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2,300	CT Head wo contrast 1/6/2022 12:26 AM Clinical Information: COVID Confirmed AMS Comparison: None. Technique: Unenhanced axial brain CT. Bone and soft tissue windows were reviewed. Sagittal and coronal images were generated from the axial data. Scan field of view: 230 mm. DLP: 1177 mGy cm. Findings:Study limited by streak artifacts from extraneous material resulting in suboptimal visualization at the level of skull base. No large vascular territory stroke, brain edema, intracranial hemorrhage, intracranial mass, mass effect or midline shift. No hydrocephalus. Bilateral eye proptosis. Otherwise, bilateral orbits are unremarkable. Mucous retention cyst in the right maxillary sinus, otherwise visualized paranasal sinuses, mastoid air cells and middle ear cavities are unremarkable. No acute skull fractures. Hyperostosis frontalis interna. Conclusion: 1. No acute intracranial abnormality. 2. Symmetric proptosis of bilateral eyes.	Findings:Study limited by streak artifacts from extraneous material resulting in suboptimal visualization at the level of skull base. No large vascular territory stroke, brain edema, intracranial hemorrhage, intracranial mass, mass effect or midline shift. No hydrocephalus. Bilateral eye proptosis. Otherwise, bilateral orbits are unremarkable. Mucous retention cyst in the right maxillary sinus, otherwise visualized paranasal sinuses, mastoid air cells and middle ear cavities are unremarkable. No acute skull fractures. Hyperostosis frontalis interna.	FINDINGS: There is slightly increased left supracerebellar subdural hygroma measuring 3 mm in thickness. Small subdural hygroma over the right frontal convexity remains unchanged, again measures 4 mm in thickness. There are new 6 mm focal cortical hemorrhage in the left inferior parietal lobule and small subdural hemorrhage over the left occipital convexity. The right maxillary sinus hemorrhage is also increased in amount.
2,301	EXAM: CT Chest High Resolution wo contrast CLINICAL INFORMATION: COMPARISON: None. TECHNIQUE: CT Chest High Resolution wo contrast. Scan field of view: 339 mm. DLP: 346 mGy cm. High-resolution CT imaging of the chest was performed per protocol with inspiratory and expiratory technique in prone position. FINDINGS: STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Focal reticulation with traction bronchiectasis and fibrotic changes involving the anterior apical segment of the right upper lobe. Additional reticulation with fibrotic changes along the anterior periphery of the right lung. Additional scattered subpleural bandlike scarring. Diffuse mild bronchiectasis. Minimal reticulation with fibrotic changes involving the lingula. No evidence of air trapping. No endobronchial lesions. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Small sliding hiatal hernia. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Multiple bilateral renal cysts with a simple 9 cm exophytic left upper pole cyst. Nonobstructing 3 mm stone within the right kidney. Diverticulosis is present. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. Scattered chronic interstitial lung disease with fibrotic changes that are most pronounced in the apical segment of the right upper lobe with traction bronchiectasis. 2. Small sliding hiatal hernia. 3. Nonobstructing right kidney stone. 4. Diverticulosis.	FINDINGS: STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Focal reticulation with traction bronchiectasis and fibrotic changes involving the anterior apical segment of the right upper lobe. Additional reticulation with fibrotic changes along the anterior periphery of the right lung. Additional scattered subpleural bandlike scarring. Diffuse mild bronchiectasis. Minimal reticulation with fibrotic changes involving the lingula. No evidence of air trapping. No endobronchial lesions. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Small sliding hiatal hernia. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Multiple bilateral renal cysts with a simple 9 cm exophytic left upper pole cyst. Nonobstructing 3 mm stone within the right kidney. Diverticulosis is present. MUSCULOSKELETAL: No significant abnormality.	FINDINGS: STRUCTURED REPORT: CT Chest Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Mild dependent atelectasis in the lung bases. No focal consolidation, pleural effusion, or pneumothorax. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: Prominent axillary nodes appear similar. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Normal. MUSCULOSKELETAL: Ballistic tract extends through the soft tissues posterior to the right shoulder. A portion of the ballistic tract extends through the right deltoid muscle. Minimal hemorrhage and gas within the right deltoid. No large hematoma or active extravasation. A tiny ballistic fragment is seen in the subcutaneous soft tissues posterior to the right acromion (image 12 series 301). No acute fracture.
2,302	EXAM: CT Angio Chest wo+w contrast CLINICAL INFORMATION: Right chest pain, shortness of breath. COMPARISON: Chest radiograph from the same day. TECHNIQUE: CT Angio Chest wo+w contrast. Additional 3D image post-processing was performed to generate MIP and/or volume-rendered images. Patient weight: 145 lbs. IV contrast: Omnipaque 350, 60 ml, per protocol. Saline flush: 75 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bt sec. Scan field of view: 332 mm. KVP: 100 DLP: 161.10 mGy cm. FINDINGS: STRUCTURED REPORT: CT PE OVERALL DIAGNOSTIC QUALITY: Full diagnostic quality. LOWER NECK: No abnormality. CHEST: PULMONARY ARTERIES: Negative for pulmonary embolus LUNGS / AIRWAYS / PLEURA: Multifocal posterior right upper lobe groundglass opacities. Mild bilateral dependent atelectasis. No pleural effusion or pneumothorax. HEART / OTHER VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Subcentimeter hepatic dome cyst. MUSCULOSKELETAL: No acute osseous abnormality. Tiny sclerotic densities in the bilateral humeral heads are compatible with benign finding bone islands. CONCLUSION: 1. No pulmonary thromboembolism. 2. Multifocal posterior right upper lobe groundglass opacities, likely infectious/inflammatory. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.	FINDINGS: STRUCTURED REPORT: CT PE OVERALL DIAGNOSTIC QUALITY: Full diagnostic quality. LOWER NECK: No abnormality. CHEST: PULMONARY ARTERIES: Negative for pulmonary embolus LUNGS / AIRWAYS / PLEURA: Multifocal posterior right upper lobe groundglass opacities. Mild bilateral dependent atelectasis. No pleural effusion or pneumothorax. HEART / OTHER VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Subcentimeter hepatic dome cyst. MUSCULOSKELETAL: No acute osseous abnormality. Tiny sclerotic densities in the bilateral humeral heads are compatible with benign finding bone islands.	FINDINGS: BRAIN PARENCHYMA: No intraparenchymal hemorrhage, mass effect or edema. Decreased cerebral cortical volume. Periventricular hypoattenuation consistent with chronic microangiopathy. EXTRA-AXIAL SPACES: Similar appearance of approximately 1 cm thick chronic subdural hematoma with stable small acute hemorrhage. Additionally, the previously described left hygroma appears unchanged. SKULL AND SKULL BASE: No acute fracture. VENTRICULAR SYSTEM: Ex vacuo dilation. ORBITS: Normal. SINUSES: Antrostomy postsurgical changes bilaterally. Mucosal thickening within the bilateral maxillary sinuses with hyperattenuating contents in the right maxillary sinus. MASTOIDS: Clear. SOFT TISSUES: Unremarkable.
2,303	CLINICAL HISTORY: Assess for sinusitis TECHNIQUE: Thin unenhanced axial images were obtained through the paranasal sinuses using the Stealth protocol reformatted in multiple planes. Scan field of view: 180 mm. DLP: 1197 mGy cm. COMPARISON: None available FINDINGS: There is severe opacification of the left frontal sinus and frontoethmoidal recess with hyperdense contents. There is mild mucosal thickening involving the right frontal sinus with opacified right frontoethmoidal recess. There is moderate opacification of left greater than right ethmoid air cells. There are postsurgical changes of bilateral maxillary antrostomies and uncinectomies. Sinuses are relatively well aerated. The surgical ostia are patent.Sphenoid sinuses are clear.Mild mucosal thickening in the left sphenoethmoidal recess. Mild rightward deviation of the nasal septum The anterior skull base is intact. Keros type III cribriform plates. There is unroofing of bilateral anterior ethmoidal artery notches. Pneumatization the right anterior clinoid process. Sellar pneumatization pattern of the sphenoid sinuses. There is no acute intracranial hemorrhage, territorial infarct or hydrocephalus. IMPRESSION: Status post bilateral maxillary antrostomies. Continued moderate to severe opacification of the left greater than right frontal ethmoidal sinuses with hyperdense debris.	FINDINGS: There is severe opacification of the left frontal sinus and frontoethmoidal recess with hyperdense contents. There is mild mucosal thickening involving the right frontal sinus with opacified right frontoethmoidal recess. There is moderate opacification of left greater than right ethmoid air cells. There are postsurgical changes of bilateral maxillary antrostomies and uncinectomies. Sinuses are relatively well aerated. The surgical ostia are patent.Sphenoid sinuses are clear.Mild mucosal thickening in the left sphenoethmoidal recess. Mild rightward deviation of the nasal septum The anterior skull base is intact. Keros type III cribriform plates. There is unroofing of bilateral anterior ethmoidal artery notches. Pneumatization the right anterior clinoid process. Sellar pneumatization pattern of the sphenoid sinuses. There is no acute intracranial hemorrhage, territorial infarct or hydrocephalus.	FINDINGS: BRAIN PARENCHYMA: Encephalomalacia of the bilateral cerebellar lobes appears similar reflecting evolving postsurgical changes. No intraparenchymal hemorrhage. Gray-white matter differentiation is maintained. Cerebral cortical volume is appropriate for patient's age. EXTRA-AXIAL SPACES: No epidural, subdural, or subarachnoid hemorrhage. SKULL AND SKULL BASE: Suboccipital craniectomy postsurgical changes. VENTRICULAR SYSTEM: Right frontal approach ventriculostomy catheter terminates within the frontal horn of the right lateral ventricle near midline. Stable mild ventriculomegaly. ORBITS: Normal. SINUSES: Well aerated. MASTOIDS: Trace left mastoid effusion. SOFT TISSUES: Similar appearance of fluid collection superficial to the suboccipital craniectomy measuring 3.2 x 1.5 cm in maximum axial dimensions (series 201 image 6) may correlate with developing pseudomeningocele.
2,304	EXAM: CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: 89-year-old male with evaluation for possible volume loss. COMPARISON: CT abdomen dated 1/1/2020. TECHNIQUE: CT Abdomen and Pelvis w contrast. Patient weight: 248 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. Oral contrast Omnipaque: 16.9 oz. Saline flush: 90 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 70 sec Scan field of view: 483 mm. DLP: 1090 mGy cm. FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Small pleural effusions and associated atelectasis. DISTAL ESOPHAGUS: Esophogastric tube tip is seen in the stomach body with the sidehole near the gastric esophageal junction. HEART / VESSELS: Dilated main pulmonary artery measuring 3.5 cm. Cardiac lead tips are seen in the right atrium and right ventricle. ABDOMEN and PELVIS: LIVER: Subcentimeter hypoattenuating lesions are similar and are too small to characterize. No suspicious lesion. Hepatic steatosis. BILIARY TRACT: Normal. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Right renal cyst. Subcentimeter hypoattenuating lesions are too small characterize. No hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Gastrostomy tube in place. COLON / APPENDIX: Wall thickening of the distal sigmoid colon and rectum are similar. Diverticulosis. The cecum is dilated measuring up to 11.3 cm (series 4, image 45), similar prior exam. The cecum is oriented in the right upper abdomen, unchanged. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Presacral edema is increased. VESSELS: Scattered mild atherosclerosis. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Prostate gland is surgically absent. BODY WALL: Mild anasarca. MUSCULOSKELETAL: Mild spondylosis of the shoulder spine without acute osseous abnormality. CONCLUSION: 1. Similar dilation of the cecum with orientation in the right upper abdomen without acute pathology. 2. Similar wall thickening of the distal sigmoid colon and rectum can be seen in proctocolitis.. 3. Esophogastric tube tip in the stomach body with the sidehole near the gastroesophageal junction. Consider advancing approximately 10 cm for ideal positioning. 4. Dilated main pulmonary artery can be seen in pulmonary hypertension. Hepatic steatosis and other ancillary findings above. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.	FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Small pleural effusions and associated atelectasis. DISTAL ESOPHAGUS: Esophogastric tube tip is seen in the stomach body with the sidehole near the gastric esophageal junction. HEART / VESSELS: Dilated main pulmonary artery measuring 3.5 cm. Cardiac lead tips are seen in the right atrium and right ventricle. ABDOMEN and PELVIS: LIVER: Subcentimeter hypoattenuating lesions are similar and are too small to characterize. No suspicious lesion. Hepatic steatosis. BILIARY TRACT: Normal. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Right renal cyst. Subcentimeter hypoattenuating lesions are too small characterize. No hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Gastrostomy tube in place. COLON / APPENDIX: Wall thickening of the distal sigmoid colon and rectum are similar. Diverticulosis. The cecum is dilated measuring up to 11.3 cm (series 4, image 45), similar prior exam. The cecum is oriented in the right upper abdomen, unchanged. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Presacral edema is increased. VESSELS: Scattered mild atherosclerosis. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Prostate gland is surgically absent. BODY WALL: Mild anasarca. MUSCULOSKELETAL: Mild spondylosis of the shoulder spine without acute osseous abnormality.	Findings: Brain parenchyma: Mild diffuse age-appropriate brain parenchymal volume loss is seen. Mild frontal periventricular white matter hypoattenuation is noted, suggestive of early chronic microvascular scheme disease. The white-gray matter differentiation is preserved. Tiny cavum septum pellucidum. Ventricular system: Normal configuration. No hydrocephalus. Basal cisterns: There is no significant effacement of the basilar cisterns. Extra-axial spaces: Incidental rounded, extra-axial, hyperdense suprasellar lesion is noted, measuring approximately 8 x 7.7 mm. No abnormal extra-axial fluid collections. Hemorrhage: No intracranial hemorrhage is identified. Midline shift: No significant midline shift is seen. Vascular system: Punctate atherosclerotic calcifications of the bilateral carotid siphons and the left vertebral artery. Soft tissues: Unremarkable without discrete fluid collections. Orbits: Normal appearance. Calvarium and skull base: No acute fractures or suspicious osseous lesions identified. The bilateral mastoid air cell complexes are well-developed and clear. Paranasal sinuses: Right maxillary sinus mucosal thickening and mucous retention cyst. Otherwise, appear well aerated.
2,305	EXAM: CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: Left upper quadrant pain, nausea and vomiting COMPARISON: 2/19/2016 TECHNIQUE: CT Abdomen and Pelvis w contrast. Patient weight: 115 lbs. IV contrast: Omnipaque 350, 80 ml, per protocol. IV contrast injection rate: 3 ml per sec. Scan delay: 67 sec. Scan field of view: 310 mm. DLP: 376 mGy cm. FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Unremarkable DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Mild hepatomegaly, unchanged. Focal fat adjacent to the falciform ligament is unchanged. No concerning mass or lesion identified. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: The a linear hypodensity within the spleen likely represents a prominent cleft/sequela of is chronic scarring. ADRENALS: Unremarkable KIDNEYS: Bilateral renal scarring. No hydronephrosis. Minute subcentimeter hypodensity within the left kidney is technically indeterminate but statistically likely cysts. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: There is mild gaseous distention of the colon with mild to moderate fecal burden. Colonic wall thickening previously visualized has resolved. The appendix is not visualized. The distal colon is collapsed PERITONEUM / MESENTERY: There is a small amount of free fluid in the pelvis, likely physiologic in nature. RETROPERITONEUM: Normal. VESSELS: Mild aortoiliac atherosclerosis without aneurysmal dilatation. URINARY BLADDER: Mild thickening with perivesicular stranding REPRODUCTIVE ORGANS: Uterus appears mildly enlarged and heterogenous, relatively unchanged compared to prior exam. There is a small amount of endometrial fluid, likely physiologic in nature. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No acute or aggressive osseous abnormality. CONCLUSION: 1. Findings concerning for cystitis/UTI. Bilateral renal scarring, left worse than right. Subtle superimposed left pyelonephritis cannot be excluded. No hydronephrosis. 2. Hepatomegaly. Additional findings above. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.	FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Unremarkable DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Mild hepatomegaly, unchanged. Focal fat adjacent to the falciform ligament is unchanged. No concerning mass or lesion identified. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: The a linear hypodensity within the spleen likely represents a prominent cleft/sequela of is chronic scarring. ADRENALS: Unremarkable KIDNEYS: Bilateral renal scarring. No hydronephrosis. Minute subcentimeter hypodensity within the left kidney is technically indeterminate but statistically likely cysts. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: There is mild gaseous distention of the colon with mild to moderate fecal burden. Colonic wall thickening previously visualized has resolved. The appendix is not visualized. The distal colon is collapsed PERITONEUM / MESENTERY: There is a small amount of free fluid in the pelvis, likely physiologic in nature. RETROPERITONEUM: Normal. VESSELS: Mild aortoiliac atherosclerosis without aneurysmal dilatation. URINARY BLADDER: Mild thickening with perivesicular stranding REPRODUCTIVE ORGANS: Uterus appears mildly enlarged and heterogenous, relatively unchanged compared to prior exam. There is a small amount of endometrial fluid, likely physiologic in nature. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No acute or aggressive osseous abnormality.	FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Right IJ approach central venous catheter with tip at the brachiocephalic vein. Two enteric tubes. CHEST: LUNGS / AIRWAYS / PLEURA: The right-sided chest tube courses anteroposteriorly through the major fissure and is kinked on itself posteriorly. There is a small right pneumothorax. Likely atelectasis in the right lower lobe (image 87 series 701) the left lung is clear. No pleural effusion. Endotracheal tube terminates above the carina, with layering secretions. HEART / VESSELS: Right internal jugular central venous catheter tip terminates in the caudal right brachiocephalic vein. Extensive thrombus in the distal left pulmonary artery extending into several left upper and lower lobe branches. Thrombus in the right pulmonary artery extending into right upper and middle and probably lower lobe branches, not well evaluated on this nonoptimized study. MEDIASTINUM / ESOPHAGUS: Enteric tubes course through the esophagus. Residual thymus. DIAPHRAGM: Postsurgical changes of right diaphragmatic the lateral aspect of the right diaphragm with underlying packing material. LYMPH NODES: None enlarged. CHEST WALL: Ballistic fragments in the right lateral chest wall. Soft tissue gas surrounding the right chest tube. ABDOMEN and PELVIS: LIVER: Postsurgical changes of complex hepatorrhaphy with packing material and laparotomy pads overlying the right hepatic lobe. Transhepatic ballistic laceration extending through the right hepatic lobe with gas and occasional metallic fragment along the track. Heterogenous perfusion of the liver. Left hepatic lobe laceration measures approximately 2 cm (image 58 series 501). No active extravasation or pseudoaneurysm identified. BILIARY TRACT: Extensive periportal edema. GALLBLADDER: Gallbladder wall edema. PANCREAS: Streak artifact limits evaluation of the head. There is hypoenhancement of a portion of the pancreatic body (. SPLEEN: Normal. ADRENALS: Hyperenhancing. KIDNEYS: Postsurgical changes of right nephrectomy and ligation of right renal artery with packing material and laparotomy pad in the nephrectomy bed. The left kidney is normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Esophagogastric tube terminates in the distal stomach. The feeding tube is coiled back on itself in the transverse portion of the duodenum. Postsurgical changes of duodenal repair, not well evaluated due to artifact from Dobbhoff tube. The remainder of the small bowel appears unremarkable.. COLON / APPENDIX: Mild wall thickening at the hepatic flexure. The remainder of the colon is unremarkable. PERITONEUM / MESENTERY: Small volume hemoperitoneum and other fluid and scattered pneumoperitoneum, expected in the postoperative setting. RETROPERITONEUM: Normal. VESSELS: Surgical clips surrounding the IVC, related to known IVC reconstruction. Veins are not well evaluated due to phase of contrast, but IVC thrombus could produce a similar appearance. See below for CTA Runoff. URINARY BLADDER: Collapsed around a Foley catheter. REPRODUCTIVE ORGANS: Focus of air at the scrotum BODY WALL: Open abdomen with wound closure device in place. MUSCULOSKELETAL: Healed right fracture deformity of the proximal femur, with right femoral intramedullary nail and trochanteric nail in place. Ballistic entry/exit wounds are seen in the anterior distal thigh, medial distal thigh, right lateral distal thigh, and right posterior distal thigh. Comminuted ballistic intra-articular fracture of the right proximal tibia. Fracture of the left medial femoral condyle. Extensively comminuted fracture of the right patella. Lipohemarthrosis and gas within the right suprapatellar recess. Gas tracking throughout the soft tissues of the right proximal with hemorrhage throughout the right proximal thigh. Comminuted ballistic fracture of the distal fibula/lateral malleolus, with surrounding hemorrhage and gas tracking throughout the left ankle and foot. Extensive ballistic fragments throughout the musculature of the left mid thigh with associated gas and hemorrhage. No left femur fracture identified. CTA RUNOFF: DISTAL DESCENDING THORACIC AORTA: No significant abnormality. ABDOMINAL AORTA: No significant abnormality. CELIAC AXIS: Marked focal narrowing of the celiac origin which appears to be secondary to compression due to the median arcuate ligament. SMA: No significant abnormality. RIGHT RENAL: Surgical changes of right renal artery ligation. LEFT RENAL: Two left renal arteries. IMA: No significant abnormality. RIGHT ILIAC ARTERIES: No significant abnormality. RIGHT FEMORAL \T\ POPLITEAL ARTERIES: No significant abnormality. RIGHT TIBIAL AND PERONEAL ARTERIES: No significant abnormality. Three-vessel runoff to the right foot. RIGHT FOOT ARTERIES: No significant abnormality. LEFT ILIAC ARTERIES: No significant abnormality. LEFT FEMORAL \T\ POPLITEAL ARTERIES: No significant abnormality. LEFT TIBIAL AND PERONEAL ARTERIES: Abrupt nonopacification of the anterior tibial artery at the level of the distal tibia with surrounding hemorrhage and a few foci of high density which may represent small ballistic fragments. There is an adjacent high density focus within the surrounding hematoma (image 473 series 501) which does not appear to significantly change on delayed phase, suggesting pseudoaneurysm. The peroneal artery narrows mildly to moderately just proximal to the ankle. at the level of soft tissue gas and hemorrhage, suggesting ballistic injury. The posterior tibial artery is opacified to the level of the foot. LEFT FOOT ARTERIES: Not well evaluated. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal.
