillofacial Trauma FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. Cerebral cortical volume is normal. EXTRA-AXIAL SPACES: Normal. VENTRICULAR SYSTEM: Normal. ORBITS: Right orbital fractures as below. No muscle herniation. No evidence of retrobulbar hemorrhage or proptosis. Right malar and periorbital hematoma. SKULL AND SKULL BASE: Comminuted greater sphenoid wing and obliquely oriented right temporal bone fractures as described below. Moderate amount of fluid filling the right mastoid air cells, likely hemorrhage. Left mastoid air cells are clear. FACIAL BONES: Right ZMC fracture with comminuted fractures of the right zygomatic process, maxillary sinus, and inferior orbital rim. Fracture extends to the right greater sphenoid wing, squamous portion of the temporal bone, and right temporomandibular joint capsule. Hematoma anterior to the right zygomatic process extending down the cheek. Pterygoid plates are intact. MANDIBLE: Fracture extending to the right temporomandibular joint capsule as above. The bilateral temporomandibular joints are intact. No acute mandible fracture. SINONASAL CAVITIES: Moderate amount of hemorrhage in the right maxillary sinus. Tiny foci of gas in the right pterygopalatine fossa posterior to the maxillary sinus. CONCLUSION: 1. No acute intracranial process. 2. Comminuted right ZMC fracture extending to the right greater sphenoid wing, right squamous temporal bone, right temporomandibular joint capsule and right orbital floor as above. Moderate associated right maxillary intrasinus hemorrhage. COMMUNICATION: Stephanie Colvin, MD communicated preliminary findings by phone with Dr. Davis on 1/9/2022 5:34 AM. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. Cerebral cortical volume is normal. EXTRA-AXIAL SPACES: Normal. VENTRICULAR SYSTEM: Normal. ORBITS: Right orbital fractures as below. No muscle herniation. No evidence of retrobulbar hemorrhage or proptosis. Right malar and periorbital hematoma. SKULL AND SKULL BASE: Comminuted greater sphenoid wing and obliquely oriented right temporal bone fractures as described below. Moderate amount of fluid filling the right mastoid air cells, likely hemorrhage. Left mastoid air cells are clear. FACIAL BONES: Right ZMC fracture with comminuted fractures of the right zygomatic process, maxillary sinus, and inferior orbital rim. Fracture extends to the right greater sphenoid wing, squamous portion of the temporal bone, and right temporomandibular joint capsule. Hematoma anterior to the right zygomatic process extending down the cheek. Pterygoid plates are intact. MANDIBLE: Fracture extending to the right temporomandibular joint capsule as above. The bilateral temporomandibular joints are intact. No acute mandible fracture. SINONASAL CAVITIES: Moderate amount of hemorrhage in the right maxillary sinus. Tiny foci of gas in the right pterygopalatine fossa posterior to the maxillary sinus.
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Findings: There is no evidence of intracranial hemorrhage . Chronic lacunar infarcts right centrum semiovale, both corona radiata and right frontal periventricular white matter. Ill-defined hypoattenuation in the posterior limb of left internal capsule. There is no evidence of hydrocephalus or of an intracranial mass.
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3,817
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RADIOLOGIC EXAM: CT Angio Neck, CT Cervical Spine From Reformat CLINICAL INFORMATION: Trauma. COMPARISON: None. TECHNIQUE: CT Angio Neck, CT Cervical Spine From ReformatPatient weight: 140 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 247 mm. DLP: 1010.80 mGy cm. Following CT of the neck, reformatted images were produced to optimize visualization of the osseous structures of the cervical spine. 3-D CT MIP were generated in post processing. FINDINGS: CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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FINDINGS: CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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Findings: RAPID images demonstrate CBF less than 30% volume: 0 ml and T. Max greater than 6seconds volume: 4ml . Mismatch volume is 4 ml. This is seen in the region of pons on the color maps and could be artifactual. Otherwise there is no abnormal MTT, T max, CBV and CBF to suggest significant ischemia or infarction at the territory of the major intracranial arteries.
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3,818
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EXAM: CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: History of hidradenitis with vaginal and rectal bleeding. COMPARISON: CT abdomen pelvis 12/6/2021 TECHNIQUE: CT Abdomen and Pelvis w contrast. Patient weight: 200 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 80 sec Scan field of view: 383.60 mm. DLP: 722.10 mGy cm. FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Right greater than left dependent atelectasis DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Punctate nonobstructive nephrolithiasis in the bilateral kidneys. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Sigmoid colon anastomosis is again seen. Mild amount of formed fecal material throughout colon. The appendix is unremarkable. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Mildly distended. REPRODUCTIVE ORGANS: Unchanged calcification adjacent to the right ovary. BODY WALL: Small fat-containing ventral hernia in the left rectus muscle from prior ostomy. Skin thickening is noted along the perineum and gluteal cleft with redemonstration of the sinus tract extending from the gluteal cleft to the left gluteal skin. Nodular densities in the gluteal subcutaneous tissues is again seen. No organized fluid collection. Skin thickening near the vaginal introitus extending to the labia and mons pubis is also similar to prior. No organized fluid collection. MUSCULOSKELETAL: No aggressive osseous lesions. Straightening of the normal lumbar lordosis. Unchanged superior endplate compression deformity of T11. CONCLUSION: 1. Similar appearance of sequela of hidradenitis with skin thickening and inflammatory changes involving the gluteal cleft, peritoneum, and labia without organized fluid collection. Sinus tract persists in the left gluteal subcutaneous soft tissues. 2. No acute intra-abdominal abnormality. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Right greater than left dependent atelectasis DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Punctate nonobstructive nephrolithiasis in the bilateral kidneys. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Sigmoid colon anastomosis is again seen. Mild amount of formed fecal material throughout colon. The appendix is unremarkable. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Mildly distended. REPRODUCTIVE ORGANS: Unchanged calcification adjacent to the right ovary. BODY WALL: Small fat-containing ventral hernia in the left rectus muscle from prior ostomy. Skin thickening is noted along the perineum and gluteal cleft with redemonstration of the sinus tract extending from the gluteal cleft to the left gluteal skin. Nodular densities in the gluteal subcutaneous tissues is again seen. No organized fluid collection. Skin thickening near the vaginal introitus extending to the labia and mons pubis is also similar to prior. No organized fluid collection. MUSCULOSKELETAL: No aggressive osseous lesions. Straightening of the normal lumbar lordosis. Unchanged superior endplate compression deformity of T11.
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FINDINGS: SOFT TISSUES: Normal. LYMPH NODES: The patient is status post bilateral neck dissection. Prominent submental and bilateral submandibular lymph nodes are again noted in favor of reactive changes not significant change since 3/17/2020. AERODIGESTIVE STRUCTURES: Status post total laryngectomy and also voice restoration device placement. No definite new enhancing soft tissue subject to surgery to suggest local recurrence. PAROTID GLANDS: Normal. SUBMANDIBULAR GLANDS: Have been resected THYROID GLAND: As been resected VASCULAR STRUCTURES: Aortic arch is patent with multiple calcified atherosclerotic plaques. The origin of main arteries are patent. It appears that the right common carotid is occluded. Reconstitution of the proximal right ICA and the right external carotid artery is seen. The left common carotid artery is patent with extensive atherosclerosis and mild narrowing. Heavily calcified atherosclerotic plaque of the left carotid bifurcation is seen without opacification of the cervical portion of the left internal carotid artery concerning for occlusion. The right vertebral artery is patent. The left vertebral artery is rudimentary and its origin is not well seen. Intracranial atherosclerosis along the bilateral carotid arteries is seen. OSSEOUS STRUCTURES: No fracture, dislocation, or destructive lesion. ORBITS: Normal. PARANASAL SINUSES AND MASTOID AIR CELLS: Clear. PARTIALLY VISUALIZED INTRACRANIAL STRUCTURES: Normal. LUNG APICES: There is a 9 mm and 3 mm calcified granuloma in the superior portion of the right lower lobe.
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3,819
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EXAM: CT Head wo contrast, CT Cervical Spine wo contrast CLINICAL INFORMATION: Trauma COMPARISON: None. TECHNIQUE: CT Head wo contrastScan field of view: 223 mm. DLP: 1427 mGy cm. (accession CT220004573), Scan field of view: 232 mm. DLP: 357.40 mGy cm. (accession CT220004574) FINDINGS: HEAD: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal. CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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FINDINGS: HEAD: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal. CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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FINDINGS: The study is mildly degraded by metallic streak artifact from dental amalgam. SOFT TISSUES: Interval postsurgical changes from right buccal mass resection and graft repair. Incidental focus of gas at the right parotid duct ostium as well as diffuse soft tissue gas throughout the left parotid duct and intraparotid ductal system, likely related to puffed cheek maneuver. No focal masslike enhancement. LYMPH NODES: No pathologic adenopathy by imaging size criteria. AERODIGESTIVE STRUCTURES: No asymmetric contrast enhancement or asymmetric soft tissue nodularity. PAROTID GLANDS: Normal. SUBMANDIBULAR GLANDS: Normal. THYROID GLAND: Multiple subcentimeter low-attenuating right thyroid lobe nodules, unchanged. VASCULAR STRUCTURES: Mild carotid siphon calcific atherosclerosis without flow-limiting stenosis. OSSEOUS STRUCTURES: No fracture, dislocation, or destructive lesion. Multilevel cervical spine degenerative discogenic disease with moderate to severe disc space height loss, most prominently at C3-C6, similar to prior. Trace stepwise degenerative retrolisthesis of C3 on C4 and C4 on C5, unchanged. Mild retrolisthesis of C5 on C6, unchanged. Mild anterolisthesis of C6 on C7, unchanged. ORBITS: Normal. PARANASAL SINUSES AND MASTOID AIR CELLS: Partial opacification of the bilateral maxillary sinuses with aerated secretions, increased compared to prior. Partial opacification of the bilateral ethmoid sinuses extending into an opacified underpneumatized right frontal sinus, similar to prior. The left frontal sinus, sphenoid sinuses, and mastoid air cells are clear. VISUALIZED INTRACRANIAL STRUCTURES: Normal. LUNG APICES: Biapical pleuroparenchymal scarring. Bilateral dependent atelectasis.
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3,820
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EXAM: CT Head wo contrast, CT Cervical Spine wo contrast CLINICAL INFORMATION: Trauma COMPARISON: None. TECHNIQUE: CT Head wo contrastScan field of view: 223 mm. DLP: 1427 mGy cm. (accession CT220004573), Scan field of view: 232 mm. DLP: 357.40 mGy cm. (accession CT220004574) FINDINGS: HEAD: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal. CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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FINDINGS: HEAD: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal. CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT CAP LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Scattered groundglass and consolidative airspace opacities in bilateral lungs in a bibasal predominant pattern. Findings are compatible with known COVID 19 infection. Scattered subcentimeter pulmonary nodules in bilateral lungs may also be related to the same etiology. No pleural effusion or pneumothorax. Trachea and central airways appear patent. HEART / VESSELS: Scattered atherosclerosis. Heart size is within normal limits. Trace pericardial fluid. MEDIASTINUM / ESOPHAGUS: Small hiatal hernia. Mild thickening of the distal esophageal wall, likely related to reflux esophagitis. LYMPH NODES: None enlarged. CHEST WALL: Bilateral mild gynecomastia. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Mild diffuse atrophy. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Mild atrophy of bilateral kidneys. Left pelvic transplant kidney. Mild prominence of the transplant renal collecting system without definite hydronephrosis. No obstructing radiodense renal or ureteric calculi. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Postsurgical changes in the right lower quadrant likely related to pancreatic transplant. Immediate postsurgical changes related to prior study have resolved. Nonspecific scattered fluid distended small bowel loops without evidence for obstruction. COLON / APPENDIX: Gaseous distention of the colon. Appendix is unremarkable. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Scattered vessel wall calcifications. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Small fat-containing umbilical hernia. Anterior abdominal wall midline surgical incision with chronic healing response. MUSCULOSKELETAL: No significant acute abnormality.
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3,821
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EXAM: CT Chest with contrast, CT Abdomen and Pelvis w contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat CLINICAL INFORMATION: Fall, chest and abdominal pain. COMPARISON: CT abdomen and pelvis with contrast 12/28/2021. TECHNIQUE: CT Chest with contrast, CT Abdomen and Pelvis w contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat. Patient weight: 170 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 80 ml. IV contrast injection rate: 2.50 ml per sec. Scan delay: 70 sec Scan field of view: 440 mm. DLP: 867.50 mGy cm. (accession CT220004592), Patient weight: 170 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 80 ml. IV contrast injection rate: 2.50 ml per sec. Scan delay: 70 sec Scan field of view: 440 mm. (accession CT220004575), Patient weight: 170 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 80 ml. IV contrast injection rate: 2.50 ml per sec. Scan delay: 70 sec Scan field of view: 440 mm. DLP: 867.50 mGy cm. (accession CT220004578), Patient weight: 170 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 80 ml. IV contrast injection rate: 2.50 ml per sec. Scan delay: 70 sec Scan field of view: 440 mm. DLP: 867.50 mGy cm. (accession CT220004593) FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: The central tracheobronchial tree is patent. Mild dependent atelectatic changes. No focal consolidation, pleural effusion, or pneumothorax. HEART / VESSELS: Heart size is normal. No pericardial effusion. Mild calcific atherosclerosis in the coronary arteries. The main pulmonary artery and thoracic aorta are normal in caliber. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Scattered hypoattenuating lesions in the right hepatic lobe are too small to characterize, but are unchanged from prior examination and are statistically likely represent cysts. No new abnormality. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal size. Tiny calcified splenic granuloma. ADRENALS: Normal. KIDNEYS: Symmetric contrast enhancement. Simple cysts in the right lower pole. No radiopaque nephrolithiasis. No hydroureteronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Postsurgical changes from Roux-en-Y gastric bypass with patent gastrojejunal anastomosis. Patent enteroenteric anastomoses in the midabdomen. No evidence of small bowel obstruction. COLON / APPENDIX: No significant abnormality in the colon. The appendix is not definitely visualized. PERITONEUM / MESENTERY: Trace free fluid in the pelvis. No pneumoperitoneum. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: The uterus is not well visualized. Significant adnexal abnormality. BODY WALL: Postoperative from recent midline laparotomy with subincisional fluid collection and a few foci of subcutaneous gas fluid collection measuring 4.1 x 3.1 cm (series 202, image 478) with minimal peripheral enhancement. A few scattered foci of gas in the right lower quadrant ventral abdominal wall are likely related to recent medication injection. Mild body wall edema. MUSCULOSKELETAL: No aggressive osseous abnormality is identified. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. Mild multilevel discogenic degenerative changes. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No spondylolisthesis. LUMBAR SPINE: VERTEBRA: No acute fracture. Unchanged mild anterior wedging of L1. DISC SPACES AND FACET JOINTS: No acute injury. Multilevel discogenic degenerative changes, most advanced at L4-5. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No spondylolisthesis. CONCLUSION: 1. No acute traumatic abnormality in the chest, abdomen, or pelvis. No acute fracture or subluxation in the thoracolumbar spine. 2. Postsurgical changes with subincisional fluid collection at the midline anterior abdominal wall. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: The central tracheobronchial tree is patent. Mild dependent atelectatic changes. No focal consolidation, pleural effusion, or pneumothorax. HEART / VESSELS: Heart size is normal. No pericardial effusion. Mild calcific atherosclerosis in the coronary arteries. The main pulmonary artery and thoracic aorta are normal in caliber. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Scattered hypoattenuating lesions in the right hepatic lobe are too small to characterize, but are unchanged from prior examination and are statistically likely represent cysts. No new abnormality. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal size. Tiny calcified splenic granuloma. ADRENALS: Normal. KIDNEYS: Symmetric contrast enhancement. Simple cysts in the right lower pole. No radiopaque nephrolithiasis. No hydroureteronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Postsurgical changes from Roux-en-Y gastric bypass with patent gastrojejunal anastomosis. Patent enteroenteric anastomoses in the midabdomen. No evidence of small bowel obstruction. COLON / APPENDIX: No significant abnormality in the colon. The appendix is not definitely visualized. PERITONEUM / MESENTERY: Trace free fluid in the pelvis. No pneumoperitoneum. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: The uterus is not well visualized. Significant adnexal abnormality. BODY WALL: Postoperative from recent midline laparotomy with subincisional fluid collection and a few foci of subcutaneous gas fluid collection measuring 4.1 x 3.1 cm (series 202, image 478) with minimal peripheral enhancement. A few scattered foci of gas in the right lower quadrant ventral abdominal wall are likely related to recent medication injection. Mild body wall edema. MUSCULOSKELETAL: No aggressive osseous abnormality is identified. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. Mild multilevel discogenic degenerative changes. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No spondylolisthesis. LUMBAR SPINE: VERTEBRA: No acute fracture. Unchanged mild anterior wedging of L1. DISC SPACES AND FACET JOINTS: No acute injury. Multilevel discogenic degenerative changes, most advanced at L4-5. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No spondylolisthesis.
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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT CAP LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Scattered groundglass and consolidative airspace opacities in bilateral lungs in a bibasal predominant pattern. Findings are compatible with known COVID 19 infection. Scattered subcentimeter pulmonary nodules in bilateral lungs may also be related to the same etiology. No pleural effusion or pneumothorax. Trachea and central airways appear patent. HEART / VESSELS: Scattered atherosclerosis. Heart size is within normal limits. Trace pericardial fluid. MEDIASTINUM / ESOPHAGUS: Small hiatal hernia. Mild thickening of the distal esophageal wall, likely related to reflux esophagitis. LYMPH NODES: None enlarged. CHEST WALL: Bilateral mild gynecomastia. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Mild diffuse atrophy. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Mild atrophy of bilateral kidneys. Left pelvic transplant kidney. Mild prominence of the transplant renal collecting system without definite hydronephrosis. No obstructing radiodense renal or ureteric calculi. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Postsurgical changes in the right lower quadrant likely related to pancreatic transplant. Immediate postsurgical changes related to prior study have resolved. Nonspecific scattered fluid distended small bowel loops without evidence for obstruction. COLON / APPENDIX: Gaseous distention of the colon. Appendix is unremarkable. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Scattered vessel wall calcifications. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Small fat-containing umbilical hernia. Anterior abdominal wall midline surgical incision with chronic healing response. MUSCULOSKELETAL: No significant acute abnormality.
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3,822
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EXAM: CT Knee Right wo contrast CLINICAL INFORMATION: MVC COMPARISON: 1/9/2022 TECHNIQUE: CT Knee Right wo contrast Scan field of view: 204 mm. DLP: 324.70 mGy cm. FINDINGS/CONCLUSION: Comminuted fractures of the medial and lateral tibial plateaus. There is approximately 1.8 cm of depression of the lateral tibial plateau fracture fragments. No significant depression of the medial plateau fracture fragments. The fracture planes extend into the proximal tibial metadiaphysis. Comminuted fracture of the fibular head. No acute fracture of the patella or distal femur. Moderate lipohemarthrosis. Mild soft tissue edema about the knee.
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FINDINGS/CONCLUSION: Comminuted fractures of the medial and lateral tibial plateaus. There is approximately 1.8 cm of depression of the lateral tibial plateau fracture fragments. No significant depression of the medial plateau fracture fragments. The fracture planes extend into the proximal tibial metadiaphysis. Comminuted fracture of the fibular head. No acute fracture of the patella or distal femur. Moderate lipohemarthrosis. Mild soft tissue edema about the knee.
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Findings: The previously seen asymmetric thickening of the left posterior aryepiglottic fold is less prominent on today's examination (series 201, image 95). Overall decrease in wall thickening. The vocal cords appear symmetric. There are small bilateral laryngoceles. The nasopharynx and oropharynx are normal. Mucosal thickening of the frontal sinuses, ethmoid air cells and left sphenoid sinus. The base of the tongue and lymphoid tissue within Waldeyer's ring are unremarkable. The parotid and submandibular glands are normal. No discrete mass or pathological lymphadenopathy. Scattered atherosclerotic calcifications of the carotid vessels. Imaged portions of the brain and skull base are normal. The well-circumscribed lucency in the C3 and C4 vertebral bodies are unchanged. Coronary artery calcification is seen.
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3,823
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CT MAXILLOFACIAL BONES WITHOUT CONTRAST CLINICAL INFORMATION: Facial trauma. COMPARISON: None. TECHNIQUE: Axial thin sections images were obtained from the top of the frontal sinuses through the bottom of the mandible utilizing multislice helical technique. Reformatted coronal and sagittal images were also obtained. Scan field of view: 188.40 mm. DLP: 1101.50 mGy cm. FINDINGS: FACIAL BONES: No fracture. Bilateral pterygoid plates are intact. Small contusion of the left malar and nasal soft tissues. MANDIBLE: No fracture. Bilateral temporomandibular joints are intact. REMAINING VISUALIZED BONES: Normal. SINONASAL CAVITIES: Paranasal sinuses are clear. VISUALIZED INTRACRANIAL STRUCTURES: Normal. ORBITAL CONTENTS: Small left periorbital hematoma. Normal appearance of the globes. No fracture. CONCLUSION: 1. No maxillofacial fracture. 2. Small contusion of the left periorbital, nasal, and malar 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.
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FINDINGS: FACIAL BONES: No fracture. Bilateral pterygoid plates are intact. Small contusion of the left malar and nasal soft tissues. MANDIBLE: No fracture. Bilateral temporomandibular joints are intact. REMAINING VISUALIZED BONES: Normal. SINONASAL CAVITIES: Paranasal sinuses are clear. VISUALIZED INTRACRANIAL STRUCTURES: Normal. ORBITAL CONTENTS: Small left periorbital hematoma. Normal appearance of the globes. No fracture.
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FINDINGS: STRUCTURED REPORT: CT PE OVERALL DIAGNOSTIC QUALITY: Full diagnostic quality LOWER NECK: No abnormality. CHEST: PULMONARY ARTERIES: Negative for pulmonary embolus. The pain pulmonary artery is normal in size. LUNGS / AIRWAYS / PLEURA: Centrilobular nodularity throughout the right middle and upper lobes. Bilateral, peripheral groundglass opacities. Noncalcified nodule in the left lower lobe measuring 8 mm (image 82, series 2). No pleural effusion or pneumothorax. HEART / OTHER VESSELS: The heart size is normal. Three-vessel coronary artery calcifications and moderate atherosclerotic calcifications of the thoracic aorta. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: Borderline enlarged gastrohepatic lymph node. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Normal. MUSCULOSKELETAL: No significant abnormality.
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3,824
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EXAM: CT Chest with contrast, CT Abdomen and Pelvis w contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat CLINICAL INFORMATION: Fall, chest and abdominal pain. COMPARISON: CT abdomen and pelvis with contrast 12/28/2021. TECHNIQUE: CT Chest with contrast, CT Abdomen and Pelvis w contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat. Patient weight: 170 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 80 ml. IV contrast injection rate: 2.50 ml per sec. Scan delay: 70 sec Scan field of view: 440 mm. DLP: 867.50 mGy cm. (accession CT220004592), Patient weight: 170 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 80 ml. IV contrast injection rate: 2.50 ml per sec. Scan delay: 70 sec Scan field of view: 440 mm. (accession CT220004575), Patient weight: 170 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 80 ml. IV contrast injection rate: 2.50 ml per sec. Scan delay: 70 sec Scan field of view: 440 mm. DLP: 867.50 mGy cm. (accession CT220004578), Patient weight: 170 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 80 ml. IV contrast injection rate: 2.50 ml per sec. Scan delay: 70 sec Scan field of view: 440 mm. DLP: 867.50 mGy cm. (accession CT220004593) FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: The central tracheobronchial tree is patent. Mild dependent atelectatic changes. No focal consolidation, pleural effusion, or pneumothorax. HEART / VESSELS: Heart size is normal. No pericardial effusion. Mild calcific atherosclerosis in the coronary arteries. The main pulmonary artery and thoracic aorta are normal in caliber. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Scattered hypoattenuating lesions in the right hepatic lobe are too small to characterize, but are unchanged from prior examination and are statistically likely represent cysts. No new abnormality. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal size. Tiny calcified splenic granuloma. ADRENALS: Normal. KIDNEYS: Symmetric contrast enhancement. Simple cysts in the right lower pole. No radiopaque nephrolithiasis. No hydroureteronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Postsurgical changes from Roux-en-Y gastric bypass with patent gastrojejunal anastomosis. Patent enteroenteric anastomoses in the midabdomen. No evidence of small bowel obstruction. COLON / APPENDIX: No significant abnormality in the colon. The appendix is not definitely visualized. PERITONEUM / MESENTERY: Trace free fluid in the pelvis. No pneumoperitoneum. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: The uterus is not well visualized. Significant adnexal abnormality. BODY WALL: Postoperative from recent midline laparotomy with subincisional fluid collection and a few foci of subcutaneous gas fluid collection measuring 4.1 x 3.1 cm (series 202, image 478) with minimal peripheral enhancement. A few scattered foci of gas in the right lower quadrant ventral abdominal wall are likely related to recent medication injection. Mild body wall edema. MUSCULOSKELETAL: No aggressive osseous abnormality is identified. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. Mild multilevel discogenic degenerative changes. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No spondylolisthesis. LUMBAR SPINE: VERTEBRA: No acute fracture. Unchanged mild anterior wedging of L1. DISC SPACES AND FACET JOINTS: No acute injury. Multilevel discogenic degenerative changes, most advanced at L4-5. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No spondylolisthesis. CONCLUSION: 1. No acute traumatic abnormality in the chest, abdomen, or pelvis. No acute fracture or subluxation in the thoracolumbar spine. 2. Postsurgical changes with subincisional fluid collection at the midline anterior abdominal wall. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: The central tracheobronchial tree is patent. Mild dependent atelectatic changes. No focal consolidation, pleural effusion, or pneumothorax. HEART / VESSELS: Heart size is normal. No pericardial effusion. Mild calcific atherosclerosis in the coronary arteries. The main pulmonary artery and thoracic aorta are normal in caliber. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Scattered hypoattenuating lesions in the right hepatic lobe are too small to characterize, but are unchanged from prior examination and are statistically likely represent cysts. No new abnormality. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal size. Tiny calcified splenic granuloma. ADRENALS: Normal. KIDNEYS: Symmetric contrast enhancement. Simple cysts in the right lower pole. No radiopaque nephrolithiasis. No hydroureteronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Postsurgical changes from Roux-en-Y gastric bypass with patent gastrojejunal anastomosis. Patent enteroenteric anastomoses in the midabdomen. No evidence of small bowel obstruction. COLON / APPENDIX: No significant abnormality in the colon. The appendix is not definitely visualized. PERITONEUM / MESENTERY: Trace free fluid in the pelvis. No pneumoperitoneum. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: The uterus is not well visualized. Significant adnexal abnormality. BODY WALL: Postoperative from recent midline laparotomy with subincisional fluid collection and a few foci of subcutaneous gas fluid collection measuring 4.1 x 3.1 cm (series 202, image 478) with minimal peripheral enhancement. A few scattered foci of gas in the right lower quadrant ventral abdominal wall are likely related to recent medication injection. Mild body wall edema. MUSCULOSKELETAL: No aggressive osseous abnormality is identified. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. Mild multilevel discogenic degenerative changes. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No spondylolisthesis. LUMBAR SPINE: VERTEBRA: No acute fracture. Unchanged mild anterior wedging of L1. DISC SPACES AND FACET JOINTS: No acute injury. Multilevel discogenic degenerative changes, most advanced at L4-5. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No spondylolisthesis.
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FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Chronic appearing right lamina papyracea defect, likely related to remote trauma. Otherwise bilateral orbits are unremarkable. SINUSES: Left maxillary uncinectomy and antrostomy. Partial left ethmoidectomy. No acute abnormalities. MAXILLOFACIAL: Left premaxillary and prezygomatic soft tissue contusion. No acute axial facial or mandibular fracture. Bilateral temporomandibular joints are intact. Bilateral mastoid air cells and middle ear cavities are within normal limits.
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3,825
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EXAM: CT Bone Pelvis w soft tissue no charge CLINICAL INFORMATION: Rule out femoral neck fracture COMPARISON: CT angiogram same date, pelvic radiograph same date. TECHNIQUE: CT Bone Pelvis w soft tissue no charge Scan field of view: 415 mm. STRUCTURED REPORT: CT Bone vDec2021 FINDINGS: BONES/JOINTS: Nondisplaced fracture of the anterior wall of the right acetabulum (series 509, image 175 and series 5011, image 52). Incidentally, there are multiple periarticular bone islands, likely representing osteopoikilosis. SOFT TISSUES: No joint effusion or lipohemarthrosis. Small volume hemoperitoneum. No soft tissue gas or hematoma. Small contusion over the anterior left hip and lower abdomen, likely representing seatbelt sign. CONCLUSION: 1. Nondisplaced right anterior acetabular wall fracture. No femoral neck fracture. 2. Please see separately dictated CT abdomen pelvis for additional findings.
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FINDINGS: BONES/JOINTS: Nondisplaced fracture of the anterior wall of the right acetabulum (series 509, image 175 and series 5011, image 52). Incidentally, there are multiple periarticular bone islands, likely representing osteopoikilosis. SOFT TISSUES: No joint effusion or lipohemarthrosis. Small volume hemoperitoneum. No soft tissue gas or hematoma. Small contusion over the anterior left hip and lower abdomen, likely representing seatbelt sign.
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FINDINGS: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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3,826
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EXAM: CT right knee from Reformat CLINICAL INFORMATION: Trauma COMPARISON: Concurrent CTA abdomen and pelvis with runoff TECHNIQUE: CT right knee from Reformat FINDINGS/CONCLUSION: Comminuted fracture of the patella, probably involving the superior pole. There are multiple osseous fragments within the soft tissues superior to the patella concerning for at least partial tear of the quadriceps tendon. Comminuted fracture of the lateral aspect of the lateral femoral condyle. Nondisplaced fracture of the fibular head/neck. There is a questionable nondisplaced fracture of the posterolateral aspect of the lateral tibial plateau. Incidental note of the osteochondroma arising from the proximal fibula. Scattered foci of gas are noted within the knee joint and soft tissues surrounding the knee. Please see separately dictated and concurrently obtained CTA abdomen and pelvis with runoff for vascular findings.
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FINDINGS/CONCLUSION: Comminuted fracture of the patella, probably involving the superior pole. There are multiple osseous fragments within the soft tissues superior to the patella concerning for at least partial tear of the quadriceps tendon. Comminuted fracture of the lateral aspect of the lateral femoral condyle. Nondisplaced fracture of the fibular head/neck. There is a questionable nondisplaced fracture of the posterolateral aspect of the lateral tibial plateau. Incidental note of the osteochondroma arising from the proximal fibula. Scattered foci of gas are noted within the knee joint and soft tissues surrounding the knee. Please see separately dictated and concurrently obtained CTA abdomen and pelvis with runoff for vascular findings.
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FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Chronic appearing right lamina papyracea defect, likely related to remote trauma. Otherwise bilateral orbits are unremarkable. SINUSES: Left maxillary uncinectomy and antrostomy. Partial left ethmoidectomy. No acute abnormalities. MAXILLOFACIAL: Left premaxillary and prezygomatic soft tissue contusion. No acute axial facial or mandibular fracture. Bilateral temporomandibular joints are intact. Bilateral mastoid air cells and middle ear cavities are within normal limits.
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3,827
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EXAM: CT Lower Extremity from Reformat CLINICAL INFORMATION: Trauma COMPARISON: Right ankle radiograph same date TECHNIQUE: CT Lower Extremity from Reformat STRUCTURED REPORT: CT Bone vDec2021 FINDINGS: BONES/JOINTS: Comminuted medial malleolar fracture extending to the posterior tibial plafond. These fracture fragments closely approach the medial skin surface without focal cutaneous defects. Avulsion fractures of the posterior and anterior fibular tip. Tiny avulsion fracture of the lateral talar body. Essentially nondisplaced fracture of the posterior lateral talar tubercle. Essentially nondisplaced fracture of the undersurface of the lateral talar head (series 411, image 111). Tiny fracture of the medial talar dome at the level of the perched medial malleolar fracture fragment (series 4010, image 126). Multiple tibiotalar intra-articular fracture fragments. No widening of the syndesmosis. SOFT TISSUES: There is soft tissue swelling/hemorrhage surrounding the ankle without soft tissue gas or radiopaque foreign body. The posterior tibial tendon is encased within the medial malleolar fracture fragments (series 410, image 218). CONCLUSION: 1. Comminuted, displaced fracture of the medial malleolus extending to the posterior medial tibial plafond. Posterior tibialis tendon is encased within these fracture fragments. 2. Avulsion fractures of the lateral malleolar tip. 3. Avulsion fractures of the lateral talar body and talar head. Additional, essentially nondisplaced fractures of the posterior lateral talar tubercle and medial talar dome. 4. Intra-articular tibiotalar fracture fragments.
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FINDINGS: BONES/JOINTS: Comminuted medial malleolar fracture extending to the posterior tibial plafond. These fracture fragments closely approach the medial skin surface without focal cutaneous defects. Avulsion fractures of the posterior and anterior fibular tip. Tiny avulsion fracture of the lateral talar body. Essentially nondisplaced fracture of the posterior lateral talar tubercle. Essentially nondisplaced fracture of the undersurface of the lateral talar head (series 411, image 111). Tiny fracture of the medial talar dome at the level of the perched medial malleolar fracture fragment (series 4010, image 126). Multiple tibiotalar intra-articular fracture fragments. No widening of the syndesmosis. SOFT TISSUES: There is soft tissue swelling/hemorrhage surrounding the ankle without soft tissue gas or radiopaque foreign body. The posterior tibial tendon is encased within the medial malleolar fracture fragments (series 410, image 218).
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FINDINGS: VERTEBRA: No acute displaced fracture. The vertebral body heights are maintained. DISC SPACES AND FACET JOINTS: Advanced disc space narrowing at L5-S1 with vacuum phenomenon. Vacuum phenomenon is also present at L4-L5. There is a mild posterior disc osteophyte complex seen at L4-L5 which causes mild spinal bilateral neuroforaminal stenosis. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Degenerative grade 1 anterolisthesis of L4 on L5. Otherwise normal alignment of the lumbar spine. SOFT TISSUES: Right nephrectomy changes are noted. There is a lesion in the right adnexa measuring 3.3 cm which measures soft tissue attenuation may be ovarian in etiology. There is a similar lesion in the left adnexa measuring 3.3 cm.
