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There is a linear, irregular, hyperdense structure seen in the distal jejunal loop on the right side that seems to partially pierce the wall. It is associated with fat stranding and adjacent prominent mesenteric lymph nodes. Raising the possibility of foreign body ingestion with possible perforation.No free fluid or pneumoperitoneum.No bowel dilatation.The gallbladder appears septated with multiple stones.A tiny renal cortical cyst was seen in the upper pole of the right kidney.

Technique: IV and rectal contrast were given. Findings:The previously mentioned linear irregular hyperdense structure is now seen in the proximal ileal loop on the left side, which seems to partially pierce the wall. It is associated with focal wall thickening, fat stranding, and adjacent prominent mesenteric lymph nodes. Raising the possibility of foreign body ingestion with possible perforation.No free fluid or pneumoperitoneum.No bowel dilatation.The gallbladder appears septated with multiple stones.A tiny renal cortical cyst was seen in the upper pole of the right kidney.

Technique patient premedication: beta blocker and nitrates acquisition method: step and shoot (prospective acquisition) contrast injection protocol: triphasic injection standard image reconstruction Findings normal coronary origins and proximal courses right or balanced coronary arterial dominance Plaque burden:calcium score: no calcificationsRight coronary artery (RCA): gives rise to a double posterior descending artery no plaques or stenoses in the proximal, middle and distal segments posterior descending artery (PDA): no plaques or stenosis Left main (LM): short, otherwise inconspicuousLeft anterior descending artery (LAD): one small diagonal branch no plaques or stenoses in the proximal, middle and distal segments no plaques or stenoses of the diagonal branch (D1) Circumflex artery (CX): obtuse marginal branch, two left posterolateral branches no plaques or stenoses in the main epicardial vessel no plaques or stenosis of the obtuse marginal (OM) and posterolateral branches Impression normal coronary CT angiogram no evidence of coronary stenosis or plaques - CAD-RADS 0 old spinal compression fractures Exam courtesy: Yvonne Kirchner-Bock (radiographer)

MonoE 40 & 55 keV virtual monoenergetic images, synthesized at a level of 40 keV and 55 keV respectively reconstructions in a soft tissue algorithm with a window setting C:800 W:2000 Conventional + MonoE 40 overlayconventional images, reconstructed with a standard soft tissue filter and supplemented with a color-coded MonoE 40 overlay ranging from -600 to 1400 (C:400 W:2000)Iodine no water + virtual non-contrast overlay iodine no water images obtained by subtracting water from contrast-enhanced images with a color-coded virtual non-contrast overlay (VNC) ranging from -200 to 400 (C:100 W:600) this setting can be nicely used to illustrate calcium (no coronary calcifications in this study) Z-effectivethe effective atomic number Zeff calculated by dual-energy analysis

Contrast-enhanced CT demonstrating a 10 x 7 cm cystic lesion in the left cardiophrenic angle. The cyst has no enhancing solid component, septa, and calcification. The findings are most suggestive of a pericardial cyst.

CT of the cervical spine shows grade V spondylolisthesis of C6 on C7, known as spondyloptosis. The C6 and C7 vertebral bodies are at the same level, which is considered Type II spondyloptosis. The malalignment is in a Tetris S type configuration.

There is a high vertex, left subgaleal hematoma and soft tissue swelling corresponding to the site of blunt impact. The cranium and visualized facial bones are intact. There are scattered scalp and facial soft tissue punctate superficial densities likely representing a combination of dermal calcification and foreign bodies/debris.There is acute subarachnoid hemorrhage with hyperdense blood interdigitating along the anterior interhemispheric fissure, best appreciated on the sagittal reconstructed images.There is an acute right tentorial cerebelli subdural hematoma.There are no other post-traumatic intracranial abnormalities present.

CT scan of the chest in the mediastinal window demonstrates a symmetrical thickening of the distal esophagus.

Saddle pulmonary embolus with extensive clot burden expanding and involving the segmental arteries of all the lobes. Thrombus within the right atrium. Enlargement of the right ventricle (RV/LV ratio: 1.88), reverse bowing of the IV septum and reflux of contrast into the hepatic and azygous veins. No enlargement of the main pulmonary trunk. Trace pericardial effusion.Subtle mosaic attenuation of the lungs in keeping with the multiple pulmonary emboli. Minor basal atelectasis. No pneumothorax or pleural effusion.No enlarged lymph nodes.ImpressionSaddle pulmonary embolus with extensive clot burden involving the segmental arteries of all lobes. Thrombus within the right atrium. Associated features of right heart strain.

Left frontal completely calcified parasagittal intra-axial lesion surrounded by mild gliosis. The medial aspect of the lesion is abutting the falx.

There is a 4 mm calculus within the urinary bladder within a subtle rounded cystic structure protruding from the left VUJ. Hypo-enhancement of the left renal upper pole and mild prominence of the pelvicalyceal system. Duplex collecting system with no dilatation of the upper or lower pole moieties. The right renal tract is unremarkable. No significant bladder wall thickening or pericystic fat stranding.No intraperitoneal free fluid or free gas. VP shunt tubing noted in the upper right abdomen. No associated intra-abdominal collection.The liver demonstrates homogeneous reduced attenuation in keeping with steatosis. No focal liver lesions. Gallbladder, pancreas, cysts, spleen and adrenal glands appear unremarkable. Previous gastric surgery and small hiatus hernia. Small and large bowel are unremarkable.ImpressionLeft bladder calculus within a ureterocoele with features of a left duplex system. Left renal upper pole hypo-enhancement could be due to recent mild obstruction secondary to the ureterocoele calculus or superimpose

Arterial sigmoid colon diverticular hemorrhage with contrast dispersing and pooling on portal venous phase. Extensive sigmoid colon diverticulosis. No focal colonic wall thickening or pericolic fat stranding.Normal appearance of the liver. Cholelithiasis in a collapsed gallbladder. No pericholecystic fluid. Normal appearance of the pancreas, spleen and adrenal glands. Several fluid density cortical renal cysts bilaterally.Mural calcification along the abdominal aorta without aneurysmal dilatation. Minor calcification along the bilateral femoral arteries.Small pericardial effusion.Lytic lesion in the right sacrum is unchanged over the past 2 years. Osteopenia. Grade 1 anterolisthesis of L5 on S1. L2 heamangioma.ImpressionArterial sigmoid colon diverticular hemorrhage. IR team notified.