2,306	EXAM: CT Angio Chest wo+w contrast CLINICAL INFORMATION: Covid confirmed, history of PTE, chest pain, dyspnea COMPARISON: 6/3/2021 TECHNIQUE: CT Angio Chest wo+w contrast Additional 3D image post-processing was performed to generate MIP and/or volume-rendered images. Patient weight: 220 lbs. IV contrast: Omnipaque 350, 80 ml, per protocol. Saline flush: 75 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bt sec. Scan field of view: 319 mm. Premedication given: Yes KVP: 120 DLP: 398.40 mGy cm. FINDINGS: STRUCTURED REPORT: CT PE OVERALL DIAGNOSTIC QUALITY: Full diagnostic quality LOWER NECK: No abnormality. CHEST: PULMONARY ARTERIES: Negative for pulmonary embolus LUNGS / AIRWAYS / PLEURA: Normal. HEART / OTHER VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Similar size and appearance of a cystic left renal lesion with enhancing internal septations. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. Negative for pulmonary embolus or other acute process. 2. Stable size and appearance of a cystic left renal lesion with enhancing internal septations.	FINDINGS: STRUCTURED REPORT: CT PE OVERALL DIAGNOSTIC QUALITY: Full diagnostic quality LOWER NECK: No abnormality. CHEST: PULMONARY ARTERIES: Negative for pulmonary embolus LUNGS / AIRWAYS / PLEURA: Normal. HEART / OTHER VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Similar size and appearance of a cystic left renal lesion with enhancing internal septations. MUSCULOSKELETAL: No significant abnormality.	FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Right IJ approach central venous catheter with tip at the brachiocephalic vein. Two enteric tubes. CHEST: LUNGS / AIRWAYS / PLEURA: The right-sided chest tube courses anteroposteriorly through the major fissure and is kinked on itself posteriorly. There is a small right pneumothorax. Likely atelectasis in the right lower lobe (image 87 series 701) the left lung is clear. No pleural effusion. Endotracheal tube terminates above the carina, with layering secretions. HEART / VESSELS: Right internal jugular central venous catheter tip terminates in the caudal right brachiocephalic vein. Extensive thrombus in the distal left pulmonary artery extending into several left upper and lower lobe branches. Thrombus in the right pulmonary artery extending into right upper and middle and probably lower lobe branches, not well evaluated on this nonoptimized study. MEDIASTINUM / ESOPHAGUS: Enteric tubes course through the esophagus. Residual thymus. DIAPHRAGM: Postsurgical changes of right diaphragmatic the lateral aspect of the right diaphragm with underlying packing material. LYMPH NODES: None enlarged. CHEST WALL: Ballistic fragments in the right lateral chest wall. Soft tissue gas surrounding the right chest tube. ABDOMEN and PELVIS: LIVER: Postsurgical changes of complex hepatorrhaphy with packing material and laparotomy pads overlying the right hepatic lobe. Transhepatic ballistic laceration extending through the right hepatic lobe with gas and occasional metallic fragment along the track. Heterogenous perfusion of the liver. Left hepatic lobe laceration measures approximately 2 cm (image 58 series 501). No active extravasation or pseudoaneurysm identified. BILIARY TRACT: Extensive periportal edema. GALLBLADDER: Gallbladder wall edema. PANCREAS: Streak artifact limits evaluation of the head. There is hypoenhancement of a portion of the pancreatic body (. SPLEEN: Normal. ADRENALS: Hyperenhancing. KIDNEYS: Postsurgical changes of right nephrectomy and ligation of right renal artery with packing material and laparotomy pad in the nephrectomy bed. The left kidney is normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Esophagogastric tube terminates in the distal stomach. The feeding tube is coiled back on itself in the transverse portion of the duodenum. Postsurgical changes of duodenal repair, not well evaluated due to artifact from Dobbhoff tube. The remainder of the small bowel appears unremarkable.. COLON / APPENDIX: Mild wall thickening at the hepatic flexure. The remainder of the colon is unremarkable. PERITONEUM / MESENTERY: Small volume hemoperitoneum and other fluid and scattered pneumoperitoneum, expected in the postoperative setting. RETROPERITONEUM: Normal. VESSELS: Surgical clips surrounding the IVC, related to known IVC reconstruction. Veins are not well evaluated due to phase of contrast, but IVC thrombus could produce a similar appearance. See below for CTA Runoff. URINARY BLADDER: Collapsed around a Foley catheter. REPRODUCTIVE ORGANS: Focus of air at the scrotum BODY WALL: Open abdomen with wound closure device in place. MUSCULOSKELETAL: Healed right fracture deformity of the proximal femur, with right femoral intramedullary nail and trochanteric nail in place. Ballistic entry/exit wounds are seen in the anterior distal thigh, medial distal thigh, right lateral distal thigh, and right posterior distal thigh. Comminuted ballistic intra-articular fracture of the right proximal tibia. Fracture of the left medial femoral condyle. Extensively comminuted fracture of the right patella. Lipohemarthrosis and gas within the right suprapatellar recess. Gas tracking throughout the soft tissues of the right proximal with hemorrhage throughout the right proximal thigh. Comminuted ballistic fracture of the distal fibula/lateral malleolus, with surrounding hemorrhage and gas tracking throughout the left ankle and foot. Extensive ballistic fragments throughout the musculature of the left mid thigh with associated gas and hemorrhage. No left femur fracture identified. CTA RUNOFF: DISTAL DESCENDING THORACIC AORTA: No significant abnormality. ABDOMINAL AORTA: No significant abnormality. CELIAC AXIS: Marked focal narrowing of the celiac origin which appears to be secondary to compression due to the median arcuate ligament. SMA: No significant abnormality. RIGHT RENAL: Surgical changes of right renal artery ligation. LEFT RENAL: Two left renal arteries. IMA: No significant abnormality. RIGHT ILIAC ARTERIES: No significant abnormality. RIGHT FEMORAL \T\ POPLITEAL ARTERIES: No significant abnormality. RIGHT TIBIAL AND PERONEAL ARTERIES: No significant abnormality. Three-vessel runoff to the right foot. RIGHT FOOT ARTERIES: No significant abnormality. LEFT ILIAC ARTERIES: No significant abnormality. LEFT FEMORAL \T\ POPLITEAL ARTERIES: No significant abnormality. LEFT TIBIAL AND PERONEAL ARTERIES: Abrupt nonopacification of the anterior tibial artery at the level of the distal tibia with surrounding hemorrhage and a few foci of high density which may represent small ballistic fragments. There is an adjacent high density focus within the surrounding hematoma (image 473 series 501) which does not appear to significantly change on delayed phase, suggesting pseudoaneurysm. The peroneal artery narrows mildly to moderately just proximal to the ankle. at the level of soft tissue gas and hemorrhage, suggesting ballistic injury. The posterior tibial artery is opacified to the level of the foot. LEFT FOOT ARTERIES: Not well evaluated. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal.
2,307	EXAM: CT Chest with contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat, CT Abdomen and Pelvis w contrast, CT Head wo contrast CLINICAL INFORMATION: Trauma COMPARISON: None. TECHNIQUE: CT Chest with contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat, CT Abdomen and Pelvis w contrast, CT Head wo contrast. Patient weight: 220 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 70sec Scan field of view: 428.10 mm. (accession CT220002771), Patient weight: 220 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 70sec Scan field of view: 428.10 mm. (accession CT220002775), Patient weight: 220 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 70sec Scan field of view: 428.10 mm. (accession CT220002774), Patient weight: 220 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 70sec Scan field of view: 428.10 mm. DLP: 2064 mGy cm. (accession CT220002772) FINDINGS: BRAIN PARENCHYMA111: No hemorrhage, mass effect or edema. There is an empty sella. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No acute fracture. There is postsurgical craniotomy changes to the left occipital region.. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: There is a small mucus retention cyst seen within the left maxillary sinus. There is a small amount of right maxillary sinus mucosal thickening. STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: There is a 3 mm pulmonary nodule in the right upper lobe on image 162, series 502, along the minor fissure, likely a intrapulmonary lymph node. The lungs are otherwise clear. The central airways are patent. No pleural effusion or pneumothorax. HEART / VESSELS: An Amplatz ASD occlusion devices seen. No pericardial effusion. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: A simple cyst is seen in the upper pole the right kidney LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Hysterectomy changes are noted. No adnexal mass. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. THORACIC AND LUMBAR SPINE CT: There is a minimally displaced superior endplate anterior wedge compression fracture of L3 with approximately 10% loss of height. No significant retropulsion or spinal canal stenosis. No acute fracture or dislocation of the thoracic spine. Vertebral body hemangiomas are seen in T5 and T6. CONCLUSION: 1. Acute anterior wedge compression fracture of L3, as described. 2. Otherwise, no acute traumatic injury identified within the chest, abdomen, or pelvis. 3. No acute intracranial process is identified. 4. Additional findings above.	FINDINGS: BRAIN PARENCHYMA111: No hemorrhage, mass effect or edema. There is an empty sella. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No acute fracture. There is postsurgical craniotomy changes to the left occipital region.. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: There is a small mucus retention cyst seen within the left maxillary sinus. There is a small amount of right maxillary sinus mucosal thickening. STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: There is a 3 mm pulmonary nodule in the right upper lobe on image 162, series 502, along the minor fissure, likely a intrapulmonary lymph node. The lungs are otherwise clear. The central airways are patent. No pleural effusion or pneumothorax. HEART / VESSELS: An Amplatz ASD occlusion devices seen. No pericardial effusion. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: A simple cyst is seen in the upper pole the right kidney LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Hysterectomy changes are noted. No adnexal mass. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. THORACIC AND LUMBAR SPINE CT: There is a minimally displaced superior endplate anterior wedge compression fracture of L3 with approximately 10% loss of height. No significant retropulsion or spinal canal stenosis. No acute fracture or dislocation of the thoracic spine. Vertebral body hemangiomas are seen in T5 and T6.	FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Right IJ approach central venous catheter with tip at the brachiocephalic vein. Two enteric tubes. CHEST: LUNGS / AIRWAYS / PLEURA: The right-sided chest tube courses anteroposteriorly through the major fissure and is kinked on itself posteriorly. There is a small right pneumothorax. Likely atelectasis in the right lower lobe (image 87 series 701) the left lung is clear. No pleural effusion. Endotracheal tube terminates above the carina, with layering secretions. HEART / VESSELS: Right internal jugular central venous catheter tip terminates in the caudal right brachiocephalic vein. Extensive thrombus in the distal left pulmonary artery extending into several left upper and lower lobe branches. Thrombus in the right pulmonary artery extending into right upper and middle and probably lower lobe branches, not well evaluated on this nonoptimized study. MEDIASTINUM / ESOPHAGUS: Enteric tubes course through the esophagus. Residual thymus. DIAPHRAGM: Postsurgical changes of right diaphragmatic the lateral aspect of the right diaphragm with underlying packing material. LYMPH NODES: None enlarged. CHEST WALL: Ballistic fragments in the right lateral chest wall. Soft tissue gas surrounding the right chest tube. ABDOMEN and PELVIS: LIVER: Postsurgical changes of complex hepatorrhaphy with packing material and laparotomy pads overlying the right hepatic lobe. Transhepatic ballistic laceration extending through the right hepatic lobe with gas and occasional metallic fragment along the track. Heterogenous perfusion of the liver. Left hepatic lobe laceration measures approximately 2 cm (image 58 series 501). No active extravasation or pseudoaneurysm identified. BILIARY TRACT: Extensive periportal edema. GALLBLADDER: Gallbladder wall edema. PANCREAS: Streak artifact limits evaluation of the head. There is hypoenhancement of a portion of the pancreatic body (. SPLEEN: Normal. ADRENALS: Hyperenhancing. KIDNEYS: Postsurgical changes of right nephrectomy and ligation of right renal artery with packing material and laparotomy pad in the nephrectomy bed. The left kidney is normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Esophagogastric tube terminates in the distal stomach. The feeding tube is coiled back on itself in the transverse portion of the duodenum. Postsurgical changes of duodenal repair, not well evaluated due to artifact from Dobbhoff tube. The remainder of the small bowel appears unremarkable.. COLON / APPENDIX: Mild wall thickening at the hepatic flexure. The remainder of the colon is unremarkable. PERITONEUM / MESENTERY: Small volume hemoperitoneum and other fluid and scattered pneumoperitoneum, expected in the postoperative setting. RETROPERITONEUM: Normal. VESSELS: Surgical clips surrounding the IVC, related to known IVC reconstruction. Veins are not well evaluated due to phase of contrast, but IVC thrombus could produce a similar appearance. See below for CTA Runoff. URINARY BLADDER: Collapsed around a Foley catheter. REPRODUCTIVE ORGANS: Focus of air at the scrotum BODY WALL: Open abdomen with wound closure device in place. MUSCULOSKELETAL: Healed right fracture deformity of the proximal femur, with right femoral intramedullary nail and trochanteric nail in place. Ballistic entry/exit wounds are seen in the anterior distal thigh, medial distal thigh, right lateral distal thigh, and right posterior distal thigh. Comminuted ballistic intra-articular fracture of the right proximal tibia. Fracture of the left medial femoral condyle. Extensively comminuted fracture of the right patella. Lipohemarthrosis and gas within the right suprapatellar recess. Gas tracking throughout the soft tissues of the right proximal with hemorrhage throughout the right proximal thigh. Comminuted ballistic fracture of the distal fibula/lateral malleolus, with surrounding hemorrhage and gas tracking throughout the left ankle and foot. Extensive ballistic fragments throughout the musculature of the left mid thigh with associated gas and hemorrhage. No left femur fracture identified. CTA RUNOFF: DISTAL DESCENDING THORACIC AORTA: No significant abnormality. ABDOMINAL AORTA: No significant abnormality. CELIAC AXIS: Marked focal narrowing of the celiac origin which appears to be secondary to compression due to the median arcuate ligament. SMA: No significant abnormality. RIGHT RENAL: Surgical changes of right renal artery ligation. LEFT RENAL: Two left renal arteries. IMA: No significant abnormality. RIGHT ILIAC ARTERIES: No significant abnormality. RIGHT FEMORAL \T\ POPLITEAL ARTERIES: No significant abnormality. RIGHT TIBIAL AND PERONEAL ARTERIES: No significant abnormality. Three-vessel runoff to the right foot. RIGHT FOOT ARTERIES: No significant abnormality. LEFT ILIAC ARTERIES: No significant abnormality. LEFT FEMORAL \T\ POPLITEAL ARTERIES: No significant abnormality. LEFT TIBIAL AND PERONEAL ARTERIES: Abrupt nonopacification of the anterior tibial artery at the level of the distal tibia with surrounding hemorrhage and a few foci of high density which may represent small ballistic fragments. There is an adjacent high density focus within the surrounding hematoma (image 473 series 501) which does not appear to significantly change on delayed phase, suggesting pseudoaneurysm. The peroneal artery narrows mildly to moderately just proximal to the ankle. at the level of soft tissue gas and hemorrhage, suggesting ballistic injury. The posterior tibial artery is opacified to the level of the foot. LEFT FOOT ARTERIES: Not well evaluated. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal.
