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PA AND LATERAL CHEST THORACIC AND LUMBOSACRAL SPINE, RIBS SERIES AND PELVIS:

Examination of the chest demonstrates a hyperlucent lung on the left consistent with mastectomy. The heart size, pulmonary vascularity and parenchyma are normal without evidence of effusion or infiltrate. Old rib fractures are evidenced on the right 4" through 6" anterolateral portions. Mild but diffuse osteopenia is evident.

Thoracic spine exam shows no evidence of vertebral body collapse, pedicular sclerosis or focal lytic abnormality. Mild anterior wedging is present at the L2 vertebral body. Metallic surgical clips are seen adjacent to the L2 vertebral body. Schmorl's nodes are evident through the lumbar vertebral bodies and a lumbarized S1 transitional vertebra is evident. Multiple midline metallic anterior abdominal sutures are evident within the pelvis. Evaluation of the sacrum is difficult due to the overlying bowel gas and fecal content.

IMPRESSION:

• Old rib fractures.
• Post surgical changes within the abdomen and pelvis.

ABDOMINAL Ultrasounds:   No focal liver lesions are noted. There is no evidence of intrahepatic biliary obstruction. The right lobe of the liver measures 9.7 cm in the longitudinal dimension. No focal spleen lesions are noted. The kidneys appear unremarkable.

IMPRESSION:   No evidence of tumor. CAROTID DOPPLER ULTRASOUND:   Small amount of plaque is seen at the origin of the internal carotid arteries bilaterally, greater on the right side. velocities do not demonstrate evidence of hemodynamically significant stenosis. Antegrade flow is noted in the vertebral and external carotid arteries. Triphasic flow is noted in the subclavian artery.

IMPRESSION:  Mild atherosclerotic plaque at the origin of the internal carotid arteries bilaterally, greater on the right side, without evidence of hemodynamically significant lesion. THYROID ULTRASOUND:   The thyroid gland appears diffusely inhomogeneous with focal nodularity in the upper left pole measuring approximately 2 x 2 cm. Both thyroid lobes measure approximately 6 cm in the longitudinal dimension and 2.7 cm in the AP. Increased flow, resistance flow is noted to the thyroid gland.

IMPRESSION:   Findings compatible with adenomatous hyperplasia. Other neoplastic entities cannot be excluded. Recommend correlation with nuclear medicine studies if clinically indicated. RENAL DOPPLER ULTRASOUND:   The right kidney measures approximately 10.6 cm without architectural abnormality. The right renal segmental artery Doppler exam demonstrates normal waveform and no evidence of stenosis. The left kidney is not well visualized but does demonstrate areas of hyperechogenicity with approximate measurement of 3.7 cm. The left kidney is not well seen on the previous exam.

IMPRESSION:

• No evidence of right renal artery stenosis or focal abnormalities.
• Small, not well visualized left kidney compatible with history of nonfunctional kidney.

ULTRASOUND, RIGHT BREAST:   Ultrasound examination performed on the right breast in the area of the palpable abnormality. No cystic or solid lesions are noted in this area.

IMPRESSION:   Normal breast.

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