ImranzamanML/Clinical_Documents_on_Syndromes_Disease

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FINDINGS:

There are two small foci of increased activity in the left axilla. This is consistent with the sentinel lymph node. No other areas of activity are visualized outside of the injection site and two axillary lymph nodes.

IMPRESSION:

Technically successful lymph node injection with two areas of increased activity in the left axilla consistent with sentinel lymph node.
INDICATION:

Lung carcinoma.

Whole body PET scanning was performed with 11 mCi of 18 FDG. Axial, coronal and sagittal imaging was performed over the neck, chest abdomen and pelvis.

FINDINGS:

There is normal physiologic activity identified in the myocardium, liver, spleen, ureters, kidneys and bladder.

There is abnormal FDG-avid activity identified in the posterior left paraspinal region best seen on axial images 245-257 with an SUV of 3.8, no definite bone lesion is identified on the CT scan or the bone scan dated 08/14/2007 (It may be purely lytic).

Additionally there is a significant area of activity corresponding to a mass in the region of the left hilum that is visible on the CT scan with an SUV of 18.1, the adjacent atelectasis as likely post obstructive in nature.

Additionally, although there is no definite lesion identified on CT

there is a tiny satellite nodule in the left upper lobe that is hypermetabolic with an SUV of 5.0. The spiculated density seen in the right upper lobe on the CT scan does not demonstrate FDG activity on this PET scan.

There is a hypermetabolic lymph node identified in the aorta pulmonary window with an SUV of 3.7 in the mediastinum.

IMPRESSION:

No prior PET scans for comparison, there is a large lesion identified in the area of the left hilum with an SUV of 18.1 likely causing the obstructive atelectasis seen on the CT scan.

There is a tiny satellite area of hypermetabolic FDG in the left upper lobe adjacent to the pleura with an SUV of 5.0.

There is a area of hypermetabolic activity in the left paraspinal soft tissues at the level of the lung apices which may represent a focal bone lesion. However no lesion is identified on bone scan or CT scan.

There is a hypermetabolic lymph node identified. The aorta pulmonary window with a corresponding finding on CT scan with an SUV of 3.7.
EXAM:

Nuclear medicine tumor localization, whole body.

HISTORY:

Status post subtotal thyroidectomy for thyroid carcinoma, histology not provided.

FINDINGS:

Following the oral administration of 4.3 mCi Iodine-131, whole body planar images were obtained in the anterior and posterior projections at 24, 48, and 72 hours.

There is increased uptake in the left upper quadrant, which persists throughout the examination. There is a focus of increased activity in the right lower quadrant, which becomes readily apparent at 72 hours. Physiologic uptake in the liver, spleen, and transverse colon is noted. Physiologic urinary bladder uptake is also appreciated. There is low-grade uptake in the oropharyngeal region.

IMPRESSION:

Iodine-avid foci in the right lower quadrant and left upper quadrant medially suspicious for distant metastasis. Anatomical evaluation, i.e.

CT is advised to determine if there are corresponding mesenteric lesions. Ultimately (provided that the original pathology of the thyroid tumor with iodine-avid) PET scanning may be necessary. No evidence of iodine added locoregional metastasis.
INDICATIONS:

Previously markedly abnormal dobutamine Myoview stress test and gated scan.

PROCEDURE DONE:

Resting Myoview perfusion scan and gated myocardial scan.

MYOCARDIAL PERFUSION IMAGING:

Resting myocardial perfusion SPECT imaging and gated scan were carried out with 32.6 mCi of Tc-99m Myoview. Rest study was done and compared to previous dobutamine Myoview stress test done on Month DD

YYYY. The lung heart ratio is 0.34. There appears to be a moderate size inferoapical perfusion defect of moderate degree. The gated myocardial scan revealed mild apical and distal inferoseptal hypokinesis with ejection fraction of 55%.

CONCLUSIONS:

Study done at rest only revealed findings consistent with an inferior non-transmural scar of moderate size and moderate degree. The left ventricular systolic function is markedly improved with much better regional wall motion of all left ventricular segments when compared to previous study done on Month DD

YYYY. We cannot assess the presence of any reversible perfusion defects because no stress imaging was performed.
DIAGNOSIS:

Shortness of breath. Fatigue and weakness. Hypertension. Hyperlipidemia.

INDICATION:

To evaluate for coronary artery disease.

FINDINGS:

There are posttraumatic cysts along the volar midline and volar lateral aspects of the lunate which are likely posttraumatic. There is no acute marrow edema (series #12 images #5-7). Marrow signal is otherwise normal in the distal radius and ulna, throughout the carpals and throughout the proximal metacarpals.

There is a partial tear of the volar component of the scapholunate ligament in the region of the posttraumatic lunate cyst with retraction and thickening towards the scaphoid (series #6 image #5, series #8 images #22-36). There is tearing of the membranous portion of the ligament. The dorsal component is intact.

The lunatotriquetral ligament is thickened and lax, but intact (series #8 image #32).

There is no tearing of the radial or ulnar attachment of the triangular fibrocartilage (series #6 image #7). There is a mildly positive ulnar variance. Normal ulnar collateral ligament.

The patient was positioned in dorsiflexion. Carpal alignment is normal and there are no tears of the dorsal or ventral intercarpal ligaments (series #14 image #9).

There is a longitudinal split tear of the ECU tendon which is enlarged both at the level of and distal to the ulnar styloid with severe synovitis (series #4 images #8-16, series #3 images #9-16).

There is thickening of the extensor tendon sheaths within the fourth dorsal compartment with intrinsically normal tendons (series #4 image #12).

There is extensor carpi radialis longus and brevis synovitis in the second dorsal compartment (series #4 image #13).

FINDINGS:

There are two small foci of increased activity in the left axilla. This is consistent with the sentinel lymph node. No other areas of activity are visualized outside of the injection site and two axillary lymph nodes.

IMPRESSION:

Technically successful lymph node injection with two areas of increased activity in the left axilla consistent with sentinel lymph node.

INDICATION:

Lung carcinoma.

Whole body PET scanning was performed with 11 mCi of 18 FDG. Axial, coronal and sagittal imaging was performed over the neck, chest abdomen and pelvis.

FINDINGS:

There is normal physiologic activity identified in the myocardium, liver, spleen, ureters, kidneys and bladder.

There is abnormal FDG-avid activity identified in the posterior left paraspinal region best seen on axial images 245-257 with an SUV of 3.8, no definite bone lesion is identified on the CT scan or the bone scan dated 08/14/2007 (It may be purely lytic).

Additionally there is a significant area of activity corresponding to a mass in the region of the left hilum that is visible on the CT scan with an SUV of 18.1, the adjacent atelectasis as likely post obstructive in nature.

Additionally, although there is no definite lesion identified on CT

there is a tiny satellite nodule in the left upper lobe that is hypermetabolic with an SUV of 5.0. The spiculated density seen in the right upper lobe on the CT scan does not demonstrate FDG activity on this PET scan.

There is a hypermetabolic lymph node identified in the aorta pulmonary window with an SUV of 3.7 in the mediastinum.

IMPRESSION:

No prior PET scans for comparison, there is a large lesion identified in the area of the left hilum with an SUV of 18.1 likely causing the obstructive atelectasis seen on the CT scan.

There is a tiny satellite area of hypermetabolic FDG in the left upper lobe adjacent to the pleura with an SUV of 5.0.

There is a area of hypermetabolic activity in the left paraspinal soft tissues at the level of the lung apices which may represent a focal bone lesion. However no lesion is identified on bone scan or CT scan.

There is a hypermetabolic lymph node identified. The aorta pulmonary window with a corresponding finding on CT scan with an SUV of 3.7.

EXAM:

Nuclear medicine tumor localization, whole body.

HISTORY:

Status post subtotal thyroidectomy for thyroid carcinoma, histology not provided.

FINDINGS:

Following the oral administration of 4.3 mCi Iodine-131, whole body planar images were obtained in the anterior and posterior projections at 24, 48, and 72 hours.

There is increased uptake in the left upper quadrant, which persists throughout the examination. There is a focus of increased activity in the right lower quadrant, which becomes readily apparent at 72 hours. Physiologic uptake in the liver, spleen, and transverse colon is noted. Physiologic urinary bladder uptake is also appreciated. There is low-grade uptake in the oropharyngeal region.

IMPRESSION:

Iodine-avid foci in the right lower quadrant and left upper quadrant medially suspicious for distant metastasis. Anatomical evaluation, i.e.

CT is advised to determine if there are corresponding mesenteric lesions. Ultimately (provided that the original pathology of the thyroid tumor with iodine-avid) PET scanning may be necessary. No evidence of iodine added locoregional metastasis.

INDICATIONS:

Previously markedly abnormal dobutamine Myoview stress test and gated scan.

PROCEDURE DONE:

Resting Myoview perfusion scan and gated myocardial scan.

MYOCARDIAL PERFUSION IMAGING:

Resting myocardial perfusion SPECT imaging and gated scan were carried out with 32.6 mCi of Tc-99m Myoview. Rest study was done and compared to previous dobutamine Myoview stress test done on Month DD

YYYY. The lung heart ratio is 0.34. There appears to be a moderate size inferoapical perfusion defect of moderate degree. The gated myocardial scan revealed mild apical and distal inferoseptal hypokinesis with ejection fraction of 55%.

CONCLUSIONS:

Study done at rest only revealed findings consistent with an inferior non-transmural scar of moderate size and moderate degree. The left ventricular systolic function is markedly improved with much better regional wall motion of all left ventricular segments when compared to previous study done on Month DD

YYYY. We cannot assess the presence of any reversible perfusion defects because no stress imaging was performed.

DIAGNOSIS:

Shortness of breath. Fatigue and weakness. Hypertension. Hyperlipidemia.

INDICATION:

To evaluate for coronary artery disease.

FINDINGS:

There are posttraumatic cysts along the volar midline and volar lateral aspects of the lunate which are likely posttraumatic. There is no acute marrow edema (series #12 images #5-7). Marrow signal is otherwise normal in the distal radius and ulna, throughout the carpals and throughout the proximal metacarpals.

There is a partial tear of the volar component of the scapholunate ligament in the region of the posttraumatic lunate cyst with retraction and thickening towards the scaphoid (series #6 image #5, series #8 images #22-36). There is tearing of the membranous portion of the ligament. The dorsal component is intact.

The lunatotriquetral ligament is thickened and lax, but intact (series #8 image #32).

There is no tearing of the radial or ulnar attachment of the triangular fibrocartilage (series #6 image #7). There is a mildly positive ulnar variance. Normal ulnar collateral ligament.

The patient was positioned in dorsiflexion. Carpal alignment is normal and there are no tears of the dorsal or ventral intercarpal ligaments (series #14 image #9).

There is a longitudinal split tear of the ECU tendon which is enlarged both at the level of and distal to the ulnar styloid with severe synovitis (series #4 images #8-16, series #3 images #9-16).

There is thickening of the extensor tendon sheaths within the fourth dorsal compartment with intrinsically normal tendons (series #4 image #12).

There is extensor carpi radialis longus and brevis synovitis in the second dorsal compartment (series #4 image #13).