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2,500	EXAM: CT Chest with contrast CLINICAL INFORMATION: 82-year-old female, for follow-up of pleural effusions. COMPARISON: CT chest dated 1/1/2022. TECHNIQUE: CT Chest with contrast. Patient weight: 210 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 80sec Scan field of view: 413 mm. FINDINGS: LOWER NECK: Heterogeneous thyroid gland with a few low-attenuation nodules, overall unchanged. CHEST: LUNGS / AIRWAYS / PLEURA: Interval placement of right pleural drain drainage catheter that terminates anterior to the loculated effusion component in the parenchyma, recommend repositioning. Development of small volume anterior right pneumothorax, with overall unchanged large volume multiloculated right pleural effusion and enhancing mildly thickened pleura, remains suspicious for empyema no complete atelectasis of the right lower lobe, partial atelectasis of the right middle lobe appears overall unchanged. Left basilar atelectasis. A 7 mm peripheral right upper lobe nodule on axial image 61; series 2, overall unchanged. HEART / VESSELS: Normal sized cardiac chambers. Three-vessel coronary artery calcifications. No central PE. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: A few mildly enlarged mediastinal lymph nodes, likely reactive. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Will be reported separately. MUSCULOSKELETAL: No destructive osseous lesion. Partially visualized lower cervical spine fusion hardware. CONCLUSION: 1. Interval placement of right pleural pigtail drainage catheter, that appears to terminate anterior to the collection in the parenchyma. Persistent large volume multiloculated right pleural effusion with enhancing mildly thickened pleura, remains suspicious for empyema. Interval development of small anterior right pneumothorax. The right pleural drainage catheter should be repositioned for appropriate drainage of the collection. 2 Reactive mediastinal and cardiophrenic lymph nodes. 3. Other incidental findings as above. Findings were discussed with Dr. Angela sickles by Dr. Manapragada via telephone on 1/6/2022 at around 11:15 AM .	FINDINGS: LOWER NECK: Heterogeneous thyroid gland with a few low-attenuation nodules, overall unchanged. CHEST: LUNGS / AIRWAYS / PLEURA: Interval placement of right pleural drain drainage catheter that terminates anterior to the loculated effusion component in the parenchyma, recommend repositioning. Development of small volume anterior right pneumothorax, with overall unchanged large volume multiloculated right pleural effusion and enhancing mildly thickened pleura, remains suspicious for empyema no complete atelectasis of the right lower lobe, partial atelectasis of the right middle lobe appears overall unchanged. Left basilar atelectasis. A 7 mm peripheral right upper lobe nodule on axial image 61; series 2, overall unchanged. HEART / VESSELS: Normal sized cardiac chambers. Three-vessel coronary artery calcifications. No central PE. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: A few mildly enlarged mediastinal lymph nodes, likely reactive. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Will be reported separately. MUSCULOSKELETAL: No destructive osseous lesion. Partially visualized lower cervical spine fusion hardware.	FINDINGS: STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Subtle persistent groundglass opacities and tree-in-bud nodularity in the base of the right lower lobe, less pronounced than on prior examinations. Small peripheral nodules in the LUL on series 2 images 61 and 67 are unchanged. Area of scarring in the anterior RML is unchanged. Slight peripheral bronchiectasis is seen in the upper lobes with mucous plugging in the left lung apex on image 38 similar to the previous exam. Additional mucous plugging is again seen in the LLL on series 2 image 182. No new focal consolidation, pleural effusion, or pneumothorax. Stable biapical pleural-parenchymal scarring. HEART / VESSELS: Heart size is normal. No pericardial effusion. Moderate coronary artery calcifications. MEDIASTINUM / ESOPHAGUS: Circumferential mucosal thickening of the distal esophagus. LYMPH NODES: Prominent lymph nodes throughout the mediastinum and bilateral hila. The subcarinal node measuring 10 mm in short axis on series 2 image 116 is borderline enlarged as is the right paratracheal node on image 90 and the AP window node on image 82. These are slightly decreased from the prior. No axillary adenopathy. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Normal noncontrast appearance of the imaged upper abdomen. MUSCULOSKELETAL: No acute or aggressive appearing osseous abnormality.
2,501	EXAM: CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: Nausea and vomiting COMPARISON: CT abdomen pelvis with contrast 9/17/2021 TECHNIQUE: CT Abdomen and Pelvis w contrast. Patient weight: 200 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 78sec Scan field of view: 453 mm. DLP: 780.50 mGy cm. FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Small pleural effusions and bibasilar atelectasis bilaterally. DISTAL ESOPHAGUS: Minimal fluid within the distal esophagus, suggesting gastroesophageal reflux and placing the patient at risk for aspiration. HEART / VESSELS: The heart is normal in size. Coronary artery and aortic annular calcifications, partially imaged. ABDOMEN and PELVIS: LIVER: Similar appearance of numerous subcentimeter indeterminate hypoattenuating lesions involving both hepatic lobes. These appear similar in size and distribution to the prior CT examination and while technically indeterminate and may represent small hepatic cysts or hamartomas. BILIARY TRACT: Minimal central intrahepatic bile duct prominence without significant dilation. The common bile duct is normal in caliber. GALLBLADDER: Cholelithiasis; no other abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Similar minimal nodularity of the adrenal glands bilaterally without discrete nodule measuring greater than 1 cm. KIDNEYS: Renal cysts and Too small to characterize hypoattenuating lesions in the kidneys bilaterally appear similar to the prior CT examination. No hydronephrosis or suspicious solid enhancing renal mass. Thinly septated cyst in the left lower pole appears similar. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Gastric distention with gas and fluid. Dilated fluid and gas filled segments of small bowel extending to the midline right lower abdomen (image 186, series 2). No definite mass at the transition to distal decompressed small bowel. Distal small bowel bowel anastomosis right lower abdomen. COLON / APPENDIX: The colon is normal in caliber. Scattered predominantly sigmoid colon noninflamed colonic diverticula. Gas and stool are seen within the colon. PERITONEUM / MESENTERY: Minimal small volume pneumoperitoneum with percutaneous surgical drains, consistent with recent abdominal wall hernia repair. Trace ascites. RETROPERITONEUM: Normal. VESSELS: Moderate atherosclerotic calcifications. Focal ectasia of the infrarenal abdominal aorta measuring up to 2.2 cm (image 154, series 80,368). The IVC is normal in caliber. Patent left, right and main portal vein. Patent hepatic veins. URINARY BLADDER: Left posterior bladder wall diverticulum. No focal bladder wall thickening. REPRODUCTIVE ORGANS: Prostamegaly. BODY WALL: There has been interval closure of the midline fascial defect, consistent with ventral hernia repair. Diffuse subcutaneous emphysema and mild subcutaneous edema, consistent with recent surgery. Midline subcutaneous fat stranding and loculated fluid collections with complexity and containing gas. In conglomerate these subcutaneous stranding/collections measure approximately 11 x 3 x 7 cm in the midline. MUSCULOSKELETAL: Degenerative changes in the imaged thoracolumbar spine. Similar appearance of avascular necrosis in the femoral heads bilaterally. Diffuse osteopenia. No new destructive osseous lesion. CONCLUSION: 1. Findings suggesting high-grade small bowel obstruction, probably secondary to adhesions with transition in the right midline lower abdomen, as detailed. 2. Postsurgical changes consistent with ventral hernia repair with midline subcutaneous fat stranding and loculated fluid collections with complexity and containing gas, probable postoperative collection/seroma. Superimposed infection/abscess would be challenging to exclude; however, given interval since surgery, this is less favored. 3. Small pleural effusions and bibasilar atelectasis. 4. Additional incidental findings appear similar to prior CT examination 9/17/2021, including moderate atherosclerosis, thinly septated left lower pole renal cyst, bladder diverticulum, cholelithiasis, and presumed hepatic cysts/hamartomas. Additional findings, as detailed. This report may contain findings critical to patient care. These findings were discussed with Dr. Mydlowska at 1026 on 1/6/2022 10:26 AM.	FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Small pleural effusions and bibasilar atelectasis bilaterally. DISTAL ESOPHAGUS: Minimal fluid within the distal esophagus, suggesting gastroesophageal reflux and placing the patient at risk for aspiration. HEART / VESSELS: The heart is normal in size. Coronary artery and aortic annular calcifications, partially imaged. ABDOMEN and PELVIS: LIVER: Similar appearance of numerous subcentimeter indeterminate hypoattenuating lesions involving both hepatic lobes. These appear similar in size and distribution to the prior CT examination and while technically indeterminate and may represent small hepatic cysts or hamartomas. BILIARY TRACT: Minimal central intrahepatic bile duct prominence without significant dilation. The common bile duct is normal in caliber. GALLBLADDER: Cholelithiasis; no other abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Similar minimal nodularity of the adrenal glands bilaterally without discrete nodule measuring greater than 1 cm. KIDNEYS: Renal cysts and Too small to characterize hypoattenuating lesions in the kidneys bilaterally appear similar to the prior CT examination. No hydronephrosis or suspicious solid enhancing renal mass. Thinly septated cyst in the left lower pole appears similar. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Gastric distention with gas and fluid. Dilated fluid and gas filled segments of small bowel extending to the midline right lower abdomen (image 186, series 2). No definite mass at the transition to distal decompressed small bowel. Distal small bowel bowel anastomosis right lower abdomen. COLON / APPENDIX: The colon is normal in caliber. Scattered predominantly sigmoid colon noninflamed colonic diverticula. Gas and stool are seen within the colon. PERITONEUM / MESENTERY: Minimal small volume pneumoperitoneum with percutaneous surgical drains, consistent with recent abdominal wall hernia repair. Trace ascites. RETROPERITONEUM: Normal. VESSELS: Moderate atherosclerotic calcifications. Focal ectasia of the infrarenal abdominal aorta measuring up to 2.2 cm (image 154, series 80,368). The IVC is normal in caliber. Patent left, right and main portal vein. Patent hepatic veins. URINARY BLADDER: Left posterior bladder wall diverticulum. No focal bladder wall thickening. REPRODUCTIVE ORGANS: Prostamegaly. BODY WALL: There has been interval closure of the midline fascial defect, consistent with ventral hernia repair. Diffuse subcutaneous emphysema and mild subcutaneous edema, consistent with recent surgery. Midline subcutaneous fat stranding and loculated fluid collections with complexity and containing gas. In conglomerate these subcutaneous stranding/collections measure approximately 11 x 3 x 7 cm in the midline. MUSCULOSKELETAL: Degenerative changes in the imaged thoracolumbar spine. Similar appearance of avascular necrosis in the femoral heads bilaterally. Diffuse osteopenia. No new destructive osseous lesion.	Findings: Sinuses and drainage pathways: Frontal sinus: Clear on both sides. Frontoethmoidal recess: Patent. Maxillary sinus: Severe. 9 mm retention cyst in the right maxillary antrum. Ostiomeatal complex: Patent. Ethmoid sinus: Clear. Sphenoid sinus: Clear. Sphenoethmoidal recess: Patent. Nasal cavity: No polyp or mass. No significant variation of the nasal septum and turbinates. Olfactory fossa: Keros type 1. No bony dehiscence. Orbits: Normal Anterior cranial fossa: Unremarkable. Dentition: Unremarkable. Mandible and temporomandibular joint: Unremarkable.
2,502	CT Neck Soft Tissue w contrast Clinical Information: tongue neck swelling Spec Inst: suspect angioedema. cf deep space infxn neck. Patient with hypertension on lisinopril. Comparison: None Technique: Axial images of the neck were obtained following the administration of intravenous contrast. Reformatted coronal and sagittal images were also obtained. Patient weight: 121 lbs. IV contrast: Omnipaque 350, 100 ml, per protocol. IV contrast injection rate: 3 ml per sec. Scan delay: 45 sec. Scan field of view: 252 mm. DLP: 647 mGy cm. Findings: Included portions of the brain and skull base appear normal. There is diffuse swelling and enlargement of the oral cavity, tongue and base of the tongue. Mucosal hyperenhancement of the nasopharyngeal and oropharyngeal walls. The epiglottis is effaced by the swelling base of tongue but appears mildly edematous. There is mild edema of the bilateral aryepiglottic folds and thickening of the glottis. Superficial fascial edema of the neck. Mild edema within the submandibular spaces as well as within the floor of mouth. The parotid, submandibular, and thyroid glands are normal. Mucosal thickening of ethmoid air cells. Fluid within the nasal cavity, nasopharynx, and right maxillary sinus. Mastoid air cells are clear. Endotracheal tube in place. Oroesophageal tube in place. Advanced atherosclerotic disease involving the cervical internal carotid arteries with significant stenosis of the left immediate post bifurcation internal carotid. Moderate atherosclerotic narrowing of the proximal right greater than left bilateral common carotid arteries. No enlarged cervical lymph nodes. Review of bone window demonstrate no aggressive osseous lesion. Degenerative changes in the cervical spine. Conclusion: 1. Anterior and posterior tongue edema. Laryngeal edema. 2. Extensive additional transspatial edema in the neck soft tissues. No abscesses or discrete fluid collections. 3. Extensive calcific and mixed density atherosclerosis with severe narrowing of left proximal ICA in the neck. Moderate narrowing of bilateral right greater than left proximal common carotid arteries. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.	Findings: Included portions of the brain and skull base appear normal. There is diffuse swelling and enlargement of the oral cavity, tongue and base of the tongue. Mucosal hyperenhancement of the nasopharyngeal and oropharyngeal walls. The epiglottis is effaced by the swelling base of tongue but appears mildly edematous. There is mild edema of the bilateral aryepiglottic folds and thickening of the glottis. Superficial fascial edema of the neck. Mild edema within the submandibular spaces as well as within the floor of mouth. The parotid, submandibular, and thyroid glands are normal. Mucosal thickening of ethmoid air cells. Fluid within the nasal cavity, nasopharynx, and right maxillary sinus. Mastoid air cells are clear. Endotracheal tube in place. Oroesophageal tube in place. Advanced atherosclerotic disease involving the cervical internal carotid arteries with significant stenosis of the left immediate post bifurcation internal carotid. Moderate atherosclerotic narrowing of the proximal right greater than left bilateral common carotid arteries. No enlarged cervical lymph nodes. Review of bone window demonstrate no aggressive osseous lesion. Degenerative changes in the cervical spine.	FINDINGS: STRUCTURED REPORT: CT HCC Follow-up IMAGE QUALITY: Moderately decreased because of motion artifact LOWER CHEST: Please see separate CT chest report. ABDOMEN: LIVER: Cirrhotic. No steatosis. TREATED LIVER LESIONS: - Lesion Number: 1 - Description: Irregular posttreatment change consistent with I 90, similar to prior. - Location: Segment(s) 4A/B - Size of largest enhancing portion of the mass: 4.3 x 3.9 cm (series 16, image 174). - Enhancement: Treatment-specific expected enhancement pattern. - Additional features: - Arterial phase hyperenhancement: Not present. - Washout: Not present. - Enhancement similar to pretreatment: Not present. - Vascular invasion: No - LI-RADS: LR-TR Nonviable UNTREATED OR NEW LIVER LESION(S): None. LIVER VASCULATURE AND COLLATERALS: - Hepatic artery patency and anatomy: Patent with conventional anatomy. - Portal venous system: Patent intra- and extra-hepatic portal venous system. - Hepatic veins: Patent right, middle and left hepatic veins. - Esophageal varices: None. - Other varices or collaterals: None. LIVER RELATED FINDINGS: BILIARY DUCTS: No biliary dilatation. GALLBLADDER: No abnormality. LYMPH NODES: None enlarged. SPLEEN: Normal size and appearance. PERITONEUM / ASCITES: No ascites. OTHER FINDINGS: PANCREAS: Normal. ADRENALS: Normal. KIDNEYS: Normal. Visualized STOMACH / SMALL BOWEL: No abnormality. Visualized COLON: No abnormality. MESENTERY: Mild soft tissue stranding is again seen in the mesenteric root, similar to prior. RETROPERITONEUM: Normal. OTHER VESSELS: Severe atherosclerotic disease of normal caliber infrarenal aorta and common iliac arteries. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No destructive osseous lesions seen..