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3,828
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EXAM: CT Abdomen and Pelvis wo+w contrast CLINICAL INFORMATION: Gastrointestinal bleeding with bloody diarrhea. COMPARISON: CT abdomen pelvis 11/5/2021 TECHNIQUE: CT Abdomen and Pelvis wo+w contrast. Patient weight: 275 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. Saline flush: 90 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked, 15 secs, 55 secs Scan field of view: 500 mm. DLP: 3342.20 mGy cm. FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Trace left pleural effusion. With persistent elevation of the left hemidiaphragm. Subsegmental right lower lobe atelectasis. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: The nondependent gas in the right ventricle, likely iatrogenic. ABDOMEN and PELVIS: LIVER: Subcentimeter hypoattenuating lesion in the right hepatic lobe is too small to characterize, but unchanged. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Right adrenal nodule measuring 3.1 x 2.3 cm (series 601, image 268) is unchanged since 2015. KIDNEYS: The kidneys are mildly atrophied bilaterally. Bilateral cortical cysts and additional subcentimeter hypoattenuating lesions that are too small to characterize. Punctate calcifications in the bilateral kidneys, nonobstructive calculi. No hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: The stomach is unremarkable and the small bowel is normal caliber. No intraluminal contrast extravasation. COLON / APPENDIX: Colonic diverticulosis. On venous phase imaging, there is a linear focus of intraluminal contrast extravasation from the anterior wall of the superior rectum (series 601, image 277) no intraluminal contrast extravasation is seen on arterial phase. PERITONEUM / MESENTERY: No free air or free fluid. RETROPERITONEUM: Normal. VESSELS: Right common femoral vein central venous catheter. The inferior vena cava is collapsed. Greater than 50% stenosis of the left superficial femoral artery. Moderate atherosclerotic disease of the abdominal aorta and its branches. URINARY BLADDER: Streak artifact from right hip arthroplasty obscures the pelvis. The urinary bladder is decompressed around a Foley catheter. There is a calcification along the dependent portion of the urinary bladder (image 278, series 201). REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Rectus diastases. Fat-containing right inguinal hernia. MUSCULOSKELETAL: Decreased osseous mineralization. Right total hip arthroplasty hardware with adjacent heterotopic ossification. Pubic symphysis chondral calcinosis. Postsurgical changes from median sternotomy. Unchanged chronic L1 compression fracture with unchanged greater than 25% height loss. Moderate multilevel degenerative changes of the thoracic and lumbar spine. CONCLUSION: 1. Active venous bleeding from the superior rectum. No evidence of active arterial contrast extravasation. 2. The inferior vena cava is collapsed suggesting volume depletion. 3. Greater than 50% stenosis of the left superficial femoral artery. 4. Stable right adrenal nodule since 2015 and additional chronic findings as above. Preliminary findings discussed with Wes Brown M.D. by Ivan Morales, M.D. on 1/9/2022 10:37 AM As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Trace left pleural effusion. With persistent elevation of the left hemidiaphragm. Subsegmental right lower lobe atelectasis. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: The nondependent gas in the right ventricle, likely iatrogenic. ABDOMEN and PELVIS: LIVER: Subcentimeter hypoattenuating lesion in the right hepatic lobe is too small to characterize, but unchanged. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Right adrenal nodule measuring 3.1 x 2.3 cm (series 601, image 268) is unchanged since 2015. KIDNEYS: The kidneys are mildly atrophied bilaterally. Bilateral cortical cysts and additional subcentimeter hypoattenuating lesions that are too small to characterize. Punctate calcifications in the bilateral kidneys, nonobstructive calculi. No hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: The stomach is unremarkable and the small bowel is normal caliber. No intraluminal contrast extravasation. COLON / APPENDIX: Colonic diverticulosis. On venous phase imaging, there is a linear focus of intraluminal contrast extravasation from the anterior wall of the superior rectum (series 601, image 277) no intraluminal contrast extravasation is seen on arterial phase. PERITONEUM / MESENTERY: No free air or free fluid. RETROPERITONEUM: Normal. VESSELS: Right common femoral vein central venous catheter. The inferior vena cava is collapsed. Greater than 50% stenosis of the left superficial femoral artery. Moderate atherosclerotic disease of the abdominal aorta and its branches. URINARY BLADDER: Streak artifact from right hip arthroplasty obscures the pelvis. The urinary bladder is decompressed around a Foley catheter. There is a calcification along the dependent portion of the urinary bladder (image 278, series 201). REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Rectus diastases. Fat-containing right inguinal hernia. MUSCULOSKELETAL: Decreased osseous mineralization. Right total hip arthroplasty hardware with adjacent heterotopic ossification. Pubic symphysis chondral calcinosis. Postsurgical changes from median sternotomy. Unchanged chronic L1 compression fracture with unchanged greater than 25% height loss. Moderate multilevel degenerative changes of the thoracic and lumbar spine.
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Findings: Again seen is acute intraparenchymal hemorrhage centered around the left thalamus with intraventricular extension. Interval right frontal approach ventricular drainage catheter with its tip in the frontal horn of the lateral ventricle The bifrontal ventricular diameter appears overall smaller measuring 38 mm, previously 40 mm. Peripheral wedge-shaped hypodensity in the right parietal lobe is again seen. Diffuse generalized effacement of the cortical sulci noted.
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3,829
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EXAM: CT Cervical Spine wo contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat, CT Chest with contrast, CT Abdomen and Pelvis w contrast, CT Head wo contrast CLINICAL INFORMATION: Trauma COMPARISON: None. TECHNIQUE: CT Cervical Spine wo contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat, CT Chest with contrast, CT Abdomen and Pelvis w contrast, CT Head wo contrast Scan field of view: 180.50 mm. DLP: 326.30 mGy cm. (accession CT220004589), Patient weight: 140 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 70 sec Scan field of view: 371.80 mm. DLP: 661.40 mGy cm. (accession CT220004587), Patient weight: 140 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 70 sec Scan field of view: 371.80 mm. (accession CT220004588), Scan field of view: 246.90 mm. DLP: 1315.50 mGy cm. (accession CT220004586) FINDINGS: HEAD: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Small area of encephalomalacia within the anterior left frontal lobe. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal. CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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FINDINGS: HEAD: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Small area of encephalomalacia within the anterior left frontal lobe. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal. CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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FINDINGS: STRUCTURED REPORT: CT Abdomen LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Mild bilateral pelvocaliectasis, slightly increased compared to the prior exam. Nephrograms are symmetric. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Postoperative changes from prior Roux-en-Y gastric bypass. No dilated loops of small bowel. COLON: No abnormality. PERITONEUM / MESENTERY: Postsurgical changes from previous resection of the left upper quadrant mesenteric mass. There is persistent mesenteric stranding with multiple prominent mesenteric nodes, overall similar to the prior examination. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. BODY WALL: Unchanged incisional ventral abdominal hernia containing loops of nondilated small bowel MUSCULOSKELETAL: No significant abnormality.
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3,830
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EXAM: CT Cervical Spine wo contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat, CT Chest with contrast, CT Abdomen and Pelvis w contrast, CT Head wo contrast CLINICAL INFORMATION: Trauma COMPARISON: None. TECHNIQUE: CT Cervical Spine wo contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat, CT Chest with contrast, CT Abdomen and Pelvis w contrast, CT Head wo contrast Scan field of view: 180.50 mm. DLP: 326.30 mGy cm. (accession CT220004589), Patient weight: 140 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 70 sec Scan field of view: 371.80 mm. DLP: 661.40 mGy cm. (accession CT220004587), Patient weight: 140 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 70 sec Scan field of view: 371.80 mm. (accession CT220004588), Scan field of view: 246.90 mm. DLP: 1315.50 mGy cm. (accession CT220004586) FINDINGS: HEAD: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Small area of encephalomalacia within the anterior left frontal lobe. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal. CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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FINDINGS: HEAD: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Small area of encephalomalacia within the anterior left frontal lobe. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal. CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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Findings: Large left frontal sinus osteoma is seen with scalloping and remodeling of the sinus wall and protrusion into the left orbit, left anterior ethmoid air cells and right frontal sinus. It measures about 23 x 57 x 37 mm Mild mucosal thickening noted in the right frontal sinus and both maxillary sinuses. Remainder of the paranasal sinuses are clear. The temporal bones appear normal. The intraorbital soft tissues appear normal.
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3,831
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EXAM: CT Cervical Spine wo contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat, CT Chest with contrast, CT Abdomen and Pelvis w contrast, CT Head wo contrast CLINICAL INFORMATION: Trauma COMPARISON: None. TECHNIQUE: CT Cervical Spine wo contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat, CT Chest with contrast, CT Abdomen and Pelvis w contrast, CT Head wo contrast Scan field of view: 180.50 mm. DLP: 326.30 mGy cm. (accession CT220004589), Patient weight: 140 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 70 sec Scan field of view: 371.80 mm. DLP: 661.40 mGy cm. (accession CT220004587), Patient weight: 140 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 70 sec Scan field of view: 371.80 mm. (accession CT220004588), Scan field of view: 246.90 mm. DLP: 1315.50 mGy cm. (accession CT220004586) FINDINGS: HEAD: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Small area of encephalomalacia within the anterior left frontal lobe. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal. CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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FINDINGS: HEAD: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Small area of encephalomalacia within the anterior left frontal lobe. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal. CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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Findings: - CT angiogram of the brain: Mixed atherosclerotic plaque, cavernous segment of right ICA with no flow limiting stenosis. The visualized portions of the ICAs and vertebrobasilar system appear within normal limits. The visualized portions of the ACAs, MCAs, and PCAs appear within normal limits. - CT angiogram of the neck: Calcific and noncalcific as described plaques at the left carotid bifurcation and proximal left ICA with about 60% luminal narrowing of the left proximal ICA by NASCET. Atherosclerotic plaques in the right common carotid artery impression no evidence of foraminal stenosis.. There is a normal three great vessel arch. The visualized portions of the common, as well as cervical portions of the internal, and external carotid arteries appear within normal limits. The visualized vertebral arteries appear within normal limits. -
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3,832
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EXAM: CT Cervical Spine wo contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat, CT Chest with contrast, CT Abdomen and Pelvis w contrast, CT Head wo contrast CLINICAL INFORMATION: Trauma COMPARISON: None. TECHNIQUE: CT Cervical Spine wo contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat, CT Chest with contrast, CT Abdomen and Pelvis w contrast, CT Head wo contrast Scan field of view: 180.50 mm. DLP: 326.30 mGy cm. (accession CT220004589), Patient weight: 140 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 70 sec Scan field of view: 371.80 mm. DLP: 661.40 mGy cm. (accession CT220004587), Patient weight: 140 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 70 sec Scan field of view: 371.80 mm. (accession CT220004588), Scan field of view: 246.90 mm. DLP: 1315.50 mGy cm. (accession CT220004586) FINDINGS: HEAD: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Small area of encephalomalacia within the anterior left frontal lobe. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal. CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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FINDINGS: HEAD: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Small area of encephalomalacia within the anterior left frontal lobe. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal. CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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Findings: - CT angiogram of the brain: Mixed atherosclerotic plaque, cavernous segment of right ICA with no flow limiting stenosis. The visualized portions of the ICAs and vertebrobasilar system appear within normal limits. The visualized portions of the ACAs, MCAs, and PCAs appear within normal limits. - CT angiogram of the neck: Calcific and noncalcific as described plaques at the left carotid bifurcation and proximal left ICA with about 60% luminal narrowing of the left proximal ICA by NASCET. Atherosclerotic plaques in the right common carotid artery impression no evidence of foraminal stenosis.. There is a normal three great vessel arch. The visualized portions of the common, as well as cervical portions of the internal, and external carotid arteries appear within normal limits. The visualized vertebral arteries appear within normal limits. -
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3,833
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EXAM: CT Cervical Spine wo contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat, CT Chest with contrast, CT Abdomen and Pelvis w contrast, CT Head wo contrast CLINICAL INFORMATION: Trauma COMPARISON: None. TECHNIQUE: CT Cervical Spine wo contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat, CT Chest with contrast, CT Abdomen and Pelvis w contrast, CT Head wo contrast Scan field of view: 180.50 mm. DLP: 326.30 mGy cm. (accession CT220004589), Patient weight: 140 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 70 sec Scan field of view: 371.80 mm. DLP: 661.40 mGy cm. (accession CT220004587), Patient weight: 140 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 70 sec Scan field of view: 371.80 mm. (accession CT220004588), Scan field of view: 246.90 mm. DLP: 1315.50 mGy cm. (accession CT220004586) FINDINGS: HEAD: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Small area of encephalomalacia within the anterior left frontal lobe. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal. CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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FINDINGS: HEAD: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Small area of encephalomalacia within the anterior left frontal lobe. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal. CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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Findings: There is no evidence of intracranial hemorrhage or acute infarction. Unchanged 12 x 8 mm colloid cyst of the third ventricle. Chronic lacunar infarct in the right medial thalamus. Mild generalized prominence of the extra-axial spaces. Similar appearance of the mineralization of the clivus. There is no evidence of hydrocephalus or of an intracranial mass.
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3,834
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EXAM: CT Cervical Spine wo contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat, CT Chest with contrast, CT Abdomen and Pelvis w contrast, CT Head wo contrast CLINICAL INFORMATION: Trauma COMPARISON: None. TECHNIQUE: CT Cervical Spine wo contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat, CT Chest with contrast, CT Abdomen and Pelvis w contrast, CT Head wo contrast Scan field of view: 180.50 mm. DLP: 326.30 mGy cm. (accession CT220004589), Patient weight: 140 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 70 sec Scan field of view: 371.80 mm. DLP: 661.40 mGy cm. (accession CT220004587), Patient weight: 140 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 70 sec Scan field of view: 371.80 mm. (accession CT220004588), Scan field of view: 246.90 mm. DLP: 1315.50 mGy cm. (accession CT220004586) FINDINGS: HEAD: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Small area of encephalomalacia within the anterior left frontal lobe. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal. CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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FINDINGS: HEAD: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Small area of encephalomalacia within the anterior left frontal lobe. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal. CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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Findings: RAPID images demonstrate CBF less than 30% volume: 0 ml and T. Max greater than 6seconds volume: 0 ml . Mismatch volume is 0 ml. There is no abnormal MTT, T max, CBV and CBF to suggest significant ischemia or infarction at the territory of the major intracranial arteries.
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3,835
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EXAM: CT Chest with contrast, CT Abdomen and Pelvis w contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat CLINICAL INFORMATION: Fall, chest and abdominal pain. COMPARISON: CT abdomen and pelvis with contrast 12/28/2021. TECHNIQUE: CT Chest with contrast, CT Abdomen and Pelvis w contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat. Patient weight: 170 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 80 ml. IV contrast injection rate: 2.50 ml per sec. Scan delay: 70 sec Scan field of view: 440 mm. DLP: 867.50 mGy cm. (accession CT220004592), Patient weight: 170 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 80 ml. IV contrast injection rate: 2.50 ml per sec. Scan delay: 70 sec Scan field of view: 440 mm. (accession CT220004575), Patient weight: 170 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 80 ml. IV contrast injection rate: 2.50 ml per sec. Scan delay: 70 sec Scan field of view: 440 mm. DLP: 867.50 mGy cm. (accession CT220004578), Patient weight: 170 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 80 ml. IV contrast injection rate: 2.50 ml per sec. Scan delay: 70 sec Scan field of view: 440 mm. DLP: 867.50 mGy cm. (accession CT220004593) FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: The central tracheobronchial tree is patent. Mild dependent atelectatic changes. No focal consolidation, pleural effusion, or pneumothorax. HEART / VESSELS: Heart size is normal. No pericardial effusion. Mild calcific atherosclerosis in the coronary arteries. The main pulmonary artery and thoracic aorta are normal in caliber. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Scattered hypoattenuating lesions in the right hepatic lobe are too small to characterize, but are unchanged from prior examination and are statistically likely represent cysts. No new abnormality. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal size. Tiny calcified splenic granuloma. ADRENALS: Normal. KIDNEYS: Symmetric contrast enhancement. Simple cysts in the right lower pole. No radiopaque nephrolithiasis. No hydroureteronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Postsurgical changes from Roux-en-Y gastric bypass with patent gastrojejunal anastomosis. Patent enteroenteric anastomoses in the midabdomen. No evidence of small bowel obstruction. COLON / APPENDIX: No significant abnormality in the colon. The appendix is not definitely visualized. PERITONEUM / MESENTERY: Trace free fluid in the pelvis. No pneumoperitoneum. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: The uterus is not well visualized. Significant adnexal abnormality. BODY WALL: Postoperative from recent midline laparotomy with subincisional fluid collection and a few foci of subcutaneous gas fluid collection measuring 4.1 x 3.1 cm (series 202, image 478) with minimal peripheral enhancement. A few scattered foci of gas in the right lower quadrant ventral abdominal wall are likely related to recent medication injection. Mild body wall edema. MUSCULOSKELETAL: No aggressive osseous abnormality is identified. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. Mild multilevel discogenic degenerative changes. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No spondylolisthesis. LUMBAR SPINE: VERTEBRA: No acute fracture. Unchanged mild anterior wedging of L1. DISC SPACES AND FACET JOINTS: No acute injury. Multilevel discogenic degenerative changes, most advanced at L4-5. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No spondylolisthesis. CONCLUSION: 1. No acute traumatic abnormality in the chest, abdomen, or pelvis. No acute fracture or subluxation in the thoracolumbar spine. 2. Postsurgical changes with subincisional fluid collection at the midline anterior abdominal wall. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: The central tracheobronchial tree is patent. Mild dependent atelectatic changes. No focal consolidation, pleural effusion, or pneumothorax. HEART / VESSELS: Heart size is normal. No pericardial effusion. Mild calcific atherosclerosis in the coronary arteries. The main pulmonary artery and thoracic aorta are normal in caliber. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Scattered hypoattenuating lesions in the right hepatic lobe are too small to characterize, but are unchanged from prior examination and are statistically likely represent cysts. No new abnormality. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal size. Tiny calcified splenic granuloma. ADRENALS: Normal. KIDNEYS: Symmetric contrast enhancement. Simple cysts in the right lower pole. No radiopaque nephrolithiasis. No hydroureteronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Postsurgical changes from Roux-en-Y gastric bypass with patent gastrojejunal anastomosis. Patent enteroenteric anastomoses in the midabdomen. No evidence of small bowel obstruction. COLON / APPENDIX: No significant abnormality in the colon. The appendix is not definitely visualized. PERITONEUM / MESENTERY: Trace free fluid in the pelvis. No pneumoperitoneum. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: The uterus is not well visualized. Significant adnexal abnormality. BODY WALL: Postoperative from recent midline laparotomy with subincisional fluid collection and a few foci of subcutaneous gas fluid collection measuring 4.1 x 3.1 cm (series 202, image 478) with minimal peripheral enhancement. A few scattered foci of gas in the right lower quadrant ventral abdominal wall are likely related to recent medication injection. Mild body wall edema. MUSCULOSKELETAL: No aggressive osseous abnormality is identified. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. Mild multilevel discogenic degenerative changes. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No spondylolisthesis. LUMBAR SPINE: VERTEBRA: No acute fracture. Unchanged mild anterior wedging of L1. DISC SPACES AND FACET JOINTS: No acute injury. Multilevel discogenic degenerative changes, most advanced at L4-5. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No spondylolisthesis.
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Findings: Extensive postsurgical changes from multiple prior sinus surgeries with bilateral ethmoidectomies, uncinectomies, bilateral superior and middle turbinectomies and septoplasty. Enhancing soft tissues seen in the right nasal cavity inferiorly not separately seen from the right inferior turbinate. Additional enhancing soft tissue seen arising from the anterior skull base extending to the left. Severe mucosal thickening both maxillary sinuses. Complete opacification of the left hemisphenoid sinus. The frontal and the right sphenoid sinuses are unremarkable. The temporal bones appear normal. The intraorbital soft tissues appear normal.
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3,836
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EXAM: CT Chest with contrast, CT Abdomen and Pelvis w contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat CLINICAL INFORMATION: Fall, chest and abdominal pain. COMPARISON: CT abdomen and pelvis with contrast 12/28/2021. TECHNIQUE: CT Chest with contrast, CT Abdomen and Pelvis w contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat. Patient weight: 170 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 80 ml. IV contrast injection rate: 2.50 ml per sec. Scan delay: 70 sec Scan field of view: 440 mm. DLP: 867.50 mGy cm. (accession CT220004592), Patient weight: 170 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 80 ml. IV contrast injection rate: 2.50 ml per sec. Scan delay: 70 sec Scan field of view: 440 mm. (accession CT220004575), Patient weight: 170 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 80 ml. IV contrast injection rate: 2.50 ml per sec. Scan delay: 70 sec Scan field of view: 440 mm. DLP: 867.50 mGy cm. (accession CT220004578), Patient weight: 170 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 80 ml. IV contrast injection rate: 2.50 ml per sec. Scan delay: 70 sec Scan field of view: 440 mm. DLP: 867.50 mGy cm. (accession CT220004593) FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: The central tracheobronchial tree is patent. Mild dependent atelectatic changes. No focal consolidation, pleural effusion, or pneumothorax. HEART / VESSELS: Heart size is normal. No pericardial effusion. Mild calcific atherosclerosis in the coronary arteries. The main pulmonary artery and thoracic aorta are normal in caliber. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Scattered hypoattenuating lesions in the right hepatic lobe are too small to characterize, but are unchanged from prior examination and are statistically likely represent cysts. No new abnormality. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal size. Tiny calcified splenic granuloma. ADRENALS: Normal. KIDNEYS: Symmetric contrast enhancement. Simple cysts in the right lower pole. No radiopaque nephrolithiasis. No hydroureteronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Postsurgical changes from Roux-en-Y gastric bypass with patent gastrojejunal anastomosis. Patent enteroenteric anastomoses in the midabdomen. No evidence of small bowel obstruction. COLON / APPENDIX: No significant abnormality in the colon. The appendix is not definitely visualized. PERITONEUM / MESENTERY: Trace free fluid in the pelvis. No pneumoperitoneum. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: The uterus is not well visualized. Significant adnexal abnormality. BODY WALL: Postoperative from recent midline laparotomy with subincisional fluid collection and a few foci of subcutaneous gas fluid collection measuring 4.1 x 3.1 cm (series 202, image 478) with minimal peripheral enhancement. A few scattered foci of gas in the right lower quadrant ventral abdominal wall are likely related to recent medication injection. Mild body wall edema. MUSCULOSKELETAL: No aggressive osseous abnormality is identified. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. Mild multilevel discogenic degenerative changes. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No spondylolisthesis. LUMBAR SPINE: VERTEBRA: No acute fracture. Unchanged mild anterior wedging of L1. DISC SPACES AND FACET JOINTS: No acute injury. Multilevel discogenic degenerative changes, most advanced at L4-5. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No spondylolisthesis. CONCLUSION: 1. No acute traumatic abnormality in the chest, abdomen, or pelvis. No acute fracture or subluxation in the thoracolumbar spine. 2. Postsurgical changes with subincisional fluid collection at the midline anterior abdominal wall. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: The central tracheobronchial tree is patent. Mild dependent atelectatic changes. No focal consolidation, pleural effusion, or pneumothorax. HEART / VESSELS: Heart size is normal. No pericardial effusion. Mild calcific atherosclerosis in the coronary arteries. The main pulmonary artery and thoracic aorta are normal in caliber. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Scattered hypoattenuating lesions in the right hepatic lobe are too small to characterize, but are unchanged from prior examination and are statistically likely represent cysts. No new abnormality. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal size. Tiny calcified splenic granuloma. ADRENALS: Normal. KIDNEYS: Symmetric contrast enhancement. Simple cysts in the right lower pole. No radiopaque nephrolithiasis. No hydroureteronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Postsurgical changes from Roux-en-Y gastric bypass with patent gastrojejunal anastomosis. Patent enteroenteric anastomoses in the midabdomen. No evidence of small bowel obstruction. COLON / APPENDIX: No significant abnormality in the colon. The appendix is not definitely visualized. PERITONEUM / MESENTERY: Trace free fluid in the pelvis. No pneumoperitoneum. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: The uterus is not well visualized. Significant adnexal abnormality. BODY WALL: Postoperative from recent midline laparotomy with subincisional fluid collection and a few foci of subcutaneous gas fluid collection measuring 4.1 x 3.1 cm (series 202, image 478) with minimal peripheral enhancement. A few scattered foci of gas in the right lower quadrant ventral abdominal wall are likely related to recent medication injection. Mild body wall edema. MUSCULOSKELETAL: No aggressive osseous abnormality is identified. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. Mild multilevel discogenic degenerative changes. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No spondylolisthesis. LUMBAR SPINE: VERTEBRA: No acute fracture. Unchanged mild anterior wedging of L1. DISC SPACES AND FACET JOINTS: No acute injury. Multilevel discogenic degenerative changes, most advanced at L4-5. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No spondylolisthesis.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Atelectatic changes at bilateral lung bases. DISTAL ESOPHAGUS: Small hiatal hernia. Mild thickening of the distal esophageal wall, likely reflux gastritis. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Calcified granuloma in the left lobe of liver. BILIARY TRACT: Normal. GALLBLADDER: Status post cholecystectomy. PANCREAS: Atrophy at the pancreatic head. Pancreatic duct is not dilated. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Prominent bilateral renal collecting systems without definite evidence for distal obstructing etiology. However evaluation of bilateral distal ureters is limited by extensive streak artifact from right hip replacement prosthesis in the pelvis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Redemonstration of dilated proximal small bowel loops with area of transition in the right upper quadrant with associated twisting of the mesenteric vessels, which suggests a component of malrotation versus internal hernia in this region. Similar appearance was seen on the recent prior outside imaging study. There are mildly decompressed bowel loops distal to this region suggesting a partial small bowel obstruction. There is mild thickening and wall edema of the bowel loops at the region of obstruction and distal to the level of obstruction. Mild mesenteric fat stranding in the mesentery adjacent to the obstructed bowel loop. COLON / APPENDIX: Gas, fluid and stool is seen in the colon and rectum. Appendix is not identified. PERITONEUM / MESENTERY: See. RETROPERITONEUM: Normal. VESSELS: Fat stranding along the SMV tributaries in the right upper quadrant at the region of twisted/obstructed bowel loop. Cannot exclude impaired mesenteric venous return in this region. URINARY BLADDER: Streak artifact limits evaluation. Within this limitation, no significant abnormality. REPRODUCTIVE ORGANS: Calcified uterine fibroids. Left adnexa is unremarkable. Right adnexa is incompletely evaluated secondary to streak artifact. BODY WALL: Small fat-containing anterior abdominal wall hernia in the periumbilical region. Lower anterior abdominal/pelvic wall healed midline anterior abdominal wall surgical scar. MUSCULOSKELETAL: Multilevel degenerative changes in the visualized cervical lumbar spine with chronic grade 1 anterolisthesis of L4 on L5. Partial sacralization of L5.
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3,837
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CLINICAL HISTORY: HTN, hallucinations Spec Inst: repeat scan after new SAH EXAM: CT Head wo contrast TECHNIQUE: 5 mm thick serial axial images were obtained throughout the head without intravenous contrast. Scan field of view: 214 mm. DLP: 922 mGy cm. COMPARISON: 1/6/2022 FINDINGS: Resolving small amount of right frontal lobe subarachnoid hemorrhage. There is questionable trace right parietal lobe subarachnoid hemorrhage probably secondary to redistribution. There is also questionable trace left temporal lobe subarachnoid hemorrhage. There is a small hyperdensity within the right temporal lobe and another within the right frontal lobe which appear to represent tiny hemorrhagic contusions which are new or slightly more conspicuous since prior exam. There appears to been a faint hyperdensity on coronal image 36 on prior exam which may have represented tiny hemorrhagic contusion. There are stable small bifrontal CSF hygromas. There is stable hypoattenuation within the right frontal parietal region. There is also stable small area of hypoattenuation within the left periatrial white matter. There are no abnormal areas of hypoattenuation to suggest acute infarction. The ventricles are unremarkable There is no mass effect. The calvarium is intact. The visualized paranasal sinuses and mastoid air cells are clear. The orbits are unremarkable. CONCLUSION: 01. Small amount of right cerebral hemisphere and also likely left cerebral hemisphere subarachnoid hemorrhage. There appears to been mild redistribution but no evidence of interval new hemorrhage 02. Tiny hyperdensities probably representing hemorrhagic contusions within the superior right temporal lobe and right frontal lobe. There is also a tiny hyperdensity within the posterior right hippocampus which is stable, may represent tiny calcification or additional hemorrhage. 03. Stable small areas of hypoattenuation within the right frontal parietal region and left periatrial white matter which may represent remote infarctions. 04. Stable small hygromas overlying both frontal lobes.
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FINDINGS: Resolving small amount of right frontal lobe subarachnoid hemorrhage. There is questionable trace right parietal lobe subarachnoid hemorrhage probably secondary to redistribution. There is also questionable trace left temporal lobe subarachnoid hemorrhage. There is a small hyperdensity within the right temporal lobe and another within the right frontal lobe which appear to represent tiny hemorrhagic contusions which are new or slightly more conspicuous since prior exam. There appears to been a faint hyperdensity on coronal image 36 on prior exam which may have represented tiny hemorrhagic contusion. There are stable small bifrontal CSF hygromas. There is stable hypoattenuation within the right frontal parietal region. There is also stable small area of hypoattenuation within the left periatrial white matter. There are no abnormal areas of hypoattenuation to suggest acute infarction. The ventricles are unremarkable There is no mass effect. The calvarium is intact. The visualized paranasal sinuses and mastoid air cells are clear. The orbits are unremarkable.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis ABDOMEN and PELVIS: LIVER: Postsurgical changes from right hepatectomy. Ablation defects in hepatic segment IVA appear similar, including defect related to more recent ablation along the left hepatic vein. No new liver lesions or suspicious enhancement to suggest residual tumor. BILIARY: Not dilated. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Enlarged. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: Nonenlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Post surgical changes from partial colectomy with anastomosis in the midline pelvis. No perianastomotic abnormality. Scattered noninflamed colonic diverticula. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Enlarging hypoattenuating soft tissue near the IMA origin measures 2.5 x 1.6 cm on image 343 series 9, previously 1.6 x 1.2 cm. VESSELS: Infrarenal IVC filter is in place. Left upper quadrant collaterals. Similar positioning of the hepatic artery infusion pump catheter. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Prostate gland is enlarged. Left hydrocele. BODY WALL: Left hemiabdomen hepatic artery infusion pump. Post surgical changes from right inguinal hernia repair. MUSCULOSKELETAL: Unchanged proximal right femoral osteochondroma.
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3,838
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CT Perfusion 1/9/2022 6:16 AM Clinical Information: Stroke. occlusive narrowing of R MCA branches Comparison: None Technique: A CT perfusion study was performed during single pass of 50 cc contrast bolus. Axial images were acquired at 8 axial locations and time-attenuation curves generated from this dataset were utilized to calculate cerebral blood flow, mean transit time, time to peak, and cerebral blood volume maps as well as region of interest specific quantitative data. "Prognostic" color maps were also generated depicting areas of ischemia (voxel values for MTT > 1.4 times mirror image voxels on the contralateral "normal side") in the color green and areas predictive of infarction (CBV values < 2.0 ml/100g) in the color red. Patient weight: 123 lbs. IV contrast: Omnipaque 350, 40 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 0 sec. Scan field of view: 233 mm. DLP: 1440 mGy cm. Findings: . Color parametric maps demonstrate focal wedge-shaped area of increased Tmax and also mean transit time within the right parietal lobe. No abnormal areas of R CBF or R CBV. Prognostic maps demonstrate small area of increased Tmax greater than 6 seconds within the right parietal lobe. There is no corresponding CBF less than 30%.. Conclusion: Presumed small area of ischemia within the right parietal lobe. No completed infarction.
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Findings: . Color parametric maps demonstrate focal wedge-shaped area of increased Tmax and also mean transit time within the right parietal lobe. No abnormal areas of R CBF or R CBV. Prognostic maps demonstrate small area of increased Tmax greater than 6 seconds within the right parietal lobe. There is no corresponding CBF less than 30%..
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FINDINGS: Scouts: No additional findings. Lines and tubes: Left chest wall port catheter tip is in the distal SVC. Lungs and pleura: Interval increase in size of multiple noncalcified pulmonary nodules bilaterally. Juxtapleural nodule in the right upper lobe laterally now shows internal cavitation and surrounding groundglass density, and measures 32 x 11 mm (series 9 image 98), previously 9 x 7 mm. Juxtapleural location right lower lobe situated nodule now measures 17 x 11 mm (series 9 image 168), previously 12 x 9 mm. No definite new nodules identified Scattered calcified granulomas bilaterally. Linear/subsegmental atelectasis in the lingula. No pleural effusion. No pneumothorax. Esophagus, Mediastinum and neck: Esophagus is normal. No abnormality in the mediastinum. The thyroid gland is normal. Lymph Nodes: None enlarged. Cardiovascular: Mild left atrial and ventricular dilation. No pericardial effusion. Mild systolic calcifications involving the thoracic aorta, aortic arch sidebranches Coronary artery atherosclerotic calcification: Small amount. Abdomen: Please refer to same day CT abdomen report for detailed findings below the diaphragm. Body Wall/Musculoskeletal: No soft tissue masses. Bilateral gynecomastia. No aggressive appearing skeletal lesions.
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3,839
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RADIOLOGIC EXAM: CT Head wo No Charge CLINICAL INFORMATION: Code stroke. COMPARISON: CT head 1/1/2022. MR brain 1/1/2022. TECHNIQUE: CT Head wo No ChargeScan field of view: 250 mm. DLP: 1150.60 mGy cm. STRUCTURED REPORT: CT Head FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. No evidence of acute infarction. Evolving subacute infarct in the left frontal lobe. No evidence of hemorrhagic conversion. Periventricular white matter hypoattenuation consistent with chronic microangiopathic changes. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. Bilateral mastoid air cells are clear. VENTRICULAR SYSTEM: Normal. ORBITS: Bilateral pseudophakia. SINUSES: Clear. VESSELS: Normal noncontrast appearance of the vessels. CONCLUSION: Evolving subacute infarct in the left frontal lobe. No evidence of hemorrhagic conversion. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. No evidence of acute infarction. Evolving subacute infarct in the left frontal lobe. No evidence of hemorrhagic conversion. Periventricular white matter hypoattenuation consistent with chronic microangiopathic changes. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. Bilateral mastoid air cells are clear. VENTRICULAR SYSTEM: Normal. ORBITS: Bilateral pseudophakia. SINUSES: Clear. VESSELS: Normal noncontrast appearance of the vessels.
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FINDINGS: Cortical encephalomalacia of the right frontal lobe and superficial portion of the right temporal lobe are noted because of previous trauma. The brain parenchyma appears normal without evidence for acute territorial infarct, mass lesion, mass effect, or recent hemorrhage. The ventricles are normal in size. There is no abnormal extra axial collection. There is persistent fracture line along the right frontal bone. The visualized paranasal sinuses and mastoid air cells are well aerated. The orbits are normal. Soft tissue stranding of the left frontal vertex is seen as a sequela of previous trauma.
