Diagnosis Disclaimed

July 26, 2013

Clinical history listed as "pain," no comparison studies provided, patient motion and suboptimal positioning limit diagnostic detail. Sound familiar?

STUDY TYPE: Noncontrast CT chest/abdomen/pelvis. Please note absence of enhancement impairs parenchymal assessment.

CLINICAL HISTORY: "Pain." (Please note lack of pertinent historical details may limit diagnostic accuracy.)

COMPARISONS: None provided. If reports, or preferably images, from previous studies can be supplied, interpretation will improve, and an addendum may be generated.

TECHNIQUE: Axial imaging of the chest, abdomen, and pelvis was performed. Coronal and sagittal reconstructions are not provided, and some pathology may therefore not be appreciated. Patient's motion and failure to suspend respiration limit diagnostic detail. There is also substantial beam-hardening from habitus and suboptimal positioning, with upper extremities not removed from the field of view. Upper margin of study does not entirely cover the thoracic apex. Lower margin of study partially excludes the pelvis and perineum. Artifact from patient's jewelry and metallic items in clothing (none of which have been removed for study) also limits visibility.

FINDINGS: Heart and major thoracic vasculature are grossly unremarkable on this non-gated study. Against the background of motion artifact, lungs are predominantly clear although tiny nodular densities and subtle pneumonitis are not reliably excluded. No bulky lymphadenopathy is seen but early metastatic disease could still be present.

Tiny hypoattenuating foci are questioned in liver, spleen, pancreas, and kidneys, nonspecific. Liver and spleen are prominent but this could relate to patient habitus. Borderline-thickening of the adrenals is indeterminate. Gallbladder is present, without definite pathology although this modality is limited for such determination. Ureters are not reliably followed and phleboliths are indistinguishable from small stones of the distal tract, bilaterally.

Bladder is nondistended and not reliably assessed. No appreciable uterine/adnexal pathology by this modality; consider ultrasound if clinically appropriate. Appendix not reliably seen, and much of bowel is decompressed; enteritis cannot be excluded. Small quantity of free pelvic fluid is seen, possibly physiological but potentially pathological. No definite free air, although small quantities are difficult to distinguish from gas in closely-adjacent bowel segments. Degenerative changes within the axial skeleton may be related to patient age and habitus but more significant arthropathy is possible. Radionuclide bone scan may be more reliable for metastatic assessment.

IMPRESSION: No definite pathology, allowing for some limitations mentioned above.