2,503	EXAM: CT Angio Lower Ext Bil wo+w contrast CLINICAL INFORMATION: 62-year-old woman with history of infected left total knee arthroplasty. She underwent irrigation and debridement with antibiotic spacer placement on 12/13/2021. This runoff CTA was performed for flap planning purposes. COMPARISON: None. TECHNIQUE: CT Angio Lower Ext Bil wo+w contrast. Additional 3D image post-processing was performed to generate MIP and/or volume-rendered images. Patient weight: 130 lbs. IV contrast: Omnipaque 350, 80 ml, per protocol. Saline flush: 75 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracker Scan field of view: 425 mm. DLP: 1002.90 mGy cm. FINDINGS: STRUCTURED REPORT: CTA Lower Extremities VASCULATURE: ABDOMINAL AORTA: Normal caliber. Circumferential calcified atherosclerotic plaque without occlusion. RIGHT ILIAC ARTERIES: Curvilinear plaque without stenosis. RIGHT FEMORAL \T\ POPLITEAL ARTERIES: Scattered calcified plaque. No significant abnormality. RIGHT TIBIAL AND PERONEAL ARTERIES: No significant abnormality. Three-vessel runoff appears present. RIGHT FOOT ARTERIES: No significant abnormality. LEFT ILIAC ARTERIES: Curvilinear plaque without stenosis. LEFT FEMORAL \T\ POPLITEAL ARTERIES: Scattered calcified plaque with focal diminutive caliber of the popliteal and early venous filling about the knee. The site of arteriovenous fistulization is not demonstrated but is likely due to multiple small vessels given the degree of inflammation in this region. LEFT TIBIAL AND PERONEAL ARTERIES: Detail is obscured by the early venous filling throughout the lower leg, however three-vessel runoff appears present. LEFT FOOT ARTERIES: Not detected on initial or delayed runoff acquisitions, likely technical due to arteriovenous communication about the knee. ------------------------------------------------------------- LOWER ABDOMEN: BOWEL: Changes of enteroenterostomy, no obstruction noted. PERITONEUM: Normal. OTHER: No other abnormality. PELVIS: Detail in the pelvis is obscured by streak artifact produced by the left total hip arthroplasty. VESSELS: No significant abnormality. LYMPH NODES: None enlarged. PERIRECTAL / PERIANAL REGION: Normal. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality noted. BODY WALL: Diastases of the lower rectus muscles. No frank hernia noted. MUSCULOSKELETAL: Degenerative change in the lumbar facets and right hip. Left total hip arthroplasty. The patient has undergone removal of left knee arthroplasty, with retention of the femoral component. There is an open defect along the lateral aspect of the spacer material at the femoral condyle level, measuring approximately 3 cm in width. Scattered foci of gas are seen in the soft tissues adjacent to the lower femoral shaft as well as within the medullary space at the superior end of the residual femoral component, with periosteal reaction. There is hyperemia and curvilinear enhancement of the soft tissues (residual joint space) along the distal femur. CONCLUSION: 1. Diffuse atherosclerotic disease without significant focal stenosis of the aorta, iliac systems, or femoral arteries. 2. Left popliteal atherosclerotic plaque with focal diminution in size and diffuse early venous filling about the knee likely related to the degree of inflammation/infection. However, there appears to be three-vessel runoff. 3. Postsurgical changes of left knee with space material and overlying lateral wound. Gas within the soft tissues about the knee and femoral medullary space along with hyperemia and periosteal reaction, consistent with persistent infection.	FINDINGS: STRUCTURED REPORT: CTA Lower Extremities VASCULATURE: ABDOMINAL AORTA: Normal caliber. Circumferential calcified atherosclerotic plaque without occlusion. RIGHT ILIAC ARTERIES: Curvilinear plaque without stenosis. RIGHT FEMORAL \T\ POPLITEAL ARTERIES: Scattered calcified plaque. No significant abnormality. RIGHT TIBIAL AND PERONEAL ARTERIES: No significant abnormality. Three-vessel runoff appears present. RIGHT FOOT ARTERIES: No significant abnormality. LEFT ILIAC ARTERIES: Curvilinear plaque without stenosis. LEFT FEMORAL \T\ POPLITEAL ARTERIES: Scattered calcified plaque with focal diminutive caliber of the popliteal and early venous filling about the knee. The site of arteriovenous fistulization is not demonstrated but is likely due to multiple small vessels given the degree of inflammation in this region. LEFT TIBIAL AND PERONEAL ARTERIES: Detail is obscured by the early venous filling throughout the lower leg, however three-vessel runoff appears present. LEFT FOOT ARTERIES: Not detected on initial or delayed runoff acquisitions, likely technical due to arteriovenous communication about the knee. ------------------------------------------------------------- LOWER ABDOMEN: BOWEL: Changes of enteroenterostomy, no obstruction noted. PERITONEUM: Normal. OTHER: No other abnormality. PELVIS: Detail in the pelvis is obscured by streak artifact produced by the left total hip arthroplasty. VESSELS: No significant abnormality. LYMPH NODES: None enlarged. PERIRECTAL / PERIANAL REGION: Normal. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality noted. BODY WALL: Diastases of the lower rectus muscles. No frank hernia noted. MUSCULOSKELETAL: Degenerative change in the lumbar facets and right hip. Left total hip arthroplasty. The patient has undergone removal of left knee arthroplasty, with retention of the femoral component. There is an open defect along the lateral aspect of the spacer material at the femoral condyle level, measuring approximately 3 cm in width. Scattered foci of gas are seen in the soft tissues adjacent to the lower femoral shaft as well as within the medullary space at the superior end of the residual femoral component, with periosteal reaction. There is hyperemia and curvilinear enhancement of the soft tissues (residual joint space) along the distal femur.	FINDINGS: STRUCTURED REPORT: CT Chest Examination moderately limited due to motion artifact. LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: The previously noted right upper lobe and left upper lobe pulmonary nodules are not identified on this examination, however the area of interest in the upper chest is less well visualized due to motion artifact. No new suspicious pulmonary nodules are identified. Elevation of the left hemidiaphragm is seen with left basilar atelectasis. No focal consolidation, pleural effusion, or pneumothorax. Stable appearance of severe biapical centrilobular emphysema. HEART / VESSELS: Heart size is normal. No pericardial effusion. Calcific atherosclerosis is seen in the aorta and its branches. Post CABG changes are present. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: Prominent mediastinal lymph nodes, none pathologically enlarged, for example, right paratracheal lymph node measuring 6 mm in short axis diameter on series 16 image 44. Enlarged right internal mammary nodes are seen on series 17 images 166 and 187. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Please see same day CT abdomen for abdomen findings. MUSCULOSKELETAL: No acute or aggressive appearing osseous abnormality. Interval sternotomy changes.
2,504	EXAM: CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: 62-year-old male with large B-cell lymphoma, surveillance scan. COMPARISON: CT abdomen and pelvis 3/31/2021 and PET scan 9/2/2021 TECHNIQUE: CT Abdomen and Pelvis w contrast. Patient weight: 190 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 20 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 78sec Scan field of view: 410 mm. DLP: 1400.69 mGy cm. FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: Please see separately dictated same-day CT chest. ABDOMEN and PELVIS: LIVER: Normal for technique. BILIARY TRACT: Normal. GALLBLADDER: Contracted with cholelithiasis. No gallbladder wall thickening or pericholecystic fluid. PANCREAS: Normal for technique. SPLEEN: Prior granulomatous disease. ADRENALS: Normal. KIDNEYS: Subcentimeter hypodensity within the right mid kidney is too small to characterize (series 601 image 144); however, likely representing a cyst. No hydronephrosis bilaterally. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. Duodenal diverticulum. COLON / APPENDIX: Diverticulosis without evidence of diverticulitis. The appendix is not well visualized. PERITONEUM / MESENTERY: There is a heterogeneously enhancing, mixed density mass within the left mid abdomen measuring 5.1 x 4.4 cm (series 2 image 311) with surrounding fat stranding and edema, previously 17.6 x 15.9 cm on CT from 3/31/2021 and 6.3 x 5.0 cm on PET from 9/2/2021 as measured by me. This lesion is in close proximity to the small bowel and posterior to the transverse colon. RETROPERITONEUM: Normal. VESSELS: There are two right renal arteries. Mild scattered atherosclerotic calcifications of the abdominal aorta which is normal in caliber. URINARY BLADDER: Collapsed. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Small fat-containing umbilical hernia. MUSCULOSKELETAL: Mild degenerative changes. No aggressive osseous lesions. CONCLUSION: 1. Interval decrease in size of the heterogeneously enhancing mesenteric lesion within the left mid abdomen, suggestive of treatment response. 2. No pathologic lymphadenopathy within the abdomen or pelvis. 3. Additional chronic and incidental findings as described above. 4. Please see separately dictated same-day CT chest. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.	FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: Please see separately dictated same-day CT chest. ABDOMEN and PELVIS: LIVER: Normal for technique. BILIARY TRACT: Normal. GALLBLADDER: Contracted with cholelithiasis. No gallbladder wall thickening or pericholecystic fluid. PANCREAS: Normal for technique. SPLEEN: Prior granulomatous disease. ADRENALS: Normal. KIDNEYS: Subcentimeter hypodensity within the right mid kidney is too small to characterize (series 601 image 144); however, likely representing a cyst. No hydronephrosis bilaterally. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. Duodenal diverticulum. COLON / APPENDIX: Diverticulosis without evidence of diverticulitis. The appendix is not well visualized. PERITONEUM / MESENTERY: There is a heterogeneously enhancing, mixed density mass within the left mid abdomen measuring 5.1 x 4.4 cm (series 2 image 311) with surrounding fat stranding and edema, previously 17.6 x 15.9 cm on CT from 3/31/2021 and 6.3 x 5.0 cm on PET from 9/2/2021 as measured by me. This lesion is in close proximity to the small bowel and posterior to the transverse colon. RETROPERITONEUM: Normal. VESSELS: There are two right renal arteries. Mild scattered atherosclerotic calcifications of the abdominal aorta which is normal in caliber. URINARY BLADDER: Collapsed. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Small fat-containing umbilical hernia. MUSCULOSKELETAL: Mild degenerative changes. No aggressive osseous lesions.	FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: Please see separately dictated CT chest. ABDOMEN and PELVIS: LIVER: Peripherally enhancing hepatic dome lesion measures 0.8 x 0.8 cm on image 29 series 10, previously measuring 0.6 x 0.6 cm. Unchanged tiny focus of arterial enhancement in the lateral segment left hepatic lobe on image 97 series 5 near the previously seen hypoattenuating lesion. No new lesions. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Left-sided parapelvic cysts. Additional subcentimeter foci of hypoattenuation both kidneys are too small fracture characterization. Nonobstructing left lower pole nephrolithiasis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Similar lytic lesions in the L2 vertebral body and sacrum at S1. Lytic lesion in the left iliac bone also appears similar. No evidence of new osseous metastatic disease. Lower lumbar spine degenerative changes.
2,505	EXAM: CT Chest with contrast CLINICAL INFORMATION: 62-year-old male follow-up diffuse large B-cell lymphoma outside chest CT dated COMPARISON: April 7, 2021 TECHNIQUE: CT Chest with contrast. Patient weight: 190 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 20 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 78sec Scan field of view: 410 mm. DLP: 1400.69 mGy cm. FINDINGS: Only small subcentimeter size nodes are present in the mediastinum along with calcified node in the right paraesophageal location. Minimal diffuse peribronchial thickening without discrete lung nodule/mass, airspace consolidation or interstitial abnormality. There is no pleural or pericardial effusion and visualized bones are unremarkable. The ill-defined inflammatory stranding in the left chest wall and axilla seen previously have resolved. CONCLUSION: No intrathoracic lymphoma or new disease.	FINDINGS: Only small subcentimeter size nodes are present in the mediastinum along with calcified node in the right paraesophageal location. Minimal diffuse peribronchial thickening without discrete lung nodule/mass, airspace consolidation or interstitial abnormality. There is no pleural or pericardial effusion and visualized bones are unremarkable. The ill-defined inflammatory stranding in the left chest wall and axilla seen previously have resolved.	Findings: No enlarged intrathoracic nodes are present. The heart size and mediastinum are normal. Slight pleural thickening is seen posteriorly in the mid right hemithorax unchanged. No pleural effusion. A new tiny nodule is seen in the right lung apex on series 10 image 56 with additional new nodule on image 93.. Nodules along the right major and minor fissure remain unchanged. Left apical nodule on image 36 is unchanged. Pleural-based 4 mm LLL nodule on image 159 is also unchanged as is the small medial LLL nodule on image 161. A few calcified granuloma are seen in the RLL.. Mixed lytic and sclerotic change in the right glenoid and acromion as well as in the superior aspect of T2 are unchanged. No additional lytic or blastic lesions are identified. CT abdomen pelvis will be reported separately.
2,506	EXAM: CT Chest with contrast CLINICAL INFORMATION: 67-year-old female follow-up metastatic lung cancer COMPARISON: November 3, 2021 TECHNIQUE: CT Chest with contrast. Patient weight: 236 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. Saline flush: 10 ml. IV contrast injection rate: 2 ml per sec. Scan delay: 100 sec Scan field of view: 500 mm. DLP: 1950 mGy cm. FINDINGS: Index lesions are measured in series 3. Heterogeneously enhancing irregular right lower lobe nodule in image 118 measures 24 x 19 mm, it was 29 x 23 mm. There is persistent occlusion of the posterior basal segmental right lower lobe bronchus. Subcarinal right paraesophageal node in image 86 is 24 x 14 mm, it was 26 x 15 mm. The right-sided pleural effusion has decreased while left-sided pleural effusion persist unchanged. There is no pericardial effusion and visualized bones are unremarkable. CONCLUSION: 1. Slight interval reduction in the right lower lobe heterogeneous lung mass with persistent occlusion of posterior basal segmental bronchus and stable to slightly decreased size of subcarinal enlarged node. 2. Interval reduction in the right-sided pleural effusion while left pleural effusion persist. No new intrathoracic abnormality	FINDINGS: Index lesions are measured in series 3. Heterogeneously enhancing irregular right lower lobe nodule in image 118 measures 24 x 19 mm, it was 29 x 23 mm. There is persistent occlusion of the posterior basal segmental right lower lobe bronchus. Subcarinal right paraesophageal node in image 86 is 24 x 14 mm, it was 26 x 15 mm. The right-sided pleural effusion has decreased while left-sided pleural effusion persist unchanged. There is no pericardial effusion and visualized bones are unremarkable.	FINDINGS: STRUCTURED REPORT: CTA Aorta Runoff VASCULATURE: ABDOMINAL AORTA: No significant abnormality. RIGHT RENAL: Partially visualized and patent without significant stenosis. LEFT RENAL: Partially visualized and patent without significant stenosis. IMA: Patent. RIGHT ILIAC ARTERIES: No significant abnormality. RIGHT FEMORAL \T\ POPLITEAL ARTERIES: No significant abnormality. RIGHT TIBIAL AND PERONEAL ARTERIES: Patent without significant stenosis or injury. Hypoplastic anterior tibial artery with the peroneal artery continuing as the dorsalis pedis artery, normal congenital variant. RIGHT FOOT ARTERIES: No significant abnormality. LEFT ILIAC ARTERIES: No significant abnormality. LEFT FEMORAL \T\ POPLITEAL ARTERIES: No significant abnormality. LEFT TIBIAL AND PERONEAL ARTERIES: Patent without significant stenosis or injury. Hypoplastic anterior tibial artery with the peroneal artery continuing as the dorsalis pedis artery, normal congenital variant. LEFT FOOT ARTERIES: No significant abnormality. ------------------------------------------------------------- PELVIS: UPPER ABDOMEN: Visualized portion of the liver and kidneys are unremarkable. BOWEL: Visualized portions of the small and large bowel are unremarkable. The appendix is normal. PERITONEUM / MESENTERY: No intraperitoneal free fluid or air. RETROPERITONEUM: Normal. OTHER VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Ballistic fragments are present in the left hip soft tissues adjacent to the left iliac crest without subcutaneous emphysema. Tiny fat-containing umbilical hernia. SOFT TISSUES: Ballistic fragments and subcutaneous gas are present in the medial left knee vastus medialis with adjacent small hematoma. There is associated subcutaneous emphysema in the medial left thigh. MUSCULOSKELETAL: No acute displaced fracture.
2,507	EXAM: CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: Metastatic lung cancer COMPARISON: 11/3/2021 TECHNIQUE: CT Abdomen and Pelvis w contrast. Patient weight: 236 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. Saline flush: 10 ml. IV contrast injection rate: 2 ml per sec. Scan delay: 100 sec Scan field of view: 500 mm. FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis ABDOMEN and PELVIS: LIVER: Hypoattenuating focus on series 3 image 153 is unchanged and appears cystic in nature. 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: Diverticulosis. PERITONEUM / MESENTERY: Previously seen small amount of fluid has resolved. RETROPERITONEUM: Normal. VESSELS: Scattered atherosclerosis. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Small fat-containing umbilical hernia. MUSCULOSKELETAL: No destructive lesions. Degenerative changes in the spine. CONCLUSION: 1. No new evidence of metastatic disease in the abdomen or pelvis. 2. Other incidental and noncontributory findings as described above. Chest findings to be dictated separately; please see separate chest CT report same day.	FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis ABDOMEN and PELVIS: LIVER: Hypoattenuating focus on series 3 image 153 is unchanged and appears cystic in nature. 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: Diverticulosis. PERITONEUM / MESENTERY: Previously seen small amount of fluid has resolved. RETROPERITONEUM: Normal. VESSELS: Scattered atherosclerosis. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Small fat-containing umbilical hernia. MUSCULOSKELETAL: No destructive lesions. Degenerative changes in the spine.	FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Trace right pleural effusion and mild atelectasis. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Coronary vascular calcifications. No pericardial effusion. ABDOMEN and PELVIS: LIVER: Subcentimeter indeterminate liver lesion on image 98, series 301. Otherwise unremarkable BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Mildly atrophic but otherwise normal SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Punctate nonobstructing right renal stones. Few small renal cysts and scattered renal cortical scarring. Otherwise normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: A few noninflamed colonic diverticula. Rectum is mildly distended with formed fecal material. PERITONEUM / MESENTERY: No free fluid or free air. RETROPERITONEUM: Minimal presacral stranding. VESSELS: Aortoiliac atherosclerotic disease without aneurysm or flow-limiting stenosis. URINARY BLADDER: Largely decompressed around a Foley catheter with iatrogenic gas in the bladder lumen. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: L2 compression deformity with approximately 25% vertebral body height loss anteriorly. There is also an indeterminate aged minimally displaced fracture of the lower sacrum at the S5 levels such as on image 31, series 301 and image 89, coronal series. Bone island in the right sacrum.