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3,840
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Radiologic Exam: CT Angio Neck, CT Angio Head Code Stroke 1/9/2022 6:54 AM Clinical Information: Other- Spec Inst: CODE STROKE: Acute Symptoms. Comparison: Multiple prior CT heads, most recently same day. CTA neck 1/6/2021. CTA head and neck 1/1/2021. Technique: Helical CT images were obtained before and after the administration of contrast from the base of the skull to the vertex. Contrast enhanced CT angiographic images were obtained from the superior mediastinum to the vertex during the arterial phase. 3-D CT angiographic images were generated from the axial data set. "Sliding MIP" images were also generated in the sagittal, axial, and coronal planes. Patient weight: 170 lbs. IV contrast: Omnipaque 350, 100 ml, per protocol. Saline flush: 50 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 224 mm. (accession CT220004598), Patient weight: 170 lbs. IV contrast: Omnipaque 350, 100 ml, per protocol. Saline flush: 50 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 224 mm. DLP: 2961 mGy cm. (accession CT220004597) FINDINGS: CT of the head with and without contrast: Please see separately reported same day noncontrast CT head. No abnormal intracranial enhancement within the limitations of arterial phase exam. CT angiogram of the brain: RIGHT CAROTID: Moderate calcified atherosclerosis without flow-limiting stenosis. There is no evidence of occlusion or aneurysmal dilation. LEFT CAROTID: Moderate calcified atherosclerosis of the carotid siphon resulting in approximately 50% narrowing of the left supraclinoid ICA, unchanged (image 169, series #407). There is no evidence of occlusion or aneurysmal dilation. ANTERIOR, MIDDLE, AND POSTERIOR CEREBRAL ARTERIES: Unchanged mild irregular narrowing of the right M1 segment and severe irregular narrowing of a right M2 branch (image 191, series #407). Unchanged severe irregular narrowing of the left M1 segment and M2 branches. Normal appearance of the bilateral ACAs and PCAs. VERTEBROBASILAR ARTERIES: Unchanged occlusion of the mid left V4 segment. The right vertebral artery and basilar artery are patent. CT angiogram of the neck: Exam is limited due to photon starvation and motion artifact. AORTIC ARCH and PROXIMAL GREAT VESSELS: Unremarkable. RIGHT CAROTID: Severely limited evaluation due to motion artifact. Mild calcified atherosclerosis of the proximal ICA without flow-limiting stenosis. Moderate noncalcified atherosclerosis of the distal cervical ICA just before the petrous portion, unchanged. LEFT CAROTID: Postsurgical change from recent carotid endarterectomy similar increased diameter of the left carotid bulb and proximal ICA. The left carotid bulb and proximal ICA are widely patent. Previously noted small intimal flap in the left cervical ICA is not definitely appreciated. RIGHT VERTEBRAL ARTERY: Mild narrowing at C5-C6, unchanged . No occlusion or aneurysmal dilation. LEFT VERTEBRAL ARTERY: Unchanged appearance of multifocal severe irregular narrowing of the left vertebral artery. SOFT TISSUES: Interval removal of the left lateral neck surgical drain. Decreased bowel gas in the left neck soft tissues. Visualized lung apices are clear. CERVICAL SPINE: No acute osseous abnormality. Mild multilevel discogenic degenerative changes of the cervical spine. CONCLUSION: 1. Postsurgical change from recent left carotid endarterectomy with widely patent left carotid. Previously noted intimal flap in the left ICA is not definitely visualized however evaluation is mildly somewhat limited due to motion artifact. 2. Unchanged chronic occlusion of the left V4 segment and multifocal severe irregular narrowing of the left cervical vertebral artery. 3. Other unchanged multifocal atherosclerotic disease as above. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: CT of the head with and without contrast: Please see separately reported same day noncontrast CT head. No abnormal intracranial enhancement within the limitations of arterial phase exam. CT angiogram of the brain: RIGHT CAROTID: Moderate calcified atherosclerosis without flow-limiting stenosis. There is no evidence of occlusion or aneurysmal dilation. LEFT CAROTID: Moderate calcified atherosclerosis of the carotid siphon resulting in approximately 50% narrowing of the left supraclinoid ICA, unchanged (image 169, series #407). There is no evidence of occlusion or aneurysmal dilation. ANTERIOR, MIDDLE, AND POSTERIOR CEREBRAL ARTERIES: Unchanged mild irregular narrowing of the right M1 segment and severe irregular narrowing of a right M2 branch (image 191, series #407). Unchanged severe irregular narrowing of the left M1 segment and M2 branches. Normal appearance of the bilateral ACAs and PCAs. VERTEBROBASILAR ARTERIES: Unchanged occlusion of the mid left V4 segment. The right vertebral artery and basilar artery are patent. CT angiogram of the neck: Exam is limited due to photon starvation and motion artifact. AORTIC ARCH and PROXIMAL GREAT VESSELS: Unremarkable. RIGHT CAROTID: Severely limited evaluation due to motion artifact. Mild calcified atherosclerosis of the proximal ICA without flow-limiting stenosis. Moderate noncalcified atherosclerosis of the distal cervical ICA just before the petrous portion, unchanged. LEFT CAROTID: Postsurgical change from recent carotid endarterectomy similar increased diameter of the left carotid bulb and proximal ICA. The left carotid bulb and proximal ICA are widely patent. Previously noted small intimal flap in the left cervical ICA is not definitely appreciated. RIGHT VERTEBRAL ARTERY: Mild narrowing at C5-C6, unchanged . No occlusion or aneurysmal dilation. LEFT VERTEBRAL ARTERY: Unchanged appearance of multifocal severe irregular narrowing of the left vertebral artery. SOFT TISSUES: Interval removal of the left lateral neck surgical drain. Decreased bowel gas in the left neck soft tissues. Visualized lung apices are clear. CERVICAL SPINE: No acute osseous abnormality. Mild multilevel discogenic degenerative changes of the cervical spine.
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Findings: CT angiogram of the brain: Prominent bilateral posterior communicating arteries. Diminutive bilateral P1 segments of PCAs. Otherwise, visualized portions of the ACAs, MCAs, and PCAs appear within normal limits. Diminutive basilar artery and V4 segments of the vertebral arteries. Previously described questionable left cavernous ICA anterior genu aneurysm is less well appreciated on the current study. Scattered atherosclerosis of bilateral intracranial ICAs. Otherwise, the visualized portions of the ICAs and vertebrobasilar system appear within normal limits. Dural venous sinuses are patent. Major cortical veins are patent. CT angiogram of the neck: Scattered atherosclerosis. Direct origin of left vertebral artery from the aortic arch. Otherwise, normal appearing ionic arch and proximal arch vessels. Minimal atherosclerotic calcifications in bilateral carotid bulbs. Otherwise, the visualized portions of the common, as well as cervical portions of the internal, and external carotid arteries appear within normal limits. Bilateral vertebral arteries are diminutive. Otherwise, visualized vertebral arteries demonstrate no significant abnormalities. Miscellaneous: Multiple scattered hypodense nodules in bilateral thyroid lobes. Index nodule in the thyroid isthmus measuring approximately 1.1 cm in size. Findings suggest multinodular goiter. Small asymmetric fullness in the right oropharyngeal soft tissues, likely tonsillar hypertrophy. Scattered atelectatic changes in visualized upper lungs. Stable right paratracheal lymph node measuring 2.1 cm in size.
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3,841
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Radiologic Exam: CT Angio Neck, CT Angio Head Code Stroke 1/9/2022 6:54 AM Clinical Information: Other- Spec Inst: CODE STROKE: Acute Symptoms. Comparison: Multiple prior CT heads, most recently same day. CTA neck 1/6/2021. CTA head and neck 1/1/2021. Technique: Helical CT images were obtained before and after the administration of contrast from the base of the skull to the vertex. Contrast enhanced CT angiographic images were obtained from the superior mediastinum to the vertex during the arterial phase. 3-D CT angiographic images were generated from the axial data set. "Sliding MIP" images were also generated in the sagittal, axial, and coronal planes. Patient weight: 170 lbs. IV contrast: Omnipaque 350, 100 ml, per protocol. Saline flush: 50 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 224 mm. (accession CT220004598), Patient weight: 170 lbs. IV contrast: Omnipaque 350, 100 ml, per protocol. Saline flush: 50 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 224 mm. DLP: 2961 mGy cm. (accession CT220004597) FINDINGS: CT of the head with and without contrast: Please see separately reported same day noncontrast CT head. No abnormal intracranial enhancement within the limitations of arterial phase exam. CT angiogram of the brain: RIGHT CAROTID: Moderate calcified atherosclerosis without flow-limiting stenosis. There is no evidence of occlusion or aneurysmal dilation. LEFT CAROTID: Moderate calcified atherosclerosis of the carotid siphon resulting in approximately 50% narrowing of the left supraclinoid ICA, unchanged (image 169, series #407). There is no evidence of occlusion or aneurysmal dilation. ANTERIOR, MIDDLE, AND POSTERIOR CEREBRAL ARTERIES: Unchanged mild irregular narrowing of the right M1 segment and severe irregular narrowing of a right M2 branch (image 191, series #407). Unchanged severe irregular narrowing of the left M1 segment and M2 branches. Normal appearance of the bilateral ACAs and PCAs. VERTEBROBASILAR ARTERIES: Unchanged occlusion of the mid left V4 segment. The right vertebral artery and basilar artery are patent. CT angiogram of the neck: Exam is limited due to photon starvation and motion artifact. AORTIC ARCH and PROXIMAL GREAT VESSELS: Unremarkable. RIGHT CAROTID: Severely limited evaluation due to motion artifact. Mild calcified atherosclerosis of the proximal ICA without flow-limiting stenosis. Moderate noncalcified atherosclerosis of the distal cervical ICA just before the petrous portion, unchanged. LEFT CAROTID: Postsurgical change from recent carotid endarterectomy similar increased diameter of the left carotid bulb and proximal ICA. The left carotid bulb and proximal ICA are widely patent. Previously noted small intimal flap in the left cervical ICA is not definitely appreciated. RIGHT VERTEBRAL ARTERY: Mild narrowing at C5-C6, unchanged . No occlusion or aneurysmal dilation. LEFT VERTEBRAL ARTERY: Unchanged appearance of multifocal severe irregular narrowing of the left vertebral artery. SOFT TISSUES: Interval removal of the left lateral neck surgical drain. Decreased bowel gas in the left neck soft tissues. Visualized lung apices are clear. CERVICAL SPINE: No acute osseous abnormality. Mild multilevel discogenic degenerative changes of the cervical spine. CONCLUSION: 1. Postsurgical change from recent left carotid endarterectomy with widely patent left carotid. Previously noted intimal flap in the left ICA is not definitely visualized however evaluation is mildly somewhat limited due to motion artifact. 2. Unchanged chronic occlusion of the left V4 segment and multifocal severe irregular narrowing of the left cervical vertebral artery. 3. Other unchanged multifocal atherosclerotic disease as above. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: CT of the head with and without contrast: Please see separately reported same day noncontrast CT head. No abnormal intracranial enhancement within the limitations of arterial phase exam. CT angiogram of the brain: RIGHT CAROTID: Moderate calcified atherosclerosis without flow-limiting stenosis. There is no evidence of occlusion or aneurysmal dilation. LEFT CAROTID: Moderate calcified atherosclerosis of the carotid siphon resulting in approximately 50% narrowing of the left supraclinoid ICA, unchanged (image 169, series #407). There is no evidence of occlusion or aneurysmal dilation. ANTERIOR, MIDDLE, AND POSTERIOR CEREBRAL ARTERIES: Unchanged mild irregular narrowing of the right M1 segment and severe irregular narrowing of a right M2 branch (image 191, series #407). Unchanged severe irregular narrowing of the left M1 segment and M2 branches. Normal appearance of the bilateral ACAs and PCAs. VERTEBROBASILAR ARTERIES: Unchanged occlusion of the mid left V4 segment. The right vertebral artery and basilar artery are patent. CT angiogram of the neck: Exam is limited due to photon starvation and motion artifact. AORTIC ARCH and PROXIMAL GREAT VESSELS: Unremarkable. RIGHT CAROTID: Severely limited evaluation due to motion artifact. Mild calcified atherosclerosis of the proximal ICA without flow-limiting stenosis. Moderate noncalcified atherosclerosis of the distal cervical ICA just before the petrous portion, unchanged. LEFT CAROTID: Postsurgical change from recent carotid endarterectomy similar increased diameter of the left carotid bulb and proximal ICA. The left carotid bulb and proximal ICA are widely patent. Previously noted small intimal flap in the left cervical ICA is not definitely appreciated. RIGHT VERTEBRAL ARTERY: Mild narrowing at C5-C6, unchanged . No occlusion or aneurysmal dilation. LEFT VERTEBRAL ARTERY: Unchanged appearance of multifocal severe irregular narrowing of the left vertebral artery. SOFT TISSUES: Interval removal of the left lateral neck surgical drain. Decreased bowel gas in the left neck soft tissues. Visualized lung apices are clear. CERVICAL SPINE: No acute osseous abnormality. Mild multilevel discogenic degenerative changes of the cervical spine.
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Findings: CT angiogram of the brain: Prominent bilateral posterior communicating arteries. Diminutive bilateral P1 segments of PCAs. Otherwise, visualized portions of the ACAs, MCAs, and PCAs appear within normal limits. Diminutive basilar artery and V4 segments of the vertebral arteries. Previously described questionable left cavernous ICA anterior genu aneurysm is less well appreciated on the current study. Scattered atherosclerosis of bilateral intracranial ICAs. Otherwise, the visualized portions of the ICAs and vertebrobasilar system appear within normal limits. Dural venous sinuses are patent. Major cortical veins are patent. CT angiogram of the neck: Scattered atherosclerosis. Direct origin of left vertebral artery from the aortic arch. Otherwise, normal appearing ionic arch and proximal arch vessels. Minimal atherosclerotic calcifications in bilateral carotid bulbs. Otherwise, the visualized portions of the common, as well as cervical portions of the internal, and external carotid arteries appear within normal limits. Bilateral vertebral arteries are diminutive. Otherwise, visualized vertebral arteries demonstrate no significant abnormalities. Miscellaneous: Multiple scattered hypodense nodules in bilateral thyroid lobes. Index nodule in the thyroid isthmus measuring approximately 1.1 cm in size. Findings suggest multinodular goiter. Small asymmetric fullness in the right oropharyngeal soft tissues, likely tonsillar hypertrophy. Scattered atelectatic changes in visualized upper lungs. Stable right paratracheal lymph node measuring 2.1 cm in size.
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3,842
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CT Perfusion 1/9/2022 6:41 AM Clinical Information: RIGHT SIDED WEAKNESS Comparison: CT head earlier same day. Technique: A CT perfusion study was performed during single pass of contrast bolus. Axial images were acquired at 16 axial locations and time-attenuation curves generated from this dataset were utilized to calculate cerebral blood flow, mean transit time, time to peak, and cerebral blood volume maps as well as region of interest specific quantitative data. "Prognostic" color maps were also generated depicting areas of ischemia (voxel values for MTT > 1.4 times mirror image voxels on the contralateral "normal side") in the color green and areas predictive of infarction (CBV values < 2.0 ml/100g) in the color red Patient weight: 170 lbs. IV contrast: Omnipaque 350, 80 ml, per protocol. Saline flush: 90 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 0 sec. Scan field of view: 212 mm. DLP: 1676 mGy cm. FINDINGS: RAPID images demonstrate CBF less than 30% volume: 0 mL and T Max greater than 6 seconds volume: 31 mL. Mismatch volume is 31 mL. There is no abnormal decreased cerebral blood flow to suggest infarct. Prolonged Tmax in the left MCA territory. CONCLUSION: No evidence of acute infarction. Prolonged Tmax in the left MCA territory suggestive of ischemia. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: RAPID images demonstrate CBF less than 30% volume: 0 mL and T Max greater than 6 seconds volume: 31 mL. Mismatch volume is 31 mL. There is no abnormal decreased cerebral blood flow to suggest infarct. Prolonged Tmax in the left MCA territory.
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Findings: There is no evidence of acute infarction, hemorrhage or hydrocephalus. There is no vasogenic edema or mass effect. The left mastoid air cells are poorly aerated. There is right mastoidectomy and middle ears postsurgical changes. The visualized paranasal sinuses are otherwise clear. There is no acute osseous abnormality.
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3,843
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RADIOLOGIC EXAM: CT Head wo contrast CLINICAL INFORMATION: Pupillary change. COMPARISON: Multiple prior CT heads, most recently 1/8/2022.. TECHNIQUE: CT Head wo contrastScan field of view: 226 mm. DLP: 1106 mGy cm. STRUCTURED REPORT: CT Head FINDINGS: Right frontal VP shunt catheter is in unchanged position with tip terminating in the frontal horn of the right lateral ventricle. Small amount of evolving hemorrhage in the left occipital horn, unchanged. Stable size of the ventricles with mild asymmetric dilation of the left lateral ventricle. Stable size and appearance of the intraparenchymal hemorrhage in the left frontal lobe measuring 2.4 x 1.7 cm (image 170, series #3), previously 2.5 x 1.6 cm (remeasured on prior exam). There is moderate associated edema, unchanged. No midline shift. No new areas of intracranial hemorrhage. Unchanged hypoattenuation in the left temporal lobe and inferior left frontal lobe from evolving hemorrhage. Gray-white matter differentiation is maintained. No evidence of acute infarction. Basal cisterns are patent. Normal appearance of the orbits. Unchanged prior VP shunt catheter tract in the left frontal cranium. Paranasal sinuses and mastoid air cells are clear. CONCLUSION: 1. Stable exam with evolving multifocal hemorrhage, predominantly in the left frontal lobe with associated moderate edema. No midline shift. 2. Unchanged position of the right frontal approach VP shunt catheter terminating in the right lateral ventricle. Stable size of the ventricles with asymmetric dilation of the left lateral ventricle and small volume evolving intraventricular hemorrhage. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: Right frontal VP shunt catheter is in unchanged position with tip terminating in the frontal horn of the right lateral ventricle. Small amount of evolving hemorrhage in the left occipital horn, unchanged. Stable size of the ventricles with mild asymmetric dilation of the left lateral ventricle. Stable size and appearance of the intraparenchymal hemorrhage in the left frontal lobe measuring 2.4 x 1.7 cm (image 170, series #3), previously 2.5 x 1.6 cm (remeasured on prior exam). There is moderate associated edema, unchanged. No midline shift. No new areas of intracranial hemorrhage. Unchanged hypoattenuation in the left temporal lobe and inferior left frontal lobe from evolving hemorrhage. Gray-white matter differentiation is maintained. No evidence of acute infarction. Basal cisterns are patent. Normal appearance of the orbits. Unchanged prior VP shunt catheter tract in the left frontal cranium. Paranasal sinuses and mastoid air cells are clear.
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Findings: RAPID images demonstrate CBF less than 30% volume: 0 ml and T. Max greater than 6seconds volume: 0 ml . Mismatch volume is 0 ml. There is no abnormal MTT, T max, CBV and CBF to suggest significant ischemia or infarction at the territory of the major intracranial arteries.
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3,844
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EXAM: CT Knee Left wo contrast CLINICAL INFORMATION: GSW to the knee. COMPARISON: 1/9/2022. TECHNIQUE: CT Knee Left wo contrast Scan field of view: 200 mm. DLP: 490.30 mGy cm. FINDINGS: BONES/JOINTS: Comminuted ballistic fractures of the patella and central tibial plateau with extension to the articular surface of the lateral tibial plateau (image 178, series 205) with retained bullet within the tibial epiphysis. Moderate suprapatellar pneumolipohemarthrosis is present. There are numerous tiny ossific densities within the joint space. SOFT TISSUES: Soft tissue edema with associated subcutaneous emphysema and ballistic foreign bodies about the joint. CONCLUSION: 1. Comminuted patellar and tibial plateau ballistic fractures with retention of the bullet in the proximal tibia and moderate suprapatellar pneumolipohemarthrosis. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: BONES/JOINTS: Comminuted ballistic fractures of the patella and central tibial plateau with extension to the articular surface of the lateral tibial plateau (image 178, series 205) with retained bullet within the tibial epiphysis. Moderate suprapatellar pneumolipohemarthrosis is present. There are numerous tiny ossific densities within the joint space. SOFT TISSUES: Soft tissue edema with associated subcutaneous emphysema and ballistic foreign bodies about the joint.
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Findings: No acute infarction, hemorrhage, or cerebral edema. The gray-white matter differentiation is maintained. Subcortical and periventricular hypodensities likely representing mild chronic microangiopathic changes.. The cerebral volume is appropriate for patient's age. There is no space occupying intracranial lesion, mass effect, or hydrocephalus. No abnormal intracranial enhancement. Bilateral calcifications of the carotid artery siphons. Bilateral lens replacements. There is no acute osseous or orbital abnormality. Interval opacification of the right maxillary sinus with small foci of gas. There is opacification of the right ostiomeatal complex. Small mucosal retention cysts in the left maxillary and bilateral ethmoid air cells are redemonstrated. The remainder of the visualized paranasal sinuses and mastoid air cells are clear.
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3,845
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CT Head wo contrast 1/10/2022 1:26 AM Clinical Information: COVID Confirmed GSW Spec Inst: STEALTH PROTOCOL Comparison: 1/5/2022 Technique: Unenhanced axial brain CT. Scan field of view: 257 mm. DLP: 1930 mGy cm. Findings: Left frontal approach EVD is again noted and terminates in the left frontal horn. The ventricular system is slightly prominent when compared to prior study. Status post gunshot wound with multiple ballistic and osseous fragments in the right frontoparietal lobes and associated postsurgical changes as right decompressive craniectomy. There are significant streaky artifacts from the ballistic fragments, limits the evaluation of adjacent brain parenchyma. Diffuse encephalomalacia in the right frontoparietal and occipital lobes, unchanged from the prior study. There is again subgaleal fluid collection in the right temporal, frontoparietal regions. Stable hyperdense collection adjacent to the craniectomy flap anteriorly, likely small extra-axial hematoma. Impression: 1. Stable left frontal approach ventriculostomy catheter. Interval slight enlargement of the ventricular system as described above. 2. Stable postsurgical changes as right hemicraniectomy and diffuse encephalomalacia involving the right frontal, parietal and occipital lobes and associated ballistic and osseous fragments. Stable subgaleal fluid collection along the right cerebral convexity.
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Findings: Left frontal approach EVD is again noted and terminates in the left frontal horn. The ventricular system is slightly prominent when compared to prior study. Status post gunshot wound with multiple ballistic and osseous fragments in the right frontoparietal lobes and associated postsurgical changes as right decompressive craniectomy. There are significant streaky artifacts from the ballistic fragments, limits the evaluation of adjacent brain parenchyma. Diffuse encephalomalacia in the right frontoparietal and occipital lobes, unchanged from the prior study. There is again subgaleal fluid collection in the right temporal, frontoparietal regions. Stable hyperdense collection adjacent to the craniectomy flap anteriorly, likely small extra-axial hematoma.
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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Bilateral mosaic attenuation. No pleural effusion. DISTAL ESOPHAGUS: Small hiatal hernia. HEART / VESSELS: Coronary artery calcifications. Decreased attenuation of blood suggests anemia. ABDOMEN and PELVIS: LIVER: Unremarkable for technique. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Fatty atrophy. SPLEEN: Unremarkable for technique ADRENALS: Normal. KIDNEYS: No significant abnormality. No abnormal calcifications or hydronephrosis. Mild perinephric stranding, unchanged. LYMPH NODES: Multiple prominent retroperitoneal, iliac, inguinal lymph nodes, without pathological enlargement. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. Normal appendix. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Moderate atherosclerotic calcifications of the abdominal aorta and branches. URINARY BLADDER: Decompressed by Foley catheter. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Anasarca and mild skin thickening in the lower abdomen and along the bilateral flanks. The previously seen hyperdense collection in the superficial soft tissues overlying the lumbar spine measures 8.9 x 4.9 x 8.9 cm (series 204, image 90 and series 201, image 149), previously 8.7 x 5.3 x 9.1 cm in similar dimensions. No significant change in morphology. No significant fat stranding or cutaneous tract identified. Diastases recti. MUSCULOSKELETAL: Mild multilevel degenerative changes of the spine with anterior osteophyte formation. No aggressive osseous lesions identified. Left hip arthroplasty hardware without complication.
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3,846
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EXAM: CT Chest with contrast, CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: Evaluate for metastatic disease. History of multiple myeloma. COMPARISON: CT chest 6/10/2017 and CT abdomen 12/18/2014 TECHNIQUE: CT Chest with contrast, CT Abdomen and Pelvis w contrast. Patient weight: 172 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 2.50 ml per sec. Scan delay: 86 sec Scan field of view: 428 mm. DLP: 628 mGy cm. (accession CT220004603), Patient weight: 172 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 2.50 ml per sec. Scan delay: 86 sec Scan field of view: 428 mm. (accession CT220004604) FINDINGS: STRUCTURED REPORT: CT CAP LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: The central airways are patent. Mild bilateral dependent atelectasis. No suspicious nodules or masses. No pleural effusion. HEART / VESSELS: The heart is normal in size. Mild multivessel coronary artery atherosclerotic calcifications. Annular mitral and aortic valve calcifications. Mild atherosclerotic disease of the thoracic aorta and proximal arch vessels. Surgical clips are seen anterior to the ascending aorta. The right internal jugular vein appears chronically occluded. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: Postsurgical changes from median sternotomy. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Subcentimeter hypoattenuating lesion in the right kidney is too small to characterize. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Mild atherosclerotic disease of the abdominal aorta and its branches. URINARY BLADDER: Mildly distended. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Decreased osseous mineralization. Innumerable lytic lesions throughout the visualized osseous structures. Chronic bilateral rib deformities. Postsurgical changes from anterograde left femoral intramedullary nail. Exaggerated thoracic kyphosis. Multilevel compression fracture deformities are again seen in the thoracic spine. Increased 25-50% height loss at T5-T7. The height loss at T8 is similar to prior. Moderate multilevel degenerative changes of the thoracolumbar spine. CONCLUSION: 1. Diffuse lytic disease throughout the visualized osseous structures consistent with history of multiple myeloma. 2. Increased height loss and multiple thoracic compression fracture deformities from T5 to T7. Recommend correlation with point tenderness to assess for acuity as well as recent dedicated spine imaging. 3. No other acute abnormality in the abdomen or pelvis. Additional chronic findings as above. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: STRUCTURED REPORT: CT CAP LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: The central airways are patent. Mild bilateral dependent atelectasis. No suspicious nodules or masses. No pleural effusion. HEART / VESSELS: The heart is normal in size. Mild multivessel coronary artery atherosclerotic calcifications. Annular mitral and aortic valve calcifications. Mild atherosclerotic disease of the thoracic aorta and proximal arch vessels. Surgical clips are seen anterior to the ascending aorta. The right internal jugular vein appears chronically occluded. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: Postsurgical changes from median sternotomy. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Subcentimeter hypoattenuating lesion in the right kidney is too small to characterize. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Mild atherosclerotic disease of the abdominal aorta and its branches. URINARY BLADDER: Mildly distended. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Decreased osseous mineralization. Innumerable lytic lesions throughout the visualized osseous structures. Chronic bilateral rib deformities. Postsurgical changes from anterograde left femoral intramedullary nail. Exaggerated thoracic kyphosis. Multilevel compression fracture deformities are again seen in the thoracic spine. Increased 25-50% height loss at T5-T7. The height loss at T8 is similar to prior. Moderate multilevel degenerative changes of the thoracolumbar spine.
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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Interval increase in size of the upper lobe pulmonary nodule today measuring 16 x 16 mm on series 2 image 75, previously 12 x 12 mm. This corresponds to the hypermetabolic pulmonary nodule described on outside PET/CT dated 11/30/2021. There is an additional 7 mm pulmonary nodule in the right upper lobe on series 2 image 61 that was not definitively seen on prior examinations. Scattered calcified granuloma are seen in the right lung. There is mild bilateral mosaic attenuation. No focal consolidation, pleural effusion, or pneumothorax. Central airways are patent. HEART / VESSELS: Heart size is normal. No pericardial effusion. Mild atherosclerotic disease. No significant coronary artery calcifications. MEDIASTINUM / ESOPHAGUS: Prominent mediastinal lymph nodes, see below. LYMPH NODES: Prominent right hilar and mediastinal lymph nodes, largest measuring 1.3 cm in short axis diameter on series 2 image 98 in the right hilum and 1.3 cm in short axis diameter in the pretracheal distribution on series 2 image 83. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Normal noncontrast appearance of the imaged upper abdomen. MUSCULOSKELETAL: No acute or aggressive appearing osseous abnormality. Multilevel degenerative changes of the lower thoracic spine.
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3,847
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EXAM: CT Chest with contrast, CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: Evaluate for metastatic disease. History of multiple myeloma. COMPARISON: CT chest 6/10/2017 and CT abdomen 12/18/2014 TECHNIQUE: CT Chest with contrast, CT Abdomen and Pelvis w contrast. Patient weight: 172 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 2.50 ml per sec. Scan delay: 86 sec Scan field of view: 428 mm. DLP: 628 mGy cm. (accession CT220004603), Patient weight: 172 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 2.50 ml per sec. Scan delay: 86 sec Scan field of view: 428 mm. (accession CT220004604) FINDINGS: STRUCTURED REPORT: CT CAP LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: The central airways are patent. Mild bilateral dependent atelectasis. No suspicious nodules or masses. No pleural effusion. HEART / VESSELS: The heart is normal in size. Mild multivessel coronary artery atherosclerotic calcifications. Annular mitral and aortic valve calcifications. Mild atherosclerotic disease of the thoracic aorta and proximal arch vessels. Surgical clips are seen anterior to the ascending aorta. The right internal jugular vein appears chronically occluded. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: Postsurgical changes from median sternotomy. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Subcentimeter hypoattenuating lesion in the right kidney is too small to characterize. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Mild atherosclerotic disease of the abdominal aorta and its branches. URINARY BLADDER: Mildly distended. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Decreased osseous mineralization. Innumerable lytic lesions throughout the visualized osseous structures. Chronic bilateral rib deformities. Postsurgical changes from anterograde left femoral intramedullary nail. Exaggerated thoracic kyphosis. Multilevel compression fracture deformities are again seen in the thoracic spine. Increased 25-50% height loss at T5-T7. The height loss at T8 is similar to prior. Moderate multilevel degenerative changes of the thoracolumbar spine. CONCLUSION: 1. Diffuse lytic disease throughout the visualized osseous structures consistent with history of multiple myeloma. 2. Increased height loss and multiple thoracic compression fracture deformities from T5 to T7. Recommend correlation with point tenderness to assess for acuity as well as recent dedicated spine imaging. 3. No other acute abnormality in the abdomen or pelvis. Additional chronic findings as above. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: STRUCTURED REPORT: CT CAP LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: The central airways are patent. Mild bilateral dependent atelectasis. No suspicious nodules or masses. No pleural effusion. HEART / VESSELS: The heart is normal in size. Mild multivessel coronary artery atherosclerotic calcifications. Annular mitral and aortic valve calcifications. Mild atherosclerotic disease of the thoracic aorta and proximal arch vessels. Surgical clips are seen anterior to the ascending aorta. The right internal jugular vein appears chronically occluded. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: Postsurgical changes from median sternotomy. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Subcentimeter hypoattenuating lesion in the right kidney is too small to characterize. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Mild atherosclerotic disease of the abdominal aorta and its branches. URINARY BLADDER: Mildly distended. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Decreased osseous mineralization. Innumerable lytic lesions throughout the visualized osseous structures. Chronic bilateral rib deformities. Postsurgical changes from anterograde left femoral intramedullary nail. Exaggerated thoracic kyphosis. Multilevel compression fracture deformities are again seen in the thoracic spine. Increased 25-50% height loss at T5-T7. The height loss at T8 is similar to prior. Moderate multilevel degenerative changes of the thoracolumbar spine.
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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: No focal consolidation or pleural effusion. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: The heart size is normal. ABDOMEN and PELVIS: LIVER: Calcified granuloma in the right anterior lobe. Otherwise normal within limits of technique. BILIARY TRACT: Normal. GALLBLADDER: Cholelithiasis. No secondary signs of acute cholecystitis. PANCREAS: Normal within limits of technique. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Mild bilateral perinephric fat stranding, nonspecific. Asymmetric prominence of right renal collecting system and right ureter without definite distal obstructing etiology may be secondary to back pressure changes from overly distended urinary bladder. No left hydronephrosis or hydroureter ureter. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Oral contrast reaches the distal small bowel and proximal colon. No dilatation or obstruction. COLON / APPENDIX: The appendix is normal. Mild nonspecific presacral and perirectal fat stranding. Stool ball in the rectum. Redundant sigmoid colon. Moderate gas and stool distended colon. PERITONEUM / MESENTERY: No intraperitoneal free fluid or air. RETROPERITONEUM: Normal. VESSELS: Mild calcified atherosclerotic calcifications of the abdominal aorta and its branches. URINARY BLADDER: Overly distended urinary bladder. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
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3,848
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RADIOLOGIC EXAM: CT Head wo contrast, CT Maxillofacial wo contrast CLINICAL INFORMATION: Facial trauma COMPARISON: CT head 10/14/2005. TECHNIQUE: CT Head wo contrast, CT Maxillofacial wo contrastScan field of view: 230 mm. DLP: 1428.30 mGy cm. (accession CT220004605), Scan field of view: 198.20 mm. DLP: 1101.30 mGy cm. (accession CT220004607) STRUCTURED REPORT: CT Head and Maxillofacial Trauma FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. Cerebral volume is normal. Punctate calcification in the right parietal lobe. EXTRA-AXIAL SPACES: Normal. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SOFT TISSUES: Normal. SKULL AND SKULL BASE: No fracture. FACIAL BONES: Normal. MANDIBLE: Normal. SINONASAL CAVITIES: Postsurgical changes of left antrostomy, left middle turbinectomy, and bilateral ethmoidectomies. Sclerotic changes right maxillary sinus are compatible with chronic sinusitis. Mild to moderate mucosal thickening of all the visualized sinuses. Mild opacification of the right mastoid air cells. CONCLUSION: No acute intracranial process or maxillofacial fracture. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. Cerebral volume is normal. Punctate calcification in the right parietal lobe. EXTRA-AXIAL SPACES: Normal. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SOFT TISSUES: Normal. SKULL AND SKULL BASE: No fracture. FACIAL BONES: Normal. MANDIBLE: Normal. SINONASAL CAVITIES: Postsurgical changes of left antrostomy, left middle turbinectomy, and bilateral ethmoidectomies. Sclerotic changes right maxillary sinus are compatible with chronic sinusitis. Mild to moderate mucosal thickening of all the visualized sinuses. Mild opacification of the right mastoid air cells.
