I love my job! / Stuff I transcribe
I have probably 300 different reports I would like to post in order to be able to show a good representation of what I transcribe, but it's going to be a gargantuan task, so here are just a few for now. See, in addition to everything radiology (plain films, CTs, ultrasound, MRIs, MR angiograms, nuclear medicine, PET scans, ESIs, fluoro et al.), I also do radiation oncology, cardiology, EEGs, sleep studies, mammography (incl. FNAs and biopsies), discharge summaries, H & Ps, pain management, dermatology, pulmonology, urology and occasionally a few others.
The reports below are going to have incorrect grammar in places because each physician has his or her own style that they prefer, and a lot of times that includes ignoring what is correct format - whatever works for them. Also, when this blog posts, it only keeps one space in between sentences instead of two. Ahh, such is cyber life. lol
Note: I have removed all identifying terms in order to comply with HIPAA.
The reports below are going to have incorrect grammar in places because each physician has his or her own style that they prefer, and a lot of times that includes ignoring what is correct format - whatever works for them. Also, when this blog posts, it only keeps one space in between sentences instead of two. Ahh, such is cyber life. lol
Note: I have removed all identifying terms in order to comply with HIPAA.
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MAGNETIC RESONANCE IMAGING OF THE BRAIN WITH AND WITHOUT CONTRAST:
HISTORY: Left-sided sensory neural hearing loss.
TECHNIQUE: Multiplanar, multisequence magnetic resonance imaging of the brain was performed according to the internal auditory canal protocol, including postcontrast imaging. An additional whole-brain axial FLAIR sequence and a limited axial T2 STIR sequence were also obtained.
FINDINGS: No previous examinations are available for direct comparison.
Age-appropriate moderate cerebral atrophy is present. Minimal foci of increased T2 and FLAIR signal intensity involving the periventricular white matter is seen suggesting minimal small vessel disease in a patient of this age. There is no acute intracranial hemorrhage, mass effect, midline shift nor extra-axial fluid collection seen. No diffusion abnormalities are seen to suggest recent ischemia. The ventricular system is within normal limits for the degree of atrophy present. The craniocervical junction is in normal position. The visualized orbits and paranasal sinuses are unremarkable.
In particular, there are no abnormalities involving the cerebellopontine angles nor internal auditory canals identified to explain the patient's sensory neural hearing loss.
However, there is a somewhat ill-defined approximate 6-mm focal area of contrast enhancement in the right lateral aspect of the pons without associated mass effect. There is no associated restriction diffusion. This lesion shows slightly increased T2 signal intensity with a small amount of T2 star blooming artifact. This pattern of findings is most suggestive of a small vascular malformation such as a small cavernoma or perhaps a capillary telangiectasia. The sequelae of an infectious or inflammatory process is a less likely consideration given the T2 star changes noted. Short-term followup imaging in approximately three months' time is recommended to ensure stability or resolution of this finding. Correlate with clinical history.
IMPRESSION:
MAGNETIC RESONANCE IMAGING OF THE BRAIN WITH AND WITHOUT CONTRAST:
HISTORY: Left-sided sensory neural hearing loss.
TECHNIQUE: Multiplanar, multisequence magnetic resonance imaging of the brain was performed according to the internal auditory canal protocol, including postcontrast imaging. An additional whole-brain axial FLAIR sequence and a limited axial T2 STIR sequence were also obtained.
FINDINGS: No previous examinations are available for direct comparison.
Age-appropriate moderate cerebral atrophy is present. Minimal foci of increased T2 and FLAIR signal intensity involving the periventricular white matter is seen suggesting minimal small vessel disease in a patient of this age. There is no acute intracranial hemorrhage, mass effect, midline shift nor extra-axial fluid collection seen. No diffusion abnormalities are seen to suggest recent ischemia. The ventricular system is within normal limits for the degree of atrophy present. The craniocervical junction is in normal position. The visualized orbits and paranasal sinuses are unremarkable.
In particular, there are no abnormalities involving the cerebellopontine angles nor internal auditory canals identified to explain the patient's sensory neural hearing loss.
However, there is a somewhat ill-defined approximate 6-mm focal area of contrast enhancement in the right lateral aspect of the pons without associated mass effect. There is no associated restriction diffusion. This lesion shows slightly increased T2 signal intensity with a small amount of T2 star blooming artifact. This pattern of findings is most suggestive of a small vascular malformation such as a small cavernoma or perhaps a capillary telangiectasia. The sequelae of an infectious or inflammatory process is a less likely consideration given the T2 star changes noted. Short-term followup imaging in approximately three months' time is recommended to ensure stability or resolution of this finding. Correlate with clinical history.
IMPRESSION:
1. SMALL, SOMEWHAT ILL-DEFINED AREA OF CONTRAST ENHANCEMENT WITH SUBTLE ASSOCIATED T2 STAR BLOOMING CHANGE SUGGESTING OLD BLOOD PRODUCTS OR CALCIFICATION SEEN IN THE RIGHT LATERAL ASPECT OF THE PONS. THE PATTERN OF FINDINGS FAVORS A SMALL VASCULAR MALFORMATION. SHORT-TERM FOLLOWUP IMAGING IN APPROXIMATELY THREE MONTHS' TIME IS RECOMMENDED TO ENSURE STABILITY OR RESOLUTION OF THIS FINDING.
2. AGE-APPROPRIATE CEREBRAL ATROPHY.
3. MINIMAL PERIVENTRICULAR WHITE MATTER CHANGES SUGGESTING SMALL VESSEL DISEASE IN A PATIENT OF THIS AGE.
4. OTHERWISE UNREMARKABLE MAGNETIC RESONANCE IMAGING OF THE BRAIN WITHOUT EXPLANATION FOR THE PATIENT'S REPORTED SENSORY NEURAL HEARING LOSS IDENTIFIED.
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2D/3D RECONSTRUCTIONS DONE AS PER PROTOCOL.
CT OF THE SOFT TISSUE NECK WITHOUT CONTRAST:
HISTORY: Sleep apnea. Assess for airway compromise.
TECHNIQUE: Axial images obtained. Extended study. Study reviewed on an Advantage Windows Workstation.
FINDINGS: Bilateral hilar and mediastinal calcifications are seen. The pulmonary parenchymal structures look normal. The frontal, maxillary, sphenoid and ethmoid air cells look normally aerated. Bilateral middle turbinate concha bullosa are seen, larger on the right side than on the left. Also the margin around the inferior aspect of the nasal turbinates bilaterally posteriorly looks nodular. This is seen best on the coronal reformatted views on the workstation. The orbital margins look intact.