1 cm stone in left submandibular duct location at the floor of mouth with no ductal dilatation. Normal symmetrical size of both submandibular glands with no glandular stones or ductal dilatation.

Extensive severe bullous emphysema in both lungs. There is a nodular density in the right upper lobe with adjacent stranding that is stable from previous imaging. Enlarged 11 mm subcarinal lymph node which is also stable from previous imaging. No other significant intrathoracic abnormality is present.

Technique patient premedication: beta blocker and nitrates acquisition method: step and shoot (prospective acquisition) contrast injection protocol: triphasic injection image reconstruction: standard with and without edge correction dual-energy maps (see next study) Findings anomalous origin of the left main stem from right coronary sinus with a prepulmonic course right coronary arterial dominance with a large right posterolateral branch (PLB) corkscrew-like tortuous terminal vessels Plaque burden: calcium score: ~120 segment involvement score (SIS): 4 segments Right coronary artery (RCA): gives off the posterior descending artery (PDA) and a large posterolateral branch (PLB) calcified plaques with mild stenosis in the proximal segment (D: 25-49%; A: <60-65%) no plaques or stenoses in the middle segment, PDA and RPLB Left main (LM): anomalous origin from the right coronary sinus, prepulmonic coursecalcified plaques with mild stenosis (D: 25-49%; A: <50%)Left anterior descending artery (LAD): thin shortno plaques or stenosesRamus intermedius: strong, branching, supplying the anterior wallno plaques or stenosesCircumflex artery (CX): one thin obtuse marginal branch (OM) proximal non-stenotic plaque with high-risk features (spotty calcium & positive remodeling) no further plaques or stenoses in the main epicardial vessel and the marginal branch Impression anomalous origin of the left main stem from right coronary sinus with a prepulmonic course right coronary arterial dominance maybe even superdominant right coronary artery mild amount of plaque - CAC-DRS A2/N3 and V2/N3 mild non-obstructive coronary artery disease - CADRADS2/P2/HRP/E Exam courtesy: Yvonne Kirchner-Bock (radiographer)

Virtual non-contrast virtual non-contrast (VNC) images can be used as a substitute for a non-contrast scan and to depict coronary calcifications window setting ranging from -200 to 400 (C:100 W:600) Iodine no water + virtual non-contrast overlay iodine no water images obtained by subtracting water from contrast-enhanced images with a color-coded virtual non-contrast overlay (VNC) ranging from -200 to 400 (C:100 W:600) this setting can be also used to illustrate coronary calcium, the punctate calcifications of the proximal circumflex artery plaque are also barely visible MonoE 40 virtual monoenergetic or monochromatic images synthesized at a level of 40 keV reconstructions with a window setting C:800 W:2000 Conventional + MonoE 40 overlayconventional images, reconstructed with a standard soft tissue filter and augmented with a color-coded MonoE 40 overlay ranging from -600 to 1400 (C:400 W:2000)Z-effectivethe effective atomic number Zeff calculated by dual-energy analysis

There is a large, heterogeneous, enhancing, occipital soft tissue mass, with regional bone erosion and intracranial extension. There are scattered peripheral/ rim calcifications. The mass measures 11.5 x 9.8 x 6.7 cm ( cc x w x AP).Prominent superficial draining veins.Contrast-enhanced CT brain is otherwise normal.

There is diffuse hypodensity with a loss of grey-white matter differentiation in the right frontal lobe. A few hyperdense foci are observed within this area consistent with blood. A hyperdense linear structure, probably a cortical vein, overlies the abnormality extending to the superior sagittal sinus which is also hyperdense. A 5 mm hyperdense lesion is seen in the roof of the 3rd ventricle consistent with a colloid cyst.

There is dislocation of the occipital condyles (left, right) ventrally on the C1 lateral masses. There is significant prevertebral edema from the skull base through C4. Additional soft tissue stranding and edema is seen in the right lateral neck and along the left scalene musculature also concerning for sequelae of trauma and soft tissue injury.There is soft tissue density dorsal to the thecal sac at the C1-C2 level concerning for edema an/or epidural hematoma with possible ligamentous injury. There is widening of the dorsal interspace between C1 and C2.There is congenital nonunion of the posterior arch of C1.There are mild to moderate degenerative changes of the cervical spine most pronounced at C4-C5 and C5-C6. No significant osseous canal stenosis is evident on noncontrast CT but further assessment is recommended given the injury is noted above.There is a minimally displaced fracture of the posterior aspect of the medial left T1 rib.