2,308	EXAM: CT Chest with contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat, CT Abdomen and Pelvis w contrast, CT Head wo contrast CLINICAL INFORMATION: Trauma COMPARISON: None. TECHNIQUE: CT Chest with contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat, CT Abdomen and Pelvis w contrast, CT Head wo contrast. Patient weight: 220 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 70sec Scan field of view: 428.10 mm. (accession CT220002771), Patient weight: 220 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 70sec Scan field of view: 428.10 mm. (accession CT220002775), Patient weight: 220 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 70sec Scan field of view: 428.10 mm. (accession CT220002774), Patient weight: 220 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 70sec Scan field of view: 428.10 mm. DLP: 2064 mGy cm. (accession CT220002772) FINDINGS: BRAIN PARENCHYMA111: No hemorrhage, mass effect or edema. There is an empty sella. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No acute fracture. There is postsurgical craniotomy changes to the left occipital region.. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: There is a small mucus retention cyst seen within the left maxillary sinus. There is a small amount of right maxillary sinus mucosal thickening. STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: There is a 3 mm pulmonary nodule in the right upper lobe on image 162, series 502, along the minor fissure, likely a intrapulmonary lymph node. The lungs are otherwise clear. The central airways are patent. No pleural effusion or pneumothorax. HEART / VESSELS: An Amplatz ASD occlusion devices seen. No pericardial effusion. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: A simple cyst is seen in the upper pole the right kidney LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Hysterectomy changes are noted. No adnexal mass. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. THORACIC AND LUMBAR SPINE CT: There is a minimally displaced superior endplate anterior wedge compression fracture of L3 with approximately 10% loss of height. No significant retropulsion or spinal canal stenosis. No acute fracture or dislocation of the thoracic spine. Vertebral body hemangiomas are seen in T5 and T6. CONCLUSION: 1. Acute anterior wedge compression fracture of L3, as described. 2. Otherwise, no acute traumatic injury identified within the chest, abdomen, or pelvis. 3. No acute intracranial process is identified. 4. Additional findings above.	FINDINGS: BRAIN PARENCHYMA111: No hemorrhage, mass effect or edema. There is an empty sella. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No acute fracture. There is postsurgical craniotomy changes to the left occipital region.. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: There is a small mucus retention cyst seen within the left maxillary sinus. There is a small amount of right maxillary sinus mucosal thickening. STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: There is a 3 mm pulmonary nodule in the right upper lobe on image 162, series 502, along the minor fissure, likely a intrapulmonary lymph node. The lungs are otherwise clear. The central airways are patent. No pleural effusion or pneumothorax. HEART / VESSELS: An Amplatz ASD occlusion devices seen. No pericardial effusion. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: A simple cyst is seen in the upper pole the right kidney LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Hysterectomy changes are noted. No adnexal mass. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. THORACIC AND LUMBAR SPINE CT: There is a minimally displaced superior endplate anterior wedge compression fracture of L3 with approximately 10% loss of height. No significant retropulsion or spinal canal stenosis. No acute fracture or dislocation of the thoracic spine. Vertebral body hemangiomas are seen in T5 and T6.	FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Right IJ approach central venous catheter with tip at the brachiocephalic vein. Two enteric tubes. CHEST: LUNGS / AIRWAYS / PLEURA: The right-sided chest tube courses anteroposteriorly through the major fissure and is kinked on itself posteriorly. There is a small right pneumothorax. Likely atelectasis in the right lower lobe (image 87 series 701) the left lung is clear. No pleural effusion. Endotracheal tube terminates above the carina, with layering secretions. HEART / VESSELS: Right internal jugular central venous catheter tip terminates in the caudal right brachiocephalic vein. Extensive thrombus in the distal left pulmonary artery extending into several left upper and lower lobe branches. Thrombus in the right pulmonary artery extending into right upper and middle and probably lower lobe branches, not well evaluated on this nonoptimized study. MEDIASTINUM / ESOPHAGUS: Enteric tubes course through the esophagus. Residual thymus. DIAPHRAGM: Postsurgical changes of right diaphragmatic the lateral aspect of the right diaphragm with underlying packing material. LYMPH NODES: None enlarged. CHEST WALL: Ballistic fragments in the right lateral chest wall. Soft tissue gas surrounding the right chest tube. ABDOMEN and PELVIS: LIVER: Postsurgical changes of complex hepatorrhaphy with packing material and laparotomy pads overlying the right hepatic lobe. Transhepatic ballistic laceration extending through the right hepatic lobe with gas and occasional metallic fragment along the track. Heterogenous perfusion of the liver. Left hepatic lobe laceration measures approximately 2 cm (image 58 series 501). No active extravasation or pseudoaneurysm identified. BILIARY TRACT: Extensive periportal edema. GALLBLADDER: Gallbladder wall edema. PANCREAS: Streak artifact limits evaluation of the head. There is hypoenhancement of a portion of the pancreatic body (. SPLEEN: Normal. ADRENALS: Hyperenhancing. KIDNEYS: Postsurgical changes of right nephrectomy and ligation of right renal artery with packing material and laparotomy pad in the nephrectomy bed. The left kidney is normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Esophagogastric tube terminates in the distal stomach. The feeding tube is coiled back on itself in the transverse portion of the duodenum. Postsurgical changes of duodenal repair, not well evaluated due to artifact from Dobbhoff tube. The remainder of the small bowel appears unremarkable.. COLON / APPENDIX: Mild wall thickening at the hepatic flexure. The remainder of the colon is unremarkable. PERITONEUM / MESENTERY: Small volume hemoperitoneum and other fluid and scattered pneumoperitoneum, expected in the postoperative setting. RETROPERITONEUM: Normal. VESSELS: Surgical clips surrounding the IVC, related to known IVC reconstruction. Veins are not well evaluated due to phase of contrast, but IVC thrombus could produce a similar appearance. See below for CTA Runoff. URINARY BLADDER: Collapsed around a Foley catheter. REPRODUCTIVE ORGANS: Focus of air at the scrotum BODY WALL: Open abdomen with wound closure device in place. MUSCULOSKELETAL: Healed right fracture deformity of the proximal femur, with right femoral intramedullary nail and trochanteric nail in place. Ballistic entry/exit wounds are seen in the anterior distal thigh, medial distal thigh, right lateral distal thigh, and right posterior distal thigh. Comminuted ballistic intra-articular fracture of the right proximal tibia. Fracture of the left medial femoral condyle. Extensively comminuted fracture of the right patella. Lipohemarthrosis and gas within the right suprapatellar recess. Gas tracking throughout the soft tissues of the right proximal with hemorrhage throughout the right proximal thigh. Comminuted ballistic fracture of the distal fibula/lateral malleolus, with surrounding hemorrhage and gas tracking throughout the left ankle and foot. Extensive ballistic fragments throughout the musculature of the left mid thigh with associated gas and hemorrhage. No left femur fracture identified. CTA RUNOFF: DISTAL DESCENDING THORACIC AORTA: No significant abnormality. ABDOMINAL AORTA: No significant abnormality. CELIAC AXIS: Marked focal narrowing of the celiac origin which appears to be secondary to compression due to the median arcuate ligament. SMA: No significant abnormality. RIGHT RENAL: Surgical changes of right renal artery ligation. LEFT RENAL: Two left renal arteries. IMA: No significant abnormality. RIGHT ILIAC ARTERIES: No significant abnormality. RIGHT FEMORAL \T\ POPLITEAL ARTERIES: No significant abnormality. RIGHT TIBIAL AND PERONEAL ARTERIES: No significant abnormality. Three-vessel runoff to the right foot. RIGHT FOOT ARTERIES: No significant abnormality. LEFT ILIAC ARTERIES: No significant abnormality. LEFT FEMORAL \T\ POPLITEAL ARTERIES: No significant abnormality. LEFT TIBIAL AND PERONEAL ARTERIES: Abrupt nonopacification of the anterior tibial artery at the level of the distal tibia with surrounding hemorrhage and a few foci of high density which may represent small ballistic fragments. There is an adjacent high density focus within the surrounding hematoma (image 473 series 501) which does not appear to significantly change on delayed phase, suggesting pseudoaneurysm. The peroneal artery narrows mildly to moderately just proximal to the ankle. at the level of soft tissue gas and hemorrhage, suggesting ballistic injury. The posterior tibial artery is opacified to the level of the foot. LEFT FOOT ARTERIES: Not well evaluated. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal.
2,309	EXAM: CT Chest with contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat, CT Abdomen and Pelvis w contrast, CT Head wo contrast CLINICAL INFORMATION: Trauma COMPARISON: None. TECHNIQUE: CT Chest with contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat, CT Abdomen and Pelvis w contrast, CT Head wo contrast. Patient weight: 220 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 70sec Scan field of view: 428.10 mm. (accession CT220002771), Patient weight: 220 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 70sec Scan field of view: 428.10 mm. (accession CT220002775), Patient weight: 220 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 70sec Scan field of view: 428.10 mm. (accession CT220002774), Patient weight: 220 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 70sec Scan field of view: 428.10 mm. DLP: 2064 mGy cm. (accession CT220002772) FINDINGS: BRAIN PARENCHYMA111: No hemorrhage, mass effect or edema. There is an empty sella. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No acute fracture. There is postsurgical craniotomy changes to the left occipital region.. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: There is a small mucus retention cyst seen within the left maxillary sinus. There is a small amount of right maxillary sinus mucosal thickening. STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: There is a 3 mm pulmonary nodule in the right upper lobe on image 162, series 502, along the minor fissure, likely a intrapulmonary lymph node. The lungs are otherwise clear. The central airways are patent. No pleural effusion or pneumothorax. HEART / VESSELS: An Amplatz ASD occlusion devices seen. No pericardial effusion. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: A simple cyst is seen in the upper pole the right kidney LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Hysterectomy changes are noted. No adnexal mass. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. THORACIC AND LUMBAR SPINE CT: There is a minimally displaced superior endplate anterior wedge compression fracture of L3 with approximately 10% loss of height. No significant retropulsion or spinal canal stenosis. No acute fracture or dislocation of the thoracic spine. Vertebral body hemangiomas are seen in T5 and T6. CONCLUSION: 1. Acute anterior wedge compression fracture of L3, as described. 2. Otherwise, no acute traumatic injury identified within the chest, abdomen, or pelvis. 3. No acute intracranial process is identified. 4. Additional findings above.	FINDINGS: BRAIN PARENCHYMA111: No hemorrhage, mass effect or edema. There is an empty sella. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No acute fracture. There is postsurgical craniotomy changes to the left occipital region.. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: There is a small mucus retention cyst seen within the left maxillary sinus. There is a small amount of right maxillary sinus mucosal thickening. STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: There is a 3 mm pulmonary nodule in the right upper lobe on image 162, series 502, along the minor fissure, likely a intrapulmonary lymph node. The lungs are otherwise clear. The central airways are patent. No pleural effusion or pneumothorax. HEART / VESSELS: An Amplatz ASD occlusion devices seen. No pericardial effusion. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: A simple cyst is seen in the upper pole the right kidney LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Hysterectomy changes are noted. No adnexal mass. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. THORACIC AND LUMBAR SPINE CT: There is a minimally displaced superior endplate anterior wedge compression fracture of L3 with approximately 10% loss of height. No significant retropulsion or spinal canal stenosis. No acute fracture or dislocation of the thoracic spine. Vertebral body hemangiomas are seen in T5 and T6.	Findings: The gray-white matter differentiation is intact. There is no evidence of acute infarct, hemorrhage, mass or mass effect. The ventricular system and extra-axial spaces appear normal. The visualized paranasal sinuses and mastoid air cells are aerated. No calvarial fracture is identified.
2,310	RADIOLOGIC EXAM: CT Cervical Spine From Reformat CLINICAL INFORMATION: Trauma. Pedestrian versus car. COMPARISON: None. TECHNIQUE: CT Cervical Spine From Reformat Following CT of the neck, reformatted images were produced to optimize visualization of the osseous structures of the cervical spine. STRUCTURED REPORT: CT Cervical Spine Trauma FINDINGS: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (	FINDINGS: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (	FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Unremarkable. CHEST: LUNGS / AIRWAYS / PLEURA: The lungs are clear. No pleural effusion or pneumothorax is identified. The central airways are patent. HEART / VESSELS: The heart is normal in size. MEDIASTINUM / ESOPHAGUS: Residual thymic tissue in anterior superior mediastinum. The esophagus appears unremarkable. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No acute displaced rib, clavicle or sternal fracture. ABDOMEN and PELVIS: LIVER: Focal fat along the falciform ligament; no suspicious lesion. BILIARY TRACT: Normal. GALLBLADDER: Unremarkable. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: No hydronephrosis, suspicious mass or laceration. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: The stomach appears unremarkable. The loops of small bowel are normal in caliber. COLON / APPENDIX: No evidence of acute colonic pathology. Appendix appears unremarkable. PERITONEUM / MESENTERY: No free air or free fluid. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Unremarkable. REPRODUCTIVE ORGANS: The uterus is present. BODY WALL: No significant acute abnormality. MUSCULOSKELETAL: No acute pelvic fracture identified. THORACIC SPINE: VERTEBRA: No acute fracture is identified. There is a butterfly vertebra at the T11 level. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: There is partial sacralization of L5 on the right. No acute fracture is identified. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal.
2,311	EXAM: CT Chest with contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat, CT Abdomen and Pelvis w contrast, CT Head wo contrast CLINICAL INFORMATION: Trauma COMPARISON: None. TECHNIQUE: CT Chest with contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat, CT Abdomen and Pelvis w contrast, CT Head wo contrast. Patient weight: 220 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 70sec Scan field of view: 428.10 mm. (accession CT220002771), Patient weight: 220 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 70sec Scan field of view: 428.10 mm. (accession CT220002775), Patient weight: 220 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 70sec Scan field of view: 428.10 mm. (accession CT220002774), Patient weight: 220 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 70sec Scan field of view: 428.10 mm. DLP: 2064 mGy cm. (accession CT220002772) FINDINGS: BRAIN PARENCHYMA111: No hemorrhage, mass effect or edema. There is an empty sella. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No acute fracture. There is postsurgical craniotomy changes to the left occipital region.. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: There is a small mucus retention cyst seen within the left maxillary sinus. There is a small amount of right maxillary sinus mucosal thickening. STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: There is a 3 mm pulmonary nodule in the right upper lobe on image 162, series 502, along the minor fissure, likely a intrapulmonary lymph node. The lungs are otherwise clear. The central airways are patent. No pleural effusion or pneumothorax. HEART / VESSELS: An Amplatz ASD occlusion devices seen. No pericardial effusion. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: A simple cyst is seen in the upper pole the right kidney LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Hysterectomy changes are noted. No adnexal mass. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. THORACIC AND LUMBAR SPINE CT: There is a minimally displaced superior endplate anterior wedge compression fracture of L3 with approximately 10% loss of height. No significant retropulsion or spinal canal stenosis. No acute fracture or dislocation of the thoracic spine. Vertebral body hemangiomas are seen in T5 and T6. CONCLUSION: 1. Acute anterior wedge compression fracture of L3, as described. 2. Otherwise, no acute traumatic injury identified within the chest, abdomen, or pelvis. 3. No acute intracranial process is identified. 4. Additional findings above.	FINDINGS: BRAIN PARENCHYMA111: No hemorrhage, mass effect or edema. There is an empty sella. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No acute fracture. There is postsurgical craniotomy changes to the left occipital region.. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: There is a small mucus retention cyst seen within the left maxillary sinus. There is a small amount of right maxillary sinus mucosal thickening. STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: There is a 3 mm pulmonary nodule in the right upper lobe on image 162, series 502, along the minor fissure, likely a intrapulmonary lymph node. The lungs are otherwise clear. The central airways are patent. No pleural effusion or pneumothorax. HEART / VESSELS: An Amplatz ASD occlusion devices seen. No pericardial effusion. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: A simple cyst is seen in the upper pole the right kidney LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Hysterectomy changes are noted. No adnexal mass. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. THORACIC AND LUMBAR SPINE CT: There is a minimally displaced superior endplate anterior wedge compression fracture of L3 with approximately 10% loss of height. No significant retropulsion or spinal canal stenosis. No acute fracture or dislocation of the thoracic spine. Vertebral body hemangiomas are seen in T5 and T6.	FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Unremarkable. CHEST: LUNGS / AIRWAYS / PLEURA: The lungs are clear. No pleural effusion or pneumothorax is identified. The central airways are patent. HEART / VESSELS: The heart is normal in size. MEDIASTINUM / ESOPHAGUS: Residual thymic tissue in anterior superior mediastinum. The esophagus appears unremarkable. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No acute displaced rib, clavicle or sternal fracture. ABDOMEN and PELVIS: LIVER: Focal fat along the falciform ligament; no suspicious lesion. BILIARY TRACT: Normal. GALLBLADDER: Unremarkable. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: No hydronephrosis, suspicious mass or laceration. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: The stomach appears unremarkable. The loops of small bowel are normal in caliber. COLON / APPENDIX: No evidence of acute colonic pathology. Appendix appears unremarkable. PERITONEUM / MESENTERY: No free air or free fluid. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Unremarkable. REPRODUCTIVE ORGANS: The uterus is present. BODY WALL: No significant acute abnormality. MUSCULOSKELETAL: No acute pelvic fracture identified. THORACIC SPINE: VERTEBRA: No acute fracture is identified. There is a butterfly vertebra at the T11 level. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: There is partial sacralization of L5 on the right. No acute fracture is identified. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal.
