Friday, November 10, 2006

MT-radiology-1

EXAM: CT CHEST/ABD/PEL W/WO

COMPARISON: None.

INDICATION: Weight loss, abdominal pain, breast cancer.

FINDINGS: Axial images obtained from the lung apices through the pubic symphysis following IV bolus administration of 125 cc of Optiray 320 as well as oral contrast without immediate adverse reaction was obtained.

Mediastinal windows demonstrate no pathologically enlarged mediastinal or hilar adenopathy. No sizeable pleural or pericardial effusions are noted. Diffuse atherosclerotic changes are seen.

Evaluation of the pulmonary parenchyma demonstrates no consolidations, infiltrates or obvious pulmonary masses. Mild interstitial disease is noted.

IMPRESSION: Mild chronic changes without focal acute intrathoracic process.



CT OF THE ABDOMEN

Imaging extending into the abdomen demonstrates the non-contrast images that show diffuse atherosclerotic disease. There is some calcification in the ________ likely most consistent with vascular calcification. The gallbladder is surgically absent. Renal vascular calcifications are noted, but no obvious hydronephrosis or nephrolithiasis is noted.

Following contrast administration, no solid organ masses, free fluid, or fluid collections are seen. The visualized large and small bowel shows no obstruction or mass.

IMPRESSION: Atherosclerotic disease without obvious focal acute process in the abdomen.



CT OF THE PELVIS

Imaging extending into the pelvis demonstrates the distal ureters to be normal in appearance without calcification or obstruction. No free fluid, fluid collections, or focal inflammatory changes are noted. Following contrast administration, the large and small bowel shows no obstruction or mass.

IMPRESSION: No obvious acute process in the pelvis.


COMPARISON: A non-contrasted CT of the abdomen and pelvis dated 03/14/06.

INDICATION: Abdominal pain and dysuria.

FINDINGS: Axial images obtained from the lung bases through the pubic symphysis both pre and post administration of 125 cc of Optiray 320 as well as oral contrast without immediate adverse reaction. Non-contrasted images demonstrate limited imaging of the lung bases to be unremarkable. Images through the kidneys demonstrate no calcifications or hydronephrosis. Several diffuse vascular calcifications are noted. The gallbladder is surgically absent. Following contrast administration, no solid organ masses, free fluid, or fluid collections are seen. No inflammatory changes are noted. The visualized large and small bowel shows no obstruction or mass.

Delayed images shows normal excretion from both kidneys without obvious filling defect.

IMPRESSION: Essentially negative CT of the abdomen with no obvious acute process seen.



CT OF THE PELVIS

Imaging extending into the pelvis demonstrates the distal ureters to be normal in size and caliber without calcification or obstruction. Following contrast administration, the large and small bowel shows no obstruction or mass. No free fluid, fluid collections, or focal inflammatory changes are noted.

Once again, several phleboliths are seen in the pelvis.

IMPRESSION: Phleboliths in the pelvis as noted above. Otherwise, no acute process seen.


EXAM: CT ST NECK

COMPARISON: None.

FINDINGS: Axial images obtained from the skull base through the thoracic inlet following IV contrast administration without immediate adverse reaction was obtained. A total of 100 cc of Optiray 300 was injected.

Limited imaging of the skull base shows no acute process. Imaging through the neck demonstrates several shotty lymph nodes in the internal jugular chain bilaterally, but no pathologically enlarged adenopathy or necrotic adenopathy is noted. No cystic or solid lesions or abnormal enhancing masses are identified. A ________ marker is seen in the right neck, but no underlying mass or abnormal enhancement is seen. The airway is widely patent. The true and false cords are grossly normal in appearance.

IMPRESSION: Shotty adenopathy in the neck, a relatively nonspecific finding without obvious focal acute process. No underlying mass or abnormal enhancement seen that correspond to the abnormality corresponding to the ________ marker.


COMPARISON: None.

INDICATION: Headaches.

FINDINGS: Axial non-contrasted images of the brain showed no acute hemorrhage or infarct. No mass lesion, mass effect, midline shift or extra-axial fluid collections are noted. The ventricles are symmetrical and midline.

IMPRESSION: No acute intracerebral process.



CT OF THE SINUSES

Coronal thin-cut images obtained through the paranasal sinuses without contrast administration demonstrates the sinuses to be relatively well aerated and clear. No bony erosions, sclerosis or significant mucosal thickening is noted. No obvious gas fluid levels are seen.

IMPRESSION: Clear sinuses.


COMPARISON: None.

INDICATION: Radiculitis.

FINDINGS: Axial thin-cut images obtained through the cervical spine with sagittal and coronal reconstruction images demonstrate axial images that show no fracture or malalignment. There is diffuse osteoarthritic change with facet hypertrophy at all levels from C2-C3 through C7-T1. Prominent anterior osteophytes at C5-C6 and C6-C7 are noted with endplate changes and disc space narrowing at C4-C5 and C5-C6. No significant spinal stenosis or significant bony neural foraminal narrowing is noted. Paravertebral soft tissues are within normal limits.

