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What Do These CT Abdomen And Pelvis Scan Indicate?
Question: AKI (acute kidney injury) (HCC) 03/01/2016
Right wrist pain 03/02/2016
Right elbow pain 03/02/2016
Liver cyst 03/02/2016
Polycystic kidney disease 03/02/2016
Right shoulder injury 03/29/2016
Rotator cuff injury 03/29/2016
CKD (chronic kidney disease) stage 3, GFR 30-59 ml/min 03/29/2016
Hyponatremia 03/29/2016
History of hernia repair 05/06/2016
Renovascular hypertension 05/06/2016
S/P umbilical hernia repair, follow-up exam 05/12/2016
Elevated hemoglobin (HCC) 08/13/2016
Conjunctivitis of left eye 08/13/2016
Essential hypertension with goal blood pressure less than 130/80 08/13/2016
Severe single current episode of major depressive disorder, without psychotic features (HCC) 08/13/2016
more...
EXAM:
CT ABDOMEN AND PELVIS
EXAM DATE: 3/30/2016 03:39 AM.
CLINICAL HISTORY: Abdominal pain.
COMPARISONS: 03/01/2016.
TECHNIQUE: Routine helical CT imaging was performed through the abdomen and pelvis. IV contrast: No. Enteric contrast: No. Reconstructions: Coronal and sagittal.
FINDINGS:
Lung Bases: Unremarkable.
Liver: Innumerable hepatic cysts are again seen.
Gallbladder/Bile Ducts: Unremarkable. No evidence of biliary obstruction.
Spleen: Normal.
Pancreas: Normal.
Adrenal Glands: Normal.
Kidneys: Innumerable bilateral renal cysts are seen in markedly enlarged kidneys, consistent with polycystic kidney disease. Several of the small cysts are hyperdense. No hydronephrosis. A 3 mm nonobstructing left lower pole renal stone is seen.
Peritoneal Cavity/Bowel: Small volume hyperdense fluid is present in the left paracolic gutter and the pelvis. Etiology is uncertain. Bowel has normal caliber. There is no pneumoperitoneum. The appendix is not clearly visualized.
Pelvic Organs: Normal. The bladder and visualized pelvic organs are within normal limits.
Vasculature: No aneurysms or other significant abnormality.
Bones: No significant abnormality.
Other: None.
Impression
1. Small volume acute pneumoperitoneum.
2. Polycystic kidney disease.
3. Cystic liver.
Critical result: Findings were discussed with XXXXXXX Reka, PA, by Dr. Fullmer on 03/30/2016 at 0425 hours.
RADIA
ADDENDUM: 03/30/16 04:26
There is a typographical error in the first impression point. The word pneumoperitoneum should be replaced with hemoperitoneum.
EXAM:
CHEST RADIOGRAPHY
EXAM DATE: 3/30/2016 03:44 AM.
CLINICAL HISTORY: SOB.
COMPARISON: None.
TECHNIQUE: 2 views.
FINDINGS:
Lungs/Pleura: Minimal right basilar atelectasis. The lungs are otherwise clear. No pneumothorax or pleural effusion.
Mediastinum: Heart and mediastinal contours are unremarkable.
Other: None.
Impression
Minimal right basilar atelectasis.
RADIA
Electronically
HISTORY:
49 years. Male. Abdominal pain, motor vehicle accident, groin pain
TECHNIQUE:
5-mm axial images were acquired through the abdomen and pelvis. 1.25 mm axial and 2 mm coronal reconstructions were performed.
Oral Contrast: None.
IV contrast: 100 mL IsoVue 300
COMPARISON:
None.
FINDINGS:
Normal cardiac size. A 3 mm calcified left lower lobe pulmonary nodule. Bibasilar subsegmental atelectasis or scarring. Normal cardiac size.
The distal esophagus is normal.
Multiple simple appearing hepatic cysts the liver measures 20.3 cm in craniocaudal length. The largest cyst in right liver lobe measures 6.9 x 6 cm. No biliary dilation.
The spleen is normal in size and attenuation. Small splenic cysts, larger measuring approximately 1.1 cm.
The pancreas is normal in size and attenuation. No solid or cystic masses are noted.
The gallbladder is normal in size. No stones, sludge or wall thickening is noted.
The adrenal glands are normal in size bilaterally. There is no evidence of an adrenal adenoma or hyperplasia.
Enlarged both kidneys with multiple cysts the right kidney measures 18 cm in craniocaudal length. The left kidney measures 21.5 cm in craniocaudal length.
A 4 cm stone in lower pole of the left kidney. No hydronephrosis bilaterally. No ureteric stone is visualized.
Aortobiiliac atherosclerosis.
No free fluid or free air is present.
No adenopathy is seen in the abdomen or pelvis.
The stomach, duodenum, jejunum, ileum, ileocecal valve are normal. No air-fluid levels are seen to suggest obstruction. The appendix is identified and is normal. Colonic diverticulosis without acute diverticulitis.
In the pelvis the bladder is fluid filled and has a normal contour and wall thickness. No intraluminal filling defects are seen. No diverticulum is noted.
Normal size prostrate with small dystrophic calcifications.
Small fat-containing bilateral renal hernias, left greater than right.
The osseous structures do not demonstrate lytic or blastic lesions. The SI joints and hip joints are normal. Mild thoracolumbar dextro scoliosis.
Impression
1. Small bilateral inguinal hernias, left greater than right. Left inguinal hernia probably account for palpable swelling.
2. Adult polycystic kidney disease.
3. Polycystic liver.
4. A 4 mm nonobstructive stone in lower pole of the left kidney.
5. Additional incidental findings as above
Component Results
Component
Your Value
Standard Range
SODIUM 134 mmol/L 135 - 143 mmol/L
Testing performed at TCL, 7131 W Grandridge Blvd, Kennewick, WA 99336
POTASSIUM 4.1 mmol/L 3.5 - 4.9 mmol/L
Testing performed at TCL, 7131 W Grandridge Blvd, Kennewick, WA 99336
CHLORIDE 104 mmol/L 99 - 109 mmol/L
Testing performed at TCL, 7131 W Grandridge Blvd, Kennewick, WA 99336
CO2 25 mmol/L 23 - 32 mmol/L
Testing performed at TCL, 7131 W Grandridge Blvd, Kennewick, WA 99336
ANION GAP AGAP 9 mmol/L 5 - 20 mmol/L
Testing performed at TCL, 7131 W Grandridge Blvd, Kennewick, WA 99336
GLUCOSE 112 mg/dL 65 - 99 mg/dL
Testing performed at TCL, 7131 W Grandridge Blvd, Kennewick, WA 99336
BUN 22 mg/dL 8 - 25 mg/dL
Testing performed at TCL, 7131 W Grandridge Blvd, Kennewick, WA 99336
CREATININE 1.46 mg/dL 0.70 - 1.30 mg/dL
Testing performed at TCL, 7131 W Grandridge Blvd, Kennewick, WA 99336
CALCIUM 9.2 mg/dL 8.5 - 10.5 mg/dL
Testing performed at TCL, 7131 W Grandridge Blvd, Kennewick, WA 99336
ALBUMIN 3.5 g/dL 3.6 - 5.0 g/dL
Testing performed at TCL, 7131 W Grandridge Blvd, Kennewick, WA 99336
PHOSPHORUS 3.3 mg/dL 2.3 - 4.8 mg/dL
Testing performed at TCL, 7131 W Grandridge Blvd, Kennewick, WA 99336
EGFR 55 mL/min/1.73m2 >60 mL/min/1.73m2
GFR <60: CHRONIC KIDNEY DISEASE, IF FOUND OVER A 3 MONTH PERIOD.
GFR <15: KIDNEY FAILURE.
