تعليم الأشعة المقطعية_Ct Scan

Right lower renal calyceal two stones measures about 10.8 x 5.6 mms with density 1132 HU and 3.6 x 3.1 mms with density 506 HU.

• Diffuse circumfrential mural thicknening of left lung , the lung parynchema showing interlobular septal thickening . • The left lung shows volume loss and elevation of the hemi-diaphragm with shift of mediastinum . • Left paratracheal enlarged lymphadenopathies of average 16 mms and 15 mms. • Right basal ground glass opacities with fibroatlectatic bands with no definite consolidation . • Normal non contrast C.T. appearance of the mediastinum vessels. • Normal size of the heart with mild pericardial effusion CONCLUSION :- • Left sided circumfrential mural thickening with volume loss and interlobular septal thickening suggesting mesothelioma and lymphangitis carcinoamstosis for better assessment by contrast study . • Mediastinal lymphadenopathies likely metastatic . • Mild pericardial effusion. PECT CT is recommended.

• The upper abdominal cuts shows well defined splenic cystic lesion measures bout 5.8 x 4.5 cm with density 5-7 HU.

•• Right vesico-ureteric stone is noted measuring 5.2 x 4.8 mm (of average density about 737 HU.) causing subsequent minimal dilatation of the ureter and its plevicayceal system . • Bilateral few small renal stone , the largest measures about 3 x 3 mms.

 Bilateral periventricular white matter hypodenisty being more hypodense at bifrontal watershed areas.  Mild dilatation of the cerebral ventricles with no midline shift or deformity.  Prominent cortical sulci and extra axial CSF spaces. OPINION: • Bilateral periventricular white matter hypodenisty being more hypodense at bifrontal watershed areas (deep white matter ischemia) for MRI if clinically indicated. • Brain involutional changes .

 Bilateral maxillary mucoperiosteal thickening with bubblky appearance indicating acute sinusitis.  Obliterated both osteomeatal units.  Bilateral ethmoidal air cells and left sphenoidal partial opacification.  Near obliterated right and obliterated left sphenoethmopidal recess.  Hypertrophied both inferior nasal turbinates.  Minimal rightward devaited nasal septum.

Both kidneys are seen ectopically located at the pelvis showing parynchymal fusion below the aortic bifurcation ,

• Defect in the floor of left maxillary sinus associated with total opacification of the left maxillary sinus with obliteration and widening of the left osteomeatl unit subsequent to left antral erosin . • Bilateral aerated middle chonca bullosa . • Hypertrophied both inferior turbinates. • The nasal septum is markedenly left sided deviated with spur..

• Bilateral inplace double-J stent with . • Minimal right renal hydronephrosis yet no obstructing stones. • Left kidney shows lower calyceal hydeocalecosis seconadary to obstructing stone seen at the junction between plevis and lower calycx , the stone measuers about 22 x 7 mms with density 734 HU . No hydronephrotic changes could be noted. • Minimal left perinephric fat stranding with multiple abdominal lymphadenopatheis likely recative for follow up .. • Bilateral hyperdese lower calyceal stones:

• Normal C.T. density of the liver parenchyma, with regular outlines ,it shows large well defined hepatic focal lesion seen occypying the right lobe off the liver (segment V,VI,VII,VIII ) measures about 12 x 11.9 cm showing peripheral rather continuous enhancement at arterial and porto-venous phase with central break down and fill in at delayed images showing no capsular retraction . • Few well definied rounded porta-hepatic and aorto-caval lymphadenopathies , the largest measuers 17 x 21 mms seen at porta-hepatis . • Large bilateral suprarenal soft tissue masses showing no definite enhancement measures about 8.4 x 5.6 cm at right side and about 5.9 x 6 cm at left side .

 Left upper ureteric stone measuring 7x5 mm of average denisty of 1030 HFU at the level of L4 causing subsequent left mild to moderate hydroureteronephrosis.  Left cortical simple cyst.  Right lower calyceal and left middle and lower calyceal small stones of average 3 mm , denisty of 360 HFU .  Left inguinal small indirect hernia containing fat for US.  No radio-opaque calculi or pathological calcification seen within the urinary bladder.

 Fracture of left inferior orbital wall with no muscle entrapment.  Anterior and medial left maxillary wall fracture with surgical plate and screws. fracture of left nasal bone. The fracture being comminuted near the attachment of the maxillary sinus walls with the maxilla.  Minimal left subcutaneous tissue fat stranding and edematous changes “post surgical changes), no definite localized collection noted.  Left maxillary minimal opacity of high density (residual hemosinus).

Aneurysmally dilated ascending aorta reaching 4.5 cm

Evidence of right mandibular(centered on the right angle of mandible) large bony defect with a tooth seen inferiorly deposited with surrounding soft tissue thickening , the soft tissue seen inside the mandibular medullary cavity and shows few air bubbles being connected with the oral cavity air, right cortical mandibular bony thickening.

 Right sided mainly postrobasal area of few small rounded dense GG opacity , ongoing infectious process.  Left sided basal posterior costal area of pleural thickening with thick pleural calcification with related area of thickened fibrotic changes and tractional bronchial dilatation.  Left diaphragmatic pleural calcification.  Subcentimetric reactionary looking mediastinal lymph nodes.  No evidence of right sided pleural effusion, pleural thickening or masses seen.  Cardiomegaly with sternotomy sutures and prothetic valves. No pericardial effusion detected.multiple aortic calcific plaques .  Aneurysmally dilated ascending aorta reaching 4.5 cm for better assessment by ECG gated aortography.  Spine osteodegenerative changes with multiple osteophytes

• Right mainly postrobasal GG opacity dense of ongoing infectious /inflammatory process . • Left lower posterior costal area of pleural thickening and calcification with related fibrotic changes and tractional bronchial dilatation. • Dilated Ascending aorta as described. • Cardiomegaly -Overall study for better assessment by contrast study and/or comparison with previous available studies.

CT study revealed left adenxal likely ovarian cystic lesion measures about 8x7.8 cm.