RADIATION AND ONCOLOGY FILES

RADIO_2

PORTABLE CHEST

The heart is enlarged.  Patchy infiltrates are present in both midlungs laterally.  There is no clear evidence of congestive heart failure.

The tip of the ET tube is at the clavicular level.  There is a nasogastric tube coiled in the stomach.  External cardiac monitors are present.

IMPRESSION

1.Cardimegaly without obvious congestive heart failure.

2.The pulmonary infiltrates most likely represent pneumonia, although patchy edema could produce this picture in the face of underlying obstructive lung disease.

PORTABLE CHEST

There is now widespread patchy air space disease throughout both lungs.

Heart remains enlarged.  Bony structures are diffusely osteoporotic.  The endotracheal tube and nasogastric tube have been removed.

IMPRESSION

1.Interval extubation.

2.The pulmonary signs are now most suggestive of diffuse pulmonary edema.

PORTABLE CHEST

The cardiac enlargement is again noted.  There has been slight diminution in the diffuse pulmonary air space disease.

There is probably a moderate amount of fluid in each pleural space.

Impression

1.Slight decrease in air space disease.

2.Interval development of bilateral pleural effusion.

PORTABLE CHEST

The cardiomegaly remains.  There is some tenting of the left hemidiaphragm.  There is a right subclavian catheter in place with its tip just within the right atrium.  No pneumothorax is recognized.  The Dobbhoff tube is still present.

IMPRESSION

1.The appearance of the infiltrates presently, together with the tenting of the left hemidiaphragm, suggests that there may be a component of fibrosis in the lungs.

2.Interval placement of right subclavian catheter without complication.

RADIO_3

CHEST

PA and lateral views reveal the hemidiaphragms to be smooth, but the right hemidiaphragm and costophrenic angle are partially obscured by basilar pleural and parenchymal scarring.  The left costophrenic angle is blunted, and both posterior sulci are blunted and shortened.  Slight fibrocalcific residuals are noted in the parahilar regions, with a thin fibronodular infiltrate extending into both subapical regions.  Slight pleural scarring is seen over each apex.  The hilum is slightly elevated on the left.  The lungs are considerably overexpanded but otherwise appear generally clear with normal vascularity.

The aorta is moderately elongated and slightly calcified.  The heart is enlarged, with an LVH configuration.  No mediastinal masses are noted.

The AP diameter of the chest is considerably increased.  There is a marked middorsal kyphosis secondary to anterior compression fracture injuries at T6, T7, T9, and T10 levels.  The anterior and central compression at the T6 level shows no evident healing changes and may be of recent origin.  There is a moderately severe generalized bone demineralization.

IMPRESSION

1.No evident active pulmonary disease or congestive heart failure.

2.Minor old healed granulomatous disease residuals appear stable, with chronic fibrotic changes at both bases.

3.Moderately severe emphysematous disease changes.

4.Moderately severe kyphoscoliosis with moderate generalized osteoporosis.

5.Several anterior compression fracture injuries are noted the mid and lower dorsal spine, and apparent recent fracture injury at the T6 level.

RADIO_4

CERVICAL SPINE

There is evidence of diffuse spondylosis seen throughout the mid to lower cervical spine, with disk space narrowing and marginal osteophyte formation seen both anteriorly and posteriorly.  These findings appear to be most severe at C6-C7.  Grossly the alignment of the bodies and posterior elements appears normal, and there does not appear to be any definite central stenosis from the lateral views.  The oblique views reveal posterolateral osteophyte formation at multiple levels, with what appears to be mild to moderate narrowing of the right C5-C6 neural foramen and what appears to be moderate narrowing of the left C4-C5 and C5-C6 neural foramina.  Some of the apparent narrowing on the left may be distorted by somewhat suboptimal obliquity to the foramen itself.  No other significant findings are otherwise noted.

IMPRESSION

1.Diffuse cervical spondylosis, as described above, consisting of disk space narrowing and marginal osteophyte formation both anteriorly and posteriorly at multiple levels, as described above.

2.No obvious central stenosis, though there does appear to be compromise of the right C5-C6 and left C4-C5 and left C5-C6 neural foramina, as described above.

If further information is needed concerning the possibility of disk herniation or evaluating for the possibility of central spinal stenosis, we would recommend magnetic resonance scanning.

RADIO_5

INTRAVENOUS PYELOGRAM

The KUB study shows the 4 mm in diameter calcification in the lower midpole of the right kidney and is unchanged in the interval since our comparison study.  The right kidney also appeared normal at that time.  The left kidney showed exactly the same configuration on the outside study presented for review, with an irregular right upper pole and 2 small cystic changes lateral to the upper pole caliceal system, measuring 2.0 cm and 2.5 cm in diameter.  The curvilinear displacement of the caliceal systems also suggests a larger cystic change in the parapelvic region, measuring approximately 5 cm in diameter.  The compression of the renal pelvis and deviation of the left upper ureter are essentially the same as seen on our intravenous pyelogram.

The bladder again appears normal with a minimal residual.

IMPRESSION

1.  Right renal lithiasis and slight right nephroptosis on the upright study; otherwise normal-appearing right upper urinary tract and ureter.

2.  Deformity of the upper pole of the left kidney with some blunting of the caliceal system and the formation of cystic calices lateral to the main upper pole caliceal system suggests a pyelonephritis.  Tuberculosis should be considered as an etiology.

3.  A larger peripelvic cyst is also noted, displacing the renal pelvis inferiorly and causing some deformity but no evident amputation of the middle or lower pole caliceal systems.

4.  The study is consistent with essentially the same findings on the job would flag this discrepancy to the attention of the dictator.

RADIO_6

AORTOFEMORAL RUNOFF

With aseptic conditions and following local anesthesia, an aortofemoral arterial runoff was performed with placement of a 4 French pigtail catheter in the abdominal aorta.  Mild diffuse atherosclerotic disease involves the distal abdominal aorta.  Renal arteries appear normal bilaterally.  A relatively severe stenosis involves the proximal right common iliac artery focally.  Focal stenoses are present at the origin and in the midportion of the right superficial femoral artery.

The right superficial femoral artery is also occluded distally, extending to the level of the adductor hiatus.

The right popliteal, anterior tibial, peroneal, and posterior tibial arteries are normal.

The left common iliac and external iliac arteries are occluded.  The occlusion begins at the bifurcation of the aorta.  The left common femoral is reconstituted via pelvic collateral vessels.  The left superficial femoral artery is occluded from its origin extemdomg tp the addictpr hiatus.  Left popilteal artery is normal.  A focal stenosis involves the origin of the left anterior tibial artery.

Moderate diffuse disease involves the left peroneal artery.

Posterior tibial is widely patent.

IMPRESSIONS

1.  Occlusion of the left common iliac and external iliac arteries.

2.  Occlusion of the left superficial femoral artery extending to the adductor hiatus.

3.  Focal stenoses of the right common iliac, origin of the right superficial femoral artery, and occlusion of the right superficial artery.

4.  Good peripheral runoff is present bilaterally, beginning at the level of the popliteal arteries.