FOR XXXXXXX AMERICANS, MULTIPLY THE CALCULATED GFR BY 1.210.
Testing performed at TCL, 7131 W Grandridge Blvd, Kennewick, WA 99336
ALDOSTERONE 7.9 ng/dL <39.2 ng/dL
UPRIGHT: <39.2 NG/DL SUPINE: <23.2 NG/DL
NORMAL SERUM ALDOSTERONE LEVELS ARE DEPENDENT ON MANY FACTORS: POSTURE
, SODIUM INTAKE, AND TIME OF DAY. EVALUATION OF SERUM ALDOSTERONE
SHOULD BE INTERPRETED UNDER STRICTLY CONTROLLED CONDITIONS.
Testing performed at PAML, 110 W Cliff Avenue, XXXXXXX WA 99204
RENIN,DIRECT <2.1 pg/mL
UPRIGHT < OR = 40 YEARS OLD 4.2 TO 52.2 PG/ML
UPRIGHT >40 YEARS OLD 3.6 TO 81.6 PG/ML
SUPINE < OR = 40 YEARS OLD 3.2 TO 33.2 PG/ML
SUPINE >40 YEARS OLD 2.5 TO 45.1 PG/ML
Testing performed at PAML, 110 W Cliff Avenue, XXXXXXX WA 99204
ALDOSTERONE/RENIN >3.8 ratio 0 - 25 ratio
Reference range: 0.1 to 3.7
AN ALDOSTERONE/DIRECT RENIN RATIO OF GREATER THAN 3.7 IS SUGGESTIVE OF
HYPERALDOSTERONISM.
Testing performed at XXX
Right wrist pain 03/02/2016
Right elbow pain 03/02/2016
Liver cyst 03/02/2016
Polycystic kidney disease 03/02/2016
Right shoulder injury 03/29/2016
Rotator cuff injury 03/29/2016
CKD (chronic kidney disease) stage 3, GFR 30-59 ml/min 03/29/2016
Hyponatremia 03/29/2016
History of hernia repair 05/06/2016
Renovascular hypertension 05/06/2016
S/P umbilical hernia repair, follow-up exam 05/12/2016
Elevated hemoglobin (HCC) 08/13/2016
Conjunctivitis of left eye 08/13/2016
Essential hypertension with goal blood pressure less than 130/80 08/13/2016
Severe single current episode of major depressive disorder, without psychotic features (HCC) 08/13/2016
more...
EXAM:
CT ABDOMEN AND PELVIS
EXAM DATE: 3/30/2016 03:39 AM.
CLINICAL HISTORY: Abdominal pain.
COMPARISONS: 03/01/2016.
TECHNIQUE: Routine helical CT imaging was performed through the abdomen and pelvis. IV contrast: No. Enteric contrast: No. Reconstructions: Coronal and sagittal.
FINDINGS:
Lung Bases: Unremarkable.
Liver: Innumerable hepatic cysts are again seen.
Gallbladder/Bile Ducts: Unremarkable. No evidence of biliary obstruction.
Spleen: Normal.
Pancreas: Normal.
Adrenal Glands: Normal.
Kidneys: Innumerable bilateral renal cysts are seen in markedly enlarged kidneys, consistent with polycystic kidney disease. Several of the small cysts are hyperdense. No hydronephrosis. A 3 mm nonobstructing left lower pole renal stone is seen.
Peritoneal Cavity/Bowel: Small volume hyperdense fluid is present in the left paracolic gutter and the pelvis. Etiology is uncertain. Bowel has normal caliber. There is no pneumoperitoneum. The appendix is not clearly visualized.
Pelvic Organs: Normal. The bladder and visualized pelvic organs are within normal limits.
Vasculature: No aneurysms or other significant abnormality.
Bones: No significant abnormality.
Other: None.
Impression
1. Small volume acute pneumoperitoneum.
2. Polycystic kidney disease.
3. Cystic liver.
Critical result: Findings were discussed with XXXXXXX Reka, PA, by Dr. Fullmer on 03/30/2016 at 0425 hours.