2,508	EXAM: CT Chest wo contrast CLINICAL INFORMATION: 64-year-old male, for follow-up of lung nodule. Prior history of right upper lobe wedge resection in September 2020 with pathology of adenocarcinoma. Lung nodule, > 8 mm. COMPARISON: Multiple prior CT chest, most recently 10/7/2021. CT abdomen and pelvis 10/18/2018, 4/7/2016. TECHNIQUE: CT Chest wo contrast. Scan field of view: 350 mm. DLP: 212.30 mGy cm. 1.5 mm axial, coronal and sagittal reformats, with additional 8mm axial MIP and 1 mm axial reformats were made and reviewed. FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Stable to minimal increased size of the right upper lobe nodule measuring 10 x 8 mm (image 290, series #202), previously 8 x 6 mm which may appear larger to secondary to differences in technique. Unchanged size of the right lower lobe spiculated nodule measuring 13 x 10 mm (image 344, series #202) compared to prior exam, previously measuring 13 x 10 mm, but appears mildly denser with mild interval prominence of adjacent pleural tagging/retraction. Right lower lobe pleural-based nodules also appear unchanged (image 289 and 282, series #202). Stable groundglass opacity in the right lower lobe (image 325, series #202). No new suspicious nodule or pulmonary mass. Bilateral apical predominant centrilobular and paraseptal emphysematous change. Stable postsurgical change from prior right upper lobe wedge resection. No pneumothorax or pleural effusion. Central airways are patent. Mild peribronchial thickening. HEART / VESSELS: Normal heart size. Trace pericardial effusion. Advanced multivessel coronary artery atherosclerosis. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: Shotty mediastinal lymph nodes are unchanged. Enlarged subcarinal lymph node measures 3.2 x 1.2 cm (image 33, series #202), unchanged. Scattered calcified mediastinal lymph nodes, likely sequelae of prior granulomatous disease. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Unchanged left adrenal adenoma. Punctate nonobstructing right renal calculus. MUSCULOSKELETAL: No aggressive osseous lesions. Unchanged anterior compression deformity of T9. Mild multilevel discogenic degenerative changes of the thoracic spine. CONCLUSION: 1. Stable to minimal increased size of the right upper lobe nodule which may appear minimally larger secondary to differences in technique. 2. Peripheral right lower lobe nodule, that appears mildly denser with interval prominence of adjacent pleural retraction/tagging. Close attention at follow-up studies is recommended to monitor for developing second lung primary. 3. Stable size of the right lower lobe spiculated nodule, and other groundglass opacities, overall unchanged. No new pulmonary nodule or mass identified. 4. Other stable incidental findings as above. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.	FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Stable to minimal increased size of the right upper lobe nodule measuring 10 x 8 mm (image 290, series #202), previously 8 x 6 mm which may appear larger to secondary to differences in technique. Unchanged size of the right lower lobe spiculated nodule measuring 13 x 10 mm (image 344, series #202) compared to prior exam, previously measuring 13 x 10 mm, but appears mildly denser with mild interval prominence of adjacent pleural tagging/retraction. Right lower lobe pleural-based nodules also appear unchanged (image 289 and 282, series #202). Stable groundglass opacity in the right lower lobe (image 325, series #202). No new suspicious nodule or pulmonary mass. Bilateral apical predominant centrilobular and paraseptal emphysematous change. Stable postsurgical change from prior right upper lobe wedge resection. No pneumothorax or pleural effusion. Central airways are patent. Mild peribronchial thickening. HEART / VESSELS: Normal heart size. Trace pericardial effusion. Advanced multivessel coronary artery atherosclerosis. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: Shotty mediastinal lymph nodes are unchanged. Enlarged subcarinal lymph node measures 3.2 x 1.2 cm (image 33, series #202), unchanged. Scattered calcified mediastinal lymph nodes, likely sequelae of prior granulomatous disease. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Unchanged left adrenal adenoma. Punctate nonobstructing right renal calculus. MUSCULOSKELETAL: No aggressive osseous lesions. Unchanged anterior compression deformity of T9. Mild multilevel discogenic degenerative changes of the thoracic spine.	FINDINGS: STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Stable postradiation changes and parenchymal scarring in the left perihilar region and right lower lobe. Similar appearance of pleural thickening and atelectasis in the right lower lobe within the right lower lobe radiation bed. Unchanged appearance of irregular pulmonary nodules in the apical left lower lobe as seen on series 10 image 78. No suspicious new pulmonary nodules are identified. No focal consolidation, pleural effusion, or pneumothorax. Previously noted bilateral groundglass opacities are less pronounced on today's examination with still mild bronchial wall thickening seen in the small bronchi.. HEART / VESSELS: Heart size is normal. No pericardial effusion. Moderate coronary artery calcifications. Moderate atherosclerotic calcifications of the thoracic aorta and great vessel origins. MEDIASTINUM / ESOPHAGUS: Circumferential wall thickening of the distal esophagus is redemonstrated. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Please see same day CT abdomen for abdomen findings. MUSCULOSKELETAL: No acute or aggressive appearing osseous abnormality. Chronic appearing fractures of the right anterior third through sixth ribs.
2,509	CT Maxillofacial wo contrast, CT 3D Neuro Requiring Indep Wkst 1/6/2022 9:09 AM Clinical Information: sp ORIF multiple facial fractures Comparison: Maxillofacial CT 1/2/2022. Technique: Axial helical CT images were obtained through the maxillofacial region. 2-D coronal reconstructions were generated from the axial data. 3-D volume rendered reconstructions of the face in multiple projections were performed and reviewed. Scan field of view: 200 mm. DLP: 366 mGy cm. Findings: Interval postsurgical changes of plate and screw fixations involving fractures bilateral maxillary alveoli, bilateral zygomatic maxillary regions, left lateral orbital wall, inferior left orbital rim and bilateral medial maxillary sinus walls. Metallic mesh repair involving the fractures inferior and medial left orbital wall. Redemonstration of extensive maxillofacial fractures including bilateral nasal bone fractures, right nasal process of maxilla fracture, bilateral anterior, posterior and medial maxillary wall fractures. Additional fractures involving bilateral pterygoid plates, left zygomatic arch, bilateral hard palate. Fracture involving bony nasal septum. Mandible and bilateral temporomandibular joints appear intact. Right orbit is unremarkable. Mild extraconal fat stranding in the left orbit heterogenous density fluid in bilateral maxillary sinuses and bilateral ethmoid sinuses. Small effusions and mucosal thickening in left frontal sinus and bilateral sphenoid sinuses. Minimal mucosal thickening in the right frontal sinus. Visualized portions of the calvarium, mastoid air cells and middle ear cavities are unremarkable. Visualized intracranial structures are stable from prior study. Improved soft tissue emphysema. Mild residual soft tissue swelling involving the bilateral premaxillary, prezygomatic and periorbital soft tissues. 3-D volume rendered facial reconstructions were performed and reviewed. Conclusion: 1. Interval fixation of few of the complex maxillofacial fractures as described above. Additional stable maxillofacial fractures as described in detail above. No new or unexpected findings. 2. Multiple paranasal sinuses demonstrate expected hemosinus. Interval improvement in soft tissue swelling in the face. 2. 3-D volume rendered facial reconstructions were performed and reviewed.	Findings: Interval postsurgical changes of plate and screw fixations involving fractures bilateral maxillary alveoli, bilateral zygomatic maxillary regions, left lateral orbital wall, inferior left orbital rim and bilateral medial maxillary sinus walls. Metallic mesh repair involving the fractures inferior and medial left orbital wall. Redemonstration of extensive maxillofacial fractures including bilateral nasal bone fractures, right nasal process of maxilla fracture, bilateral anterior, posterior and medial maxillary wall fractures. Additional fractures involving bilateral pterygoid plates, left zygomatic arch, bilateral hard palate. Fracture involving bony nasal septum. Mandible and bilateral temporomandibular joints appear intact. Right orbit is unremarkable. Mild extraconal fat stranding in the left orbit heterogenous density fluid in bilateral maxillary sinuses and bilateral ethmoid sinuses. Small effusions and mucosal thickening in left frontal sinus and bilateral sphenoid sinuses. Minimal mucosal thickening in the right frontal sinus. Visualized portions of the calvarium, mastoid air cells and middle ear cavities are unremarkable. Visualized intracranial structures are stable from prior study. Improved soft tissue emphysema. Mild residual soft tissue swelling involving the bilateral premaxillary, prezygomatic and periorbital soft tissues. 3-D volume rendered facial reconstructions were performed and reviewed.	FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: Please see separately dictated CT chest. ABDOMEN and PELVIS: LIVER: Hepatic cirrhosis. No suspicious liver lesions. BILIARY TRACT: Normal. GALLBLADDER: Cholelithiasis. PANCREAS: Normal. Probable anatomic variant pancreas divisum. SPLEEN: Unchanged hypoattenuating lesion in the caudal spleen. ADRENALS: Normal. KIDNEYS: Right upper pole cyst. Additional subcentimeter foci of hypoattenuation are too small fracture characterization. LYMPH NODES: Stable enlarged portal lymph nodes. No new lymphadenopathy. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Scattered noninflamed colonic diverticula. Normal appendix. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Direct origin of the left gastric artery from the aorta with replaced left hepatic artery arising from the left gastric artery. Replaced right gastric artery arising from the SMA. Advanced calcified and noncalcified atherosclerotic plaque of the abdominal aorta and branch vessels. Small upper abdominal varices/collaterals. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Tiny fat-containing umbilical hernia. MUSCULOSKELETAL: Lucencies related to prior internal fixation hardware in the right femur. No destructive osseous lesion.
2,510	EXAM: CT Chest wo contrast CLINICAL INFORMATION: 88-year-old female follow-up mycobacterial infection COMPARISON: January 4, 2021 TECHNIQUE: CT Chest wo contrast. Scan field of view: 330 mm. DLP: 85.54 mGy cm. FINDINGS: Since prior examination there is increase in the nodular changes especially in the right lower lobe with a new larger nodule measuring 12 x 10 mm in image 161, series 2. Partial volume loss of the inferior lingula persist along with mild central bronchiectasis in both lower lobes, right middle lobe and lingula. Degenerative calcification of the tracheobronchial airway. Borderline size nodes are present in the precarinal region as before. Small hiatal hernia is present Atherosclerotic disease changes in the thoracic aorta and its branches. There is no pleural or pericardial effusion or focal lytic or sclerotic bone lesion. CONCLUSION: Slight interval worsening of nodular lung disease especially in the right lower lobe with persistent previously noted scattered lung nodules, bronchiectasis and partial lingular volume loss.	FINDINGS: Since prior examination there is increase in the nodular changes especially in the right lower lobe with a new larger nodule measuring 12 x 10 mm in image 161, series 2. Partial volume loss of the inferior lingula persist along with mild central bronchiectasis in both lower lobes, right middle lobe and lingula. Degenerative calcification of the tracheobronchial airway. Borderline size nodes are present in the precarinal region as before. Small hiatal hernia is present Atherosclerotic disease changes in the thoracic aorta and its branches. There is no pleural or pericardial effusion or focal lytic or sclerotic bone lesion.	FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. No pathologic enhancement. Gray-white matter differentiation is maintained. Moderate frontoparietal cerebral volume loss. Right medial cerebellar hemisphere chronic lacunar infarct. Minimal bilateral carotid siphon atherosclerotic calcifications. Fetal origin of the left PCA, incidental variant. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Prominent likely suggesting chronic central predominant parenchymal volume loss ORBITS: Bilateral ocular lens replacements. SINUSES: Complete opacification of the sphenoid sinuses. The mastoid air cells are otherwise clear. SOFT TISSUES: Normal.
2,511	EXAM: CT Angio Abdomen and or Pelvis w Runoff CLINICAL INFORMATION: 68-year-old male with clinical history of peripheral vascular disease. COMPARISON: None. TECHNIQUE: CT Angio Abdomen and or Pelvis w Runoff. Additional 3D image post-processing was performed to generate MIP and/or volume-rendered images. Patient weight: 250 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. Saline flush: 20 ml. IV contrast injection rate: 4 ml per sec. Scan delay: BOLUS TRACK sec. Scan field of view: 500 mm. DLP: 3032.11 mGy cm. FINDINGS: STRUCTURED REPORT: CTA Aorta Runoff VASCULATURE: DISTAL DESCENDING THORACIC AORTA: No significant abnormality. ABDOMINAL AORTA: Extensive atherosclerotic ossifications present throughout the infrarenal abdominal aorta and its branches. CELIAC AXIS: Mild to moderate stenosis due to the large amount of atherosclerotic calcification present in the origin. The accessory left hepatic artery via the left gastric artery. SMA: No significant abnormality. RIGHT RENAL: Dual renal artery supply with a large amount of atherosclerotic calcification present in both origins. LEFT RENAL: Large amount of atherosclerotic desiccation is present in the origin causing mild stenosis. IMA: Patent RIGHT ILIAC ARTERIES: Extensive atherosclerotic calcifications present in the right common iliac artery causing moderate to severe stenosis, a moderate amount of atherosclerotic calcification present in the external iliac artery causing moderate to severe proximal stenosis, and a large amount of atherosclerotic calcification present in the internal iliac artery. RIGHT FEMORAL \T\ POPLITEAL ARTERIES: Complete to near complete occlusion of the right common femoral artery. There is occlusion of the right superficial femoral artery with reconstitution (axial image 678 series 302). There is large amount of atherosclerotic calcification and long segment stenosis of the mid superficial femoral artery. There is a stent in the mid to distal superficial femoral/proximal popliteal artery that is near nearly occlusive. There is a short segment occlusion of the femoral artery distal to the stent. The popliteal artery is intermittently patent. RIGHT TIBIAL AND PERONEAL ARTERIES: Two-vessel runoff to the ankle via the posterior tibial and peroneal artery. LEFT ILIAC ARTERIES: Large amount of atherosclerotic calcifications present at the common iliac, there is a extensive amount of atherosclerotic calcification in the internal iliac, and there is a mild amount of atherosclerotic calcification present in the external iliac artery. LEFT FEMORAL \T\ POPLITEAL ARTERIES: There is a extensive amount of atherosclerotic calcification present in the distal common femoral artery and bifurcation with a short segment occlusion of the proximal superficial femoral artery with recanalization (axial image 684 series 302). There is also moderate severe stenosis of the distal left common femoral artery. There is multifocal severe stenotic lesions throughout the superficial femoral artery proximally. There is a mid femoral artery stent that is patent. There is a distal femoral artery stent that is mostly patent but there is a fairly focal critical stenosis to occlusion in the distal stent (series 302/image 1145).. The popliteal artery is patent from the midportion to the distal portion. LEFT TIBIAL AND PERONEAL ARTERIES: Two vessel runoff via the posterior tibial and peroneal artery. High origin of the left anterior tibial artery is noted. ------------------------------------------------------------- LOWER CHEST: LUNG BASES / PLEURA: Bibasilar atelectatic changes. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Moderate pericardial effusion. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Suspected splenule in the caudal portion of the kidney.. ADRENALS: Normal. KIDNEYS: Symmetric enhancement of bilateral kidneys without evidence of hydronephrosis or nephrolithiasis. There is a tiny hypoattenuating foci in the left interpolar to lower pole region that is too small to characterize accurately. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Prostatic calcifications are present. BODY WALL: There is a right fat-containing hernia. There is also a hydrocele of the right scrotal region that is partially visualized. MUSCULOSKELETAL: Multilevel discogenic degenerative arthrosis present throughout the vertebral column visualized. Degenerative changes noted in the right ankle. Small left knee effusion. Fatty atrophy of the right soleus muscle. CONCLUSION: 1. Severe bilateral peripheral vascular disease as described above. 2. Moderate pericardial effusion. 3. Right hydrocele. 4. Additional chronic/incidental findings are described above. Findings were discussed with Dr. William Gaillard by Dr. Cazano via telephone at 1/6/2022 1:48 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.	FINDINGS: STRUCTURED REPORT: CTA Aorta Runoff VASCULATURE: DISTAL DESCENDING THORACIC AORTA: No significant abnormality. ABDOMINAL AORTA: Extensive atherosclerotic ossifications present throughout the infrarenal abdominal aorta and its branches. CELIAC AXIS: Mild to moderate stenosis due to the large amount of atherosclerotic calcification present in the origin. The accessory left hepatic artery via the left gastric artery. SMA: No significant abnormality. RIGHT RENAL: Dual renal artery supply with a large amount of atherosclerotic calcification present in both origins. LEFT RENAL: Large amount of atherosclerotic desiccation is present in the origin causing mild stenosis. IMA: Patent RIGHT ILIAC ARTERIES: Extensive atherosclerotic calcifications present in the right common iliac artery causing moderate to severe stenosis, a moderate amount of atherosclerotic calcification present in the external iliac artery causing moderate to severe proximal stenosis, and a large amount of atherosclerotic calcification present in the internal iliac artery. RIGHT FEMORAL \T\ POPLITEAL ARTERIES: Complete to near complete occlusion of the right common femoral artery. There is occlusion of the right superficial femoral artery with reconstitution (axial image 678 series 302). There is large amount of atherosclerotic calcification and long segment stenosis of the mid superficial femoral artery. There is a stent in the mid to distal superficial femoral/proximal popliteal artery that is near nearly occlusive. There is a short segment occlusion of the femoral artery distal to the stent. The popliteal artery is intermittently patent. RIGHT TIBIAL AND PERONEAL ARTERIES: Two-vessel runoff to the ankle via the posterior tibial and peroneal artery. LEFT ILIAC ARTERIES: Large amount of atherosclerotic calcifications present at the common iliac, there is a extensive amount of atherosclerotic calcification in the internal iliac, and there is a mild amount of atherosclerotic calcification present in the external iliac artery. LEFT FEMORAL \T\ POPLITEAL ARTERIES: There is a extensive amount of atherosclerotic calcification present in the distal common femoral artery and bifurcation with a short segment occlusion of the proximal superficial femoral artery with recanalization (axial image 684 series 302). There is also moderate severe stenosis of the distal left common femoral artery. There is multifocal severe stenotic lesions throughout the superficial femoral artery proximally. There is a mid femoral artery stent that is patent. There is a distal femoral artery stent that is mostly patent but there is a fairly focal critical stenosis to occlusion in the distal stent (series 302/image 1145).. The popliteal artery is patent from the midportion to the distal portion. LEFT TIBIAL AND PERONEAL ARTERIES: Two vessel runoff via the posterior tibial and peroneal artery. High origin of the left anterior tibial artery is noted. ------------------------------------------------------------- LOWER CHEST: LUNG BASES / PLEURA: Bibasilar atelectatic changes. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Moderate pericardial effusion. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Suspected splenule in the caudal portion of the kidney.. ADRENALS: Normal. KIDNEYS: Symmetric enhancement of bilateral kidneys without evidence of hydronephrosis or nephrolithiasis. There is a tiny hypoattenuating foci in the left interpolar to lower pole region that is too small to characterize accurately. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Prostatic calcifications are present. BODY WALL: There is a right fat-containing hernia. There is also a hydrocele of the right scrotal region that is partially visualized. MUSCULOSKELETAL: Multilevel discogenic degenerative arthrosis present throughout the vertebral column visualized. Degenerative changes noted in the right ankle. Small left knee effusion. Fatty atrophy of the right soleus muscle.	FINDINGS: STRUCTURED REPORT: CTA Abdomen Pelvis Stent VASCULATURE: Moderate atherosclerosis. ENDOVASCULAR STENT: Patent aortobiiliac stent with the cranial aspect superior to the left renal artery extending into the common iliac arteries. ENDOLEAK: Redemonstration of type II endoleak from right L4 lumbar artery (series 5, image 192). DISTAL DESCENDING THORACIC AORTA: No significant abnormality. ABDOMINAL AORTA: Excluded infrarenal aneurysmal sac now measures 6.9 x 6.1 cm (series 5, image 168), previously 6.8 x 6.1 cm, similar to prior. CELIAC AXIS: No significant abnormality. SMA: Right hepatic artery arises from the SMA. No significant abnormality. RIGHT RENAL: Duplicated. No significant abnormality. LEFT RENAL: No significant abnormality. IMA: No significant abnormality. RIGHT ILIAC / PROXIMAL FEMORAL ARTERIES: Redemonstration of right common iliac ectasia measuring 2.1 cm on series 5, image 225 previously 2.0 cm on series 11 image 172. LEFT ILIAC / PROXIMAL FEMORAL ARTERIES: No significant abnormality. ------------------------------------------------------------- LOWER CHEST: Please see separate CT chest report. ABDOMEN and PELVIS: LIVER: Subcentimeter hypodensities of the right hepatic dome are statistically cysts. Arterial hyperenhancing lesion in segment VI now measures 1.0 x 0.5 cm (series 3, image 250), previously 1.6 x 1.0 cm, not seen on the venous phase, possibly flash filling hemangioma. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Similar appearance of right simple cyst. Subcentimeter hypodensities are statistically cysts but formally indeterminate. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Small hiatal hernia. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: No ascites. RETROPERITONEUM: Normal. OTHER VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Enlarged prostate. BODY WALL: Tiny fat-containing umbilical hernia. MUSCULOSKELETAL: Mild multilevel degenerative changes of the lumbar spine and bilateral SI joints. No suspicious osseous lesion.
