Assessment #3 set #1 case #8

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left pyelonephritis

Obstructing left distal ureteral stone with associated hydroureteronephrosis, perirenal inflammatory changes, and hemoretroperitoneum.

Findings/impression:
Retroperitoneal fluid is present surrounding the left kidney and may represent a retroperitoneal hematoma, however ureteral injury is also considered. Recommend correlation with Hounsfield units. Recommend multi phase imaging for further evaluation if there is continuing clinical concern after the previous recommendations.
Multiple mixed density bilateral renal cysts are present. Recommend evaluation with computed units and multiphasic CT for further evaluation. Neoplasm cannot be excluded.
Mild periportal edema. Hypodensities are present within the portal veins. This could represent thrombus, however contrast mixing is more likely. Recommend multiphase imaging for further evaluation if there is continued clinical concern.
Indistinct hypodensities are present in the liver and most prominent along the right anterior liver. This could represent neoplasm.
Hyperdense surgical material is within the liver.
Calcifications are present within the breasts. Asymmetric breast tissue is present with increased tissue on the left. Attention on follow-up.
Moderate hiatal hernia with fluid places the patient at risk of aspiration..
A gastric polyp versus lipoma is present within the hiatal hernia.
Surgical changes of the colon are present. Recommend correlation with patient’s clinical history.
Diverticulosis without frank diverticulitis.
Mild colonic wall thickening with minimal surrounding inflammatory changes could represent mild infectious/inflammatory colitis in the proper clinical setting. Recommend correlation with patient’s symptoms and labs.
Posterior soft tissue hypodensities are present in the represent fat necrosis.
S shaped curvature of the lumbar spine. Spondylosis.

Pyelo left

multiple soft tissue nodules
cardiomegaly
esophagus/hernia
liver
bl stones and hydro left greater than right. lots of left inflammation needs cystogram
bowel surgery

Left mid ureteral stone with moderate hydronephrosis and left pyelonephritis

left obstructive uropathy with left renal collecting system rupture

Obstructing stone w/ hydro

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Left distal ureteral stone with mild hydroureteronephrosis and a moderate perinephric fluid collection.
Renal cysts
hepatic cysts
scoliosis
metal FB in liver – correlate with surgical history.

Obstructing L mid ureteral stone w/ mod hydro. L perinephric fluid concerning for forniceal rupture or alternatively inflammatory change due to obstruction.
Additional renal stones bilaterally.
Mod hiatal hernia.
Scattered hyopattenuating liver lesions, correlate with prior imaging.

Hydroureteronephrosis with extensive perinephric edema and fat stranding of the left kidney and ureter. There is a calculus lodged in the distal portion of left ureter. Finding is consistent with obstructive uropathy.

There are multiple additional renal cysts and calculi in both kidneys.

Mild to moderate left sided hydronephrossis with left perinephric fluid, and asymetric patchy attenuation of the left kidney. Region of more focal fluid density along the left kidney concerning for phlegmatous changes/early abscess formation. Obstructive stone in the left ureter.
No right hydronephrosis. Bilateral renal cysts.
Surgical changes to the liver and bowel.
No evidence of bowel obstruction.

Left ureteral stone results in moderate hydronephrosis. Free fluid surrounds kidney.

Bilateral nephrolithiasis with obstructing left upper pole renal stone causing moderate left hydroureteronephrosis.
Asymmetric left perinephric fat stranding and pelvic and proximal ureteral urothelial thickening and enhancement, concerning for ascending infection. There is also small volume ascites in the anterior pararenal and splenorenal spaces.
Bilateral simple appearing renal cysts and subcentimeter lesions too small to characterize.
Mild periportal edema. Two linear radiopaque streaks through the liver, favored sequela of Y90 radioembolization. Indeterminate lesion of segment 7. Recommend liver protocol CT or MRI for further evaluation.
Moderate hiatal hernia with patulous esophagus, increasing patient’s risk of aspiration. There is a nodular focus along the posterior distal esophageal wall, concerning for neoplasm. Recommend endoscopic evaluation.
Diverticulosis without diverticulitis. No bowel obstruction. Appendectomy.
Small fat containing periumbilical hernia.
Multiple nodules of the subcutaneous gluteal tissues bilaterally, favored injection granulomas.
L4 vertebral venous malformation.
Partially calcified nodularity along the anterior T12-L1 intervetebral space, suspicious for neoplasm. Consider PET CT for further evaluation.

hypodensity of the right hepatic lobe – cyst vs hemangioma
Hyperenhancing attenuation of the left ureter, perinephric edema and heteregeneous left kidney – ureteritis/pyelonephritis
Inflammation of descending and sigmoid colon – Enteritis of infectious or inflammatory origin.
Multiple subcutaneous nodules – reactive lymphadenopathy.