There is also thickening of the posterior superior aspect of the nasal septum, which does narrow the posterior nasal cavity. This is present bilaterally. There is a relatively long uvula. The retropalatal airway cross-sectional area measures 90 mm2 in minimal dimension. There is a thick posterior soft palate. The posterior soft palate measures 12 mm in thickness.
The retroglossal airway is widely patent measuring over 250 mm2. The dimensions of the oropharynx look normal. The vallecula looks symmetrical. The right piriform sinus is larger than on the left side; this is probably due to retropharyngeal left internal carotid artery which loops behind the left side of the hypopharynx which is a normal anatomic variant. The hypopharyngeal airway and glottis, cervical trachea and carina look normal. There is no mass or adenopathy seen in the neck. Mild degenerative changes are seen in the cervical spine. The muscles of mastication look symmetrical. There are prominent medial pterygoid muscles bilaterally and lateral pterygoid muscles seen with also prominent anterior belly of the digastric muscle present bilaterally. This could be seen with bruxism or clenching.
Three-D evaluation of the facial skeleton demonstrates normal sized maxilla and mandible, and there is no midface fracture identified.
OPINION:
1. THERE IS MILD DEVIATION OF THE NASAL SEPTUM.
2. MILD TURBINATE HYPERTROPHY IS SEEN. THERE IS ALSO A NODULAR APPEARANCE OF THE INFERIOR ASPECT OF THE TURBINATES BILATERALLY INFERIORLY. THIS CAN BE SEEN WITH SMALL POLYPS OR WITH RHINITIS WITH MUCOSAL HYPERTROPHY.
3. THERE IS A THICK PALATE. THE RETROPALATAL AIRWAY MEASURES LESS THAN 1 CM. THE DEGREE OF RETROPALATAL NARROWING MAY BE WORSE IN A SEDATED OR SLEEPING STATE, AND THIS COULD BE ESPOUSED TO SNORING. TYPICALLY SEVERE SLEEP APNEA IS ASSOCIATED WITH A RETROPALATAL DIMENSION OF LESS THAN 5 MM. CONSIDER DIRECT ENDOSCOPIC EVALUATION WITH A MUELLER MANEUVER.
4. THERE IS SLIGHT ASYMMETRY OF THE LEFT PIRIFORM SINUS. THIS IS PROBABLY DUE TO PRESENCE OF AN INCIDENTAL RETROPHARYNGEAL LEFT INTERNAL CAROTID ARTERY WHICH IS A NORMAL ANATOMIC VARIANT.
5. THERE IS BILATERAL HILAR AND MEDIASTINAL CALCIFICATION SEEN. DIFFERENTIAL DIAGNOSIS WOULD INCLUDE PRIOR GRANULOMATOUS-TYPE INFECTION. THIS COULD BE SEEN LESS LIKELY WITH TREATED LYMPHATIC INFILTRATIVE DISORDER. THE CALCIFICATIONS ARE COARSE, AND THERE IS NO INTERSTITIAL LUNG DISEASE TO SUGGEST SILICOSIS.
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NUCLEAR MEDICINE SCAN, BREMSSTRAHLUNG IMAGING:
Approximately 0.5 gigabecquerel of SIRSphere was slowly infused into the middle hepatic artery, which distributes in the anatomic distributions of the middle and left hepatic areas.
SPECT images were performed. There is accumulation of radiopharmaceutical within the left lobe of the liver. There is no gross evidence of extrahepatic deposition.
IMPRESSION: POST-RADIOEMBOLIZATION IMAGES DEMONSTRATING DEPOSITION OF RADIOACTIVE MICROSPHERES WITHIN THE LEFT LOBE OF THE LIVER.
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RIGHT CHEST PORT PLACEMENT:
INDICATION: Chemotherapy for ovarian cancer.
PROCEDURE: Informed consent was obtained. Conscious sedation was achieved with fentanyl and Versed given by the conscious sedation nurse according to the institution protocol. The patient was appropriately monitored and a moderate sedation level achieved for approximately 30 minutes.
The right neck and chest were prepped and draped in the usual manner. Using ultrasound guidance, the right internal jugular vein was punctured at the base of the neck with a micropuncture set, and a guidewire was advanced centrally. The subcutaneous pocket was then created over the right upper chest wall at the second anterior rib level. This was performed under local anesthesia using sharp and blunt dissection. Once the pocket was completed, the single-lumen catheter was attached to a tunneler and brought through a subcutaneous tunnel created from the port pocket to the anatomy site. The catheter was cut to length and attached to the port. The port was flushed. The port was then secured in place in the pocket with Prolene suture. The pocket was irrigated. The port was flushed. The catheter was then passed centrally through the peelaway sheath and the sheath removed. The venotomy site was then closed with Dermabond glue. The port pocket was closed in layers of 2-0 Vicryl and 4-0 Monocryl followed by Dermabond glue. The post aspirated and flushed well. Heparinized saline was used to irrigate the port. A film was obtained which confirmed the catheter tip in the upper portion of the right atrium.
SUMMARY: UNCOMPLICATED PLACEMENT OF A SINGLE-LUMEN RIGHT BARD CHEST PORT.
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2D/3D RECONSTRUCTIONS DONE AS PER PROTOCOL.
CT OF THE SOFT TISSUE NECK WITHOUT CONTRAST:
HISTORY: Sleep apnea. Assess for airway compromise.
TECHNIQUE: Axial images obtained. Extended study. Study reviewed on an Advantage Windows Workstation.
FINDINGS: Bilateral hilar and mediastinal calcifications are seen. The pulmonary parenchymal structures look normal. The frontal, maxillary, sphenoid and ethmoid air cells look normally aerated. Bilateral middle turbinate concha bullosa are seen, larger on the right side than on the left. Also the margin around the inferior aspect of the nasal turbinates bilaterally posteriorly looks nodular. This is seen best on the coronal reformatted views on the workstation. The orbital margins look intact.
There is also thickening of the posterior superior aspect of the nasal septum, which does narrow the posterior nasal cavity. This is present bilaterally. There is a relatively long uvula. The retropalatal airway cross-sectional area measures 90 mm2 in minimal dimension. There is a thick posterior soft palate. The posterior soft palate measures 12 mm in thickness.
The retroglossal airway is widely patent measuring over 250 mm2. The dimensions of the oropharynx look normal. The vallecula looks symmetrical. The right piriform sinus is larger than on the left side; this is probably due to retropharyngeal left internal carotid artery which loops behind the left side of the hypopharynx which is a normal anatomic variant. The hypopharyngeal airway and glottis, cervical trachea and carina look normal. There is no mass or adenopathy seen in the neck. Mild degenerative changes are seen in the cervical spine. The muscles of mastication look symmetrical. There are prominent medial pterygoid muscles bilaterally and lateral pterygoid muscles seen with also prominent anterior belly of the digastric muscle present bilaterally. This could be seen with bruxism or clenching.