2,512	EXAM: CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: 66-year-old female with recurrent ovarian cancer, increase in CA-125. COMPARISON: CT abdomen and pelvis 12/7/2020 TECHNIQUE: CT Abdomen and Pelvis w contrast. Patient weight: 177 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Oral contrast Omnipaque: 16.9 oz. Saline flush: 20 ml. IV contrast injection rate: 3.80 ml per sec. Scan delay: 70sec Scan field of view: 410 mm. DLP: 1118.41 mGy cm. FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: Please see separately dictated same-day CT chest. ABDOMEN and PELVIS: LIVER: Redemonstration of an ablation of the lateral segment of the left hepatic lobe and small ablation of the right hepatic lobe. There is a new area of ill-defined hypodensity within the inferior right hepatic lobe measuring approximately 1.2 x 0.7 cm (series 2 image 261). Additional new hypodensity in the caudate measures 1.8 x 1.1 cm on axial series 2, image 214. Another subcentimeter hypodensity within the posterior right hepatic lobe is too small to characterize but appears new since prior. BILIARY TRACT: Normal. GALLBLADDER: Cholelithiasis. No pericholecystic fluid or gallbladder wall thickening. PANCREAS: Redemonstration of postsurgical changes from a distal pancreatectomy. The residual pancreas shows normal enhancement. No pancreatic duct dilation. SPLEEN: Surgically absent. ADRENALS: Normal. KIDNEYS: Small bilateral subcentimeter hypodensities are too small to characterize; however, likely representing cysts. No hydronephrosis bilaterally. LYMPH NODES: Recent demonstration of prominent retroperitoneal lymph nodes. Interval enlargement of a left paraesophageal lymph node which currently measures 0.7 cm in short axis on axial series 2, image 193. STOMACH / SMALL BOWEL: Small hiatal hernia. The small bowel is unremarkable. COLON / APPENDIX: No abnormality. The appendix is not well visualized. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Scattered mild atherosclerotic calcifications of the abdominal aorta which is normal in caliber. There is a circumaortic left renal vein. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: The uterus is absent. No adnexal masses or abnormal enhancement within the region of the adnexa. BODY WALL: Fat-containing midline ventral hernia. MUSCULOSKELETAL: Multilevel discogenic degenerative changes. No aggressive osseous lesions. CONCLUSION: 1. Interval development of several hypoattenuating hepatic lesions, highly suspicious for metastatic disease. 2. Interval enlargement of a nonspecific left paraesophageal lymph node. Recommend attention on follow-up. 3. Additional chronic and incidental findings as described above. 4. Please see separately dictated same-day CT chest. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.	FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: Please see separately dictated same-day CT chest. ABDOMEN and PELVIS: LIVER: Redemonstration of an ablation of the lateral segment of the left hepatic lobe and small ablation of the right hepatic lobe. There is a new area of ill-defined hypodensity within the inferior right hepatic lobe measuring approximately 1.2 x 0.7 cm (series 2 image 261). Additional new hypodensity in the caudate measures 1.8 x 1.1 cm on axial series 2, image 214. Another subcentimeter hypodensity within the posterior right hepatic lobe is too small to characterize but appears new since prior. BILIARY TRACT: Normal. GALLBLADDER: Cholelithiasis. No pericholecystic fluid or gallbladder wall thickening. PANCREAS: Redemonstration of postsurgical changes from a distal pancreatectomy. The residual pancreas shows normal enhancement. No pancreatic duct dilation. SPLEEN: Surgically absent. ADRENALS: Normal. KIDNEYS: Small bilateral subcentimeter hypodensities are too small to characterize; however, likely representing cysts. No hydronephrosis bilaterally. LYMPH NODES: Recent demonstration of prominent retroperitoneal lymph nodes. Interval enlargement of a left paraesophageal lymph node which currently measures 0.7 cm in short axis on axial series 2, image 193. STOMACH / SMALL BOWEL: Small hiatal hernia. The small bowel is unremarkable. COLON / APPENDIX: No abnormality. The appendix is not well visualized. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Scattered mild atherosclerotic calcifications of the abdominal aorta which is normal in caliber. There is a circumaortic left renal vein. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: The uterus is absent. No adnexal masses or abnormal enhancement within the region of the adnexa. BODY WALL: Fat-containing midline ventral hernia. MUSCULOSKELETAL: Multilevel discogenic degenerative changes. No aggressive osseous lesions.	FINDINGS: Vascular findings: Mild atherosclerotic calcifications are seen along the nonaneurysmal thoracic aorta. The heart is not enlarged. No pericardial effusion. The pulmonary artery are normal in caliber. Mild to moderate coronary artery calcifications. Nonvascular findings: The supraclavicular region is unremarkable. Central airways are patent. Small subcentimeter mediastinal lymph nodes are noted. Right hilar lymph nodes measure up to 14 mm in short axis. Calcified left hilar lymph nodes are present. The esophagus is not dilated. Moderate hiatal hernia. Mild upper lobe predominant centrilobular paraseptal emphysema. Patchy groundglass opacities are seen within the periphery of the right upper, middle and lower lobes and also within the posterior left lower lobe. The left lower lobe opacity is new from the abdominal CT of 7/22/2021. A few tiny calcified granulomas are noted bilaterally. No pleural effusion or pleural thickening. The CT of the abdomen and pelvis will be dictated separately. No acute or aggressive osseous abnormality.
2,513	EXAM: CT Chest with contrast CLINICAL INFORMATION: 66-year-old female follow-up ovarian cancer COMPARISON: September 2, 2020 TECHNIQUE: CT Chest with contrast. Patient weight: 177 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Oral contrast Omnipaque: 16.9 oz. Saline flush: 20 ml. IV contrast injection rate: 3.80 ml per sec. Scan delay: 70sec Scan field of view: 410 mm. DLP: 1118.41 mGy cm. FINDINGS: Previously noted ill-defined groundglass opacities in the left lower lobe have resolved. No new lung nodule or mass is noted. Subcentimeter size nodes in the mediastinum are unchanged. There is no axillary adenopathy. No pleural or pericardial effusion is seen and visualized bones are unremarkable. CONCLUSION: Interval resolution of left lower lobe ill-defined groundglass opacities without intrathoracic metastasis or new disease	FINDINGS: Previously noted ill-defined groundglass opacities in the left lower lobe have resolved. No new lung nodule or mass is noted. Subcentimeter size nodes in the mediastinum are unchanged. There is no axillary adenopathy. No pleural or pericardial effusion is seen and visualized bones are unremarkable.	FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Clear without focal consolidation or pleural effusion. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal for unenhanced technique. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal for unenhanced technique. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: No hydronephrosis or renal calculus bilaterally. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: No intraperitoneal free fluid or air. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus present. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
2,514	EXAM: CT Abdomen and Pelvis wo+w contrast CLINICAL INFORMATION: Breast cancer restaging COMPARISON: 10/4/2021 TECHNIQUE: CT Abdomen and Pelvis wo+w contrast. Patient weight: 187 lbs. IV contrast: Omnipaque 350, 143 ml, per protocol. IV contrast injection rate: 4 ml per sec. Scan delay: bt sec. Scan field of view: 383 mm. DLP: 1156 mGy cm. FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: Please see separately reported chest CT. ABDOMEN and PELVIS: LIVER: Small hypoattenuating cyst within the right hepatic lobe, unchanged. Noncirrhotic morphology. No steatosis. No new concerning mass or lesion. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. Small accessory spleen along the inferior border. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. Shotty bilateral inguinal lymph nodes, likely reactive in nature. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. The appendix is normal. PERITONEUM / MESENTERY: Postsurgical changes are seen involving the anterior abdominal wall and along the anterior aspect of the peritoneum of the lower abdomen and pelvis. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Decompressed. REPRODUCTIVE ORGANS: Stable appearing heterogenously enhancing uterus with several submucosal and subserosal fibroids. No adnexal masses visualized. BODY WALL: Surgical clips are seen involving the anterior abdominal wall. Tiny fat-containing umbilical hernia noted. MUSCULOSKELETAL: No acute or aggressive osseous abnormality. There are areas of crescentic subchondral lucency involving the bilateral femoral heads with increasing sclerotic borders. The femoral heads are not collapsed. The hip joints spaces are well maintained bilaterally. CONCLUSION: 1. No metastatic disease within the abdomen/pelvis. 2. Progressive osteonecrosis of the bilateral femoral heads without collapse, stage III. 2. Fibroid uterus and other stable incidental findings as outlined above. Please see separately reported chest CT. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.	FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: Please see separately reported chest CT. ABDOMEN and PELVIS: LIVER: Small hypoattenuating cyst within the right hepatic lobe, unchanged. Noncirrhotic morphology. No steatosis. No new concerning mass or lesion. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. Small accessory spleen along the inferior border. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. Shotty bilateral inguinal lymph nodes, likely reactive in nature. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. The appendix is normal. PERITONEUM / MESENTERY: Postsurgical changes are seen involving the anterior abdominal wall and along the anterior aspect of the peritoneum of the lower abdomen and pelvis. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Decompressed. REPRODUCTIVE ORGANS: Stable appearing heterogenously enhancing uterus with several submucosal and subserosal fibroids. No adnexal masses visualized. BODY WALL: Surgical clips are seen involving the anterior abdominal wall. Tiny fat-containing umbilical hernia noted. MUSCULOSKELETAL: No acute or aggressive osseous abnormality. There are areas of crescentic subchondral lucency involving the bilateral femoral heads with increasing sclerotic borders. The femoral heads are not collapsed. The hip joints spaces are well maintained bilaterally.	Findings: No enlarged hilar or mediastinal nodes are present. The mediastinum is normal. Mild paraseptal and centrilobular emphysema bilaterally with bronchial wall thickening. Unchanged subsegmental/linear atelectasis in the right middle lobe. Scattered calcified granuloma. Coronary artery calcification: Patient's had a previous CABG. Abdomen: No upper abdominal abnormality identified. Musculoskeletal: No soft tissue masses. No aggressive appearing skeletal lesions. Postsurgical changes from prior median sternotomy with intact wires. Degenerative changes in spine.
2,515	EXAM: CT Chest with contrast CLINICAL INFORMATION: 45-year-old female with breast cancer. COMPARISON: CT chest with contrast dated 10/4/2021.. TECHNIQUE: CT Chest with contrast. Patient weight: 187 lbs. IV contrast: Omnipaque 350, 143 ml, per protocol. IV contrast injection rate: 4 ml per sec. Scan delay: bt sec. Scan field of view: 383 mm. DLP: 1156 mGy cm. FINDINGS: Index lesions: 1. Interval decrease in the size of right lower lobe nodular opacity, measuring 2.2 x 1.3 cm on axial image 16; series 307, previously 2.6 x 1.9 cm. 2. Tiny nodule in the right upper lobe on axial image 46; series 307, unchanged. No new nodule. LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Central airways are patent. No new nodule. Index lesion described as above. No pleural effusion. HEART / VESSELS: Normal sized cardiac chambers. No central PE. No pericardial effusion. Right IJ approach portacatheter terminates at the cavoatrial junction. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: Postsurgical changes from prior left mastectomy and reconstruction. Mild diffuse skin thickening in the left breast, overall unchanged. UPPER ABDOMEN: Reported separately. MUSCULOSKELETAL: No destructive osseous lesion. CONCLUSION: Mild interval decrease in the size of right lower lobe nodular opacity. No new nodule.	FINDINGS: Index lesions: 1. Interval decrease in the size of right lower lobe nodular opacity, measuring 2.2 x 1.3 cm on axial image 16; series 307, previously 2.6 x 1.9 cm. 2. Tiny nodule in the right upper lobe on axial image 46; series 307, unchanged. No new nodule. LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Central airways are patent. No new nodule. Index lesion described as above. No pleural effusion. HEART / VESSELS: Normal sized cardiac chambers. No central PE. No pericardial effusion. Right IJ approach portacatheter terminates at the cavoatrial junction. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: Postsurgical changes from prior left mastectomy and reconstruction. Mild diffuse skin thickening in the left breast, overall unchanged. UPPER ABDOMEN: Reported separately. MUSCULOSKELETAL: No destructive osseous lesion.	FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Small hiatal hernia with prominent paraesophageal lymph node. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: A few prominent but nonenlarged central mesenteric lymph nodes. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Haziness of the central mesentery with a few adjacent prominent lymph nodes. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
2,516	EXAM: CT Angio Chest wo+w contrast CLINICAL INFORMATION: Concern for PTE 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: 160 lbs. IV contrast: Omnipaque 350, 60 ml, per protocol. Saline flush: 80 ml. IV contrast injection rate: 3.80 ml per sec. Scan delay: bolus tracked Scan field of view: 275 mm. KVP: 100 DLP: 235.50 mGy cm. FINDINGS: STRUCTURED REPORT: CT PE OVERALL DIAGNOSTIC QUALITY: Full diagnostic quality LOWER NECK: No abnormality. CHEST: PULMONARY ARTERIES: Negative for pulmonary embolus LUNGS / AIRWAYS / PLEURA: Small left pleural effusion. No pneumothorax or pleural effusion. Scattered subsegmental atelectasis as well as more rounded region of subpleural consolidation in the left lower lobe on such as on image 91, series 401 HEART / OTHER VESSELS: Heart is mildly enlarged. Mild coronary arterial and aortic atherosclerotic calcification. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: Partially calcified left hilar nodes. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Normal. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. No pulmonary embolism. 2. Small left pleural effusion. Small rounded area of subpleural consolidation in the left lower lobe could reflect pneumonia versus additional region of developing atelectasis. 3. Mild cardiac enlargement and additional incidental findings as above.	FINDINGS: STRUCTURED REPORT: CT PE OVERALL DIAGNOSTIC QUALITY: Full diagnostic quality LOWER NECK: No abnormality. CHEST: PULMONARY ARTERIES: Negative for pulmonary embolus LUNGS / AIRWAYS / PLEURA: Small left pleural effusion. No pneumothorax or pleural effusion. Scattered subsegmental atelectasis as well as more rounded region of subpleural consolidation in the left lower lobe on such as on image 91, series 401 HEART / OTHER VESSELS: Heart is mildly enlarged. Mild coronary arterial and aortic atherosclerotic calcification. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: Partially calcified left hilar nodes. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Normal. MUSCULOSKELETAL: No significant abnormality.	FINDINGS: STRUCTURED REPORT: CT Chest LOWER NECK: Please see same-day CT neck for neck findings. CHEST: LUNGS / AIRWAYS / PLEURA: No change in the right lower lobe pleural-based nodule measuring 5 mm in diameter on series 2 image 72. Nodule along the right minor fissure on image 66 is slightly decreased. Previous granulomatous disease. No new suspicious pulmonary nodule. Focal layering secretions in the trachea. HEART / VESSELS: Heart size is normal. No pericardial effusion. Moderate coronary artery calcifications. MEDIASTINUM / ESOPHAGUS: Prominent right paratracheal lymph node measuring 1.2 x 0.8 cm on series 2 image 12, better appreciated on same day neck CT. LYMPH NODES: None enlarged. Prominent right paratracheal lymph node, as above. Calcified mediastinal and hilar nodes are also seen. CHEST WALL: Interval resection of previously noted large right lateral chest wall lipoma. UPPER ABDOMEN: Stable left upper pole cystic lesions. Scattered too small to characterize hepatic hypodensities are unchanged, likely benign cysts. MUSCULOSKELETAL: No acute or aggressive appearing osseous abnormality.