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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Wedgelike peripheral consolidation in the right upper lobe with adjacent mild traction bronchiectasis. Focus of peripheral groundglass opacities in the left upper lobe. Small bilateral pleural effusions. Mild bibasilar atelectasis. HEART / VESSELS: No significant abnormality. Heart is normal in size. No pericardial effusion. MEDIASTINUM / ESOPHAGUS: No significant abnormality. LYMPH NODES: None enlarged. CHEST WALL: Extensive diffuse anasarca. UPPER ABDOMEN: Moderate amount of ascites. Postsurgical changes of gastric bypass. MUSCULOSKELETAL: Mild multilevel degenerative changes of the thoracic spine with anterior wedging in the lower thoracic spine. No acute or destructive osseous lesion seen.
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3,849
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RADIOLOGIC EXAM: CT Cervical Spine wo contrast CLINICAL INFORMATION: Neck trauma, dangerous injury mechanism COMPARISON: CT C-spine 10/14/2005 TECHNIQUE: CT Cervical Spine wo contrast Scan field of view: 220 mm. DLP: 594.40 mGy cm. STRUCTURED REPORT: CT Cervical Spine FINDINGS: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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FINDINGS: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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Findings: No enlarged hilar or mediastinal nodes are present. The ascending thoracic aorta is dilated measuring up to 4.2 cm. There are atherosclerotic calcification along the aortic arch and descending thoracic aorta. Aortic valve and mitral annular calcifications are present. Mild upper lobe predominant centrilobular emphysema. Small (less than 6 mm) calcified and noncalcified lung nodules are present bilaterally. For example, a solid noncalcified nodule within the medial segment of the middle lobe on image 289 of series 301 measures 3 mm. A 4 mm peri-fissural nodule along the right major fissure on image 256 has the appearance of an intrapulmonary lymph node. 3 mm left upper lobe nodule on image 158. No suspicious lung nodules. Mild bilateral lower lobe atelectasis. Coronary artery calcification: The visual score of calcification is 4. (Based on a publication by Kirsch et al (Detection of Coronary calcium During Standard Chest Computed Tomography Correlates With Multi-Detector Computed Tomography Coronary Artery Calcium score, Int J Cardiovasc Imaging (2012) 28:1249-1256), visual score >7 is associated with an Agatston score > 400 and independently validated increased incidence of cardiovascular mortality). The visualized liver, spleen, adrenals, and bowel are unremarkable. Bones: No acute or aggressive osseous abnormality.
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3,850
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RADIOLOGIC EXAM: CT Head wo contrast, CT Maxillofacial wo contrast CLINICAL INFORMATION: Facial trauma COMPARISON: CT head 10/14/2005. TECHNIQUE: CT Head wo contrast, CT Maxillofacial wo contrastScan field of view: 230 mm. DLP: 1428.30 mGy cm. (accession CT220004605), Scan field of view: 198.20 mm. DLP: 1101.30 mGy cm. (accession CT220004607) STRUCTURED REPORT: CT Head and Maxillofacial Trauma FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. Cerebral volume is normal. Punctate calcification in the right parietal lobe. EXTRA-AXIAL SPACES: Normal. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SOFT TISSUES: Normal. SKULL AND SKULL BASE: No fracture. FACIAL BONES: Normal. MANDIBLE: Normal. SINONASAL CAVITIES: Postsurgical changes of left antrostomy, left middle turbinectomy, and bilateral ethmoidectomies. Sclerotic changes right maxillary sinus are compatible with chronic sinusitis. Mild to moderate mucosal thickening of all the visualized sinuses. Mild opacification of the right mastoid air cells. CONCLUSION: No acute intracranial process or maxillofacial fracture. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. Cerebral volume is normal. Punctate calcification in the right parietal lobe. EXTRA-AXIAL SPACES: Normal. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SOFT TISSUES: Normal. SKULL AND SKULL BASE: No fracture. FACIAL BONES: Normal. MANDIBLE: Normal. SINONASAL CAVITIES: Postsurgical changes of left antrostomy, left middle turbinectomy, and bilateral ethmoidectomies. Sclerotic changes right maxillary sinus are compatible with chronic sinusitis. Mild to moderate mucosal thickening of all the visualized sinuses. Mild opacification of the right mastoid air cells.
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FINDINGS: No acute fracture or dislocation of the humerus, elbow, or forearm. Within the anterior compartment of the upper arm along the medial aspect of the biceps brachia, is a peripheral enhancing fluid collection with internal foci of gas the collection extends from the antecubital fossa all the way up to the shoulder measuring approximately 1.8 x 2.0 x 31.3 cm (image 161, series 304; image 24, series 307). Foci of soft tissue gas are also noted extending medially across the chest between the pectoralis major and minor muscles. No elbow joint effusion. Extensive subcutaneous soft tissue swelling and cutaneous thickening is noted within the right upper extremity consistent with cellulitis. No focal drainable fluid collection is seen within the right forearm soft tissues. The visualized intrathoracic and intra-abdominal structures are unremarkable.
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3,851
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EXAM: CT Thoracic Spine from Reformat CLINICAL INFORMATION: Female patient 60 years with incontinence, weakness, back pain Spec Inst: cf thoracic cord compression . TECHNIQUE: 2 mm thick serial axial images of the thoracic spine were reformatted from the chest CT axial data set. Sagittal and coronal reformatted views were also obtained. : COMPARISON: None available. FINDINGS: There is mild T6 anterior wedging. No discrete cortical disruption is identified. There is no subluxation.. There is increased attenuation posterior to the T6 vertebral body. Involving the ventral epidural space and also the lateral epidural space. There appears to be significant compression of the thecal sac and spinal cord at this level. There is also increased soft tissue attenuation within the prevertebral soft tissues at this level. On the lowest most image there is also a destructive lesion involving the left L2 transverse process. Please see chest CT for description of pulmonary findings CONCLUSION: 01. There is mild anterior wedging of the T6 vertebral body.. There is increased attenuation/enhancement involving the epidural space at this level resulting in severe narrowing of the thecal sac/cord compression. There is also significant prevertebral soft tissue enhancement. Findings likely represent neoplastic process arising from T6 vertebral body with both epidural and prevertebral extension. Findings are concerning for metastatic lesion with probable cord compression. MRI of the thoracic spine could be obtained for confirmation. 02. Partial visualization of destructive osseous lesion involving the left L2 transverse process on the lowest most image probably represents additional metastatic lesion. 03. Multilevel mild degenerative changes. No other significant thoracic spinal canal narrowing
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FINDINGS: There is mild T6 anterior wedging. No discrete cortical disruption is identified. There is no subluxation.. There is increased attenuation posterior to the T6 vertebral body. Involving the ventral epidural space and also the lateral epidural space. There appears to be significant compression of the thecal sac and spinal cord at this level. There is also increased soft tissue attenuation within the prevertebral soft tissues at this level. On the lowest most image there is also a destructive lesion involving the left L2 transverse process. Please see chest CT for description of pulmonary findings
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FINDINGS: No acute fracture or dislocation of the humerus, elbow, or forearm. Within the anterior compartment of the upper arm along the medial aspect of the biceps brachia, is a peripheral enhancing fluid collection with internal foci of gas the collection extends from the antecubital fossa all the way up to the shoulder measuring approximately 1.8 x 2.0 x 31.3 cm (image 161, series 304; image 24, series 307). Foci of soft tissue gas are also noted extending medially across the chest between the pectoralis major and minor muscles. No elbow joint effusion. Extensive subcutaneous soft tissue swelling and cutaneous thickening is noted within the right upper extremity consistent with cellulitis. No focal drainable fluid collection is seen within the right forearm soft tissues. The visualized intrathoracic and intra-abdominal structures are unremarkable.
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3,852
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EXAM: CT Chest with contrast, CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: History of metastatic cancer undergoing staging. COMPARISON: CT chest 11/10/2021 and abdomen 3/28/2021 and PET/CT from 12/17/2021. TECHNIQUE: CT Chest with contrast, CT Abdomen and Pelvis w contrast. Patient weight: 236.50 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. Saline flush: 10 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 70 sec Scan field of view: 500 mm. DLP: 2181 mGy cm. (accession CT220004609), Patient weight: 236.50 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. Saline flush: 60 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 70 sec Scan field of view: 500 mm. (accession CT220004610) FINDINGS: STRUCTURED REPORT: CT CAP LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Right inferior hilar mass heterogeneously enhances and measures 6.6 x 3.6 cm (series 3, image 109). Associated occlusion of the right lower lobe bronchus with complete atelectasis of the right lower lobe and medial segment of the right middle lobe. Small right pleural effusion. Mosaic attenuation the bilateral lungs, which can be seen with pulmonary arterial hypertension or small airway disease. HEART / VESSELS: The heart is normal in size with mild aortic valve calcifications. Mild atherosclerotic disease of the thoracic aorta and proximal arch vessels. Right hilar mass results in stenosis of multiple right pulmonary artery and vein branches. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: Increased bulky mediastinal and right hilar lymphadenopathy. For example there is a right paratracheal lymph node conglomerate measuring 3.8 x 3.3 cm (series 3, image 79) that previously measured 3.1 x 2.8 cm on image 83, series 4 from recent PET/CT. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Scattered hypoenhancing lesions with peripheral enhancement scattered throughout the liver. For example, the largest lesion in the lateral segment of the left hepatic lobe measures 2.2 x 2.1 cm (series 3, image 174). BILIARY TRACT: Normal. GALLBLADDER: Surgically absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Subcentimeter hypoattenuating lesions in the bilateral kidneys are too small to characterize. LYMPH NODES: Left inguinal lymph node measures 1.6 cm on image 377, series 3. STOMACH / SMALL BOWEL: Small hiatal hernia. Stomach and small bowel are otherwise unremarkable. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Partially calcified nodule adjacent to the cecum, possibly fat necrosis. No free fluid or free air. RETROPERITONEUM: Normal. VESSELS: Moderate atherosclerotic disease of the abdominal aorta and its branches. URINARY BLADDER: Streak artifact from bilateral hip arthroplasty limits evaluation of the pelvis. The urinary bladder is grossly unremarkable. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Subcutaneous emphysema in the anterior abdominal wall likely related to recent injections. MUSCULOSKELETAL: Bilateral total hip arthroplasties. Proximal bilateral femoral cerclages. Postsurgical changes from L5 to S1 posterior fusion and L5 laminectomy. Mixed lytic and sclerotic lesion in the left pubic body with associated pathologic fracture. Lytic lesion in the left L3 transverse process. Similar appearance of expansile lesion in the lateral eighth rib. Moderate multilevel degenerative changes of the thoracolumbar spine. Osseous lesion involving the T6 vertebral body with soft tissue extension into the central canal resulting in significant stenosis at this level. CONCLUSION: 1. Increased size of heterogeneously enhancing right hilar mass with associated right lower lobe bronchus and medial segment right middle lobe bronchus occlusion and atelectasis compatible with known lung malignancy. 2. Increased size of mediastinal metastatic lymphadenopathy. 3. Multifocal hepatic metastases. 4. Osseous lesion involving the T6 vertebral body with soft tissue extension into the central canal resulting in apparent spinal cord compression. Correlate with same day dedicated spine imaging. 5. Lytic lesion in the transverse process of L3 and in the left pubic body with associated pathological fracture are also compatible osseous metastatic disease. 6. Additional findings as above. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: STRUCTURED REPORT: CT CAP LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Right inferior hilar mass heterogeneously enhances and measures 6.6 x 3.6 cm (series 3, image 109). Associated occlusion of the right lower lobe bronchus with complete atelectasis of the right lower lobe and medial segment of the right middle lobe. Small right pleural effusion. Mosaic attenuation the bilateral lungs, which can be seen with pulmonary arterial hypertension or small airway disease. HEART / VESSELS: The heart is normal in size with mild aortic valve calcifications. Mild atherosclerotic disease of the thoracic aorta and proximal arch vessels. Right hilar mass results in stenosis of multiple right pulmonary artery and vein branches. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: Increased bulky mediastinal and right hilar lymphadenopathy. For example there is a right paratracheal lymph node conglomerate measuring 3.8 x 3.3 cm (series 3, image 79) that previously measured 3.1 x 2.8 cm on image 83, series 4 from recent PET/CT. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Scattered hypoenhancing lesions with peripheral enhancement scattered throughout the liver. For example, the largest lesion in the lateral segment of the left hepatic lobe measures 2.2 x 2.1 cm (series 3, image 174). BILIARY TRACT: Normal. GALLBLADDER: Surgically absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Subcentimeter hypoattenuating lesions in the bilateral kidneys are too small to characterize. LYMPH NODES: Left inguinal lymph node measures 1.6 cm on image 377, series 3. STOMACH / SMALL BOWEL: Small hiatal hernia. Stomach and small bowel are otherwise unremarkable. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Partially calcified nodule adjacent to the cecum, possibly fat necrosis. No free fluid or free air. RETROPERITONEUM: Normal. VESSELS: Moderate atherosclerotic disease of the abdominal aorta and its branches. URINARY BLADDER: Streak artifact from bilateral hip arthroplasty limits evaluation of the pelvis. The urinary bladder is grossly unremarkable. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Subcutaneous emphysema in the anterior abdominal wall likely related to recent injections. MUSCULOSKELETAL: Bilateral total hip arthroplasties. Proximal bilateral femoral cerclages. Postsurgical changes from L5 to S1 posterior fusion and L5 laminectomy. Mixed lytic and sclerotic lesion in the left pubic body with associated pathologic fracture. Lytic lesion in the left L3 transverse process. Similar appearance of expansile lesion in the lateral eighth rib. Moderate multilevel degenerative changes of the thoracolumbar spine. Osseous lesion involving the T6 vertebral body with soft tissue extension into the central canal resulting in significant stenosis at this level.
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FINDINGS: No acute fracture or dislocation of the humerus, elbow, or forearm. Within the anterior compartment of the upper arm along the medial aspect of the biceps brachia, is a peripheral enhancing fluid collection with internal foci of gas the collection extends from the antecubital fossa all the way up to the shoulder measuring approximately 1.8 x 2.0 x 31.3 cm (image 161, series 304; image 24, series 307). Foci of soft tissue gas are also noted extending medially across the chest between the pectoralis major and minor muscles. No elbow joint effusion. Extensive subcutaneous soft tissue swelling and cutaneous thickening is noted within the right upper extremity consistent with cellulitis. No focal drainable fluid collection is seen within the right forearm soft tissues. The visualized intrathoracic and intra-abdominal structures are unremarkable.
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3,853
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EXAM: CT Chest with contrast, CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: History of metastatic cancer undergoing staging. COMPARISON: CT chest 11/10/2021 and abdomen 3/28/2021 and PET/CT from 12/17/2021. TECHNIQUE: CT Chest with contrast, CT Abdomen and Pelvis w contrast. Patient weight: 236.50 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. Saline flush: 10 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 70 sec Scan field of view: 500 mm. DLP: 2181 mGy cm. (accession CT220004609), Patient weight: 236.50 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. Saline flush: 60 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 70 sec Scan field of view: 500 mm. (accession CT220004610) FINDINGS: STRUCTURED REPORT: CT CAP LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Right inferior hilar mass heterogeneously enhances and measures 6.6 x 3.6 cm (series 3, image 109). Associated occlusion of the right lower lobe bronchus with complete atelectasis of the right lower lobe and medial segment of the right middle lobe. Small right pleural effusion. Mosaic attenuation the bilateral lungs, which can be seen with pulmonary arterial hypertension or small airway disease. HEART / VESSELS: The heart is normal in size with mild aortic valve calcifications. Mild atherosclerotic disease of the thoracic aorta and proximal arch vessels. Right hilar mass results in stenosis of multiple right pulmonary artery and vein branches. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: Increased bulky mediastinal and right hilar lymphadenopathy. For example there is a right paratracheal lymph node conglomerate measuring 3.8 x 3.3 cm (series 3, image 79) that previously measured 3.1 x 2.8 cm on image 83, series 4 from recent PET/CT. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Scattered hypoenhancing lesions with peripheral enhancement scattered throughout the liver. For example, the largest lesion in the lateral segment of the left hepatic lobe measures 2.2 x 2.1 cm (series 3, image 174). BILIARY TRACT: Normal. GALLBLADDER: Surgically absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Subcentimeter hypoattenuating lesions in the bilateral kidneys are too small to characterize. LYMPH NODES: Left inguinal lymph node measures 1.6 cm on image 377, series 3. STOMACH / SMALL BOWEL: Small hiatal hernia. Stomach and small bowel are otherwise unremarkable. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Partially calcified nodule adjacent to the cecum, possibly fat necrosis. No free fluid or free air. RETROPERITONEUM: Normal. VESSELS: Moderate atherosclerotic disease of the abdominal aorta and its branches. URINARY BLADDER: Streak artifact from bilateral hip arthroplasty limits evaluation of the pelvis. The urinary bladder is grossly unremarkable. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Subcutaneous emphysema in the anterior abdominal wall likely related to recent injections. MUSCULOSKELETAL: Bilateral total hip arthroplasties. Proximal bilateral femoral cerclages. Postsurgical changes from L5 to S1 posterior fusion and L5 laminectomy. Mixed lytic and sclerotic lesion in the left pubic body with associated pathologic fracture. Lytic lesion in the left L3 transverse process. Similar appearance of expansile lesion in the lateral eighth rib. Moderate multilevel degenerative changes of the thoracolumbar spine. Osseous lesion involving the T6 vertebral body with soft tissue extension into the central canal resulting in significant stenosis at this level. CONCLUSION: 1. Increased size of heterogeneously enhancing right hilar mass with associated right lower lobe bronchus and medial segment right middle lobe bronchus occlusion and atelectasis compatible with known lung malignancy. 2. Increased size of mediastinal metastatic lymphadenopathy. 3. Multifocal hepatic metastases. 4. Osseous lesion involving the T6 vertebral body with soft tissue extension into the central canal resulting in apparent spinal cord compression. Correlate with same day dedicated spine imaging. 5. Lytic lesion in the transverse process of L3 and in the left pubic body with associated pathological fracture are also compatible osseous metastatic disease. 6. Additional findings as above. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: STRUCTURED REPORT: CT CAP LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Right inferior hilar mass heterogeneously enhances and measures 6.6 x 3.6 cm (series 3, image 109). Associated occlusion of the right lower lobe bronchus with complete atelectasis of the right lower lobe and medial segment of the right middle lobe. Small right pleural effusion. Mosaic attenuation the bilateral lungs, which can be seen with pulmonary arterial hypertension or small airway disease. HEART / VESSELS: The heart is normal in size with mild aortic valve calcifications. Mild atherosclerotic disease of the thoracic aorta and proximal arch vessels. Right hilar mass results in stenosis of multiple right pulmonary artery and vein branches. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: Increased bulky mediastinal and right hilar lymphadenopathy. For example there is a right paratracheal lymph node conglomerate measuring 3.8 x 3.3 cm (series 3, image 79) that previously measured 3.1 x 2.8 cm on image 83, series 4 from recent PET/CT. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Scattered hypoenhancing lesions with peripheral enhancement scattered throughout the liver. For example, the largest lesion in the lateral segment of the left hepatic lobe measures 2.2 x 2.1 cm (series 3, image 174). BILIARY TRACT: Normal. GALLBLADDER: Surgically absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Subcentimeter hypoattenuating lesions in the bilateral kidneys are too small to characterize. LYMPH NODES: Left inguinal lymph node measures 1.6 cm on image 377, series 3. STOMACH / SMALL BOWEL: Small hiatal hernia. Stomach and small bowel are otherwise unremarkable. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Partially calcified nodule adjacent to the cecum, possibly fat necrosis. No free fluid or free air. RETROPERITONEUM: Normal. VESSELS: Moderate atherosclerotic disease of the abdominal aorta and its branches. URINARY BLADDER: Streak artifact from bilateral hip arthroplasty limits evaluation of the pelvis. The urinary bladder is grossly unremarkable. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Subcutaneous emphysema in the anterior abdominal wall likely related to recent injections. MUSCULOSKELETAL: Bilateral total hip arthroplasties. Proximal bilateral femoral cerclages. Postsurgical changes from L5 to S1 posterior fusion and L5 laminectomy. Mixed lytic and sclerotic lesion in the left pubic body with associated pathologic fracture. Lytic lesion in the left L3 transverse process. Similar appearance of expansile lesion in the lateral eighth rib. Moderate multilevel degenerative changes of the thoracolumbar spine. Osseous lesion involving the T6 vertebral body with soft tissue extension into the central canal resulting in significant stenosis at this level.
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Findings: There is no evidence of acute intra- or extra-axial hemorrhage. There is no midline shift, mass effect, or other space-occupying lesion. Gray-white differentiation appears maintained. The ventricular system are normal in configuration. The basal cisterns are clear. Scattered paranasal sinus mucosal thickening. The mastoid air cells are clear of acute process. The visualized bones of the calvarium demonstrate no acute osseous abnormality.
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3,854
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EXAM: CT Neck Soft Tissue wo contrast CLINICAL INFORMATION: Female patient 72 years with neck pain and fevers TECHNIQUE: 1 mm thick serial axial images of the neck were obtained without intravenous contrast. Sagittal and coronal reformatted views were also obtained. Technique: Scan field of view: 316 mm. DLP: 478 mGy cm. COMPARISON: None available. FINDINGS: Examination is degraded secondary to motion artifact. Examination is also limited without intravenous contrast. No definite lesion is identified within the nasopharynx, oropharynx or hypopharynx. No laryngeal mass is identified. Trachea appears within normal limits. There is enlargement of the right lobe of the thyroid gland. There is a large hypodense lesion which measures approximately 3 x 2.7 cm in the axial plane and measures approximately 4.2 cm in cephalocaudad orientation. There is mild heterogeneity of the nonenlarged left lobe of the thyroid gland. Submandibular glands and parotid glands appear unremarkable. There is no lymphadenopathy using CT size criteria. There is no destructive osseous lesion.. There is multilevel degenerative disc disease There is patchy airspace disease within the lungs. There are also bilateral pleural effusions. Visualized paranasal sinuses and mastoid air cells are clear. No definite acute abnormality is identified within the brain CONCLUSION: 01. Bilateral pneumonia with small pleural effusions within the visualized lungs. 02. Enlarged right lobe of the thyroid gland containing large hypodense lesion which was diagnosed as a cyst on recent ultrasound. No additional lesion is identified within the neck.
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FINDINGS: Examination is degraded secondary to motion artifact. Examination is also limited without intravenous contrast. No definite lesion is identified within the nasopharynx, oropharynx or hypopharynx. No laryngeal mass is identified. Trachea appears within normal limits. There is enlargement of the right lobe of the thyroid gland. There is a large hypodense lesion which measures approximately 3 x 2.7 cm in the axial plane and measures approximately 4.2 cm in cephalocaudad orientation. There is mild heterogeneity of the nonenlarged left lobe of the thyroid gland. Submandibular glands and parotid glands appear unremarkable. There is no lymphadenopathy using CT size criteria. There is no destructive osseous lesion.. There is multilevel degenerative disc disease There is patchy airspace disease within the lungs. There are also bilateral pleural effusions. Visualized paranasal sinuses and mastoid air cells are clear. No definite acute abnormality is identified within the brain
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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Pelvis Renal Transplant VASCULATURE: LOWER ABDOMINAL AORTA: Severe calcified atherosclerotic disease. RIGHT COMMON / INTERNAL ILIAC ARTERIES: Moderate calcified atherosclerotic disease. RIGHT EXTERNAL ILIAC ARTERY: Mild calcified atherosclerotic disease. LEFT COMMON / INTERNAL ILIAC ARTERIES: Moderate calcified atherosclerotic disease. LEFT EXTERNAL ILIAC ARTERY: Mild calcified atherosclerotic disease. LOWER ABDOMEN: BOWEL: Colonic diverticulosis PERITONEUM: No abnormality OTHER: Partially visualized right renal cyst PELVIS: LYMPH NODES: None enlarged. PERIRECTAL / PERIANAL REGION: Normal. URINARY BLADDER: Decompressed REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Fused changes of renal osteodystrophy.
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3,855
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EXAM: CT Abdomen and Pelvis w contrast, CT Chest with contrast CLINICAL INFORMATION: Evaluate for source of leukocytosis. History of perforated diverticulosis. COMPARISON: CT abdomen pelvis on 1/3/2022 TECHNIQUE: CT Abdomen and Pelvis w contrast, CT Chest with contrast. Patient weight: 295 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. Saline flush: 80 ml. IV contrast injection rate: 2.50 ml per sec. Scan delay: 100 sec Scan field of view: 500 mm. DLP: 2279 mGy cm. (accession CT220004614), Patient weight: 295 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. Saline flush: 80 ml. IV contrast injection rate: 2.50 ml per sec. Scan delay: 100 sec Scan field of view: 500 mm. (accession CT220004613) FINDINGS: STRUCTURED REPORT: CT CAP LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: The central airways are patent. Trace bilateral pleural effusions. Bilateral right greater than left dependent atelectasis. HEART / VESSELS: Tiny filling defect near the junction of the right internal jugular vein and axillary vein (image 15, series 3). MEDIASTINUM / ESOPHAGUS: Normal. 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: Right renal cortical cyst. No hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: The stomach is unremarkable. Small periampullary duodenal diverticulum. Postsurgical changes from diverting loop ileostomy in the right abdomen. Multiple mildly dilated loops of small bowel in the anterior abdomen as well as several loops of small bowel with mild wall thickening and perienteric inflammatory changes in the mid pelvis. Small bowel is collapsed distal to this. COLON / APPENDIX: Postsurgical changes from partial sigmoidectomy with colorectal anastomosis. Scattered locules of gas and small volume of adjacent fluid seen adjacent to the anastomosis and extending inferiorly in the left perirectal space. The colon is collapsed with diffuse pericolonic inflammatory changes with associated wall thickening. PERITONEUM / MESENTERY: Small volume free fluid scattered throughout the abdomen. Multiple areas of peritoneal thickening and enhancement with more focal loculation of the mid right abdomen (image 281, series 3). Diffuse mesenteric stranding and pericoloenteric inflammatory changes. Surgical drain in the left hemiabdomen terminates in the pelvis. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Circumferential bladder wall thickening with perivesicular inflammatory changes. More focal thickening along the urinary bladder dome may be postsurgical. Nondependent gas in the urinary bladder possibly secondary to recent catheterization. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Mild anasarca. Postsurgical changes from midline laparotomy with dehiscence of the superficial incision in the lower abdomen. Tiny seroma in the superior incision measuring 2.0 x 1.3 cm (series 3, image 241). Right hemidiaphragm loop ileostomy. Subcutaneous gas in the anterior abdominal wall likely related to recent injections. MUSCULOSKELETAL: No aggressive osseous lesions. CONCLUSION: 1. Small volume free fluid with peritoneal thickening/enhancement, compatible peritonitis. More focal collection in the mid right abdomen may represent developing abscess. 2. Diffuse mesenteric stranding and pericoloenteric inflammatory changes, likely reactive. More dilated proximal small bowel suggests a component of partial small bowel obstruction transitioning in the mid pelvis. 3. Postsurgical changes from sigmoidectomy and with colorectal anastomosis. Adjacent fluid and gas at the level of the anastomosis may be postsurgical, but anastomotic leak cannot be excluded. 4. Circumferential bladder wall thickening and perivesicular inflammatory changes possibly reactive/post surgical. Recommend urinalysis to exclude cystitis. 5. Possible filling defect at the junction of the right internal jugular vein and axillary vein may represent a small deep venous thrombosis. Further evaluation with ultrasound can be obtained. 6. Trace bilateral pleural effusions with right greater than left dependent atelectasis. 7. Additional findings as above. These findings were discussed with Dr. Uhlich by Dr. Zarzour via telephone on 1/9/2022 2:07 PM. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: STRUCTURED REPORT: CT CAP LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: The central airways are patent. Trace bilateral pleural effusions. Bilateral right greater than left dependent atelectasis. HEART / VESSELS: Tiny filling defect near the junction of the right internal jugular vein and axillary vein (image 15, series 3). MEDIASTINUM / ESOPHAGUS: Normal. 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: Right renal cortical cyst. No hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: The stomach is unremarkable. Small periampullary duodenal diverticulum. Postsurgical changes from diverting loop ileostomy in the right abdomen. Multiple mildly dilated loops of small bowel in the anterior abdomen as well as several loops of small bowel with mild wall thickening and perienteric inflammatory changes in the mid pelvis. Small bowel is collapsed distal to this. COLON / APPENDIX: Postsurgical changes from partial sigmoidectomy with colorectal anastomosis. Scattered locules of gas and small volume of adjacent fluid seen adjacent to the anastomosis and extending inferiorly in the left perirectal space. The colon is collapsed with diffuse pericolonic inflammatory changes with associated wall thickening. PERITONEUM / MESENTERY: Small volume free fluid scattered throughout the abdomen. Multiple areas of peritoneal thickening and enhancement with more focal loculation of the mid right abdomen (image 281, series 3). Diffuse mesenteric stranding and pericoloenteric inflammatory changes. Surgical drain in the left hemiabdomen terminates in the pelvis. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Circumferential bladder wall thickening with perivesicular inflammatory changes. More focal thickening along the urinary bladder dome may be postsurgical. Nondependent gas in the urinary bladder possibly secondary to recent catheterization. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Mild anasarca. Postsurgical changes from midline laparotomy with dehiscence of the superficial incision in the lower abdomen. Tiny seroma in the superior incision measuring 2.0 x 1.3 cm (series 3, image 241). Right hemidiaphragm loop ileostomy. Subcutaneous gas in the anterior abdominal wall likely related to recent injections. MUSCULOSKELETAL: No aggressive osseous lesions.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis Trauma LOWER CHEST: LUNG BASES / PLEURA: No focal consolidation or pleural effusion. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Postsurgical changes of CABG and three-vessel coronary artery calcifications. The heart is normal in size. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Mild extrahepatic biliary duct dilatation is likely related to prior cholecystectomy. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Bilateral partially exophytic simple cysts. Multiple subcentimeter lesions scattered throughout both kidneys are technically too small to characterize, but statistically represent cysts. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. The appendix is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Mild atherosclerotic calcifications of the abdominal aorta and its branches. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: The uterus is absent. BODY WALL: Tiny fat-containing umbilical hernia. MUSCULOSKELETAL: No acute displaced fracture. Moderate disc space narrowing with vacuum phenomenon at L5-S1 with degenerative grade 1 anterolisthesis of L5 on S1.
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3,856
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EXAM: CT Abdomen and Pelvis w contrast, CT Chest with contrast CLINICAL INFORMATION: Evaluate for source of leukocytosis. History of perforated diverticulosis. COMPARISON: CT abdomen pelvis on 1/3/2022 TECHNIQUE: CT Abdomen and Pelvis w contrast, CT Chest with contrast. Patient weight: 295 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. Saline flush: 80 ml. IV contrast injection rate: 2.50 ml per sec. Scan delay: 100 sec Scan field of view: 500 mm. DLP: 2279 mGy cm. (accession CT220004614), Patient weight: 295 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. Saline flush: 80 ml. IV contrast injection rate: 2.50 ml per sec. Scan delay: 100 sec Scan field of view: 500 mm. (accession CT220004613) FINDINGS: STRUCTURED REPORT: CT CAP LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: The central airways are patent. Trace bilateral pleural effusions. Bilateral right greater than left dependent atelectasis. HEART / VESSELS: Tiny filling defect near the junction of the right internal jugular vein and axillary vein (image 15, series 3). MEDIASTINUM / ESOPHAGUS: Normal. 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: Right renal cortical cyst. No hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: The stomach is unremarkable. Small periampullary duodenal diverticulum. Postsurgical changes from diverting loop ileostomy in the right abdomen. Multiple mildly dilated loops of small bowel in the anterior abdomen as well as several loops of small bowel with mild wall thickening and perienteric inflammatory changes in the mid pelvis. Small bowel is collapsed distal to this. COLON / APPENDIX: Postsurgical changes from partial sigmoidectomy with colorectal anastomosis. Scattered locules of gas and small volume of adjacent fluid seen adjacent to the anastomosis and extending inferiorly in the left perirectal space. The colon is collapsed with diffuse pericolonic inflammatory changes with associated wall thickening. PERITONEUM / MESENTERY: Small volume free fluid scattered throughout the abdomen. Multiple areas of peritoneal thickening and enhancement with more focal loculation of the mid right abdomen (image 281, series 3). Diffuse mesenteric stranding and pericoloenteric inflammatory changes. Surgical drain in the left hemiabdomen terminates in the pelvis. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Circumferential bladder wall thickening with perivesicular inflammatory changes. More focal thickening along the urinary bladder dome may be postsurgical. Nondependent gas in the urinary bladder possibly secondary to recent catheterization. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Mild anasarca. Postsurgical changes from midline laparotomy with dehiscence of the superficial incision in the lower abdomen. Tiny seroma in the superior incision measuring 2.0 x 1.3 cm (series 3, image 241). Right hemidiaphragm loop ileostomy. Subcutaneous gas in the anterior abdominal wall likely related to recent injections. MUSCULOSKELETAL: No aggressive osseous lesions. CONCLUSION: 1. Small volume free fluid with peritoneal thickening/enhancement, compatible peritonitis. More focal collection in the mid right abdomen may represent developing abscess. 2. Diffuse mesenteric stranding and pericoloenteric inflammatory changes, likely reactive. More dilated proximal small bowel suggests a component of partial small bowel obstruction transitioning in the mid pelvis. 3. Postsurgical changes from sigmoidectomy and with colorectal anastomosis. Adjacent fluid and gas at the level of the anastomosis may be postsurgical, but anastomotic leak cannot be excluded. 4. Circumferential bladder wall thickening and perivesicular inflammatory changes possibly reactive/post surgical. Recommend urinalysis to exclude cystitis. 5. Possible filling defect at the junction of the right internal jugular vein and axillary vein may represent a small deep venous thrombosis. Further evaluation with ultrasound can be obtained. 6. Trace bilateral pleural effusions with right greater than left dependent atelectasis. 7. Additional findings as above. These findings were discussed with Dr. Uhlich by Dr. Zarzour via telephone on 1/9/2022 2:07 PM. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: STRUCTURED REPORT: CT CAP LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: The central airways are patent. Trace bilateral pleural effusions. Bilateral right greater than left dependent atelectasis. HEART / VESSELS: Tiny filling defect near the junction of the right internal jugular vein and axillary vein (image 15, series 3). MEDIASTINUM / ESOPHAGUS: Normal. 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: Right renal cortical cyst. No hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: The stomach is unremarkable. Small periampullary duodenal diverticulum. Postsurgical changes from diverting loop ileostomy in the right abdomen. Multiple mildly dilated loops of small bowel in the anterior abdomen as well as several loops of small bowel with mild wall thickening and perienteric inflammatory changes in the mid pelvis. Small bowel is collapsed distal to this. COLON / APPENDIX: Postsurgical changes from partial sigmoidectomy with colorectal anastomosis. Scattered locules of gas and small volume of adjacent fluid seen adjacent to the anastomosis and extending inferiorly in the left perirectal space. The colon is collapsed with diffuse pericolonic inflammatory changes with associated wall thickening. PERITONEUM / MESENTERY: Small volume free fluid scattered throughout the abdomen. Multiple areas of peritoneal thickening and enhancement with more focal loculation of the mid right abdomen (image 281, series 3). Diffuse mesenteric stranding and pericoloenteric inflammatory changes. Surgical drain in the left hemiabdomen terminates in the pelvis. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Circumferential bladder wall thickening with perivesicular inflammatory changes. More focal thickening along the urinary bladder dome may be postsurgical. Nondependent gas in the urinary bladder possibly secondary to recent catheterization. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Mild anasarca. Postsurgical changes from midline laparotomy with dehiscence of the superficial incision in the lower abdomen. Tiny seroma in the superior incision measuring 2.0 x 1.3 cm (series 3, image 241). Right hemidiaphragm loop ileostomy. Subcutaneous gas in the anterior abdominal wall likely related to recent injections. MUSCULOSKELETAL: No aggressive osseous lesions.
