84-year-old male with critical limb ischemia. Possible TAVR. Please evaluate from arch to toes. History failed transplant kidney.Patient is on hemodialysis per clinical service. VESSELS:SINUS OF VALSALVA: 3.8 X 3.7 X 3.6 cmSINOTUBULAR JUNCTION: 3.3 X 3.3 cmASCENDING THORACIC AORTA AT LEVEL OF MAIN PULMONARY ARTERY: 3.6 X 4.0 cmPROXIMAL ARCH: 3.7 X 3.4 cmDISTAL ARCH: 2.7 X 2.6 cmSUPRARENAL ABDOMINAL AORTA: 1.9 X 1.9 cmINFRARENAL ABDOMINAL AORTA: 1.6 X 1.5 cmRIGHT COMMON ILIAC ARTERY: 10 X 9 mmRIGHT EXTERNAL ILIAC ARTERY: 8 X 7 mmRIGHT COMMON FEMORAL ARTERY: 8 X 7 mmLEFT COMMON ILIAC ARTERY: 11 X 9 mmLEFT EXTERNAL ILIAC ARTERY: 8 X 7 mmLEFT COMMON FEMORAL ARTERY: 7 X 7 mmCHEST:LUNGS AND PLEURA: Lower lobe bronchiectasis bilaterally adjacent groundglass opacities (left greater than right), suggesting chronic aspiration and/or infection. No pleural effusions or thickening.Right upper lobe granuloma.MEDIASTINUM AND HILA: Scattered calcified mediastinal lymph nodes reflect previous granulomatous disease.Coronary artery calcifications involving all 3 vessels.Aortic valve calcifications. This exam was not tailored to evaluate aortic valve morphology.Left jugular central venous catheter with tip in distal SVC.CHEST WALL: Gynecomastia. Subacute left sided rib fractures. Presumed bursal fluid about the right shoulder is incompletely evaluated.ABDOMEN: LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Atrophic end stage kidneys. Failed LLQ renal transplant.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:Bladder: Wall thickening.Pelvic kidney: Note is made of a significantly dilated collecting system of the known failed transplant kidney.Extraperitoneal space and lymph nodes: No significant abnormalities.Prostate: No significant abnormalities noted.BONES, SOFT TISSUES: Right hip prosthesis. Lumbar fixation rods and screws. L1 chronic appearing compression fracture.LOWER EXTREMITY RUN-OFF:RIGHT LEG: Mild disease of the common femoral artery with multifocal mild-to-moderate disease of the SFA.Profunda femoris patent but diffusely calcified.Popliteal artery: Multifocal disease with areas of severe narrowing at the level of the knee.Diffuse calcific disease limits evaluation of the runoff vessels. Given this limitation, probable two-vessel runoff to the right foot via anterior tibial and peroneal arteries.Anterior tibial: Multifocal moderate disease.Posterior tibial: Occluded proximally.Peroneal: Occluded proximally with reconstitution via collaterals at the level of the mid-calf.Dorsalis pedis: Patent.LEFT LEG: Severe stenosis of the proximal common femoral artery with multifocal moderate-to-severe disease of the SFA.Profunda femoris patent but diffusely calcified.Popliteal artery: moderate-to-severe disease.Diffuse calcific disease limits evaluation of the runoff vessels. Given this limitation, probable single-vessel runoff to the left foot via a severely diseased anterior tibial artery.Anterior tibial: Multifocal severe disease.Posterior tibial: Occluded.Peroneal: Probable occlusion of the peroneal artery at the midcalf level.Dorsalis pedis: Patent via collateral filling.
1. Calcified aortic valve. Ascending aorta measures 3.9 cm (nonorthogonal) at the level of the main pulmonary. Please note that this examination was not tailored for evaluation of aortic valve morphology.2. Diffuse atherosclerotic calcifications of the descending abdominal aorta and iliac vessels, which are otherwise patent.3. Left pelvic kidney with significant dilatation of the collecting system corresponds to known failed renal transplant. Bladder wall thickening is also noted.4. Bibasilar bronchiectasis with adjacent groundglass opacities (left greater than right), suggesting chronic aspiration and/or infection. Given the patient's age this should be followed to resolution to exclude underlying neoplasm, especially if there are no signs or symptoms of infection/aspiration.5. RIGHT LOWER EXTREMITY RUN-OFF: Mild inflow disease with multifocal mild-to-moderate outflow disease involving the superficial femoral artery. There is severe narrowing of the popliteal artery at the level of the knee with probable two-vessel runoff to the right foot via diseased anterior tibial and peroneal arteries.6. LEFT LOWER EXTREMITY RUN-OFF: Focal severe disease of the proximal common femoral artery with multifocal moderate-to-severe disease of the superficial femoral artery. Moderate-to-severe disease of the popliteal artery with probable single-vessel runoff to the left foot via a severely diseased anterior tibial artery.