Sagittal and coronal reconstruction images confirm the findings on the axial images and show no obvious malalignment or acute bony process. Once again, diffuse degenerative changes are noted most prominent at C4-C5, C5-C6, and C6-C7 with disc space narrowing and prominent anterior osteophytes as discussed above.

INDICATION: Status post trauma with right-sided pain.

FINDINGS: Axial images obtained from the lung apices through the pubic symphysis following IV contrast administration without immediate adverse reaction. Images demonstrate mediastinal windows that show what appears to be aneurismal dilatation of the proximal descending thoracic aorta with a maximum diameter of up to 3.9 cm x 4.0 cm in AP x transverse dimensions. This area is peripherally calcified. There does appear to be a focal ulceration and/or focal dissection at the level just below the carina best seen on image #23. Distal to this, the aorta is normal in appearance. No peri-aortic inflammatory changes are noted and I suspect this represents some tortuosity and focal aneurismal dilatation. Correlation with history and if necessary followup study recommended. No pleural or pericardial effusions are noted. No enlarged adenopathy is seen. Evaluation of the pulmonary parenchyma demonstrates COPD changes without focal infiltrate or edema. No obvious pneumothorax or pulmonary contusions are noted.

Review of bone windows demonstrates degenerative changes without definite acute bony injury.

Imaging extending into the abdomen demonstrates a peripherally enhancing lesion in the inferior aspect of the right hepatic lobe, which tends to fill in more on delayed imaging most consistent with a prominent hemangioma measuring 3.7 cm x 4.2 cm. The gallbladder contains small amount of calcified stones, but no pericholecystic fluid or gallbladder wall thickening is noted. No other solid organ lesions, free fluid, or fluid collections are noted. The large and small bowel shows no obstruction or mass.

IMPRESSION: Suspect cholelithiasis and right hepatic hemangioma, but no obvious acute process in the abdomen.



CT OF THE PELVIS

Imaging extending into the pelvis demonstrates the large and small bowel that shows no obstruction or mass. No free fluid, fluid collections, or focal inflammatory changes are noted.

Review of bone windows demonstrates spinous process fractures on the right at L1, L2, L3, and L4. No obvious vertebral body fractures or significant dislocation is noted. No spinal stenosis is noted.

IMPRESSION: No acute process in the pelvis. Bone windows demonstrate spinous process fractures of the lumbar spine on the right as discussed above. Please note results were called to Dr. ________ at Fast ER immediately following exam.

COMPARISON: None.

INDICATION: Radiculitis.

FINDINGS: Axial thin-cut images obtained through the lumbar spine with sagittal and coronal reconstruction images demonstrate axial images that show no obvious fractures or acute bony injuries. L1-L2 and L2-L3 as well as L3-L4 show no significant disc bulge or herniation. Mild bulge at L3-L4 is noted. L4-L5 also shows a very mild disc bulge slightly more prominent to the left, but no neural foraminal narrowing or nerve root impingement. L5-S1 shows a relatively broad-based disc bulge with slightly more prominent leftward component, but no significant neural foraminal narrowing or nerve root impingement.

Coronal and sagittal reconstruction images confirm the above findings and show no obvious neural foraminal narrowing or disc space narrowing. Mild atherosclerotic disease of the aorta is noted.

IMPRESSION: Minimal disc disease at L3-L4, L4-L5 and L5-S1 on the left as noted above with no obvious acute bony injury.

COMPARISON: CT of the chest dated 12/27/05.

FINDINGS: Axial images obtained from the lung bases through the lung apices following rapid IV bolus administration of 125 cc of Optiray 320 without immediate adverse reaction as well as coronal reconstruction CT pulmonary angiogram demonstrate the mediastinal windows that show the pulmonary arteries to be widely patent without filling defect to suggest the presence of pulmonary emboli. No pathologically enlarged mediastinal or hilar adenopathy is noted. No sizeable pleural or pericardial effusions are evident.

Evaluation of the pulmonary parenchyma demonstrates diffuse COPD and emphysematous changes throughout both lungs with some mild peripheral fibrotic type changes. No consolidations, infiltrates or obvious pulmonary masses are identified. No obvious endobronchial lesions are seen.

Coronal reconstruction CT pulmonary angiograms confirm the findings on the axial images that show no obvious filling defects within the main pulmonary vessels.

IMPRESSION:
No CTA evidence of central pulmonary emboli.
No obvious acute intrathoracic process.


COMPARISON: None.

INDICATION: Abdominal pain, UTI.

FINDINGS: Axial images obtained from the lung bases through the pubic symphysis both pre and post administration of 125 cc of Optiray 320 as well as oral contrast without immediate adverse reaction. Images demonstrate limited imaging of the lung bases that show no acute infiltrates or masses. Non-contrasted images through the kidneys demonstrate no calcifications or hydronephrosis. The proximal ureters are normal in appearance. Following contrast administration, no solid organ masses, free fluid, or fluid collections are seen. The gallbladder is surgically absent. The large and small bowel shows no obstruction or mass. The kidneys show normal enhancement and excretion bilaterally without filling defects or obvious hydronephrosis.

IMPRESSION: No acute process in the abdomen.



CT OF THE PELVIS

Imaging into the pelvis demonstrates the distal ureters to be normal in appearance without calcification or obstruction. Following contrast, the large and small bowel showed no obstruction or mass. No free fluid, fluid collections, or focal inflammatory changes are noted.

IMPRESSION: No acute process in the pelvis.


COMPARISON: None.

INDICATION: Right radiculopathy.

FINDINGS: The lumbar spine was imaged in the sagittal and axial planes using both T1 and T2-weighted imaging parameters. Sagittal images demonstrate normal gross alignment without subluxation or dislocation. There is also disc signal and height at L4‑L5 and L5-S1 with small posterior bulges. Axial images demonstrate L1-L2 that shows no bulge or herniation. L2-L3 and L3-L4 also show no bulge or herniation. L4-L5 shows large broad-based disc bulge, which effaces the anterior thecal sac and causes bilateral neural foraminal narrowing as well as some nerve root displacement more so on the right than the right. There does appear to be some mild inflammatory change at the right exiting nerve root. L5-S1 shows a very similar appearance of the large broad-based disc bulge with severe narrowing of the right neural foramen and displacement and contact of the right exiting nerve root. Combined with facet hypertrophy, there is some mild spinal stenosis at both of these levels.

IMPRESSION: Degenerative disc and joint disease mostly on the right at L4-L5 and L5‑S1 as discussed above.

COMPARISON: None.

INDICATION: Pain and stiffness.

FINDINGS: Cervical spine was imaged in the sagittal and axial planes using both T1 and T2-weighted imaging parameters. Sagittal images demonstrate normal gross alignment without subluxation or dislocation. No abnormal signal in the spinal cord or canal is noted. There is posterior disc bulge noted at C4-C5, which does appear to impinge upon the anterior cervical cord. The remainder of the disc spaces are relatively well preserved. Axial images demonstrate C2-C3 that shows no significant bulge or herniation. C3-C4 also shows no bulge or herniation. C4-C5 demonstrates what appears to be a broad-based disc bulge slightly more prominent leftward component. There is effacement of the anterior thecal sac and mild impingement of the cord. Left-sided relatively broad-based protrusion severely narrows the left neural foramina and compresses the left exiting nerve root. C5-C6, C6-C7 and C7-T1 are grossly normal.

IMPRESSION: Degenerative disc disease most prominent centrally and to the left at C4‑C5 as discussed above.



INDICATION: Shortness of breath.

FINDINGS: Axial images obtained from the lung apices through the adrenal glands following IV bolus administration of 100 cc of Optiray 300 without immediate adverse reaction. Mediastinal windows demonstrate a 9 mm hypodensity in the left lobe of the thyroid with a more anterior 5 mm hypodensity. Findings likely representing cysts, but followup ultrasound if clinically indicated may be useful. Mediastinal windows also show no pathologically enlarged mediastinal or hilar adenopathy. No sizeable pleural or pericardial effusions are evident. Very limited imaging of the upper abdomen demonstrates several calcifications in the liver and spleen consistent with granuloma. The gallbladder is surgically absent. No solid organ masses, free fluid or fluid collections are seen.

Evaluation of the pulmonary parenchyma demonstrates mild diffuse interstitial changes without significant fibrosis or bronchiectasis. No consolidations, infiltrates or obvious pulmonary masses are noted.

IMPRESSION: Very mild chronic disease with evidence of prior granulomatous changes, but no acute intrathoracic process.

COMPARISON: None.

FINDINGS: Axial images obtained from the lung bases through the pubic symphysis following 125 cc of Optiray 320 as well as oral contrast administration without immediate adverse reaction demonstrate limited imaging of the lung bases that show no acute infiltrates or masses. Pre contrast images through the abdomen demonstrate the kidneys that show no calcification or hydronephrosis. The proximal ureters are normal in appearance. Following contrast administration, no solid organ masses, free fluid, or fluid collections are seen. The large and small bowel shows no obstruction or mass. The kidneys show normal enhancement and excretion bilaterally without calcification or obstruction.

IMPRESSION: Essentially negative CT of the abdomen. Incidental note is made of a single hypodensity in the right hepatic lobe on the abdominal delayed images most consistent with small simple hepatic cyst.


INDICATION: Followup nodule.

FINDINGS: Axial images obtained from the lung apices through the adrenal glands following IV bolus administration of 100 cc of Optiray 300 without immediate adverse reaction demonstrates mediastinal windows that show no pathologically enlarged mediastinal or hilar adenopathy. No sizeable pleural or pericardial effusions are noted.

Limited imaging of the upper abdomen demonstrates no solid organ masses, free fluid or fluid collections.

Evaluation of the pulmonary parenchyma demonstrates tiny nodular density in the lateral aspect of the upper lobe measuring 5 mm to 6 mm in size and unchanged from size and appearance than the previous study. The remainder of the lung shows questionable tiny nodular densities peripherally in both lungs although altogether unchanged from the previous study consistent with small scars or granuloma. No consolidations, infiltrates or suspicious pulmonary masses are noted.

IMPRESSION: Stable appearance of the chest when compared to the prior exam with tiny peripheral nodular densities most consistent with scarring, the largest of which in the right peripheral right upper lobe is most consistent with granuloma and unchanged measuring 5 mm to 6 mm in size.

INDICATION: Trauma, contusion of right forehead with laceration.

FINDINGS: Axial non-contrasted images through the brain demonstrate no evidence of acute hemorrhage or infarct. No mass lesion, mass effect, midline shift or extra-axial fluid collections are noted. The ventricles are symmetrical and midline. Review of bone windows demonstrates the sinuses to be relatively well aerated and clear. No obvious fractures or acute bony injuries are noted.

IMPRESSION: No acute intracerebral process.

INDICATION: Pain in the navicular area x 1 year.

FINDINGS: The wrist was imaged in the sagittal, axial, and coronal planes using both T1 and T2-weighted imaging parameters. Images demonstrate no evidence of fracture or acute bony injury. No marrow edema or abnormal signal in the navicular bone is noted. In the site of the pain marked by a marker, there is a small amount of diffuse fluid seen within the articular surfaces. A tiny amount of fluid is seen around the adductor tendons although this is very minimal and only seen on one image. The tendons themselves appear normal. No cystic lesions that suggest ganglions or acute injury are noted.

IMPRESSION: Mild ________ tiny areas of fluid in the wrist as discussed above likely physiologic, but no obvious effusion or acute injury noted.

INDICATION: Abdominal pain, left flank pain, questionable stone versus pyelonephritis.

FINDINGS: Axial images obtained from the lung bases through the pubic symphysis both pre and post administration of IV and oral contrast without immediate adverse reaction demonstrates limited imaging of the lung bases that show no acute infiltrates or masses. There is a small left pleural effusion present.

Small amount of air space disease consistent with atelectasis is seen at the left base.

Imaging extending into the abdomen demonstrates no solid organ masses, free fluid, or fluid collections. The large and small bowel shows no obstruction or mass. The kidneys show no calcifications, hydronephrosis, or abnormal enhancement or focal enhancing lesions. Delayed imaging shows normal excretion without filling defects.

IMPRESSION: No obvious acute process in the abdomen.

CT evaluation of the brain was performed prior to and following intravenous administration of contrast material. Evaluation shows a normal sized ventricular system, which is midline in location without mass effect or shift. No acute intracranial hemorrhage is seen and no focal cortical abnormalities are identified. Evaluation does show an old lacune in the right caudate head. Post contrast exam shows no areas of abnormal enhancement.

IMPRESSION: Old right caudate head lacune. No acute intracranial abnormalities and no evidence of suspicious masses.

CONTRAST: OptiMARK 20 cc.

HISTORY: Back surgery 27 years ago now with increasing lower back pain.

MRI examination of the lumbar spine was performed using standard sequences. Additional post contrast T1-weighted sagittal and axial images were obtained. Evaluation shows broad-based disc bulging centrally and right paracentrally at L1/L2 causing deformity of the right lateral recess. Displacement of the exiting right nerve root is suspected. The L2/L3 level also shows broad-based central to paracentral disc bulging. There is extension of disc material into the lateral recesses on both sides. Right-sided nerve root displacement is again suspected. Facet hypertrophy is noted. The L3/L4 level shows slightly less prominent broad-based disc bulging with associated facet hypertrophy causing mild to moderate spinal stenosis. There is some extension of disc material into the lateral recesses on both sides and again, some encroachment on the exiting nerve roots on either side could not be excluded. The L4/L5 level shows central to left paracentral disc protrusion causing deformity of the thecal sac with extension of disc material into the left lateral recess and suspected left-sided nerve root encroachment. The L5/S1 level shows relatively less broad-based disc bulging although there is some extension of disc material into the lateral recesses on both sides at that level as well such that encroachment on the exiting nerve roots cannot be excluded. Post contrast exam shows no definite abnormal enhancement to suggest post surgical scarring accounting for the soft tissue signal protrusions.

IMPRESSION: Multilevel broad-based disc protrusions as described with extension into the lateral recesses and suspected encroachment on the exiting nerve roots.


CONTRAST: Optiray 320, 125 cc.

HISTORY: Hematuria.

CT examination of the abdomen and pelvis was performed from the lung bases through the symphysis pubis following intravenous and oral administration of contrast material. Pre contrast images were also obtained through the abdomen and pelvis. Pre contrast exam shows a small 2 mm calcification in the right renal hilum apparently representing vascular calcification with other vascular calcifications seen more medially at the right hilum. Calcific densities are also seen in the left renal hilum, which also apparently represent vascular calcifications rather than calculi. A small parenchymal calcification is seen in the mid pole of the left kidney measuring 1 mm in size. The proximal ureters are normal in caliber and showed no abnormal calcifications along their course. The post contrast exam shows calcified granulomata in the lung bases measuring up to 7 mm in the right lung base. Evaluation shows normal appearing liver, spleen, and pancreas. Evaluation of the kidneys on the post contrast exam shows cyst at the upper pole of the right kidney measuring 18 mm in size. No suspicious renal masses are identified. No upper abdominal adenopathy or mass lesions are seen.

IMPRESSION: Calcified granulomata in the lower lobes of the lungs. Small parenchymal calcification in the mid left kidney with vascular calcifications at the renal hila. Small right renal cyst.

EXAM: Thorax^CHEST/ABD (Adult)

CT evaluation of the chest and abdomen was performed from the lung apices through the iliac crest following intravenous and oral administration of contrast material. Evaluation shows only small shotty nodes in the middle mediastinum, which are not changed from the prior exam. Evaluation of the pulmonary parenchyma shows an area of scarring in the right lower lobe infrahilar region, findings not changed from the previous exam. Scarring is seen more posteriorly in the right lower lobe extending into the pleural surface. No newer suspicious masses are seen and findings in the right lung appear to be unchanged from the previous exam.

IMPRESSION: Apparent post treatment changes in the right lung as described, stable from the previous exam on 04/25/06. No newer suspicious thoracic masses.



CONTRAST: Optiray 320, 125 cc.

HISTORY: Lung granuloma.

CT evaluation of the chest, abdomen and pelvis was performed from the lung apices through the symphysis pubis following intravenous and oral administration of contrast material. Comparison is made to the prior chest CT of 01/25/06. Evaluation shows no mediastinal masses or adenopathy. Evaluation of the pulmonary parenchyma shows a small pleural based nodular appearing density in the lateral left lung base measuring 5 mm in size, unchanged from the previous exam. Small 3 mm nodular density is seen along the right major fissure also remaining unchanged. No newer suspicious parenchymal masses or infiltrates are identified and there are no pleural effusions.

IMPRESSION: Stable small areas of pleural thickening or granuloma formation.


CONTRAST: Optiray 300, 50 cc.

HISTORY: Vertigo.

CT examination of the brain was performed prior to and following intravenous administration of contrast material. Evaluation shows a normal sized ventricular system, which is midline in location without mass effect or shift. No acute intracranial hemorrhage is seen and no focal cortical abnormalities are identified. The post contrast exam shows no areas of abnormal enhancement.

IMPRESSION: No evidence of acute intracranial abnormalities.

HISTORY: Abdominal pain and history of recent surgery. Symptoms suggesting abscess.

CT examination of the abdomen and pelvis was performed from the lung bases through the symphysis pubis following intravenous and oral administration of contrast material. Evaluation shows soft tissue fullness in the right side of the subcarinal region in the lower chest, incompletely imaged on this exam. Evaluation of upper abdominal structures shows normal appearing liver, spleen, pancreas, and kidneys except for a cyst at the lower pole of the left kidney. Lucent gallstones are noted within the gallbladder, but no edema is seen around the gallbladder wall. No upper abdominal masses or fluid collections are identified.

IMPRESSION: Left renal cyst. Cholelithiasis. Soft tissue fullness in the subcarinal region incompletely imaged on this exam. CT of the chest may be warranted.


CONTRAST: OptiMARK 20 cc.

HISTORY: Paresthesias.

MRI examination of the brain was performed using standard sequences prior to and following intravenous administration of gadolinium contrast material. Evaluation shows normal sized ventricular system, which is midline in location without mass effect or shift. No focal cortical abnormalities are identified. The post contrast exam shows no areas of abnormal enhancement.

IMPRESSION: Normal MRI brain.


HISTORY: Headaches and blurred vision.

MRI examination of the brain was performed using standard sequences prior to and following intravenous administration of gadolinium contrast material. Evaluation shows a normal sized ventricular system, which is midline in location without mass effect or shift. No focal cortical abnormalities are identified. There are foci of abnormally increased signal in the deep white matter of the brain particularly evident posteriorly in the parietal regions measuring up to 10 mm on the right and 7 mm on the left. The post contrast exam shows no areas of abnormal enhancement.

IMPRESSION: Foci of deep white matter disease, nonspecific finding. Clinical correlation for any evidence of demyelinating process is needed. No other acute intracranial abnormalities.
HISTORY: Migraines worsening over the last two months.