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FINDINGS: STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: No focal consolidation, pleural effusion, or pneumothorax. No evidence of pulmonary fibrosis. Central airways are patent. There is no tracheobronchomalacia. With expiration, there is no significant air trapping. No nodules or masses are identified. HEART / VESSELS: Stable cardiomegaly. Small pericardial effusion has increased from prior. Left chest wall AICD is present, leads are appropriate in position. Mild atherosclerotic disease with moderate coronary artery calcifications. Coronary artery stents are present. Left atrial appendage watchman device is present. MEDIASTINUM / ESOPHAGUS: Patulous esophagus, circumferential thickening of the distal third of the esophagus. LYMPH NODES: Prominent mediastinal lymph nodes, none pathologically enlarged. CHEST WALL: Left chest wall ICD generator. UPPER ABDOMEN: Normal noncontrast appearance of the imaged upper abdomen. MUSCULOSKELETAL: Vertebral body height loss at T11 is unchanged from 2020. No acute or aggressive appearing osseous abnormality.
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3,857
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CT Head wo Contrast TECHNIQUE: CT of the head was performed without intravenous contrast at 2.5mm slice thickness. Scan field of view: 220 mm. DLP: 1345.10 mGy cm. INDICATION: ams COMPARISON: None. STRUCTURED REPORT: CT Head FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is preserved. Cerebral volume is normal. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. The mastoid air cells are clear. VENTRICULAR SYSTEM: Normal. ORBITS: Slight thinning of the posterior sclera of the left globe. SINUSES: Well aerated. CONCLUSION: No acute intracranial process. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is preserved. Cerebral volume is normal. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. The mastoid air cells are clear. VENTRICULAR SYSTEM: Normal. ORBITS: Slight thinning of the posterior sclera of the left globe. SINUSES: Well aerated.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Small hiatal hernia. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Calcifications consistent with prior granulomatous disease. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Difficult to evaluate due to motion but appear normal. KIDNEYS: Symmetrically enhancing. No hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Scattered diverticuli without inflammation. PERITONEUM / MESENTERY: Normal. No free fluid. No loculated fluid collection or evidence of intra-abdominal abscess. RETROPERITONEUM: Normal. VESSELS: Mild atherosclerotic calcifications of the abdominal aorta URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Absent uterus. No adnexal abnormalities identified. BODY WALL: Numerous foci of subcutaneous gas and adjacent stranding in the anterior abdominal wall most likely related to recent injections. MUSCULOSKELETAL: Mild multilevel degenerative changes of the spine with bridging anterior osteophyte formation most prominent in the lower thoracic spine. No aggressive osseous lesions identified.
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3,858
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EXAM: CT Angio Chest wo+w contrast CLINICAL INFORMATION: Hypoxia, THE confirmed. COMPARISON: Chest radiograph 1/7/2022. TECHNIQUE: CT Angio Chest wo+w contrast. Additional 3D image post-processing was performed to generate MIP and/or volume-rendered images. Patient weight: 290 lbs. IV contrast: Omnipaque 350, 85 ml, per protocol. Saline flush: 80 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 401 mm. KVP: 120 DLP: 468.20 mGy cm. FINDINGS: STRUCTURED REPORT: CT PE OVERALL DIAGNOSTIC QUALITY: Moderately suboptimal quality with incomplete evaluation of segmental and subsegmental pulmonary arteries secondary to contrast bolus timing and respiratory motion. LOWER NECK: No abnormality. CHEST: PULMONARY ARTERIES: Negative for pulmonary embolus LUNGS / AIRWAYS / PLEURA: The central tracheobronchial tree is patent. Diffuse bilateral groundglass opacities with areas of interlobular septal thickening and patchy areas of consolidation. Calcified granuloma in the right lower lobe. No pleural effusions or pneumothorax. HEART / OTHER VESSELS: Mild cardiomegaly. No pericardial effusion. Advanced calcific atherosclerosis in the coronary arteries. Borderline dilatation the main pulmonary artery, measuring 31 mm in diameter. The thoracic aorta is normal in caliber. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: Enlarged subcarinal lymph nodes, likely reactive.. Calcified right lower lobe segmental peribronchial lymph nodes, likely sequela of prior granulomatous disease. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Scattered tiny calcified splenic granulomata. MUSCULOSKELETAL: No aggressive osseous abnormality is identified. Multilevel degenerative changes in the thoracic spine with flowing anterior osteophytosis, suggestive of DISH. CONCLUSION: 1. Moderately limited examination without central or proximal segmental pulmonary thromboembolus. 2. Diffuse bilateral groundglass opacities with patchy areas of consolidation, concerning for atypical/multifocal pneumonia and consistent with patient's known COVID infection. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: STRUCTURED REPORT: CT PE OVERALL DIAGNOSTIC QUALITY: Moderately suboptimal quality with incomplete evaluation of segmental and subsegmental pulmonary arteries secondary to contrast bolus timing and respiratory motion. LOWER NECK: No abnormality. CHEST: PULMONARY ARTERIES: Negative for pulmonary embolus LUNGS / AIRWAYS / PLEURA: The central tracheobronchial tree is patent. Diffuse bilateral groundglass opacities with areas of interlobular septal thickening and patchy areas of consolidation. Calcified granuloma in the right lower lobe. No pleural effusions or pneumothorax. HEART / OTHER VESSELS: Mild cardiomegaly. No pericardial effusion. Advanced calcific atherosclerosis in the coronary arteries. Borderline dilatation the main pulmonary artery, measuring 31 mm in diameter. The thoracic aorta is normal in caliber. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: Enlarged subcarinal lymph nodes, likely reactive.. Calcified right lower lobe segmental peribronchial lymph nodes, likely sequela of prior granulomatous disease. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Scattered tiny calcified splenic granulomata. MUSCULOSKELETAL: No aggressive osseous abnormality is identified. Multilevel degenerative changes in the thoracic spine with flowing anterior osteophytosis, suggestive of DISH.
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Findings: Brain parenchyma: No significant interval change in left superior and middle frontal gyri encephalomalacia as well as bilateral cerebellar remote lacunar infarcts, resulting in mild asymmetric exvacuo dilatation of the left lateral ventricle. Unchanged periventricular, subcortical and deep white matter hypoattenuation, most confluent in the left frontal centrum semiovale, suggestive of chronic microvascular disease. The white-gray matter differentiation is preserved. Basal cisterns: There is no significant effacement of the basilar cisterns. Extra-axial spaces: Normal appearance. No abnormal extra-axial fluid collections. Hemorrhage: No intracranial hemorrhage is identified. Midline shift: No significant midline shift is seen. Vascular system: Punctate atherosclerotic calcifications are seen in the bilateral carotid siphons and vertebral arteries, unchanged. Soft tissues: Unremarkable without discrete fluid collections. Partially visualized bilateral intraparotid lymph nodes, stable. Orbits: Incidental stable left globe prosthesis. Otherwise, normal appearance. Calvarium and skull base: No acute fractures or suspicious osseous lesions identified. The bilateral mastoid air cell complexes are well-developed and clear. Paranasal sinuses: Persistent tiny air-fluid level in the left maxillary sinus, with associated mild chronic osteitis. Minimal right lateral frontal sinus mucosal thickening, unchanged. Otherwise, appear well aerated.
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3,859
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RADIOLOGIC EXAM: CT Head wo contrast CLINICAL INFORMATION: Trauma. COMPARISON: None. TECHNIQUE: CT Head wo contrastScan field of view: 230 mm. DLP: 1473.90 mGy cm. STRUCTURED REPORT: CT Head FINDINGS: BRAIN PARENCHYMA: There is no acute intracranial hemorrhage or acute infarct. No brain edema or mass effect. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal. CONCLUSION: No acute intracranial process.
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FINDINGS: BRAIN PARENCHYMA: There is no acute intracranial hemorrhage or acute infarct. No brain edema or mass effect. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal.
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Findings: There is no evidence of acute intra- or extra-axial hemorrhage. There is no midline shift, mass effect, or other space-occupying lesion. Gray-white differentiation appears maintained. The ventricular system are normal in configuration. The basal cisterns are clear. Bilateral lens replacements.The visualized paranasal sinuses and mastoid air cells are clear of acute process. The visualized bones of the calvarium demonstrate no acute osseous abnormality.
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3,860
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EXAM: CT Chest with contrast, CT Abdomen and Pelvis w contrast, CT Thoracic Spine from Reformat, CT Lumbar Spine from Reformat CLINICAL INFORMATION: Trauma, MVC COMPARISON: None. TECHNIQUE: CT Chest with contrast, CT Abdomen and Pelvis w contrast, CT Thoracic Spine from Reformat, CT Lumbar Spine from Reformat. Patient weight: 310 lbs. IV contrast: Omnipaque 350, 145 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 70 sec. Scan field of view: 500 mm. DLP: 3380.30 mGy cm. (accession CT220004618), Patient weight: 310 lbs. IV contrast: Omnipaque 350, 145 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 72 sec. Scan field of view: 500 mm. (accession CT220004619) FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: The central airways are patent. Calcified granuloma in the right lower lobe. Bilateral dependent atelectasis. No pneumothorax or pleural effusion. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: Calcified right hilar lymph nodes. CHEST WALL: Subcutaneous contusions in the anterior chest and left breast. ABDOMEN and PELVIS: LIVER: Focal fatty infiltration along the falciform ligament. The liver is otherwise unremarkable. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Scattered calcified granulomas. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: No free air or free fluid. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Mildly thick-walled but incompletely distended. REPRODUCTIVE ORGANS: Left ovarian cyst measuring up to 5.2 cm. Smaller right ovarian cyst, likely physiologic. BODY WALL: Left gluteal subcutaneous calcification possibly related to prior injection. Small fat-containing umbilical hernia. MUSCULOSKELETAL: Left L3 transverse process fracture. Mild multilevel degenerative changes of the thoracic and lumbar spine. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: Left L3 to this process fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. CONCLUSION: 1. Anterior chest subcutaneous contusions consistent with seatbelt injury. 2. Left L3 transverse process fracture. 3. No evidence of additional acute traumatic injury within the chest, abdomen, pelvis, or thoracolumbar spine. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: The central airways are patent. Calcified granuloma in the right lower lobe. Bilateral dependent atelectasis. No pneumothorax or pleural effusion. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: Calcified right hilar lymph nodes. CHEST WALL: Subcutaneous contusions in the anterior chest and left breast. ABDOMEN and PELVIS: LIVER: Focal fatty infiltration along the falciform ligament. The liver is otherwise unremarkable. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Scattered calcified granulomas. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: No free air or free fluid. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Mildly thick-walled but incompletely distended. REPRODUCTIVE ORGANS: Left ovarian cyst measuring up to 5.2 cm. Smaller right ovarian cyst, likely physiologic. BODY WALL: Left gluteal subcutaneous calcification possibly related to prior injection. Small fat-containing umbilical hernia. MUSCULOSKELETAL: Left L3 transverse process fracture. Mild multilevel degenerative changes of the thoracic and lumbar spine. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: Left L3 to this process fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal.
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Findings: Conventional CT of the brain: Right temporal mass with acute hemorrhage peripheral nodular postcontrast enhancement and surrounding non enhancing hypodensity is seen. It measures 36 x 22 mm in axial plane (series 20 image 24). Trace right sylvian and frontal SAH. - CT angiogram of the brain: The severely hypoplastic right vertebral artery appears to in the hips lateral plica. Basilar artery is narrow caliber. Left-sided persistent trigeminal artery is seen communicating with the distal basilar. The right posterior cerebral artery is fetal configuration. The left PCA arises from the basilar artery. Otherwise both the PCAs are unremarkable. Aplastic A1 segment of the right ACA. The bilateral ACAs and MCAs are otherwise unremarkable. There is no evidence of dural sinus thrombosis. No definite cortical vein thrombus is identified. No aneurysm or definite arteriovenous malformation identified. CT angiogram of the neck: Left vertebral artery has a direct origin from the aortic arch. The right vertebral artery is severely hypoplastic. Mild calcific atherosclerotic disease at both carotid bifurcations with no evidence of luminal stenosis or occlusion. The visualized portions of the common, as well as cervical portions of the internal, and external carotid arteries appear within normal limits. The visualized vertebral arteries appear within normal limits. -
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3,861
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EXAM: CT Chest with contrast, CT Abdomen and Pelvis w contrast, CT Thoracic Spine from Reformat, CT Lumbar Spine from Reformat CLINICAL INFORMATION: Trauma, MVC COMPARISON: None. TECHNIQUE: CT Chest with contrast, CT Abdomen and Pelvis w contrast, CT Thoracic Spine from Reformat, CT Lumbar Spine from Reformat. Patient weight: 310 lbs. IV contrast: Omnipaque 350, 145 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 70 sec. Scan field of view: 500 mm. DLP: 3380.30 mGy cm. (accession CT220004618), Patient weight: 310 lbs. IV contrast: Omnipaque 350, 145 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 72 sec. Scan field of view: 500 mm. (accession CT220004619) FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: The central airways are patent. Calcified granuloma in the right lower lobe. Bilateral dependent atelectasis. No pneumothorax or pleural effusion. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: Calcified right hilar lymph nodes. CHEST WALL: Subcutaneous contusions in the anterior chest and left breast. ABDOMEN and PELVIS: LIVER: Focal fatty infiltration along the falciform ligament. The liver is otherwise unremarkable. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Scattered calcified granulomas. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: No free air or free fluid. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Mildly thick-walled but incompletely distended. REPRODUCTIVE ORGANS: Left ovarian cyst measuring up to 5.2 cm. Smaller right ovarian cyst, likely physiologic. BODY WALL: Left gluteal subcutaneous calcification possibly related to prior injection. Small fat-containing umbilical hernia. MUSCULOSKELETAL: Left L3 transverse process fracture. Mild multilevel degenerative changes of the thoracic and lumbar spine. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: Left L3 to this process fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. CONCLUSION: 1. Anterior chest subcutaneous contusions consistent with seatbelt injury. 2. Left L3 transverse process fracture. 3. No evidence of additional acute traumatic injury within the chest, abdomen, pelvis, or thoracolumbar spine. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: The central airways are patent. Calcified granuloma in the right lower lobe. Bilateral dependent atelectasis. No pneumothorax or pleural effusion. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: Calcified right hilar lymph nodes. CHEST WALL: Subcutaneous contusions in the anterior chest and left breast. ABDOMEN and PELVIS: LIVER: Focal fatty infiltration along the falciform ligament. The liver is otherwise unremarkable. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Scattered calcified granulomas. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: No free air or free fluid. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Mildly thick-walled but incompletely distended. REPRODUCTIVE ORGANS: Left ovarian cyst measuring up to 5.2 cm. Smaller right ovarian cyst, likely physiologic. BODY WALL: Left gluteal subcutaneous calcification possibly related to prior injection. Small fat-containing umbilical hernia. MUSCULOSKELETAL: Left L3 transverse process fracture. Mild multilevel degenerative changes of the thoracic and lumbar spine. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: Left L3 to this process fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal.
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Findings: Conventional CT of the brain: Right temporal mass with acute hemorrhage peripheral nodular postcontrast enhancement and surrounding non enhancing hypodensity is seen. It measures 36 x 22 mm in axial plane (series 20 image 24). Trace right sylvian and frontal SAH. - CT angiogram of the brain: The severely hypoplastic right vertebral artery appears to in the hips lateral plica. Basilar artery is narrow caliber. Left-sided persistent trigeminal artery is seen communicating with the distal basilar. The right posterior cerebral artery is fetal configuration. The left PCA arises from the basilar artery. Otherwise both the PCAs are unremarkable. Aplastic A1 segment of the right ACA. The bilateral ACAs and MCAs are otherwise unremarkable. There is no evidence of dural sinus thrombosis. No definite cortical vein thrombus is identified. No aneurysm or definite arteriovenous malformation identified. CT angiogram of the neck: Left vertebral artery has a direct origin from the aortic arch. The right vertebral artery is severely hypoplastic. Mild calcific atherosclerotic disease at both carotid bifurcations with no evidence of luminal stenosis or occlusion. The visualized portions of the common, as well as cervical portions of the internal, and external carotid arteries appear within normal limits. The visualized vertebral arteries appear within normal limits. -
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3,862
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RADIOLOGIC EXAM: CT Angio Neck, CT Cervical Spine From Reformat CLINICAL INFORMATION: Trauma. COMPARISON: None. TECHNIQUE: CT Angio Neck, CT Cervical Spine From ReformatPatient weight: 310 lbs. IV contrast: Omnipaque 350, 145 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus track Scan field of view: 246.90 mm. DLP: 1535.30 mGy cm. Following CT of the neck, reformatted images were produced to optimize visualization of the osseous structures of the cervical spine. 3-D CT MIP were generated in post processing. FINDINGS: CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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FINDINGS: CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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Findings: There is no evidence of intracranial hemorrhage . Chronic lacunar infarcts right centrum semiovale, both corona radiata and right frontal periventricular white matter. Ill-defined hypoattenuation in the posterior limb of left internal capsule. There is no evidence of hydrocephalus or of an intracranial mass. No new findings since the prior CT.
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3,863
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EXAM: CT Chest with contrast, CT Abdomen and Pelvis w contrast, CT Thoracic Spine from Reformat, CT Lumbar Spine from Reformat CLINICAL INFORMATION: Trauma, MVC COMPARISON: None. TECHNIQUE: CT Chest with contrast, CT Abdomen and Pelvis w contrast, CT Thoracic Spine from Reformat, CT Lumbar Spine from Reformat. Patient weight: 310 lbs. IV contrast: Omnipaque 350, 145 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 70 sec. Scan field of view: 500 mm. DLP: 3380.30 mGy cm. (accession CT220004618), Patient weight: 310 lbs. IV contrast: Omnipaque 350, 145 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 72 sec. Scan field of view: 500 mm. (accession CT220004619) FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: The central airways are patent. Calcified granuloma in the right lower lobe. Bilateral dependent atelectasis. No pneumothorax or pleural effusion. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: Calcified right hilar lymph nodes. CHEST WALL: Subcutaneous contusions in the anterior chest and left breast. ABDOMEN and PELVIS: LIVER: Focal fatty infiltration along the falciform ligament. The liver is otherwise unremarkable. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Scattered calcified granulomas. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: No free air or free fluid. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Mildly thick-walled but incompletely distended. REPRODUCTIVE ORGANS: Left ovarian cyst measuring up to 5.2 cm. Smaller right ovarian cyst, likely physiologic. BODY WALL: Left gluteal subcutaneous calcification possibly related to prior injection. Small fat-containing umbilical hernia. MUSCULOSKELETAL: Left L3 transverse process fracture. Mild multilevel degenerative changes of the thoracic and lumbar spine. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: Left L3 to this process fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. CONCLUSION: 1. Anterior chest subcutaneous contusions consistent with seatbelt injury. 2. Left L3 transverse process fracture. 3. No evidence of additional acute traumatic injury within the chest, abdomen, pelvis, or thoracolumbar spine. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: The central airways are patent. Calcified granuloma in the right lower lobe. Bilateral dependent atelectasis. No pneumothorax or pleural effusion. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: Calcified right hilar lymph nodes. CHEST WALL: Subcutaneous contusions in the anterior chest and left breast. ABDOMEN and PELVIS: LIVER: Focal fatty infiltration along the falciform ligament. The liver is otherwise unremarkable. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Scattered calcified granulomas. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: No free air or free fluid. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Mildly thick-walled but incompletely distended. REPRODUCTIVE ORGANS: Left ovarian cyst measuring up to 5.2 cm. Smaller right ovarian cyst, likely physiologic. BODY WALL: Left gluteal subcutaneous calcification possibly related to prior injection. Small fat-containing umbilical hernia. MUSCULOSKELETAL: Left L3 transverse process fracture. Mild multilevel degenerative changes of the thoracic and lumbar spine. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: Left L3 to this process fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal.
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FINDINGS: STRUCTURED REPORT: CT Abdomen LOWER CHEST: Please see separately dictated CT chest. ABDOMEN: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Absent. PANCREAS: Post surgical changes from pancreaticoduodenectomy. No evidence of residual or recurrent mass. SPLEEN: Normal. ADRENALS: Indeterminate left adrenal nodule is unchanged measuring 1.5 x 1.2 cm on image 222 series 9. KIDNEYS: Left lower pole nonobstructing calculus. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Post surgical changes from pancreaticoduodenectomy. Small bowel is normal in caliber. COLON: No abnormality. PERITONEUM / MESENTERY: Scattered areas of fat necrosis in the upper abdominal mesentery. Previously seen inflammatory changes and fluid collections have resolved. RETROPERITONEUM: Persistent postsurgical changes. VESSELS: Advanced atherosclerotic calcifications of the abdominal aorta and branch vessels. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
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3,864
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EXAM: CT Chest with contrast, CT Abdomen and Pelvis w contrast, CT Thoracic Spine from Reformat, CT Lumbar Spine from Reformat CLINICAL INFORMATION: Trauma, MVC COMPARISON: None. TECHNIQUE: CT Chest with contrast, CT Abdomen and Pelvis w contrast, CT Thoracic Spine from Reformat, CT Lumbar Spine from Reformat. Patient weight: 310 lbs. IV contrast: Omnipaque 350, 145 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 70 sec. Scan field of view: 500 mm. DLP: 3380.30 mGy cm. (accession CT220004618), Patient weight: 310 lbs. IV contrast: Omnipaque 350, 145 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 72 sec. Scan field of view: 500 mm. (accession CT220004619) FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: The central airways are patent. Calcified granuloma in the right lower lobe. Bilateral dependent atelectasis. No pneumothorax or pleural effusion. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: Calcified right hilar lymph nodes. CHEST WALL: Subcutaneous contusions in the anterior chest and left breast. ABDOMEN and PELVIS: LIVER: Focal fatty infiltration along the falciform ligament. The liver is otherwise unremarkable. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Scattered calcified granulomas. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: No free air or free fluid. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Mildly thick-walled but incompletely distended. REPRODUCTIVE ORGANS: Left ovarian cyst measuring up to 5.2 cm. Smaller right ovarian cyst, likely physiologic. BODY WALL: Left gluteal subcutaneous calcification possibly related to prior injection. Small fat-containing umbilical hernia. MUSCULOSKELETAL: Left L3 transverse process fracture. Mild multilevel degenerative changes of the thoracic and lumbar spine. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: Left L3 to this process fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. CONCLUSION: 1. Anterior chest subcutaneous contusions consistent with seatbelt injury. 2. Left L3 transverse process fracture. 3. No evidence of additional acute traumatic injury within the chest, abdomen, pelvis, or thoracolumbar spine. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: The central airways are patent. Calcified granuloma in the right lower lobe. Bilateral dependent atelectasis. No pneumothorax or pleural effusion. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: Calcified right hilar lymph nodes. CHEST WALL: Subcutaneous contusions in the anterior chest and left breast. ABDOMEN and PELVIS: LIVER: Focal fatty infiltration along the falciform ligament. The liver is otherwise unremarkable. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Scattered calcified granulomas. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: No free air or free fluid. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Mildly thick-walled but incompletely distended. REPRODUCTIVE ORGANS: Left ovarian cyst measuring up to 5.2 cm. Smaller right ovarian cyst, likely physiologic. BODY WALL: Left gluteal subcutaneous calcification possibly related to prior injection. Small fat-containing umbilical hernia. MUSCULOSKELETAL: Left L3 transverse process fracture. Mild multilevel degenerative changes of the thoracic and lumbar spine. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: Left L3 to this process fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal.
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FINDINGS: STRUCTURED REPORT: CT Chest LOWER NECK: Evaluation limited due to metallic streak artifact from overlying jewelry. No significant abnormality identified. CHEST: LUNGS / AIRWAYS / PLEURA: Redemonstration of tree-in-bud nodularity in the lower anterior aspect of the right lower lobe as seen on series 9 image 108 through 113. These nodules measures up to 5 mm in diameter on series 9 image 108, stable compared to prior examinations dating back to 1/19/2021. A 7 mm nodule within the left lower lobe on image 124 of series 9 is unchanged since 1/19/2021. Additional scattered tiny, less than 6 mm pulmonary nodules are present, for example measuring 4 mm in diameter on series 9 image 91 in the right lower lobe. Focal pleural parenchymal thickening, scarring in the left lower lobe on series 9 image 67. There is no focal consolidation, pleural effusion, or pneumothorax. Central airways are patent HEART / VESSELS: Heart size is normal. No pericardial effusion. Moderate atherosclerotic disease with moderate to severe coronary artery calcifications. MEDIASTINUM / ESOPHAGUS: Prominent mediastinal lymph nodes are present. See below. LYMPH NODES: Prominent mediastinal lymph nodes measuring up to 1.0 cm in short axis diameter in the subcarinal distribution. There is a partially calcified prominent right hilar lymph node measuring 1.2 x 1.1 cm on series 9 image 106, similar to prior examination. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Please see same day CT abdomen for abdomen findings. MUSCULOSKELETAL: No acute or aggressive appearing osseous abnormality.
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3,865
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CT Maxillofacial wo contrast 1/9/2022 9:58 AM CLINICAL INFORMATION: Trauma, MVC TECHNIQUE: Helical CT images were obtained from the top of the frontal sinuses through the bottom of the mandible without the administration of intravenous contrast. Reformatted coronal and sagittal images were also obtained. Scan field of view: 220 mm. DLP: 1057.40 mGy cm. COMPARISON EXAMINATION: None. FINDINGS: FACIAL BONES: No fracture. Small four head soft tissue laceration MANDIBLE: No fracture. Small subcutaneous contusion of the right chin REMAINING VISUALIZED BONES: Normal. SINONASAL CAVITIES: Mild mucosal thickening of the paranasal sinuses. VISUALIZED INTRACRANIAL STRUCTURES: Normal. ORBITAL CONTENTS: Normal. CONCLUSION: 1. No acute maxillofacial fractures. 2. Small forehead laceration and right chin contusion. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: FACIAL BONES: No fracture. Small four head soft tissue laceration MANDIBLE: No fracture. Small subcutaneous contusion of the right chin REMAINING VISUALIZED BONES: Normal. SINONASAL CAVITIES: Mild mucosal thickening of the paranasal sinuses. VISUALIZED INTRACRANIAL STRUCTURES: Normal. ORBITAL CONTENTS: Normal.
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Findings: No enlarged hilar or mediastinal nodes are present. The mediastinum is normal. Few small (less than 6 mm) pulmonary nodules are unchanged. For reference, a 4 mm groundglass density right upper lobe nodule (image 76, series 4), and a 3 mm nodular density along the left major fissure (image 136) are stable. No new or enlarging suspicious pulmonary nodule. Mild centrilobular emphysema. No focal consolidation. The trachea and main bronchi are patent. No pleural effusion. Coronary artery calcification: The visual score of calcification is 3. (Based on a publication by Kirsch et al (Detection of Coronary calcium During Standard Chest Computed Tomography Correlates With Multi-Detector Computed Tomography Coronary Artery Calcium score, Int J Cardiovasc Imaging (2012) 28:1249-1256), visual score >7 is associated with an Agatston score > 400 and independently validated increased incidence of cardiovascular mortality). The visualized liver, spleen, adrenals, and bowel are unremarkable. Bones: No destructive bone lesion.
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3,866
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RADIOLOGIC EXAM: CT Angio Neck, CT Cervical Spine From Reformat CLINICAL INFORMATION: Trauma. COMPARISON: None. TECHNIQUE: CT Angio Neck, CT Cervical Spine From ReformatPatient weight: 310 lbs. IV contrast: Omnipaque 350, 145 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus track Scan field of view: 246.90 mm. DLP: 1535.30 mGy cm. Following CT of the neck, reformatted images were produced to optimize visualization of the osseous structures of the cervical spine. 3-D CT MIP were generated in post processing. FINDINGS: CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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FINDINGS: CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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FINDINGS: STRUCTURED REPORT: CT Pelvis LOWER ABDOMEN: BOWEL: No abnormality. PERITONEUM: Normal. OTHER: No other abnormality. PELVIS: VESSELS: Mild to moderate atherosclerotic calcification in the iliac territories. LYMPH NODES: None enlarged. PERIRECTAL / PERIANAL REGION: Normal. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Mildly enlarged prostate indenting the bladder base. BODY WALL: Small fat-containing left inguinal hernia. MUSCULOSKELETAL: No acute osseous abnormality. Degenerative changes in the lower lumbar spine.
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3,867
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RADIOLOGIC EXAM: CT Head wo contrast, CT Maxillofacial wo contrast CLINICAL INFORMATION: Facial trauma. Reports left eye pain, nasal pain, right thigh pain, and extends from altercation at home. COMPARISON: None. TECHNIQUE: CT Head wo contrast, CT Maxillofacial wo contrastScan field of view: 209 mm. DLP: 1389.80 mGy cm. (accession CT220004628), Scan field of view: 182.40 mm. DLP: 1021.10 mGy cm. (accession CT220004627) STRUCTURED REPORT: CT Head and Maxillofacial Trauma FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. EXTRA-AXIAL SPACES: Normal. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SKULL AND SKULL BASE: No fracture. FACIAL BONES: Normal. MAXILLA/MANDIBLE: Multiple dental caries. Left maxillary lateral incisor and canine periapical lucencies. SINONASAL CAVITIES: Mild right and moderate left maxillary sinus mucosal thickening. Scattered trace bilateral ethmoid air cell and left sphenoid mucosal thickening. The remaining paranasal sinuses and mastoid air cells are otherwise clear. SOFT TISSUES: No posttraumatic injury/defect is identified. CONCLUSION: No acute intracranial abnormality. No maxillofacial fractures. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. EXTRA-AXIAL SPACES: Normal. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SKULL AND SKULL BASE: No fracture. FACIAL BONES: Normal. MAXILLA/MANDIBLE: Multiple dental caries. Left maxillary lateral incisor and canine periapical lucencies. SINONASAL CAVITIES: Mild right and moderate left maxillary sinus mucosal thickening. Scattered trace bilateral ethmoid air cell and left sphenoid mucosal thickening. The remaining paranasal sinuses and mastoid air cells are otherwise clear. SOFT TISSUES: No posttraumatic injury/defect is identified.
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FINDINGS: There has been interval improvement in the previously seen patchy peribronchovascular and subpleural groundglass opacities since the prior examination. There are residual groundglass opacities remaining in a similar distribution. Overall, these groundglass opacities have increased from 2011. There is some associated mild bronchiectasis. Within these areas of groundglass opacity, there are some areas of reticulation suggest underlying fibrosis. No definite honeycombing. Bandlike areas of atelectasis or scarring are seen within the middle lobe and lingula. Multiple calcified micronodules are again seen bilaterally. The expiratory imaging, there are scattered areas of air trapping without significant dynamic airway narrowing. No pleural effusion. A pleural lipoma along the left lateral anterior pleural surface has been present since 2011. The central airways are patent. The thoracic aorta is nonaneurysmal scattered atherosclerotic calcifications. The pulmonary arteries are not dilated. The heart is not enlarged. Prior CABG. Aortic valve and mitral annular calcifications are again seen. A stent is seen within the left proximal subclavian artery. Enlarged subcarinal lymph node measuring up to 13 mm on image 120 of series 2 is unchanged from 2011. No new or enlarging thoracic lymph nodes. The esophagus is not dilated. Cholelithiasis. Median sternotomy changes. No acute or aggressive osseous abnormality.
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3,868
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RADIOLOGIC EXAM: CT Head wo contrast, CT Maxillofacial wo contrast CLINICAL INFORMATION: Facial trauma. Reports left eye pain, nasal pain, right thigh pain, and extends from altercation at home. COMPARISON: None. TECHNIQUE: CT Head wo contrast, CT Maxillofacial wo contrastScan field of view: 209 mm. DLP: 1389.80 mGy cm. (accession CT220004628), Scan field of view: 182.40 mm. DLP: 1021.10 mGy cm. (accession CT220004627) STRUCTURED REPORT: CT Head and Maxillofacial Trauma FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. EXTRA-AXIAL SPACES: Normal. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SKULL AND SKULL BASE: No fracture. FACIAL BONES: Normal. MAXILLA/MANDIBLE: Multiple dental caries. Left maxillary lateral incisor and canine periapical lucencies. SINONASAL CAVITIES: Mild right and moderate left maxillary sinus mucosal thickening. Scattered trace bilateral ethmoid air cell and left sphenoid mucosal thickening. The remaining paranasal sinuses and mastoid air cells are otherwise clear. SOFT TISSUES: No posttraumatic injury/defect is identified. CONCLUSION: No acute intracranial abnormality. No maxillofacial fractures. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. EXTRA-AXIAL SPACES: Normal. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SKULL AND SKULL BASE: No fracture. FACIAL BONES: Normal. MAXILLA/MANDIBLE: Multiple dental caries. Left maxillary lateral incisor and canine periapical lucencies. SINONASAL CAVITIES: Mild right and moderate left maxillary sinus mucosal thickening. Scattered trace bilateral ethmoid air cell and left sphenoid mucosal thickening. The remaining paranasal sinuses and mastoid air cells are otherwise clear. SOFT TISSUES: No posttraumatic injury/defect is identified.