Three-D evaluation of the facial skeleton demonstrates normal sized maxilla and mandible, and there is no midface fracture identified.
OPINION:
1. THERE IS MILD DEVIATION OF THE NASAL SEPTUM.
2. MILD TURBINATE HYPERTROPHY IS SEEN. THERE IS ALSO A NODULAR APPEARANCE OF THE INFERIOR ASPECT OF THE TURBINATES BILATERALLY INFERIORLY. THIS CAN BE SEEN WITH SMALL POLYPS OR WITH RHINITIS WITH MUCOSAL HYPERTROPHY.
3. THERE IS A THICK PALATE. THE RETROPALATAL AIRWAY MEASURES LESS THAN 1 CM. THE DEGREE OF RETROPALATAL NARROWING MAY BE WORSE IN A SEDATED OR SLEEPING STATE, AND THIS COULD BE ESPOUSED TO SNORING. TYPICALLY SEVERE SLEEP APNEA IS ASSOCIATED WITH A RETROPALATAL DIMENSION OF LESS THAN 5 MM. CONSIDER DIRECT ENDOSCOPIC EVALUATION WITH A MUELLER MANEUVER.
4. THERE IS SLIGHT ASYMMETRY OF THE LEFT PIRIFORM SINUS. THIS IS PROBABLY DUE TO PRESENCE OF AN INCIDENTAL RETROPHARYNGEAL LEFT INTERNAL CAROTID ARTERY WHICH IS A NORMAL ANATOMIC VARIANT.
5. THERE IS BILATERAL HILAR AND MEDIASTINAL CALCIFICATION SEEN. DIFFERENTIAL DIAGNOSIS WOULD INCLUDE PRIOR GRANULOMATOUS-TYPE INFECTION. THIS COULD BE SEEN LESS LIKELY WITH TREATED LYMPHATIC INFILTRATIVE DISORDER. THE CALCIFICATIONS ARE COARSE, AND THERE IS NO INTERSTITIAL LUNG DISEASE TO SUGGEST SILICOSIS.
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NUCLEAR MEDICINE SCAN, BREMSSTRAHLUNG IMAGING:
Approximately 0.5 gigabecquerel of SIRSphere was slowly infused into the middle hepatic artery, which distributes in the anatomic distributions of the middle and left hepatic areas.
SPECT images were performed. There is accumulation of radiopharmaceutical within the left lobe of the liver. There is no gross evidence of extrahepatic deposition.
IMPRESSION: POST-RADIOEMBOLIZATION IMAGES DEMONSTRATING DEPOSITION OF RADIOACTIVE MICROSPHERES WITHIN THE LEFT LOBE OF THE LIVER.
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RIGHT CHEST PORT PLACEMENT:
INDICATION: Chemotherapy for ovarian cancer.
PROCEDURE: Informed consent was obtained. Conscious sedation was achieved with fentanyl and Versed given by the conscious sedation nurse according to the institution protocol. The patient was appropriately monitored and a moderate sedation level achieved for approximately 30 minutes.
The right neck and chest were prepped and draped in the usual manner. Using ultrasound guidance, the right internal jugular vein was punctured at the base of the neck with a micropuncture set, and a guidewire was advanced centrally. The subcutaneous pocket was then created over the right upper chest wall at the second anterior rib level. This was performed under local anesthesia using sharp and blunt dissection. Once the pocket was completed, the single-lumen catheter was attached to a tunneler and brought through a subcutaneous tunnel created from the port pocket to the anatomy site. The catheter was cut to length and attached to the port. The port was flushed. The port was then secured in place in the pocket with Prolene suture. The pocket was irrigated. The port was flushed. The catheter was then passed centrally through the peelaway sheath and the sheath removed. The venotomy site was then closed with Dermabond glue. The port pocket was closed in layers of 2-0 Vicryl and 4-0 Monocryl followed by Dermabond glue. The post aspirated and flushed well. Heparinized saline was used to irrigate the port. A film was obtained which confirmed the catheter tip in the upper portion of the right atrium.
SUMMARY: UNCOMPLICATED PLACEMENT OF A SINGLE-LUMEN RIGHT BARD CHEST PORT.
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EXAM: CT OF THE CHEST, ABDOMEN AND PELVIS
HISTORY: Colon malignancy.
Compared with CT of the chest dated 01/09/06. There has been a marked interval increase in mediastinal and bilateral hilar adenopathy. The largest mediastinal node mass is between the trachea and superior vena cava measuring 3.8 cm maximum diameter. There is partial compression of the SVC. There is a 3.1-cm node in the superior aspect of the right hilum. There are smaller left hilar and subcarinal nodes. There has been interval development of numerous pulmonary nodules as well as less well-defined parenchymal opaciites which may represent distal atelectasis and/or lymphangitic spread. The largest nodule is laterally at the left lung base measuring 2.9 cm maximum diameter. At least twenty nodular densities are now identifiable. There appear to be some tiny cavitations associated with nodules, most notable in the right middle lobe.
There is a rounded low-density lesion in the left aspect of the L2 vertebral body not seen previously, probably a bony metastasis. No other definite metastatic lesions are demonstrated. Extensive degenerative changes are present in the spine, particularly at the lumbosacral junction.
The liver is homogeneous. There is some soft tissue thickening between the stomach and crux of the left hemidiaphragm, possibly pleural thickening at the lung base. No definite adrenal enlargement is identifiable. There is a moderate amount of adenopathy in the porta hepatis and retroperitoneum surrounding the aorta and inferior vena cava. There is some compression of the vena cava in the midabdomen. It is not opacified over fairly a substantial segment. No collateral circulation is identifiable. The largest retroperitoneal node mass measures 3.2 cm maximum diameter seen at the level of the mid right kidney, although margins with the vena cava cannot be determined with accuracy.
There is a tiny, simple-appearing cyst at the lower pole of the right kidney. Otherwise the kidneys are unremarkable. There are extensive diverticula in the colon. There is wall thickening in the distal colon. By history, this probably represents the area of the patient's primary neoplasm. Diverticulosis can have this appearance.
Other chronic findings seen previously have not changed appreciably.
IMPRESSION: Marked deterioration compared to 01/09/06 with increasing mediastinal and pulmonary metastases as well as retroperitoneal and some abdominal adenopathy. Single probably bony metastasis at L2. Other findings as described above.
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CHEST:
The frontal view is rotated to the right. The trachea is in the midline with no widening or shifting of the mediastinum. The hemidiaphragms are smooth and well positioned, and the costophrenic sulci are sharp. The lungs are clear and satisfactorily aerated. The cardiovascular silhouette is normal. The visualized bony thorax is unremarkable for the patient's age. Osteopenia.
