تعليم الأشعة المقطعية_Ct Scan

 Mild bilateral ethmoidal air cells as well as maxillary antra and to less extent sphenoidal sinuses mucosal thickening has been shown  chronic sinusitis  S-shaped deviated bony nasal septum  Hypertrophied right nasal turbinate

► Fractured left sacral ala traversing left sacro-iliac joint and extending to left posterior iliac bone with surrounding callus formation ► Left superior pubic bone and acetabular anterior column and roof fractures with surrounding callus formation ► Left l2 down to L5 transverse processes fractures in place ► Mild spondylodegenerative changes of the lumbar spine are noted, evident by tiny marginal osteophytes at the vertebral endplates ► Diffuse osteopenic texture of the examined vertebrae is seen ► Bilateral degenerative sacroileitis

 Bilateral pulmonary mild diffuse interstitial reaction mainly basal showing fine reticular pattern and micro-fibro-atelectatic bands are also seen, with mild bronchial wall thickening and congested lung parenchymal vessels. However, no evidence of focal pulmonary masses, nodules or cavitations could be noted. Opinion:  Bilateral mild diffuse interstitial lung reactions likely chronic inflammatory reactions versus early interstitial lung disease for clinical correlation and follow up.

 A rounded shaped dense stone is seen lodged at the lower part (pelvic course) of the right ureter (opposite the acetabular roof), with minimal dilatation of the right ureter above however mild dilatation of renal pelvicalyceal system . It is seen measuring about 1 cm along its maximum dimension and attains mean CT density of about 1370 HU , associated subtle blurring of perinephric fat planes likely urine leakage on top of forniceal rupture.  A small right renal lower calyceal stone (about 6.5 mm in maximum diameter and 875 HU in density) is also noted with no significant related backpressure changes. Opinion:  Right lower ureteric dense stone, with minimal right distal hydroureter and mild hydronephrosis above.  Right renal lower calyceal stone. Established liver cirrhosis

• Moderately right renal pelvicalyceal system and ureter down to the pelvic ureter where abrupt transition in caliber seen , moreover scattered gases foci along dilated ureter and renal collection system with associated blurring of perinephric and right paracolic gutter fat planes likely urine leakage on top of forniceal rupture • Mild mural thickening along ascending colon with prominent submucosal fat planes • Changes related to appendectomy with not clear operative bed fat planes. • Surgically removed GB Opinion: • Suspected right distal ureteric stricture/ stenosis with consequent moderate back pressure changes and superadded inflammatory process (emphysematous pyelitis) for CT enhanced study. • Appendicectomy changes with mild operative bed inflammatory reaction • Cholecystectomy

•Right lung displays patchy area of pneumonic consolidation with air-bronchogram is seen involving all lobe with patent air bronchogram likely inflammatory. For close follow-up. •Right minimal basal pleural effusion Impression: • RIGHT LOWER LUNG LOBE CONSOLIDATIVE COLLAPSE LIKELY INFLAMMATORY. WITH MINIMAL BASAL PLEURAL EFFUSION FOR CLOSE FOLLOW-UP YOURS SINCERELY,

•Right ureteric impacted stone is noted at the upper part of ureter opposite L4 transverse process measuring about 7 x 4 mm in maximum CC and transverse diameters respectively and about 416 HU dense, with subsequent proximal moderate back preesure changes manifested by moderate ureteric & pelvi-calyceal dilatation

•Right ureteric impacted stone is noted at the upper part of ureter opposite L4 transverse process measuring about 7 x 5 mm in maximum CC and transverse diameters respectively and about 1045 HU dense, with subsequent proximal mild to moderate back preesure changes manifested by moderate ureteric & pelvi-calyceal dilatation

 Multiple branching dense stones are seen casting the shape of the left renal pelvis and all calyceal groups, with moderate dilatation of the left pelvicalyceal system. It measures roughly about 11x9 cm and attains mean CT density of about 460 HU. N.B.: right inguinal hernia with protruding omentum is incidentally noted. Opinion:  Left renal pelvis and calyceal casting “stag-horn” stone with moderate left hydronephrosis.  Right inguinal hernia.