MRI examination of the brain was performed using standard sequences. Evaluation shows a normal sized ventricular system, which is midline in location without mass effect or shift. No focal cortical abnormalities are identified and no areas of abnormal signal intensity are seen within the brain. The post contrast exam shows no areas of abnormal enhancement. Evaluation does show mucoperiosteal thickening in the maxillary sinuses and to a lesser extent in the left ethmoid sinuses.

IMPRESSION: Mild post inflammatory change in the sinuses. No acute intracranial abnormalities.


HISTORY: Chest pain, shortness of breath, abdominal pain and hematuria.

CT evaluation of the chest, abdomen and pelvis was performed from the lung apices through the symphysis pubis following intravenous and oral administration of contrast material. Pre contrast images through the chest, abdomen and pelvis were also obtained. The pre contrast images through the chest show calcifications in the aortic arch. Post contrast evaluation of the mediastinum shows lymph node in the pretracheal space measuring up to 15 mm in size. No other adenopathy or masses are identified in the mediastinum. Mild fullness of nodes is seen in the left hilum where a node is seen measuring up to 11 mm in size. Evaluation of the pulmonary parenchyma shows chronic interstitial lung disease with fibrotic change in the posterior aspect of the upper lobe with bullous emphysematous changes seen in the upper lobes. Evaluation shows dependent atelectasis in the posterior aspects of both lung bases, slightly more prominent on the right. There are areas of nodularity associated with the atelectasis measuring up to 5 mm in the left posterior lateral lung base and up to 7 mm posteriorly on the right. No pleural effusions are seen and no other suspicious masses or infiltrates are identified.

IMPRESSION: Small node in the mediastinum, likely reactive, but nonspecific. Followup imaging may be warranted. Basilar dependent atelectasis with areas of nodularity within the atelectasis, likely representing more nodular components of atelectasis rather than discrete mass although again followup imaging is recommended.


CONTRAST: OptiMARK 15 cc.

HISTORY: History of CVA with right paresthesia.

MRI examination of the brain was performed using standard sequences prior to and following intravenous administration of gadolinium contrast material. Evaluation shows normal sized ventricular system, which is midline in location without mass effect or shift. Foci of increased signal are seen in the deep white matter of brain with an area of apparent infarct in the left corona radiata extending into the superior left basal ganglion region showing low-grade enhancement post contrast suggesting subacute infarct. Other areas of increased signal are seen in the deep white matter of the brain on the T2‑weighted images with foci of increased signal also seen in the pons. Comparison to the prior study of 06/02/06 shows no change in the area of involvement in the left corona radiata and superior basal ganglion region although the lesion is somewhat more discrete on today's exam consistent with evaluation of the region of infarct. The post contrast exam shows no other areas of abnormal enhancement. Mild mucoperiosteal thickening is seen in the right ethmoid sinuses.

IMPRESSION: Left superior basal ganglion region and corona radiata infarct showing low-grade enhancement post contrast consistent with subacute infarct. Nonspecific deep white matter changes extending into the brain stem. No new cortical abnormalities identified.

HISTORY: Memory loss.

MRI examination of the brain was performed using standard sequences prior to and following intravenous administration of gadolinium contrast material. Evaluation shows normal sized ventricular system, which is midline in location without mass effect or shift. No focal cortical abnormalities are identified. Small foci of increased signal are seen in the deep white matter of the brain on T2-weighted images. Post contrast exam shows no areas of abnormal enhancement. Evaluation shows mucoperiosteal thickening in the maxillary sinuses.

IMPRESSION: Mild post inflammatory changes in the sinuses. Mild nonspecific deep white matter disease.


HISTORY: Hematuria and pain and pressure in the pelvic area.

CT examination of the abdomen and pelvis was performed from the lung bases through the symphysis pubis following intravenous and oral administration of contrast material. Pre contrast images were also obtained through the abdomen and pelvis. Evaluation shows no abnormal calcifications in the kidneys or along the course of the normal caliber abdominal ureters. Post contrast exam shows normal appearing liver, spleen, pancreas, and kidneys. The patient is status post cholecystectomy.

IMPRESSION: No evidence of acute upper abdominal abnormalities.


HISTORY: Epigastric pain.

CT examination of the abdomen and pelvis was performed from the lung bases through the symphysis pubis following intravenous and oral administration of contrast material. Evaluation shows normal appearing liver, spleen, pancreas, and kidneys. No upper abdominal mass lesions, adenopathy, or abnormal fluid collections are identified.

IMPRESSION: Normal abdominal CT.


HISTORY: Radiating pain in the right shoulder.

MRI examination of the right shoulder was performed using standard sequences. Evaluation shows mild AC joint hypertrophy without significant impingement. There is low-grade signal in the distal aspect of the supraspinatus tendon. There is no evidence of tendon retraction or discernable full thickness tear.

IMPRESSION: Signal in the distal supraspinatus tendon may indicate tendinosis versus tendinitis. No definite full thickness tear is identified. Mild AC joint hypertrophy.