2,517	EXAM: CT Chest with contrast CLINICAL INFORMATION: 67-year-old male follow-up lung cancer COMPARISON: October 7, 2021 TECHNIQUE: CT Chest with contrast. Patient weight: 150 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 10 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 78 sec Scan field of view: 476 mm. DLP: 653 mGy cm. FINDINGS: Index lesions are measured in series 3. Slightly irregular heterogeneously enhancing right upper lobe nodule in image 48 is 25 x 24 mm, it was 30 x 23 mm. A small right upper paratracheal node short axis diameter is 6 mm, it was 7 mm before. Right hilar node in image 92 is 8 mm, it was 11 mm before. Focal areas of atelectasis in the lateral segment of right middle lobe and inferior lingula persist. There is diffuse increased peribronchial thickening and mild asymmetric upper lobe dominant emphysema. No pleural or pericardial effusion is seen . Ill-defined lysis and sclerosis of the manubrium sternum with pathologic fracture. CONCLUSION: 1. The right upper lobe primary bronchogenic carcinoma mass is slightly smaller with borderline decreased size of the paratracheal and right hilar node. 2. Manubrial ill-defined lytic and sclerotic lesion suspicious for metastasis with suspected pathologic fracture.	FINDINGS: Index lesions are measured in series 3. Slightly irregular heterogeneously enhancing right upper lobe nodule in image 48 is 25 x 24 mm, it was 30 x 23 mm. A small right upper paratracheal node short axis diameter is 6 mm, it was 7 mm before. Right hilar node in image 92 is 8 mm, it was 11 mm before. Focal areas of atelectasis in the lateral segment of right middle lobe and inferior lingula persist. There is diffuse increased peribronchial thickening and mild asymmetric upper lobe dominant emphysema. No pleural or pericardial effusion is seen . Ill-defined lysis and sclerosis of the manubrium sternum with pathologic fracture.	Findings: The right paratracheal lymph node inferior to the thyroidectomy bed is slightly increased in size measuring 0.9 x 1.4 cm. Enhancing right Delphian lymphadenopathy measures 0.6 x 0.8 cm. There is an enhancing subcentimeter lymph node in the left level III measuring 0.8 x 0.4 cm, which has intact fatty hilum. No additional cervical lymphadenopathy is identified. The bilateral thyroidectomy bed shows no recurrent thyroid mass lesion.
2,518	EXAM: CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: 67-year-old male with history of lung cancer; follow-up. COMPARISON: CT abdomen pelvis 10/7/2021 TECHNIQUE: CT Abdomen and Pelvis w contrast. Patient weight: 150 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 10 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 78 sec Scan field of view: 476 mm. FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis CT chest findings are reported separately. ABDOMEN and PELVIS: LIVER: Stable subcentimeter hypodensity in the posterior right hepatic lobe, technically indeterminate but most suggestive of a cyst. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal for technique. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Short segment of suspected colonic wall thickening involving the proximal sigmoid colon. This is within a segment of diverticular disease, however, no discretely inflamed diverticulum. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Mild ectasia of the infrarenal abdominal aorta. Advanced atherosclerotic disease is present. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No suspicious osseous lesion. Chronic bilateral L5 pars defects with associated mild, grade 1 anterolisthesis of L5 on S1. CONCLUSION: 1. No definite evidence of metastatic disease within the abdomen or pelvis. 2. Focal segment of suspected sigmoid colon wall thickening. This could reflect focal colitis although underlying neoplasm is not excluded. Recommend correlation with clinical history and prior colonoscopic history.	FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis CT chest findings are reported separately. ABDOMEN and PELVIS: LIVER: Stable subcentimeter hypodensity in the posterior right hepatic lobe, technically indeterminate but most suggestive of a cyst. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal for technique. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Short segment of suspected colonic wall thickening involving the proximal sigmoid colon. This is within a segment of diverticular disease, however, no discretely inflamed diverticulum. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Mild ectasia of the infrarenal abdominal aorta. Advanced atherosclerotic disease is present. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No suspicious osseous lesion. Chronic bilateral L5 pars defects with associated mild, grade 1 anterolisthesis of L5 on S1.	FINDINGS: The study is mildly degraded by metallic streak artifact from dental amalgam. SOFT TISSUES: Normal. 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 right thyroid lobe hypoattenuating nodules up to 1.3 cm. VASCULAR STRUCTURES: Normal. MANDIBLE/MAXILLA: Tiny periapical lucency adjacent to to the left maxillary first premolar (series 5, image 100). REMAINING OSSEOUS STRUCTURES: No fracture, dislocation, or destructive lesion. Multilevel cervical spine degenerative facet arthropathy. There is diffuse osteopenia. ORBITS: Normal. PARANASAL SINUSES AND MASTOID AIR CELLS: Partial opacification of the right maxillary sinus floor with severe mucosal thickening. The paranasal sinuses and mastoid air cell are otherwise clear. VISUALIZED INTRACRANIAL STRUCTURES: Normal. LUNG APICES: Biapical pleuroparenchymal scarring. There is patchy subpleural interstitial opacification of the left upper lobe concerning for inflammation/infectious. The imaged lungs are otherwise clear.
2,519	EXAM: CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: 48-year-old female with metastatic colorectal cancer. COMPARISON: CT 8/19/2012 TECHNIQUE: CT Abdomen and Pelvis w contrast. Patient weight: 212 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. Saline flush: 10 ml. IV contrast injection rate: 2 ml per sec. Scan delay: 100 sec Scan field of view: 500 mm. FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis ABDOMEN and PELVIS: LIVER: The heterogeneous lesion in the posterior right hepatic lobe is difficult to measure due to surrounding hyperemia, but measures approximately 4.0 x 3.9 cm (image 168 series 3), previously 4.0 x 3.8 cm. Persistent partial thrombosis of the adjacent right hepatic vein. Persistent ablation defect in the anterior right hepatic lobe. BILIARY TRACT: Normal. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Persistent splenomegaly. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: Persistent borderline enlarged lower retroperitoneal lymph nodes. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: An anastomotic suture line is at the rectosigmoid junction. PERITONEUM / MESENTERY: Persistent mild fat stranding in the central mesentery. RETROPERITONEUM: Persistent fat stranding in the retroperitoneum with ill-defined soft tissue between the proximal common iliac vessels. VESSELS: Persistent partial thrombosis of the right hepatic vein as described above. There are large distal esophageal varices. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus is absent. Ovaries are not seen. BODY WALL: Tiny fat-containing umbilical hernia. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. Unchanged heterogeneous metastasis in the posterior right hepatic lobe. Persistent ill-defined soft tissue encasement of the aortic bifurcation. 2. Large distal esophageal varices and splenomegaly consistent with portal hypertension.	FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis ABDOMEN and PELVIS: LIVER: The heterogeneous lesion in the posterior right hepatic lobe is difficult to measure due to surrounding hyperemia, but measures approximately 4.0 x 3.9 cm (image 168 series 3), previously 4.0 x 3.8 cm. Persistent partial thrombosis of the adjacent right hepatic vein. Persistent ablation defect in the anterior right hepatic lobe. BILIARY TRACT: Normal. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Persistent splenomegaly. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: Persistent borderline enlarged lower retroperitoneal lymph nodes. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: An anastomotic suture line is at the rectosigmoid junction. PERITONEUM / MESENTERY: Persistent mild fat stranding in the central mesentery. RETROPERITONEUM: Persistent fat stranding in the retroperitoneum with ill-defined soft tissue between the proximal common iliac vessels. VESSELS: Persistent partial thrombosis of the right hepatic vein as described above. There are large distal esophageal varices. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus is absent. Ovaries are not seen. BODY WALL: Tiny fat-containing umbilical hernia. MUSCULOSKELETAL: No significant abnormality.	FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. LINES AND TUBES: None. LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Persistent nodular cluster in the left lower lobe is unchanged. Minimally increased ill-defined mixed consolidation/groundglass allowing for differences in technique. Minimal tree-in-bud nodularity with groundglass opacity in the right lower lobe seen on series 201 image #457. Diffuse bronchial wall thickening. HEART / VESSELS: Postsurgical changes of heart transplant. MEDIASTINUM / ESOPHAGUS: Patulous esophagus. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Normal. MUSCULOSKELETAL: Unchanged osseous structures. Subtle compression deformity with anterior height loss of T8.
2,520	EXAM: CT Chest with contrast CLINICAL INFORMATION: 48-year-old female follow-up colon cancer COMPARISON: August 19, 2021 TECHNIQUE: CT Chest with contrast. Patient weight: 212 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. Saline flush: 10 ml. IV contrast injection rate: 2 ml per sec. Scan delay: 100 sec Scan field of view: 500 mm. DLP: 2059 mGy cm. FINDINGS: Index lesions are measured in series 3. Left upper lobe nodule in image 85 measures 10 mm increased from 6 mm size before. The left lower lobe nodule in image 84 is 8 x 8 mm, it was 6 x 5 mm. Right lower lobe nodule is 11 mm in image 148, it was 7 mm before. Several new bilateral lung nodules are noted. Dense right hilar nodal calcification persists. No other mediastinal adenopathy is seen. There is no pleural or pericardial effusion and visualized bones are unremarkable. CONCLUSION: Worsening pulmonary metastatic disease.	FINDINGS: Index lesions are measured in series 3. Left upper lobe nodule in image 85 measures 10 mm increased from 6 mm size before. The left lower lobe nodule in image 84 is 8 x 8 mm, it was 6 x 5 mm. Right lower lobe nodule is 11 mm in image 148, it was 7 mm before. Several new bilateral lung nodules are noted. Dense right hilar nodal calcification persists. No other mediastinal adenopathy is seen. There is no pleural or pericardial effusion and visualized bones are unremarkable.	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: Unchanged hypodensity in the right posterior liver, technically too small to characterize but statistically represents a cyst. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Subcentimeter right adrenal adenoma. The left adrenal gland is unremarkable. KIDNEYS: Interval increase in size of the partially exophytic hyperdense lesion in the lower pole of the left kidney, which measures 3.0 x 2.6 cm (image 159, series 301), previously subcentimeter and showing some uptake iodine images. The right kidney is unremarkable. No hydronephrosis or renal calculus bilaterally. LYMPH NODES: Multiple borderline enlarged gastrohepatic and celiac axis lymph nodes. STOMACH / SMALL BOWEL: Small hiatal hernia. Otherwise unremarkable appearance of the stomach and small bowel. COLON / APPENDIX: Noninflamed colonic diverticula. The appendix is normal. PERITONEUM / MESENTERY: No free intraperitoneal fluid or air. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Small fat-containing umbilical hernia. MUSCULOSKELETAL: Right acetabular fixation hardware shows no evidence of loosening or failure. No acute displaced fracture.
2,521	EXAM: CT Chest with contrast CLINICAL INFORMATION: 59-year-old female follow-up melanoma COMPARISON: September 30, 2021 TECHNIQUE: CT Chest with contrast. Patient weight: 135 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 20 ml. IV contrast injection rate: 2.50 ml per sec. Scan delay: Bolus Tracked. Scan field of view: 440 mm. DLP: 804.87 mGy cm. FINDINGS: Small ill-defined nodular density along the minor fissure in image 106, series 9 appears unchanged. There are few other scattered calcified lesions in the right upper lobe with persistent mild diffuse increased peribronchial thickening. No new nodule or mass is noted. Several calcified nodes in the mediastinum are again noted without new mediastinal hilar or axillary adenopathy. There is no pleural or pericardial effusion. No focal lytic or sclerotic bone lesion is seen. Old healed deformity of the right posterior ribs. CONCLUSION: Stable chest CT without intrathoracic metastasis or new disease	FINDINGS: Small ill-defined nodular density along the minor fissure in image 106, series 9 appears unchanged. There are few other scattered calcified lesions in the right upper lobe with persistent mild diffuse increased peribronchial thickening. No new nodule or mass is noted. Several calcified nodes in the mediastinum are again noted without new mediastinal hilar or axillary adenopathy. There is no pleural or pericardial effusion. No focal lytic or sclerotic bone lesion is seen. Old healed deformity of the right posterior ribs.	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: Diffuse bilateral lower lung predominant centrilobular groundglass nodules. HEART / OTHER VESSELS: Borderline heart size. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Normal. MUSCULOSKELETAL: No significant abnormality.
2,522	EXAM: CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: 59-year-old female with history of melanoma; follow-up. COMPARISON: Multiple prior CTs of the abdomen pelvis, most recently 9/30/2021 TECHNIQUE: CT Abdomen and Pelvis w contrast. Patient weight: 135 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 20 ml. IV contrast injection rate: 2.50 ml per sec. Scan delay: Bolus Tracked. Scan field of view: 440 mm. DLP: 804.87 mGy cm. FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis CT chest findings are reported separately. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Punctate calcifications compatible with granulomatous disease. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Scattered colonic diverticuli without associated inflammation. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: No evidence of metastatic disease within the abdomen or pelvis.	FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis CT chest findings are reported separately. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Punctate calcifications compatible with granulomatous disease. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Scattered colonic diverticuli without associated inflammation. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.	Findings: Index lesions as below as measured on series 2: 1. Nodular opacity within the right lower lobe measures 7 mm (image 124) previously measuring 7 mm. 2. Noncalcified, solid nodule within the superior segment right lower lobe measures 4 x 6 mm (average 5 mm)(image 73), previously measuring 4 x 6 mm. 3. The mixed density nodule within the superior segment left lower lobe measures 8 x 8 mm in total (image 93) with solid portion measuring approximately 4 x 3 mm. This measured 7 x 8 mm on the prior exam on image 50 is solid component again approximately 4 mm. 4. Solid noncalcified subpleural nodule in the superior segment of the right lower lobe measures 6 x 7 mm ( image 94) and was 6 x 6 mm on the prior. Biapical pleural parenchymal scarring is unchanged. Mild scarring along the suture line in the upper left lung is also unchanged. Additional groundglass opacities are again seen in the right lung on images 51, 66, 83, 91, 98, 100 and 103 as well as in the left lung on images 149 and 177, all unchanged. No new disease. No pleural effusion. Postsurgical findings at the right hilum are unchanged. No intrathoracic adenopathy is present. A small hiatal hernia is again seen. Tiny left thyroid nodule remains unchanged. . The heart size and mediastinum are otherwise normal. No focal destructive osseous lesions identified. CT of the abdomen and pelvis will be reported separately.
2,523	Calculation of liver volumes was requested by the ordering provider and performed by a user at an independent workstation. The calculated liver volumes are as follows: Total liver volume: 2064 mL Left hepatic lobe volume: 618 mL (30%) Right hepatic lobe volume: 1446 mL (70%) Left hepatic lobe lateral segment volume: 266 mL (13%) Left hepatic lobe medial segment volume: 352 mL (17%) Right hepatic lobe anterior segment volume: 995 mL (48%) Right hepatic lobe posterior segment volume: 452 mL (22%)	The calculated liver volumes are as follows: Total liver volume: 2064 mL Left hepatic lobe volume: 618 mL (30%) Right hepatic lobe volume: 1446 mL (70%) Left hepatic lobe lateral segment volume: 266 mL (13%) Left hepatic lobe medial segment volume: 352 mL (17%) Right hepatic lobe anterior segment volume: 995 mL (48%) Right hepatic lobe posterior segment volume: 452 mL (22%)	FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis CT chest findings are reported separately. ABDOMEN and PELVIS: LIVER: Normal for technique. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal for technique. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Scattered colonic diverticuli. Moderate colonic fecal burden. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Normal caliber abdominal aorta. Mild atherosclerotic disease. Stable mild atherosclerotic narrowing near the origin of the celiac artery. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Stable appearance of benign-appearing sclerotic lesion in the left iliac bone. Multilevel endplate and facet degenerative changes.
