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CTA Head and Neck

TECHNIQUE: Standard noncontrast head CT. Post IV contrast thin section transverse images through the neck during the arterial phase of contrast enhancement. Images were reformatted in coronal and sagittal planes. COMPARISON STUDY: MRI TIA stroke protocol study from 9/11/2013. FINDINGS: Aortic arch: There is a normal anatomic branching pattern of the 3 arteries from the top of the aortic arch, without flow limiting lesions. There is mild atherosclerotic ectasia visualized within the ascending aorta and aortic arch. Carotid arteries: Right common and internal carotid: The innominate trunk is patent. There is heavily calcified atherosclerotic plaque within the distal common carotid artery extending into the proximal internal carotid artery with focal right ICA origin severe stenosis (greater than 90%). The remaining portions of the right common and cervical internal carotid arteries are patent. There is mild atherosclerotic stenosis of the distal internal carotid artery at the cavernous segment secondary to heavily calcified atherosclerosis. There are no aneurysmal dilatations. Left common and internal carotid: There is mild atherosclerotic stenosis of the distal internal carotid artery secondary to atherosclerotic plaque. There are few very small atherosclerotic excavations in the left proximal internal carotid artery without flow limiting disease. The left common and internal carotid arteries are otherwise unremarkable. Vertebral arteries: There is mild osseous remodeling in the lower cervical spine within the transverse foramina secondary to degenerative osteophytic disease, however, there are no flow limiting lesions within the vertebral arteries. Circle of Willis and intracranial arteries: There is a calcified atherosclerotic plaque in the cavernous carotid arteries, without evidence to suggest flow-limiting disease. There is no aneurysm or evidence of vascular malformation. Incidental note is made of apparent post embolization coils in the right pterygomaxillary fissure at the region of the internal maxillary artery, of uncertain clinical significance. Other: Noncontrast CT images through the head demonstrate no hemorrhage, mass effect or herniation. There are chronic microangiopathic ischemic changes in the supratentorial white matter, and diffuse brain parenchymal atrophy which are likely consistent with senescent changes. Images through the cervical spine demonstrate multifocal spondylitic changes and degenerative disc disease more pronounced in the lower cervical spine. There are no acute or aggressive osseous lesions. Limited views of the lung apices are unremarkable. The remainder of the soft tissues are unremarkable. IMPRESSION: 1. Severe (greater than 90%) short segment stenosis of the right distal common and proximal right internal carotid artery secondary to heavily calcified atherosclerotic plaque. 2. No other evidence of flow-limiting atherosclerotic disease in the neck or head. --------------------------------- Comparison: Multiple prior head CTs, most recent was on 18 of September Technique: Noncontrast CT images of the head were performed. CT angiogram images of the head and neck were then obtained following the uneventful administration of 100 cc Isovue. Multiplanar reformatted images were obtained. Findings: Given variations in technique, there is no significant change in the previous described region of encephalomalacia involving the left parietal lobe consistent with the history of prior infarct in this region. Mild diffuse enlargement of the extra axial CSF spaces likely related to volume loss, slightly increased from the prior exam. Scattered hypodensity in the periventricular white matter is likely related to small vessel ischemia. Postoperative changes, status post left parietal craniotomy are stable. There is no evidence of loosening of the craniotomy hardware. Left parietal dural based aneurysm clip is again identified adjacent to the posterior margin of the craniotomy site. Focal metallic artifact in the right parietal scalp is unchanged from the prior study. Correlate with surgical history. Evaluation of the circle of Willis demonstrates a patent vertebrobasilar system without evidence of aneurysm or stenosis. Dense atherosclerotic calcifications are noted in the cavernous carotid arteries without significant stenosis. There is no evidence of intracranial stenosis or aneurysm. Mild asymmetry of the MCA bifurcations is again noted but stable from the prior CT dated 26 August 2008 and is of doubtful clinical significance. There is no definite residual dural AV fistula however CT scan is limited in the evaluation of dural AV fistula. If there is persistent concern, catheter angiogram can be performed. Evaluation of the soft tissues of the neck again demonstrate enhancing masses within the bilateral parotid glands. Given variations in technique, these are unchanged in size from the prior study dated August 26, 2008 and may represent intraparotid lymph nodes versus other benign parotid lesions. Stability over time argues against a more aggressive process. There is a normal vascular enhancement within the vessels of the neck without focal stenosis or aneurysm. Minimal atherosclerotic calcifications are noted in the carotid bulbs bilaterally. There is a nodular prominence of the inferior aspect of the thyroid gland with heterogeneous density which extends substernally. Visualized lung apices are clear. Minimal atherosclerotic calcifications are noted in the aortic arch. Diffuse degenerative changes are present in the cervical spine with variable canal and foraminal stenosis. No aggressive lytic or blastic osseous lesion is noted. IMPRESSION: 1. Stable exam. Senescent changes and old left parietal infarct without evidence of acute intracranial pathology. 2. Postoperative changes status post dural AV fistula repair. There is no definite residual fistula however catheter angiogram is more sensitive in the evaluation of small fistulous connections. 3. Enhancing parotid nodules bilaterally, stable from prior CT scan dated 26 August 2008. Stability over time argues against an aggressive process. Differential includes intraparotid lymph nodes versus benign parotid tumors. 4. Substernal extension of thyroid gland. Other chronic findings as above.