RADIA
ADDENDUM: 03/30/16 04:26
There is a typographical error in the first impression point. The word pneumoperitoneum should be replaced with hemoperitoneum.
EXAM:
CHEST RADIOGRAPHY
EXAM DATE: 3/30/2016 03:44 AM.
CLINICAL HISTORY: SOB.
COMPARISON: None.
TECHNIQUE: 2 views.
FINDINGS:
Lungs/Pleura: Minimal right basilar atelectasis. The lungs are otherwise clear. No pneumothorax or pleural effusion.
Mediastinum: Heart and mediastinal contours are unremarkable.
Other: None.
Impression
Minimal right basilar atelectasis.
RADIA
Electronically
HISTORY:
49 years. Male. Abdominal pain, motor vehicle accident, groin pain
TECHNIQUE:
5-mm axial images were acquired through the abdomen and pelvis. 1.25 mm axial and 2 mm coronal reconstructions were performed.
Oral Contrast: None.
IV contrast: 100 mL IsoVue 300
COMPARISON:
None.
FINDINGS:
Normal cardiac size. A 3 mm calcified left lower lobe pulmonary nodule. Bibasilar subsegmental atelectasis or scarring. Normal cardiac size.
The distal esophagus is normal.
Multiple simple appearing hepatic cysts the liver measures 20.3 cm in craniocaudal length. The largest cyst in right liver lobe measures 6.9 x 6 cm. No biliary dilation.
The spleen is normal in size and attenuation. Small splenic cysts, larger measuring approximately 1.1 cm.
The pancreas is normal in size and attenuation. No solid or cystic masses are noted.
The gallbladder is normal in size. No stones, sludge or wall thickening is noted.
The adrenal glands are normal in size bilaterally. There is no evidence of an adrenal adenoma or hyperplasia.
Enlarged both kidneys with multiple cysts the right kidney measures 18 cm in craniocaudal length. The left kidney measures 21.5 cm in craniocaudal length.
A 4 cm stone in lower pole of the left kidney. No hydronephrosis bilaterally. No ureteric stone is visualized.
Aortobiiliac atherosclerosis.
No free fluid or free air is present.
No adenopathy is seen in the abdomen or pelvis.
The stomach, duodenum, jejunum, ileum, ileocecal valve are normal. No air-fluid levels are seen to suggest obstruction. The appendix is identified and is normal. Colonic diverticulosis without acute diverticulitis.
In the pelvis the bladder is fluid filled and has a normal contour and wall thickness. No intraluminal filling defects are seen. No diverticulum is noted.
Normal size prostrate with small dystrophic calcifications.
Small fat-containing bilateral renal hernias, left greater than right.
The osseous structures do not demonstrate lytic or blastic lesions. The SI joints and hip joints are normal. Mild thoracolumbar dextro scoliosis.
Impression
1. Small bilateral inguinal hernias, left greater than right. Left inguinal hernia probably account for palpable swelling.
