Sma Rad Manekshah - 10 18 2019 - 36 Files Edited

ACCESSION #: 8444379 - BILATERAL DIAGNOSTIC MAMMOGRAM
COMPARISON: 09/12/2018.
FINDINGS:
DENSITY CATEGORY: B - There are scattered fibroglandular densities.
There is a mass in the left upper-outer quadrant of the left breast biopsy-proven malignancy. The
patient is undergoing neoadjuvant therapy for known breast carcinoma. The mass is smaller than on
the prior exam from last year. There are decreased number of microcalcifications regionally
distributed in the left upper-outer quadrant. There is no new mass identified. There is no significant
interval change in the contralateral right breast compared with last year's exam.
IMPRESSION: BIRADS CATEGORY: 6 - Known biopsy proven malignancy.
1. Known left breast carcinoma. The mass is smaller than on last year's mammogram.
2. Decreased microcalcifications compared with last year's exam.
3. Ultrasound evaluation of the left breast mass is pending at this time. Refer to the ultrasound
report for additional findings and recommendations.
A negative/benign mammogram should not dissuade biopsy if clinical findings warrant. 10-15% of
lesions may be missed on mammogram, especially in dense breast tissue.
Transcribed: 10/17/2019 by sha

ACCESSION #: 8430129 - LEFT KNEE, FIVE VIEWS
TECHNIQUE: Five views of the left knee.
FINDINGS: Five views of the left knee show no fracture, dislocation, or other bone or joint injury.
The articular surfaces and joint spaces are well preserved. Mineralization is normal.
IMPRESSION: Negative left knee.

ACCESSION #: 8444080 - BILATERAL SCREENING MAMMOGRAM
COMPARISON: 08/10/2017 and 01/25/2016.
TECHNIQUE: CAD is utilized.
FINDINGS:
No developing masses, significant calcifications, or other abnormalities are seen.
IMPRESSION: Benign, no evidence of malignancy. Normal interval follow up is recommended in

twelve months.
BIRADS CATEGORY: 2 - Benign.

ACCESSION #: 8439186 - CT CHEST, ABDOMEN AND PELVIS WITHOUT AND WITH
CONTRAST
TECHNIQUE: CT scan of the chest, abdomen and pelvis without and with contrast.
FINDINGS: The lung bases demonstrate some mild discoid atelectatic change on the left. No
infiltrates or effusions present. No lung nodules or masses are seen.
The heart is normal in size. No pericardial effusion is present. Mild atherosclerosis of the coronary
arteries and aorta is seen. A port is implanted on the right.
Thyroid gland is mildly enlarged and mildly heterogeneous without dominant mass. No mediastinal
or hilar adenopathy is seen. No axillary adenopathy is demonstrated.
Liver and spleen are normal in size and demonstrate normal enhancement. The gallbladder and
pancreas are normal in appearance. The adrenal glands are normal in appearance.
The kidneys demonstrate small cyst in the upper pole of left kidney. No kidney stones are seen. No
hydronephrosis is present.
Mild atherosclerosis of the aorta is seen. IVC is normal in appearance. No retroperitoneal or pelvic
adenopathy is seen.
Pelvis is obscured by beam-hardening artifact from bilateral hip prostheses. Bladder is

incompletely imaged. Penile implant device is present.
Bone windows demonstrate some subtle sclerotic changes in the right and left iliac bone consistent
with metastatic disease. Diffuse spondylosis of the thoracic spine is seen.
IMPRESSION:
1. Prostate, bladder and pelvis are not well defined due to beam-hardening artifact from hip
prostheses.
2. Penile implant is present.
3. Tiny left renal cyst.
4. Blastic bone metastatic disease to the right and left iliac bone is seen.
5. Mild atherosclerosis is present.

