ImranzamanML/Clinical_Documents_on_Syndromes_Disease

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MRI Head W&WO Contrast.

REASON FOR EXAM:

Dyspnea.

COMPARISON:

None.

TECHNIQUE:

MRI of the head performed without and with 12 ml of IV gadolinium (Magnevist).

INTERPRETATION:

There are no abnormal/unexpected foci of contrast enhancement. There are no diffusion weighted signal abnormalities. There are minimal, predominantly periventricular, deep white matter patchy foci of FLAIR/T2 signal hyperintensity, the rest of the brain parenchyma appearing unremarkable in signal. The ventricles and sulci are prominent, but proportionate. Per T2 weighted sequence, there is no hyperdense vascularity. There are no calvarial signal abnormalities. There is no significant mastoid air cell fluid. No significant sinus mucosal disease per MRI.

IMPRESSION:

1. No abnormal/unexpected foci of contrast enhancement; specifically, no evidence for metastases or masses.

2. No evidence for acute infarction.

3. Mild, scattered, patchy, chronic small vessel ischemic disease changes.

4. Diffuse cortical volume loss, consistent with patient's age.

5. Preliminary report was issued at the time of dictation.

EXAM:

MRI LEFT FOOT

CLINICAL:

A 49-year-old female with ankle pain times one month, without a specific injury. Patient complains of moderate to severe pain, worse with standing or walking on hard surfaces, with tenderness to palpation at the plantar aspect of the foot and midfoot region and tenderness over the course of the posterior tibialis tendon.

FINDINGS:

Received for second opinion interpretations is an MRI examination performed on 05/27/2005.

There is edema of the subcutis adipose space extending along the medial and lateral aspects of the ankle.

There is edema of the subcutis adipose space posterior to the Achilles tendon. Findings suggest altered biomechanics with crural fascial strains.

There is tendinosis of the posterior tibialis tendon as it rounds the tip of the medial malleolus with mild tendon thickening. There is possible partial surface tearing of the anterior aspect of the tendon immediately distal to the tip of the medial malleolus (axial inversion recovery image #16) which is a possible hypertrophic tear less than 50% in cross sectional diameter. The study has been performed with the foot in neutral position. Confirmation of this possible partial tendon tear would require additional imaging with the foot in a plantar flexed position with transaxial images of the posterior tibialis tendon as it rounds the tip of the medial malleolus oriented perpendicular to the course of the posterior tibialis tendon.

There is minimal synovitis of the flexor digitorum longus and flexor hallucis longus tendon sheaths consistent with flexor splinting but intrinsically normal tendons.

Normal peroneal tendons.

There is tendinosis of the tibialis anterior tendon with thickening but no demonstrated tendon tear. Normal extensor hallucis longus and extensor digitorum tendons.

Normal Achilles tendon. There is a low-lying soleus muscle that extends to within 2cm of the teno-osseous insertion of the Achilles tendon.

Normal distal tibiofibular syndesmotic ligamentous complex.

Normal lateral, subtalar and deltoid ligamentous complexes.

There are no erosions of the inferior neck of the talus and there are no secondary findings of a midfoot pronating force.

Normal plantar fascia. There is no plantar calcaneal spur.

There is venous engorgement of the plantar veins of the foot extending along the medial and lateral plantar cutaneous nerves which may be acting as intermittent entrapping lesions upon the medial and lateral plantar cutaneous nerves.

Normal tibiotalar, subtalar, talonavicular and calcaneocuboid articulations.

The metatarsophalangeal joint of the hallux was partially excluded from the field-of-view of this examination.

IMPRESSION:

Tendinosis of the posterior tibialis tendon with tendon thickening and possible surface fraying / tearing of the tendon immediately distal to the tip of the medial malleolus, however, confirmation of this finding would require additional imaging.

Minimal synovitis of the flexor digitorum longus and flexor hallucis longus tendon sheaths, consistent with flexor splinting.

Edema of the subcutis adipose space along the medial and lateral aspects of the ankle suggesting altered biomechanics and crural fascial strain.

Mild tendinosis of the tibialis anterior tendon with mild tendon thickening.

Normal plantar fascia and no plantar fasciitis.

Venous engorgement of the plantar veins of the foot which may be acting as entrapping lesions upon the medial and lateral plantar cutaneous nerves.
EXAM:

MRI LEFT KNEE WITHOUT CONTRAST

CLINICAL:

Left knee pain.

FINDINGS:

Comparison is made with 10/13/05 radiographs.

There is a prominent suprapatellar effusion. Patient has increased signal within the medial collateral ligament as well as fluid around it, compatible with type 2 sprain. There is fluid around the lateral collateral ligament without increased signal within the ligament itself, compatible with type 1 sprain.

Medial and lateral menisci contain some minimal increased signal centrally that does not extend through an articular surface and findings are felt to represent minimal myxoid degeneration. No tear is seen. Anterior cruciate and posterior cruciate ligaments are intact. There is a bone bruise of medial patellar facet measuring approximately 8 x 5 mm. There is suggestion of some mild posterior aspect of the lateral tibial plateau. MR signal on the bone marrow is otherwise normal.