2,312	EXAM: CT Chest with contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat, CT Abdomen and Pelvis w contrast, CT Head wo contrast CLINICAL INFORMATION: Trauma COMPARISON: None. TECHNIQUE: CT Chest with contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat, CT Abdomen and Pelvis w contrast, CT Head wo contrast. Patient weight: 220 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 70sec Scan field of view: 428.10 mm. (accession CT220002771), Patient weight: 220 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 70sec Scan field of view: 428.10 mm. (accession CT220002775), Patient weight: 220 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 70sec Scan field of view: 428.10 mm. (accession CT220002774), Patient weight: 220 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 70sec Scan field of view: 428.10 mm. DLP: 2064 mGy cm. (accession CT220002772) FINDINGS: BRAIN PARENCHYMA111: No hemorrhage, mass effect or edema. There is an empty sella. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No acute fracture. There is postsurgical craniotomy changes to the left occipital region.. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: There is a small mucus retention cyst seen within the left maxillary sinus. There is a small amount of right maxillary sinus mucosal thickening. STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: There is a 3 mm pulmonary nodule in the right upper lobe on image 162, series 502, along the minor fissure, likely a intrapulmonary lymph node. The lungs are otherwise clear. The central airways are patent. No pleural effusion or pneumothorax. HEART / VESSELS: An Amplatz ASD occlusion devices seen. No pericardial effusion. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: A simple cyst is seen in the upper pole the right kidney LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Hysterectomy changes are noted. No adnexal mass. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. THORACIC AND LUMBAR SPINE CT: There is a minimally displaced superior endplate anterior wedge compression fracture of L3 with approximately 10% loss of height. No significant retropulsion or spinal canal stenosis. No acute fracture or dislocation of the thoracic spine. Vertebral body hemangiomas are seen in T5 and T6. CONCLUSION: 1. Acute anterior wedge compression fracture of L3, as described. 2. Otherwise, no acute traumatic injury identified within the chest, abdomen, or pelvis. 3. No acute intracranial process is identified. 4. Additional findings above.	FINDINGS: BRAIN PARENCHYMA111: No hemorrhage, mass effect or edema. There is an empty sella. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No acute fracture. There is postsurgical craniotomy changes to the left occipital region.. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: There is a small mucus retention cyst seen within the left maxillary sinus. There is a small amount of right maxillary sinus mucosal thickening. STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: There is a 3 mm pulmonary nodule in the right upper lobe on image 162, series 502, along the minor fissure, likely a intrapulmonary lymph node. The lungs are otherwise clear. The central airways are patent. No pleural effusion or pneumothorax. HEART / VESSELS: An Amplatz ASD occlusion devices seen. No pericardial effusion. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: A simple cyst is seen in the upper pole the right kidney LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Hysterectomy changes are noted. No adnexal mass. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. THORACIC AND LUMBAR SPINE CT: There is a minimally displaced superior endplate anterior wedge compression fracture of L3 with approximately 10% loss of height. No significant retropulsion or spinal canal stenosis. No acute fracture or dislocation of the thoracic spine. Vertebral body hemangiomas are seen in T5 and T6.	FINDINGS: CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
2,313	RADIOLOGIC EXAM: CT Angio Neck CLINICAL INFORMATION: Trauma. COMPARISON: None. TECHNIQUE: CT Angio Neck 3-D CT MIP and Volume rendered angiographic images were generated in post processing. Patient weight: 220 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 273.60 mm. DLP: 891.10 mGy cm. STRUCTURED REPORT: CT Angiogram Neck FINDINGS: AORTIC ARCH and PROXIMAL GREAT VESSELS: Unremarkable. RIGHT CAROTID: There is no evidence of irregularity, narrowing, occlusion or flap to indicate acute arterial injury or dissection. There is fetal communication with the right PCA incidentally noted. LEFT CAROTID: There is no evidence of irregularity, narrowing, occlusion or flap to indicate acute arterial injury or dissection. RIGHT VERTEBRAL ARTERY: There is no evidence of irregularity, narrowing, occlusion or flap to indicate acute arterial injury or dissection. LEFT VERTEBRAL ARTERY: There is no evidence of irregularity, narrowing, occlusion or flap to indicate acute arterial injury or dissection. No contrast extravasation or pseudoaneurysm is identified. There are shotty bilateral jugular chain nodes. CONCLUSION: No acute abnormality within the cervical vasculature. No definite evidence of arterial injury or dissection.	FINDINGS: AORTIC ARCH and PROXIMAL GREAT VESSELS: Unremarkable. RIGHT CAROTID: There is no evidence of irregularity, narrowing, occlusion or flap to indicate acute arterial injury or dissection. There is fetal communication with the right PCA incidentally noted. LEFT CAROTID: There is no evidence of irregularity, narrowing, occlusion or flap to indicate acute arterial injury or dissection. RIGHT VERTEBRAL ARTERY: There is no evidence of irregularity, narrowing, occlusion or flap to indicate acute arterial injury or dissection. LEFT VERTEBRAL ARTERY: There is no evidence of irregularity, narrowing, occlusion or flap to indicate acute arterial injury or dissection. No contrast extravasation or pseudoaneurysm is identified. There are shotty bilateral jugular chain nodes.	FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Unremarkable. CHEST: LUNGS / AIRWAYS / PLEURA: The lungs are clear. No pleural effusion or pneumothorax is identified. The central airways are patent. HEART / VESSELS: The heart is normal in size. MEDIASTINUM / ESOPHAGUS: Residual thymic tissue in anterior superior mediastinum. The esophagus appears unremarkable. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No acute displaced rib, clavicle or sternal fracture. ABDOMEN and PELVIS: LIVER: Focal fat along the falciform ligament; no suspicious lesion. BILIARY TRACT: Normal. GALLBLADDER: Unremarkable. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: No hydronephrosis, suspicious mass or laceration. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: The stomach appears unremarkable. The loops of small bowel are normal in caliber. COLON / APPENDIX: No evidence of acute colonic pathology. Appendix appears unremarkable. PERITONEUM / MESENTERY: No free air or free fluid. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Unremarkable. REPRODUCTIVE ORGANS: The uterus is present. BODY WALL: No significant acute abnormality. MUSCULOSKELETAL: No acute pelvic fracture identified. THORACIC SPINE: VERTEBRA: No acute fracture is identified. There is a butterfly vertebra at the T11 level. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: There is partial sacralization of L5 on the right. No acute fracture is identified. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal.
2,314	EXAM: CT Chest High Resolution wo contrast CLINICAL INFORMATION: 43-year-old female with provided history of cough and shortness of breath. COMPARISON: Chest CT 5/12/2018 TECHNIQUE: CT Chest High Resolution wo contrast. Scan field of view: 350 mm. DLP: 667 mGy cm. High-resolution CT imaging of the chest was performed per protocol with inspiratory and expiratory technique in prone position. FINDINGS: Limitations: None. Chest: Lines, tubes, and devices: None. Lung parenchyma and pleura: Mild upper lobe predominant mixed emphysema with mild diffuse bronchial wall thickening. Hazy opacity in the posterior right lower lobe (image 118, series 3), likely atelectasis. Few small (less than six) pulmonary nodules are unchanged, for example a 3 mm right middle lobe nodules at image 94, series 3. No focal consolidation. The trachea and main bronchi are patent. No pleural effusion. Expiratory images demonstrate multifocal areas of air trapping bilaterally. No evidence of tracheobronchomalacia. Thoracic inlet, heart, and mediastinum: No lymphadenopathy in the axillary, mediastinal, or hilar regions. The esophagus is nondilated. The thoracic aorta and main pulmonary artery are normal in caliber. The cardiac chambers are normal in size. No coronary artery atherosclerotic calcifications are noted, although the study is not optimized for coronary assessment. No pericardial effusion. Bones and soft tissues: No destructive bone lesion. Chest wall is unremarkable. Upper abdomen: No abnormality in the imaged upper abdomen. CONCLUSION: 1. Multifocal areas of air trapping bilaterally with mild diffuse bronchial wall thickening, likely related to small airway disease. 2. Mild emphysema. Unchanged few small pulmonary nodules.	FINDINGS: Limitations: None. Chest: Lines, tubes, and devices: None. Lung parenchyma and pleura: Mild upper lobe predominant mixed emphysema with mild diffuse bronchial wall thickening. Hazy opacity in the posterior right lower lobe (image 118, series 3), likely atelectasis. Few small (less than six) pulmonary nodules are unchanged, for example a 3 mm right middle lobe nodules at image 94, series 3. No focal consolidation. The trachea and main bronchi are patent. No pleural effusion. Expiratory images demonstrate multifocal areas of air trapping bilaterally. No evidence of tracheobronchomalacia. Thoracic inlet, heart, and mediastinum: No lymphadenopathy in the axillary, mediastinal, or hilar regions. The esophagus is nondilated. The thoracic aorta and main pulmonary artery are normal in caliber. The cardiac chambers are normal in size. No coronary artery atherosclerotic calcifications are noted, although the study is not optimized for coronary assessment. No pericardial effusion. Bones and soft tissues: No destructive bone lesion. Chest wall is unremarkable. Upper abdomen: No abnormality in the imaged upper abdomen.	FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Unremarkable. CHEST: LUNGS / AIRWAYS / PLEURA: The lungs are clear. No pleural effusion or pneumothorax is identified. The central airways are patent. HEART / VESSELS: The heart is normal in size. MEDIASTINUM / ESOPHAGUS: Residual thymic tissue in anterior superior mediastinum. The esophagus appears unremarkable. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No acute displaced rib, clavicle or sternal fracture. ABDOMEN and PELVIS: LIVER: Focal fat along the falciform ligament; no suspicious lesion. BILIARY TRACT: Normal. GALLBLADDER: Unremarkable. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: No hydronephrosis, suspicious mass or laceration. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: The stomach appears unremarkable. The loops of small bowel are normal in caliber. COLON / APPENDIX: No evidence of acute colonic pathology. Appendix appears unremarkable. PERITONEUM / MESENTERY: No free air or free fluid. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Unremarkable. REPRODUCTIVE ORGANS: The uterus is present. BODY WALL: No significant acute abnormality. MUSCULOSKELETAL: No acute pelvic fracture identified. THORACIC SPINE: VERTEBRA: No acute fracture is identified. There is a butterfly vertebra at the T11 level. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: There is partial sacralization of L5 on the right. No acute fracture is identified. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal.
2,315	EXAM: CT Chest wo contrast CLINICAL INFORMATION: Status post surgery or and RT for nasolabial squamous cell carcinoma with PA and evaluate for metastatic disease COMPARISON: None. TECHNIQUE: CT Chest wo contrast. Scan field of view: 350 mm. DLP: 271 mGy cm. FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. Small calcified nodes are seen in the mediastinum. No enlarged intrathoracic lymph nodes are identified. Small hiatal hernia is seen. Minimal coronary artery calcification is seen. The ascending aorta is mildly ectatic at 41 mm. Within the limits of a noncontrast exam the heart size and the mediastinum are otherwise normal. No pleural effusion. Mild bilateral bronchial wall thickening is present but the remainder the lungs are clear. Contrast is seen in the right renal collecting system from MRI of the face earlier this date. Limited exam of the upper abdomen is otherwise unremarkable. No focal destructive osseous lesion. CONCLUSION: 1. Previous granulomatous disease. No metastatic disease identified. 2. Mild bronchial wall thickening suggesting airway disease. 3. Mild ectasia of the ascending aorta.	FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. Small calcified nodes are seen in the mediastinum. No enlarged intrathoracic lymph nodes are identified. Small hiatal hernia is seen. Minimal coronary artery calcification is seen. The ascending aorta is mildly ectatic at 41 mm. Within the limits of a noncontrast exam the heart size and the mediastinum are otherwise normal. No pleural effusion. Mild bilateral bronchial wall thickening is present but the remainder the lungs are clear. Contrast is seen in the right renal collecting system from MRI of the face earlier this date. Limited exam of the upper abdomen is otherwise unremarkable. No focal destructive osseous lesion.	FINDINGS: CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
2,316	EXAM: CT Chest with contrast CLINICAL INFORMATION: 54-year-old female status post abscess drainage of the right axilla. COMPARISON: Ultrasound of the right upper extremity dated 1/5/2022. TECHNIQUE: CT Chest with contrast. Patient weight: 142 lbs. IV contrast: Omnipaque 350, 100 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 35 sec Scan field of view: 415 mm. DLP: 176.20 mGy cm. FINDINGS: STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Normal. HEART / VESSELS: Trace pericardial effusion. No central pulmonary embolism. Heart is normal in size. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: Prominent right axillary lymph nodes are likely reactive. CHEST WALL: Intact bilateral breast implants. UPPER ABDOMEN: Hepatic steatosis. MUSCULOSKELETAL: Stranding and postsurgical changes of the right axilla are seen without drainable fluid collection seen. CONCLUSION: Postprocedural changes of right axillary fluid collection drainage. No residual drainable fluid collection identified. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.	FINDINGS: STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Normal. HEART / VESSELS: Trace pericardial effusion. No central pulmonary embolism. Heart is normal in size. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: Prominent right axillary lymph nodes are likely reactive. CHEST WALL: Intact bilateral breast implants. UPPER ABDOMEN: Hepatic steatosis. MUSCULOSKELETAL: Stranding and postsurgical changes of the right axilla are seen without drainable fluid collection seen.	FINDINGS: STRUCTURED REPORT: CT PE OVERALL DIAGNOSTIC QUALITY: Slightly degraded by motion. LOWER NECK: Left PICC terminates at the cavoatrial junction. CHEST: PULMONARY ARTERIES: Negative for pulmonary embolus LUNGS / AIRWAYS / PLEURA: There are patchy peripheral alveolar opacities concerning for atypical pneumonia bilaterally. These are more prominent at the lung bases where partial collapse is also observed. Tree-in-bud appearance is more evident at the right upper lobe, right middle lobe and lingula. HEART / OTHER VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Normal. MUSCULOSKELETAL: Interval development of T12 superior endplate fracture with associated to T11-T12 vacuum disc phenomenon. Sclerosis is seen involving the superior endplate. There is no significant height loss of the middle column. This is concerning for interval development fracture may be associated to patient's CML diagnosis.
2,317	EXAM: CT Shoulder Right with contrast CLINICAL INFORMATION: S/P right axilla abscess drainage. COMPARISON: None. TECHNIQUE: CT Shoulder Right with contrast Patient weight: 142 lbs. IV contrast: Omnipaque 350, 100 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 210 sec Scan field of view: 250 mm. DLP: 382.10 mGy cm. STRUCTURED REPORT: CT Bone vDec2021 FINDINGS: BONES/JOINTS: No acute fracture or malalignment. No signs of osteomyelitis. SOFT TISSUES: Fat stranding and subcutaneous emphysema within the right axilla without discrete rim-enhancing fluid collection. Reactive lymphadenopathy within the axilla. CONCLUSION: Postprocedural changes from right axillary fluid collection drainage without residual collection. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.	FINDINGS: BONES/JOINTS: No acute fracture or malalignment. No signs of osteomyelitis. SOFT TISSUES: Fat stranding and subcutaneous emphysema within the right axilla without discrete rim-enhancing fluid collection. Reactive lymphadenopathy within the axilla.	FINDINGS: Aortic arch: Patent without flow-limiting stenosis. Normal three vessel aortic arch is noted. Right carotid: Fibrofatty plaques and atherosclerotic calcifications are noted resulting in mild luminal narrowing of the proximal right ICA. Otherwise, remains patent without flow-limiting stenosis. Left carotid: Nonflow limiting atherosclerotic calcifications of the left carotid bifurcation and proximal left ICA. Patent without flow-limiting stenosis. Right vertebral artery: Multilevel uncovertebral and facet hypertrophy, resulting in multifocal luminal narrowing of the right vertebral artery, moderate at C3-C4 and C4-C5. Otherwise, remains patent without flow-limiting stenosis. Left vertebral artery: Patent without flow-limiting stenosis. Codominant vertebral arteries. Intracranial arteries: Atherosclerotic calcifications of the bilateral cavernous and supraclinoid ICAs, resulting in mild supraclinoid luminal narrowing respectively. Hypoplastic right A1 segment. The bilateral ACAs, MCAs and PCAs appear patent, without flow-limiting stenoses or discrete aneurysms. The vertebrobasilar axis is mildly tortuous, without flow-limiting stenoses. NONVASCULAR FINDINGS: Please refer to concomitant CT of the head for complete description of intracranial findings. The oral cavity, nasopharynx, oropharynx, and laryngopharynx have normal appearance. No intrinsic abnormality is seen within the larynx or trachea. The true and false vocal cords are without focal abnormality. The superficial soft tissues of the neck have a normal appearance with no enhancing lesion identified. No enlarged lymph nodes are seen. The parotid and submandibular glands are normal in appearance. The thyroid gland is without focal abnormality. Partially visualized emphysematous changes in the lung apices. Chronic multilevel degenerative changes of cervical spine, with mild retrolisthesis of C3 on C4 and C4 on C5. Multilevel intervertebral disc space loss, endplate sclerosis, osteophytosis and subchondral cysts, severe at C3-C4, C4-C5, C6-C7, and moderate at C5-C6 and C7-T1.
2,318	RADIOLOGIC EXAM: CT Head wo contrast, CT Cervical Spine From Reformat, CT Angio Neck CLINICAL INFORMATION: Trauma. COMPARISON: None. TECHNIQUE: Additional 3D image post-processing was performed to generate MIP and/or volume-rendered images. CT Head wo contrast, CT Cervical Spine From Reformat, CT Angio NeckScan field of view: 215 mm. DLP: 1442.40 mGy cm. (accession CT220002782), Patient weight: 200 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 253.50 mm. DLP: 991.90 mGy cm. (accession CT220002789), Scan field of view: 215 mm. DLP: 1442.40 mGy cm. (accession CT220002785) FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal. AORTIC ARCH and PROXIMAL GREAT VESSELS: Unremarkable. RIGHT CAROTID: There is no evidence of irregularity, narrowing, occlusion or flap to indicate acute arterial injury or dissection. LEFT CAROTID: There is no evidence of irregularity, narrowing, occlusion or flap to indicate acute arterial injury or dissection. RIGHT VERTEBRAL ARTERY: There is no evidence of irregularity, narrowing, occlusion or flap to indicate acute arterial injury or dissection. LEFT VERTEBRAL ARTERY: There is no evidence of irregularity, narrowing, occlusion or flap to indicate acute arterial injury or dissection. No contrast extravasation or pseudoaneurysm is identified. FINDINGS: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (	FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal. AORTIC ARCH and PROXIMAL GREAT VESSELS: Unremarkable. RIGHT CAROTID: There is no evidence of irregularity, narrowing, occlusion or flap to indicate acute arterial injury or dissection. LEFT CAROTID: There is no evidence of irregularity, narrowing, occlusion or flap to indicate acute arterial injury or dissection. RIGHT VERTEBRAL ARTERY: There is no evidence of irregularity, narrowing, occlusion or flap to indicate acute arterial injury or dissection. LEFT VERTEBRAL ARTERY: There is no evidence of irregularity, narrowing, occlusion or flap to indicate acute arterial injury or dissection. No contrast extravasation or pseudoaneurysm is identified. FINDINGS: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (	FINDINGS: Aortic arch: Patent without flow-limiting stenosis. Normal three vessel aortic arch is noted. Right carotid: Fibrofatty plaques and atherosclerotic calcifications are noted resulting in mild luminal narrowing of the proximal right ICA. Otherwise, remains patent without flow-limiting stenosis. Left carotid: Nonflow limiting atherosclerotic calcifications of the left carotid bifurcation and proximal left ICA. Patent without flow-limiting stenosis. Right vertebral artery: Multilevel uncovertebral and facet hypertrophy, resulting in multifocal luminal narrowing of the right vertebral artery, moderate at C3-C4 and C4-C5. Otherwise, remains patent without flow-limiting stenosis. Left vertebral artery: Patent without flow-limiting stenosis. Codominant vertebral arteries. Intracranial arteries: Atherosclerotic calcifications of the bilateral cavernous and supraclinoid ICAs, resulting in mild supraclinoid luminal narrowing respectively. Hypoplastic right A1 segment. The bilateral ACAs, MCAs and PCAs appear patent, without flow-limiting stenoses or discrete aneurysms. The vertebrobasilar axis is mildly tortuous, without flow-limiting stenoses. NONVASCULAR FINDINGS: Please refer to concomitant CT of the head for complete description of intracranial findings. The oral cavity, nasopharynx, oropharynx, and laryngopharynx have normal appearance. No intrinsic abnormality is seen within the larynx or trachea. The true and false vocal cords are without focal abnormality. The superficial soft tissues of the neck have a normal appearance with no enhancing lesion identified. No enlarged lymph nodes are seen. The parotid and submandibular glands are normal in appearance. The thyroid gland is without focal abnormality. Partially visualized emphysematous changes in the lung apices. Chronic multilevel degenerative changes of cervical spine, with mild retrolisthesis of C3 on C4 and C4 on C5. Multilevel intervertebral disc space loss, endplate sclerosis, osteophytosis and subchondral cysts, severe at C3-C4, C4-C5, C6-C7, and moderate at C5-C6 and C7-T1.