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liver lesions
hiatal hernia
subq nodules
sigmoid edema?
extensive fluid L kidney urothelial thickening pyelo

pyelo nonnob stones

Hypodense lesions in liver (segment 4B). Hiatal hernia. Bilateral kidney stones and cysts. Enhancement and dilatation of the left ureter. Perinephric fluid – ruptured ureter?

obstructing distal left ureteral stone.
ureteral enh and dilation c/w mild hydro.
left kidney, overall decreased enh. sugg of pyelo.

Obstructing left renal calculus in the distal left ureter with upstream hydroureteronephrosis, perinephric stranding and fluid.

There is an obstructing calculus in the distal left ureter with proximal ureteral enhancement, dilation, and left-sided perinephric fluid with hydronephrosis.

There is mild mucosal thickening of the rectum and sigmoid colon. This may represent colitis in the appropriate clinical setting.

left obstructive uterolith with perinephric fluid and infection

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Obstructing left ureteral stone with left hydro. Urothelial thickening and perinephric fluid / stranding concerning for superimposed infx.

Moderate left hydronephrosis. Obstructive stone in the distal left ureter, > 4 mm. Ureteral thickening and enhancement. Extensive left perinephric stranding. Lots of additional stones in the kidneys bilaterally. Bunch of other incidentals.

obstructing left ureterolithiasis w extensive left perirena lfluid cold raise concern for calyceal rupture, urogram can further evaluate

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hernia, kidney-severe hydro thickening,stranding,

Mild leftsided hydroureternephrosis with hyperdense calcification in the distal left ureter, consistent with obstructive stone. There is left-sided perinephric edema, as well as additional non-obstructive stones in the bilateral kidneys.

Hypointense liver lesions, largest in the left lobe, which in the setting of known metastatic disease are favored to represent metastatic lesions.

Moderate hiatal hernia containing a mural based lesion, correlation with EGD should be considered if not already performed.

Advanced degenerative disease of the lumbar spine with osteolytic lesion of L4, MRI lumbar spine may be of use for further evaluation.

Cholecystectomy changes with post cholecystectomy ductal ectasia.

Lesions in the soft tissue of the bilateral back, favored to represent metastatic disease

Postsurgical changes from hysterectomy.

Left hydro and UTI. Diffuse bowel wall thickening infectious versus inflammatory.

Low attenuation hepatic lesions favored to represent mets
small-moderate volume left perinephric fluid with hydroureteronephrosis with obstructive stone in mid left ureter
colonic wall thickening consistent with colitis
soft tissue lesions in lower back

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L obstructing ureteral stone with urethelial inflammation and stranding arond thing L kidney.

Findings concerning for left renal forniceal rupture with an obstructing calculus within the distal left ureter and moderate volume of fluid within the left perirenal space, likely representing extravasated urine.

Bilateral nonobstructing renal calculi.

Linear metallic hyperdensities within the liver, possibly representing foreign bodies. Represent correlation with procedural/surgical history. Small hypoattenuating lesion within the right hepatic dome, possibly representing metastatic disease.

Hypervascular round lesions in the pancreas, also possibly representing metastatic disease.

Thickening and hyperenhancement of the rectosigmoid colon, suspicious for nonspecific colitis of inflammatory, infectious, or less likely ischemic in etiology.

Moderate hiatal hernia.

Obstructive stone in the distal left ureter which results in moderate hydronephrosis. Diffuse perinephric fat stranding with urothelial thickening and hyperenhancment may be reactive to obstruction with possible superimposed infection.

Bilateral nephrolithiasis.

Diffuse thickening of the transverse, descending, and sigmoid colon.

Hypoattenuating liver lesions could represent metastatic disease.

Fluid attenuation within the thoracic esophagus places the patient at risk for aspiration.
Hiatal hernia
Surgical clip within the liver.
Hydronephrosis/hydroureter on the left. Ureteral enhancement. Stone within the distal left ureter. Fluid attenuation about the left kidney could fornix rupture. Bilateral renal cysts.
Colitis
Free fluid
Lucencies within the bone concerning for metastases.

A few scattered well defined hypodensities within the liver in keep with the patient’s known history of metastatic carcinoid. Metallic density with tract within the liver dome likely post-operative changes.

s/p chole with dilatation of the cbd due to reservoir effect.

Moderate sized hiatal hernia with air fluid level places the patient at risk for aspiration, recommend NG tube placement.

Obstructing right renal stone resulting in mild hydronephrosis.
Obstructing left renal and distal uretral calculi resulting in moderate hydroureteronephrosis.

Left periurethral and calyceal stranding noted likely representative of UTI. Although no injury is visualized, large fluid surrounding the left kidney is concerning for renal injury. Recommend emergent urologic/surgical consultation.

Significant wall thickening/edema of the rectosigmoid colon suggestive of infectious/inflammatory proctocolitis.