CONCLUSION: Normal chest.
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CT ANGIOGRAM:
HISTORY: Headache this morning.
TECHNIQUE: Axial images obtained with CT angiographic protocol, 80 cc of Isovue 370.
FINDINGS: There is a subarachnoid hemorrhage in the posterior fossa and in the prepontine cistern, slightly more on the right side than on the left. No hydrocephalus is seen. The right posterior cerebral artery is diffusely larger then on the left side, but there is no aneurysm seen.
The left posterior communicating artery is larger than on the right side, but there is no aneurysm identified.
OPINION: NO ANEURYSM IS SEEN. A SUBARACHNOID HEMORRHAGE IS IDENTIFIED. NO HYDROCEPHALUS DETECTED.
HISTORY: Colon malignancy.
Compared with CT of the chest dated 01/09/06. There has been a marked interval increase in mediastinal and bilateral hilar adenopathy. The largest mediastinal node mass is between the trachea and superior vena cava measuring 3.8 cm maximum diameter. There is partial compression of the SVC. There is a 3.1-cm node in the superior aspect of the right hilum. There are smaller left hilar and subcarinal nodes. There has been interval development of numerous pulmonary nodules as well as less well-defined parenchymal opaciites which may represent distal atelectasis and/or lymphangitic spread. The largest nodule is laterally at the left lung base measuring 2.9 cm maximum diameter. At least twenty nodular densities are now identifiable. There appear to be some tiny cavitations associated with nodules, most notable in the right middle lobe.
There is a rounded low-density lesion in the left aspect of the L2 vertebral body not seen previously, probably a bony metastasis. No other definite metastatic lesions are demonstrated. Extensive degenerative changes are present in the spine, particularly at the lumbosacral junction.
The liver is homogeneous. There is some soft tissue thickening between the stomach and crux of the left hemidiaphragm, possibly pleural thickening at the lung base. No definite adrenal enlargement is identifiable. There is a moderate amount of adenopathy in the porta hepatis and retroperitoneum surrounding the aorta and inferior vena cava. There is some compression of the vena cava in the midabdomen. It is not opacified over fairly a substantial segment. No collateral circulation is identifiable. The largest retroperitoneal node mass measures 3.2 cm maximum diameter seen at the level of the mid right kidney, although margins with the vena cava cannot be determined with accuracy.
There is a tiny, simple-appearing cyst at the lower pole of the right kidney. Otherwise the kidneys are unremarkable. There are extensive diverticula in the colon. There is wall thickening in the distal colon. By history, this probably represents the area of the patient's primary neoplasm. Diverticulosis can have this appearance.
Other chronic findings seen previously have not changed appreciably.
IMPRESSION: Marked deterioration compared to 01/09/06 with increasing mediastinal and pulmonary metastases as well as retroperitoneal and some abdominal adenopathy. Single probably bony metastasis at L2. Other findings as described above.
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CHEST:
The frontal view is rotated to the right. The trachea is in the midline with no widening or shifting of the mediastinum. The hemidiaphragms are smooth and well positioned, and the costophrenic sulci are sharp. The lungs are clear and satisfactorily aerated. The cardiovascular silhouette is normal. The visualized bony thorax is unremarkable for the patient's age. Osteopenia.
CONCLUSION: Normal chest.
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CT ANGIOGRAM:
HISTORY: Headache this morning.
TECHNIQUE: Axial images obtained with CT angiographic protocol, 80 cc of Isovue 370.
FINDINGS: There is a subarachnoid hemorrhage in the posterior fossa and in the prepontine cistern, slightly more on the right side than on the left. No hydrocephalus is seen. The right posterior cerebral artery is diffusely larger then on the left side, but there is no aneurysm seen.
The left posterior communicating artery is larger than on the right side, but there is no aneurysm identified.
OPINION: NO ANEURYSM IS SEEN. A SUBARACHNOID HEMORRHAGE IS IDENTIFIED. NO HYDROCEPHALUS DETECTED.
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CT CHEST, ABDOMEN AND PELVIS WITH IV CONTRAST:
COMPARISON: None.
INDICATION: Rollover ATV accident.
TECHNIQUE: Following the uneventful injection of 120 ml of Isovue 370, contiguous axial images were obtained through the chest, abdomen and pelvis.
FINDINGS:
CHEST: Thoracic inlet is unremarkable. No axillary, hilar or mediastinal adenopathy. There is a small amount of soft tissue within the low anterior mediastinum, likely representing residual thymus. The thoracic aorta is normal in course and caliber without convincing evidence for caliber change or contour deformity. Heart is within normal limits.
Lungs are clear. No pleural fluid collections or pneumothoraces. The airways are widely patent.
ABDOMEN: Liver, spleen, adrenal glands, kidneys, and pancreas are unremarkable. The gallbladder is normal in size and configuration, and there is no intra- or extrahepatic biliary ductal dilatation.
No retroperitoneal or mesenteric adenopathy.
No infiltration of the mesentery, and no free fluid.
PELVIS: Trace free fluid, likely physiologic. Uterus and ovaries are grossly unremarkable. No free air. The urinary bladder is grossly unremarkable.
Bowel gas pattern is not obstructed. There is moderate retained stool within the colon.
No displaced fractures identified.
IMPRESSION: ESSENTIALLY UNREMARKABLE EXAMINATION, WITH NO SIGNIFICANT
POST-TRAUMATIC CHANGE.
COMPARISON: None.
INDICATION: Rollover ATV accident.
TECHNIQUE: Following the uneventful injection of 120 ml of Isovue 370, contiguous axial images were obtained through the chest, abdomen and pelvis.
FINDINGS:
CHEST: Thoracic inlet is unremarkable. No axillary, hilar or mediastinal adenopathy. There is a small amount of soft tissue within the low anterior mediastinum, likely representing residual thymus. The thoracic aorta is normal in course and caliber without convincing evidence for caliber change or contour deformity. Heart is within normal limits.
Lungs are clear. No pleural fluid collections or pneumothoraces. The airways are widely patent.
ABDOMEN: Liver, spleen, adrenal glands, kidneys, and pancreas are unremarkable. The gallbladder is normal in size and configuration, and there is no intra- or extrahepatic biliary ductal dilatation.
No retroperitoneal or mesenteric adenopathy.
No infiltration of the mesentery, and no free fluid.
PELVIS: Trace free fluid, likely physiologic. Uterus and ovaries are grossly unremarkable. No free air. The urinary bladder is grossly unremarkable.
Bowel gas pattern is not obstructed. There is moderate retained stool within the colon.
No displaced fractures identified.
IMPRESSION: ESSENTIALLY UNREMARKABLE EXAMINATION, WITH NO SIGNIFICANT
POST-TRAUMATIC CHANGE.
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MRI OF THE BRAIN WITHOUT AND WITH CONTRAST:
HISTORY: Renal cell cancer. No neural symptoms.
IMAGES: Greater than twenty-five.
Multiplanar, multisequence MR imaging was accomplished through the brain without and with contrast. Ventricles are midline and not dilated. Sulci are age appropriate. Gray-white matter interface is preserved. Patchy punctate T2 FLAIR signal hyperintensity is seen in the periventricular hemispheric white matter, consistent with small vessel change. This also extends into the pons. Major vascular structures including major dural venous sinuses are patent. After contrast administration, no abnormally enhancing lesions are identified. Diffusion-weighted imaging shows no acute restriction.
HISTORY: Renal cell cancer. No neural symptoms.
IMAGES: Greater than twenty-five.
Multiplanar, multisequence MR imaging was accomplished through the brain without and with contrast. Ventricles are midline and not dilated. Sulci are age appropriate. Gray-white matter interface is preserved. Patchy punctate T2 FLAIR signal hyperintensity is seen in the periventricular hemispheric white matter, consistent with small vessel change. This also extends into the pons. Major vascular structures including major dural venous sinuses are patent. After contrast administration, no abnormally enhancing lesions are identified. Diffusion-weighted imaging shows no acute restriction.
IMPRESSION: NO ACUTE FINDINGS.
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EXAM: OBSTETRICAL ULTRASOUND:
HISTORY: EDC xxx. Left pelvic pain.
FETAL BIOMETRY: There is a single intrauterine pregnancy. The fetus is in a transverse lie with head on the maternal left. Aggregate measurements are consistent with a gestational age of 20 weeks/4 days, correlating adequately with the first-trimester estimate of 19 weeks/6 days. Measurements are as follows: HC = 19 weeks/5 days; AC = 21 weeks/0 days; FL = 21 weeks/0 days.
PLACENTA: Posterior. No evidence of placenta previa.
BIOPHYSICAL PROFILE: Normal amniotic fluid volume, fetal tone and fetal motion.
FETAL ANATOMY: Image quality is limited because of maternal body habitus. Satisfactory images of the ventricular outflow tracts, nose and lips were not obtained. Imaging of the posterior fossa is also unsatisfactory. Allowing for these significant limitations, no abnormalities are identified. Heart rate is 152.
UTERINE AND EXTRAUTERINE ANATOMY: There is an isoechoic, intramural fibroid or persistent myometrial contraction in the anterior fundus measuring 4.6 x 5.5 x 7.0 cm. Otherwise no evidence of uterine or extrauterine abnormalities.
The patient indicated that her pain was in the left inguinal area. She points to a lymph node measuring 5 x 10 x 13 mm that has a prominent fatty hilum and is not significantly enlarged.
IMPRESSION: Appropriate growth since 04/18/06. Limited, incomplete fetal anatomic survey. Anterior fundal fibroid or persistent myometrial contraction. Recommend followup. Pain in the left inguinal area appears to localize to a benign lymph node.
HISTORY: EDC xxx. Left pelvic pain.
FETAL BIOMETRY: There is a single intrauterine pregnancy. The fetus is in a transverse lie with head on the maternal left. Aggregate measurements are consistent with a gestational age of 20 weeks/4 days, correlating adequately with the first-trimester estimate of 19 weeks/6 days. Measurements are as follows: HC = 19 weeks/5 days; AC = 21 weeks/0 days; FL = 21 weeks/0 days.
PLACENTA: Posterior. No evidence of placenta previa.
BIOPHYSICAL PROFILE: Normal amniotic fluid volume, fetal tone and fetal motion.
FETAL ANATOMY: Image quality is limited because of maternal body habitus. Satisfactory images of the ventricular outflow tracts, nose and lips were not obtained. Imaging of the posterior fossa is also unsatisfactory. Allowing for these significant limitations, no abnormalities are identified. Heart rate is 152.
UTERINE AND EXTRAUTERINE ANATOMY: There is an isoechoic, intramural fibroid or persistent myometrial contraction in the anterior fundus measuring 4.6 x 5.5 x 7.0 cm. Otherwise no evidence of uterine or extrauterine abnormalities.
The patient indicated that her pain was in the left inguinal area. She points to a lymph node measuring 5 x 10 x 13 mm that has a prominent fatty hilum and is not significantly enlarged.
IMPRESSION: Appropriate growth since 04/18/06. Limited, incomplete fetal anatomic survey. Anterior fundal fibroid or persistent myometrial contraction. Recommend followup. Pain in the left inguinal area appears to localize to a benign lymph node.
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CT OF THE THORAX, ABDOMEN AND PELVIS:
COMPARISON: None.
FINDINGS: There is moderate-to-marked global cardiomegaly. Atherosclerosis including the coronary arteries. There is enlargement of the central pulmonary arteries suggesting pulmonary arterial hypertension. There is enlargement of the aortic arch with maximum transverse dimension of 3.4 cm. Prominent atherosclerosis is noted in this region. Small penetrating ulcer into a plaque in the medial aspect of the aortic arch is a consideration. Irregular partial mural thrombus intraluminally could render a similar configuration. Calcified mediastinal and hilar lymph nodes which is compatible with a granulomatous residua. There is left paratracheal confluent lymphadenopathy. Subcentimeter mediastinal and hilar lymph nodes are also noted which are nonspecific. Subcentimeter hypodense focus is noted within the right lobe of the thyroid which could represent a small nodule or cyst of indeterminate etiology. There is minimal soft tissue prominence of the distal esophagus which is nonspecific.
Imaging of the lungs demonstrates moderate centrilobular emphysematous changes. Mild focal eventration of the left hemidiaphragm posteriorly. No focal consolidation, pleural effusion or discrete pulmonary nodularity.
Imaging of the abdomen and pelvis demonstrates no discrete focal hepatic abnormality. Slightly diminished attenuation of the liver in relation to the spleen, however this may be related to early phase of intravenous contrast opacification; subtle fatty infiltration cannot be excluded. The spleen, pancreas, and adrenal glands are within normal limits. Partial enhancement of the renal cortices may be related to early phase of contrast opacification. Atherosclerosis of the renal artery origins is noted for which renal artery stenosis cannot be excluded. There is a subcentimeter, hypodense focus in the interpolar region of the left kidney, which while too small to characterize could represent a cyst. There is ectasia of the abdominal aorta with a borderline aneurysmal dilatation of the infrarenal aorta measuring 2.8 cm AP x 2.0 cm transversely. In this region of maximum diameter (at the level of the inferior pole of the kidneys), there is prominence of partially circumferential mural thrombus. Superimposed prominent penetrating ulcer versus less likely chronic focal dissection is noted. There is fusiform aneurysmal dilatation of the common iliac arteries, with the right and left common iliac arteries each measuring 1.7 cm in maximum transverse diameter. Prominent atherosclerotic changes in these regions are also noted. The left hypogastric (internal iliac) appears to be thrombosed. The right hypogastric (internal iliac) artery distally is diminutive. There is also focal narrowing of the external iliac arteries bilaterally.
