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Cherry CT abdomen and pelvis with and without

TECHNIQUE: CT abdomen and pelvis with intravenous and oral contrast; 100 mL of Omnipaque 300 were administered. Precontrast images were obtained through the kidneys. Coronal and sagittal reconstructions are provided along with delayed images through the kidneys and urinary bladder.

FINDINGS: Precontrast images through the kidneys are without nephrolithiasis or calcified renal mass. After the administration of intravenous contrast, the kidneys are seen to enhance homogeneously and without mass or hydronephrosis. No perinephric fluid collection. There is no filling defect within the urinary bladder on the delayed images. No bladder calculus.

The imaged lung bases are clear.

Liver is without mass or ductal dilatation. Gallbladder is surgically absent. There is dilatation of the distal common bile duct at 9 mm. This may be related to postsurgical state. No obstructing stone or mass is identified. No peripancreatic inflammatory changes. This can be correlated with hepatic function test. The spleen is normal in size and appearance. Adrenal glands are normal. Aorta without aneurysm or dissection. No retroperitoneal adenopathy.

No bowel obstruction or evidence of inflammatory bowel process. No free air, free fluid or abscess. No adenopathy. No evidence of lumbar fracture.

CT ABDOMEN AND PELVIS WITHOUT (STONE PROTOCOL)

TECHNIQUE: CT abdomen and pelvis, stone protocol. No contrast. Coronal and sagittal reconstructions are provided.

COMPARISON: 01/28/2014.

FINDINGS: There is a 4 mm stone in the right ureter approaching the pelvic inlet. This results in a moderate hydronephrosis and hydroureter. Mild perinephric stranding on the right. No free fluid. Left kidney and ureter are unremarkable. No bladder calculus.

No bowel obstruction or free air. No abscess. Calcified gallstones again seen within the gallbladder without evidence of biliary tree dilatation. Aortobifemoral graft again noted in place. No lumbar fracture.

IMPRESSION: 4 mm stone in the right ureter approaching the pelvic inlet with resultant moderate hydronephrosis. No free fluid.

CHERRY MRI WRIST WITHOUT CONTRAST

TECHNIQUE: MRI of the right wrist, no contrast.

FINDINGS:

BONE AND JOINT SPACE: No fracture or osteonecrosis. There is widening of the scaphoid lunate interval. There is dorsal positioning of the distal ulna at the distal radial ulnar joint. There is moderate effusion of the distal radial ulnar joint and small effusion of the radial carpal joint. Trace fluid at mid carpal joint spaces.

At the edge of the study, there is noted to be increased T2 signal with somewhat ill-defined borders within the marrow space of distal radial shaft over a length of 13 mm. No end ostial scalloping or adjacent soft tissue mass. Recommend correlation with radiographs. If there is known history of malignancy, would recommend further assessment with bone scan. This may require at the least, MRI followup in 2-3 months.

TRIANGULAR FIBROCARTILAGE: Small perforation or tear within the main disc approaching the radial insertion. There is at least a moderate sprain involving the volar radial ulnar ligament near the ulnar insertion.

LIGAMENTS: There is tear involving the central portion of the scapholunate ligament and at least a moderate sprain of the volar component. There is also capsular sprain on radial side of wrist. Edema over dorsum of wrist greater on the radial side also compatible with an extrinsic ligament sprain.

TENDONS: No tendon tear or tenosynovitis. No significant tendinopathy.

OTHER: No soft tissue mass or ganglion. Contents of the carpal tunnel are within normal limits.

IMPRESSION: Multifocal abnormality as above.

Cherry MRI lumbar without contrast.

PROCEDURE: MRI of the lumbar spine. No contrast.

FINDINGS: AP alignment is within normal limits. There is multilevel spondylosis. Spur formation is more prominent anteriorly at the L3-4 and L1-2 levels. No fracture or infiltrative marrow disorder. There is a small Schmorl's node and adjacent type 1 endplate change at the inferior endplate of L4. There is increased disc space signal at T11-12 and T10-11 that is either degenerative or potentially calcification. The conus terminates at lower L1 level and is unremarkable.

Aorta without aneurysm. No retroperitoneal adenopathy

L1-2: No posterior disc herniation or canal stenosis.

L2-3: Generalized disc bulge without focal herniation. When combined with congenital narrowing and hypertrophic change of the posterior elements results in a mild central canal stenosis and bilateral mild recess stenosis.

L3-4: Generalized disc bulge without posterior disc herniation. There is severe degenerative change at left facet joint and moderate degenerative change at right facet joint. When combined with congenital narrowing, results in a mild central canal stenosis.

L4-5: Disc bulge with a superimposed central and right paracentral protrusion that have mass effect upon the thecal sac with borderline mild central canal stenosis. There is a mild bilateral recess stenosis. Mild foraminal narrowing bilaterally.

L5-S1: No posterior disc herniation. There is small annular tear at rightward location. No canal stenosis. Moderate degenerative change at the facet joints bilaterally. No evidence of nerve root compromise.

IMPRESSION

Cherry MRI cervical without contrast

TECHNIQUE: MRI of the cervical spine. No contrast.

COMPARISON: None available.

FINDINGS: There is minimal posterior offset of C4 upon C5 which is on a degenerative bases. There is solid fusion across the C6-7 disc space. No fracture or infiltrative marrow disorder. No cord edema or syrinx. No tonsillar ectopia.

C2-3: No disc herniation or canal stenosis.

C3-4: Minimal posterior spur formation. No focal disc herniation or canal stenosis. There is mild foraminal narrowing on the right related to lateral spur.

C4-5: Posterior osteophyte and disc complex asymmetric towards to the right subtly effacing the right ventral margin of the cord and contributing to a mild central canal stenosis. There is bilateral foraminal narrowing of at least moderate degree on right and mild foraminal narrowing on the left.

C5-6: Posterior osteophyte and disc complex is asymmetric towards the right contacting the right ventral margin of the cord, but no effacement. Borderline mild central canal stenosis. Moderate foraminal narrowing on the right and mild narrowing on the left.

C6-7: No posterior spur formation or canal stenosis. No foraminal stenosis.

C7-T1: There is disc herniation posteriorly and centrally with minimal cranial extension. There is no canal stenosis or foraminal stenosis.

IMPRESSION:

Cherry MRI knee without contrast.

TECHNIQUE: MRI of the ________ knee. No contrast.

FINDINGS:

MENISCI: There is complex tear involving a long segment of the posterior horn of the medial meniscus. Tear is primarily a vertically oriented longitudinal tear with communication to both the superior and inferior surfaces. There is additional horizontal tear to the inferior surface that communicates with a peripheral nonarticular margin, but no appreciable meniscal cyst. No centrally displaced fragment. Tear continues to body level primarily as obliquely oriented signal to the inferior surface. Anterior horn intact.

Lateral meniscus is without tear.

LIGAMENTS AND TENDONS: There is rupture of the anterior cruciate ligament. Posterior cruciate ligament intact. There is edema along the medial collateral ligament compatible with a mild sprain. This includes deeper capsular injury, possibly meniscofemoral ligament injury at body and posterior medial corner level. Fibular collateral ligament and posterior lateral corner appear to be intact. Extensor tendons are intact.

BONE AND CARTILAGE: The patella is normally located. No focal patellar cartilage defect.

Moderate area of marrow contusion posteriorly at the lateral tibial plateau and small area of marrow contusion middle third of lateral femoral condyle. Moderate contusion posteriorly of the medial tibial plateau with probable posteromedial capsule sprain. Small area of contusion or tug-related edema at the peripheral nonarticular margin of medial femoral condyle.

JOINT SPACE AND SOFT TISSUES: Moderate size knee joint effusion. There is debris or possibly small loose body located posteriorly adjacent to the distal insertion of PCL. No hematoma. There is strain or contusion of the popliteus muscle.

IMPRESSION:

CHERRY MRI SHOULDER WITHOUT CONTRAST.

TECHNIQUE: MRI of __________ shoulder. No contrast.

FINDINGS:

ROTATOR CUFF: There is severe diffuse tendinopathy of the supraspinatus and infraspinatus with large areas of ill-defined interstitial nonretracted tear with area of communication to both the bursal and articular surfaces. There is moderate muscle atrophy. There is cyst or ganglion centrally at the superior border of the supraspinatus measuring 2 cm x 0.8 cm. There is tendinopathy and chronic partial tear of the subscapularis.

SUPRASPINATUS OUTLET: There is marked hypertrophic and inflammatory change of the acromioclavicular joint with chronic reabsorption of the distal clavicle. Subacromial spur formation likely contributing to some impingement. There is a moderate subacromial and subdeltoid bursitis.

LONG HEAD BICEPS TENDON: Severe tendinopathy with at least partial tear. Intracapsular segment not well visualized and probably torn.

LABRUM: Multifocal degenerative tear throughout the labrum.

BONE: Advanced joint space narrowing with remodeling of the glenoid medial joint. There is subchondral edema, sclerosis and cyst-like changes on both sides. There is joint effusion with synovitis. There is large subscapular recess collection of fluid.

IMPRESSION:

CHERRY KNEE XRAY

______ knee, three views.

FINDINGS: No fracture or malalignment. No significant joint space narrowing on these nonweightbearing views. No knee joint effusion. No erosion or periostitis. No foreign body or soft tissue gas.

IMPRESSION: No fracture or destructive bony process.

CHERRY ANKLE XRAY

__________ ankle, three views.

FINDINGS: No malleolar fracture. No evidence of talar dome lesion. No tibiotalar effusion. Subtalar facet joints appear to be patent. No foreign body or soft tissue gas.

IMPRESSION: No fracture or destructive bony process.

CHERRY FOOT XRAY

_________ foot, three views.

FINDINGS: No evidence of fracture or malalignment. No epiphyseal displacement. No foreign body or soft tissue gas. No erosion or periostitis.

IMPRESSION: No foot fracture.

CHERRY SHOULDER XRAY

________shoulder, three views.

FINDINGS: No fracture or malalignment. There is no appreciable degenerative change. No calcific tendinopathy.

IMPRESSION: No fracture or destructive bony process.

CERVICAL SPINE

Cervical spine, two views.

FINDINGS: No subluxation or fracture. No significant disc space narrowing. Prevertebral soft tissues are within normal limits.

IMPRESSION: No fracture or any significant degenerative change.

LUMBAR SPINE

Lumbar spine flexion and extension.

Lumbar spine, two views.

FINDINGS: AP alignment within normal limits. No abnormal motion with flexion or extension. No evidence of fracture. Spondylosis with anterior spur formation present at T12-L1.

FINDINGS: No subluxation or fracture. No significant disc space narrowing. Vertebral body heights are maintained. No significant degenerative change at the facet joints. Sacroiliac joints are patent. No pelvic tilt.

IMPRESSION: No abnormal motion with flexion or extension.

IMPRESSION: No fracture or significant degenerative change.

CHERRY THORACIC SPINE XRAY

Thoracic spine, two views.

FINDINGS: No subluxation or fracture. No significant disc space narrowing. No evidence of paraspinal soft tissue mass or posterior rib fracture.

IMPRESSION: No fracture or any significant degenerative change.

CHERRY HIP ARTHROGRAM W/INJECTION

FINDINGS: Scout radiograph without fracture or malalignment. No appreciable joint space narrowing. No calcific tendinopathy.

Arthrogram performed from an anterior approach using sterile technique, local anesthetic and a 20-gauge spinal needle under fluoroscopic guidance. 30 seconds of fluoroscopy time. 15 mL of contrast material injected (0.3 mL Magnevist 20 mL of Omnipaque 240) No loose body identified.

IMPRESSION: Right hip arthrogram with MRI to follow.

CHERRY KNEE ARTHROGRAM W/INJECTION

FINDINGS: Scout radiograph without fracture or malalignment. No appreciable knee joint effusion.

Arthrogram performed using sterile technique, local anesthetic and a 25-gauge needle under fluoroscopic guidance. Needle was positioned laterally at the patellofemoral compartment with 20 mL contrast material injected. No loose body identified.

IMPRESSION: No loose body. MRI to follow.

CHERRY Wrist Arthrogram (Right) 73115 w/injection 25246

FINDINGS: Scout radiograph demonstrates advanced degenerative change at the first carpal metacarpal joint. No acute fracture.

Timeout procedure performed. Using sterile technique, local anesthetic and a 25-gauge butterfly needle, arthrogram performed dorsally at the radioscaphoid space under fluoroscopic guidance. 2 mL of contrast material was injected. Contrast seen communicating to the mid carpal and distal radial ulnar joint spaces.

IMPRESSION: Contrast communicating to the mid carpal and distal radial ulnar joint spaces. MRI to follow.

CHERRY Shoulder Arthrogram (Right) 73040 w/injection 23350

FINDINGS: Scout radiograph is without fracture or malalignment. There is hypertrophic degenerative change at the acromioclavicular joint. No calcific tendinopathy. Arthrogram was performed from an anterior approach using sterile technique, local anesthetic and a 20-gauge spinal needle under fluoroscopic guidance. 30 seconds of fluoroscopy time. 12 mL of contrast material was injected (0.3 mL of Magnevist and 10 mL of Omnipaque 240). There is no communication of contrast subacromial bursa to indicate a full thickness rotator cuff tear.

IMPRESSION: No evidence of full thickness rotator cuff tear. MRI to follow.

CHERRY TESTICULAR ULTRASOUND

FINDINGS: The right testicle measures 5.2 x 3.7 x 2.7 cm. Left testicle measures 4.8 x 3.1 x 2.7 cm. Both testicles are homogeneous in their appearance and without mass. There is symmetric vascular flow bilaterally.

Small (5 mm) benign cyst head of left epididymis. There is no increased vascular flow to indicates epididymitis. No hydrocele or varicocele.

IMPRESSION: 5 mm epididymal cyst on the left. Otherwise unremarkable.

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