ACCESSION #: 8432796 - CT ABDOMEN WITHOUT AND WITH CONTRAST
TECHNIQUE: CT scan of the abdomen without and with IV contrast. Multiphase postcontrast
imaging through the abdomen as per hepatic imaging protocol. Oral contrast administered for this
study.
COMPARISON: Right upper quadrant ultrasound dated 09/19/2019.
FINDINGS:
Lung bases are clear. Normal heart size.
Abdomen: Spleen appears normal. Adrenal glands appear normal. Left kidney appears normal.
Right parapelvic renal cysts. Pancreas appears normal. Cholecystectomy. Stomach and duodenum
appear normal. Visualized bowel loops appear normal. The appendix appears normal. No
adenopathy is seen. No ascites is seen.
There is a cyst seen in the left hepatic lobe at segment II. On series 5 image #18 this measures 1.2
cm. This corresponds with the cyst seen on the previous ultrasound study.
No osseous lesion is seen.
IMPRESSION:
1. No acute-appearing abnormality is seen.
2. Small cyst in the left hepatic lobe.
3. Right parapelvic renal cyst.

ACCESSION #: 8435401 - CERVICAL SPINE, FIVE VIEWS
FINDINGS: Fusion of C5 and C6. There are modest osteophytes at C4-C5 and C6-C7. There is
narrowing of the C6-C7 intervertebral disc space. There is narrowing of the C4-C5, C5-C6, and C6-
C7 neural foramina on the left and narrowing of the C5-C6 and C6-C7 neural foramina on the right.
IMPRESSION: Moderate to marked degenerative osteoarthritic changes with fusion of C5-C6 and
marked degenerative disc disease at C6-C7.

COMPARISON: 08/16/2017 and 08/24/2015.
FINDINGS:

twelve months.

COMPARISON: 09/21/2018 and 09/20/2017.
FINDINGS:

twelve months.

ACCESSION #: 8439114 - CT SINUSES
FINDINGS: Frontal sinuses are well aerated. Ethmoid air cells also are well aerated. No mucosal
thickening is seen.
Mucosal thickening is seen in the floor of the right maxillary sinus. The right maxillary accessory
antral window is present. The right and left ostiomeatal units are patent.
Concha bullosa of the left middle nasal turbinates is seen. Diffuse thickening of the septum and
turbinates is present.
Postoperative changes of the previous pituitary surgery are seen. Opacification of the sphenoid
sinuses is demonstrated. Sphenoid sinus changes are unchanged from previous exam from 2013.
IMPRESSION:
1. Postoperative changes of the pituitary gland with opacification of the sphenoid sinuses. This
appears chronic and unchanged.
2. Right maxillary sinus mucosal thickening.
3. Left concha bullosa.
4. Thickening of the nasal turbinates and septum is seen.

ACCESSION #: 8439377 - RIGHT FOOT, THREE VIEWS
TECHNIQUE: Three views of the right foot.
FINDINGS: Three views obtained of the right foot show no fracture, dislocation, or other bone or
joint injury. Mineralization is normal. The articular surfaces and joint spaces are preserved.
IMPRESSION: Negative right foot.

ACCESSION #: 8434567 - UGI/ESOPHAGRAM
FINDINGS: There is mild proximal escape. The esophageal peristalsis is otherwise unremarkable.
There is mild gastroesophageal reflux during provocative maneuvers including Valsalva. There is
normal gastric peristalsis. The esophagus demonstrates no evidence of stricture, ulceration, or
filling defect. There is no hiatal hernia. The gastric rugal fold pattern appears within normal limits.
There is no evidence of stricture or ulceration. The duodenal bulb and sweep appear unremarkable.
The visualized proximal small bowel appears unremarkable with normal fold pattern and fold
thickness.
IMPRESSION: Mild gastroesophageal reflux and mildly disordered esophageal peristalsis, as

above. Otherwise unremarkable double contrast upper GI.

ACCESSION #: 8421144 - CT SINUSES
FINDINGS: Complete opacification of the left frontal sinus is present with obstruction of the left
frontoethmoidal recess. The right frontal sinus is normal in appearance. Right frontoethmoidal
recess is patent.
Marked opacification of anterior and middle left ethmoid air cells is seen. Posterior left ethmoid air
cells are well aerated. Right ethmoid air cells are normal in appearance.
The sphenoid sinuses are unremarkable.
Complete opacification of the left maxillary sinus is seen. Obstruction of the ostiomeatal unit is
present. This appears to be expanded suggesting chronic change.
Right maxillary sinus and right ostiomeatal unit is normal in appearance.
Temporal bones are unremarkable.
IMPRESSION:
1. Marked sinus disease involving the left frontal sinus, left ethmoid air cells, left maxillary sinus
with obstruction of the ostiomeatal unit.
2. Right septal deviation with thickening of the nasal turbinates.

ACCESSION #: 8448880 - THORACIC SPINE SERIES
FINDINGS: Mild diffuse degenerative disk disease and spurring throughout the thoracic spine is
seen. No fractures or subluxations are demonstrated. No lytic or blastic bone change is identified.
Mild degenerative changes of the cervical spine are seen as well.
IMPRESSION: Diffuse degenerative changes.

ACCESSION #: 8439390 - LEFT CALCANEUS, TWO VIEWS
FINDINGS: Lateral and axial views of the left calcaneus show no fracture or other bony pathology.
Mineralization is normal. The articular surfaces and joint spaces are preserved.
IMPRESSION: Negative left calcaneus.

ACCESSION #: 8417191 - UGI/SMALL BOWEL FOLLOWTHROUGH
FINDINGS: There is normal esophageal peristalsis. No evidence of stricture, ulceration, or filling

defect. The gastric peristalsis appears mildly delayed and diminished. The gastric rugal fold pattern
appears unremarkable. There is no evidence of ulceration, stricture, or filling defect. The duodenal
bulb and sweep appear unremarkable. Small bowel demonstrates normal fold pattern and fold
thickness. There is a small hiatal hernia with mild to moderate spontaneous gastroesophageal
reflux. The small bowel demonstrates normal fold pattern and fold thickness. The terminal ileum
appears normal. There is no evidence of stricture, ulceration, or filling defect. There is no evidence
of fistula or abnormal separation of bowel loops. The small bowel transit time is one hour.
IMPRESSION: Small hiatal hernia with mild to moderate spontaneous gastroesophageal reflux.
Otherwise, unremarkable upper GI with small bowel followthrough.

ACCESSION #: 8439391 - LUMBOSACRAL SPINE, THREE VIEWS
FINDINGS: There is generalized demineralization of the osseous structures. Vertebral body heights
and intervertebral disc spaces are unremarkable. No fractures are identified.
IMPRESSION: Demineralization, possibly secondary to osteoporosis or osteopenia.

ACCESSION #: 8439392 - CERVICAL SPINE SERIES
FINDINGS: There are modest osteophytes at C3, C4, C5 and C6. There is mild narrowing of the
C5-C6 intervertebral disk space. There is mild narrowing of the neural foramen at C5-C6.
IMPRESSION: Mild degenerative changes, predominantly involving C5-C6 with osteophyte

formation, degenerative disk disease and neural foraminal narrowing. Findings have remained
stable since the prior examination of 2017.

ADDENDUM:
COMPARISON: Prior mammograms dated 08/12/2009 and 01/31/2008 have become available in
the interval for comparison.
FINDINGS: In comparison to these prior mammograms, there have been no significant interval
changes, therefore the amended BIRADS category remains,
BIRADS CATEGORY: 1 - Negative.

ADDENDUM:
COMPARISON: In the interval, comparison examinations dated 10/09/2017 and 09/30/2015 have
become available for comparison.
In comparison to these prior mammographic examinations, there have been no significant interval
changes, therefore the amended BIRADS category remains,

ACCESSION #: 8439491 - RIGHT HAND SERIES
FINDINGS: There is modest periarticular demineralization and erosion of the ulnar styloid process.
Joint spaces are unremarkable.
IMPRESSION: Findings are compatible with inflammatory arthritis.

ACCESSION #: 8439498 - RIGHT HAND SERIES
FINDINGS: There is mild demineralization of the osseous structures. Joint spaces are
unremarkable. No fractures are identified.
IMPRESSION: Demineralization, probably secondary to osteoporosis or osteopenia.

COMPARISON: 10/03/2017, 09/19/2017, 01/25/2016 and 12/07/2015.
FINDINGS:

twelve months.

ACCESSION #: 8425326 - CT NECK WITH CONTRAST
TECHNIQUE: CT soft tissue neck following administration of intravenous contrast.
COMPARISON: Prior study of thyroid ultrasound performed on 02/18/2019.
FINDINGS: Base of brain appears normal. Parotid glands appear normal. The submandibular
glands appear normal. The epiglottis appears normal. Prominence of the lingual tonsils. The glottis
appears normal. The lung apices are clear. Slight emphysema suggested in the lung apices, correlate
for any smoking history.
Small scattered cervical lymph nodes are present, which are not pathologically enlarged.
There is massive enlargement of the thyroid gland. The thyroid gland is diffusely heterogeneous.
There is mild nodularity of the thyroid gland, refer to the previous dedicated thyroid ultrasound
exam report. The thyroid isthmus measures 21 mm AP. The right thyroid lobe measures 10.4 cm
craniocaudal. The left thyroid lobe measures 10.0 cm craniocaudal.
IMPRESSION: Massive thyroid gland enlargement. There is also heterogeneity as well as some
nodularity in the thyroid gland.

ACCESSION #: 8439357 - LUMBOSACRAL SPINE, THREE VIEWS
COMPARISON: Comparison is made with prior examination of 2005.
FINDINGS: There is mild curvature of the lumbar spine with the concavity on the right. Modest
demineralization of the osseous structures. There are mild osteophytes at L2, L3, L4 and L5 and
modest osteophytes at T11, T12 and L1. Vertebral body heights and intervertebral disc spaces are
maintained.
IMPRESSION:
1. Modest degenerative osteophytic changes.
2. Demineralization, probably secondary to osteoporosis or osteopenia.
3. Mild curvature of the lumbar spine with concavity on the right.

ACCESSION #: 8436101 - GALLBLADDER/LIVER ULTRASOUND
TECHNIQUE: Right upper quadrant ultrasound.
COMPARISON: Compared with an old ultrasound from May 2013 and also reviewed with the
more recent CT from 03/22/2019.
FINDINGS: Liver length measured at 15.7 cm. Right lobe small subcentimeter lesions possibly
small cysts. No right renal lesion identified. There may be a small amount of fluid present in the
hepatorenal space. The right renal cortical parenchyma is isoechoic to the liver suggesting the
possibility of renal parenchymal disease. Sludge is suggested in the gallbladder. No biliary ductal
dilatation identified. Portal vein diameter 9 mm. No visible pancreas mass.
IMPRESSION:
1. Suspect gallbladder sludge.
2. Trace fluid may be present in the hepatorenal space, Morison’s pouch region.
3. Subcentimeter probably tiny cystic lesions in the liver.
4. See additional comments in the body of the report.

ACCESSION #: 8439571 - CHEST, TWO VIEWS
FINDINGS: PA and lateral views of the chest show the cardiovascular and mediastinal silhouettes
to be normal in size, contour, and position. Both lungs are well expanded and free of infiltrate,
pleural effusion, pneumothorax, or other significant abnormality. There are modest osteophytes
noted throughout the thoracic spine.
IMPRESSION: Negative chest.

ACCESSION #: 8437012 - CT ABDOMEN AND PELVIS WITHOUT CONTRAST
TECHNIQUE: CT scan of the abdomen and pelvis without contrast.
FINDINGS: Lung bases are free of infiltrate and effusion. No lung nodules are present. No
bronchiectasis or atelectasis is seen.
The liver is normal in size. A small cyst in the right lobe appears unchanged. Gallbladder, spleen
and pancreas are normal in appearance.
Adrenal glands are unremarkable.
The right kidney is normal in size and appearance. The left kidney demonstrates marked cortical
scarring. Marked lobulation is seen. A small stone in the lower pole of the left kidney is unchanged.
Focal cortical scarring is seen and this calcification could be within a calyx or parenchyma. No
hydronephrosis or acute ureteral obstruction is seen.
The bladder is normal in appearance.
No bowel obstruction or distention is seen. Diverticular changes are present.
The aorta and IVC are normal in size. No retroperitoneal adenopathy is present.
Dextroscoliosis of the lumbar spine is seen. Diffuse degenerative changes are present.
IMPRESSION:
1. Left renal cortical scarring and small left renal calcification or stone is unchanged.
2. Diverticular changes of the colon are present.
3. Dextroscoliosis and diffuse degenerative changes are present.
4. Stable small hepatic cyst.

ACCESSION #: 8439544 - RIGHT FOOT, THREE VIEWS
TECHNIQUE: Three views of the right foot.
FINDINGS: No acute fractures are identified. There are mild degenerative changes of the first
cuneiform metatarsal joint with osteophytes noted posteriorly. There is a modest plantar spur.
IMPRESSION: Mild degenerative changes, otherwise unremarkable exam.