2,319	EXAM: CT Abdomen and Pelvis w contrast, CT Chest with contrast, CT Thoracic Spine from Reformat, CT Lumbar Spine from Reformat CLINICAL INFORMATION: Trauma. COMPARISON: None. TECHNIQUE: CT Abdomen and Pelvis w contrast, CT Chest with contrast, CT Thoracic Spine from Reformat, CT Lumbar Spine from Reformat. Patient weight: 200 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 70sec Scan field of view: 435.40 mm. DLP: 1348 mGy cm. (accession CT220002784), Patient weight: 200 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 70sec Scan field of view: 435.40 mm. (accession CT220002783) FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Dependent atelectasis. There is trace pneumothorax on the left with adjacent subtle pulmonary contusive changes in the lingula. There are subtle pulmonary contusive changes in the anterior medial right upper lobe. No effusion evident. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Trace retrosternal hemorrhage in the setting of sternal fracture. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: Minimally displaced mildly comminuted sternal body fracture with small associated retrosternal hematoma. Posterior left 12th rib fracture. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Gastric contents distending the stomach. Small bowel is unremarkable. COLON / APPENDIX: Colon is unremarkable. The appendix is not well visualized. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Decompressed. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Tiny fat-containing umbilical hernia. MUSCULOSKELETAL: The T12 burst fracture and mild bony retropulsion. Subtle fracture extension into the posterior elements and distraction of the spinous processes of T11-T12. Subtle inferior endplate depression at T11. Sternal body fracture, mildly comminuted. THORACIC \T\ LUMBAR SPINE: VERTEBRA: T12 complete burst fracture with approximately 30% height loss extending posteriorly into the pedicles and involving the lamina. There is approximately 7 mm of retropulsion with the posterior fracture fragment contacting the cord and producing spinal canal stenosis, mild to moderate. There is interspinous widening at T11-T12. Very minimal endplate depression superiorly at T11. Remaining thoracic vertebral bodies appear maintained in height. The lumbar vertebral bodies appear maintained in height. No acute fracture is evident in the lumbar spine. DISC SPACES AND FACET JOINTS: Subtle fracture extension into the anterior articular facet base on the left and right at T12 with interspinous widening of T11-T12. PREVERTEBRAL SOFT TISSUES: Small hematoma surrounding the burst fracture of T12. ALIGNMENT: Slight anterolisthesis of T11 on T12. The remainder of posterior vertebral alignment is maintained. CONCLUSION: 1. Burst T12 fracture with retropulsed fragment contacting the anterior spinal cord resulting in mild to moderate spinal canal narrowing. There is fracture extension into the posterior elements and interspinous widening at T11-T12 compatible with a chance type fracture equivalent and interspinous ligament disruption is suspected. 2. Comminuted sternal body fracture with small associated retrosternal hematoma. There is trace left pneumothorax and there are subtle bilateral pulmonary contusions. 3. Left posterior 12th rib fracture. 4. No acute fracture or malalignment of the lumbar spine. Other incidental findings as above. Note: Findings were discussed with Dr. Joshua Day by Dr. Guidry at 1/5/2022 4:58 PM. Updated findings called to Dr. Joshua Day by Dr. Spann at 5:45 PM January 5, 2022. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.	FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Dependent atelectasis. There is trace pneumothorax on the left with adjacent subtle pulmonary contusive changes in the lingula. There are subtle pulmonary contusive changes in the anterior medial right upper lobe. No effusion evident. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Trace retrosternal hemorrhage in the setting of sternal fracture. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: Minimally displaced mildly comminuted sternal body fracture with small associated retrosternal hematoma. Posterior left 12th rib fracture. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Gastric contents distending the stomach. Small bowel is unremarkable. COLON / APPENDIX: Colon is unremarkable. The appendix is not well visualized. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Decompressed. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Tiny fat-containing umbilical hernia. MUSCULOSKELETAL: The T12 burst fracture and mild bony retropulsion. Subtle fracture extension into the posterior elements and distraction of the spinous processes of T11-T12. Subtle inferior endplate depression at T11. Sternal body fracture, mildly comminuted. THORACIC \T\ LUMBAR SPINE: VERTEBRA: T12 complete burst fracture with approximately 30% height loss extending posteriorly into the pedicles and involving the lamina. There is approximately 7 mm of retropulsion with the posterior fracture fragment contacting the cord and producing spinal canal stenosis, mild to moderate. There is interspinous widening at T11-T12. Very minimal endplate depression superiorly at T11. Remaining thoracic vertebral bodies appear maintained in height. The lumbar vertebral bodies appear maintained in height. No acute fracture is evident in the lumbar spine. DISC SPACES AND FACET JOINTS: Subtle fracture extension into the anterior articular facet base on the left and right at T12 with interspinous widening of T11-T12. PREVERTEBRAL SOFT TISSUES: Small hematoma surrounding the burst fracture of T12. ALIGNMENT: Slight anterolisthesis of T11 on T12. The remainder of posterior vertebral alignment is maintained.	Findings: Unchanged diffuse brain parenchymal volume loss, resulting in and ex vacuo dilatation of the ventricular system. Confluent periventricular, deep and subcortical white matter hypoattenuation is stable, suggestive of severe chronic microangiopathic changes. Small unchanged bilateral occipital encephalomalacia and remote lacunar infarcts in the cerebellum and left subinsular cortex. No acute intracranial hemorrhage, mass effect, or midline shift. No abnormal extra-axial fluid collection. Persistent dense atherosclerotic calcifications of the bilateral carotid siphons. Orbits are unremarkable. Visualized paranasal sinuses and mastoid air cells are clear. No acute osseous or soft tissue abnormality.
2,320	EXAM: CT Abdomen and Pelvis w contrast, CT Chest with contrast, CT Thoracic Spine from Reformat, CT Lumbar Spine from Reformat CLINICAL INFORMATION: Trauma. COMPARISON: None. TECHNIQUE: CT Abdomen and Pelvis w contrast, CT Chest with contrast, CT Thoracic Spine from Reformat, CT Lumbar Spine from Reformat. Patient weight: 200 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 70sec Scan field of view: 435.40 mm. DLP: 1348 mGy cm. (accession CT220002784), Patient weight: 200 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 70sec Scan field of view: 435.40 mm. (accession CT220002783) FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Dependent atelectasis. There is trace pneumothorax on the left with adjacent subtle pulmonary contusive changes in the lingula. There are subtle pulmonary contusive changes in the anterior medial right upper lobe. No effusion evident. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Trace retrosternal hemorrhage in the setting of sternal fracture. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: Minimally displaced mildly comminuted sternal body fracture with small associated retrosternal hematoma. Posterior left 12th rib fracture. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Gastric contents distending the stomach. Small bowel is unremarkable. COLON / APPENDIX: Colon is unremarkable. The appendix is not well visualized. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Decompressed. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Tiny fat-containing umbilical hernia. MUSCULOSKELETAL: The T12 burst fracture and mild bony retropulsion. Subtle fracture extension into the posterior elements and distraction of the spinous processes of T11-T12. Subtle inferior endplate depression at T11. Sternal body fracture, mildly comminuted. THORACIC \T\ LUMBAR SPINE: VERTEBRA: T12 complete burst fracture with approximately 30% height loss extending posteriorly into the pedicles and involving the lamina. There is approximately 7 mm of retropulsion with the posterior fracture fragment contacting the cord and producing spinal canal stenosis, mild to moderate. There is interspinous widening at T11-T12. Very minimal endplate depression superiorly at T11. Remaining thoracic vertebral bodies appear maintained in height. The lumbar vertebral bodies appear maintained in height. No acute fracture is evident in the lumbar spine. DISC SPACES AND FACET JOINTS: Subtle fracture extension into the anterior articular facet base on the left and right at T12 with interspinous widening of T11-T12. PREVERTEBRAL SOFT TISSUES: Small hematoma surrounding the burst fracture of T12. ALIGNMENT: Slight anterolisthesis of T11 on T12. The remainder of posterior vertebral alignment is maintained. CONCLUSION: 1. Burst T12 fracture with retropulsed fragment contacting the anterior spinal cord resulting in mild to moderate spinal canal narrowing. There is fracture extension into the posterior elements and interspinous widening at T11-T12 compatible with a chance type fracture equivalent and interspinous ligament disruption is suspected. 2. Comminuted sternal body fracture with small associated retrosternal hematoma. There is trace left pneumothorax and there are subtle bilateral pulmonary contusions. 3. Left posterior 12th rib fracture. 4. No acute fracture or malalignment of the lumbar spine. Other incidental findings as above. Note: Findings were discussed with Dr. Joshua Day by Dr. Guidry at 1/5/2022 4:58 PM. Updated findings called to Dr. Joshua Day by Dr. Spann at 5:45 PM January 5, 2022. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.	FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Dependent atelectasis. There is trace pneumothorax on the left with adjacent subtle pulmonary contusive changes in the lingula. There are subtle pulmonary contusive changes in the anterior medial right upper lobe. No effusion evident. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Trace retrosternal hemorrhage in the setting of sternal fracture. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: Minimally displaced mildly comminuted sternal body fracture with small associated retrosternal hematoma. Posterior left 12th rib fracture. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Gastric contents distending the stomach. Small bowel is unremarkable. COLON / APPENDIX: Colon is unremarkable. The appendix is not well visualized. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Decompressed. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Tiny fat-containing umbilical hernia. MUSCULOSKELETAL: The T12 burst fracture and mild bony retropulsion. Subtle fracture extension into the posterior elements and distraction of the spinous processes of T11-T12. Subtle inferior endplate depression at T11. Sternal body fracture, mildly comminuted. THORACIC \T\ LUMBAR SPINE: VERTEBRA: T12 complete burst fracture with approximately 30% height loss extending posteriorly into the pedicles and involving the lamina. There is approximately 7 mm of retropulsion with the posterior fracture fragment contacting the cord and producing spinal canal stenosis, mild to moderate. There is interspinous widening at T11-T12. Very minimal endplate depression superiorly at T11. Remaining thoracic vertebral bodies appear maintained in height. The lumbar vertebral bodies appear maintained in height. No acute fracture is evident in the lumbar spine. DISC SPACES AND FACET JOINTS: Subtle fracture extension into the anterior articular facet base on the left and right at T12 with interspinous widening of T11-T12. PREVERTEBRAL SOFT TISSUES: Small hematoma surrounding the burst fracture of T12. ALIGNMENT: Slight anterolisthesis of T11 on T12. The remainder of posterior vertebral alignment is maintained.	A CT perfusion study was performed during single pass of 50 cc contrast bolus. Axial images were acquired at 8 axial locations and time-attenuation curves generated from this dataset were utilized to calculate cerebral blood flow, mean transit time, time to peak, and cerebral blood volume maps as well as region of interest specific quantitative data. "Prognostic" color maps were also generated depicting areas of ischemia (voxel values for MTT > 1.4 times mirror image voxels on the contralateral "normal side") in the color green and areas predictive of infarction (CBV values 6.0s volume of 80 mL, giving a mismatch volume of 75 mL.
2,321	RADIOLOGIC EXAM: CT Head wo contrast, CT Cervical Spine From Reformat, CT Angio Neck CLINICAL INFORMATION: Trauma. COMPARISON: None. TECHNIQUE: Additional 3D image post-processing was performed to generate MIP and/or volume-rendered images. CT Head wo contrast, CT Cervical Spine From Reformat, CT Angio NeckScan field of view: 215 mm. DLP: 1442.40 mGy cm. (accession CT220002782), Patient weight: 200 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 253.50 mm. DLP: 991.90 mGy cm. (accession CT220002789), Scan field of view: 215 mm. DLP: 1442.40 mGy cm. (accession CT220002785) FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal. AORTIC ARCH and PROXIMAL GREAT VESSELS: Unremarkable. RIGHT CAROTID: There is no evidence of irregularity, narrowing, occlusion or flap to indicate acute arterial injury or dissection. LEFT CAROTID: There is no evidence of irregularity, narrowing, occlusion or flap to indicate acute arterial injury or dissection. RIGHT VERTEBRAL ARTERY: There is no evidence of irregularity, narrowing, occlusion or flap to indicate acute arterial injury or dissection. LEFT VERTEBRAL ARTERY: There is no evidence of irregularity, narrowing, occlusion or flap to indicate acute arterial injury or dissection. No contrast extravasation or pseudoaneurysm is identified. FINDINGS: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (	FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal. AORTIC ARCH and PROXIMAL GREAT VESSELS: Unremarkable. RIGHT CAROTID: There is no evidence of irregularity, narrowing, occlusion or flap to indicate acute arterial injury or dissection. LEFT CAROTID: There is no evidence of irregularity, narrowing, occlusion or flap to indicate acute arterial injury or dissection. RIGHT VERTEBRAL ARTERY: There is no evidence of irregularity, narrowing, occlusion or flap to indicate acute arterial injury or dissection. LEFT VERTEBRAL ARTERY: There is no evidence of irregularity, narrowing, occlusion or flap to indicate acute arterial injury or dissection. No contrast extravasation or pseudoaneurysm is identified. FINDINGS: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (	FINDINGS: BRAIN PARENCHYMA: No intraparenchymal hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. Cerebral cortical volume is appropriate for patient's age. EXTRA-AXIAL SPACES: No epidural, subdural, or subarachnoid hemorrhage. SKULL AND SKULL BASE: No acute fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Layering fluid within the bilateral sphenoid sinuses. MASTOIDS: Clear. SOFT TISSUES: Unremarkable.
2,322	EXAM: CT Abdomen and Pelvis w contrast, CT Chest with contrast, CT Thoracic Spine from Reformat, CT Lumbar Spine from Reformat CLINICAL INFORMATION: Trauma. COMPARISON: None. TECHNIQUE: CT Abdomen and Pelvis w contrast, CT Chest with contrast, CT Thoracic Spine from Reformat, CT Lumbar Spine from Reformat. Patient weight: 200 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 70sec Scan field of view: 435.40 mm. DLP: 1348 mGy cm. (accession CT220002784), Patient weight: 200 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 70sec Scan field of view: 435.40 mm. (accession CT220002783) FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Dependent atelectasis. There is trace pneumothorax on the left with adjacent subtle pulmonary contusive changes in the lingula. There are subtle pulmonary contusive changes in the anterior medial right upper lobe. No effusion evident. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Trace retrosternal hemorrhage in the setting of sternal fracture. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: Minimally displaced mildly comminuted sternal body fracture with small associated retrosternal hematoma. Posterior left 12th rib fracture. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Gastric contents distending the stomach. Small bowel is unremarkable. COLON / APPENDIX: Colon is unremarkable. The appendix is not well visualized. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Decompressed. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Tiny fat-containing umbilical hernia. MUSCULOSKELETAL: The T12 burst fracture and mild bony retropulsion. Subtle fracture extension into the posterior elements and distraction of the spinous processes of T11-T12. Subtle inferior endplate depression at T11. Sternal body fracture, mildly comminuted. THORACIC \T\ LUMBAR SPINE: VERTEBRA: T12 complete burst fracture with approximately 30% height loss extending posteriorly into the pedicles and involving the lamina. There is approximately 7 mm of retropulsion with the posterior fracture fragment contacting the cord and producing spinal canal stenosis, mild to moderate. There is interspinous widening at T11-T12. Very minimal endplate depression superiorly at T11. Remaining thoracic vertebral bodies appear maintained in height. The lumbar vertebral bodies appear maintained in height. No acute fracture is evident in the lumbar spine. DISC SPACES AND FACET JOINTS: Subtle fracture extension into the anterior articular facet base on the left and right at T12 with interspinous widening of T11-T12. PREVERTEBRAL SOFT TISSUES: Small hematoma surrounding the burst fracture of T12. ALIGNMENT: Slight anterolisthesis of T11 on T12. The remainder of posterior vertebral alignment is maintained. CONCLUSION: 1. Burst T12 fracture with retropulsed fragment contacting the anterior spinal cord resulting in mild to moderate spinal canal narrowing. There is fracture extension into the posterior elements and interspinous widening at T11-T12 compatible with a chance type fracture equivalent and interspinous ligament disruption is suspected. 2. Comminuted sternal body fracture with small associated retrosternal hematoma. There is trace left pneumothorax and there are subtle bilateral pulmonary contusions. 3. Left posterior 12th rib fracture. 4. No acute fracture or malalignment of the lumbar spine. Other incidental findings as above. Note: Findings were discussed with Dr. Joshua Day by Dr. Guidry at 1/5/2022 4:58 PM. Updated findings called to Dr. Joshua Day by Dr. Spann at 5:45 PM January 5, 2022. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.	FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Dependent atelectasis. There is trace pneumothorax on the left with adjacent subtle pulmonary contusive changes in the lingula. There are subtle pulmonary contusive changes in the anterior medial right upper lobe. No effusion evident. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Trace retrosternal hemorrhage in the setting of sternal fracture. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: Minimally displaced mildly comminuted sternal body fracture with small associated retrosternal hematoma. Posterior left 12th rib fracture. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Gastric contents distending the stomach. Small bowel is unremarkable. COLON / APPENDIX: Colon is unremarkable. The appendix is not well visualized. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Decompressed. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Tiny fat-containing umbilical hernia. MUSCULOSKELETAL: The T12 burst fracture and mild bony retropulsion. Subtle fracture extension into the posterior elements and distraction of the spinous processes of T11-T12. Subtle inferior endplate depression at T11. Sternal body fracture, mildly comminuted. THORACIC \T\ LUMBAR SPINE: VERTEBRA: T12 complete burst fracture with approximately 30% height loss extending posteriorly into the pedicles and involving the lamina. There is approximately 7 mm of retropulsion with the posterior fracture fragment contacting the cord and producing spinal canal stenosis, mild to moderate. There is interspinous widening at T11-T12. Very minimal endplate depression superiorly at T11. Remaining thoracic vertebral bodies appear maintained in height. The lumbar vertebral bodies appear maintained in height. No acute fracture is evident in the lumbar spine. DISC SPACES AND FACET JOINTS: Subtle fracture extension into the anterior articular facet base on the left and right at T12 with interspinous widening of T11-T12. PREVERTEBRAL SOFT TISSUES: Small hematoma surrounding the burst fracture of T12. ALIGNMENT: Slight anterolisthesis of T11 on T12. The remainder of posterior vertebral alignment is maintained.	FINDINGS: STRUCTURED REPORT: CTA CAP VASCULATURE: CORONARY ARTERIES: There are mild atherosclerotic calcifications of the native coronary arteries. PULMONARY ARTERIES: No central pulmonary embolus. Normal size. ASCENDING THORACIC AORTA/AORTIC ARCH: Similar postsurgical changes of the ascending aorta and hemiarch replacement. Unchanged ulceration of the anterior neointima within the proximal graft measuring up to 12 mm (image 89 series 602). Unchanged posterior ulceration into the neointima measuring 5 x 9 mm (image 81 series 602). No evidence of pseudoaneurysm or endoleak. ARCH VESSELS: Common origin of the right brachiocephalic and left subclavian arteries. DESCENDING THORACIC AORTA: No significant abnormality. ABDOMINAL AORTA: No significant abnormality. Mild scattered atherosclerotic calcifications. CELIAC AXIS: No significant abnormality. SMA: No significant abnormality. RIGHT RENAL: No significant abnormality. LEFT RENAL: No significant abnormality. IMA: No significant abnormality. RIGHT ILIAC / PROXIMAL FEMORAL ARTERIES: No significant abnormality. LEFT ILIAC / PROXIMAL FEMORAL ARTERIES: No significant abnormality. ------------------------------------------------------------- LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Unchanged small left lower lobe subpleural nodules (image 246 series 9). Bibasilar atelectasis, left greater than right. HEART / OTHER VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Small hiatal hernia not seen on most recent prior. Distal esophageal wall thickening, as can be seen in reflux esophagitis. LYMPH NODES: Unchanged right hilar lymph nodes measuring up to 13 mm short axis (image 74 series 602). CHEST WALL: Sternotomy changes. ABDOMEN and PELVIS: LIVER: Subcentimeter hypodensity at the left liver lobe, incompletely characterized but statistically benign, unchanged. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Stable bilateral adrenal nodularity. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Diverticulosis. Normal appendix. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Small fat-containing umbilical hernia. MUSCULOSKELETAL: Degenerative changes of the spine. L5-S1 vacuum disc phenomenon.