Multiple mesenteric cystic lymph nodes are noted up to 2 cm (measured in short axial dimension).The spleen is markedly atrophic.There are no visible pathologically thickened walls of the large and small bowels.

two anomalous pulmonary veins located in the right lung that both drain into the IVC main scimitar vein is located anteriorly and superiorly relative to the second anomalous vein the smaller vein is partly calcified cardiac dextroposition and right lung hypoplasia hyparterial right main bronchus with abnormal branching pattern bronchial wall thickening and mild bronchiectasis in the right lung left pulmonary artery asymmetrically larger than the right (best seen in the coronal plane) focal consolidation in the left upper lobe, consistent with pneumonia

Non contrast CT of the chest shows a hyper lucent left upper lobe with blind-ending (atretic) bronchi with proximal intraluminal mucous plugging.

FDG avid posterior mediastinal large lobulated soft tissue mass lesion. It measures about 13.7x 9.7x12.0 cm along its max axial and CC dimensions with SUV max. The lesion shows non homogenous CT attenuation with coarse calcifications. The lesion displaces the left lung anteriorly. It encases the aorta and displaces it anteriorly. It's also abutting the posterior cardiac surface, the esophagus and the bronchi displacing them anteriorly and to the right. The lesions show intraspinal extension effacing the left lateral CSF space and displacing the dorsal cord to the right. The related posterior aspects of the left 7th, 8th, and 9th ribs are widened with bony erosions of those ribs and D7, D8 and D9 vertebrae. Few posterior mediastinal para-aortic lymph nodes showing internal calcifications.Mild dorsal scoliotic deformity convex to the left.Mild left pleural effusion.

An ill-defined soft tissue density lesion was noted centered in the right nasopharynx, measuring approximately 5.8 x 4.3 x 5.7 cm (CC x AP x trans). There is non-visualization of the right torus tubarius. A few foci of calcifications are noted within the lesion. No e/o fat attenuation is noted within the lesion. The lesion is extending anteriorly into the posterior portion of bilateral nasal cavities (right > left) via the bilateral posterior choana. The lesion is abutting the bilateral lateral pterygoid muscle laterally. There is e/o mild soft tissue infiltration in the right parapharyngeal space. There is a minimal extension of the lesion into the right pterygopalatine fossa and right sphenopalatine foramen. The lesion is extending into bilateral sphenoid sinuses superiorly and up to the level of the C1 vertebra inferiorly. Posteriorly, there is a loss of fat plane with prevertebral muscles. There is e/o erosion of the floor of the bilateral sphenoid sinus, the body of the sphenoid, the bilateral greater wing of the sphenoid, petrous segment of the bilateral temporal bone, and clivus.The bilateral foramen ovale and foramen spinosum are preserved. Mucosal thickening of the bilateral maxillary and ethmoid sinuses is noted.Ill-defined soft tissue density lesion centered in the right nasopharynx with erosion of the bone of the skull base and extension as described above (D/D nasopharyngeal carcinoma).

Ileocecal valve margins are markedly thickened and infiltrated with fat, suggesting lipomatosis of the ileocecal valve.There is a definable, hypodense (with fluid density) lesion of about 2.3 x 2.9 cm in the vicinity of the cecal base (which is non-separable from its wall without definite communication to the lumen), which could be a duplication cyst. No surrounding stranding is seen. No dilatation or stricture lesion of the small or large bowel is appreciated.

Because of inferior vena caval contrast reflux, the accessory right inferior hepatic vein is clearly seen.Other findings are bilateral pulmonary contusions, comminuted burst fractures of the L1 vertebra, rib fractures, and right pneumothorax.

The appendix is dilated measuring 11 mm with wall stratification due to submucosal edema (target-like sign) with minimal fat stranding. It shows appendico-cecal invagination (appendiceal intussusception) of proximal part of the appendix with dilated intra-cecal part measuring 22 mm surrounded by encysted intracecal fluid. No suspicious cecal wall thickening or masses.Bilateral inguinal hernias transmitting omental fat, larger on right side.Basal lung zones show multiple calcific foci at both lower lobes.

Heterogenous mass of the body and tail of the pancreas with vessel encasement (superior mesenteric artery, splenic artery, and veins).Dilatation of the main pancreatic duct and biliary ducts upstream of this mass.There is a duodenal prosthesis to relieve obstruction and gastric dilatation due to the mass.

After getting patient consent. In a supine position.Local anesthesia of the puncture site using 2% lidocaineInsertion of a 21G Chiba needle through a trans-colonic approach to reach the right anterior para-aortic space.Injection of a mixture of lidocaine and contrast (diluted to 5%) to confirm the good position of the needle tip.Once the position is confirmed, we inject 10 ml of ethanol (95% concentration) with 0.5 ml of contrast.Withdrawal of the needle and repositioning the tip in the left anterior pre-aortic space.Injection of 10 ml of ethanol (95% concentration) with 0.5 ml of contrast.Withdrawal of the Chiba needle.Post-procedure CT is unremarkable.

There is a filling of the peripheral bronchi with mucus in a branching pattern (bronchocele) in the medial segment of the right middle lobe.A sub-centimeter calcified lymph node is seen in the pre-tracheal region as well.A single enlarged lymph node with about 10.0 mm (SAD) is noted in the right axillary region which could be reactionary rather than metastatic.

The fundus of the gall bladder extends to the level of the iliac crest in the right lower quadrant, indicating a dilated gall bladder with a maximum transverse diameter of 60mm and notably extended to a length of 170mm. There were multiple calcific luminal gallstones, with some in the gall bladder neck. The gall bladder fossa (between the liver and the gall bladder) has a thin film of pericholecystic fluid but no pericholecystic fat stranding. The gall bladder wall was not thickened, and there was no evidence of wall necrosis.The common bile duct is 4mm in diameter, and no calculus was seen along it. The intrahepatic biliary ducts were normal, and no biliary system mass lesion was observed.The left adrenal gland has a 13 x 20 x 16mm lipid-rich adenoma with fatty areas at -30 HU. The right adrenal gland was normal.