Evaluation of the pelvis is very limited due to extensive streak artifact from bilateral hip prostheses. There is mild distention of the urinary bladder. The prostate and rectum as well as the portions of the sigmoid colon are not well visualized. Small inguinal hernias bilaterally containing nonobstructive loops of small bowel, most pronounced on the left. No retroperitoneal iliac or inguinal chain lymphadenopathy by strict size criteria. Incidental notation is made of atherosclerotic changes of the celiac and SMA axes which appear to be focally stenosed. Multifocal degenerative changes of the glenohumeral joints and spine. Heterotopic bone formation is noted surrounding the hip prostheses. ? Poorly visualized degenerative change and/or nonspecific lucent lesions with cortical irregularity in the left acetabulum/superior pubic ramus. Similar-appearing lucencies are also evident within the left scapula adjacent to the glenoid. These findings may represent prominent degenerative geodes, however metastasis or other primary osseous neoplasm, or even Paget’s disease or fibrous dysplasia, cannot be excluded.
Remote anterolateral rib fractures bilaterally.
IMPRESSION:
1. LEFT PARATRACHEAL LYMPHADENOPATHY. PRIMARY METASTATIC MALIGNANCY, LYMPHOMA OR EVEN REACTIVE ETIOLOGIES CAN BE CONSIDERED. CONTINUE SHORT-TERM FOLLOW UP WITH A REPEAT CT OF THE THORAX IS RECOMMENDED. ALTERNATIVELY, PET SCAN CAN BE PERFORMED.
2. SUBCENTIMETER MEDIASTINAL AND HILAR LYMPH NODES WHICH ARE NONSPECIFIC.
COMPARISON: None.
FINDINGS: There is moderate-to-marked global cardiomegaly. Atherosclerosis including the coronary arteries. There is enlargement of the central pulmonary arteries suggesting pulmonary arterial hypertension. There is enlargement of the aortic arch with maximum transverse dimension of 3.4 cm. Prominent atherosclerosis is noted in this region. Small penetrating ulcer into a plaque in the medial aspect of the aortic arch is a consideration. Irregular partial mural thrombus intraluminally could render a similar configuration. Calcified mediastinal and hilar lymph nodes which is compatible with a granulomatous residua. There is left paratracheal confluent lymphadenopathy. Subcentimeter mediastinal and hilar lymph nodes are also noted which are nonspecific. Subcentimeter hypodense focus is noted within the right lobe of the thyroid which could represent a small nodule or cyst of indeterminate etiology. There is minimal soft tissue prominence of the distal esophagus which is nonspecific.
Imaging of the lungs demonstrates moderate centrilobular emphysematous changes. Mild focal eventration of the left hemidiaphragm posteriorly. No focal consolidation, pleural effusion or discrete pulmonary nodularity.
Imaging of the abdomen and pelvis demonstrates no discrete focal hepatic abnormality. Slightly diminished attenuation of the liver in relation to the spleen, however this may be related to early phase of intravenous contrast opacification; subtle fatty infiltration cannot be excluded. The spleen, pancreas, and adrenal glands are within normal limits. Partial enhancement of the renal cortices may be related to early phase of contrast opacification. Atherosclerosis of the renal artery origins is noted for which renal artery stenosis cannot be excluded. There is a subcentimeter, hypodense focus in the interpolar region of the left kidney, which while too small to characterize could represent a cyst. There is ectasia of the abdominal aorta with a borderline aneurysmal dilatation of the infrarenal aorta measuring 2.8 cm AP x 2.0 cm transversely. In this region of maximum diameter (at the level of the inferior pole of the kidneys), there is prominence of partially circumferential mural thrombus. Superimposed prominent penetrating ulcer versus less likely chronic focal dissection is noted. There is fusiform aneurysmal dilatation of the common iliac arteries, with the right and left common iliac arteries each measuring 1.7 cm in maximum transverse diameter. Prominent atherosclerotic changes in these regions are also noted. The left hypogastric (internal iliac) appears to be thrombosed. The right hypogastric (internal iliac) artery distally is diminutive. There is also focal narrowing of the external iliac arteries bilaterally.
Evaluation of the pelvis is very limited due to extensive streak artifact from bilateral hip prostheses. There is mild distention of the urinary bladder. The prostate and rectum as well as the portions of the sigmoid colon are not well visualized. Small inguinal hernias bilaterally containing nonobstructive loops of small bowel, most pronounced on the left. No retroperitoneal iliac or inguinal chain lymphadenopathy by strict size criteria. Incidental notation is made of atherosclerotic changes of the celiac and SMA axes which appear to be focally stenosed. Multifocal degenerative changes of the glenohumeral joints and spine. Heterotopic bone formation is noted surrounding the hip prostheses. ? Poorly visualized degenerative change and/or nonspecific lucent lesions with cortical irregularity in the left acetabulum/superior pubic ramus. Similar-appearing lucencies are also evident within the left scapula adjacent to the glenoid. These findings may represent prominent degenerative geodes, however metastasis or other primary osseous neoplasm, or even Paget’s disease or fibrous dysplasia, cannot be excluded.
Remote anterolateral rib fractures bilaterally.
IMPRESSION:
1. LEFT PARATRACHEAL LYMPHADENOPATHY. PRIMARY METASTATIC MALIGNANCY, LYMPHOMA OR EVEN REACTIVE ETIOLOGIES CAN BE CONSIDERED. CONTINUE SHORT-TERM FOLLOW UP WITH A REPEAT CT OF THE THORAX IS RECOMMENDED. ALTERNATIVELY, PET SCAN CAN BE PERFORMED.