2,323	EXAM: CT Abdomen and Pelvis w contrast, CT Chest with contrast, CT Thoracic Spine from Reformat, CT Lumbar Spine from Reformat CLINICAL INFORMATION: Trauma. COMPARISON: None. TECHNIQUE: CT Abdomen and Pelvis w contrast, CT Chest with contrast, CT Thoracic Spine from Reformat, CT Lumbar Spine from Reformat. Patient weight: 200 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 70sec Scan field of view: 435.40 mm. DLP: 1348 mGy cm. (accession CT220002784), Patient weight: 200 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 70sec Scan field of view: 435.40 mm. (accession CT220002783) FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Dependent atelectasis. There is trace pneumothorax on the left with adjacent subtle pulmonary contusive changes in the lingula. There are subtle pulmonary contusive changes in the anterior medial right upper lobe. No effusion evident. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Trace retrosternal hemorrhage in the setting of sternal fracture. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: Minimally displaced mildly comminuted sternal body fracture with small associated retrosternal hematoma. Posterior left 12th rib fracture. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Gastric contents distending the stomach. Small bowel is unremarkable. COLON / APPENDIX: Colon is unremarkable. The appendix is not well visualized. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Decompressed. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Tiny fat-containing umbilical hernia. MUSCULOSKELETAL: The T12 burst fracture and mild bony retropulsion. Subtle fracture extension into the posterior elements and distraction of the spinous processes of T11-T12. Subtle inferior endplate depression at T11. Sternal body fracture, mildly comminuted. THORACIC \T\ LUMBAR SPINE: VERTEBRA: T12 complete burst fracture with approximately 30% height loss extending posteriorly into the pedicles and involving the lamina. There is approximately 7 mm of retropulsion with the posterior fracture fragment contacting the cord and producing spinal canal stenosis, mild to moderate. There is interspinous widening at T11-T12. Very minimal endplate depression superiorly at T11. Remaining thoracic vertebral bodies appear maintained in height. The lumbar vertebral bodies appear maintained in height. No acute fracture is evident in the lumbar spine. DISC SPACES AND FACET JOINTS: Subtle fracture extension into the anterior articular facet base on the left and right at T12 with interspinous widening of T11-T12. PREVERTEBRAL SOFT TISSUES: Small hematoma surrounding the burst fracture of T12. ALIGNMENT: Slight anterolisthesis of T11 on T12. The remainder of posterior vertebral alignment is maintained. CONCLUSION: 1. Burst T12 fracture with retropulsed fragment contacting the anterior spinal cord resulting in mild to moderate spinal canal narrowing. There is fracture extension into the posterior elements and interspinous widening at T11-T12 compatible with a chance type fracture equivalent and interspinous ligament disruption is suspected. 2. Comminuted sternal body fracture with small associated retrosternal hematoma. There is trace left pneumothorax and there are subtle bilateral pulmonary contusions. 3. Left posterior 12th rib fracture. 4. No acute fracture or malalignment of the lumbar spine. Other incidental findings as above. Note: Findings were discussed with Dr. Joshua Day by Dr. Guidry at 1/5/2022 4:58 PM. Updated findings called to Dr. Joshua Day by Dr. Spann at 5:45 PM January 5, 2022. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.	FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Dependent atelectasis. There is trace pneumothorax on the left with adjacent subtle pulmonary contusive changes in the lingula. There are subtle pulmonary contusive changes in the anterior medial right upper lobe. No effusion evident. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Trace retrosternal hemorrhage in the setting of sternal fracture. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: Minimally displaced mildly comminuted sternal body fracture with small associated retrosternal hematoma. Posterior left 12th rib fracture. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Gastric contents distending the stomach. Small bowel is unremarkable. COLON / APPENDIX: Colon is unremarkable. The appendix is not well visualized. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Decompressed. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Tiny fat-containing umbilical hernia. MUSCULOSKELETAL: The T12 burst fracture and mild bony retropulsion. Subtle fracture extension into the posterior elements and distraction of the spinous processes of T11-T12. Subtle inferior endplate depression at T11. Sternal body fracture, mildly comminuted. THORACIC \T\ LUMBAR SPINE: VERTEBRA: T12 complete burst fracture with approximately 30% height loss extending posteriorly into the pedicles and involving the lamina. There is approximately 7 mm of retropulsion with the posterior fracture fragment contacting the cord and producing spinal canal stenosis, mild to moderate. There is interspinous widening at T11-T12. Very minimal endplate depression superiorly at T11. Remaining thoracic vertebral bodies appear maintained in height. The lumbar vertebral bodies appear maintained in height. No acute fracture is evident in the lumbar spine. DISC SPACES AND FACET JOINTS: Subtle fracture extension into the anterior articular facet base on the left and right at T12 with interspinous widening of T11-T12. PREVERTEBRAL SOFT TISSUES: Small hematoma surrounding the burst fracture of T12. ALIGNMENT: Slight anterolisthesis of T11 on T12. The remainder of posterior vertebral alignment is maintained.	FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: The visualized lung bases are clear. No pleural effusions are seen. DISTAL ESOPHAGUS: Unremarkable. HEART / VESSELS: The visualized heart is normal in size. ABDOMEN and PELVIS: LIVER: Subcentimeter low-attenuation lesion in the right lobe of the liver, too small to characterize. BILIARY TRACT: Normal. GALLBLADDER: Status post cholecystectomy. PANCREAS: Normal. SPLEEN: Spleen is enlarged which 14.7 cm. ADRENALS: Normal. KIDNEYS: No hydronephrosis. 1.3 cm indeterminate low-attenuation lesion in the right kidney. There are additional subcentimeter low-attenuation lesion in the right kidney, too small to characterize. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: The stomach appears unremarkable. The loops of small bowel are normal in caliber. COLON / APPENDIX: No evidence of acute colonic pathology. There is focal thickened enhancement/high attenuation in the base (best seen on the iodine only image #303) of the appendix with dilation of the fluid-filled appendix measuring up to 2 cm in diameter. There is adjacent stranding and fluid with prominent lymph nodes. PERITONEUM / MESENTERY: Small amount of scattered free fluid in the right lower quadrant. No free air. RETROPERITONEUM: Normal. VESSELS: Mild calcified atherosclerotic disease of the aorta. URINARY BLADDER: Unremarkable. REPRODUCTIVE ORGANS: Unremarkable. BODY WALL: Small fat-containing bilateral inguinal hernias. MUSCULOSKELETAL: There are degenerative changes of the spine.
2,324	RADIOLOGIC EXAM: CT Head wo contrast, CT Cervical Spine From Reformat, CT Angio Neck CLINICAL INFORMATION: Trauma. COMPARISON: None. TECHNIQUE: Additional 3D image post-processing was performed to generate MIP and/or volume-rendered images. CT Head wo contrast, CT Cervical Spine From Reformat, CT Angio NeckScan field of view: 215 mm. DLP: 1442.40 mGy cm. (accession CT220002782), Patient weight: 200 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 253.50 mm. DLP: 991.90 mGy cm. (accession CT220002789), Scan field of view: 215 mm. DLP: 1442.40 mGy cm. (accession CT220002785) FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal. AORTIC ARCH and PROXIMAL GREAT VESSELS: Unremarkable. RIGHT CAROTID: There is no evidence of irregularity, narrowing, occlusion or flap to indicate acute arterial injury or dissection. LEFT CAROTID: There is no evidence of irregularity, narrowing, occlusion or flap to indicate acute arterial injury or dissection. RIGHT VERTEBRAL ARTERY: There is no evidence of irregularity, narrowing, occlusion or flap to indicate acute arterial injury or dissection. LEFT VERTEBRAL ARTERY: There is no evidence of irregularity, narrowing, occlusion or flap to indicate acute arterial injury or dissection. No contrast extravasation or pseudoaneurysm is identified. FINDINGS: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (	FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal. AORTIC ARCH and PROXIMAL GREAT VESSELS: Unremarkable. RIGHT CAROTID: There is no evidence of irregularity, narrowing, occlusion or flap to indicate acute arterial injury or dissection. LEFT CAROTID: There is no evidence of irregularity, narrowing, occlusion or flap to indicate acute arterial injury or dissection. RIGHT VERTEBRAL ARTERY: There is no evidence of irregularity, narrowing, occlusion or flap to indicate acute arterial injury or dissection. LEFT VERTEBRAL ARTERY: There is no evidence of irregularity, narrowing, occlusion or flap to indicate acute arterial injury or dissection. No contrast extravasation or pseudoaneurysm is identified. FINDINGS: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (	FINDINGS: BRAIN PARENCHYMA: No intraparenchymal hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. Cerebral cortical volume is appropriate for patient's age. EXTRA-AXIAL SPACES: No epidural, subdural, or subarachnoid hemorrhage. SKULL AND SKULL BASE: No acute fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Mucosal retention cyst within the bilateral maxillary and sphenoid sinuses. Mucosal thickening of the ethmoid air cells and bilateral sphenoid sinuses. Left nasal septal deviation. MASTOIDS: Clear. SOFT TISSUES: Unremarkable.
2,325	EXAM: CT Abdomen and Pelvis wo IV contrast CLINICAL INFORMATION: Right flank pain radiating to right testicle. COMPARISON: None available. TECHNIQUE: CT Abdomen and Pelvis wo IV contrast. Scan field of view: 399 mm. DLP: 725.20 mGy cm. FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Decompressed PANCREAS: Unremarkable for technique SPLEEN: Unremarkable for technique ADRENALS: Normal. KIDNEYS: No radiopaque urinary calculus or hydronephrosis. Otherwise unremarkable for technique LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Normal colon. Normal appendix. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Suboptimally evaluated due to underdistention with mild anterior wall thickening. No significant perivesicular fat stranding. REPRODUCTIVE ORGANS: Small scrotal hydroceles. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Multilevel mild to moderate thoracolumbar spine degenerative changes. Chronic-appearing mild sclerotic endplate deformities spanning L4-S1. Moderate bilateral hip joint degenerative osteoarthrosis. No aggressive osseous lesion. CONCLUSION: 1. No acute abnormality is identified within the limitations of noncontrast CT. 2. Small scrotal hydroceles. Additional findings above. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.	FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Decompressed PANCREAS: Unremarkable for technique SPLEEN: Unremarkable for technique ADRENALS: Normal. KIDNEYS: No radiopaque urinary calculus or hydronephrosis. Otherwise unremarkable for technique LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Normal colon. Normal appendix. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Suboptimally evaluated due to underdistention with mild anterior wall thickening. No significant perivesicular fat stranding. REPRODUCTIVE ORGANS: Small scrotal hydroceles. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Multilevel mild to moderate thoracolumbar spine degenerative changes. Chronic-appearing mild sclerotic endplate deformities spanning L4-S1. Moderate bilateral hip joint degenerative osteoarthrosis. No aggressive osseous lesion.	FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Unremarkable. CHEST: LUNGS / AIRWAYS / PLEURA: There is bilateral dependent atelectasis. No pleural effusion or pneumothorax is identified. The central airways are patent. HEART / VESSELS: The heart is normal in size. MEDIASTINUM / ESOPHAGUS: No significant mediastinal hematoma. The esophagus appears unremarkable. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No acute displaced rib, clavicle or sternal fracture is identified. ABDOMEN and PELVIS: LIVER: No suspicious lesion. BILIARY TRACT: Normal. GALLBLADDER: Unremarkable PANCREAS: Normal. SPLEEN: The spleen is enlarged measuring 14.7 cm. ADRENALS: Normal. KIDNEYS: No hydronephrosis, suspicious mass or laceration. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: The stomach appears unremarkable. The loops small bowel are normal in caliber. COLON / APPENDIX: No evidence of acute colonic pathology. The appendix appears unremarkable. PERITONEUM / MESENTERY: No free air or free fluid. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Unremarkable. REPRODUCTIVE ORGANS: The uterus is present. BODY WALL: Minimal fat-containing umbilical hernia. MUSCULOSKELETAL: No significant abnormality. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal.
2,326	EXAM: CT Chest wo contrast CLINICAL INFORMATION: lung nodules, E27.8 Other specified disorders of adrenal gland, R91.8 Other nonspecific abnormal finding of lung field COMPARISON: None. TECHNIQUE: Helical multidetector noncontrast CT of the chest was performed. Axial, sagittal, and coronal multiplanar reformats were subsequently obtained.. Scan field of view: 320 mm. DLP: 658 mGy cm. FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. LINES AND TUBES: None. LOWER NECK: Heterogeneous thyroid goiter. CHEST: LUNGS / AIRWAYS / PLEURA: Multiple stable to slightly less pronounced nodules are identified throughout the lungs which measures less than 6 mm. The most suspicious nodules within the right middle lobe best seen on series #2 image #123. HEART / VESSELS: Scattered coronary artery calcifications. The aorta is normal caliber with normal atherosclerotic disease. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Unchanged low-attenuation right adrenal lesion. Similar appearing high density left renal lesion. MUSCULOSKELETAL: No significant abnormality. IMPRESSION: 1. Multiple scattered subcentimeter pulmonary nodules (less than 6 mm) which are stable or improved. No new nodules are identified. Follow-up in 18-24 months can be obtained if the patient is high risk for malignancy. 2. Heterogenous and enlarged thyroid.	FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. LINES AND TUBES: None. LOWER NECK: Heterogeneous thyroid goiter. CHEST: LUNGS / AIRWAYS / PLEURA: Multiple stable to slightly less pronounced nodules are identified throughout the lungs which measures less than 6 mm. The most suspicious nodules within the right middle lobe best seen on series #2 image #123. HEART / VESSELS: Scattered coronary artery calcifications. The aorta is normal caliber with normal atherosclerotic disease. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Unchanged low-attenuation right adrenal lesion. Similar appearing high density left renal lesion. MUSCULOSKELETAL: No significant abnormality.	FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Unremarkable. CHEST: LUNGS / AIRWAYS / PLEURA: There is bilateral dependent atelectasis. No pleural effusion or pneumothorax is identified. The central airways are patent. HEART / VESSELS: The heart is normal in size. MEDIASTINUM / ESOPHAGUS: No significant mediastinal hematoma. The esophagus appears unremarkable. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No acute displaced rib, clavicle or sternal fracture is identified. ABDOMEN and PELVIS: LIVER: No suspicious lesion. BILIARY TRACT: Normal. GALLBLADDER: Unremarkable PANCREAS: Normal. SPLEEN: The spleen is enlarged measuring 14.7 cm. ADRENALS: Normal. KIDNEYS: No hydronephrosis, suspicious mass or laceration. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: The stomach appears unremarkable. The loops small bowel are normal in caliber. COLON / APPENDIX: No evidence of acute colonic pathology. The appendix appears unremarkable. PERITONEUM / MESENTERY: No free air or free fluid. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Unremarkable. REPRODUCTIVE ORGANS: The uterus is present. BODY WALL: Minimal fat-containing umbilical hernia. MUSCULOSKELETAL: No significant abnormality. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal.