Tenckhoff catheter seen at the left anterior lower abdominal wall with its curved tip within the central pelvis. No kinking, fracture, or entrapment of the catheter. No pericatheter contrast leak. Subcutaneous thick wall pericatheter collection with adjacent fat streakiness. No contrast leak or air pockets within.No contrast leak along the anterior or posterior peritoneum.Another subcutaneous track is noted at the right lower anterior abdomen likely due to the previous Tenckhoff catheter insertion site.Homogeneous distribution of contrast and dialysate mixture within the peritoneal cavity. No loculation or septation seen.Umbilical hernia noted with bowel within. Contrast and dialysate mixture content are also found within.Focus of calcification in the segment V of liver.Left renal cortical cysts.

No contrast leak was seen at 4 hours post contrast infusion.

There is a well-defined, hyperattenuating nodule-like lesion in the vicinity of the apicoposterior segment of the left upper lobe, which is most likely a mucus plug in the atretic bronchiole with surrounding hyperinflated parenchyma or air-trapping.The patient is a known case of rectal adenocarcinoma.A small pleural-based nodule in the left lower lobe is newly found and is too small for characterization (needs follow-up).

The patient underwent bariatric surgery with anterocolic-anterogastric transposition of the Roux loop.It's possible to observe the distension of the proximal jejunum, fluid content, stacking coins sign, until the portion in mesogastric abdomen, where there is narrowing and abrupt return to normal caliber, coinciding with the point of latero-lateral anastomosis of bariatric surgery.

A CT scan reveals a dilated pulmonary artery and its branches, with the pulmonary trunk located on the right side in a parallel course with the ascending aorta.The left ventricle is markedly dilated and shows a moderator band (morphologically, the right ventricle).Multiple small VSD membranous and muscular types.The rest of the major cardiac vessels are normally related anatomically to their corresponding chambers.Overall features consistent with L-TGA

Os calcaneus secundarius (anterior process of the calcaneus)Os intermetatarseum (between the bases of the first and second metatarsals)Note how both structures have well-defined smooth cortical margins on all sides.

There is well defined lobulated relatively hype vascular enhancing soft tissue lesion measuring 3.6 x 2.8 cm seen in the left submandibular space, at the level of the left carotid bifurcation without obvious displaying carotid arteries however, it deviates them medially, this mass also deviates the submandibular gland anteriorly with a clear separating fatty planes, it appears to be mainly supplied from the ascending pharyngeal artery.The thyroid gland appears enlarged with a heterogenous nodule seen in the left lobe.

There is a solitary calcified nodule seen in the anterior segment of the right upper lobe, which measures about 2.5 mm.A linear atelectatic band is seen in the lingula.There are abnormally enhancing cervical and mediastinal lymph nodes seen as the following:The left anterior jugular measures about 1.6 x 0.9 cm, the left lower cervical measures about 1.0 x 1.3 cm, and the left upper paratracheal, the largest, measures about 1.8 x 1.0 cm.

There is a circumferential, irregular, and asymmetric increase in mural thickness (up to about 1.4 cm in maximum size, unilaterally on the anterior aspect) of the thoracic esophagus from D5 up to D9 level, with about 10.1 cm in total length of the involved segment. Marked surrounding stranding with luminal dilatation of the involved segment is seen.The involved segment encases the adjacent thoracic aorta more than 90 degrees, and tir-angular fat between the esophagus, aorta, and spine is lost.The left bronchus is also slightly displaced anteriorly by an adjacent disease segment, suggesting their invasion.Few enlarged and matted lymph nodes (non-separable from the anterior involved wall of the esophagus) are noted in the pre-esophageal region (opposite to D7/8 level), with the largest one measuring about 1.5 x 2.5 cm.Consolidation with the air-bronchogram of the right middle lobe is seen; however, the lobar bronchus appears patent with a differential middle lobe collapse.

Well-defined ovoid heterogeneously hypodense mass located under the left lobe of the liver.Moderate dilatation of the intrahepatic biliary ducts and CBD with no choledocholithiasis.Small fluid collection within the left psoas muscle (incidental finding).The rest of the CT exam was unremarkable.

Well-defined hepatic mass centered on segment 7 with a small arciform peripheral calcification and mixed hypoechoic and hyperechoic matrix due to the detachment of the inner layer membrane with no daughter cysts. No enhancement following IV contrast.Small hepatic hemangioma straddling the segments 4 and 5.Moderate splenomegaly (length = 16 cm).

A non-contrast and contrast CT scan of the abdomen shows a bulky, moderately enhanced soft tissue density mass in the pyloric antrum.A gap is seen in the anterior wall of the antrum. Gas is escaping through the gap and extending superiorly and inferiorly through peritoneal space. The air-fluid level is also noted.Multiple peripherally enhancing soft tissue masses are seen in the celiac axis and within the mesentery.Bilateral pleural effusions and huge ascites are noted.

Densely ossified rounded right occipital lesion, continuous with the outer table of the occipital bone.

There is severe mucosal disease in the maxillary sinus, left ethmoidal air cells, frontoethmoidal junction, the right frontal sinus. There is soft tissue fullness in the right frontal sinus which extends into the superior right orbit. The posterior wall of the right frontal sinus is dehiscent just above the orbital roof.Other findings include a right frontal craniotomy, encephalomalacia in both inferior frontal lobes (right more than left), and a fracture in the left superior aspect of the sphenoid sinus.

There are innumerable cystic lesions scattered diffusely throughout both lungs with larger and more confluent cysts at the bases. They are relatively smooth, thin-walled, irregularly shaped cysts. The intervening lung parenchyma is normal. There are bilateral chest tubes in place with tips at the apices. There is a small residual right-sided pneumothorax. There is bilateral subcutaneous emphysema in the chest wall.