ACCESSION #: 8438224 - BILATERAL SCREENING MAMMOGRAM WITH IMPLANTS
COMPARISON: 09/27/2018, 08/22/2017, 08/16/2016 and 06/23/2015.
FINDINGS:
DENSITY CATEGORY: C - The breast tissue is heterogeneously dense, which could obscure
detection of small masses.
Bilateral breast implants are noted. On the right mediolateral oblique projection mammogram, there
is significant motion artifact. There is also motion artifact on the craniocaudal projection
mammogram to a lesser degree. These should be repeated. The implant displaced views and the left
mammographic images do not have significant motion artifact.
There is no suspicious cluster of microcalcifications or masses.
IMPRESSION: BIRADS CATEGORY: 0 - Incomplete. Needs additional imaging evaluation.
Recommend repeat right mediolateral oblique and craniocaudal projection images in the implant-
included views.

ACCESSION #: 8438571 - CT CHEST WITHOUT CONTRAST
TECHNIQUE: CT scan of the chest without contrast.
COMPARISON: None.
FINDINGS: No active airspace or pleural disease. There is nonspecific dependent atelectasis. Faint
8 mm ground-glass opacity in the right upper lobe abutting major fissure on image #33 series 8.
Right upper lobe subpleural 5 mm noncalcified outside nodule on image #36 series 8. A 3 mm
subpleural noncalcified nodule at the peripheral margin of the right major fissure on image #39
series 8. With prone imaging, the previous areas of dependent atelectasis resolved. No air trapping
identified. Some mild right lower lobe discoid atelectasis or scarring noted. High-resolution images
do not demonstrate bronchiectasis or a diffuse pattern of nodules or septal thickening.
No axillary, mediastinal or hilar adenopathy. Thoracic aortic caliber is normal. Heart size is normal.
No pericardial effusion. No adrenal nodules. Inferior margin of the liver demonstrates a small
hypodensity that is too small to optimally characterize with diameter of 1.3 cm. Multilevel
degenerative changes of the spine are noted without acute finding.
IMPRESSION:
1. Right lung 9 mm ground-glass nodule. Recommend followup CT chest in six to twelve months
using current Fleischner Society guidelines.
2. Nonspecific subpleural nodules in the right lower lung, maximum diameter 5 mm. These could
be reassessed at time of recommended followup in six- to twelve-month CT examination.

COMPARISON: 09/04/2018 and 08/31/2017.
FINDINGS:
DENSITY CATEGORY: A - The breast is almost entirely fat.

twelve months.

ACCESSION #: 8439634 - SACROILIAC JOINT SERIES
FINDINGS: Multiple views of the sacroiliac joints show them symmetrical and patent bilaterally.
There is no evidence of fracture or sclerosis. The soft tissues are unremarkable.
IMPRESSION: Negative sacroiliac joints.

COMPARISON: 10/11/2018, 09/13/2017, 05/31/2016, and 05/26/2015.
FINDINGS:
IMPRESSION: Negative. No evidence of malignancy. Normal interval followup is recommended

in twelve months.
BIRADS CATEGORY: 1 - Negative.

COMPARISON: None.
FINDINGS:

twelve months.

COMPARISON: 10/25/2017 and 10/24/2016.
FINDINGS:

twelve months.

ACCESSION #: 8448561 - CT ABDOMEN AND PELVIS WITH CONTRAST
TECHNIQUE: CT scan of the abdomen and pelvis performed with IV contrast. No oral contrast is
seen.
FINDINGS: Cuts through the included lung bases demonstrate no consolidating infiltrates or
effusions. Small amounts of platelike atelectasis noted.
Multiple liver lesions of unknown origin are noted. These do not appear to be typical of cysts.
These require followup. They may be hemangiomas; however, lesions of unknown other origin
cannot be excluded. Recommend followup MRI liver protocol. Suspect splenomegaly. No adrenal
lesion identified. No pancreas lesion identified. Clips from cholecystectomy are apparent.
Moderate amount of fluid noted in the urinary bladder. Numerous calcifications in the pelvis are
noted. Uterus is not identified. Please correlate with surgical history.
Bowel evaluation is limited without oral contrast. Retained feces throughout the colon. The
appendix does not appear inflamed.
No bony destruction identified. There is a grade 2 anterolisthesis L5 with respect to S1 with