HISTORY: Headaches in the left posterior occipital area.

CT examination of the brain was performed without contrast administration. Examination shows a normal sized ventricular system, which is midline in location without mass effect or shift. No acute intracranial hemorrhage is seen and no focal cortical abnormalities are identified. The visualized sinuses are well aerated and clear.

IMPRESSION: No acute intracranial abnormalities.

HISTORY: Hematuria and left-sided pain with history of renal stones.

CT examination of the abdomen and pelvis was performed from the upper abdomen through the symphysis pubis without contrast administration. Evaluation of upper abdominal structures is limited without contrast. Evaluation shows no gross abnormalities in the visualized portions of the liver, the spleen, or pancreas. Evaluation of the kidneys shows a 2 mm stone in the mid portion of the left kidney with tiny 1 mm stone suspected in the mid portion of the right kidney. The proximal ureters are normal in caliber and showed no abnormal calcifications along their course.

IMPRESSION: Suspect small intrarenal calculi. No ureteral stones or hydronephrosis evident.
CONTRAST: OptiMARK 15 cc.

HISTORY: Left-sided numbness.

MRI examination of the brain was performed using standard sequences. Evaluation shows a normal sized ventricular system, which is midline in location without mass effect or shift. No focal cortical abnormalities are identified. The post contrast exam shows no areas of abnormal enhancement.

IMPRESSION: Normal MRI brain.

CONTRAST: Optiray 320, 125 cc.

HISTORY: Hematuria.

CT examination of the abdomen and pelvis was performed from the lung bases through the symphysis pubis following intravenous and oral administration of contrast material. Pre contrast images were also obtained through the abdomen and pelvis. The pre contrast exam shows a 2 mm calcification at the upper pole of the right kidney with a 2 mm calcification also seen at the upper pole of the left kidney with two 2 mm calcifications noted in the mid pole of the left kidney. There is no hydronephrosis. The proximal ureters are normal in caliber and showed no abnormal calcifications along their course. The post contrast exam shows fatty infiltration of the liver. No suspicious hepatic masses are identified. The spleen and pancreas are normal in appearance. The post contrast evaluation of the kidneys shows no suspicious masses. There was prompt excretion bilaterally.

IMPRESSION:
Small intrarenal calculi with no evidence of hydronephrosis or ureteral stones.
Fatty infiltration of the liver.


REASON FOR EXAM: Left flank pain.

An unenhanced CT of the abdomen was performed without comparisons.

Inferior most lung bases appear clear. Mild hepatic steatosis noted with multiple tiny splenic calcified granulomata. There is no abdominal mass, adenopathy, abnormal free fluid/gas collections, or inflammatory process. The kidneys and ureters appear normal without evidence for intrarenal/ureteral calculi, hydronephrosis or definite mass.

IMPRESSIONS: Grossly normal abdominal CT with no evidence for renal/ureteral calculi, obstructive uropathy, mass or acute abnormality. Hepatic steatosis noted.


REASON FOR EXAM: Followup for renal evaluation.

An unenhanced CT of the abdomen was performed with comparisons to 04/17/06.

Lung bases are clear. Unenhanced liver, spleen, pancreas, and adrenal glands appear grossly unremarkable with no definite evidence for abdominal mass, adenopathy, or abnormal free fluid/gas collections. There is no evidence for intrarenal/ureteral calculi or hydronephrosis. Gastrointestinal and vascular structures appear grossly unremarkable. Again, appears to be a persistent stable appearing lobulated appearing kidneys with no interval change or definite well-defined focal mass. There is fairly stable appearing minimal/vague hypoattenuation in the upper central kidney, which I suspect most likely represents volume averaging with adjacent fat although inner detail is limited with lack of IV enhancement. In either case, this appears unchanged. Again, sonographic correlation or post enhanced CT at a later date to continue demonstrating stability may be useful as exam again is somewhat limited with lack of IV enhancement.

IMPRESSIONS: Stable abdominal CT with again somewhat lobular appearing kidneys demonstrating no evidence for interval change or definite well defined focal mass. No acute intra-abdominal abnormality or definite interval change.

EXAM: CT BRAIN

An unenhanced CT of the brain was performed without comparisons. There is no evidence for acute intracranial hemorrhage, midline shift, gross mass or acute ischemic territorial process. Mild atrophic changes are noted. Very tiny old right basal ganglion lacune is suspected. Incidental note is made of very minimal ethmoidal and possibly bilateral maxillary sinus mucosal thickening.

IMPRESSIONS: Mild atrophy with no definite acute intracranial abnormality. Very minimal paranasal sinus disease.


EXAM: Thorax^CHEST/ABD/PEL (Adult)

A pulmonary CT was performed following IV contrast administration with comparisons to 02/22/06.