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FINDINGS: The thyroid gland is unremarkable. Central airways are widely patent. The thoracic aorta is nonaneurysmal with scattered atherosclerotic calcifications. The pulmonary arteries are not dilated. Areas of heterogeneous low attenuation within the pulmonary arteries which do not have the typical appearance of pulmonary emboli and likely represent mixing artifact. The heart is not enlarged. There are moderate coronary artery calcifications. No pericardial effusion. Multiple mediastinal and hilar lymph nodes bilaterally show some calcifications. A 25 x 18 mm subcarinal lymph node on image 131 of series 2 was not included on recent abdominal CTs. However, this is increased in size from 2013. It does have some internal calcifications along its superior aspect. The esophagus is not dilated. There is a small hiatal hernia. Endobronchial filling defects are seen within the lateral basilar segmental and subsegmental bronchi. Some of these were present back in 2013 whereas the more central filling defects are new. There is moderate upper lobe predominant centrilobular emphysema with biapical pleural parenchymal scarring. Calcified granulomas in the right upper and left lower lobes. No pleural effusion or pleural thickening. The gallbladder is surgically absent. Calcified granulomas in the spleen. There is no acute or aggressive osseous abnormality.
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3,869
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EXAM: CT Abdomen and Pelvis wo IV contrast, CT Chest wo contrast CLINICAL INFORMATION: Altered mental status. History of metastatic cancer. Elevated liver enzymes COMPARISON: 11/12/2021 TECHNIQUE: CT Abdomen and Pelvis wo IV contrast, CT Chest wo contrast. Scan field of view: 384 mm. (accession CT220004630), Scan field of view: 384 mm. DLP: 927.50 mGy cm. (accession CT220004629) FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT CAP LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Scattered bilateral groundglass opacities bilateral dependent atelectasis. No pneumothorax. Central airways patent. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: Left perihilar and mediastinal adenopathy is difficult to evaluate given lack of intravenous contrast however the previously seen left hilar mass measures 2.0 x 1.9 cm on image 97, series 201 (previously 3.7 x 2.5 cm. The AP window metastatic adenopathy measures 2.4 x 1.9 cm on image 88, series 201 (previously 3.0 x 2.1 cm). No new adenopathy is seen. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Diffuse hepatic metastases are better appreciated on prior contrast-enhanced examination. The degree of metastatic disease is grossly similar and at the very least is not significantly changed. Small perihepatic fluid collection. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Unremarkable for technique SPLEEN: Unremarkable for technique ADRENALS: Normal. KIDNEYS: Low attenuated lesion within the right kidney is unchanged. No hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Stomach and small bowel are normal in caliber. COLON / APPENDIX: Mild thickening of the colon. The appendix is unremarkable. PERITONEUM / MESENTERY: Trace upper abdominal ascites, slightly increased from before RETROPERITONEUM: Normal. VESSELS: Moderate atherosclerotic disease. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Moderate anasarca. MUSCULOSKELETAL: No acute or aggressive appearing osseous abnormality. Moderate to advanced degenerative changes of the lower lumbar spine. Most pronounced at L4-S1 CONCLUSION: 1. Scattered bilateral groundglass opacities concerning for atypical/viral pneumonia. 2. Diffuse hepatic metastases are better appreciated on prior contrast-enhanced examinations, but overall not thought to be significantly changed. New trace perihepatic ascites. Correlation with liver enzymes recommended. 3. Left hilar and mediastinal adenopathy, slightly improved. 4. Mild anasarca. 5. Nonspecific colonic wall thickening. Correlation with colitis recommended. 6. Additional chronic and incidental findings as above including atherosclerotic disease As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT CAP LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Scattered bilateral groundglass opacities bilateral dependent atelectasis. No pneumothorax. Central airways patent. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: Left perihilar and mediastinal adenopathy is difficult to evaluate given lack of intravenous contrast however the previously seen left hilar mass measures 2.0 x 1.9 cm on image 97, series 201 (previously 3.7 x 2.5 cm. The AP window metastatic adenopathy measures 2.4 x 1.9 cm on image 88, series 201 (previously 3.0 x 2.1 cm). No new adenopathy is seen. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Diffuse hepatic metastases are better appreciated on prior contrast-enhanced examination. The degree of metastatic disease is grossly similar and at the very least is not significantly changed. Small perihepatic fluid collection. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Unremarkable for technique SPLEEN: Unremarkable for technique ADRENALS: Normal. KIDNEYS: Low attenuated lesion within the right kidney is unchanged. No hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Stomach and small bowel are normal in caliber. COLON / APPENDIX: Mild thickening of the colon. The appendix is unremarkable. PERITONEUM / MESENTERY: Trace upper abdominal ascites, slightly increased from before RETROPERITONEUM: Normal. VESSELS: Moderate atherosclerotic disease. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Moderate anasarca. MUSCULOSKELETAL: No acute or aggressive appearing osseous abnormality. Moderate to advanced degenerative changes of the lower lumbar spine. Most pronounced at L4-S1
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: There is a 10 x 9 mm nodule in the medial left lung base (image 21 series 900). Persistent nodular density in the right middle lobe adjacent to the fissure. These nodules have progressively enlarged since 2019. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Mild diffuse liver steatosis. Normal variant focal fatty change in the left hepatic lobe adjacent to the falciform ligament. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: There is vague nodular enhancing tissue at the resection margin in the left kidney measuring 3.0 x 2.2 cm in axial image 114 series 7 and seen on coronal image 143 series 9. This tissue invades the central sinus fat. No venous invasion. Kidneys are otherwise normal. There is a single left renal artery and single preaortic left renal vein. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Moderate aortoiliac calcified atherosclerosis. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Tiny ventral midline abdominal wall hernia in the supraumbilical region. MUSCULOSKELETAL: No significant abnormality.
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3,870
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EXAM: CT Abdomen and Pelvis wo IV contrast, CT Chest wo contrast CLINICAL INFORMATION: Altered mental status. History of metastatic cancer. Elevated liver enzymes COMPARISON: 11/12/2021 TECHNIQUE: CT Abdomen and Pelvis wo IV contrast, CT Chest wo contrast. Scan field of view: 384 mm. (accession CT220004630), Scan field of view: 384 mm. DLP: 927.50 mGy cm. (accession CT220004629) FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT CAP LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Scattered bilateral groundglass opacities bilateral dependent atelectasis. No pneumothorax. Central airways patent. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: Left perihilar and mediastinal adenopathy is difficult to evaluate given lack of intravenous contrast however the previously seen left hilar mass measures 2.0 x 1.9 cm on image 97, series 201 (previously 3.7 x 2.5 cm. The AP window metastatic adenopathy measures 2.4 x 1.9 cm on image 88, series 201 (previously 3.0 x 2.1 cm). No new adenopathy is seen. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Diffuse hepatic metastases are better appreciated on prior contrast-enhanced examination. The degree of metastatic disease is grossly similar and at the very least is not significantly changed. Small perihepatic fluid collection. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Unremarkable for technique SPLEEN: Unremarkable for technique ADRENALS: Normal. KIDNEYS: Low attenuated lesion within the right kidney is unchanged. No hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Stomach and small bowel are normal in caliber. COLON / APPENDIX: Mild thickening of the colon. The appendix is unremarkable. PERITONEUM / MESENTERY: Trace upper abdominal ascites, slightly increased from before RETROPERITONEUM: Normal. VESSELS: Moderate atherosclerotic disease. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Moderate anasarca. MUSCULOSKELETAL: No acute or aggressive appearing osseous abnormality. Moderate to advanced degenerative changes of the lower lumbar spine. Most pronounced at L4-S1 CONCLUSION: 1. Scattered bilateral groundglass opacities concerning for atypical/viral pneumonia. 2. Diffuse hepatic metastases are better appreciated on prior contrast-enhanced examinations, but overall not thought to be significantly changed. New trace perihepatic ascites. Correlation with liver enzymes recommended. 3. Left hilar and mediastinal adenopathy, slightly improved. 4. Mild anasarca. 5. Nonspecific colonic wall thickening. Correlation with colitis recommended. 6. Additional chronic and incidental findings as above including atherosclerotic disease As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT CAP LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Scattered bilateral groundglass opacities bilateral dependent atelectasis. No pneumothorax. Central airways patent. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: Left perihilar and mediastinal adenopathy is difficult to evaluate given lack of intravenous contrast however the previously seen left hilar mass measures 2.0 x 1.9 cm on image 97, series 201 (previously 3.7 x 2.5 cm. The AP window metastatic adenopathy measures 2.4 x 1.9 cm on image 88, series 201 (previously 3.0 x 2.1 cm). No new adenopathy is seen. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Diffuse hepatic metastases are better appreciated on prior contrast-enhanced examination. The degree of metastatic disease is grossly similar and at the very least is not significantly changed. Small perihepatic fluid collection. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Unremarkable for technique SPLEEN: Unremarkable for technique ADRENALS: Normal. KIDNEYS: Low attenuated lesion within the right kidney is unchanged. No hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Stomach and small bowel are normal in caliber. COLON / APPENDIX: Mild thickening of the colon. The appendix is unremarkable. PERITONEUM / MESENTERY: Trace upper abdominal ascites, slightly increased from before RETROPERITONEUM: Normal. VESSELS: Moderate atherosclerotic disease. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Moderate anasarca. MUSCULOSKELETAL: No acute or aggressive appearing osseous abnormality. Moderate to advanced degenerative changes of the lower lumbar spine. Most pronounced at L4-S1
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Findings: Slightly age advanced frontoparietal brain parenchymal volume loss is seen. Gray-white differentiation is maintained. There is no intra- or extra-axial hemorrhage. There is no midline shift, mass effect, or other space-occupying lesion. The ventricular system has normal size and configuration. The basal cisterns are clear. Atherosclerotic calcifications of the bilateral carotid siphons and vertebral arteries. The visualized paranasal sinuses and mastoid air cells are clear. The visualized bones of the calvarium demonstrate no acute osseous abnormality.
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3,871
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EXAM: CT Chest with contrast CLINICAL INFORMATION: Evaluate effusion. COMPARISON: CT chest 1/5/2022. TECHNIQUE: CT Chest with contrast. Patient weight: 195 lbs. IV contrast: Omnipaque 350, 60 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 35 sec Scan field of view: 350 mm. DLP: 341.30 mGy cm. FINDINGS: STRUCTURED REPORT: CT CAP LOWER NECK: Postsurgical changes from tracheostomy. CHEST: LUNGS / AIRWAYS / PLEURA: Respiratory motion degradation. The tracheostomy terminates in the upper trachea. The central airways are patent. Small bilateral pleural effusions. Interval resolution of trace left pneumothorax. Near complete atelectasis of the left lower lobe, but with slight improvement. Redemonstration of consolidative and groundglass opacities in the right upper lobe with air bronchograms, similar prior. Increased left upper lobe groundglass and consolidative opacities. HEART / VESSELS: Mild coronary artery atherosclerotic calcifications. The heart is normal in size with no pericardial effusion. Stable tiny filling defect in the lateral brachiocephalic vein (image 22, series 2) near the junction with the left internal jugular vein. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: Similar size of left anterior chest wall fluid collection extending into the retrosternal and intrapectoral spaces associated with the severely displaced left-sided rib/costochondral fractures. The collection now measures 13.3 x 7.2 cm (series 2, image 39), unchanged. IMAGES ABDOMEN: MUSCULOSKELETAL: Redemonstration of numerous bilateral rib and left costochondral fractures. The left scapular and sternal body fractures are unchanged. CONCLUSION: 1. Increased left upper lobe airspace opacities and similar appearance of right upper lobe airspace opacities concerning for pneumonia. 2. Interval resolution of left pneumothorax. Small bilateral pleural effusions are increased in size compared to prior. 3. Similar size of left anterior chest wall fluid collection associated with the severely displaced left-sided costochondral and rib fractures. 4. Stable tiny filling defect in the left internal jugular vein/brachiocephalic junction likely represents a small DVT, unchanged. 5. Stable post redemonstration of multiple traumatic injuries including bilateral rib fractures, sternal fracture, and scapular fracture. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: STRUCTURED REPORT: CT CAP LOWER NECK: Postsurgical changes from tracheostomy. CHEST: LUNGS / AIRWAYS / PLEURA: Respiratory motion degradation. The tracheostomy terminates in the upper trachea. The central airways are patent. Small bilateral pleural effusions. Interval resolution of trace left pneumothorax. Near complete atelectasis of the left lower lobe, but with slight improvement. Redemonstration of consolidative and groundglass opacities in the right upper lobe with air bronchograms, similar prior. Increased left upper lobe groundglass and consolidative opacities. HEART / VESSELS: Mild coronary artery atherosclerotic calcifications. The heart is normal in size with no pericardial effusion. Stable tiny filling defect in the lateral brachiocephalic vein (image 22, series 2) near the junction with the left internal jugular vein. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: Similar size of left anterior chest wall fluid collection extending into the retrosternal and intrapectoral spaces associated with the severely displaced left-sided rib/costochondral fractures. The collection now measures 13.3 x 7.2 cm (series 2, image 39), unchanged. IMAGES ABDOMEN: MUSCULOSKELETAL: Redemonstration of numerous bilateral rib and left costochondral fractures. The left scapular and sternal body fractures are unchanged.
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Findings/Conclusion: There are scattered colonic diverticula. Limited images of the abdomen are otherwise unremarkable for technique.
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3,872
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CT Head wo contrast Clinical Information: Headache in setting of recent head injury Comparison: CT head 12/8/2016. Technique: Unenhanced axial brain CT with sagittal and coronal reformats. Scan field of view: 233 mm. DLP: 1136 mGy cm. Findings: CT head: BRAIN PARENCHYMA: No hemorrhage, intracranial mass, large territory infarct, or edema. Gray-white matter differentiation maintained. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No acute fracture. No aggressive osseous lesion. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Mild mucosal thickening of left and small mucosal retention cyst in right maxillary sinuses. The remaining visualized paranasal sinuses and mastoid air cells are clear. Conclusion: No acute intracranial abnormality. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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Findings: CT head: BRAIN PARENCHYMA: No hemorrhage, intracranial mass, large territory infarct, or edema. Gray-white matter differentiation maintained. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No acute fracture. No aggressive osseous lesion. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Mild mucosal thickening of left and small mucosal retention cyst in right maxillary sinuses. The remaining visualized paranasal sinuses and mastoid air cells are clear.
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No enlarged hilar or mediastinal nodes are present. The mediastinum is normal. The lungs are normal without noncalcified nodules or masses. There is no significant pleural disease. Coronary arterial calcification: Visual score of 8, compared to a score of 3 in the prior scan. (Based on a publication by Kirsch et al (Detection of Coronary calcium During Standard Chest Computed Tomography Correlates With Multi-Detector Computed Tomography Coronary Artery Calcium score, Int J Cardiovasc Imaging (2012) 28:1249-1256), visual score >7 is associated with an Agatston score > 400 and independently validated increased incidence of cardiovascular mortality). The Visualized thoracic skeleton is unremarkable. Noncontrast views of the upper abdomen are unremarkable.
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3,873
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Craniocervical CT angiogram 1/9/2022 5:07 PM Indication: COVID Confirmed stroke workup Comparison: MRI brain without contrast dated 1/8/2022. Technique: 1.4 mm axial images were obtained during the early arterial phase of a rapid IV infusion of contrast, from the thoracic inlet through the circle of Willis. 3-D CT angiographic images were generated from axial data set. "Sliding slab MIP" images were also generated. Patient weight: 198 lbs. IV contrast: Omnipaque 350, 125 ml, per protocol. Saline flush: 60 ml. IV contrast injection rate: 4 ml per sec. Scan delay: Bolus Tracked. Scan field of view: 255 mm. (accession CT220004634), Patient weight: 198 lbs. IV contrast: Omnipaque 350, 125 ml, per protocol. Saline flush: 60 ml. IV contrast injection rate: 4 ml per sec. Scan delay: Bolus Tracked. Scan field of view: 255 mm. DLP: 6308 mGy cm. (accession CT220004633). 3-D reconstructions were generated per the ordering physician's request from the axial data. This was performed under the supervision of the interpreting radiologist. Findings related to the 3-D reconstructions are included in this report. VASCULAR FINDINGS: Aortic arch: Patent without flow-limiting stenosis. Normal three vessel aortic arch is noted. Right carotid: Patent without flow-limiting stenosis. Left carotid: Diffuse decreased caliber of the left ICA, predominantly along the intracranial segments, most likely developmental in nature. Patent without flow-limiting stenosis. Short retropharyngeal course of the bilateral internal carotid arteries. Right vertebral artery: Patent without flow-limiting stenosis. Left vertebral artery: Dominant. Patent without flow-limiting stenosis. Intracranial arteries: Nonflow limiting atherosclerotic calcifications of the bilateral cavernous ICAs. Hypoplastic left A1 segment. The bilateral ACAs, MCAs and PCAs appear patent, without flow-limiting stenoses or discrete aneurysms. Near fetal origin of the right PCA. The vertebrobasilar axis is mildly tortuous, without flow-limiting stenoses. NONVASCULAR FINDINGS: Mild frontal age-appropriate brain parenchymal volume loss is again seen. Ill-defined hypoattenuation in the central pons, consistent with evolving early subacute infarct without evidence of hemorrhagic transformation, is better characterized in prior MRI of the brain. The white-gray matter differentiation is otherwise preserved. There is no abnormal enhancement, acute intracranial hemorrhage, midline shift, basal cistern effacement, hydrocephalus or abnormal extra-axial fluid collections. Persistent pansinus left greater than right opacification extending into the left mastoid air cells. The visualized orbits and bilateral middle ear cavities appear unremarkable. Incidental hyperostosis frontalis interna. The oral cavity, nasopharynx, oropharynx, and laryngopharynx have normal appearance. No intrinsic abnormality is seen within the larynx or trachea. The true and false vocal cords are without focal abnormality. The superficial soft tissues of the neck have a normal appearance with no enhancing lesion identified. No enlarged lymph nodes are seen. The parotid and submandibular glands are normal in appearance. The thyroid gland demonstrates 3.5 mm hypodense nodule in the left anterior thyroid lobe, likely a colloid cyst. Post surgical anterior spinal fusion at C4-C5, with moderate bony callus formation, without perihardware lucencies, malpositioning or hardware fractures. Multilevel intervertebral disc space loss, endplate sclerosis and osteophytosis, severe at C6-C7, moderate at C3-C4. Partially visualized bilateral airspace disease in the lung apices. IMPRESSION: 1. Ill-defined hypoattenuation in the central pons, consistent with evolving early subacute infarct without evidence of hemorrhagic transformation, is better characterized in prior MRI of the brain. 2. Diffuse decreased caliber of the left ICA, predominantly along the intracranial segments, most likely developmental in nature. 3. Mild multifocal atherosclerosis as described. Otherwise patent cervical and intracranial arteries, without evidence of acute vascular injury or flow-limiting stenosis.
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FINDINGS: Aortic arch: Patent without flow-limiting stenosis. Normal three vessel aortic arch is noted. Right carotid: Patent without flow-limiting stenosis. Left carotid: Diffuse decreased caliber of the left ICA, predominantly along the intracranial segments, most likely developmental in nature. Patent without flow-limiting stenosis. Short retropharyngeal course of the bilateral internal carotid arteries. Right vertebral artery: Patent without flow-limiting stenosis. Left vertebral artery: Dominant. Patent without flow-limiting stenosis. Intracranial arteries: Nonflow limiting atherosclerotic calcifications of the bilateral cavernous ICAs. Hypoplastic left A1 segment. The bilateral ACAs, MCAs and PCAs appear patent, without flow-limiting stenoses or discrete aneurysms. Near fetal origin of the right PCA. The vertebrobasilar axis is mildly tortuous, without flow-limiting stenoses. NONVASCULAR FINDINGS: Mild frontal age-appropriate brain parenchymal volume loss is again seen. Ill-defined hypoattenuation in the central pons, consistent with evolving early subacute infarct without evidence of hemorrhagic transformation, is better characterized in prior MRI of the brain. The white-gray matter differentiation is otherwise preserved. There is no abnormal enhancement, acute intracranial hemorrhage, midline shift, basal cistern effacement, hydrocephalus or abnormal extra-axial fluid collections. Persistent pansinus left greater than right opacification extending into the left mastoid air cells. The visualized orbits and bilateral middle ear cavities appear unremarkable. Incidental hyperostosis frontalis interna. The oral cavity, nasopharynx, oropharynx, and laryngopharynx have normal appearance. No intrinsic abnormality is seen within the larynx or trachea. The true and false vocal cords are without focal abnormality. The superficial soft tissues of the neck have a normal appearance with no enhancing lesion identified. No enlarged lymph nodes are seen. The parotid and submandibular glands are normal in appearance. The thyroid gland demonstrates 3.5 mm hypodense nodule in the left anterior thyroid lobe, likely a colloid cyst. Post surgical anterior spinal fusion at C4-C5, with moderate bony callus formation, without perihardware lucencies, malpositioning or hardware fractures. Multilevel intervertebral disc space loss, endplate sclerosis and osteophytosis, severe at C6-C7, moderate at C3-C4. Partially visualized bilateral airspace disease in the lung apices.
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Findings/Conclusion: There is a punctate left renal calculus. Limited images of the abdomen are otherwise unremarkable for technique.
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3,874
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Craniocervical CT angiogram 1/9/2022 5:07 PM Indication: COVID Confirmed stroke workup Comparison: MRI brain without contrast dated 1/8/2022. Technique: 1.4 mm axial images were obtained during the early arterial phase of a rapid IV infusion of contrast, from the thoracic inlet through the circle of Willis. 3-D CT angiographic images were generated from axial data set. "Sliding slab MIP" images were also generated. Patient weight: 198 lbs. IV contrast: Omnipaque 350, 125 ml, per protocol. Saline flush: 60 ml. IV contrast injection rate: 4 ml per sec. Scan delay: Bolus Tracked. Scan field of view: 255 mm. (accession CT220004634), Patient weight: 198 lbs. IV contrast: Omnipaque 350, 125 ml, per protocol. Saline flush: 60 ml. IV contrast injection rate: 4 ml per sec. Scan delay: Bolus Tracked. Scan field of view: 255 mm. DLP: 6308 mGy cm. (accession CT220004633). 3-D reconstructions were generated per the ordering physician's request from the axial data. This was performed under the supervision of the interpreting radiologist. Findings related to the 3-D reconstructions are included in this report. VASCULAR FINDINGS: Aortic arch: Patent without flow-limiting stenosis. Normal three vessel aortic arch is noted. Right carotid: Patent without flow-limiting stenosis. Left carotid: Diffuse decreased caliber of the left ICA, predominantly along the intracranial segments, most likely developmental in nature. Patent without flow-limiting stenosis. Short retropharyngeal course of the bilateral internal carotid arteries. Right vertebral artery: Patent without flow-limiting stenosis. Left vertebral artery: Dominant. Patent without flow-limiting stenosis. Intracranial arteries: Nonflow limiting atherosclerotic calcifications of the bilateral cavernous ICAs. Hypoplastic left A1 segment. The bilateral ACAs, MCAs and PCAs appear patent, without flow-limiting stenoses or discrete aneurysms. Near fetal origin of the right PCA. The vertebrobasilar axis is mildly tortuous, without flow-limiting stenoses. NONVASCULAR FINDINGS: Mild frontal age-appropriate brain parenchymal volume loss is again seen. Ill-defined hypoattenuation in the central pons, consistent with evolving early subacute infarct without evidence of hemorrhagic transformation, is better characterized in prior MRI of the brain. The white-gray matter differentiation is otherwise preserved. There is no abnormal enhancement, acute intracranial hemorrhage, midline shift, basal cistern effacement, hydrocephalus or abnormal extra-axial fluid collections. Persistent pansinus left greater than right opacification extending into the left mastoid air cells. The visualized orbits and bilateral middle ear cavities appear unremarkable. Incidental hyperostosis frontalis interna. The oral cavity, nasopharynx, oropharynx, and laryngopharynx have normal appearance. No intrinsic abnormality is seen within the larynx or trachea. The true and false vocal cords are without focal abnormality. The superficial soft tissues of the neck have a normal appearance with no enhancing lesion identified. No enlarged lymph nodes are seen. The parotid and submandibular glands are normal in appearance. The thyroid gland demonstrates 3.5 mm hypodense nodule in the left anterior thyroid lobe, likely a colloid cyst. Post surgical anterior spinal fusion at C4-C5, with moderate bony callus formation, without perihardware lucencies, malpositioning or hardware fractures. Multilevel intervertebral disc space loss, endplate sclerosis and osteophytosis, severe at C6-C7, moderate at C3-C4. Partially visualized bilateral airspace disease in the lung apices. IMPRESSION: 1. Ill-defined hypoattenuation in the central pons, consistent with evolving early subacute infarct without evidence of hemorrhagic transformation, is better characterized in prior MRI of the brain. 2. Diffuse decreased caliber of the left ICA, predominantly along the intracranial segments, most likely developmental in nature. 3. Mild multifocal atherosclerosis as described. Otherwise patent cervical and intracranial arteries, without evidence of acute vascular injury or flow-limiting stenosis.
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FINDINGS: Aortic arch: Patent without flow-limiting stenosis. Normal three vessel aortic arch is noted. Right carotid: Patent without flow-limiting stenosis. Left carotid: Diffuse decreased caliber of the left ICA, predominantly along the intracranial segments, most likely developmental in nature. Patent without flow-limiting stenosis. Short retropharyngeal course of the bilateral internal carotid arteries. Right vertebral artery: Patent without flow-limiting stenosis. Left vertebral artery: Dominant. Patent without flow-limiting stenosis. Intracranial arteries: Nonflow limiting atherosclerotic calcifications of the bilateral cavernous ICAs. Hypoplastic left A1 segment. The bilateral ACAs, MCAs and PCAs appear patent, without flow-limiting stenoses or discrete aneurysms. Near fetal origin of the right PCA. The vertebrobasilar axis is mildly tortuous, without flow-limiting stenoses. NONVASCULAR FINDINGS: Mild frontal age-appropriate brain parenchymal volume loss is again seen. Ill-defined hypoattenuation in the central pons, consistent with evolving early subacute infarct without evidence of hemorrhagic transformation, is better characterized in prior MRI of the brain. The white-gray matter differentiation is otherwise preserved. There is no abnormal enhancement, acute intracranial hemorrhage, midline shift, basal cistern effacement, hydrocephalus or abnormal extra-axial fluid collections. Persistent pansinus left greater than right opacification extending into the left mastoid air cells. The visualized orbits and bilateral middle ear cavities appear unremarkable. Incidental hyperostosis frontalis interna. The oral cavity, nasopharynx, oropharynx, and laryngopharynx have normal appearance. No intrinsic abnormality is seen within the larynx or trachea. The true and false vocal cords are without focal abnormality. The superficial soft tissues of the neck have a normal appearance with no enhancing lesion identified. No enlarged lymph nodes are seen. The parotid and submandibular glands are normal in appearance. The thyroid gland demonstrates 3.5 mm hypodense nodule in the left anterior thyroid lobe, likely a colloid cyst. Post surgical anterior spinal fusion at C4-C5, with moderate bony callus formation, without perihardware lucencies, malpositioning or hardware fractures. Multilevel intervertebral disc space loss, endplate sclerosis and osteophytosis, severe at C6-C7, moderate at C3-C4. Partially visualized bilateral airspace disease in the lung apices.
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No enlarged hilar or mediastinal nodes are present. The mediastinum is normal. The lungs are normal without noncalcified nodules or masses. There is no significant pleural disease. Coronary arterial calcification: None Visualized thoracic skeleton is unremarkable. Noncontrast views of the upper abdomen are unremarkable.
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3,875
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EXAM: CT Abdomen and Pelvis wo IV contrast CLINICAL INFORMATION: Abdominal distention COMPARISON: None. TECHNIQUE: CT Abdomen and Pelvis wo IV contrast. Scan field of view: 500 mm. Oral contrast Omnipaque: 16 oz. DLP: 1260 mGy cm. FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Incidental bibasilar pulmonary nodules measuring up to 7 mm on series 3 image 55. Bilateral dependent and linear subsegmental atelectasis. More rounded consolidation is present in the lingula. Trace left pleural effusion. DISTAL ESOPHAGUS: Esophagogastric tube in place. HEART / VESSELS: Cardiomegaly. Trace pericardial effusion. Postsurgical changes from midline sternotomy ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Cholelithiasis. No evidence of acute cholecystitis. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Multiple fluid-filled loops of nondistended small bowel are present, more prominent in the ileum. COLON / APPENDIX: Diffuse gaseous distention of the colon. The cecum measures up to 8.6 cm in diameter, transverse colon measures up to 6.0 cm. There is mild pericolonic inflammatory stranding. There is gradual tapering to more normal caliber sigmoid colon on series 3 image 258 and 259. Noninflamed colonic diverticula are present. PERITONEUM / MESENTERY: Trace free fluid. No pneumoperitoneum. RETROPERITONEUM: Normal. VESSELS: Moderate atherosclerotic disease. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Mild anasarca. Post median sternotomy changes. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. Diffuse gaseous distention of the colon and distal small bowel; findings are likely related to adynamic ileus given the gradual transition in the proximal sigmoid colon. Mild pericolonic stranding and trace mesenteric fluid may suggest underlying infection or inflammation. Given the gradual transition in the proximal sigmoid colon, radiographic follow-up is recommended to exclude developing bowel obstruction. 2. Cholelithiasis without CT evidence of acute cholecystitis. 3. Incidental pulmonary nodules measuring up to 7 mm. Recommend further evaluation with dedicated CT chest to follow up. 4. Additional findings above including trace pericardial effusion and trace left pleural 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.
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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Incidental bibasilar pulmonary nodules measuring up to 7 mm on series 3 image 55. Bilateral dependent and linear subsegmental atelectasis. More rounded consolidation is present in the lingula. Trace left pleural effusion. DISTAL ESOPHAGUS: Esophagogastric tube in place. HEART / VESSELS: Cardiomegaly. Trace pericardial effusion. Postsurgical changes from midline sternotomy ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Cholelithiasis. No evidence of acute cholecystitis. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Multiple fluid-filled loops of nondistended small bowel are present, more prominent in the ileum. COLON / APPENDIX: Diffuse gaseous distention of the colon. The cecum measures up to 8.6 cm in diameter, transverse colon measures up to 6.0 cm. There is mild pericolonic inflammatory stranding. There is gradual tapering to more normal caliber sigmoid colon on series 3 image 258 and 259. Noninflamed colonic diverticula are present. PERITONEUM / MESENTERY: Trace free fluid. No pneumoperitoneum. RETROPERITONEUM: Normal. VESSELS: Moderate atherosclerotic disease. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Mild anasarca. Post median sternotomy changes. MUSCULOSKELETAL: No significant abnormality.
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FINDINGS: STRUCTURED REPORT: CT Abdomen LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Numerous arterially enhancing lesions cystic lesions about the liver, the largest of which is in the right hepatic dome and measures 6.9 x 6.2 x 6.0 cm (series 900 image 56). BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Heterogeneous attenuation and enhancement of the spleen which may be on the basis of splenic vein occlusion. There does appear to be at least one peripherally arterially enhancing lesion in the spleen concerning for metastasis (series 900 image 69). ADRENALS: Left adrenal nodularity. Normal right adrenal. KIDNEYS: Normal. LYMPH NODES: Borderline enlarged periportal lymph nodes STOMACH / SMALL BOWEL: Markedly thickened and hyperemic mucosa of the gastric fundus. Large perigastric collateral vessels.. COLON: Fluid throughout the colon suggestive of a diarrheal illness. PERITONEUM / MESENTERY: No ascites. RETROPERITONEUM: Normal. VESSELS: Large perigastric and upper abdominal collateral vessels. Occlusive thrombus within the splenic vein. BODY WALL: Ventral abdominal postoperative changes. MUSCULOSKELETAL: No significant abnormality.
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3,876
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EXAM: CT Angio Chest wo+w contrast CLINICAL INFORMATION: Covid, rule out PE COMPARISON: None. TECHNIQUE: CT Angio Chest wo+w contrast. Additional 3D image post-processing was performed to generate MIP and/or volume-rendered images. Patient weight: 144 lbs. IV contrast: Omnipaque 350, 60 ml, per protocol. Saline flush: 60 ml. IV contrast injection rate: 3.50 ml per sec. Scan delay: Bolus Tracked. Scan field of view: 312 mm. KVP: 100 DLP: 166 mGy cm. FINDINGS: STRUCTURED REPORT: CT PE OVERALL DIAGNOSTIC QUALITY: Full diagnostic quality LOWER NECK: No abnormality. CHEST: PULMONARY ARTERIES: Negative for pulmonary embolus LUNGS / AIRWAYS / PLEURA: Emphysematous changes. Patchy airspace opacities are noted in the periphery of the upper lobes, greater on the right. Basilar atelectasis present in the bilateral lower lobes. HEART / OTHER VESSELS: Common origin of the right brachiocephalic and left common carotid arteries. Coronary artery calcification is noted. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: Right axillary graft extends along the right lateral chest wall and is filled with contrast. UPPER ABDOMEN: Cholelithiasis. Multiple cysts are present throughout the liver. Partially visualized right renal hypoattenuating lesion. There is a soft tissue nodule along the superior aspect of the stomach that measures 1.6 x 1.3 cm on image 107, series 101. 1.2 cm right adrenal nodule is present. MUSCULOSKELETAL: Mild degenerative changes throughout the lumbar spine. No aggressive osseous lesion. Prominent anterior cervical spine from the visualized portions of the inferior cervical spine. CONCLUSION: 1. No evidence of pulmonary thromboembolus. 2. Patchy airspace opacities in the periphery of the upper lobes likely reflects sequela of Covid. Basilar atelectasis without pleural effusion. 3. Indeterminate right adrenal nodule. One-year follow-up CT is recommended. 4. Soft tissue nodule superior to the stomach may represent an enlarged lymph node or potentially an exophytic lesion arising from the gastric wall. Nonemergent CT of the abdomen is recommended with contrast for further characterization. 4. Cholelithiasis, numerous hepatic cysts, and additional findings as above.
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FINDINGS: STRUCTURED REPORT: CT PE OVERALL DIAGNOSTIC QUALITY: Full diagnostic quality LOWER NECK: No abnormality. CHEST: PULMONARY ARTERIES: Negative for pulmonary embolus LUNGS / AIRWAYS / PLEURA: Emphysematous changes. Patchy airspace opacities are noted in the periphery of the upper lobes, greater on the right. Basilar atelectasis present in the bilateral lower lobes. HEART / OTHER VESSELS: Common origin of the right brachiocephalic and left common carotid arteries. Coronary artery calcification is noted. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: Right axillary graft extends along the right lateral chest wall and is filled with contrast. UPPER ABDOMEN: Cholelithiasis. Multiple cysts are present throughout the liver. Partially visualized right renal hypoattenuating lesion. There is a soft tissue nodule along the superior aspect of the stomach that measures 1.6 x 1.3 cm on image 107, series 101. 1.2 cm right adrenal nodule is present. MUSCULOSKELETAL: Mild degenerative changes throughout the lumbar spine. No aggressive osseous lesion. Prominent anterior cervical spine from the visualized portions of the inferior cervical spine.