2,524	EXAM: CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: Left lower quadrant abdominal pain COMPARISON: None. TECHNIQUE: CT Abdomen and Pelvis w contrast. Patient weight: 130 lbs. IV contrast: Omnipaque 350, 80 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 2.30 ml per sec. Scan delay: 76 sec Scan field of view: 340 mm. DLP: 428 mGy cm. FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Circumferential wall thickening and mucosal hyperenhancement of the distal thoracic esophagus. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Low-attenuation in the region of the pancreaticoduodenal groove. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No bowel obstruction. Distended stomach with air-fluid level. Mild wall thickening of the descending and proximal transverse duodenum COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Moderately distended but otherwise normal. REPRODUCTIVE ORGANS: No acute abnormality BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. Prominence submucosal edema within the distal thoracic esophagus consistent with esophagitis. 2. Wall thickening of the descending and proximal transverse duodenum with mild increased low attenuation in the region of the pancreaticoduodenal groove suggesting duodenitis versus paraduodenal/groove pancreatitis. 4. Additional chronic and incidental findings as above.	FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Circumferential wall thickening and mucosal hyperenhancement of the distal thoracic esophagus. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Low-attenuation in the region of the pancreaticoduodenal groove. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No bowel obstruction. Distended stomach with air-fluid level. Mild wall thickening of the descending and proximal transverse duodenum COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Moderately distended but otherwise normal. REPRODUCTIVE ORGANS: No acute abnormality BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.	FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Chest LOWER NECK: Small low-attenuation lesions in the right lobe of the thyroid is perhaps enlarged although difficult to ascertain on this noncontrast examination. CHEST: LUNGS / AIRWAYS / PLEURA: A couple of calcified nodules in the right upper lobe and a tiny calcified nodule in the left upper lobe. No suspicious noncalcified pulmonary nodules. Tiny nodular opacities along the left lung fissure likely represent tiny fissural lymph nodes. HEART / VESSELS: Moderate to severe coronary artery calcifications. Mildly ectatic ascending aorta measuring up to 4.2 cm, not significantly changed. Main pulmonary artery is mildly enlarged at 3.2 cm suggesting some element of pulmonary artery hypertension. MEDIASTINUM / ESOPHAGUS: Mildly patulous esophagus. LYMPH NODES: No pathologically enlarged intrathoracic lymph nodes. Calcified mediastinal lymph nodes suggestive of old granulomatous disease. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Small left adrenal nodule measuring about 1.0 cm is not significantly changed. MUSCULOSKELETAL: No significant abnormality.
2,525	RADIOLOGIC EXAM: CT Head wo contrast CLINICAL INFORMATION: Trauma. COMPARISON: None. TECHNIQUE: CT Head wo contrastScan field of view: 228 mm. DLP: 2437.80 mGy cm. STRUCTURED REPORT: CT Head Trauma FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Minimal mucosal thickening in the left sphenoid chamber. No acute abnormality. CONCLUSION: No acute intracranial process.	FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Minimal mucosal thickening in the left sphenoid chamber. No acute abnormality.	FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Hazy peripheral groundglass opacities in the bilateral lower lobes may represent atypical infection. Right lower lobe pulmonary nodule measures about 0.7 x 0.6 cm (series 3; image 123), previously about 0.6 x 0.8 cm. Tiny nodules seen on the lateral segment of the middle lobe (series 3; image 86 measures about 0.6 x 0.3 cm (series 4; image 122) on the coronal images, unchanged. No new or growing pulmonary nodules. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Please note that the concurrently obtained CT scan of the Abdomen will be dictated separately.. Partially visualized surgical clips in the left retrocardiac peritoneum. MUSCULOSKELETAL: No significant abnormality.
2,526	EXAM: CT Chest High Resolution wo contrast CLINICAL INFORMATION: 67-year-old male with COPD and suspected restrictive lung disease COMPARISON: December 8, 2020 TECHNIQUE: CT Chest High Resolution wo contrast. Scan field of view: 374 mm. DLP: 630 mGy cm. High-resolution CT imaging of the chest was performed per protocol with inspiratory and expiratory technique in prone position. FINDINGS: Asymmetric upper lobe dominant mixed emphysema. The ill-defined groundglass density 4 mm nodule in the lateral basal segment of left lower lobe appears unchanged in image 113, series 3. Minimal subpleural linear scarring in the right middle lobe is unchanged. Slightly dilated central bronchi. There is no honeycombing minimal expiratory air trapping is present . The AP diameter of the distal trachea both bronchi and bronchus intermedius decreases more than 50% on expiratory series. Atherosclerotic disease changes in the thoracic aorta and its branches. No mediastinal adenopathy is noted. Excessive fat is present in the mediastinum as well as in the intrathoracic fascia. There is no pleural or pericardial effusion and visualized bones are unremarkable. CONCLUSION: 1. COPD with mild tracheobronchomalacia. 2. No definitive interstitial lung disease changes are seen. 3. Stable 4 mm ill-defined groundglass density nodule in the left lower lobe.	FINDINGS: Asymmetric upper lobe dominant mixed emphysema. The ill-defined groundglass density 4 mm nodule in the lateral basal segment of left lower lobe appears unchanged in image 113, series 3. Minimal subpleural linear scarring in the right middle lobe is unchanged. Slightly dilated central bronchi. There is no honeycombing minimal expiratory air trapping is present . The AP diameter of the distal trachea both bronchi and bronchus intermedius decreases more than 50% on expiratory series. Atherosclerotic disease changes in the thoracic aorta and its branches. No mediastinal adenopathy is noted. Excessive fat is present in the mediastinum as well as in the intrathoracic fascia. There is no pleural or pericardial effusion and visualized bones are unremarkable.	FINDINGS: The calvarium and skull base are intact. Intracranially there is no evidence of cerebral contusion, hemorrhage, edema or mass effect. No evidence of acute cerebral ischemic pathology is noted. The ventricles are normal in size and configuration. The cortical sulci and subarachnoid cisterns are symmetric and age-appropriate. There is no extra-axial pathology. Right frontal sinus retention cyst and sphenoid sinus small air-fluid levels are noted.
2,527	CT Head wo contrast 1/6/2022 8:25 AM Clinical Information: subdural hemorrhage (sdh), S06.5X9A Traumatic subdural hemorrhage with loss of consciousness of unspecified duration, initial encounter Spec Inst: subdural hematoma following MVC; please schedule to correlate for a follow up 1045 appointment on 162022 if possible Comparison: Head CT 12/5/2021 Technique: Unenhanced axial brain CT with coronal and sagittal reconstructions. Scan field of view: 219 mm. DLP: 436 mGy cm. Findings: There has been interval resolution of the right cerebral convexity subdural hematoma and associated mass effect. Effacement of the right lateral ventricle and previously seen leftward midline shift have resolved. There is no evidence of acute infarction, hemorrhage or hydrocephalus. There is no vasogenic edema or mass effect. The visualized paranasal sinuses and mastoid air cells are clear. There is no acute osseous abnormality. Impression: Resolution of the previous right cerebral convexity subdural hematoma and associated mass effect. No CT evidence of acute intracranial abnormality.	Findings: There has been interval resolution of the right cerebral convexity subdural hematoma and associated mass effect. Effacement of the right lateral ventricle and previously seen leftward midline shift have resolved. There is no evidence of acute infarction, hemorrhage or hydrocephalus. There is no vasogenic edema or mass effect. The visualized paranasal sinuses and mastoid air cells are clear. There is no acute osseous abnormality.	Findings: The paranasal sinuses are normally formed and developed. There is minor mucosal thickening in the sphenoid and frontal sinuses and a small retention cyst in the right frontal sinus. The maxillofacial bones, orbits and orbital contents are unremarkable. The nasal passages are narrow and partially obstructed by the turbinates. No defect is seen in the anterior skull base or calvarium. ---------------
2,528	EXAM: CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: Colorectal cancer surveillance COMPARISON: 9/9/2021 TECHNIQUE: CT Abdomen and Pelvis w contrast. Patient weight: 180 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 10 ml. IV contrast injection rate: 3.50 ml per sec. Scan delay: 72 sec Scan field of view: 493 mm. FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: Please see separately reported chest CT. ABDOMEN and PELVIS: LIVER: Stable postsurgical changes related to partial hepatectomy of segment VII. No concerning mass or lesion identified. Noncirrhotic morphology. Focal fat infiltration adjacent to the falciform ligament is unchanged. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. Stable postsurgical changes related to prior partial small bowel resection without evidence of disease recurrence central lines. COLON / APPENDIX: Stable postsurgical changes related to prior sigmoidectomy without evidence of disease recurrence at the suture lines. A few scattered diverticula are present without surrounding inflammation. The appendix is normal. PERITONEUM / MESENTERY: Stable postsurgical changes as above. RETROPERITONEUM: Stable surgical clip is seen adjacent to the infrarenal abdominal aorta, likely clipped IMA. VESSELS: No significant abnormality. URINARY BLADDER: Mild bladder wall thickening is due to underdistention, no abnormalities noted. REPRODUCTIVE ORGANS: Bilateral vasectomy clips noted. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No acute or aggressive osseous abnormality. Mild degenerative changes involving the lumbar spine. CONCLUSION: 1. No recurrence or metastatic disease within the abdomen/pelvis. 2. Stable postsurgical changes of partial hepatectomy and sigmoidectomy. 2. Other incidental findings as outlined above. Please see separately reported chest CT. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.	FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: Please see separately reported chest CT. ABDOMEN and PELVIS: LIVER: Stable postsurgical changes related to partial hepatectomy of segment VII. No concerning mass or lesion identified. Noncirrhotic morphology. Focal fat infiltration adjacent to the falciform ligament is unchanged. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. Stable postsurgical changes related to prior partial small bowel resection without evidence of disease recurrence central lines. COLON / APPENDIX: Stable postsurgical changes related to prior sigmoidectomy without evidence of disease recurrence at the suture lines. A few scattered diverticula are present without surrounding inflammation. The appendix is normal. PERITONEUM / MESENTERY: Stable postsurgical changes as above. RETROPERITONEUM: Stable surgical clip is seen adjacent to the infrarenal abdominal aorta, likely clipped IMA. VESSELS: No significant abnormality. URINARY BLADDER: Mild bladder wall thickening is due to underdistention, no abnormalities noted. REPRODUCTIVE ORGANS: Bilateral vasectomy clips noted. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No acute or aggressive osseous abnormality. Mild degenerative changes involving the lumbar spine.	FINDINGS: Vascular findings:. Eccentric atherosclerotic plaque is again seen along the aortic arch and descending thoracic aorta, similar to the prior examination. There is no acute aortic abnormality. Dilation of the ascending thoracic aorta is again seen with measurements provided below: Aortic measurements are as follows (using center line technique): Aortic root at the level of the sinuses: 43 x 39 x 39 mm as measured from sinus to commissure. Mid-ascending thoracic aorta: 50 x 49 mm (previously 51 x 50 mm). Aortic arch: 41 x 38 mm. Proximal descending thoracic aorta: 34 x 29 mm. Mid descending thoracic aorta: 38 x 34 mm. Distal descending thoracic aorta: 33 x 30 mm. The heart is not enlarged. The pulmonary arteries are normal in caliber. No pericardial effusion. The cardiac pacer leads are appropriately positioned. Nonvascular findings: The supraclavicular region is unremarkable. Central airways are patent. No enlarged thoracic lymph nodes. No acute lung abnormality. Minimal linear scarring within the right lung apex. No new or enlarging lung nodules. No pleural effusion or pleural thickening. No acute or aggressive osseous abnormality.
2,529	EXAM: CT Chest with contrast CLINICAL INFORMATION: History of metastatic colorectal cancer undergoing surveillance. COMPARISON: CT chest 9/9/2021 TECHNIQUE: CT Chest with contrast. Patient weight: 180 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 10 ml. IV contrast injection rate: 3.50 ml per sec. Scan delay: 72 sec Scan field of view: 493 mm. DLP: 764 mGy cm. FINDINGS: STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: The central airways are patent. No focal airspace consolidation, suspicious nodule/mass, or pleural effusion. HEART / VESSELS: The heart is normal in size without pericardial effusion. Thoracic aorta and pulmonary artery are normal in caliber. No large central pulmonary embolus. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. MUSCULOSKELETAL: No aggressive osseous lesion. Mild multilevel degenerative changes of the thoracic spine. CONCLUSION: No evidence of intrathoracic metastatic disease or acute abnormality. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.	FINDINGS: STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: The central airways are patent. No focal airspace consolidation, suspicious nodule/mass, or pleural effusion. HEART / VESSELS: The heart is normal in size without pericardial effusion. Thoracic aorta and pulmonary artery are normal in caliber. No large central pulmonary embolus. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. MUSCULOSKELETAL: No aggressive osseous lesion. Mild multilevel degenerative changes of the thoracic spine.	FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Scattered hepatic cysts. Additional subcentimeter foci of hypoattenuation are too small for accurate characterization. BILIARY TRACT: Normal. GALLBLADDER: Absent. PANCREAS: Cystic lesion in the uncinate measures 0.8 cm on image 96 series 2. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Subcentimeter foci of hypoattenuation are too small for accurate characterization. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Scattered noninflamed colonic diverticula. No evidence of radiation proctitis. No evidence of colitis. Appendix is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Moderate atherosclerotic calcifications of the abdominal aorta and branch vessels. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Prominent periuterine vessels. Patient's known cervical malignancy is not well evaluated with CT. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
2,530	EXAM: CT Chest with contrast CLINICAL INFORMATION: History of lung cancer post chemoradiation. COMPARISON: CT chest on 7/21 TECHNIQUE: CT Chest with contrast. Patient weight: 215 lbs. IV contrast: Omnipaque 350, 80 ml, per protocol. Saline flush: 20 ml. IV contrast injection rate: 2 ml per sec. Scan delay: 35 sec. Scan field of view: 400 mm. DLP: 334.95 mGy cm. FINDINGS: STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Redemonstration of superior left lower lobe and posterior left upper lobe bronchiectasis and atelectasis/pleural parenchymal scarring with similar appearance of adjacent ground glass opacities. Unchanged appearance of focal cavitation in the dependent left lower lobe with surrounding ill-defined soft tissue consolidation. Mild right middle and right lower lobe bronchiectasis. Mild paraseptal emphysema. No new suspicious nodule or mass. HEART / VESSELS: The heart is normal in size with trace pericardial effusion, similar to prior. Mild atherosclerotic disease of the thoracic aorta. MEDIASTINUM / ESOPHAGUS: There is leftward shift of the mediastinum. The esophagus is unremarkable. LYMPH NODES: Calcified left hilar lymph node. Shotty mediastinal lymph nodes appear similar prior but are not pathologically enlarged by CT criteria. UPPER ABDOMEN: Normal. MUSCULOSKELETAL: No aggressive osseous lesions. Decreased osseous mineralization. Chronic left posterior rib fractures are again seen. Mild multilevel degenerative changes of the thoracic spine with exaggerated thoracic kyphosis. CONCLUSION: 1. Stable posttreatment changes in the left lung without evidence of disease progression. 2. Stable cavitation in the left lower lobe with adjacent lung parenchymal and pleural soft tissue and overlying posterior chest wall thickening. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.	FINDINGS: STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Redemonstration of superior left lower lobe and posterior left upper lobe bronchiectasis and atelectasis/pleural parenchymal scarring with similar appearance of adjacent ground glass opacities. Unchanged appearance of focal cavitation in the dependent left lower lobe with surrounding ill-defined soft tissue consolidation. Mild right middle and right lower lobe bronchiectasis. Mild paraseptal emphysema. No new suspicious nodule or mass. HEART / VESSELS: The heart is normal in size with trace pericardial effusion, similar to prior. Mild atherosclerotic disease of the thoracic aorta. MEDIASTINUM / ESOPHAGUS: There is leftward shift of the mediastinum. The esophagus is unremarkable. LYMPH NODES: Calcified left hilar lymph node. Shotty mediastinal lymph nodes appear similar prior but are not pathologically enlarged by CT criteria. UPPER ABDOMEN: Normal. MUSCULOSKELETAL: No aggressive osseous lesions. Decreased osseous mineralization. Chronic left posterior rib fractures are again seen. Mild multilevel degenerative changes of the thoracic spine with exaggerated thoracic kyphosis.	FINDINGS: STRUCTURED REPORT: CT Chest LOWER NECK: Please note that the concurrently obtained CT scan of the neck will be dictated separately. CHEST: LUNGS / AIRWAYS / PLEURA: Bilateral dependent groundglass opacities are presumed atelectasis. Tiny peripheral nodules in the left lung apex (series 2; image 37) are unchanged. No new or growing pulmonary nodules. HEART / VESSELS: Moderate coronary artery calcifications. Mild mitral annulus calcification. Aortic valve calcifications without significant dilation of the ascending aorta. MEDIASTINUM / ESOPHAGUS: Small hiatal hernia. LYMPH NODES: Small mediastinal lymph nodes including a couple of atypical lymph node adjacent to the gastroesophageal junction all measure well under a centimeter and are unchanged. CHEST WALL: A right chest port terminates near the cavoatrial junction. Chest wall is otherwise unremarkable. UPPER ABDOMEN: Please note that the concurrently obtained CT scan of the Abdomen will be dictated separately. MUSCULOSKELETAL: No significant abnormality.