2,327	EXAM: CT Abdomen wo IV contrast CLINICAL INFORMATION: 76-year-old female with adrenal mass less than 4 cm COMPARISON: CT abdomen and pelvis 9/14/2021 TECHNIQUE: CT Abdomen wo IV contrast. Scan field of view: 375 mm. DLP: 185 mGy cm. FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Abdomen LOWER CHEST: Please see separately dictated same-day CT chest. ABDOMEN: LIVER: Heterogenous hypoattenuation around the gallbladder fossa is less apparent on the current examination likely secondary to noncontrast technique. BILIARY TRACT: Normal. GALLBLADDER: Surgically absent. PANCREAS: Normal for technique. SPLEEN: Normal. ADRENALS: Right adrenal nodule measuring 3.0 x 0.9 cm (series 2, image 81), with attenuation less than 10 Hounsfield units on noncontrast sequence. The left adrenal gland is normal. KIDNEYS: No renal calculi or hydronephrosis. Left upper pole hyperdense lesion measuring approximately 0.6 cm, likely a hemorrhagic cyst. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON: Diverticulosis without evidence of diverticulitis. The appendix is not well-visualized. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Moderate to severe atherosclerotic calcifications of the abdominal aorta which is normal in caliber. BODY WALL: Ventral abdominal wall defect measuring 1.8 cm with a fat-containing hernia (series 2, image 192). MUSCULOSKELETAL: Multilevel discogenic degenerative changes. Mild retrolisthesis of L1 on L2. No aggressive osseous lesions. CONCLUSION: 1. Right adrenal nodule consistent with an adrenal adenoma. 2. Interval cholecystectomy and wedge hepatectomy. Evaluation of the remaining hepatic parenchyma is limited by noncontrast technique. 3. Additional chronic and incidental findings as described above. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.	FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Abdomen LOWER CHEST: Please see separately dictated same-day CT chest. ABDOMEN: LIVER: Heterogenous hypoattenuation around the gallbladder fossa is less apparent on the current examination likely secondary to noncontrast technique. BILIARY TRACT: Normal. GALLBLADDER: Surgically absent. PANCREAS: Normal for technique. SPLEEN: Normal. ADRENALS: Right adrenal nodule measuring 3.0 x 0.9 cm (series 2, image 81), with attenuation less than 10 Hounsfield units on noncontrast sequence. The left adrenal gland is normal. KIDNEYS: No renal calculi or hydronephrosis. Left upper pole hyperdense lesion measuring approximately 0.6 cm, likely a hemorrhagic cyst. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON: Diverticulosis without evidence of diverticulitis. The appendix is not well-visualized. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Moderate to severe atherosclerotic calcifications of the abdominal aorta which is normal in caliber. BODY WALL: Ventral abdominal wall defect measuring 1.8 cm with a fat-containing hernia (series 2, image 192). MUSCULOSKELETAL: Multilevel discogenic degenerative changes. Mild retrolisthesis of L1 on L2. No aggressive osseous lesions.	FINDINGS: CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
2,328	RADIOLOGIC EXAM: CT Head wo contrast CLINICAL INFORMATION: septic shock, sp cardiac arrest, anemia. COMPARISON: None. TECHNIQUE: CT of the head without intravenous contrast. Scan field of view: 229 mm. DLP: 1219.50 mGy cm. FINDINGS: BRAIN PARENCHYMA: No hemorrhage, acute infarct, or cerebral edema. No midline shift or mass effect. Prominent perivascular spaces in the basal ganglia. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Small right maxillary mucous retention cysts. Minimal mucosal thickening of the right sphenoid sinus. Mastoid effusions. SOFT TISSUES: Normal. CONCLUSION: No acute intracranial process. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.	FINDINGS: BRAIN PARENCHYMA: No hemorrhage, acute infarct, or cerebral edema. No midline shift or mass effect. Prominent perivascular spaces in the basal ganglia. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Small right maxillary mucous retention cysts. Minimal mucosal thickening of the right sphenoid sinus. Mastoid effusions. SOFT TISSUES: Normal.	FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Unremarkable. CHEST: LUNGS / AIRWAYS / PLEURA: There is bilateral dependent atelectasis. No pleural effusion or pneumothorax is identified. The central airways are patent. HEART / VESSELS: The heart is normal in size. MEDIASTINUM / ESOPHAGUS: No significant mediastinal hematoma. The esophagus appears unremarkable. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No acute displaced rib, clavicle or sternal fracture is identified. ABDOMEN and PELVIS: LIVER: No suspicious lesion. BILIARY TRACT: Normal. GALLBLADDER: Unremarkable PANCREAS: Normal. SPLEEN: The spleen is enlarged measuring 14.7 cm. ADRENALS: Normal. KIDNEYS: No hydronephrosis, suspicious mass or laceration. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: The stomach appears unremarkable. The loops small bowel are normal in caliber. COLON / APPENDIX: No evidence of acute colonic pathology. The appendix appears unremarkable. PERITONEUM / MESENTERY: No free air or free fluid. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Unremarkable. REPRODUCTIVE ORGANS: The uterus is present. BODY WALL: Minimal fat-containing umbilical hernia. MUSCULOSKELETAL: No significant abnormality. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal.
2,329	EXAM: CT Chest wo contrast, CT Abdomen and Pelvis wo IV contrast CLINICAL INFORMATION: septic shock, sp cardiac arrest, anemia. COMPARISON: CT 11/17/2021, chest radiograph 1/4/2022. TECHNIQUE: CT Chest wo contrast, CT Abdomen and Pelvis wo IV contrast. Scan field of view: 394 mm. Oral contrast Omnipaque: 16.9 oz. (accession CT220002795), Scan field of view: 394 mm. Oral contrast Omnipaque: 16.9 oz. DLP: 981 mGy cm. (accession CT220002796) FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT CAP LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Patchy diffuse bilateral groundglass and consolidative opacities are overall similar to slightly progressed from recent radiograph. Trace effusions. Endotracheal tube tip 3 cm above carina. HEART / VESSELS: Right IJ port with tip at cavoatrial junction. MEDIASTINUM / ESOPHAGUS: Esophagogastric tube with fluid in the distal esophagus. LYMPH NODES: Scattered mildly enlarged mediastinal nodes, for example, a right paratracheal node measuring 1.3 cm (series 2 image 70), likely reactive. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Borderline steatosis. BILIARY TRACT: Normal. GALLBLADDER: Small amount of layering sludge/stones. PANCREAS: Normal. SPLEEN: Interval decrease in spleen size with scattered persistent hypoattenuating wedge-shaped lesions. ADRENALS: Normal. KIDNEYS: No hydronephrosis or nephrolithiasis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Small hiatal hernia. Esophagogastric tube with tip in gastric body. COLON / APPENDIX: Normal. PERITONEUM / MESENTERY: Trace layering hyperattenuating fluid in the pelvis. RETROPERITONEUM: Normal. VESSELS: Left femoral CVL. URINARY BLADDER: Decompressed by Foley catheter. REPRODUCTIVE ORGANS: Left testicular clips. Prostamegaly. BODY WALL: Scattered extraperitoneal clips adjacent to the sigmoid. Mild anasarca. Fat-containing umbilical hernia. MUSCULOSKELETAL: New minimally displaced right through seventh and left fourth through sixth rib fractures. Degenerative spine changes. No aggressive osseous abnormality. CONCLUSION: 1. Patchy diffuse bilateral groundglass and consolidative opacities suggestive of multifocal pneumonia are overall similar to slightly progressed from recent radiograph. 2. No significant interval abdominopelvic abnormality. 3. Interval decrease in spleen size with scattered persistent hypoattenuating wedge-shaped lesions suggestive of infarcts. 4. New minimally displaced right through seventh and left fourth through sixth rib fractures, likely from recent resuscitation. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.	FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT CAP LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Patchy diffuse bilateral groundglass and consolidative opacities are overall similar to slightly progressed from recent radiograph. Trace effusions. Endotracheal tube tip 3 cm above carina. HEART / VESSELS: Right IJ port with tip at cavoatrial junction. MEDIASTINUM / ESOPHAGUS: Esophagogastric tube with fluid in the distal esophagus. LYMPH NODES: Scattered mildly enlarged mediastinal nodes, for example, a right paratracheal node measuring 1.3 cm (series 2 image 70), likely reactive. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Borderline steatosis. BILIARY TRACT: Normal. GALLBLADDER: Small amount of layering sludge/stones. PANCREAS: Normal. SPLEEN: Interval decrease in spleen size with scattered persistent hypoattenuating wedge-shaped lesions. ADRENALS: Normal. KIDNEYS: No hydronephrosis or nephrolithiasis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Small hiatal hernia. Esophagogastric tube with tip in gastric body. COLON / APPENDIX: Normal. PERITONEUM / MESENTERY: Trace layering hyperattenuating fluid in the pelvis. RETROPERITONEUM: Normal. VESSELS: Left femoral CVL. URINARY BLADDER: Decompressed by Foley catheter. REPRODUCTIVE ORGANS: Left testicular clips. Prostamegaly. BODY WALL: Scattered extraperitoneal clips adjacent to the sigmoid. Mild anasarca. Fat-containing umbilical hernia. MUSCULOSKELETAL: New minimally displaced right through seventh and left fourth through sixth rib fractures. Degenerative spine changes. No aggressive osseous abnormality.	FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Unremarkable. CHEST: LUNGS / AIRWAYS / PLEURA: There is bilateral dependent atelectasis. No pleural effusion or pneumothorax is identified. The central airways are patent. HEART / VESSELS: The heart is normal in size. MEDIASTINUM / ESOPHAGUS: No significant mediastinal hematoma. The esophagus appears unremarkable. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No acute displaced rib, clavicle or sternal fracture is identified. ABDOMEN and PELVIS: LIVER: No suspicious lesion. BILIARY TRACT: Normal. GALLBLADDER: Unremarkable PANCREAS: Normal. SPLEEN: The spleen is enlarged measuring 14.7 cm. ADRENALS: Normal. KIDNEYS: No hydronephrosis, suspicious mass or laceration. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: The stomach appears unremarkable. The loops small bowel are normal in caliber. COLON / APPENDIX: No evidence of acute colonic pathology. The appendix appears unremarkable. PERITONEUM / MESENTERY: No free air or free fluid. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Unremarkable. REPRODUCTIVE ORGANS: The uterus is present. BODY WALL: Minimal fat-containing umbilical hernia. MUSCULOSKELETAL: No significant abnormality. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal.
2,330	EXAM: CT Chest wo contrast, CT Abdomen and Pelvis wo IV contrast CLINICAL INFORMATION: septic shock, sp cardiac arrest, anemia. COMPARISON: CT 11/17/2021, chest radiograph 1/4/2022. TECHNIQUE: CT Chest wo contrast, CT Abdomen and Pelvis wo IV contrast. Scan field of view: 394 mm. Oral contrast Omnipaque: 16.9 oz. (accession CT220002795), Scan field of view: 394 mm. Oral contrast Omnipaque: 16.9 oz. DLP: 981 mGy cm. (accession CT220002796) FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT CAP LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Patchy diffuse bilateral groundglass and consolidative opacities are overall similar to slightly progressed from recent radiograph. Trace effusions. Endotracheal tube tip 3 cm above carina. HEART / VESSELS: Right IJ port with tip at cavoatrial junction. MEDIASTINUM / ESOPHAGUS: Esophagogastric tube with fluid in the distal esophagus. LYMPH NODES: Scattered mildly enlarged mediastinal nodes, for example, a right paratracheal node measuring 1.3 cm (series 2 image 70), likely reactive. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Borderline steatosis. BILIARY TRACT: Normal. GALLBLADDER: Small amount of layering sludge/stones. PANCREAS: Normal. SPLEEN: Interval decrease in spleen size with scattered persistent hypoattenuating wedge-shaped lesions. ADRENALS: Normal. KIDNEYS: No hydronephrosis or nephrolithiasis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Small hiatal hernia. Esophagogastric tube with tip in gastric body. COLON / APPENDIX: Normal. PERITONEUM / MESENTERY: Trace layering hyperattenuating fluid in the pelvis. RETROPERITONEUM: Normal. VESSELS: Left femoral CVL. URINARY BLADDER: Decompressed by Foley catheter. REPRODUCTIVE ORGANS: Left testicular clips. Prostamegaly. BODY WALL: Scattered extraperitoneal clips adjacent to the sigmoid. Mild anasarca. Fat-containing umbilical hernia. MUSCULOSKELETAL: New minimally displaced right through seventh and left fourth through sixth rib fractures. Degenerative spine changes. No aggressive osseous abnormality. CONCLUSION: 1. Patchy diffuse bilateral groundglass and consolidative opacities suggestive of multifocal pneumonia are overall similar to slightly progressed from recent radiograph. 2. No significant interval abdominopelvic abnormality. 3. Interval decrease in spleen size with scattered persistent hypoattenuating wedge-shaped lesions suggestive of infarcts. 4. New minimally displaced right through seventh and left fourth through sixth rib fractures, likely from recent resuscitation. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.	FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT CAP LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Patchy diffuse bilateral groundglass and consolidative opacities are overall similar to slightly progressed from recent radiograph. Trace effusions. Endotracheal tube tip 3 cm above carina. HEART / VESSELS: Right IJ port with tip at cavoatrial junction. MEDIASTINUM / ESOPHAGUS: Esophagogastric tube with fluid in the distal esophagus. LYMPH NODES: Scattered mildly enlarged mediastinal nodes, for example, a right paratracheal node measuring 1.3 cm (series 2 image 70), likely reactive. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Borderline steatosis. BILIARY TRACT: Normal. GALLBLADDER: Small amount of layering sludge/stones. PANCREAS: Normal. SPLEEN: Interval decrease in spleen size with scattered persistent hypoattenuating wedge-shaped lesions. ADRENALS: Normal. KIDNEYS: No hydronephrosis or nephrolithiasis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Small hiatal hernia. Esophagogastric tube with tip in gastric body. COLON / APPENDIX: Normal. PERITONEUM / MESENTERY: Trace layering hyperattenuating fluid in the pelvis. RETROPERITONEUM: Normal. VESSELS: Left femoral CVL. URINARY BLADDER: Decompressed by Foley catheter. REPRODUCTIVE ORGANS: Left testicular clips. Prostamegaly. BODY WALL: Scattered extraperitoneal clips adjacent to the sigmoid. Mild anasarca. Fat-containing umbilical hernia. MUSCULOSKELETAL: New minimally displaced right through seventh and left fourth through sixth rib fractures. Degenerative spine changes. No aggressive osseous abnormality.	FINDINGS: CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
2,331	Lung Cancer Screening Clinical Information: Lung cancer screening Technique: Scan field of view: 300 mm. Height: 66 in. Patient weight: 165 lbs. CTDI vol: 0.50 mGy. DLP: 18 mGy cm. 0.60 mm images were obtained through the chest. The CT is jointly interpreted by Drs. Manapragada and Abozeed Smoking Status: Current If not current, quit years ago: 0 Pack Years: 35 Screen Year: Baseline Comparison: None Interpretation and recommendations are based on 2019 version of ACR LungRads recommendations Findings: No enlarged hilar or mediastinal nodes are present. The mediastinum is normal. A 3 mm right lower lobe subpleural nodule (image 234; series 4) is noted. Mild upper lobe predominant centrilobular emphysema. No focal consolidation. Bilateral dependent atelectasis. Retained secretions the trachea, otherwise patent central airways. No pleural effusion. Coronary artery calcification: The visual score of calcification is 8. (Based on a publication by Kirsch et al (Detection of Coronary calcium During Standard Chest Computed Tomography Correlates With Multi-Detector Computed Tomography Coronary Artery Calcium score, Int J Cardiovasc Imaging (2012) 28:1249-1256), visual score >7 is associated with an Agatston score > 400 and independently validated increased incidence of cardiovascular mortality). The visualized liver, spleen, adrenals, and bowel are unremarkable for the technique. Bones: Unremarkable. Impression: 1. No suspicious pulmonary nodule. A tiny 3 mm right lower lobe nodule. Mild emphysema. 2. Significant coronary calcifications. LungRads category: 2S Lung-Rads Modifier S: Significant coronary calcification. Recommendation: 1. Continue annual screening. 2. Cardiology consultation for evaluation of obstructive coronary artery disease, if not already done. ====================================================================================== REFERENCES: http://www.acr.org/\R\/media/ACR/Documents/PDF/QualitySafety/Resources/LungRADS/AssessmentCateg ries http://www.acr.org/Quality-Safety/Lung-Cancer-Screening-Center Category 0: Incomplete. Category 1: Negative - No nodules or definitely benign nodules. Category 2: Benign Appearance or Behavior - Nodules with a very low likelihood of becoming a clinically active cancer due to size or lack of growth. Category 3: Probably benign finding(s) - Short term follow-up suggested; includes nodules with a low likelihood of becoming a clinically active cancer. Category 4A: Suspicious - Findings for which additional diagnostic testing is recommended. Category 4B and 4X: Very Suspicious - Findings for which additional diagnostic testing and/or tissue sampling is recommended. Modifier S: Other Findings - Clinically significant or potentially clinically significant findings (non-lung cancer). References: http://www.acr.org/\R\/media/ACR/Documents/PDF/QualitySafety/Resources/LungRADS/AssessmentCateg ries http://www.acr.org/Quality-Safety/Lung-Cancer-Screening-Center	Findings: No enlarged hilar or mediastinal nodes are present. The mediastinum is normal. A 3 mm right lower lobe subpleural nodule (image 234; series 4) is noted. Mild upper lobe predominant centrilobular emphysema. No focal consolidation. Bilateral dependent atelectasis. Retained secretions the trachea, otherwise patent central airways. No pleural effusion. Coronary artery calcification: The visual score of calcification is 8. (Based on a publication by Kirsch et al (Detection of Coronary calcium During Standard Chest Computed Tomography Correlates With Multi-Detector Computed Tomography Coronary Artery Calcium score, Int J Cardiovasc Imaging (2012) 28:1249-1256), visual score >7 is associated with an Agatston score > 400 and independently validated increased incidence of cardiovascular mortality). The visualized liver, spleen, adrenals, and bowel are unremarkable for the technique. Bones: Unremarkable.	FINDINGS: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
2,332	EXAM: CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: 44-year-old female with left lower quadrant pain. COMPARISON: Ultrasound of the pelvis of same day. TECHNIQUE: CT Abdomen and Pelvis w contrast. Patient weight: 270 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. Saline flush: 80 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 80 sec Scan field of view: 392 mm. DLP: 1389.30 mGy cm. FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Congenital malrotation of the right kidney. No suspicious lesion or hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Some mucosal fat deposition in the cecum and ascending colon likely represent sequelae of inflammation. Appendix is normal. PERITONEUM / MESENTERY: Trace fluid in the pelvis. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Right adnexal large cystic mass is seen measuring 13.1 x 11.9 x 12.8 cm (series 201, image 203 and series 203, image 53) and there appears to be tissue, possibly solid tissue along the caudal margin. 1.2 cm hypoattenuating lesion of the uterine fundus likely represents a fibroid (series 201, image 266). BODY WALL: Tiny fat-containing umbilical hernia. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: Large right adnexal cystic mass with possible solid components caudally is demonstrated concerning for ovarian neoplasm or large complex hemorrhagic cyst. GYN consultation is recommended. See separately dictated pelvic ultrasound from the same day. Case and follow-up recommendations discussed with Kelly Jones, NP by Dr. Spann at 9:52 pm 1/5/2022 via telephone. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.	FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Congenital malrotation of the right kidney. No suspicious lesion or hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Some mucosal fat deposition in the cecum and ascending colon likely represent sequelae of inflammation. Appendix is normal. PERITONEUM / MESENTERY: Trace fluid in the pelvis. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Right adnexal large cystic mass is seen measuring 13.1 x 11.9 x 12.8 cm (series 201, image 203 and series 203, image 53) and there appears to be tissue, possibly solid tissue along the caudal margin. 1.2 cm hypoattenuating lesion of the uterine fundus likely represents a fibroid (series 201, image 266). BODY WALL: Tiny fat-containing umbilical hernia. MUSCULOSKELETAL: No significant abnormality.	FINDINGS: STRUCTURED REPORT: Thoracic and lumbar spine trauma THORACIC SPINE: VERTEBRA: Compression deformity of T6 with 40% loss of vertebral body height, one retropulsion, and focal kyphosis. Minor T12 compression deformity with approximately 20% loss of vertebral body height and no bony retropulsion. Additional Schmorl's node at this location. DISC SPACES AND FACET JOINTS: Multilevel discogenic degenerative change. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal anteroposterior alignment with exception of minimal retropulsion of T6 as above. LUMBAR SPINE: VERTEBRA: Transitional lumbosacral anatomy, with transitional vertebra labeled L5 on this evaluation. Minor compression deformity of L1 with 20% loss of vertebral body height. DISC SPACES AND FACET JOINTS: Multilevel facet arthropathy and discogenic degenerative change, worst at the inferior lumbar spine. Associated likely central canal stenosis at L3-4. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Grade 1 anterolisthesis of L3 on L4. OTHER: Likely renal cysts. Large hiatal hernia. Multifocal pulmonary opacities likely infectious or inflammatory. Abdominal vascular calcifications. Colonic diverticulosis.