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Findings: Evolving right PICA infarct with mass effect on the fourth ventricle. No evidence of large volume hemorrhagic transformation. Generalized parenchymal atrophy, likely age related. Patchy white matter hypodensities likely related to chronic microangiopathy. Evolving right frontal scalp hematoma. No worrisome new findings
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3,877
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CT Head wo No Charge Clinical Information: Other- Spec Inst: CODE STROKE: Acute Symptoms Comparison: 9/22/2019. Technique: Unenhanced axial brain CT with sagittal and coronal reformats. Scan field of view: 225 mm. DLP: 1222.80 mGy cm. Findings: CT head: BRAIN PARENCHYMA: No hemorrhage, intracranial mass, large territory infarct, or edema. Gray-white matter differentiation maintained. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No acute fracture. No aggressive osseous lesion. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal. Conclusion: No acute intracranial abnormality. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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Findings: CT head: BRAIN PARENCHYMA: No hemorrhage, intracranial mass, large territory infarct, or edema. Gray-white matter differentiation maintained. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No acute fracture. No aggressive osseous lesion. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Calcifications of the aortic valve and coronary arteries. 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: Scattered mild atherosclerotic calcifications of the abdominal aorta and branch vessels. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Fat containing periumbilical hernia defect measures 3.9 cm on image 213 series 2. No significant fat stranding. Small bilateral fat-containing inguinal hernias. MUSCULOSKELETAL: No significant abnormality.
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3,878
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Radiologic Exam: CT Angio Neck, CT Venogram Head 1/9/2022 11:07 AM Clinical Information: CODE STROKE: Acute Symptoms. Comparison: CT head and CT perfusion dated same day. Technique: Helical CT images were obtained before and after the administration of contrast from the base of the skull to the vertex. Contrast enhanced CT angiographic images were obtained from the superior mediastinum to the vertex during the arterial phase. 3-D CT angiographic images were generated from the axial data set under the supervision of the reporting physician. Results are reported below. "Sliding MIP" images were also generated in the sagittal, axial, and coronal planes. Patient weight: 160 lbs. IV contrast: Omnipaque 350, 80 ml, per protocol. Saline flush: 40 ml. IV contrast injection rate: 3.50 ml per sec. Scan delay: bolus tracked Scan field of view: 287 mm. DLP: 2959 mGy cm. (accession CT220004639), Patient weight: 160 lbs. IV contrast: Omnipaque 350, 80 ml, per protocol. Saline flush: 40 ml. IV contrast injection rate: 3.50 ml per sec. Scan delay: bolus tracked Scan field of view: 287 mm. DLP: 232 mGy cm. (accession CT220004656) FINDINGS: CT angiogram of the brain: RIGHT CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. ANTERIOR, MIDDLE, AND POSTERIOR CEREBRAL ARTERIES: Unremarkable. VERTEBROBASILAR ARTERIES: There is no evidence of stenosis, occlusion, or aneurysmal dilation. CT angiogram of the neck: AORTIC ARCH and PROXIMAL GREAT VESSELS: Conventional three-vessel branching pattern. Unremarkable. RIGHT CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. RIGHT VERTEBRAL ARTERY: There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT VERTEBRAL ARTERY: There is no evidence of stenosis, occlusion, or aneurysmal dilation. Both internal jugular veins appear within normal limits SOFT TISSUES: Subcentimeter left thyroid lobe hypodense nodule. CERVICAL SPINE: Reversal of the normal cervical lordosis. No spondylolisthesis. No significant degenerative disease. CT venogram: There is no evidence of venous sinus thrombosis. There is normal asymmetric size of the right transverse sinus relative to the left. The deep cerebral veins also appear patent. Included portions of the internal jugular veins appear patent. CONCLUSION: No evidence of acute arterial or venous pathology. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: CT angiogram of the brain: RIGHT CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. ANTERIOR, MIDDLE, AND POSTERIOR CEREBRAL ARTERIES: Unremarkable. VERTEBROBASILAR ARTERIES: There is no evidence of stenosis, occlusion, or aneurysmal dilation. CT angiogram of the neck: AORTIC ARCH and PROXIMAL GREAT VESSELS: Conventional three-vessel branching pattern. Unremarkable. RIGHT CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. RIGHT VERTEBRAL ARTERY: There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT VERTEBRAL ARTERY: There is no evidence of stenosis, occlusion, or aneurysmal dilation. Both internal jugular veins appear within normal limits SOFT TISSUES: Subcentimeter left thyroid lobe hypodense nodule. CERVICAL SPINE: Reversal of the normal cervical lordosis. No spondylolisthesis. No significant degenerative disease. CT venogram: There is no evidence of venous sinus thrombosis. There is normal asymmetric size of the right transverse sinus relative to the left. The deep cerebral veins also appear patent. Included portions of the internal jugular veins appear patent.
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FINDINGS: Aortic arch: Patent without flow-limiting stenosis. Incidental bovine origin of the great vessels from the aortic arch, with scattered nonflow limiting atherosclerotic calcifications. Right carotid: Patent without flow-limiting stenosis. Left carotid: Nonflow limiting atherosclerotic calcifications of the left carotid bifurcation extending into the proximal left ICA. Patent without flow-limiting stenosis. Right vertebral artery: Patent without flow-limiting stenosis. Left vertebral artery: Dominant. Patent without flow-limiting stenosis. Intracranial arteries: Punctate nonflow limiting atherosclerotic calcifications of the bilateral cavernous ICAs. Hypoplastic right A1 segment. The bilateral ACAs, MCAs and PCAs appear patent, without flow-limiting stenoses or discrete aneurysms. The vertebrobasilar axis is mildly tortuous, without flow-limiting stenoses. NONVASCULAR FINDINGS: Irregular hypoattenuation involving the left lateral thalamus is noted and may represent late subacute to chronic infarct. Mild diffuse age-appropriate brain parenchymal volume loss is seen. Mild periventricular and subcortical white matter hypoattenuation is noted, suggestive of mild chronic ischemic microvascular disease. The white-gray matter differentiation is otherwise preserved. There is no abnormal enhancement, acute intracranial hemorrhage, midline shift, basal cistern effacement, hydrocephalus or abnormal extra-axial fluid collections. Mild right lateral sphenoid sinus mucosal thickening. The visualized paranasal sinuses, mastoid air cells and orbits appear otherwise unremarkable. The oral cavity, nasopharynx, oropharynx, and laryngopharynx have normal appearance. No intrinsic abnormality is seen within the larynx or trachea. The true and false vocal cords are without focal abnormality. The superficial soft tissues of the neck have a normal appearance with no enhancing lesion identified. No enlarged lymph nodes are seen. The parotid and submandibular glands are normal in appearance. Rounded heterogeneously enhancing nodule is noted in the right tracheoesophageal groove, measuring approximately 18 x 18 mm. Heterogeneous thyroid gland with atrophic right thyroid lobe is also seen.
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3,879
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RADIOLOGIC EXAM: CT Head wo contrast CLINICAL INFORMATION: SDH COMPARISON: 1/9/2022 TECHNIQUE: CT of the head without intravenous contrast. Scan field of view: 203 mm. DLP: 875 mGy cm. FINDINGS: No significant change in the evolving acute on chronic left subdural hematoma with 7 mm left-to-right midline shift. No new intracranial hemorrhage. No new abnormality. Conus cerebral atrophy. Mild ex vacuo ventriculomegaly. No acute orbital abnormality. No aggressive osseous lesion. Paranasal sinuses and mastoid air cells are clear. CONCLUSION: Unchanged evolving acute or chronic left subdural hematoma with unchanged 7 mm midline shift. No new intracranial abnormality. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: No significant change in the evolving acute on chronic left subdural hematoma with 7 mm left-to-right midline shift. No new intracranial hemorrhage. No new abnormality. Conus cerebral atrophy. Mild ex vacuo ventriculomegaly. No acute orbital abnormality. No aggressive osseous lesion. Paranasal sinuses and mastoid air cells are clear.
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FINDINGS: Aortic arch: Patent without flow-limiting stenosis. Incidental bovine origin of the great vessels from the aortic arch, with scattered nonflow limiting atherosclerotic calcifications. Right carotid: Patent without flow-limiting stenosis. Left carotid: Nonflow limiting atherosclerotic calcifications of the left carotid bifurcation extending into the proximal left ICA. Patent without flow-limiting stenosis. Right vertebral artery: Patent without flow-limiting stenosis. Left vertebral artery: Dominant. Patent without flow-limiting stenosis. Intracranial arteries: Punctate nonflow limiting atherosclerotic calcifications of the bilateral cavernous ICAs. Hypoplastic right A1 segment. The bilateral ACAs, MCAs and PCAs appear patent, without flow-limiting stenoses or discrete aneurysms. The vertebrobasilar axis is mildly tortuous, without flow-limiting stenoses. NONVASCULAR FINDINGS: Irregular hypoattenuation involving the left lateral thalamus is noted and may represent late subacute to chronic infarct. Mild diffuse age-appropriate brain parenchymal volume loss is seen. Mild periventricular and subcortical white matter hypoattenuation is noted, suggestive of mild chronic ischemic microvascular disease. The white-gray matter differentiation is otherwise preserved. There is no abnormal enhancement, acute intracranial hemorrhage, midline shift, basal cistern effacement, hydrocephalus or abnormal extra-axial fluid collections. Mild right lateral sphenoid sinus mucosal thickening. The visualized paranasal sinuses, mastoid air cells and orbits appear otherwise unremarkable. The oral cavity, nasopharynx, oropharynx, and laryngopharynx have normal appearance. No intrinsic abnormality is seen within the larynx or trachea. The true and false vocal cords are without focal abnormality. The superficial soft tissues of the neck have a normal appearance with no enhancing lesion identified. No enlarged lymph nodes are seen. The parotid and submandibular glands are normal in appearance. Rounded heterogeneously enhancing nodule is noted in the right tracheoesophageal groove, measuring approximately 18 x 18 mm. Heterogeneous thyroid gland with atrophic right thyroid lobe is also seen.
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3,880
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CT Head wo Contrast TECHNIQUE: CT of the head was performed without intravenous contrast at 2.5mm slice thickness. Scan field of view: 288 mm. DLP: 1384 mGy cm. INDICATION: COVID Confirmed; fall COMPARISON: CT the head without contrast dated 3/25/2015 STRUCTURED REPORT: CT Head FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is preserved. Cerebral volume is normal. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. There is a small amount of fluid within the left mastoid air cells. The right mastoid air cells are clear. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: No acute sinusitis SOFT TISSUES: Redemonstrated numerous benign calcified subcutaneous scalp lesions. CONCLUSION: No acute intracranial process. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is preserved. Cerebral volume is normal. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. There is a small amount of fluid within the left mastoid air cells. The right mastoid air cells are clear. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: No acute sinusitis SOFT TISSUES: Redemonstrated numerous benign calcified subcutaneous scalp lesions.
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Findings: CT head: BRAIN PARENCHYMA: No hemorrhage, intracranial mass, large territory infarct, or edema. Gray-white matter differentiation maintained. Mild age-appropriate predominantly frontoparietal brain parenchymal volume loss is again seen, resulting in mild exvacuo dilatation of the ventricular system. Mild periventricular frontal white matter hypoattenuation is noted suggestive of mild chronic microvascular ischemic disease, with remote lacunar infarcts in the right corona radiata and right putamen. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: Partially empty sella, unchanged. No acute fracture. No aggressive osseous lesion. Unchanged punctate atherosclerotic calcifications of the bilateral carotid siphons. ORBITS: Interval development of bilateral lens replacements. SINUSES: Stable mild scattered anterior ethmoid air cell mucosal thickening. The visualized paranasal sinuses and mastoid air cells are otherwise clear.
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3,881
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EXAM: CT Abdomen and Pelvis wo IV contrast CLINICAL INFORMATION: Left lower quadrant abdominal pain. Evaluate for diverticular disease. COMPARISON: CT abdomen and pelvis 12/12/2014 TECHNIQUE: CT Abdomen and Pelvis wo IV contrast. Scan field of view: 420 mm. DLP: 546 mGy cm. FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Mild bilateral dependent atelectasis. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Punctate nonobstructive nephrolithiasis in the left upper pole. No hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: The colon and appendix are unremarkable. No convincing diverticulosis or evidence of diverticulitis. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: The uterus is surgically absent. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No aggressive osseous lesions. Moderate multilevel degenerative changes of the thoracic and lumbar spine. Grade 1 L3 over L4 anterolisthesis with degenerative endplate changes and intervertebral height loss. CONCLUSION: 1. No acute abnormality 2. Nonobstructing left upper pole nephrolithiasis. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Mild bilateral dependent atelectasis. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Punctate nonobstructive nephrolithiasis in the left upper pole. No hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: The colon and appendix are unremarkable. No convincing diverticulosis or evidence of diverticulitis. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: The uterus is surgically absent. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No aggressive osseous lesions. Moderate multilevel degenerative changes of the thoracic and lumbar spine. Grade 1 L3 over L4 anterolisthesis with degenerative endplate changes and intervertebral height loss.
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Findings: There is an avulsion fracture of the fibular head, likely related to the biceps femoris and FCL attachment sites. There is 1.4 cm of proximal retraction of the proximal fragment. There is a small osseous fragment in the region of the horizontal portion of the PCL. There is hemorrhage obscuring both the ACL and PCL. There is a considerable posterior drawer sign. Quadriceps and patellar tendons are grossly intact. There is a small knee joint effusion but no lipohemarthrosis.
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3,882
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EXAM: CT Angio Chest wo+w contrast CLINICAL INFORMATION: COVID 19 with dyspnea. Rule out pulmonary embolism. COMPARISON: Chest radiograph earlier same day. TECHNIQUE: CT Angio Chest wo+w contrast. Additional 3D image post-processing was performed to generate MIP and/or volume-rendered images. Patient weight: 360 lbs. IV contrast: Omnipaque 350, 76 ml, per protocol. Saline flush: 50 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 299 mm. KVP: 120 DLP: 921 mGy cm. FINDINGS: STRUCTURED REPORT: CT PE OVERALL DIAGNOSTIC QUALITY: Suboptimal bolus timing limits evaluation of segmental and subsegmental pulmonary arteries LOWER NECK: No abnormality. CHEST: PULMONARY ARTERIES: Negative for pulmonary embolus in the central and proximal segmental pulmonary arteries. LUNGS / AIRWAYS / PLEURA: The central airways are patent. Scattered lower lung and peripheral predominant patchy groundglass opacities throughout the bilateral lungs. No pleural effusion or pneumothorax. HEART / OTHER VESSELS: The heart is normal in size without pericardial effusion. The thoracic aorta is normal in caliber. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Postsurgical changes from sleeve gastrectomy. Hepatic steatosis. MUSCULOSKELETAL: No aggressive osseous lesions. Mild multilevel degenerative changes of the thoracic spine. CONCLUSION: 1. No evidence of acute pulmonary embolus in the central or proximal segmental pulmonary arteries. 2. Bilateral pulmonary airspace opacities consistent with COVID pneumonia. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: STRUCTURED REPORT: CT PE OVERALL DIAGNOSTIC QUALITY: Suboptimal bolus timing limits evaluation of segmental and subsegmental pulmonary arteries LOWER NECK: No abnormality. CHEST: PULMONARY ARTERIES: Negative for pulmonary embolus in the central and proximal segmental pulmonary arteries. LUNGS / AIRWAYS / PLEURA: The central airways are patent. Scattered lower lung and peripheral predominant patchy groundglass opacities throughout the bilateral lungs. No pleural effusion or pneumothorax. HEART / OTHER VESSELS: The heart is normal in size without pericardial effusion. The thoracic aorta is normal in caliber. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Postsurgical changes from sleeve gastrectomy. Hepatic steatosis. MUSCULOSKELETAL: No aggressive osseous lesions. Mild multilevel degenerative changes of the thoracic spine.
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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Absent. PANCREAS: Small amount of parenchymal calcification, likely related to chronic pancreatitis. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Colonic diverticulosis PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Moderate aortobiiliac atherosclerosis without aneurysm. URINARY BLADDER: Decompressed REPRODUCTIVE ORGANS: Uterus is surgically absent BODY WALL: No significant abnormality. MUSCULOSKELETAL: Multilevel degenerative changes in the lumbar spine.
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3,883
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EXAM: CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: 61-year-old female with pancreatitis and sepsis. COMPARISON: None. TECHNIQUE: CT Abdomen and Pelvis w contrast. Patient weight: 165 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 90 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 78 sec Scan field of view: 308 mm. DLP: 1014 mGy cm. FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Minimal bibasilar atelectatic changes. Small left greater than right pleural effusions. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Normal sized cardiac chambers. Trace pericardial effusion. ABDOMEN and PELVIS: LIVER: Noncirrhotic morphology. Two subcentimeter hypoattenuating lesions in the left hepatic lobe. No other significant abnormality. BILIARY TRACT: Normal. No definite evidence of choledocholithiasis. GALLBLADDER: Cholelithiasis. No gallbladder wall thickening or pericholecystic fluid. PANCREAS: Diffuse pancreatic swelling with focal areas of relative hypoenhancement in the region of the head (series 3 image 117) anterior (series 3 image 76) may be due to increased focal edema. Diffuse peripancreatic fluid and fat stranding. SPLEEN: Wedge-shaped area of hypoattenuation anteriorly, suggestive of a splenic infarct. ADRENALS: Bilateral adrenal thickening, likely representing adrenal hyperplasia. KIDNEYS: Patchy areas of subcortical hypoenhancement involving the left greater than right kidneys. Nonobstructing calculus in the left lower renal pole measuring 5 mm. No hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Esophagogastric tube in place with tip terminating in the proximal duodenum. Stomach is decompressed with mild wall edema, otherwise unremarkable. Small bowel is normal in appearance. COLON / APPENDIX: Mild thickening of the sigmoid colon, splenic flexure with surrounding fat stranding, may be reactive or may be due to mild inflammation. No abnormal dilation. PERITONEUM / MESENTERY: Irregular pocket of fluid without definite walls distal to the pancreatic tail measures approximately 4.3 x 2.3 cm (series 3 image 80). Small pocket of fluid is also present along the greater curvature of the stomach (series 3 image 61). Small volume free fluid. Mesenteric stranding and edema, as above. RETROPERITONEUM: Mild retroperitoneal edema. No other significant abnormality. VESSELS: Splenic artery appears significantly attenuated and thinned in caliber. Mild calcific atherosclerosis of the abdominal aorta and its branch vessels. Probable penetrating aortic ulcer/ulcerated plaque in the aorta just cranial to the origin of the celiac artery (series 3 image 81). Left internal iliac artery shows high-grade stenosis (series 3 image 224). Right femoral approach venous catheter in place with small amount of nonocclusive catheter associated thrombus in the right common iliac vein. URINARY BLADDER: Decompressed with indwelling Foley catheter. REPRODUCTIVE ORGANS: Asymmetric hypoenhancement of the left uterine body. Distal endometrial cavity is fluid-filled. No adnexal mass. BODY WALL: Mild diffuse body wall anasarca. Fat-containing bilateral inguinal hernias. Catheter in the right femoral vein with small focus of gas likely iatrogenic. MUSCULOSKELETAL: No significant abnormality. Degenerative changes in spine. CONCLUSION: 1. Findings compatible with interstitial edematous pancreatitis with acute peripancreatic fluid collections as above. 2. Wedge-shaped area of hypoenhancement in the anterior spleen, concerning for splenic infarction. 3. Diffuse linear areas of subcortical hypoenhancement in the left greater than right kidneys. This finding is nonspecific but may represent developing renal infarcts or renal cortical/tubular necrosis. No hydronephrosis. 4. Suspected left uterine ischemia/developing infarct. High grade stenosis in the left internal iliac artery. 5. Nonocclusive catheter associated thrombus in the right common iliac vein. 6. Fluid-filled distal endometrial canal. Nonemergent outpatient follow-up evaluation with pelvic ultrasound is recommended. Additional chronic and incidental findings as above. *****IMPORTANT INCIDENTAL IMAGING FINDINGS REPORTED***** These findings were reported to Dr. Jennifer Heim at 6:34 PM on 1/9/2022 by Dr. Dylan Bittles. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Minimal bibasilar atelectatic changes. Small left greater than right pleural effusions. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Normal sized cardiac chambers. Trace pericardial effusion. ABDOMEN and PELVIS: LIVER: Noncirrhotic morphology. Two subcentimeter hypoattenuating lesions in the left hepatic lobe. No other significant abnormality. BILIARY TRACT: Normal. No definite evidence of choledocholithiasis. GALLBLADDER: Cholelithiasis. No gallbladder wall thickening or pericholecystic fluid. PANCREAS: Diffuse pancreatic swelling with focal areas of relative hypoenhancement in the region of the head (series 3 image 117) anterior (series 3 image 76) may be due to increased focal edema. Diffuse peripancreatic fluid and fat stranding. SPLEEN: Wedge-shaped area of hypoattenuation anteriorly, suggestive of a splenic infarct. ADRENALS: Bilateral adrenal thickening, likely representing adrenal hyperplasia. KIDNEYS: Patchy areas of subcortical hypoenhancement involving the left greater than right kidneys. Nonobstructing calculus in the left lower renal pole measuring 5 mm. No hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Esophagogastric tube in place with tip terminating in the proximal duodenum. Stomach is decompressed with mild wall edema, otherwise unremarkable. Small bowel is normal in appearance. COLON / APPENDIX: Mild thickening of the sigmoid colon, splenic flexure with surrounding fat stranding, may be reactive or may be due to mild inflammation. No abnormal dilation. PERITONEUM / MESENTERY: Irregular pocket of fluid without definite walls distal to the pancreatic tail measures approximately 4.3 x 2.3 cm (series 3 image 80). Small pocket of fluid is also present along the greater curvature of the stomach (series 3 image 61). Small volume free fluid. Mesenteric stranding and edema, as above. RETROPERITONEUM: Mild retroperitoneal edema. No other significant abnormality. VESSELS: Splenic artery appears significantly attenuated and thinned in caliber. Mild calcific atherosclerosis of the abdominal aorta and its branch vessels. Probable penetrating aortic ulcer/ulcerated plaque in the aorta just cranial to the origin of the celiac artery (series 3 image 81). Left internal iliac artery shows high-grade stenosis (series 3 image 224). Right femoral approach venous catheter in place with small amount of nonocclusive catheter associated thrombus in the right common iliac vein. URINARY BLADDER: Decompressed with indwelling Foley catheter. REPRODUCTIVE ORGANS: Asymmetric hypoenhancement of the left uterine body. Distal endometrial cavity is fluid-filled. No adnexal mass. BODY WALL: Mild diffuse body wall anasarca. Fat-containing bilateral inguinal hernias. Catheter in the right femoral vein with small focus of gas likely iatrogenic. MUSCULOSKELETAL: No significant abnormality. Degenerative changes in spine.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Mild bibasilar bronchiectasis. DISTAL ESOPHAGUS: Prominent distal esophageal lymph node is unchanged since 2015, suggesting benignity. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Right upper pole simple cyst. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Scattered noninflamed colonic diverticula. Normal appendix. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Scattered atherosclerotic calcifications of the abdominal aorta and branch vessels. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Small fat-containing right inguinal hernia. MUSCULOSKELETAL: Lower lumbar spine degenerative changes.
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3,884
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CT Head wo contrast Clinical Information: headache Comparison: CT 6/15/2016. Technique: Unenhanced axial brain CT with sagittal and coronal reformats. Scan field of view: 249 mm. DLP: 1473.20 mGy cm. Findings: CT head: BRAIN PARENCHYMA: Asymmetric hyperdensity with adjacent small area of adjacent change in the left inferior frontal lobe, image 33, series 201). Chronic left pontine infarct, new from 2016. The gray-white matter differentiation is preserved. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No acute fracture. No aggressive osseous lesion. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal. Conclusion: Intraparenchymal hyperdensity in the left inferior frontal lobe suggesting small hemorrhage versus lesion. Recommend MR brain for further evaluation. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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Findings: CT head: BRAIN PARENCHYMA: Asymmetric hyperdensity with adjacent small area of adjacent change in the left inferior frontal lobe, image 33, series 201). Chronic left pontine infarct, new from 2016. The gray-white matter differentiation is preserved. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No acute fracture. No aggressive osseous lesion. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal.
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FINDINGS: STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: There is no focal consolidation, pleural effusion, or pneumothorax. No fibrotic, cystic or nodular lung disease. There is bilateral dependent atelectasis. No suspicious pulmonary nodule is identified. Central airways are patent. With expiration, there is no significant air trapping. There is no tracheobronchomalacia. HEART / VESSELS: Heart size is normal. No pericardial effusion. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Cholelithiasis. MUSCULOSKELETAL: No acute or aggressive appearing osseous abnormality.
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3,885
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RADIOLOGIC EXAM: CT Head wo contrast, CT Maxillofacial wo contrast CLINICAL INFORMATION: Trauma COMPARISON: None. TECHNIQUE: CT Head wo contrast, CT Maxillofacial wo contrast Scan field of view: 313 mm. DLP: 1473.90 mGy cm. (accession CT220004647), Scan field of view: 206 mm. DLP: 1092.60 mGy cm. (accession CT220004653) STRUCTURED REPORT: CT Head and Maxillofacial Trauma FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. Cerebral cortical volume is normal. EXTRA-AXIAL SPACES: Normal. VENTRICULAR SYSTEM: Normal. ORBITS: Disconjugate gaze. Otherwise normal. SKULL AND SKULL BASE: No fracture. There is a small amount of fluid layering dependently within the right mastoid air cells. Left mastoid air cells are clear. FACIAL BONES: Normal. MANDIBLE: Normal. SINONASAL CAVITIES: Well-aerated. SOFT TISSUES: Injury to the left ear with gas tracking along the left frontotemporal scalp and within the soft tissues of the posterior left neck. The left external auditory canal and middle ear are clear. CONCLUSION: 1. No acute intracranial abnormality or maxillofacial fracture. 2. Left ear avulsion injury with small amount of adjacent subcutaneous gas. The left external auditory canal, middle ear and mastoid air cells are clear. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. Cerebral cortical volume is normal. EXTRA-AXIAL SPACES: Normal. VENTRICULAR SYSTEM: Normal. ORBITS: Disconjugate gaze. Otherwise normal. SKULL AND SKULL BASE: No fracture. There is a small amount of fluid layering dependently within the right mastoid air cells. Left mastoid air cells are clear. FACIAL BONES: Normal. MANDIBLE: Normal. SINONASAL CAVITIES: Well-aerated. SOFT TISSUES: Injury to the left ear with gas tracking along the left frontotemporal scalp and within the soft tissues of the posterior left neck. The left external auditory canal and middle ear are clear.
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Findings: No enlarged hilar or mediastinal nodes are present. The mediastinum is normal. Few small (less than 6 mm) pulmonary nodules are unchanged. For reference, a 2 mm right upper lobe nodule (image 71, series 3), a 2 mm left upper lobe subpleural nodule (image 69), and a 3 mm left lower lobe subpleural nodule adjacent to the major fissure (image 146) are stable. No new or enlarging suspicious pulmonary nodule. Scattered calcified granulomas. Left lower lobe subsegmental atelectasis/scarring, similar to prior. Severe mixed upper lobe predominant emphysema with multiple emphysematous bullae. The trachea and main bronchi are patent. No pleural effusion. Coronary artery calcification: The visual score of calcification is 4. (Based on a publication by Kirsch et al (Detection of Coronary calcium During Standard Chest Computed Tomography Correlates With Multi-Detector Computed Tomography Coronary Artery Calcium score, Int J Cardiovasc Imaging (2012) 28:1249-1256), visual score >7 is associated with an Agatston score > 400 and independently validated increased incidence of cardiovascular mortality). Abdomen: Splenic granulomas. Partially visualized high attenuation left upper pole renal lesion, unchanged. The visualized liver, adrenals and bowel are unremarkable. Bones: Unremarkable.
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3,886
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EXAM: CT Abdomen and Pelvis w contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat, CT Chest with contrast CLINICAL INFORMATION: Trauma COMPARISON: CT chest abdomen and pelvis 6/20/2020 TECHNIQUE: CT Abdomen and Pelvis w contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat, CT Chest with contrast. Patient weight: 180 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 80 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 437 mm. (accession CT220004649), Patient weight: 180 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 80 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 437 mm. DLP: 882.20 mGy cm. (accession CT220004648), Patient weight: 180 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 80 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 437 mm. (accession CT220004652), Patient weight: 180 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 80 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 437 mm. (accession CT220004651) FINDINGS: STRUCTURED REPORT: CT Chest, Abdomen, and Pelvis with Thoracic and Lumbar Spine LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: The central airways are patent. Moderate paraseptal emphysema with large right apical bulla and bilateral blebs. Mild bilateral dependent atelectasis. HEART / VESSELS: The heart is normal in size without pericardial effusion. Aberrant right subclavian artery courses posterior to the esophagus. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: Streak artifact from adjacent arms limits evaluation for subtle injuries. 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: Moderately distended. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Chronic appearing Hill-Sachs deformity of the left humeral head. Irregularity of the anterior inferior left bony glenoid is also chronic appearing. THORACIC AND LUMBAR SPINE: VERTEBRA: No fracture. Transitional lumbosacral vertebra. Partial lumbarization of S1. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. CONCLUSION: 1. No evidence of acute traumatic injury in the chest, abdomen, or pelvis. 2. No acute fracture or malalignment of the thoracic or lumbar spine. 3. Left glenohumeral joint effusion. Left shoulder dislocation seen on same-day radiograph has been reduced without residual malalignment. Irregularity of the left glenoid rim and impaction fracture deformity of the humeral head appear chronic. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: STRUCTURED REPORT: CT Chest, Abdomen, and Pelvis with Thoracic and Lumbar Spine LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: The central airways are patent. Moderate paraseptal emphysema with large right apical bulla and bilateral blebs. Mild bilateral dependent atelectasis. HEART / VESSELS: The heart is normal in size without pericardial effusion. Aberrant right subclavian artery courses posterior to the esophagus. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: Streak artifact from adjacent arms limits evaluation for subtle injuries. 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: Moderately distended. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Chronic appearing Hill-Sachs deformity of the left humeral head. Irregularity of the anterior inferior left bony glenoid is also chronic appearing. THORACIC AND LUMBAR SPINE: VERTEBRA: No fracture. Transitional lumbosacral vertebra. Partial lumbarization of S1. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal.
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Findings: CT head: BRAIN PARENCHYMA: No hemorrhage, intracranial mass, large territory infarct, or edema. Gray-white matter differentiation maintained. Subcortical and periventricular hypodensities likely represent chronic microangiopathy changes. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No acute fracture. No aggressive osseous lesion. VENTRICULAR SYSTEM: Ex vacuo ventriculomegaly with mild asymmetry of the lateral ventricles, left larger than right, which may be due to patient rotation. There is a cavum septum pellucidum. ORBITS: Normal. SINUSES: Small mucosal retention cyst in the left maxillary sinus. Otherwise the visualized paranasal sinuses and mastoid air cells are clear.
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3,887
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EXAM: CT Abdomen and Pelvis w contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat, CT Chest with contrast CLINICAL INFORMATION: Trauma COMPARISON: CT chest abdomen and pelvis 6/20/2020 TECHNIQUE: CT Abdomen and Pelvis w contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat, CT Chest with contrast. Patient weight: 180 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 80 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 437 mm. (accession CT220004649), Patient weight: 180 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 80 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 437 mm. DLP: 882.20 mGy cm. (accession CT220004648), Patient weight: 180 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 80 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 437 mm. (accession CT220004652), Patient weight: 180 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 80 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 437 mm. (accession CT220004651) FINDINGS: STRUCTURED REPORT: CT Chest, Abdomen, and Pelvis with Thoracic and Lumbar Spine LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: The central airways are patent. Moderate paraseptal emphysema with large right apical bulla and bilateral blebs. Mild bilateral dependent atelectasis. HEART / VESSELS: The heart is normal in size without pericardial effusion. Aberrant right subclavian artery courses posterior to the esophagus. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: Streak artifact from adjacent arms limits evaluation for subtle injuries. 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: Moderately distended. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Chronic appearing Hill-Sachs deformity of the left humeral head. Irregularity of the anterior inferior left bony glenoid is also chronic appearing. THORACIC AND LUMBAR SPINE: VERTEBRA: No fracture. Transitional lumbosacral vertebra. Partial lumbarization of S1. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. CONCLUSION: 1. No evidence of acute traumatic injury in the chest, abdomen, or pelvis. 2. No acute fracture or malalignment of the thoracic or lumbar spine. 3. Left glenohumeral joint effusion. Left shoulder dislocation seen on same-day radiograph has been reduced without residual malalignment. Irregularity of the left glenoid rim and impaction fracture deformity of the humeral head appear chronic. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: STRUCTURED REPORT: CT Chest, Abdomen, and Pelvis with Thoracic and Lumbar Spine LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: The central airways are patent. Moderate paraseptal emphysema with large right apical bulla and bilateral blebs. Mild bilateral dependent atelectasis. HEART / VESSELS: The heart is normal in size without pericardial effusion. Aberrant right subclavian artery courses posterior to the esophagus. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: Streak artifact from adjacent arms limits evaluation for subtle injuries. 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: Moderately distended. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Chronic appearing Hill-Sachs deformity of the left humeral head. Irregularity of the anterior inferior left bony glenoid is also chronic appearing. THORACIC AND LUMBAR SPINE: VERTEBRA: No fracture. Transitional lumbosacral vertebra. Partial lumbarization of S1. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal.
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Findings: CT head: BRAIN PARENCHYMA: No hemorrhage, intracranial mass, large territory infarct, or edema. Gray-white matter differentiation maintained. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No acute fracture. No aggressive osseous lesion. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Moderate mucosal thickening and fluid of the paranasal sinuses. The mastoid air cells are clear. SOFT TISSUES: Small subgaleal hematoma over the midline posterior parietal scalp.