There is a metallic foreign body (axial, sagittal) within the proximal one-third of the esophagus.

Prostatomegaly, transverse diameter 5.7 cm, with heterogeneous enhancement, the right lobe of prostate is relatively hyper-enhancing compared to the left; the hyper-enhancing focus measures up to 3.9 cm and involves the peripheral and central zone. There is some contiguous enhancement of the right seminal vesicle raising the possibility of local invasion.No hydroureter nor hydronephrosis. Small simple right renal cysts, kidneys are otherwise normal.Enhancing focus in left lobe of the liver with appearances consistent with hemangioma. Liver is otherwise normal with no concerning focal liver abnormality. No biliary dilatation.Normal appearances of the pancreas with no focal mass lesion or ductal dilatation. Normal gallbladder, adrenals and spleen.Mild sigmoid diverticulosis, otherwise normal appearances of the large and small bowel.No size significant abdominal or pelvic nodal enlargement. No free abdominal or pelvic fluid.The lungs are clear. No pleural effusion or pericardial effusion. No large central pulmonary thromboemboli. No size significant thoracic nodal enlargement.Heterogeneous appearances of the imaged skeleton with multiple foci of sclerotic change.Vertebral body heights are maintained. No pathological fracture.Opinion:Appearances of the skeleton suggests widespread sclerotic metastases, no pathological fracture.Enlarged prostate with hyper-enhancing right lobe, given the skeletal appearances prostatic malignancy requires exclusion.

Non-contrast CT scan of the chest demonstrates bilateral pulmonary cavitating nodules with a ground glass halo, distributed throughout all zones of the lungs.A feeding vessel sign can be seen in a few of the nodules.Bilateral pleural effusion is seen.

19.6 x 20.1 cm loculated pleural collection containing with gas-fluid level. Occluded bronchus intermedius and compression atelectasis of the right middle and lower lobes. Contralateral mediastinal shift. Subcarinal lymphadenopathy.

Hiatus hernia, patulous esophagus and features of chronic aspiration in the lung bases, i.e. bronchial dilatation and plugging with peribronchial opacity.4.5 cm mass-like fat attenuation within the interatrial septum, sparing the fossa ovalis.

No fracture or luxation.L4-L5 medial disc protrusion, exerting mild pressure on the thecal sac.Subcecal vermiform appendix containing calcific material. Abutting the distal third of the appendix is a miniscule oval fat-density structure with a hyperdense central dot, surrounded by fat stranding - features suggestive of epiploic appendagitis.Small umbilical hernia containing fat.

There is a large well defined retroperitoneal lesion measuring 14.1 cm in maximum dimension. There is internal complexity and the impression of enhancement on the portal venous phase- this is not certain in the absence of a pre-contrast series. No avid arterial enhancement.The lesion lies above and wraps around the hepatic artery though there is no associated vessel stricturing. The mass runs alongside the SMV/splenic confluence and portal vein which are displaced but not strictured. The pancreas is in contact with the lesion but it is unclear whether this is arising from the pancreas.  The pancreas appears normal with no features to suggest acute or chronic pancreatitis. Normal biliary tree. Arcuate ligament associated narrowing of the celiac axis. Otherwise patent non- stenosed abdominal vasculature.Rest of the solid organs are unremarkable. Bowels are unremarkable. No free gas seen.Unremarkable lung bases and bone reviewComment: Large well defined retroperitoneal lesion with internal complexity but no overtly malignant features. This may represent a benign lymphatic malformation but a malignant retroperitoneal lesion such as sarcoma is a differential. The increasing amylase suggests mass effect on the pancreas which is concerning for growth.

CT urogram reveals bilateral separate pelvicalyceal system and bifid proximal ureters. A single ureter opens into the urinary bladder from the either side.

Appearances are those of acute appendicitis. Appendiceal mucocele should be considered.

The scan demonstrates: elevated and rotated left scapula. The superomedial angle of the scapula is located at the C6 level. The axial images demonstrate a fibrous omovertebral bar connecting the superomedial border of the scapula to the spinous process of T1. Finding in keeping with Sprengel deformity grade 2 dorsal scoliosis of right-sided convexity with fusion of the vertebral bodies and posterior elements of C7 with T1, T2 with T3, and T7 with T8 with rudimentary intervertebral discs in keeping with Klippel-Feil syndrome type 1 associated lumbar spina bifida at several levels as well as a rudimentary (hypoplastic) left 1st rib mild left renal hydronephrosis with a small stone

There is an irregular and asymmetric increase in mural thickness (up to 21 mm in maximum size, unilaterally at the cardia), which involves the cardia and body along the lesser curvature with surrounding fat stranding. The esophagus is dilated with air-fluid level; however, no definite abnormal increase in mural thickness or lesion is appreciated.No CT-detectable invasion of adjacent organs is noted.A few sub-centimeter lymph nodes are noted in the pre-esophageal region and in the vicinity of the lesser curvature.Multiple, variable-size simple cysts are noted in both kidneys, with the largest one measuring about 7.8 x 6.3 cm at the lower pole on the left side.The prostate is enlarged in size as well.