2,531	EXAM: CT Angio Chest wo+w contrast CLINICAL INFORMATION: COVID confirmed, rule out aortic injury, hypotensive. COMPARISON: CT chest 1/5/2022. TECHNIQUE: CT Angio Chest wo+w contrast. Additional 3D image post-processing was performed to generate MIP and/or volume-rendered images. Patient weight: 243 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: 380 mm. KVP: 120 FINDINGS: VASCULATURE: Initial precontrast images again demonstrate hematoma adjacent to the descending thoracic aorta, with mild interval worsening. CORONARY ARTERIES: There are mild atherosclerotic calcifications of the native coronary arteries. PULMONARY ARTERIES: No central pulmonary embolus. Enlarged measuring 3.4 cm. ASCENDING THORACIC AORTA: No significant abnormality, within the limitations cardiac motion. AORTIC ARCH: Minimal calcified atherosclerosis. ARCH VESSELS: No significant abnormality. DESCENDING THORACIC AORTA: There is interval increased size of the periaortic hematoma with nonorganized mixed density fluid and stranding surrounding the descending thoracic aorta, tracking into the posterior mediastinum and abdomen. No active extravasation identified. The fluid measures approximately 10.9 x 6.6 cm in total (image 356, series #503). No dissection flap or thrombus visualized. UPPER ABDOMINAL AORTA: Please see separately reported same day CTA abdomen and pelvis. ------------------------------------------------------------- LOWER NECK: Partially calcified right thyroid nodule measuring 1.1 cm. Hypoattenuating left thyroid nodule measuring 1.2 cm. CHEST: LUNGS / AIRWAYS / PLEURA: Endotracheal tube terminates in the mid trachea. Secretions in the left main bronchus with development of Left upper lobe atelectasis and partial atelectasis in the left lower lobe. Scattered areas of lower attenuation consolidation in the bilateral lower lobes, left greater than right. No pneumothorax. Moderate bilateral pleural effusions, new. HEART / OTHER VESSELS: Mildly enlarged heart size with left ventricular hypertrophy. No pericardial effusion. MEDIASTINUM / ESOPHAGUS: Enlarging periaortic hematoma as above. Circumferential thickening of the esophageal wall. No pneumomediastinum. LYMPH NODES: None enlarged. CHEST WALL: Minimal stranding in the anterior chest wall, unchanged. Minimally displaced left 12th rib fracture. UPPER ABDOMEN: Please see separately reported same day CTA abdomen and pelvis. MUSCULOSKELETAL: Interval posterior fixation of the T9-L2 vertebral bodies. Similar appearance of severe distraction/fracture of the T11 and T12 vertebral bodies. CONCLUSION: 1. Enlarging periaortic hematoma tracking into the posterior mediastinum and abdomen as above. No evidence of active extravasation. 2. Interval development of left upper lobe atelectasis and scattered areas of low-attenuation consolidation in the bilateral lower lobes, possibly aspiration. 3. Moderate bilateral pleural effusions, new from prior exam. 4. Circumferential esophageal wall thickening which may be reactive from adjacent hematoma. No pneumomediastinum. 5. Interval posterior fixation of the T9-L2 vertebral bodies with redemonstration of distraction/fracture of the T11 and T12 vertebral bodies, with adjacent postsurgical changes. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.	FINDINGS: VASCULATURE: Initial precontrast images again demonstrate hematoma adjacent to the descending thoracic aorta, with mild interval worsening. CORONARY ARTERIES: There are mild atherosclerotic calcifications of the native coronary arteries. PULMONARY ARTERIES: No central pulmonary embolus. Enlarged measuring 3.4 cm. ASCENDING THORACIC AORTA: No significant abnormality, within the limitations cardiac motion. AORTIC ARCH: Minimal calcified atherosclerosis. ARCH VESSELS: No significant abnormality. DESCENDING THORACIC AORTA: There is interval increased size of the periaortic hematoma with nonorganized mixed density fluid and stranding surrounding the descending thoracic aorta, tracking into the posterior mediastinum and abdomen. No active extravasation identified. The fluid measures approximately 10.9 x 6.6 cm in total (image 356, series #503). No dissection flap or thrombus visualized. UPPER ABDOMINAL AORTA: Please see separately reported same day CTA abdomen and pelvis. ------------------------------------------------------------- LOWER NECK: Partially calcified right thyroid nodule measuring 1.1 cm. Hypoattenuating left thyroid nodule measuring 1.2 cm. CHEST: LUNGS / AIRWAYS / PLEURA: Endotracheal tube terminates in the mid trachea. Secretions in the left main bronchus with development of Left upper lobe atelectasis and partial atelectasis in the left lower lobe. Scattered areas of lower attenuation consolidation in the bilateral lower lobes, left greater than right. No pneumothorax. Moderate bilateral pleural effusions, new. HEART / OTHER VESSELS: Mildly enlarged heart size with left ventricular hypertrophy. No pericardial effusion. MEDIASTINUM / ESOPHAGUS: Enlarging periaortic hematoma as above. Circumferential thickening of the esophageal wall. No pneumomediastinum. LYMPH NODES: None enlarged. CHEST WALL: Minimal stranding in the anterior chest wall, unchanged. Minimally displaced left 12th rib fracture. UPPER ABDOMEN: Please see separately reported same day CTA abdomen and pelvis. MUSCULOSKELETAL: Interval posterior fixation of the T9-L2 vertebral bodies. Similar appearance of severe distraction/fracture of the T11 and T12 vertebral bodies.	FINDINGS: Intracranially there is no evidence of acute vascular territory ischemia, hemorrhage, mass or mass effect. The ventricles are normal in size and configuration. The cortical sulci and subarachnoid cisterns are symmetric and age-appropriate. There is no extra-axial pathology. The calvarium and skull base show no focal bony abnormality. Visualized paranasal sinus and mastoid aerations are clear.
2,532	EXAM: CT Angio Abdomen and Pelvis CLINICAL INFORMATION: Covid confirmed, hypotension, evaluate for missed injury. COMPARISON: CT abdomen and pelvis with contrast 1/5/2022 TECHNIQUE: CT Angio Abdomen and Pelvis. Additional 3D image post-processing was performed to generate MIP and/or volume-rendered images. Patient weight: 243 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: 380 mm. DLP: 3337.20 mGy cm. FINDINGS: STRUCTURED REPORT: CTA Abdomen Pelvis VASCULATURE: DISTAL DESCENDING THORACIC AORTA: Please see separately dictated CT chest report same day for further evaluation of distal thoracic aortic injury and enlarging periaortic hematoma. There is enlarging hematoma in the inferior posterior mediastinum about the distal descending thoracic aorta and diaphragm near the hiatus. No active extravasation seen. ABDOMINAL AORTA: No significant abnormality. CELIAC AXIS: No significant abnormality. SMA: Mild atherosclerotic calcifications at the origin; otherwise, no significant abnormality. RIGHT RENAL: No significant abnormality. LEFT RENAL: Three left renal arteries, which appear patent and without significant abnormality. IMA: No significant abnormality. RIGHT ILIAC / PROXIMAL FEMORAL ARTERIES: No significant abnormality. LEFT ILIAC / PROXIMAL FEMORAL ARTERIES: No significant abnormality. ------------------------------------------------------------- Chest findings to be dictated separately; please see separate CT chest report same day. ABDOMEN and PELVIS: LIVER: Evaluation limited to arterial phase. Within these limitations. The liver is normal in size and morphology. No suspicious hepatic lesion. BILIARY TRACT: Normal. GALLBLADDER: Vicarious contrast excretion and possible small stones. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Increased attenuation of the adrenal glands bilaterally, suggesting possible shock physiology. KIDNEYS: The kidneys enhance symmetrically. No hydronephrosis, suspicious renal mass or renal laceration. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Small hiatal hernia. There is fat stranding and hematoma at the level of the hiatus and distal esophageal injury is possible. No paraesophageal gas to suggest perforation seen. COLON / APPENDIX: The colon and appendix are normal in caliber. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Worsening hematoma and stranding at the diaphragmatic hiatus with thickening of the diaphragmatic crus on the right. OTHER VESSELS: Retrograde contrast flow into the IVC, which is normal in caliber. Central venous catheter with distal catheter tip in the left common iliac vein. URINARY BLADDER: Empty with a Foley catheter. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Posterior surgical skin staples midline, consistent with thoracic spine posterior spinal fusion. Paraspinous muscle hematoma and scattered locules of gas, consistent with postsurgical change/hematoma. Small fat-containing umbilical hernia. Similar appearance of subcutaneous stranding, suggesting seatbelt injury. Subcutaneous fat stranding right flank. MUSCULOSKELETAL: Interval thoracolumbar spinal fusion T9-L2 with bilateral rods and pedicle screws. Persistent widening of the T11-T12 disc space/vertebral body fragmentation. T11-T12 laminectomies. Diffuse osteopenia. Evaluation of known facet and posterior spinous process fractures limited by streak artifact from the spinal fusion hardware. Minimally displaced posterior left rib 12 fracture. Diffuse osteopenia. CONCLUSION: 1. Distal thoracic aortic injury with enlarging periaortic hematoma. No active extravasation seen. Please see separately dictated CT chest report same day for further evaluation. 2. Enlarging hematoma about the diaphragmatic hiatus and thickening of the right diaphragmatic crus, suspicious for underlying diaphragmatic injury. Additionally, there is a small hiatal hernia with thickening of the distal esophagus with adjacent hematoma. No paraesophageal gas to suggest perforation; however, distal esophageal injury is possible. 3. Interval posterior thoracolumbar spinal fusion with bilateral rod and screw fixation T9-L2 with expected postoperative paraspinous muscle hematoma and subcutaneous locules of gas. 4. Increased attenuation of the adrenal glands bilaterally, suggesting shock physiology. Additional findings, as detailed. Please see separately dictated CT chest report same day. This report may contain findings critical to patient care. These findings were discussed with Dr. S. Morrison at 1109 on 1/6/2022 11:09 AM.	FINDINGS: STRUCTURED REPORT: CTA Abdomen Pelvis VASCULATURE: DISTAL DESCENDING THORACIC AORTA: Please see separately dictated CT chest report same day for further evaluation of distal thoracic aortic injury and enlarging periaortic hematoma. There is enlarging hematoma in the inferior posterior mediastinum about the distal descending thoracic aorta and diaphragm near the hiatus. No active extravasation seen. ABDOMINAL AORTA: No significant abnormality. CELIAC AXIS: No significant abnormality. SMA: Mild atherosclerotic calcifications at the origin; otherwise, no significant abnormality. RIGHT RENAL: No significant abnormality. LEFT RENAL: Three left renal arteries, which appear patent and without significant abnormality. IMA: No significant abnormality. RIGHT ILIAC / PROXIMAL FEMORAL ARTERIES: No significant abnormality. LEFT ILIAC / PROXIMAL FEMORAL ARTERIES: No significant abnormality. ------------------------------------------------------------- Chest findings to be dictated separately; please see separate CT chest report same day. ABDOMEN and PELVIS: LIVER: Evaluation limited to arterial phase. Within these limitations. The liver is normal in size and morphology. No suspicious hepatic lesion. BILIARY TRACT: Normal. GALLBLADDER: Vicarious contrast excretion and possible small stones. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Increased attenuation of the adrenal glands bilaterally, suggesting possible shock physiology. KIDNEYS: The kidneys enhance symmetrically. No hydronephrosis, suspicious renal mass or renal laceration. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Small hiatal hernia. There is fat stranding and hematoma at the level of the hiatus and distal esophageal injury is possible. No paraesophageal gas to suggest perforation seen. COLON / APPENDIX: The colon and appendix are normal in caliber. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Worsening hematoma and stranding at the diaphragmatic hiatus with thickening of the diaphragmatic crus on the right. OTHER VESSELS: Retrograde contrast flow into the IVC, which is normal in caliber. Central venous catheter with distal catheter tip in the left common iliac vein. URINARY BLADDER: Empty with a Foley catheter. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Posterior surgical skin staples midline, consistent with thoracic spine posterior spinal fusion. Paraspinous muscle hematoma and scattered locules of gas, consistent with postsurgical change/hematoma. Small fat-containing umbilical hernia. Similar appearance of subcutaneous stranding, suggesting seatbelt injury. Subcutaneous fat stranding right flank. MUSCULOSKELETAL: Interval thoracolumbar spinal fusion T9-L2 with bilateral rods and pedicle screws. Persistent widening of the T11-T12 disc space/vertebral body fragmentation. T11-T12 laminectomies. Diffuse osteopenia. Evaluation of known facet and posterior spinous process fractures limited by streak artifact from the spinal fusion hardware. Minimally displaced posterior left rib 12 fracture. Diffuse osteopenia.	FINDINGS: CONTRAST DISCLAIMER: Not applicable. STRUCTURED REPORT: CT Abdomen Pelvis ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Soft tissue stranding/mass again seen adjacent, see below. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Subcentimeter hypodensities are statistically cysts but formally indeterminate.. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON: No abnormality. PERITONEUM / MESENTERY: Soft tissue stranding stranding/masses is again seen adjacent to the stomach and pancreas in the left mesenteric root, smaller than prior. RETROPERITONEUM: Normal. VESSELS: Moderate atherosclerotic disease. URINARY BLADDER: Soft tissue lesion adjacent to the posterior aspect of the bladder primarily on the left is again seen. REPRODUCTIVE ORGANS: Mass involving the left aspect of the prostate is similar to prior. BODY WALL: Small fat-containing umbilical hernia MUSCULOSKELETAL: No destructive osseous lesions seen
2,533	CT Head wo contrast 1/6/2022 9:12 AM Clinical Information: acute mental status change Comparison: CT head 3/17/2021. Technique: Unenhanced axial brain CT. Bone and soft tissue windows were reviewed. Sagittal and coronal images were generated from the axial data. Scan field of view: 235 mm. DLP: 861.50 mGy cm. Findings:Redemonstration is stable appearance of ventriculomegaly, particularly of the fourth ventricle. There is also increased in size of bilateral foramen of Luschka and Magendie. Megacisterna magna. No evidence for large vascular territory stroke. No intracranial hemorrhage, intracranial mass, mass effect or midline shift. Basal cisterns appear patent. Bilateral orbits are unremarkable. Visualized paranasal sinuses, mastoid air cells and middle ear cavities are within normal limits. Redemonstration of multiple ballistic material along C1 vertebra, likely related to prior gunshot wound. No acute osseous abnormalities. Conclusion: 1. No acute intracranial abnormality. 2. Stable ventriculomegaly, particularly of the fourth ventricle. 3. Stable ballistic fragments from prior gunshot wound in the craniovertebral region.	Findings:Redemonstration is stable appearance of ventriculomegaly, particularly of the fourth ventricle. There is also increased in size of bilateral foramen of Luschka and Magendie. Megacisterna magna. No evidence for large vascular territory stroke. No intracranial hemorrhage, intracranial mass, mass effect or midline shift. Basal cisterns appear patent. Bilateral orbits are unremarkable. Visualized paranasal sinuses, mastoid air cells and middle ear cavities are within normal limits. Redemonstration of multiple ballistic material along C1 vertebra, likely related to prior gunshot wound. No acute osseous abnormalities.	FINDINGS: Evaluation of the oral cavity is limited due to streak artifact. Within this limitation, there is no suspicious oral cavity mass. No suspicious laryngeal or pharyngeal masses are identified. There are no enlarged, or morphologically abnormal cervical lymph nodes. This patient is participating in a clinical trial and a separate Tumor Metrics report will be provided and include tumor measurements as applicable for response assessment. The parotid and submandibular glands are unremarkable. Thyroid gland is within normal limits. There are postsurgical changes of bilateral maxillary antrostomies. There is new right greater than left maxillary sinus mucosal thickening. There is partial opacification of the right ethmoid air cells. The included intracranial contents and orbits are grossly unremarkable. The visualized osseous structures demonstrate no suspicious lytic or blastic lesions. Right chest wall MediPort. Please refer to the dedicated CT chest report for the assessment of thoracic contents.
2,534	CT Angio Head Code Stroke, CT Angio Neck 1/6/2022 8:56 AM Indication: dizziness Spec Inst: Hx vertebral artery dissection 1120. Comparison: CT head performed earlier on the same day.. Technique: After the administration of IV contrast bolus, helical axial images were obtained from the clavicles to the vertex and reformatted in multiple planes. 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: 130 lbs. IV contrast: Omnipaque 350, 100 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracker Scan field of view: 230 mm. DLP: 2437.60 mGy cm. (accession CT220003035), Patient weight: 130 lbs. IV contrast: Omnipaque 350, 100 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracker Scan field of view: 230 mm. (accession CT220003036) Findings: CT angiogram of the brain: Hypoplastic left vertebral V4 segment. Otherwise, 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: Streak artifact from high attenuation contrast in the left subclavian vessels limits evaluation of the arch vessels. Otherwise, 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. Miscellaneous: Biapical pleural parenchymal scarring. Small 4 mm nodule in the right upper lobe (image 222, series 603). Straightening of the cervical spine. Soft tissues of the neck are unremarkable IMPRESSION: 1. No evidence of cervical or intracranial arterial abnormality. There is mentioned history of prior vertebral artery dissection which is not evident on the current imaging.	Findings: CT angiogram of the brain: Hypoplastic left vertebral V4 segment. Otherwise, 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: Streak artifact from high attenuation contrast in the left subclavian vessels limits evaluation of the arch vessels. Otherwise, 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. Miscellaneous: Biapical pleural parenchymal scarring. Small 4 mm nodule in the right upper lobe (image 222, series 603). Straightening of the cervical spine. Soft tissues of the neck are unremarkable	FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Chest LOWER NECK: Surgical clips are again seen in the neck bilaterally. CHEST: LUNGS / AIRWAYS / PLEURA: Dependent filling defects within the bilateral lower lobe bronchi, likely retained secretions. Mild bilateral upper lung predominant centrilobular emphysema. Numerous small, less than 6 mm bilateral pulmonary nodules are not significantly changed. No new or growing pulmonary nodules. HEART / VESSELS: Normal heart size. Trace pericardial effusion. Moderate coronary artery calcifications. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Redemonstration of right renal upper pole cyst. MUSCULOSKELETAL: No significant abnormality.
2,535	CT Angio Head Code Stroke, CT Angio Neck 1/6/2022 8:56 AM Indication: dizziness Spec Inst: Hx vertebral artery dissection 1120. Comparison: CT head performed earlier on the same day.. Technique: After the administration of IV contrast bolus, helical axial images were obtained from the clavicles to the vertex and reformatted in multiple planes. 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: 130 lbs. IV contrast: Omnipaque 350, 100 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracker Scan field of view: 230 mm. DLP: 2437.60 mGy cm. (accession CT220003035), Patient weight: 130 lbs. IV contrast: Omnipaque 350, 100 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracker Scan field of view: 230 mm. (accession CT220003036) Findings: CT angiogram of the brain: Hypoplastic left vertebral V4 segment. Otherwise, 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: Streak artifact from high attenuation contrast in the left subclavian vessels limits evaluation of the arch vessels. Otherwise, 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. Miscellaneous: Biapical pleural parenchymal scarring. Small 4 mm nodule in the right upper lobe (image 222, series 603). Straightening of the cervical spine. Soft tissues of the neck are unremarkable IMPRESSION: 1. No evidence of cervical or intracranial arterial abnormality. There is mentioned history of prior vertebral artery dissection which is not evident on the current imaging.	Findings: CT angiogram of the brain: Hypoplastic left vertebral V4 segment. Otherwise, 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: Streak artifact from high attenuation contrast in the left subclavian vessels limits evaluation of the arch vessels. Otherwise, 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. Miscellaneous: Biapical pleural parenchymal scarring. Small 4 mm nodule in the right upper lobe (image 222, series 603). Straightening of the cervical spine. Soft tissues of the neck are unremarkable	FINDINGS: CT of the head with and without contrast: Normal basal cisterns. Mild diffuse cerebral volume loss with associated ex vacuo ventriculomegaly. Hypodensity in the left parietal lobe consistent with prior infarct. Nonenhancing cortical hyperdensity in the posterior insular cortex is overall stable, when compared to CTA and MRI 10/31/2018. No acute infarction, hemorrhage, or mass. No abnormal enhancment. Mild patchy white matter hypodensities seen in the bilateral cerebral white matter, reflecting chronic microangiopathic changes. Paranasal sinuses are well-aerated. Bilateral mastoid air cells are clear. Normal soft tissues. No acute fractures or suspicious osseous lesions. Bilateral lens replacements. CT angiogram of the neck: Aortic arch and proximal great vessels: Atherosclerotic calcifications of aortic arch. Right carotid: Bulky atherosclerotic calcifications at the carotid bulb resulting in narrowing of the proximal ICA approximate 80% narrowing by NASCET criteria (series 608 image 92), with diameter reducing to 0.9 mm. Minimal luminal irregularity seen along the posterior aspect of the ICA likely reflects noncalcified atherosclerotic plaque. Left carotid: Postprocedural appearance of left CEA with less than 50% narrowing of the proximal ICA. Noncalcified atherosclerotic seen throughout the ECA and ICA with mild luminal irregularity. Partial retropharyngeal course (series 8, image 809). Right vertebral artery: Mild narrowing of the origin. The vertebral artery is patent. Left vertebral artery: Tiny calcifications and luminal irregularity without flow limiting stenosis seen in the proximal V4 segment (series 8, image 887), similar to prior. CT angiogram of the head: There are mild multifocal intracranial atherosclerotic irregularities. Right Carotid: No evidence of occlusion or aneurysmal dilation. Mild atherosclerotic calcifications of the carotid siphon. Left Carotid: No evidence of occlusion or aneurysmal dilation. Mild atherosclerotic calcifications of the carotid siphon. Anterior, middle and posterior cerebral arteries: Normal. Vertebrobasilar arteries: No evidence of stenosis, occlusion, or aneurysmal dilation. Visualized pulmonary arteries: No intraluminal filling defects identified.
2,536	CT Head wo contrast 1/6/2022 8:43 AM Clinical Information: Dizziness Spec Inst: Hx vertebral artery dissection 1120 Comparison: None. Technique: Unenhanced axial brain CT. Bone and soft tissue windows were reviewed. Sagittal and coronal images were generated from the axial data. Scan field of view: 204 mm. DLP: 1266.50 mGy cm. Findings: Gray and white matter attenuation differentiation in bilateral cerebral hemispheres is maintained. No intracranial hemorrhage, intracranial mass, mass effect or midline shift. No brain edema. No hydrocephalus. Basal cisterns are patent. Stable right anterior temporal arachnoid cyst. Magna cisterna magna versus arachnoid cyst in the posterior fossa. Mild infratentorial volume loss. Bilateral orbits are unremarkable. Visualized paranasal sinuses, mastoid air cells and middle ear cavities are within normal limits. No acute osseous abnormalities. Conclusion: No acute intracranial abnormality.	Findings: Gray and white matter attenuation differentiation in bilateral cerebral hemispheres is maintained. No intracranial hemorrhage, intracranial mass, mass effect or midline shift. No brain edema. No hydrocephalus. Basal cisterns are patent. Stable right anterior temporal arachnoid cyst. Magna cisterna magna versus arachnoid cyst in the posterior fossa. Mild infratentorial volume loss. Bilateral orbits are unremarkable. Visualized paranasal sinuses, mastoid air cells and middle ear cavities are within normal limits. No acute osseous abnormalities.	FINDINGS: CT of the head with and without contrast: Normal basal cisterns. Mild diffuse cerebral volume loss with associated ex vacuo ventriculomegaly. Hypodensity in the left parietal lobe consistent with prior infarct. Nonenhancing cortical hyperdensity in the posterior insular cortex is overall stable, when compared to CTA and MRI 10/31/2018. No acute infarction, hemorrhage, or mass. No abnormal enhancment. Mild patchy white matter hypodensities seen in the bilateral cerebral white matter, reflecting chronic microangiopathic changes. Paranasal sinuses are well-aerated. Bilateral mastoid air cells are clear. Normal soft tissues. No acute fractures or suspicious osseous lesions. Bilateral lens replacements. CT angiogram of the neck: Aortic arch and proximal great vessels: Atherosclerotic calcifications of aortic arch. Right carotid: Bulky atherosclerotic calcifications at the carotid bulb resulting in narrowing of the proximal ICA approximate 80% narrowing by NASCET criteria (series 608 image 92), with diameter reducing to 0.9 mm. Minimal luminal irregularity seen along the posterior aspect of the ICA likely reflects noncalcified atherosclerotic plaque. Left carotid: Postprocedural appearance of left CEA with less than 50% narrowing of the proximal ICA. Noncalcified atherosclerotic seen throughout the ECA and ICA with mild luminal irregularity. Partial retropharyngeal course (series 8, image 809). Right vertebral artery: Mild narrowing of the origin. The vertebral artery is patent. Left vertebral artery: Tiny calcifications and luminal irregularity without flow limiting stenosis seen in the proximal V4 segment (series 8, image 887), similar to prior. CT angiogram of the head: There are mild multifocal intracranial atherosclerotic irregularities. Right Carotid: No evidence of occlusion or aneurysmal dilation. Mild atherosclerotic calcifications of the carotid siphon. Left Carotid: No evidence of occlusion or aneurysmal dilation. Mild atherosclerotic calcifications of the carotid siphon. Anterior, middle and posterior cerebral arteries: Normal. Vertebrobasilar arteries: No evidence of stenosis, occlusion, or aneurysmal dilation. Visualized pulmonary arteries: No intraluminal filling defects identified.
2,537	CT Perfusion 1/6/2022 8:56 AM Clinical Information: dizziness Spec Inst: Hx vertebral artery dissection 1120 Comparison: Concurrently performed CT of the head dated 1/6/2022. 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: 130 lbs. IV contrast: Omnipaque 350, 40 ml, per protocol. Saline flush: 75 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracker Scan field of view: 204 mm. DLP: 1440 mGy cm. 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. CONCLUSION: No significant ischemia or infarction.	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.	Findings: Comparison: No prior chest CT Vascular Findings: Pulmonary artery contrast opacification is excellent. Breathing motion artifact limits fine detail. No central PTE, main pulmonary artery enlargement, or evidence of right heart strain. Lower lobe segmental pulmonary arteries are not seen as well due to breathing motion artifact. Chest Wall and Abdomen: No destructive osseous lesions. Included portions of the upper abdomen have an unremarkable appearance. Lower Neck, Mediastinum, and Lymph Nodes: No axillary or mediastinal adenopathy. The left subareolar tissue is more confluently dense than the breast parenchyma in the upper portion of the breast. Right breast is not as fully included. Lungs and Pleura: No pleural effusion. Both lower lobes demonstrate confluent groundglass and consolidative density. Middle lobe and lingula demonstrate groundglass and crazy paving density. Mild bronchiectasis in the lower lobes suggesting at least a subacute infection.
2,538	EXAM: CT Abdomen and Pelvis wo IV contrast CLINICAL INFORMATION: Abdominal pain, concern for diverticulitis COMPARISON: 12/8/21 TECHNIQUE: CT Abdomen and Pelvis wo IV contrast. Scan field of view: 342 mm. DLP: 521.10 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: No acute abnormality. Stable 4 mm right middle lobe nodule. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Persistent small pericardial effusion. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Atrophic native kidneys again noted. Stable subcentimeter cyst at the anterior left mid kidney. Left lower quadrant renal transplant is unchanged in appearance with stable cyst and additional small hyperdense cyst. No hydronephrosis or radiopaque urinary tract stones. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Extensive colonic diverticula. Inflamed diverticulum at the distal descending colon with associated mild wall thickening and pericolonic stranding. PERITONEUM / MESENTERY: No free air or ascites. Surgical clips in the right lower abdomen with streak artifact again obscuring detailed evaluation of surrounding structures. RETROPERITONEUM: Normal. VESSELS: Advanced aortoiliac atherosclerotic calcification. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No acute fracture or destructive osseous lesion. CONCLUSION: 1. Acute uncomplicated diverticulitis at the level of the distal descending colon. 2. Additional stable chronic and incidental findings as above.	FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: No acute abnormality. Stable 4 mm right middle lobe nodule. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Persistent small pericardial effusion. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Atrophic native kidneys again noted. Stable subcentimeter cyst at the anterior left mid kidney. Left lower quadrant renal transplant is unchanged in appearance with stable cyst and additional small hyperdense cyst. No hydronephrosis or radiopaque urinary tract stones. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Extensive colonic diverticula. Inflamed diverticulum at the distal descending colon with associated mild wall thickening and pericolonic stranding. PERITONEUM / MESENTERY: No free air or ascites. Surgical clips in the right lower abdomen with streak artifact again obscuring detailed evaluation of surrounding structures. RETROPERITONEUM: Normal. VESSELS: Advanced aortoiliac atherosclerotic calcification. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No acute fracture or destructive osseous lesion.	FINDINGS: STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: A small subcentimeter nodules in the right middle lobe adjacent to the right heart border seen on series #202 image #155 is similar in size and configuration compared to 11/30/2021 with less cavitation compared to 9/21/21. A subcentimeter nodule within the lingula is similar in size and configuration. Subtle tiny nodule at the left lung base on image #225 is unchanged. Several additional tiny nodules are unchanged. HEART / VESSELS: Right-sided Mediport catheter tip terminates in the lower SVC. Minimal coronary artery calcifications. The aorta is normal in caliber. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: Similar appearing prominent left paratracheal and right hilar lymph nodes. Prominent lymph nodes within the left axilla are unchanged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: See separate abdominal dictation. MUSCULOSKELETAL: No significant abnormality. No destructive osseous lesions.
2,539	EXAM: CT Angio Chest wo+w contrast CLINICAL INFORMATION: History of bilateral thoracic outlet syndrome status post release, and rib resection. Now status post right subclavian artery pseudoaneurysm repair. Discomfort and numbness of right hand and dizziness. COMPARISON: CT neck 4/29/2019 TECHNIQUE: CT Angio Chest wo+w contrast. Additional 3D image post-processing was performed to generate MIP and/or volume-rendered images. Patient weight: 122 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 20 ml. IV contrast injection rate: 4 ml per sec. Scan delay: Bolus Tracked. Scan field of view: 280 mm. KVP: 120 DLP: 2205.88 mGy cm. FINDINGS: STRUCTURED REPORT: CTA Chest VASCULATURE: CORONARY ARTERIES: There are no atherosclerotic calcifications of the native coronary arteries. PULMONARY ARTERIES: No central pulmonary embolus. Normal size. ASCENDING THORACIC AORTA: No significant abnormality. AORTIC ARCH: No significant abnormality. ARCH VESSELS: The right innominate, subclavian, and axillary arteries are patent. Postsurgical changes are seen adjacent to the right subclavian artery. No right vertebral or thyrocervical artery opacification is visualized branching from the right subclavian artery. The right internal mammary artery is unremarkable. The left subclavian and axillary arteries are patent. The left vertebral artery is patent. Postsurgical changes are seen adjacent to the left subclavian artery. DESCENDING THORACIC AORTA: No significant abnormality. UPPER ABDOMINAL AORTA: No significant abnormality. ------------------------------------------------------------- LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: The central airways are patent. Bilateral dependent atelectasis. Expiratory appearance of the bilateral lungs. No pleural effusion or suspicious nodule/mass. HEART / OTHER VESSELS: The heart is normal in size without pericardial effusion. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Normal. MUSCULOSKELETAL: Postsurgical changes from partial bilateral first rib resections. No aggressive osseous lesions. CONCLUSION: 1. Nonopacification of the right vertebral and thyrocervical arteries, which may be secondary to occlusion versus surgical ligation given the adjacent surgical clips. 2. The innominate, bilateral subclavian, and axillary arteries are patent. 3. Postsurgical changes from bilateral first rib partial resection. 4. Please see separate dictation for CTA head and neck findings. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.	FINDINGS: STRUCTURED REPORT: CTA Chest VASCULATURE: CORONARY ARTERIES: There are no atherosclerotic calcifications of the native coronary arteries. PULMONARY ARTERIES: No central pulmonary embolus. Normal size. ASCENDING THORACIC AORTA: No significant abnormality. AORTIC ARCH: No significant abnormality. ARCH VESSELS: The right innominate, subclavian, and axillary arteries are patent. Postsurgical changes are seen adjacent to the right subclavian artery. No right vertebral or thyrocervical artery opacification is visualized branching from the right subclavian artery. The right internal mammary artery is unremarkable. The left subclavian and axillary arteries are patent. The left vertebral artery is patent. Postsurgical changes are seen adjacent to the left subclavian artery. DESCENDING THORACIC AORTA: No significant abnormality. UPPER ABDOMINAL AORTA: No significant abnormality. ------------------------------------------------------------- LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: The central airways are patent. Bilateral dependent atelectasis. Expiratory appearance of the bilateral lungs. No pleural effusion or suspicious nodule/mass. HEART / OTHER VESSELS: The heart is normal in size without pericardial effusion. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Normal. MUSCULOSKELETAL: Postsurgical changes from partial bilateral first rib resections. No aggressive osseous lesions.	FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: Chest CT is reported separately. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Persistent mild dilatation of intra and extra hepatic bile duct without any definite obstructing radiopaque calculus.. GALLBLADDER: Surgically absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Mildly atrophic left kidney. Both kidneys demonstrate symmetric enhancement. Stable tiny of left-sided ureteral stent. There is persistent moderate left proximal hydroureteronephrosis. Right kidney is unremarkable. Stable simple right renal cyst. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Partially distended, not well evaluated due to streak artifacts from right hip arthroplasty hardware. REPRODUCTIVE ORGANS: Grossly unchanged lobular soft tissue mass in the left hemipelvis. The mass compresses the left distal ureter urinary bladder and urinary bladder. Uterus is not seen separately from this mass. There is no pelvic fluid. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No acute osseous findings. Lumbar vertebrae demonstrate normal height.