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3,888
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RADIOLOGIC EXAM: CT Cervical Spine From Reformat, CT Angio Neck CLINICAL INFORMATION: Trauma. COMPARISON: 6/20/20 TECHNIQUE: CT Cervical Spine From Reformat, CT Angio Neck 3-D CT MIP and Volume rendered angiographic images were generated in post processing. Patient weight: 180 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 80 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 288 mm. DLP: 993.70 mGy cm. STRUCTURED REPORT: CT Cervical Spine Trauma, CT Angiogram Neck FINDINGS: CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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FINDINGS: CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Right lower lobe scarring/atelectasis. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Embolic coils in the right hepatic lobe. BILIARY TRACT: Normal. GALLBLADDER: Absent. 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: IVC filter is in place below the level of the main renal veins; however, there is an accessory right lower pole renal vein slightly more inferiorly that is near the cranial margin of the IVC filter. There is a small amount of adherent thrombus in the central portion of the filter elements, for example on image 120 series 5. Overall amount of thrombus has decreased compared to the study dated 8/23/2021. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Chronic right rib fractures.
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3,889
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EXAM: CT Abdomen and Pelvis w contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat, CT Chest with contrast CLINICAL INFORMATION: Trauma COMPARISON: CT chest abdomen and pelvis 6/20/2020 TECHNIQUE: CT Abdomen and Pelvis w contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat, CT Chest with contrast. Patient weight: 180 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 80 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 437 mm. (accession CT220004649), Patient weight: 180 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 80 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 437 mm. DLP: 882.20 mGy cm. (accession CT220004648), Patient weight: 180 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 80 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 437 mm. (accession CT220004652), Patient weight: 180 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 80 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 437 mm. (accession CT220004651) FINDINGS: STRUCTURED REPORT: CT Chest, Abdomen, and Pelvis with Thoracic and Lumbar Spine LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: The central airways are patent. Moderate paraseptal emphysema with large right apical bulla and bilateral blebs. Mild bilateral dependent atelectasis. HEART / VESSELS: The heart is normal in size without pericardial effusion. Aberrant right subclavian artery courses posterior to the esophagus. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: Streak artifact from adjacent arms limits evaluation for subtle injuries. 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: Moderately distended. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Chronic appearing Hill-Sachs deformity of the left humeral head. Irregularity of the anterior inferior left bony glenoid is also chronic appearing. THORACIC AND LUMBAR SPINE: VERTEBRA: No fracture. Transitional lumbosacral vertebra. Partial lumbarization of S1. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. CONCLUSION: 1. No evidence of acute traumatic injury in the chest, abdomen, or pelvis. 2. No acute fracture or malalignment of the thoracic or lumbar spine. 3. Left glenohumeral joint effusion. Left shoulder dislocation seen on same-day radiograph has been reduced without residual malalignment. Irregularity of the left glenoid rim and impaction fracture deformity of the humeral head appear chronic. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: STRUCTURED REPORT: CT Chest, Abdomen, and Pelvis with Thoracic and Lumbar Spine LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: The central airways are patent. Moderate paraseptal emphysema with large right apical bulla and bilateral blebs. Mild bilateral dependent atelectasis. HEART / VESSELS: The heart is normal in size without pericardial effusion. Aberrant right subclavian artery courses posterior to the esophagus. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: Streak artifact from adjacent arms limits evaluation for subtle injuries. 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: Moderately distended. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Chronic appearing Hill-Sachs deformity of the left humeral head. Irregularity of the anterior inferior left bony glenoid is also chronic appearing. THORACIC AND LUMBAR SPINE: VERTEBRA: No fracture. Transitional lumbosacral vertebra. Partial lumbarization of S1. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal.
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FINDINGS: STRUCTURED REPORT: CT Chest PE and Abdomen Pelvis OVERALL DIAGNOSTIC QUALITY: Mildly suboptimal quality with incomplete evaluation of subsegmental pulmonary arteries. LOWER NECK: No abnormality. CHEST: PULMONARY ARTERIES: Positive for pulmonary embolus. - Pulmonary Embolus Distribution: Nonocclusive subsegmental emboli in the left lower lobe (series 401 image 80) versus motion artifacts. Questionable right lower lobe subsegmental nonocclusive embolus (image 89), similar to CT 7/15/2021. - Pulmonary Artery Diameter: 3.1 cm, unchanged. - Ascending Aortic Diameter: 3.2 cm. - RV:LV Ratio: Normal. - Interventricular Septum: Normal. - Contrast reflux into IVC: No significant abnormality. LUNGS / AIRWAYS / PLEURA: Normal. Previously noted opacities have resolved. HEART / OTHER VESSELS: Right IJ port with tip in proximal right atrium. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Calcific densities along the right greater than left hemidiaphragms, increased. Additional hyperdensities within the left lobe intersegmental region are new. Left lateral segment vascular shunt, unchanged. BILIARY TRACT: Prominent common bile duct with diameter at the head of the pancreas measuring approximately 8 mm in size. No distal obstructing etiology is demonstrated. GALLBLADDER: Cholelithiasis. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Stomach is unremarkable. Abnormal midgut rotation without evidence of bowel obstruction. Orally administered contrast transits into the distal small bowel loops and proximal ascending colon. COLON / APPENDIX: Colonic loops displaced to the left hemiabdomen secondary to gut malrotation. Bowel loops are poorly evaluated secondary to motion artifacts. PERITONEUM / MESENTERY: Multiple calcified peritoneal nodules are redemonstrated related to peritoneal carcinomatosis. Index calcified nodule in the left upper abdominal mesentery measures approximately 2.6 x 1.3 cm (image 103, series 701). Hemoperitoneum has decreased, with probable small amount of residual blood in the pelvis. No pneumoperitoneum. RETROPERITONEUM: Normal. OTHER VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus and ovaries are absent. Left adnexal implant measuring approximately 6.7 x 5.3 cm (series 701 image 225), similar to prior. BODY WALL: Right chest port. Interval removal of midline abdominal surgical staples. Interval dehiscence of the mid and lower anterior abdominal wall surgical wound with extensive fat stranding, multiple pockets of gas and scattered fluid within the abdominal wall defect. There is no intraperitoneal extension of gas and fluid in this region. Small bowel loops are likely adherent to the anterior abdominal wall in this region. Involving there is cutaneous thickening and extensive subcutaneous fat stranding in relation to the surgical wound extending into the anterior abdominal wall pannus. MUSCULOSKELETAL: Degenerative spine changes. No aggressive osseous lesion.
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3,890
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EXAM: CT Abdomen and Pelvis w contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat, CT Chest with contrast CLINICAL INFORMATION: Trauma COMPARISON: CT chest abdomen and pelvis 6/20/2020 TECHNIQUE: CT Abdomen and Pelvis w contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat, CT Chest with contrast. Patient weight: 180 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 80 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 437 mm. (accession CT220004649), Patient weight: 180 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 80 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 437 mm. DLP: 882.20 mGy cm. (accession CT220004648), Patient weight: 180 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 80 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 437 mm. (accession CT220004652), Patient weight: 180 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 80 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 437 mm. (accession CT220004651) FINDINGS: STRUCTURED REPORT: CT Chest, Abdomen, and Pelvis with Thoracic and Lumbar Spine LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: The central airways are patent. Moderate paraseptal emphysema with large right apical bulla and bilateral blebs. Mild bilateral dependent atelectasis. HEART / VESSELS: The heart is normal in size without pericardial effusion. Aberrant right subclavian artery courses posterior to the esophagus. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: Streak artifact from adjacent arms limits evaluation for subtle injuries. 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: Moderately distended. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Chronic appearing Hill-Sachs deformity of the left humeral head. Irregularity of the anterior inferior left bony glenoid is also chronic appearing. THORACIC AND LUMBAR SPINE: VERTEBRA: No fracture. Transitional lumbosacral vertebra. Partial lumbarization of S1. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. CONCLUSION: 1. No evidence of acute traumatic injury in the chest, abdomen, or pelvis. 2. No acute fracture or malalignment of the thoracic or lumbar spine. 3. Left glenohumeral joint effusion. Left shoulder dislocation seen on same-day radiograph has been reduced without residual malalignment. Irregularity of the left glenoid rim and impaction fracture deformity of the humeral head appear chronic. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: STRUCTURED REPORT: CT Chest, Abdomen, and Pelvis with Thoracic and Lumbar Spine LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: The central airways are patent. Moderate paraseptal emphysema with large right apical bulla and bilateral blebs. Mild bilateral dependent atelectasis. HEART / VESSELS: The heart is normal in size without pericardial effusion. Aberrant right subclavian artery courses posterior to the esophagus. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: Streak artifact from adjacent arms limits evaluation for subtle injuries. 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: Moderately distended. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Chronic appearing Hill-Sachs deformity of the left humeral head. Irregularity of the anterior inferior left bony glenoid is also chronic appearing. THORACIC AND LUMBAR SPINE: VERTEBRA: No fracture. Transitional lumbosacral vertebra. Partial lumbarization of S1. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal.
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FINDINGS: STRUCTURED REPORT: CT Abdomen LOWER CHEST: LUNG BASES / PLEURA: Bilateral lower lobe bronchial wall thickening with areas of mucous plugging in the right lower lobe. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Decreased size and increasing complexity of the large collection in the right hepatic lobe, which measures 8.4 x 7.7 cm on image 51 series 2, previously 15.1 x 13.2 cm. This collection now appears to be partially loculated with mixed attenuating contents in the area of previously seen simple fluid. Small amount of hyperattenuating perihepatic fluid appears similar to prior. Pigtail drainage catheter is coiled in the right hepatic lobe. There is occlusion of a branch of the portal vein supplying the upper aspect of the right hepatic lobe. BILIARY TRACT: Normal. GALLBLADDER: Collapsed. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: Multiple prominent periportal lymph nodes, for example measuring 1.7 x 1.4 cm on image 112 series 2. STOMACH / SMALL BOWEL: No abnormality. COLON: No abnormality. PERITONEUM / MESENTERY: Similar trace perihepatic fluid. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
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3,891
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RADIOLOGIC EXAM: CT Head wo contrast, CT Maxillofacial wo contrast CLINICAL INFORMATION: Trauma COMPARISON: None. TECHNIQUE: CT Head wo contrast, CT Maxillofacial wo contrast Scan field of view: 313 mm. DLP: 1473.90 mGy cm. (accession CT220004647), Scan field of view: 206 mm. DLP: 1092.60 mGy cm. (accession CT220004653) STRUCTURED REPORT: CT Head and Maxillofacial Trauma FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. Cerebral cortical volume is normal. EXTRA-AXIAL SPACES: Normal. VENTRICULAR SYSTEM: Normal. ORBITS: Disconjugate gaze. Otherwise normal. SKULL AND SKULL BASE: No fracture. There is a small amount of fluid layering dependently within the right mastoid air cells. Left mastoid air cells are clear. FACIAL BONES: Normal. MANDIBLE: Normal. SINONASAL CAVITIES: Well-aerated. SOFT TISSUES: Injury to the left ear with gas tracking along the left frontotemporal scalp and within the soft tissues of the posterior left neck. The left external auditory canal and middle ear are clear. CONCLUSION: 1. No acute intracranial abnormality or maxillofacial fracture. 2. Left ear avulsion injury with small amount of adjacent subcutaneous gas. The left external auditory canal, middle ear and mastoid air cells are clear. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. Cerebral cortical volume is normal. EXTRA-AXIAL SPACES: Normal. VENTRICULAR SYSTEM: Normal. ORBITS: Disconjugate gaze. Otherwise normal. SKULL AND SKULL BASE: No fracture. There is a small amount of fluid layering dependently within the right mastoid air cells. Left mastoid air cells are clear. FACIAL BONES: Normal. MANDIBLE: Normal. SINONASAL CAVITIES: Well-aerated. SOFT TISSUES: Injury to the left ear with gas tracking along the left frontotemporal scalp and within the soft tissues of the posterior left neck. The left external auditory canal and middle ear are clear.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Indeterminate hyperenhancing lesions seen in the inferior right hepatic lobe on image 177, series 301 measuring 1 cm. Hepatomegaly. BILIARY TRACT: Normal. GALLBLADDER: Collapsed PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Indeterminate lesion in the lower pole the left kidney has a slightly thickened wall and is higher in attenuation than a simple cyst measuring 1.5 cm on image 157, series 301. The kidneys are otherwise unremarkable. No radiopaque urinary calculus or hydronephrosis. LYMPH NODES: There are multiple enlarged periaortic and bilateral external iliac lymph nodes STOMACH / SMALL BOWEL: The small bowel is normal in caliber. The stomach is unremarkable. COLON / APPENDIX: There is thickening of the sigmoid colon particularly in the left lower quadrant with adjacent pericolonic stranding and fluid. The appendix is normal. PERITONEUM / MESENTERY: Soft tissue stranding and fluid is seen within the lower pelvis. No free fluid or free air is seen. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Severely thickened and edematous urinary bladder. No internal gas. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: There is a fat-containing and partially fluid-filled umbilical hernia. MUSCULOSKELETAL: No significant abnormality.
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3,892
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RADIOLOGIC EXAM: CT Cervical Spine From Reformat, CT Angio Neck CLINICAL INFORMATION: Trauma. COMPARISON: 6/20/20 TECHNIQUE: CT Cervical Spine From Reformat, CT Angio Neck 3-D CT MIP and Volume rendered angiographic images were generated in post processing. Patient weight: 180 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 80 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 288 mm. DLP: 993.70 mGy cm. STRUCTURED REPORT: CT Cervical Spine Trauma, CT Angiogram Neck FINDINGS: CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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FINDINGS: CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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Findings: An enlarged right hilar node measures 12 x 16 mm on series 202 image 113 and was 10 x 12 mm on the prior. No additional enlarged intrathoracic nodes are present. Slight dilatation of the esophagus is seen. Coronary artery calcification is noted. The heart size and mediastinum are otherwise normal. A few scattered calcified granuloma are seen. Tiny nodule is seen along the upper right major fissure on image 101 unchanged from the prior exam and consistent with benign intrapulmonary lymph node. The lungs are otherwise normal without suspicious nodules or masses. No pleural effusions. No focal destructive osseous lesions identified. CT abdomen and pelvis will be dictated separately.
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3,893
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CT Perfusion 1/9/2022 10:44 AM Clinical Information: Stroke. Ischemic stroke Comparison: None Technique: A CT perfusion study was performed during single pass of 50 cc contrast bolus. Axial images were acquired at 8 axial locations and time-attenuation curves generated from this dataset were utilized to calculate cerebral blood flow, mean transit time, time to peak, and cerebral blood volume maps as well as region of interest specific quantitative data. "Prognostic" color maps were also generated depicting areas of ischemia (voxel values for MTT > 1.4 times mirror image voxels on the contralateral "normal side") in the color green and areas predictive of infarction (CBV values < 2.0 ml/100g) in the color red. Patient weight: 150 lbs. IV contrast: Omnipaque 350, 80 ml, per protocol. Saline flush: 60 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 0 sec. Scan field of view: 226 mm. DLP: 1416 mGy cm. Findings:. Color parametric maps demonstrate no areas of increased mean transit time or Tmax and no areas of decreased R CBV or our CBF.. Prognostic maps demonstrate no areas of increased Tmax greater than 6 seconds and no CBF less than 30%. Conclusion: No CT perfusion evidence of acute infarction
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Findings:. Color parametric maps demonstrate no areas of increased mean transit time or Tmax and no areas of decreased R CBV or our CBF.. Prognostic maps demonstrate no areas of increased Tmax greater than 6 seconds and no CBF less than 30%.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis ABDOMEN and PELVIS: LIVER: Subcentimeter foci of hypoattenuation scattered throughout the liver are too small for accurate characterization but likely represent cysts. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Left upper pole cyst. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Mild atherosclerotic calcifications of the abdominal aorta and branch vessels. Retroaortic left renal vein. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Prostate gland is mildly enlarged. BODY WALL: Fat-containing left inguinal hernia. MUSCULOSKELETAL: No significant abnormality.
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3,894
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Radiologic Exam: CT Angio Neck, CT Venogram Head 1/9/2022 11:07 AM Clinical Information: CODE STROKE: Acute Symptoms. Comparison: CT head and CT perfusion dated same day. Technique: Helical CT images were obtained before and after the administration of contrast from the base of the skull to the vertex. Contrast enhanced CT angiographic images were obtained from the superior mediastinum to the vertex during the arterial phase. 3-D CT angiographic images were generated from the axial data set under the supervision of the reporting physician. Results are reported below. "Sliding MIP" images were also generated in the sagittal, axial, and coronal planes. Patient weight: 160 lbs. IV contrast: Omnipaque 350, 80 ml, per protocol. Saline flush: 40 ml. IV contrast injection rate: 3.50 ml per sec. Scan delay: bolus tracked Scan field of view: 287 mm. DLP: 2959 mGy cm. (accession CT220004639), Patient weight: 160 lbs. IV contrast: Omnipaque 350, 80 ml, per protocol. Saline flush: 40 ml. IV contrast injection rate: 3.50 ml per sec. Scan delay: bolus tracked Scan field of view: 287 mm. DLP: 232 mGy cm. (accession CT220004656) FINDINGS: CT angiogram of the brain: RIGHT CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. ANTERIOR, MIDDLE, AND POSTERIOR CEREBRAL ARTERIES: Unremarkable. VERTEBROBASILAR ARTERIES: There is no evidence of stenosis, occlusion, or aneurysmal dilation. CT angiogram of the neck: AORTIC ARCH and PROXIMAL GREAT VESSELS: Conventional three-vessel branching pattern. Unremarkable. RIGHT CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. RIGHT VERTEBRAL ARTERY: There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT VERTEBRAL ARTERY: There is no evidence of stenosis, occlusion, or aneurysmal dilation. Both internal jugular veins appear within normal limits SOFT TISSUES: Subcentimeter left thyroid lobe hypodense nodule. CERVICAL SPINE: Reversal of the normal cervical lordosis. No spondylolisthesis. No significant degenerative disease. CT venogram: There is no evidence of venous sinus thrombosis. There is normal asymmetric size of the right transverse sinus relative to the left. The deep cerebral veins also appear patent. Included portions of the internal jugular veins appear patent. CONCLUSION: No evidence of acute arterial or venous pathology. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: CT angiogram of the brain: RIGHT CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. ANTERIOR, MIDDLE, AND POSTERIOR CEREBRAL ARTERIES: Unremarkable. VERTEBROBASILAR ARTERIES: There is no evidence of stenosis, occlusion, or aneurysmal dilation. CT angiogram of the neck: AORTIC ARCH and PROXIMAL GREAT VESSELS: Conventional three-vessel branching pattern. Unremarkable. RIGHT CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. RIGHT VERTEBRAL ARTERY: There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT VERTEBRAL ARTERY: There is no evidence of stenosis, occlusion, or aneurysmal dilation. Both internal jugular veins appear within normal limits SOFT TISSUES: Subcentimeter left thyroid lobe hypodense nodule. CERVICAL SPINE: Reversal of the normal cervical lordosis. No spondylolisthesis. No significant degenerative disease. CT venogram: There is no evidence of venous sinus thrombosis. There is normal asymmetric size of the right transverse sinus relative to the left. The deep cerebral veins also appear patent. Included portions of the internal jugular veins appear patent.
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FINDINGS: BRAIN PARENCHYMA: No intraparenchymal hemorrhage, mass effect or edema. Diffuse cerebral cortical volume loss. Gray-white matter attenuation differentiation is preserved. Bilateral basal ganglia calcifications. Periventricular white matter hypoattenuation consistent with chronic microangiopathy. EXTRA-AXIAL SPACES: No epidural, subdural, or subarachnoid hemorrhage. VENTRICULAR SYSTEM: Stable ex vacuo dilation. VESSELS: Bilateral carotid siphon calcifications. SKULL AND SKULL BASE: No acute fracture. ORBITS: Normal. SINUSES: Well aerated. MASTOIDS: Clear. SOFT TISSUES: Unremarkable.
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3,895
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RADIOLOGIC EXAM: CT Head wo contrast CLINICAL INFORMATION: Trauma. COMPARISON: None. TECHNIQUE: CT Head wo contrastScan field of view: 230 mm. DLP: 1310 mGy cm. STRUCTURED REPORT: CT Head FINDINGS: BRAIN PARENCHYMA: There is no acute intracranial hemorrhage or acute infarct. No brain edema or mass effect. Diffuse cerebral volume loss and chronic white matter microangiopathic changes. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal. CONCLUSION: No acute intracranial process.
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FINDINGS: BRAIN PARENCHYMA: There is no acute intracranial hemorrhage or acute infarct. No brain edema or mass effect. Diffuse cerebral volume loss and chronic white matter microangiopathic changes. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal.
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Findings: Brain parenchyma: Mild diffuse age-appropriate brain parenchymal volume loss is seen, resulting in mild exvacuodilatation of the ventricular system.. The white-gray matter differentiation is preserved. Ventricular system: Normal configuration. No hydrocephalus. Basal cisterns: There is no significant effacement of the basilar cisterns. Extra-axial spaces: Normal appearance. No abnormal extra-axial fluid collections. Hemorrhage: No intracranial hemorrhage is identified. Midline shift: No significant midline shift is seen. Vascular system: Punctate atherosclerotic calcifications of the bilateral carotid siphons.. Soft tissues: Unremarkable without discrete fluid collections. Orbits: Normal appearance. Calvarium and skull base: Incidental partially empty sella. No acute fractures or suspicious osseous lesions identified. The bilateral mastoid air cell complexes are well-developed and clear. Paranasal sinuses: Well aerated.
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3,896
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EXAM: CT Abdomen and Pelvis w contrast, CT Chest with contrast CLINICAL INFORMATION: Trauma. Fall from standing COMPARISON: None. TECHNIQUE: CT Abdomen and Pelvis w contrast, CT Chest with contrast. Patient weight: 120 lbs. IV contrast: Omnipaque 350, 80 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 3.50 ml per sec. Scan delay: 72 sec. Scan field of view: 361.80 mm. (accession CT220004659), Patient weight: 120 lbs. IV contrast: Omnipaque 350, 80 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 3.50 ml per sec. Scan delay: 70 sec. Scan field of view: 361.80 mm. DLP: 689.90 mGy cm. (accession CT220004658) FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Bilateral dependent atelectasis and basilar predominant to upper septal thickening. No focal consolidation, pleural effusion, or pneumothorax. Central airways are patent. HEART / VESSELS: Heart size is normal. No pericardial effusion. Mild atherosclerotic disease of the left anterior descending coronary artery. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Noncirrhotic abnormality. Focal fatty sparing along the falciform ligament. BILIARY TRACT: Mild intrahepatic and extra hepatic biliary ductal dilatation likely related to post cholecystectomy state. GALLBLADDER: Surgically absent PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Right lower pole renal cyst measuring 1.8 cm on series 501 image 218. There are additional bilateral too small to characterize hypodensities, likely representing benign cysts. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Colonic diverticulosis without diverticulitis. Appendix is not well seen. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Moderate atherosclerosis. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus is absent. No adnexal masses. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Comminuted intertrochanteric fracture of the right femur with surrounding intramuscular hematoma. The femoral heads are well-seated within their acetabula. VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. Moderate degenerative changes of the mid to lower lumbar spine most pronounced at L3-L4 grade 1 anterolisthesis of L3 on L4. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. CONCLUSION: 1. Comminuted intertrochanteric right femur fracture. There is no displacement of the right femoral head. 2. No other acute traumatic abnormality within the chest, abdomen, or pelvis. 3. There is a predominant interlobular septal thickening may be related to mild pulmonary edema versus atypical/viral pneumonia. 4. Additional chronic and incidental findings as above including atherosclerotic disease with coronary artery calcifications. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Bilateral dependent atelectasis and basilar predominant to upper septal thickening. No focal consolidation, pleural effusion, or pneumothorax. Central airways are patent. HEART / VESSELS: Heart size is normal. No pericardial effusion. Mild atherosclerotic disease of the left anterior descending coronary artery. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Noncirrhotic abnormality. Focal fatty sparing along the falciform ligament. BILIARY TRACT: Mild intrahepatic and extra hepatic biliary ductal dilatation likely related to post cholecystectomy state. GALLBLADDER: Surgically absent PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Right lower pole renal cyst measuring 1.8 cm on series 501 image 218. There are additional bilateral too small to characterize hypodensities, likely representing benign cysts. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Colonic diverticulosis without diverticulitis. Appendix is not well seen. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Moderate atherosclerosis. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus is absent. No adnexal masses. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Comminuted intertrochanteric fracture of the right femur with surrounding intramuscular hematoma. The femoral heads are well-seated within their acetabula. VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. Moderate degenerative changes of the mid to lower lumbar spine most pronounced at L3-L4 grade 1 anterolisthesis of L3 on L4. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal.
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FINDINGS: STRUCTURED REPORT: CT CAP LOWER NECK: Heterogeneous thyroid with enlarged left lobe. CHEST: LUNGS / AIRWAYS / PLEURA: Bilateral subsegmental atelectasis. Calcified left lower lobe granuloma. No pneumothorax or hemothorax. HEART / VESSELS: Trace calcified coronary atherosclerosis. MEDIASTINUM / ESOPHAGUS: Anterior inferior pneumomediastinum with questionable trace pneumopericardium. Esophagogastric tube. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. DIAPHRAGM: Motion limits evaluation. No definite defect. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Small amount of perisplenic hematoma. No parenchymal injury. ADRENALS: Normal. KIDNEYS: Multiple cystic lesions in the left kidney, some too small to characterize, with large multilobulated cyst in the lower pole. Nonobstructing left nephrolithiasis. No acute injury. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Esophogastric tube with tip terminating in gastric body. Small amount of hemorrhage posterior to the gastric fundal wall. No gross wall defect. COLON / APPENDIX: No acute injury. Diverticula without inflammation. Appendix is normal. PERITONEUM / MESENTERY: Scattered foci of pneumoperitoneum. Small volume hemoperitoneum. RETROPERITONEUM: Nonspecific perinephric stranding. VESSELS: Trace calcified atherosclerosis. URINARY BLADDER: Decompressed by Foley catheter. REPRODUCTIVE ORGANS: Prostatomegaly. BODY WALL: Subcutaneous gas/stranding along the left paramedian upper abdomen related to stab injury. Interval placement of midline staples. Fat-containing umbilical hernia. MUSCULOSKELETAL: Degenerative spine changes.
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3,897
|
EXAM: CT Abdomen and Pelvis w contrast, CT Chest with contrast CLINICAL INFORMATION: Trauma. Fall from standing COMPARISON: None. TECHNIQUE: CT Abdomen and Pelvis w contrast, CT Chest with contrast. Patient weight: 120 lbs. IV contrast: Omnipaque 350, 80 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 3.50 ml per sec. Scan delay: 72 sec. Scan field of view: 361.80 mm. (accession CT220004659), Patient weight: 120 lbs. IV contrast: Omnipaque 350, 80 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 3.50 ml per sec. Scan delay: 70 sec. Scan field of view: 361.80 mm. DLP: 689.90 mGy cm. (accession CT220004658) FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Bilateral dependent atelectasis and basilar predominant to upper septal thickening. No focal consolidation, pleural effusion, or pneumothorax. Central airways are patent. HEART / VESSELS: Heart size is normal. No pericardial effusion. Mild atherosclerotic disease of the left anterior descending coronary artery. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Noncirrhotic abnormality. Focal fatty sparing along the falciform ligament. BILIARY TRACT: Mild intrahepatic and extra hepatic biliary ductal dilatation likely related to post cholecystectomy state. GALLBLADDER: Surgically absent PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Right lower pole renal cyst measuring 1.8 cm on series 501 image 218. There are additional bilateral too small to characterize hypodensities, likely representing benign cysts. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Colonic diverticulosis without diverticulitis. Appendix is not well seen. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Moderate atherosclerosis. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus is absent. No adnexal masses. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Comminuted intertrochanteric fracture of the right femur with surrounding intramuscular hematoma. The femoral heads are well-seated within their acetabula. VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. Moderate degenerative changes of the mid to lower lumbar spine most pronounced at L3-L4 grade 1 anterolisthesis of L3 on L4. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. CONCLUSION: 1. Comminuted intertrochanteric right femur fracture. There is no displacement of the right femoral head. 2. No other acute traumatic abnormality within the chest, abdomen, or pelvis. 3. There is a predominant interlobular septal thickening may be related to mild pulmonary edema versus atypical/viral pneumonia. 4. Additional chronic and incidental findings as above including atherosclerotic disease with coronary artery calcifications. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Bilateral dependent atelectasis and basilar predominant to upper septal thickening. No focal consolidation, pleural effusion, or pneumothorax. Central airways are patent. HEART / VESSELS: Heart size is normal. No pericardial effusion. Mild atherosclerotic disease of the left anterior descending coronary artery. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Noncirrhotic abnormality. Focal fatty sparing along the falciform ligament. BILIARY TRACT: Mild intrahepatic and extra hepatic biliary ductal dilatation likely related to post cholecystectomy state. GALLBLADDER: Surgically absent PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Right lower pole renal cyst measuring 1.8 cm on series 501 image 218. There are additional bilateral too small to characterize hypodensities, likely representing benign cysts. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Colonic diverticulosis without diverticulitis. Appendix is not well seen. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Moderate atherosclerosis. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus is absent. No adnexal masses. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Comminuted intertrochanteric fracture of the right femur with surrounding intramuscular hematoma. The femoral heads are well-seated within their acetabula. VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. Moderate degenerative changes of the mid to lower lumbar spine most pronounced at L3-L4 grade 1 anterolisthesis of L3 on L4. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal.
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FINDINGS: STRUCTURED REPORT: CT CAP LOWER NECK: Heterogeneous thyroid with enlarged left lobe. CHEST: LUNGS / AIRWAYS / PLEURA: Bilateral subsegmental atelectasis. Calcified left lower lobe granuloma. No pneumothorax or hemothorax. HEART / VESSELS: Trace calcified coronary atherosclerosis. MEDIASTINUM / ESOPHAGUS: Anterior inferior pneumomediastinum with questionable trace pneumopericardium. Esophagogastric tube. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. DIAPHRAGM: Motion limits evaluation. No definite defect. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Small amount of perisplenic hematoma. No parenchymal injury. ADRENALS: Normal. KIDNEYS: Multiple cystic lesions in the left kidney, some too small to characterize, with large multilobulated cyst in the lower pole. Nonobstructing left nephrolithiasis. No acute injury. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Esophogastric tube with tip terminating in gastric body. Small amount of hemorrhage posterior to the gastric fundal wall. No gross wall defect. COLON / APPENDIX: No acute injury. Diverticula without inflammation. Appendix is normal. PERITONEUM / MESENTERY: Scattered foci of pneumoperitoneum. Small volume hemoperitoneum. RETROPERITONEUM: Nonspecific perinephric stranding. VESSELS: Trace calcified atherosclerosis. URINARY BLADDER: Decompressed by Foley catheter. REPRODUCTIVE ORGANS: Prostatomegaly. BODY WALL: Subcutaneous gas/stranding along the left paramedian upper abdomen related to stab injury. Interval placement of midline staples. Fat-containing umbilical hernia. MUSCULOSKELETAL: Degenerative spine changes.
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3,898
|
RADIOLOGIC EXAM: CT Cervical Spine From Reformat, CT Angio Neck CLINICAL INFORMATION: Trauma. COMPARISON: None. TECHNIQUE: CT Cervical Spine From Reformat, CT Angio Neck 3-D CT MIP and Volume rendered angiographic images were generated in post processing. Patient weight: 120 lbs. IV contrast: Omnipaque 350, 80 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 3.50 ml per sec. Scan delay: bolus track Scan field of view: 211.90 mm. DLP: 800.50 mGy cm. STRUCTURED REPORT: CT Cervical Spine Trauma, CT Angiogram Neck FINDINGS: CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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FINDINGS: CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Subsegmental atelectasis is seen within lung bases. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Unremarkable for technique BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: The low attenuated lesion/cystic lesion in the pancreatic body is again noted measuring 1.2 cm on image 60, series 201 (previously 1.2 cm on image 73, series 7. The pancreas is otherwise unremarkable for technique. SPLEEN: Unremarkable for technique ADRENALS: Normal. KIDNEYS: Left perinephric stranding is grossly unchanged. The kidney appears slightly more atrophic. There is no definite new large mass identified within limitations of noncontrast CT. Right nephrectomy changes are again noted. Right lower quadrant renal transplant is seen without hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: There is hyperdensity seen along the anterior wall of the rectum between the rectum and the prostate, indeterminate, measuring approximately 3.1 x 1.9 cm on image 256, series 201. This measures approximately 5.6 cm craniocaudally. There is potentially some extraluminal gas associated with this as seen on image 251, series 201. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Severe aortoiliac atherosclerosis is noted without aneurysmal dilatation. Severe calcification of the proximal SMA is again noted although the previously identified stenosis is not well-visualized without intravenous contrast. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Prostatomegaly with central prostatic calcifications, similar to the prior BODY WALL: Scarring in the left groin MUSCULOSKELETAL: Mild degenerative changes are seen within the spine. No focal destructive osseous lesion is identified.
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3,899
|
RADIOLOGIC EXAM: CT Thoracic Spine from Reformat, CT Lumbar Spine from Reformat CLINICAL INFORMATION: Trauma. COMPARISON: None. TECHNIQUE: CT Thoracic Spine from Reformat, CT Lumbar Spine from Reformat Following CT of the abdomen, reformatted images were produced to optimize visualization of the osseous structures of the thoracic and lumbar spine. FINDINGS: Thoracic: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. Chronic multilevel discogenic degenerative changes are noted. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. Lumbar: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. Moderate multilevel discogenic degenerative changes. Moderate facet arthropathy at the lower lumbar spine. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Subtle retrolisthesis of L1 on L2 and L4 on L5. Grade 1 anterolisthesis of L3 on L4. CONCLUSION: No acute osseous abnormality of the thoracic or lumbar spine. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: Thoracic: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. Chronic multilevel discogenic degenerative changes are noted. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. Lumbar: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. Moderate multilevel discogenic degenerative changes. Moderate facet arthropathy at the lower lumbar spine. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Subtle retrolisthesis of L1 on L2 and L4 on L5. Grade 1 anterolisthesis of L3 on L4.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Pelvic right kidney. Normally positioned left kidney. No hydronephrosis. Excreted contrast noted within both ureters and the bladder. No obstruction. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Stomach is unremarkable. No small bowel obstruction. COLON / APPENDIX: Mild gaseous prominence of the transverse colon. No evidence of obstruction. The appendix is not seen, however there is no inflammatory stranding in the right lower quadrant or pelvis. PERITONEUM / MESENTERY: No free fluid or free air. Mesenteric swirling as above. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Simple appearing left ovarian cyst measures 2.9 cm. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. LUMBAR SPINE: No acute fracture. The vertebral body heights are maintained. The disc spaces are maintained. No significant spinal canal or neural foraminal stenosis. The prevertebral soft tissues are normal.
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