There has been interval decrease at the left axillary adenopathy as well as decreased mediastinal adenopathy although there remains a persistent abnormal enlarged lymph nodes with the largest measuring approximately 2.3 cm x 2.5 cm in the right peritracheal region. Decreased although persistent subcarinal adenopathy is noted. Right hilar adenopathy also appears slightly decreased although there is a suggestion of minimal degree of increased adenopathy in the left perihilar region with the approximately calcified lymph node measuring up to 1.8 cm x 2.4 cm compared to 1.4 cm x 2.5 cm on the prior study. No definite change in the right upper lobe mass. There is, however slightly increasing size of a right lower lobe nodule now measuring 2 cm compared to 1.3 cm on the prior study. Chronic interstitial and COPD type changes are again seen with several tiny stable scattered right pulmonary nodular foci.

IMPRESSIONS: Stable right upper lobe mass with slightly increased size of a right lower lobe mass. Decreasing size of multiple enlarged mediastinal right perihilar lymph nodes with persistent adenopathy as discussed. Minimal increased size of left perihilar lymph nodes.

EXAM: T SPINE;UPPER BACK PAIN

REASON FOR EXAM: Upper back pain.

An MRI of the thoracic spine was performed utilizing multi-planar/multi-sequence technique.

No abnormal cord signal foci are seen. There appears to be some degree of spondylitic changes involving multiple mid to lower endplates more prominent on the right. There is anterior wedge compression deformity involving the T4 vertebral body with the anterior vertebral body height reduced by approximately 10% to 20%. There is increased T2 signal consistent with some degree of edematous changes particularly along the anterior and anterior mid portion of the vertebral body and slightly more towards the left. In the setting of trauma, this is suspicious for an acute compression deformity although with ________ lack of traumatic history, a pathologic compression deformity would be difficult to exclude. Clinical correlation would be suggested. No gross disc pathologic processes are seen.

IMPRESSIONS: Anterior wedge compression deformity of T2 with signal suggesting a suspected acute compression deformity for which clinical correlation is suggested as discussed above. Given somewhat more oval focal 7 mm of low signal focus on T1 towards the inferior left portion of the T4 vertebral body, a pathologic fracture would be difficult to entirely exclude. No gross disc pathologic processes.



EXAM: LUMBAR;RT RADICULOPATHY

REASON FOR EXAM: Right radiculopathy.

An MRI examination of the lumbar spine was performed with provision of T1 and T2-sagittal sequences. Of note, the patient was unable to proceed with the exam and therefore the patient returned on 08/02/06 for inclusion of axial T1 and T2-weighted sequences.

Disc dehydrative changes are noted at L5-S1. Alignment and intervertebral disc spaces appear well maintained. The L1-L2 through L3-L4 levels appears normal.

At L4-L5, extremely minimal broad-based bulge is noted with a slight asymmetric right posterolateral eccentricity. This results in only very miniscule degree of right anterior-inferior foraminal encroachment without nerve root mass effect although very minimal effacement of the exiting right L4 nerve root along the lateral foraminal margin difficult to exclude.

At L5-S1, there is a central protrusion/herniation, which may be very minimally more eccentric towards the right. Some degree of effacement of the S1 nerve roots at the thecal sac junction is suspected. Mild anterior-inferior foraminal encroachment bilaterally is seen without overt nerve root mass effect of the exiting L5 nerve roots.

IMPRESSIONS: Focal central protrusion/herniation at L5-S1 with a moderate degree with likely S1 nerve root effacement bilaterally at the thecal sac junction. Very minimal broad-based bulge at L4-L5 slightly more eccentric to the right as discussed above. Minimal foraminal encroachment is seen right greater than left at L4-L5 and bilaterally at L5-S1.

EXAM: CT ABD/PELVIS W/WO

REASON FOR EXAM: Hematuria and left pain.

An abdominal CT was performed following oral and IV contrast administration.

Very scant degree of scarring or atelectasis is seen within the right lung base. Pre IV enhanced images demonstrate no evidence for renal/ureteral calculi. Post-enhanced images demonstrate normal appearing kidneys without mass or hydronephrosis.

Solid organs appear grossly normal with no definite mass, adenopathy, or abnormal free fluid/gas collections. Gastrointestinal and vascular structures appear grossly normal.

IMPRESSIONS: No renal/ureteral calculi, nor evidence for obstructive uropathy. No mass, acute abnormality or gross inflammatory changes.

A thoracic CT was performed following IV contrast administration with comparisons to 02/02/06.

There remains no evidence for gross mediastinal mass or adenopathy. Only shotty appearing mediastinal and perihilar lymph nodes are seen. There is no evidence for pleural or pericardial effusions. Pulmonary windows demonstrate stable appearing biapical scarring, which overall is stable as well as stable appearing multifocal areas of perimediastinal and bibasilar scarring as well. There is no evidence for gross pulmonary mass or consolidation.

IMPRESSIONS: Overall stable chest CT with unchanged biapical scarring and no definite evidence for mass, adenopathy, or acute abnormality.

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