37.111.134.

54
Shifa International Hospitals Ltd
Sector H-8/4 Islamabad.
+92518464646, 8463883, 8464610
-OPD- VERIFIED
@ 29/04/2023 13:45
MR# : 23015157
Name :SAMI ULLAH - Male 67 Y
Accession# :2304280948
Order By :Hira Asim @ 28/04/2023 18:20
Service :Chest,Abdomen And Pelvis (11965)
Perform By :Jawwad Ur Rehman @ 28/04/2023 19:13

CT CHEST ABDOMEN AND PELVIS

CLINICAL INFORMATION: Known case of pancreatic adenocarcinoma. ERCP on 18/2/2023. Post Whipple's procedure
on 17 March 2023. Rule out mets. eGFR 120.

TECHNIQUE: 2 mm reconstructed images obtained form multislice CT were reviewed on workstation in multiple
planes using different window width and level setting. CT chest abdomen and pelvis.

FINDINGS:

Comparison is made with prior CT scan dated 1/4/23 and 14/3/23.

CHEST:
Right lobe of thyroid gland is persistently enlarged with calcified noncalcified nodules in both lobes, larger on the
right.
Trachea and major bronchi are patent. Esophagus is unremarkable. Gastroesophageal junction is collapsed.
There is no significant supraclavicular or axillary lymphadenopathy.

Heart and major mediastinal vessels are normally contrast opacified. There is no pericardial effusion. Subcentimeter
mediastinal lymph nodes are again noted for reference largest right paratracheal lymph node measures
approximately 7 mm (image 2-86). Atherosclerotic calcifications of the arch of aorta renoted.

Subpleural reticulations are noted in the right lung middle and lower lobe and left lung anterior and lingular
segments.
Atelectasis is noted in the right lung middle lobe.
Prior noted cystic bronchiectatic changes in bilateral lung lower lobe are unchanged.
Multiple scattered 2-3 mm nodules in both lungs are noted and are stable in interval, for referenc right lung image
2-84, 90, 92, 108, 113, 117, 123, and on the left lung image 2-142, 127, 94.
Prior noted bibasal pleural thickening and reaction has resolved in interval.
There is no consolidation, collapse, pleural effusion or pneumothorax.

ABDOMEN AND PELVIS:

Status post Whipple's procedure with patent hepaticojejunostomy, pancreatojejunostomy and gastrojejunostomy
sites. Residual pancreas shows no definite enhancing mass or nodule. Soft tissue fullness/strandy changes in the
surgical bed have also reduced.

Previously seen mural, omental and mesenteric congestive changes along transverse colon show significant interval
decrease. Bilobed collection in midline area has also significantly resolved the interval with only residual reaction
and stranding abutting aorta and branches of the SMV. No new collection is noted in interval.

Prior noted small hypodensity in segment V of the liver remain stable in interval. No new enhancing lesion is
noted.There is interval resolution of prior noted pneumobilia. Interval mild reduction in periportal tracking is seen. No
intra-hepatic biliary dilation noted. Hepatic vasculature is patent.

Spleen and right adrenal is unremarkable. Left adrenal is persistently bulky. Gallbladder is not visualized consistent
with history of cholecystectomy.
Bilateral kidneys are of normal caliber with multiple renal cysts, stable in interval. Ureters are collapsed. No renal or
ureteric calculus is noted. Bladder is underdistended. Seminal vesicles are symmetrical. Prostate is enlarged with
internal calcifications.
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 Stomach is under distended. Small bowel loops are predominantly collapsed. Large bowel loops are fecal and air
filled.

There is no significant abdominopelvic ascites. Persistent diffuse omentomesenteric congestion is noted.

Subcentimeter mesenteric lymph nodes are noted. Major abdominal vasculature is preserved. No size significant
lymphadenopathy is seen

Degenerative changes are noted within visualized bones. Sclerosis along endplates and Schmorl's nodules at L2-L3
and superior endplate of L4 may represent acute Schmorl's nodules. No definite lytic or sclerotic concerning osseous
lesion.

IMPRESSION:

Status post Whipple procedure follow-upstudy.

- Patent hepaticojejunostomy, pancreatojejunostomy and gastrojejunostomy sites. No enhancing mass suggestive
of residual or recurrent disease. Interval decrease in soft tissue fullness and strandy changes in the surgical bed. No
significant lymphadenopathy or ascites.
- Resolution of bilobed collection in mid abdomen periaortic region.
- Significant interval decrease in mural, omental and mesenteric congestive changes along transverse colon.
- Stable small multiple bilateral pulmonary nodules.
- No definite abdominal visceralor osseous metastasis.
Continued follow-up is suggested.

Reported By Reviewed By
Dr. Khush Bakht Jabbar Dr. Fatima Moin

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