2. SUBCENTIMETER MEDIASTINAL AND HILAR LYMPH NODES WHICH ARE NONSPECIFIC.
3. GRANULOMATOUS RESIDUA CONSISTING OF CALCIFICATION OF SEVERAL SUBCENTIMETER MEDIASTINAL AND HILAR LYMPH NODES.
4. NO FOCAL PULMONARY NODULE OR MASS.
5. MILD-TO-MODERATE CENTRILOBULAR EMPHYSEMATOUS CHANGES.
6. PULMONARY ARTERIAL HYPERTENSION.
7. MODERATE-TO-MARKED GLOBAL CARDIOMEGALY AND BORDERLINE PROMINENCE OF THE AORTIC ARCH.
8. EXTENSIVE SYSTEMIC ATHEROSCLEROSIS WITH PARTIALLY CIRCUMFERENTIAL MURAL THROMBUS WITHIN THE AORTIC ARCH AND ABDOMINAL AORTA. SUPERIMPOSED PENETRATING ULCERS AND/OR LONGSTANDING IRREGULAR ATHEROMATOUS PLAQUE WITH SECONDARY LUMINAL IRREGULARITY WITHIN THE AORTIC ARCH AND MID ABDOMINAL AORTA. CONCOMITANT-TO-BORDERLINE ANEURYSMAL DILATATION OF THE MID ABDOMINAL AORTA MEASURING 2.8 X 3.0 CM. MINIMAL FUSIFORM ANEURYSMAL DILATATION OF THE COMMON ILIAC ARTERIES BILATERALLY, EACH MEASURING 1.7 CM IN MAXIMUM TRANSVERSE DIAMETER.
9. THROMBOSED LEFT INTERNAL ILIAC (HYPOGASTRIC) ARTERY AS WELL AS MULTIFOCAL DIMINUTION/STENOSIS OF THE RIGHT INTERNAL ILIAC (HYPOGASTRIC) ARTERY. MILD STENOSIS OF THE EXTERNAL ILIAC ARTERIES BILATERALLY. SUBTLE STENOSIS OF THE ORIGIN OF THE SMA AND CELIAC AXES.
10. SUBTLE DIMINUTION OF THE RENAL CORTICAL ENHANCEMENT MAY BE RELATED TO EARLY PHASE OF CONTRAST OPACIFICATION, HOWEVER HYPOPERFUSION IN THE SETTING OF RENAL ARTERY STENOSIS IS NOT EXCLUDED.
11. EARLY CONTRAST OPACIFICATION OF THE LIVER VERSUS SUBTLE DIFFUSE FATTY INFILTRATION.
12. SUBCENTIMETER HYPODENSE FOCUS IN THE INTERPOLAR REGION OF THE LEFT KIDNEY WHICH, WHILE TOO SMALL TO CHARACTERIZE, COULD REPRESENT A CYST.
13. MILD DISTENTION OF THE URINARY BLADDER.
14. BILATERAL TOTAL HIP ARTHROPLASTIES WITH SURROUNDING STREAK ARTIFACT, SEVERELY LIMITING EVALUATION OF THE PELVIS.
15. INGUINAL HERNIAS BILATERALLY CONTAINING NONOBSTRUCTED SMALL BOWEL, MOST NOTABLY ON THE LEFT.
16. DIFFUSE RETAINED FECAL DEBRIS THROUGHOUT THE COLON AND ABSENCE OF ENTERIC CONTRAST IN THIS REGION PRECLUDE EVALUATION OF THE COLON. COLONOSCOPY CAN BE PERFORMED AS CLINICALLY WARRANTED.
17. MULTIFOCAL DEGENERATIVE CHANGES OF THE SPINE AND GLENOHUMERAL JOINTS. ? SUPERIMPOSED GEODES WITHIN THE LEFT GLENOID AS WELL AS THE LEFT ACETABULUM. HOWEVER GIVEN CONFIGURATION AND EXTENT AWAY FROM THE JOINT, OTHER ETIOLOGIES CANNOT BE EXCLUDED. PLEASE SEE ABOVE DISCUSSION.
18. EVALUATION OF THE PANCREATIC HEAD AND DUODENUM IS LIMITED IN THE ABSENCE OF ENTERIC CONTRAST OPACIFICATION AND CONFLUENCE OF STRUCTURES IN THIS REGION.
19. MILD EVENTRATION OF THE POSTERIOR ASPECT OF THE LEFT HEMIDIAPHRAGM.
20. MINIMAL SOFT TISSUE PROMINENCE OF THE DISTAL ESOPHAGUS WHICH IS NONSPECIFIC.
21. REMOTE ANTEROLATERAL RIB FRACTURES BILATERALLY.
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CT ABDOMEN AND PELVIS:
TECHNIQUE: Multislice exam with oral and nonionic intravenous contrast.
No bowel, biliary or urinary tract dilatation. No obstructive or inflammatory process demonstrated. No ascites or lymphadenopathy.
No abdominal wall defects of significance; a small umbilical hernia is present, containing fat, without inflammation.
Normal appendix. No diverticula. The questionable small bowel wall thickening reported on prior study is not demonstrated. The pancreas and other abdominal organs are within normal limits.
The lung bases are clear. Normal heart size.
IMPRESSION: Within normal limits.
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ULTRASOUND PELVIS:
Transabdominal and endovaginal sonography of the pelvis, the latter for optimal visualization of the adnexa and endometrium.
FINDINGS: The uterus is retroverted, measuring 5.8 cm AP x 3.9 cm CC x 5.2 cm transverse.
The endometrial canal is upper limits of normal thickness, 10 mm, but homogeneous. Likely related to phase of patient's cycle.
The right ovary measures 4.0 x 1.3 x 2.2 cm, with multiple small follicles. Normal flow.
The left ovary measures 4.4 x 3.5 x 2.6 cm, and contains a large, heterogeneous hypoechoic lesion with septations, measuring 3.0 x 2.4 x 2.0 cm. Normal flow to the ovary; no significant vascularity in or around this complex lesion.
Trace free fluid in the cul-de-sac.
IMPRESSION:
1. Complex left adnexal cystic lesion, possibly a hemorrhagic cyst or endometrioma. Followup ultrasound at a different phase of patient's cycle is recommended.
2. Trace free fluid.
3. No evidence of torsion or other acute pelvic abnormality.
4. NO FOCAL PULMONARY NODULE OR MASS.
5. MILD-TO-MODERATE CENTRILOBULAR EMPHYSEMATOUS CHANGES.
6. PULMONARY ARTERIAL HYPERTENSION.
7. MODERATE-TO-MARKED GLOBAL CARDIOMEGALY AND BORDERLINE PROMINENCE OF THE AORTIC ARCH.
8. EXTENSIVE SYSTEMIC ATHEROSCLEROSIS WITH PARTIALLY CIRCUMFERENTIAL MURAL THROMBUS WITHIN THE AORTIC ARCH AND ABDOMINAL AORTA. SUPERIMPOSED PENETRATING ULCERS AND/OR LONGSTANDING IRREGULAR ATHEROMATOUS PLAQUE WITH SECONDARY LUMINAL IRREGULARITY WITHIN THE AORTIC ARCH AND MID ABDOMINAL AORTA. CONCOMITANT-TO-BORDERLINE ANEURYSMAL DILATATION OF THE MID ABDOMINAL AORTA MEASURING 2.8 X 3.0 CM. MINIMAL FUSIFORM ANEURYSMAL DILATATION OF THE COMMON ILIAC ARTERIES BILATERALLY, EACH MEASURING 1.7 CM IN MAXIMUM TRANSVERSE DIAMETER.