Primary malignancy/clinical concern:Large heterogenous trans-spatial mass centered in the pelvis, which invades through the mesorectum into the rectum and also into the bladder. The prostate and seminal vesicles are presumably engulfed in the mass. Moderate bilateral hydroureteronephrosis.Significant mass effect within the pelvis - bilateral common iliac veins are obliterated at the level of the mass. Non-occlusive filling defects can be seen within bilateral common femoral veins (left worse than right) and the left renal vein, consistent with thrombus. Multiple pulmonary emboli are also noted.Lymph nodes:Heterogenous conglomerate lymphadenopathy affects the common iliac and pelvic sidewall stations. Pathologic lymphadenopathy in retropubic, para-aortic, bilateral hilar, and mediastinal stations.Metastases:Pulmonary bases: multiple rounded lung lesions suspicious for metastases.Liver: multiple hypodense lesions suspicious for metastases.Osseous: irregularity of the inferior left pubic ramus cortex with a lytic lesion and adjacent soft tissue component; suspicious for metastasis. There was no other bony lesion.Normal adrenal glands. No ascites or pleural effusion.

Marked interval progression of disease. The patient now has ongoing bilateral leg pain but no other neurology. No spinal metastatic disease or canal compromise; however, the mass and its nodal metastases are invading the anterior surface of the psoas muscles bilaterally and may be involving nerves arising from the lumbar plexus.

Computed tomography (CT) myelography demonstrates the left anterolateral herniation of a small portion of the spinal cord through a dural defect that confirms the idiopathic spinal cord herniation diagnosis. The dorsal subarachnoid space is widening without any apparent filling defect. Impression: The features are typical of ventral cord herniation.

No intracranial hemorrhage or loss of grey-white differentiation.Right ventricular collapse adjacent to the ventriculoperitoneal shunt.Mild descent of the cerebellar tonsils (1 mm).Enlargement of the pituitary gland and decreased fluid within the optic nerve sheaths.Shunted left temporal arachnoid cyst. There is a third left paramedian shunting catheterThere are no subdural collections.

Loss of grey-white matter differentiation, and hypoattenuation in the right frontal and insular cortex.Mild parenchymal swelling and minimal mass effect on the frontal horn of the right lateral ventricle.No intracranial bleeding. No brain herniation.Crescent-shaped mural thrombus in the right internal carotid artery, just after its bifurcation from the right common carotid.Occlusion of an M3 branch of the right middle cerebral artery.

Compared to the previous CT:Complete regression of the internal carotid artery hematoma and focal dissection.Right frontal and insular sequelae from previous ischemia.

There is a hypovascular infiltrating lesion on the portal venous phase with a mild peripheral enhancement, involving all of the liver segments.Hepatic hilum lymphadenopathies.There is no significant mass effect on vessels and biliary ducts.Focal and irregular thickening of the cecum wall, suggestive of a neoplastic lesion with pericolic mesenteric lymphadenopathies. Fat stranding adjacent to this lesion.Mild bilateral pleural effusions.Radical prostatectomy. Thrombosis of the right external iliac artery.

Nasogastric tube in situ, adequately sited.Subtotal colectomy, right iliac fossa ileostomy, and left iliac fossa mucous fistula. The rectum and sigmoid colon are sutured at the left hernial opening. Diverticulosis of the remnant sigmoid. Cholecystectomy clips.Significantly distended small bowel with a transition point at the proximal small bowel soon after the duodeno-jejunal flexure with a second transition point at the distal small bowel; the two transition points are within 3 cm of each other, which appears to be in keeping with closed-loop obstruction. Nearly the entire remnant small bowel is involved in the closed-loop. Free fluid at the paracolic gutters, particularly on the right side, and reactive mesenteric lymph nodes. No free gas. Bowel mucosa enhancement was preserved, and there was no pneumatosis or portal venous gas to suggest bowel infarction. Splanchnic vessels are patent.Simple right renal cysts, the remaining solid abdominal organs are otherwise normal. Prostatic calcification is of doubtful significance. Normal urinary bladder.Bibasal atelectasis, the imaged lung bases are otherwise clear. Unremarkable bone review.Conclusion: high-grade closed-loop small bowel obstruction involving nearly the entire remnant small bowel, with a transition point in the right abdomen. There are no current features of ischemic bowel or perforation. Small amount of free fluid is present.

Large mainly fatty mass arising from right adrenal gland with a lobulated soft tissue component and linear calcification. No significant enhancement after IV contrast injection. Right kidney is displaced inferiorly.No other significant abnormality detected.Conclusion:Large right-sided adrenal myelolipoma.

Moderate left and small right pleural effusions.Patchy consolidation in the right upper lobe is adjacent to the oblique fissure, with smaller ground-glass foci in the right upper lobe more superiorly. Bilateral lower lobe atelectasis, more so on the left than the right. Fluid tracking in the oblique fissure is bilateral. No cavitation. No airway dilatation, significant wall thickening, or frank airway plugging.Mildly enlarged mediastinal nodes are likely reactive. Trace pericardial fluid.Impression of 3.2 cm diameter area of hypoattenuation in the right lobe of the liver on this unenhanced exam, indeterminate appearance. Apparently, there is an irregular liver contour. Opinion:Bilateral pleural effusions and bilateral lower lobe compressive atelectasis with areas of consolidation in the right upper lobe, the appearances are altogether nonspecific. No cavitation.Incidental indeterminate hypoattenuating area in the right lobe of the liver. The background liver contour appears irregular; is there a history of cirrhosis?

At least seven hypodense liver lesions were demonstrated, mainly in the right lobe of the liver. Nodular background liver, as noted previously, suggests cirrhosis. Patent hepatic vasculature.At least three similar-appearing hypodense splenic lesions were seen. The spleen is enlarged, but there are no significant-sized portosystemic collaterals.Tiny bilateral non-obstructing renal calculi were noted. The rest of the solid abdominal organs are unremarkable. Small-volume upper abdominal lymph nodes are nonspecific in the setting of chronic liver disease. No significant retroperitoneal lymphadenopathy. Small amount of ascites is present. The bowels are unremarkable.There are moderately sized bilateral pleural effusions with some enhancement and complexity. Foci of enhancement are seen in the right pleural cavity with septa. Further posterior mediastinal-enhancing nodules are seen on the left.Unremarkable bone review.Conclusion:Appearances are most likely to represent a post-transplant lymphoproliferative disorder. Appearances would be unusual for HCC.