IMPRESSION:

MRI Head W&WO Contrast.

REASON FOR EXAM:

Dyspnea.

COMPARISON:

None.

TECHNIQUE:

MRI of the head performed without and with 12 ml of IV gadolinium (Magnevist).

INTERPRETATION:

There are no abnormal/unexpected foci of contrast enhancement. There are no diffusion weighted signal abnormalities. There are minimal, predominantly periventricular, deep white matter patchy foci of FLAIR/T2 signal hyperintensity, the rest of the brain parenchyma appearing unremarkable in signal. The ventricles and sulci are prominent, but proportionate. Per T2 weighted sequence, there is no hyperdense vascularity. There are no calvarial signal abnormalities. There is no significant mastoid air cell fluid. No significant sinus mucosal disease per MRI.

IMPRESSION:

1. No abnormal/unexpected foci of contrast enhancement; specifically, no evidence for metastases or masses.

2. No evidence for acute infarction.

3. Mild, scattered, patchy, chronic small vessel ischemic disease changes.

4. Diffuse cortical volume loss, consistent with patient's age.

5. Preliminary report was issued at the time of dictation.

EXAM:

MRI LEFT FOOT

CLINICAL:

A 49-year-old female with ankle pain times one month, without a specific injury. Patient complains of moderate to severe pain, worse with standing or walking on hard surfaces, with tenderness to palpation at the plantar aspect of the foot and midfoot region and tenderness over the course of the posterior tibialis tendon.

FINDINGS:

Received for second opinion interpretations is an MRI examination performed on 05/27/2005.

There is edema of the subcutis adipose space extending along the medial and lateral aspects of the ankle.

There is edema of the subcutis adipose space posterior to the Achilles tendon. Findings suggest altered biomechanics with crural fascial strains.

There is tendinosis of the posterior tibialis tendon as it rounds the tip of the medial malleolus with mild tendon thickening. There is possible partial surface tearing of the anterior aspect of the tendon immediately distal to the tip of the medial malleolus (axial inversion recovery image #16) which is a possible hypertrophic tear less than 50% in cross sectional diameter. The study has been performed with the foot in neutral position. Confirmation of this possible partial tendon tear would require additional imaging with the foot in a plantar flexed position with transaxial images of the posterior tibialis tendon as it rounds the tip of the medial malleolus oriented perpendicular to the course of the posterior tibialis tendon.

There is minimal synovitis of the flexor digitorum longus and flexor hallucis longus tendon sheaths consistent with flexor splinting but intrinsically normal tendons.

Normal peroneal tendons.

There is tendinosis of the tibialis anterior tendon with thickening but no demonstrated tendon tear. Normal extensor hallucis longus and extensor digitorum tendons.

Normal Achilles tendon. There is a low-lying soleus muscle that extends to within 2cm of the teno-osseous insertion of the Achilles tendon.

Normal distal tibiofibular syndesmotic ligamentous complex.

Normal lateral, subtalar and deltoid ligamentous complexes.

There are no erosions of the inferior neck of the talus and there are no secondary findings of a midfoot pronating force.

Normal plantar fascia. There is no plantar calcaneal spur.

There is venous engorgement of the plantar veins of the foot extending along the medial and lateral plantar cutaneous nerves which may be acting as intermittent entrapping lesions upon the medial and lateral plantar cutaneous nerves.

Normal tibiotalar, subtalar, talonavicular and calcaneocuboid articulations.

The metatarsophalangeal joint of the hallux was partially excluded from the field-of-view of this examination.

IMPRESSION:

Tendinosis of the posterior tibialis tendon with tendon thickening and possible surface fraying / tearing of the tendon immediately distal to the tip of the medial malleolus, however, confirmation of this finding would require additional imaging.

Minimal synovitis of the flexor digitorum longus and flexor hallucis longus tendon sheaths, consistent with flexor splinting.

Edema of the subcutis adipose space along the medial and lateral aspects of the ankle suggesting altered biomechanics and crural fascial strain.

Mild tendinosis of the tibialis anterior tendon with mild tendon thickening.

Normal plantar fascia and no plantar fasciitis.

Venous engorgement of the plantar veins of the foot which may be acting as entrapping lesions upon the medial and lateral plantar cutaneous nerves.

EXAM:

MRI LEFT KNEE WITHOUT CONTRAST

CLINICAL:

Left knee pain.

FINDINGS:

Comparison is made with 10/13/05 radiographs.

There is a prominent suprapatellar effusion. Patient has increased signal within the medial collateral ligament as well as fluid around it, compatible with type 2 sprain. There is fluid around the lateral collateral ligament without increased signal within the ligament itself, compatible with type 1 sprain.

Medial and lateral menisci contain some minimal increased signal centrally that does not extend through an articular surface and findings are felt to represent minimal myxoid degeneration. No tear is seen. Anterior cruciate and posterior cruciate ligaments are intact. There is a bone bruise of medial patellar facet measuring approximately 8 x 5 mm. There is suggestion of some mild posterior aspect of the lateral tibial plateau. MR signal on the bone marrow is otherwise normal.

IMPRESSION: