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Accessory spleen: A small accessory spleen is a normal variant. Arachnoid granulation: Incidentally noted, there is a prominent 8mm arachnoid granulation of the midline tentorium. Atelectasis: The lungs demonstrate bibasilar subsegmental atelectatic or fibrotic changes. Atherosclerosis: Atherosclerotic vascular calcifications are seen throughout the tortuous aorta and its major branches. There are also cardiac valvular and coronary artery atherosclerotic calcifications. Appendicitis: Proximal appendix is dilated around the appendicolith measuring approximately 1 cm in diameter. There is cecal wall thickening with extension of edema to terminal ileum. There is adjacent periappendiceal fat infiltration with mild amount of intraperitoneal free fluid in the dependent portions of the pelvis consistent with infectious process or may be also normal variant. No abscess formation is noted. There is no evidence of small bowel obstruction or perforation. Appendectomy: Surgical clips in the right lower quadrant are compatible with prior appendectomy. Bowel Wall Thickening: There is focal circumferential colonic wall thickening and luminal narrowing of the mid descending colon with associated pericolonic fat stranding. [Focal thickening and stranding with indistinct margination of the diverticuli are noted in the ascending colon at the hepatic flexure with fluid attenuation noted between the gallbladder and colon.] Calyceal diverticulum: There is an outpouching of collecting system into the corticomedullary region of [left] kidney containing a small calcification [milk of calcium]. Central line: A central venous catheter is in place with the tip in the right atrium. Cerebral Contusion: Hypodensities in the bilateral anterior temporal lobes and orbital frontal cortex bilaterally are suspicious for contusions in these locations. Cerebral Mass Effect: There is mild mass effect from the [contusions] with mild diffuse sulcal effacement however there is no significant herniation at this time. Cholecystectomy: The patient is status post cholecystectomy with multiple surgical clips noted within the gallbladder fossa. Countrecoup: [Left] cerebral hemisphere demonstrates contralateral contrecoup temporal lobe contusion. Differential Bowel Wall Thickening: Nonspecific focal circumferential descending colonic wall thickening with associated pericolonic fat stranding. Differential would include infectious or inflammatory processes, however neoplasm would be the diagnosis of exclusion. Recommend correlation with colonoscopy history and direct visualization and tissue sampling as warranted. [Given focality of the inflammation in the ascending colon, underlying neoplasm can not be excluded and followup imaging or direct visualization should be obtained once the acute episode subsides.] Differential Cortical Nephrocalcinosis: Differential would include Acute Cortical Necrosis, Chronic glomerulonephritis, Chronic hypercalcemia, Ethylene glycol poisoning, Primary oxalosis, Elis van Creveld. Differential Medially displaced ureter: Differential would include retrocaval ureter, retroperitoneal mass, pelvic lymphadenopathy, pelvic lipomatosis. Differential Medullary Nephrocalcinosis: Differential would include Medulary Sponge Kidney, Hyperparathyroidism, Renal Tubular Acidosis, Hypercalcemia, Milk alkali sy and excess of Vitamin D. Diverticulosis: Multiple diverticula are noted within the colon without evidence of fat stranding to suggest inflammation. Epidural Hematoma: The brain parenchyma demonstrates [right-sided] [temporoparietal] hyperdensity of lenticular shape measuring [1.6 x 4.0] cm in axial plane, consistent with an epidural hematoma. An adjacent nondisplaced linear fracture traverses the squamosal portion of the right temporal bone and right parietal bone. Fatty Liver: Diffuse fatty infiltration of the liver is demonstrated without focal abnormality. Fibroids: Several calcified uterine fibroids are noted. Focal Fatty Infiltration: Vague hypodense region is seen at the dome of the diaphragm in the right lobe of the liver. This most likely represents focal fatty infiltration or artifact. The liver is otherwise unremarkable on this noncontrast examination. Hemicolectomy: The patient is status post hemicolectomy with distal reanastomosis. Kidney Stone nonobstructing: There is a small calcification in the renal pelvis, which may be vascular or a nonobstructing calyceal nephroliths. Mandibular Fx: There is a nondisplaced obliquely orientated fracture of the left angle of the mandible which courses through the alveolar canal. Soft tissue edema and small pockets of