Well-defined polyp arising from the right maxillary sinus and extending into the nasopharynx through an enlarged accessory maxillary ostium in keeping with an antrochoanal polyp.Deviated nasal septum.

Rupture of a large left lung cyst with layering of the membranes and air-fluid levels associated with pleural thickening and enhancement. There is a near complete collapse of the left lung and contralateral shift of cardio mediastinum.

There is a bifid right fifth rib (normal variant) noted, while the rest of the ribs are unremarkable.Non-fusion of lateral ossification centers in the sternebrae, resulting in the mesosternum having a honeycomb-like appearance (normal variant).

On a plain CT scan, a large radiodense calculus of size 14 x 6.5 x 7.5 mm (APXMLXCC) was noted in the distalmost submandibular duct on the right side, and another calculus of size 9.7 x 5.0 x 4.4 mm (APXMLXCC) was just proximal to it.There is an associated dilated right submandibular duct, a mildly shrunken right submandibular gland (compared to the opposite one), and few subcentimeter-sized submandibular region lymph nodes found.Dilated and gas-filled parotid ducts.

Large intra-axial mass/collection with peripheral enhancement in the left frontal and parietal lobe, involving the left basal ganglia, with areas of calcification in the medial aspect. Perilesional vasogenic edema involving the frontal, parietal, and temporal lobes, crossing the midline in the frontal region. There is compression of the left lateral ventricle and effacement of the third ventricle. There is midline shift and resultant right ventricular hydrocephalus. Edema extends to the upper part of the brainstem.

CT shows decreased density of bilateral basal ganglia and thalami. No acute territorial cortical infarction or intraparenchymal hemorrhage.

Large irregular and ill-defined hepatic mass of fluid-density in the left lobe (segments 2 and 3) composed of multiple low attenuation coalescent lesions forming the "cluster sign" with peripheral rim enhancement.Incidental findings: mixed hiatus hernia gallbladder mass with retracted fundus bilateral inguinal hernias sacralization of L5 spondylolisthesis of L4 on L5 (grade I) with bilateral pars interarticularis defects (spondylolysis)

A well-defined lobulated isodense lesion measuring 3 x 3 x 4 cm (CC x AP x Trans) noted in segment VII of liver. The lesion shows homogenous enhancement in late arterial phase with prominent central artery supplied by branch of right hepatic artery. Enhancement persists in portal phase images. The lesion shows washout and appears isodense to liver parenchyma in venous and delayed phase images. No e/o fat attenuation/calcifications/central scar. The lesion is closely abutting the posterior sectorial branch of right portal vein.Impression:Well-defined lobulated outline lesion in segment VII of liver without calcification/fat attenuation & central scar showing homogenous enhancement in arterial and portal phase with washout in venous and delayed phase as described above - Benign lesion. D/D: Focal nodular hyperplasia.

The pancreas appears mildly bulky and edematous with peripancreatic inflammatory changes and fluid collection. No evidence of pancreatic/peripancreatic necrosis was seen. Mild ascites. Mild gall bladder wall edema and periportal edema, likely reactive.Suggestive of acute interstitial edematous pancreatitis (modified CT severity index 6/10).

The left vertebral artery is very small in diameter but opacifies with contrast.The dominant right vertebral artery originates distal to the left subclavian artery, with a retroesophageal and retrotracheal course. The proximal segment is dilated, which is known as a Kommerell diverticulum.

Non-contrast CT imaging of the abdomen and pelvis confirms a large, predominantly solid, lobular mass lesion arising from the left adnexa and extending superiorly to a level above the umbilicus. Speckled calcifications are present. Scattered areas of cystic breakdown are appreciated, especially within the right superior pole of the mass. The uterus and ovaries are poorly identified. There is contrast excretion (gadolinium) within the right renal tract and faint contrast within the left kidney, with mild right and moderate left renal tract obstruction. There are displaced but non-obstructed bowel loops. There is no ascites. There are obvious hepatic metastases on non-contrast CT imaging. There are no documented bone metastases.

A large, multilobulated, fibroid uterus is present. It measures at least 23.8 cm x 19.9 cm x 18.2 cm (L x AP x W) and extends up to the T12/L1 level in the left upper quadrant. There is no associated central or peripheral calcification. There is heterogeneous enhancement post-contrast administration with evidence of cystic degeneration. The right ovary is identified and appears normal. The left ovary is not identified. The bladder is displaced anteroinferior, with displaced however unobstructed ureters bilaterally. Displaced small and large bowel loops as expected, however, there is no bowel obstruction. CT imaging is otherwise unremarkable.

Soft tissue lesion in the left proximal thigh region in the anterior aspect having peripheral ossifications. The underlying bone appears normal.Linear undisplaced fracture of sacral ala on the right.

Well-defined heterogeneously enhancing lobulated soft tissue lesion in the lateral aspect of right psoas major muscle in right iliac fossa region, probably neurogenic tumor (along the course of lateral cutaneous nerve/femoral nerve).Another lobulated similar lesion was seen extending into the right obturator canal along the course of the obturator nerve and causing a smooth widening of the obturator canal, likely a neurogenic tumor originating from the obturator nerve.

CT-guided biopsy from right iliac fossa lesion.