• Evident surgical intervention with partial left maxillary antrostomy, partial inferior & middle turbinectomies & resection of the anterior superior nasal septum as well as the floor of the sphenoid sinuses. • An ill-defined heterogeneous soft tissue lesion noted involving the remaining lumen of both maxillary antra "more on the right side", the remaining left ethmoidal air cells, & left upper nasal fossa almost totally filing the left sphenoid sinus compartments. It elicits mixed iso to hyper dense texture with sclerotic related bony surfaces. No evidence of fluid levels seen. The left spheno-ethmoidal recesses are almost totally obliterated. • Multiple bone erosions & defects are noted involving the hard palate as well as left sphenoid sinus floor and anterior frontal sinuses wall • Opacified left middle ear cleft and mastoid air cells • No evident orbital or cranial extensions. • Scans taken through the cerebral parenchyma revealed left occipital old infarct along left PCA as well as atrophic brain changes. • Clear right middle ear cavity & mastoidal air cells. • Clear symmetrical nasopharynx. Opinion: Status post- left maxillary antrostomy, partial turbinectomies & resection of the anterior superior nasal septum showing mild residual/recurrent heterogeneous soft tissue lesion involving the remaining paranasal sinuses lumen &left superior nasal fossae as well as the left sphenoid sinus with multiple bone erosions involving the hard palate and left anterior frontal sinus wall as described. Possibility of invasive fungal sinusitis should be considered. Correlation with the clinical, operative, histopathological data & continued follow up are recommended. Left occipital old infarct and brain atrophy

Evidence of well defined non-enhancing abdominal cystic lesion is seen related to the tail of pancreas inferiorly , it it measures about 6 x 7.6 cm showing fluid attenuation of average 13 HU ,. • The gallbladder is surgically removed . .

Newly developed Moderate ascites with associated mild anterior peritoneal sheet like omental thickening (thickness reaches about 2.1 cm)  Enlarged size of the liver displaying hypodense parenchyma, regular contour with multiple scattered hypodense focal lesions the largest about 4.2x5.3 cm. 

• Atrophic left kidney . • Right kidney shows compensatory hypertrophy with preserved parenchymal thickness with clear perinephric fat.  Right kidney measures : 12 x 5.8 cm.  Left kidney measures : 4.2 x 2.4 cm. • Few reactionary abdominal lymphadenopathies

•Left kidney shows mild dilatation of its plevi-calyceal system and its whole ureter with no definite stones • Left perinephric and peri-ureteric fat stranding is noted sugeesting stones passer. • Left renal gravel is noted measures about 2 mms.. • Suboptimal filling of urinary bladder showing thickened wall and hyperdense stone measures about 14 x 8.5 mms with density of average 828 HU , a catheter is seen inside. Opinion: • Urinary bladder stone chronic cystitis with. • Mild left renal hydronephrotic changes with perinephric fat stranding suggesting stone passer. • Left renal gravel.

• Mild mucosal thickening of both maxillary sinuses . • Bilateral aerated middle chonca bullosa . • Hypertrophied both inferior turbinates.

Multiple Comminuted fracture of the olecranon process of the ulna, showing bony gapping and dispalcement, intra-articular separated bony fragments are also noted. ( This characterises likely refrefs to Mayo type II-B olecranon fracture )

Large branching hyperdense staghorn stone seen at the right renal plevis , the stone measures about 21.8 x 20 mms with density 867 HU and 17 x 48 mms with density 992 HU , causing subsequent moderate calycael dilatation.

• Bilateral apical paraseptal emphyseamatous changes . • Bilateral scattared fibroatlectatic bands more appreciated al left lung . • Smaller left lung with no definite consolidation or masses.

• The anterior segment of left upper lung lobe shows spiculated consolidative /solid nodule being peri-hilar and para-mediastinal with air bronchgran inside , it measures about 26 x 18 mms . • Linear branching opacities giving the appearance of tree in bud opacities seen at the upper lobe as well as the basal segment of lower lobe of right lung . • Upper abdominal cuts revealed right renal cyst measures about 4 x 3.5 cm . CONCLUSION :-  Picture of pulmonary bronchiolitis with left lupper lobe perihlar consolidation likely inflammatory process for clinical and laboratory correlation , yet short interval follow up CT is recommended to ensurersolution and exclude underlying obstructive lesion. (according to Fleischiner guidelines criteria )