vacuum phenomenon and note made of bilateral pars interarticularis defects.
Additional evaluation of the lung bases demonstrates question pericardial effusion.
IMPRESSION:
1. Liver lesions of unknown origin, possibly hemangiomas, but this need to be confirmed.
Recommend MRI liver protocol.
2. Suspect splenomegaly.
3. Retained feces.
4. L5-S1 anterolisthesis and degenerative change.
5. Question pericardial effusion.

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ACCESSION #: 8444379 - BILATERAL DIAGNOSTIC MAMMOGRAM

DENSITY CATEGORY: B - There are scattered fibroglandular densities.

IMPRESSION: BIRADS CATEGORY: 6 - Known biopsy proven malignancy.

2. Decreased microcalcifications compared with last year's exam.

Transcribed: 10/17/2019 by sha

TECHNIQUE: Five views of the left knee.

IMPRESSION: Negative left knee.

Transcribed: 10/17/2019 by sha

COMPARISON: 08/10/2017 and 01/25/2016.

TECHNIQUE: CAD is utilized.

DENSITY CATEGORY: B - There are scattered fibroglandular densities.

No developing masses, significant calcifications, or other abnormalities are seen.

IMPRESSION: Benign, no evidence of malignancy. Normal interval follow up is recommended in

BIRADS CATEGORY: 2 - Benign.

Transcribed: 10/17/2019 by sha

Pelvis is obscured by beam-hardening artifact from bilateral hip prostheses. Bladder is

2. Penile implant is present.

3. Tiny left renal cyst.

5. Mild atherosclerosis is present.

Transcribed: 10/17/2019 by sha

COMPARISON: Right upper quadrant ultrasound dated 09/19/2019.

Lung bases are clear. Normal heart size.

No osseous lesion is seen.

1. No acute-appearing abnormality is seen.

2. Small cyst in the left hepatic lobe.

3. Right parapelvic renal cyst.

Transcribed: 10/17/2019 by sha

Transcribed: 10/17/2019 by sha

COMPARISON: 08/16/2017 and 08/24/2015.

TECHNIQUE: CAD is utilized.

DENSITY CATEGORY: B - There are scattered fibroglandular densities.

No developing masses, significant calcifications, or other abnormalities are seen.

IMPRESSION: Benign, no evidence of malignancy. Normal interval follow up is recommended in

BIRADS CATEGORY: 2 - Benign.

Transcribed: 10/17/2019 by sha

COMPARISON: 09/21/2018 and 09/20/2017.

TECHNIQUE: CAD is utilized.

DENSITY CATEGORY: B - There are scattered fibroglandular densities.

No developing masses, significant calcifications, or other abnormalities are seen.

IMPRESSION: Benign, no evidence of malignancy. Normal interval follow up is recommended in

BIRADS CATEGORY: 2 - Benign.

Transcribed: 10/17/2019 by sha

2. Right maxillary sinus mucosal thickening.

3. Left concha bullosa.

4. Thickening of the nasal turbinates and septum is seen.

Transcribed: 10/17/2019 by sha

TECHNIQUE: Three views of the right foot.

IMPRESSION: Negative right foot.

Transcribed: 10/17/2019 by sha

IMPRESSION: Mild gastroesophageal reflux and mildly disordered esophageal peristalsis, as

Transcribed: 10/17/2019 by sha

The sphenoid sinuses are unremarkable.

Right maxillary sinus and right ostiomeatal unit is normal in appearance.

Temporal bones are unremarkable.

2. Right septal deviation with thickening of the nasal turbinates.

Transcribed: 10/17/2019 by sha

Mild degenerative changes of the cervical spine are seen as well.

IMPRESSION: Diffuse degenerative changes.

Transcribed: 10/17/2019 by sha

IMPRESSION: Negative left calcaneus.

Transcribed: 10/17/2019 by sha

FINDINGS: There is normal esophageal peristalsis. No evidence of stricture, ulceration, or filling

Transcribed: 10/17/2019 by sha