2,333	RADIOLOGIC EXAM: CT Head wo contrast CLINICAL INFORMATION: fall COMPARISON: None. TECHNIQUE: CT Head wo contrastScan field of view: 223 mm. DLP: 1406.90 mGy cm. STRUCTURED REPORT: CT Head Trauma FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Mild diffuse brain volume loss with ex vacuo ventricular prominence. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal. CONCLUSION: No acute intracranial process.	FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Mild diffuse brain volume loss with ex vacuo ventricular prominence. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal.	FINDINGS: STRUCTURED REPORT: Thoracic and lumbar spine trauma THORACIC SPINE: VERTEBRA: Compression deformity of T6 with 40% loss of vertebral body height, one retropulsion, and focal kyphosis. Minor T12 compression deformity with approximately 20% loss of vertebral body height and no bony retropulsion. Additional Schmorl's node at this location. DISC SPACES AND FACET JOINTS: Multilevel discogenic degenerative change. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal anteroposterior alignment with exception of minimal retropulsion of T6 as above. LUMBAR SPINE: VERTEBRA: Transitional lumbosacral anatomy, with transitional vertebra labeled L5 on this evaluation. Minor compression deformity of L1 with 20% loss of vertebral body height. DISC SPACES AND FACET JOINTS: Multilevel facet arthropathy and discogenic degenerative change, worst at the inferior lumbar spine. Associated likely central canal stenosis at L3-4. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Grade 1 anterolisthesis of L3 on L4. OTHER: Likely renal cysts. Large hiatal hernia. Multifocal pulmonary opacities likely infectious or inflammatory. Abdominal vascular calcifications. Colonic diverticulosis.
2,334	RADIOLOGIC EXAM: CT Cervical Spine wo contrast CLINICAL INFORMATION: Trauma. COMPARISON: CT C-spine 2/20/2019 TECHNIQUE: CT Cervical Spine wo contrastScan field of view: 212 mm. DLP: 346.10 mGy cm. Following CT of the neck, reformatted images were produced to optimize visualization of the osseous structures of the cervical spine. STRUCTURED REPORT: CT Cervical Spine Trauma FINDINGS: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (	FINDINGS: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (	FINDINGS: CT of the head without contrast: See separate dictation for noncontrast head CT findings. CT angiogram of the brain: RIGHT INTRACRANIAL CAROTID: Calcific and noncalcific atherosclerosis within the cavernous and clinoid segments with mild luminal narrowing. There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT INTRACRANIAL CAROTID: Calcific and noncalcific atherosclerosis within the cavernous and clinoid segments with mild luminal narrowing. Small cavernous segment aneurysm measuring 3 mm in maximum axial diameter (series 407 image 185) by 5 mm in craniocaudal dimension. ANTERIOR, MIDDLE, AND POSTERIOR CEREBRAL ARTERIES: There is no evidence of stenosis, occlusion, or aneurysmal dilation. VERTEBROBASILAR ARTERIES: Left anterior inferior cerebellar artery with large PICA. There is no evidence of stenosis, occlusion, or aneurysmal dilation. CT angiogram of the neck: AORTIC ARCH and PROXIMAL GREAT VESSELS: Calcific and noncalcific atherosclerosis. RIGHT CAROTID: Tortuous. There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. RIGHT VERTEBRAL ARTERY: There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT VERTEBRAL ARTERY: There is no evidence of stenosis, occlusion, or aneurysmal dilation. CERVICAL SPINE: Mild multilevel discogenic degenerative changes and facet joint arthropathy most prominent at C3-C4. CERVICAL SOFT TISSUES: Multiple hypoattenuating thyroid nodules with the largest measuring at least 1.2 cm in maximum axial diameter within the left lower pole but difficult to definitively measure and may be larger. OTHER: Partially imaged large hiatal hernia. Masslike consolidation within the left upper lobe measuring 2.0 x 1.3 x 1.3 cm (series 402 image 35, series 403 image 310).
2,335	EXAM: CT Ankle Right wo contrast CLINICAL INFORMATION: Trauma. COMPARISON: Radiograph 12/4/2021. TECHNIQUE: CT Ankle Right wo contrast Scan field of view: 196 mm. DLP: 244.90 mGy cm. FINDINGS: BONES/JOINTS: Oblique fracture of the distal fibula with mild lateral displacement of the distal fragment without osseous callus formation. Additionally there is lucency with surrounding sclerosis within the distal tibial metaphysis with associated periosteal reaction medially and posteriorly consistent with healing nondisplaced fracture. Small osseous fragments are present inferior to the medial malleolus consistent with prior avulsion fractures. The ankle mortise is maintained. Small ankle joint effusion. Plantar and Achilles calcaneal enthesopathic changes. SOFT TISSUES: No large hematoma or fluid collection. Surrounding subcutaneous edema. CONCLUSION: 1. Distal fibular oblique fracture. 2. Healing nondisplaced tibial metaphyseal fracture. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.	FINDINGS: BONES/JOINTS: Oblique fracture of the distal fibula with mild lateral displacement of the distal fragment without osseous callus formation. Additionally there is lucency with surrounding sclerosis within the distal tibial metaphysis with associated periosteal reaction medially and posteriorly consistent with healing nondisplaced fracture. Small osseous fragments are present inferior to the medial malleolus consistent with prior avulsion fractures. The ankle mortise is maintained. Small ankle joint effusion. Plantar and Achilles calcaneal enthesopathic changes. SOFT TISSUES: No large hematoma or fluid collection. Surrounding subcutaneous edema.	FINDINGS: CT of the head without contrast: See separate dictation for noncontrast head CT findings. CT angiogram of the brain: RIGHT INTRACRANIAL CAROTID: Calcific and noncalcific atherosclerosis within the cavernous and clinoid segments with mild luminal narrowing. There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT INTRACRANIAL CAROTID: Calcific and noncalcific atherosclerosis within the cavernous and clinoid segments with mild luminal narrowing. Small cavernous segment aneurysm measuring 3 mm in maximum axial diameter (series 407 image 185) by 5 mm in craniocaudal dimension. ANTERIOR, MIDDLE, AND POSTERIOR CEREBRAL ARTERIES: There is no evidence of stenosis, occlusion, or aneurysmal dilation. VERTEBROBASILAR ARTERIES: Left anterior inferior cerebellar artery with large PICA. There is no evidence of stenosis, occlusion, or aneurysmal dilation. CT angiogram of the neck: AORTIC ARCH and PROXIMAL GREAT VESSELS: Calcific and noncalcific atherosclerosis. RIGHT CAROTID: Tortuous. There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. RIGHT VERTEBRAL ARTERY: There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT VERTEBRAL ARTERY: There is no evidence of stenosis, occlusion, or aneurysmal dilation. CERVICAL SPINE: Mild multilevel discogenic degenerative changes and facet joint arthropathy most prominent at C3-C4. CERVICAL SOFT TISSUES: Multiple hypoattenuating thyroid nodules with the largest measuring at least 1.2 cm in maximum axial diameter within the left lower pole but difficult to definitively measure and may be larger. OTHER: Partially imaged large hiatal hernia. Masslike consolidation within the left upper lobe measuring 2.0 x 1.3 x 1.3 cm (series 402 image 35, series 403 image 310).
2,336	CT scan of the lumbar spine. Clinical: Low back pain, radiculopathy. Technical: CT L-spine protocol. DLP: 867 mGy cm. Comparison: None. Findings: There is a posterior fusion construct extending from L4 to S1 with pedicle screws and rods. There is solid osseous union of L5 and S1 and fusion of the posterior elements at L4 and L5. No screw loosening or hardware failure is seen. There is decompressive laminectomy of L5. There is motion at L3-4 and there is severe hypertrophic facet arthropathy with vacuum phenomena. There is slightly less facet arthropathy at L2-3, also with vacuum phenomena. The upper lumbar and lower thoracic vertebra are unremarkable. There is diffuse osteopenia but no lytic or blastic lesion is seen. --------------- Conclusion: Stable posterior fusion construct at L4-S1. Severe hypertrophic facet arthropathy at L3-4 with vacuum phenomena. Slightly less facet arthropathy at L2-3 with vacuum phenomena. No acute process identified.	Findings: There is a posterior fusion construct extending from L4 to S1 with pedicle screws and rods. There is solid osseous union of L5 and S1 and fusion of the posterior elements at L4 and L5. No screw loosening or hardware failure is seen. There is decompressive laminectomy of L5. There is motion at L3-4 and there is severe hypertrophic facet arthropathy with vacuum phenomena. There is slightly less facet arthropathy at L2-3, also with vacuum phenomena. The upper lumbar and lower thoracic vertebra are unremarkable. There is diffuse osteopenia but no lytic or blastic lesion is seen. ---------------	FINDINGS: BRAIN PARENCHYMA: No hemorrhage, intracranial mass, large territory infarct, or edema. White matter hypodensities in the periventricular and subcortical white matter. Humeral moderate parenchymal atrophy. Gray-white matter differentiation maintained. EXTRA-AXIAL SPACES: Empty sella. SKULL AND SKULL BASE: No fracture. No aggressive osseous lesion. VENTRICULAR SYSTEM: Normal. ORBITS: Bilateral pseudophakia. SINUSES: Normal. OTHER: Central vascular calcifications.
2,337	EXAM: CT Chest High Resolution wo contrast CLINICAL INFORMATION: 45-year-old male with provided history of abnormal pulmonary function tests. COMPARISON: Chest CT 5/15/2020 TECHNIQUE: CT Chest High Resolution wo contrast. Scan field of view: 320 mm. DLP: 323.44 mGy cm. High-resolution CT imaging of the chest was performed per protocol with inspiratory and expiratory technique in prone position. FINDINGS: Limitations: None. Chest: Lines, tubes, and devices: None. Lung parenchyma and pleura: Persistent right upper lung lobe consolidative and diffuse groundglass opacities with associated right upper lobe volume loss and bronchiectatic changes. Additional left lung apex and peripheral right middle lobe and right lower lobe subpleural reticular opacities with traction bronchiectasis are similar to prior. Bibasilar atelectasis are also noted. Moderate asymmetric upper lobe predominant paraseptal emphysema. The trachea and main bronchi are patent. No pleural effusion. Expiratory images demonstrate no significant areas of air trapping bilaterally. No evidence of tracheal bronchomalacia. Thoracic inlet, heart, and mediastinum: No lymphadenopathy in the axillary, mediastinal, or hilar regions. The esophagus is nondilated. The thoracic aorta is normal in caliber. Main pulmonary artery is dilated, measures 3.3 cm. The cardiac chambers are normal in size. No coronary artery atherosclerotic calcifications are noted, although the study is not optimized for coronary assessment. No pericardial effusion. Bones and soft tissues: Redemonstrated extensive thoracic cage and rib deformity with chronic healing right scapular fracture. Redemonstrated T9 and T10 fixation hardware. Chest wall soft tissues are unremarkable. Upper abdomen: The spleen is not visualized, likely surgically absent. Surgical changes in the upper abdomen. CONCLUSION: 1. Persistent right upper lung lobe consolidative and diffuse groundglass opacities with associated right upper lobe volume loss and bronchiectatic changes. Finding may be related to chronic persistent post-inflammatory and fibrotic changes. 2. Other findings as described.	FINDINGS: Limitations: None. Chest: Lines, tubes, and devices: None. Lung parenchyma and pleura: Persistent right upper lung lobe consolidative and diffuse groundglass opacities with associated right upper lobe volume loss and bronchiectatic changes. Additional left lung apex and peripheral right middle lobe and right lower lobe subpleural reticular opacities with traction bronchiectasis are similar to prior. Bibasilar atelectasis are also noted. Moderate asymmetric upper lobe predominant paraseptal emphysema. The trachea and main bronchi are patent. No pleural effusion. Expiratory images demonstrate no significant areas of air trapping bilaterally. No evidence of tracheal bronchomalacia. Thoracic inlet, heart, and mediastinum: No lymphadenopathy in the axillary, mediastinal, or hilar regions. The esophagus is nondilated. The thoracic aorta is normal in caliber. Main pulmonary artery is dilated, measures 3.3 cm. The cardiac chambers are normal in size. No coronary artery atherosclerotic calcifications are noted, although the study is not optimized for coronary assessment. No pericardial effusion. Bones and soft tissues: Redemonstrated extensive thoracic cage and rib deformity with chronic healing right scapular fracture. Redemonstrated T9 and T10 fixation hardware. Chest wall soft tissues are unremarkable. Upper abdomen: The spleen is not visualized, likely surgically absent. Surgical changes in the upper abdomen.	Findings: There is an apparent area of decreased CBF in the left frontal lobe which is superimposed on the extra-axial space most consistent with an artifactual finding. No significant ischemia is noted using the threshold of T max more than six second. Using the threshold of four second there are areas of minimally elevated transient time in the bilateral cerebellar hemispheres and occipital lobes which is felt to be indeterminate finding.
2,338	EXAM: CT Chest with contrast CLINICAL INFORMATION: Lung cancer. Restaging. COMPARISON: Multiple priors including outside study 10/20/2021. TECHNIQUE: Helical multidetector CT of the chest was performed after the administration of intravenous contrast. Axial, sagittal, and coronal multiplanar reformats were subsequently obtained. Patient weight: 187 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 75 ml. IV contrast injection rate: 2.50 ml per sec. Scan delay: 86 sec. Scan field of view: 409 mm. DLP: 822 mGy cm. FINDINGS: LINES AND TUBES: None. LOWER NECK: Heterogenous thryoid. CHEST: LUNGS / AIRWAYS / PLEURA: Nodular opacity and tree-in-bud opacity in the right upper lobe best seen on series #202 image #95 and #85 respectively has decreased in conspicuity. Bandlike density within the left upper lobe best seen on series #202 image #132 is stable. No new lesions are identified. HEART / VESSELS: Severe coronary artery calcifications. The aorta is normal in caliber. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: Enlarged right hilar lymph node measuring 11 x 12 mm. Top normal subcarinal lymph node measuring 10 x 18 mm, stable. CHEST WALL: No significant abnormality. UPPER ABDOMEN: See separate abdominal dictation. MUSCULOSKELETAL: No destructive osseous lesions. IMPRESSION: 1. No convincing evidence of disease progression. Multiple small scattered pulmonary nodules are stable allowing for differences in technique. No new suspicious lesions. Attention on follow-up is recommended. 2. Enlarged right hilar lymph node and top normal subcarinal lymph node. 3. See separate abdominal dictation.	FINDINGS: LINES AND TUBES: None. LOWER NECK: Heterogenous thryoid. CHEST: LUNGS / AIRWAYS / PLEURA: Nodular opacity and tree-in-bud opacity in the right upper lobe best seen on series #202 image #95 and #85 respectively has decreased in conspicuity. Bandlike density within the left upper lobe best seen on series #202 image #132 is stable. No new lesions are identified. HEART / VESSELS: Severe coronary artery calcifications. The aorta is normal in caliber. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: Enlarged right hilar lymph node measuring 11 x 12 mm. Top normal subcarinal lymph node measuring 10 x 18 mm, stable. CHEST WALL: No significant abnormality. UPPER ABDOMEN: See separate abdominal dictation. MUSCULOSKELETAL: No destructive osseous lesions.	FINDINGS: HEAD: The gray-white matter differentiation is intact. There is no evidence of acute infarct, hemorrhage, mass or mass effect. The ventricular system and extra-axial spaces appear normal. No calvarial fracture is identified. There is mild mucosal thickening in the bilateral maxillary and ethmoid sinuses. The mastoid air cells are partially opacified bilaterally. ATLANTODENTAL INTERVAL: Normal (
2,339	EXAM: CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: Lung cancer restaging COMPARISON: 12/28/2021 TECHNIQUE: CT Abdomen and Pelvis w contrast. Patient weight: 187 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 75 ml. IV contrast injection rate: 2.50 ml per sec. Scan delay: 86 sec. Scan field of view: 409 mm. FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Diffuse atherosclerosis. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Prostatomegaly with coarse calcification. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Small lucent areas in the lower thoracic spine series 202 image 248, similar to prior. Degenerative changes in the spine. CONCLUSION: 1. No new metastatic disease in the abdomen or pelvis. 2. Other incidental and noncontributory findings as described above. Chest findings to be dictated separately; please see separate chest CT report same day.	FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Diffuse atherosclerosis. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Prostatomegaly with coarse calcification. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Small lucent areas in the lower thoracic spine series 202 image 248, similar to prior. Degenerative changes in the spine.	FINDINGS: LOWER NECK: Heterogeneous thyroid without dominant nodule. CHEST: LUNGS / AIRWAYS / PLEURA: Scattered subsegmental atelectasis. HEART / VESSELS: Mild calcified atherosclerosis, including coronary atherosclerosis. Trace pericardial effusion. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: Healing/healed right 8th through 11th rib fractures. ABDOMEN and PELVIS: LIVER: Subcentimeter hypoattenuating lesion near the anterolateral dome, likely cyst. Riedel lobe. Calcified left lobe granuloma. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Calcified posterior granuloma. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Diverticula without inflammation. Appendix is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Mild scattered calcified atherosclerosis without aneurysm. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus is absent. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. THORACIC SPINE: VERTEBRA: Mild anterior wedging of T5 and T6. T10 butterfly vertebra is noted. DISC SPACES AND FACET JOINTS: No acute injury. Mild degenerative changes. ALIGNMENT: Mild focal kyphosis at T10-T11. LUMBAR SPINE: VERTEBRA: No fracture. L4-S1 posterior arthrodesis and laminectomy changes. No hardware complication. DISC SPACES AND FACET JOINTS: No acute injury. Mild degenerative changes. ALIGNMENT: Normal.