air are noted about the fracture site. No additional fractures are identified. The calvarium is intact. The orbits, mastoid air cells and bilateral temporomandibular joints are unremarkable. Medially Displaced Ureter: There is medially displaced ureter at the level of L2-L3 with mild dilatation above and normal caliber below this level. Mesenteric Lymphnodes: There are a few prominent mesenteric lymph nodes within the right lower quadrant. Normal Lung: The visualized lungs demonstrate no mass, consolidation or pleural effusion. There is no pneumothorax. Limited views of the heart are unremarkable. There is no pleural or pericardial effusion. Normal Abdomen: The liver, biliary system, pancreas, spleen, adrenals and kidneys demonstrate normal morphology [and enhancement] without mass lesions. [Enteric contrast extends to the [cecum, rectum]]. There is no evidence of free fluid or free air in the peritoneal cavity. The [non-opacified] hollow viscera are without evidence of wall thickening, mass or obstruction. There is no lymphadenopathy. The bladder is normal. [The gynecologic organs are unremarkable.] The remainder of the soft tissues and osseous structures are normal. Oral Contrast: Contrast is seen within the gastrointestinal tract to the level of the sigmoid colon. Orbital floor fx: There is a subtle, nondisplaced, angulated fracture of the left orbital floor involving the left infraorbital foramen. There is a small subperiosteal fluid collection adjacent to the left inferior orbital floor fracture. There is no entrapment of the left extraocular musculature. Mild left preseptal periorbital soft tissue swelling is likely related to prior trauma. There is no evidence of retrobulbar hematoma. There is a minimally displaced right nasal bone fracture. There is no pterygoid plate fracture or mandibular fracture. There is no zygomaticomaxillary fracture. Postoperative changes in the right posterior maxilla are likely related to prior wisdom tooth extraction. Pancreatic head mass: There is a 4.1 x 3.7 cm peripherally enhancing mass within the head of the pancreas with dilatation of the common bile duct, measuring up to 1 cm in diameter. The mass is intimately associated with the wall of the duodenum, but there is no evidence of vascular involvement or invasion of adjacent structures. There is a 5 mm cystic lesion within the tail of the pancreas. Additionally, there are scattered foci of calcifications predominantly within the pancreatic tail. There are no enlarged lymph nodes or fluid collections within the abdomen or pelvis. Renal atrophy: There is mild bilateral renal atrophy worse on the left most likely secondary to a large atherosclerotic plaque in the ostium of the left renal artery. Renal Cyst: There is a small exophytic cyst lesion in the upper pole of the right kidney, measuring [], HU: [] which is most likely a cyst. Small Bowel Obstruction: Distended loops of small bowel are seen with intermittent areas of abrupt narrowing within a few areas of the ileum. There may be a transition point towards the mid to distal portion of the ileum as the distal ileal loops are decompressed. A small amount of fluid is seen adjacent to several of these distended ileal loops. There is no wall thickening. Stool fills the cecum and ascending colon. The transverse and descending colon are decompressed. Ascites is present scattered within the abdomen. There is no free air. Spine degen: Multilevel degenerative disease of thoracolumbar spine with a right apex midlumbar scoliosis are noted. Spondylolysis: There is bilateral L5-S1 spondylolysis which results in grade 1 anterolisthesis. Subdural Hematoma: Thin subdural hematoma is noted along the left frontal and parietal lobes. Technique Abdomen: Helical CT scan examination of the abdomen and pelvis was performed following the IV administration of 100 ml of non-ionic contrast Isovue-300. Oral contrast was given prior to the start of the study. Standard 5 mm axial images were obtained with coronal and sagittal reformations. Renal delay images were also obtained. Technique Aorta: Helical CT scanning was performed from the top of the aortic arch to the level of the aortic bifurcation with sagittal and coronal reformations. No contrast was administered. Technique C-Spine: Contiguous axial CT images of the cervical spine were obtained in standard and bone kernels. Coronal and sagittal reformations were created. Technique Head: Routine transverse head CT images without contrast with sagittal reformations. Urachal Diverticulum: There is a saccular outpouching of the anterosuperior bladder which measures 1.6 x 1.4 x 1.8 cm (series 3, image 80; series 602, image #73).