CT of the pelvis confirms bilateral iliac wing fractures, with greater comminution and displacement on the right. There is displacement of the right anterior superior iliac spine. The fractures do not extend to the acetabula. There is enlargement of the right iliacus and right gluteal musculature around the right iliac wing fracture, consistent with hematoma. However, no contrast extravasation is seen to suggest an active arterial bleed. There is also subcutaneous hemorrhage/contusion overlying the bilateral iliac wings. This CT was reconstructed from a CT of the chest, abdomen, and pelvis with IV contrast. There is contrast in the urinary bladder from a prior CT performed at an outside institution.

Arterial and portal venous phase CT abdomen and pelvis. The hepatic veins are attenuated, and the liver parenchyma demonstrates mottled attenuation on the portal venous phase with an enlarged caudate lobe. The spleen is enlarged. There is a moderate amount of simple fluid in the pelvis. Normal contrast opacification of the hepatic artery and portal vein. Normal remaining appearances.

CT (non-contrast + combined urographic and portal venous phases).Large lobulated mass in the upper abdomen with enlarged mesenteric nodes more inferiorly. The mass does not demonstrate much enhancement and has a couple of discrete hypo-enhancing areas (suggesting necrosis). The mass is sandwiching the CBD, resulting in a small amount of intra- and extra-hepatic duct dilatation. There is mesenteric edema and a moderate amount of ascites. No renal stones and no hydronephrosis. Incidental gallstones.

Abdominal CT scan with IV and oral contrast demonstrates a 77 X 48 mm low-enhancing mixed cystic and solid mass with infiltrative components in the body of the pancreas that extends to the lesser sac and is accompanied by distal parenchymal atrophic changes and main pancreatic duct dilation.Effacement of the fat plane between the pancreatic mass and the left liver lobe accompanied by a 24 X 22 mm hypodense mass in the left liver lobe, in continuity with the pancreatic mass is seen which is mostly suggestive of direct invasion.Encasement associated with the narrowing of adjacent arteries (segment of celiac artery just before its branching point, proximal part of the splenic artery, left gastric artery, common hepatic artery and its branches) is seen.Narrowing of the superior mesenteric vein adjacent to the portal confluence is seen.Effacement of the fat plane between pancreatic mass and inferior part of the gastric lesser curvature is noticeable.Several enlarged lymph nodes are seen in the peripancreatic regions.Coronal reformatted image better defines the craniocaudal extent of the tumor and its relationship to the adjacent vasculature.

CT scan showing left facial swelling, edema, and abscess. There is bony erosion due to osteomyelitis causing the malar implant to penetrate the left maxillary sinus and abut the lamina papyracea.

Ulcerated, lobulated 6.6 x 9.6 x 6.5 cm right breast mass with adjacent stranding, skin thickening and pectoral muscle invasion. Necrosis with multiple fluid and gas filled locules and cutaneous fistula.Necrotic level I and II right axillary lymph nodes measuring up to 1.9 cm in short axis diameter.Necrotic right internal thoracic lymph nodes.The left breast and axillary region are normal.Normal lungs and pleura. No bone metastases.Large left renal cyst. Otherwise normal upper abdomen.

Appropriate location of the graft to the humeral head. At the level of the glenoid, the reverse Bankart lesion is visible in a 6-9 o'clock position.

CT scan showed necrosis with extensive osteolysis of the entire bone graft.

Concentric mural thickening of the rectum, sigmoid colon, descending colon and distal transverse colon with wall stratification and relatively engorged mesenteric vessels.No lymphadenopathy.No contrast extravasation.

CT demonstrates enlargement of the left kidney, that displaces the spleen forward, with low density and distended appearance of the renal calyces. Scattered air blisters are seen related to a hypodense collection with peripheral enhancement which is partly not differentiated from the dilated calyces, denoting retroperitoneal abscess formation. A large stone is observed inside a calyx at the lower pole of the left kidney. The findings advocate diffuse retroperitoneal extension of the disease (stage III).

No pulmonary embolus was identified. No significant right heart strain.Left lower lobe consolidation with ipsilateral small simple pleural effusion and a 12mm ipsilateral hilar lymph node. Bilateral lower zone atelectasis. No concerning lung nodules or endobronchial lesions. No other lymphadenopathy. Below the diaphragm, no gross pathology was demonstrated within the visualized upper abdominal viscera.No aggressive bone lesion.

There is diffuse wall thickening of the small bowel mainly involving the jejunum and the ileum. There are no findings of obstruction. There are multiple enlarged mesenteric lymph nodes.

Multiple centrilobular opacities are present in both lung fields, most prominent in the bilateral upper lobes.Conglomerated consolidation-like masses involving bilateral upper lobes and superior segments of bilateral lower lobes.Mediastinal and hilar lymphadenopathy, some of which show calcification.

CT with IV contrast was performed. Large volume subcapsular splenic hematoma and antero-inferior splenic laceration. No active blush of contrast was seen.

Significant enlargement of the hemoperitoneum with suggestion of contrast extravasation at the superolateral aspect of the spleen. No pseudo-aneurysm was visualized.

Extensive patchy confluent areas of reticular interstitial thickening with surrounding ground glass opacities in the bilateral lung, predominantly involving the bilateral upper lobes. A few small cysts in the left upper lobe.

An extensive multiloculated right-sided hypodense collection extends antero-inferiorly from the psoas major and quadratus lumborum muscles into the inguinal region. Appreciable concomitant right-sided inguinal lymphadenopathy, likely reactive. Additional features of focal cellulitis around the right rectus femoris muscle. Given the clinical history and radiological findings, this represents a psoas abscess.