9. THROMBOSED LEFT INTERNAL ILIAC (HYPOGASTRIC) ARTERY AS WELL AS MULTIFOCAL DIMINUTION/STENOSIS OF THE RIGHT INTERNAL ILIAC (HYPOGASTRIC) ARTERY. MILD STENOSIS OF THE EXTERNAL ILIAC ARTERIES BILATERALLY. SUBTLE STENOSIS OF THE ORIGIN OF THE SMA AND CELIAC AXES.
10. SUBTLE DIMINUTION OF THE RENAL CORTICAL ENHANCEMENT MAY BE RELATED TO EARLY PHASE OF CONTRAST OPACIFICATION, HOWEVER HYPOPERFUSION IN THE SETTING OF RENAL ARTERY STENOSIS IS NOT EXCLUDED.
11. EARLY CONTRAST OPACIFICATION OF THE LIVER VERSUS SUBTLE DIFFUSE FATTY INFILTRATION.
12. SUBCENTIMETER HYPODENSE FOCUS IN THE INTERPOLAR REGION OF THE LEFT KIDNEY WHICH, WHILE TOO SMALL TO CHARACTERIZE, COULD REPRESENT A CYST.
13. MILD DISTENTION OF THE URINARY BLADDER.
14. BILATERAL TOTAL HIP ARTHROPLASTIES WITH SURROUNDING STREAK ARTIFACT, SEVERELY LIMITING EVALUATION OF THE PELVIS.
15. INGUINAL HERNIAS BILATERALLY CONTAINING NONOBSTRUCTED SMALL BOWEL, MOST NOTABLY ON THE LEFT.
16. DIFFUSE RETAINED FECAL DEBRIS THROUGHOUT THE COLON AND ABSENCE OF ENTERIC CONTRAST IN THIS REGION PRECLUDE EVALUATION OF THE COLON. COLONOSCOPY CAN BE PERFORMED AS CLINICALLY WARRANTED.
17. MULTIFOCAL DEGENERATIVE CHANGES OF THE SPINE AND GLENOHUMERAL JOINTS. ? SUPERIMPOSED GEODES WITHIN THE LEFT GLENOID AS WELL AS THE LEFT ACETABULUM. HOWEVER GIVEN CONFIGURATION AND EXTENT AWAY FROM THE JOINT, OTHER ETIOLOGIES CANNOT BE EXCLUDED. PLEASE SEE ABOVE DISCUSSION.
18. EVALUATION OF THE PANCREATIC HEAD AND DUODENUM IS LIMITED IN THE ABSENCE OF ENTERIC CONTRAST OPACIFICATION AND CONFLUENCE OF STRUCTURES IN THIS REGION.
19. MILD EVENTRATION OF THE POSTERIOR ASPECT OF THE LEFT HEMIDIAPHRAGM.
20. MINIMAL SOFT TISSUE PROMINENCE OF THE DISTAL ESOPHAGUS WHICH IS NONSPECIFIC.
21. REMOTE ANTEROLATERAL RIB FRACTURES BILATERALLY.
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CT ABDOMEN AND PELVIS:
TECHNIQUE: Multislice exam with oral and nonionic intravenous contrast.
No bowel, biliary or urinary tract dilatation. No obstructive or inflammatory process demonstrated. No ascites or lymphadenopathy.
No abdominal wall defects of significance; a small umbilical hernia is present, containing fat, without inflammation.
Normal appendix. No diverticula. The questionable small bowel wall thickening reported on prior study is not demonstrated. The pancreas and other abdominal organs are within normal limits.
The lung bases are clear. Normal heart size.
IMPRESSION: Within normal limits.
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
ULTRASOUND PELVIS:
Transabdominal and endovaginal sonography of the pelvis, the latter for optimal visualization of the adnexa and endometrium.
FINDINGS: The uterus is retroverted, measuring 5.8 cm AP x 3.9 cm CC x 5.2 cm transverse.
The endometrial canal is upper limits of normal thickness, 10 mm, but homogeneous. Likely related to phase of patient's cycle.
The right ovary measures 4.0 x 1.3 x 2.2 cm, with multiple small follicles. Normal flow.
The left ovary measures 4.4 x 3.5 x 2.6 cm, and contains a large, heterogeneous hypoechoic lesion with septations, measuring 3.0 x 2.4 x 2.0 cm. Normal flow to the ovary; no significant vascularity in or around this complex lesion.
Trace free fluid in the cul-de-sac.
IMPRESSION:
1. Complex left adnexal cystic lesion, possibly a hemorrhagic cyst or endometrioma. Followup ultrasound at a different phase of patient's cycle is recommended.
2. Trace free fluid.
3. No evidence of torsion or other acute pelvic abnormality.
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CRANIAL CT:
Comparison is made with report of previous cranial CT study obtained earlier in the day.
The ventricles are normal in size and appear midline in position. There is no focal mass or extraaxial collection. There are no findings of acute intracranial hemorrhage.
The previous study reported a hyperdensity with CT density exceeding 100 Hounsfield units. No similar finding is seen on the submitted study. There is only one tiny punctate hyperattenuating focus in the subcalvarial right frontal region. This only measures approximately 40 Hounsfield units in greatest degree of attenuation and is of doubtful acute clinical significance. No additional hyperattenuating foci are identified.
The bony calvarium appears intact without depressed fracture. The visualized portions of the paranasal sinuses are free from any obvious fluid level.
IMPRESSION: NO DEFINITE ACUTE OR FOCAL INTRACRANIAL ABNORMALITY IDENTIFIED.
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AP PELVIS WITH FROG-LEG LATERAL VIEW OF THE RIGHT HIP:
COMPARISON: None.
INDICATION: Fall with hip pain.
FINDINGS: There is a large amount of stool and gas obscuring the sacrum and SI joints. The pubic symphysis is grossly in line. Pelvis and obturatorrings are grossly intact. Femoral lines are located bilaterally, and noconvincing proximal femoral fractures are identified. There is extensive vascular calcification.
IMPRESSION: NO DISPLACED FRACTURE.
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THREE-VIEW LEFT ELBOW:
COMPARISON: None.
INDICATION: Rollover ATV accident with elbow pain.
FINDINGS: Alignment at the elbow is intact. No elbow joint effusion is seen. No convincing bony fractures. There is infiltration of the soft tissues along the ulnar side of the upper arm, likely representing contusion.
IMPRESSION: NO CONVINCING FRACTURE. SOFT TISSUE INFILTRATION LIKELY REPRESENTING CONTUSION.
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posted by jep278 @ 18:28