2. Adult polycystic kidney disease.
3. Polycystic liver.
4. A 4 mm nonobstructive stone in lower pole of the left kidney.
5. Additional incidental findings as above
Component Results
Component
Your Value
Standard Range
SODIUM 134 mmol/L 135 - 143 mmol/L
Testing performed at TCL, 7131 W Grandridge Blvd, Kennewick, WA 99336
POTASSIUM 4.1 mmol/L 3.5 - 4.9 mmol/L
Testing performed at TCL, 7131 W Grandridge Blvd, Kennewick, WA 99336
CHLORIDE 104 mmol/L 99 - 109 mmol/L
Testing performed at TCL, 7131 W Grandridge Blvd, Kennewick, WA 99336
CO2 25 mmol/L 23 - 32 mmol/L
Testing performed at TCL, 7131 W Grandridge Blvd, Kennewick, WA 99336
ANION GAP AGAP 9 mmol/L 5 - 20 mmol/L
Testing performed at TCL, 7131 W Grandridge Blvd, Kennewick, WA 99336
GLUCOSE 112 mg/dL 65 - 99 mg/dL
Testing performed at TCL, 7131 W Grandridge Blvd, Kennewick, WA 99336
BUN 22 mg/dL 8 - 25 mg/dL
Testing performed at TCL, 7131 W Grandridge Blvd, Kennewick, WA 99336
CREATININE 1.46 mg/dL 0.70 - 1.30 mg/dL
Testing performed at TCL, 7131 W Grandridge Blvd, Kennewick, WA 99336
CALCIUM 9.2 mg/dL 8.5 - 10.5 mg/dL
Testing performed at TCL, 7131 W Grandridge Blvd, Kennewick, WA 99336
ALBUMIN 3.5 g/dL 3.6 - 5.0 g/dL
Testing performed at TCL, 7131 W Grandridge Blvd, Kennewick, WA 99336
PHOSPHORUS 3.3 mg/dL 2.3 - 4.8 mg/dL
Testing performed at TCL, 7131 W Grandridge Blvd, Kennewick, WA 99336
EGFR 55 mL/min/1.73m2 >60 mL/min/1.73m2
GFR <60: CHRONIC KIDNEY DISEASE, IF FOUND OVER A 3 MONTH PERIOD.
GFR <15: KIDNEY FAILURE.
FOR XXXXXXX AMERICANS, MULTIPLY THE CALCULATED GFR BY 1.210.
Testing performed at TCL, 7131 W Grandridge Blvd, Kennewick, WA 99336
ALDOSTERONE 7.9 ng/dL <39.2 ng/dL
UPRIGHT: <39.2 NG/DL SUPINE: <23.2 NG/DL
NORMAL SERUM ALDOSTERONE LEVELS ARE DEPENDENT ON MANY FACTORS: POSTURE
, SODIUM INTAKE, AND TIME OF DAY. EVALUATION OF SERUM ALDOSTERONE
SHOULD BE INTERPRETED UNDER STRICTLY CONTROLLED CONDITIONS.
Testing performed at PAML, 110 W Cliff Avenue, XXXXXXX WA 99204
RENIN,DIRECT <2.1 pg/mL
UPRIGHT < OR = 40 YEARS OLD 4.2 TO 52.2 PG/ML
UPRIGHT >40 YEARS OLD 3.6 TO 81.6 PG/ML
SUPINE < OR = 40 YEARS OLD 3.2 TO 33.2 PG/ML
SUPINE >40 YEARS OLD 2.5 TO 45.1 PG/ML
Testing performed at PAML, 110 W Cliff Avenue, XXXXXXX WA 99204
ALDOSTERONE/RENIN >3.8 ratio 0 - 25 ratio
Reference range: 0.1 to 3.7
AN ALDOSTERONE/DIRECT RENIN RATIO OF GREATER THAN 3.7 IS SUGGESTIVE OF
HYPERALDOSTERONISM.
Testing performed at XXX
Brief Answer:
ADPKD, stone and high aldosterone/ renin ratio
Detailed Answer:
Hi,
After reviewing your record i could identify three basic issues.
1. ADPKD- this is a genetic disease. Your kidney function is good serum creatinine is just 1.4 so don't worry your kidney will work for you for many years. you have to monitor serum creatinine and urine routine every month and keep an eye on your blood pressure. This disease is also associated with cyst in Liver , episodes of urine infection, & kidney stones.
2. Kidney Stone - You have a single stone of 3-4 mm size, this does not require any immediate treatment. Stones which are more than 7mm in size or which are causing any obstruction require to be treated.
3. High aldosterone/renin ratio is associated with hyper aldosteronism & adrenal gland tumors which cause episode of very high blood pressure . So if you have such episodes than you need to be evaluated for the same.
In your case you need to
- keep check of your blood pressure
- avoid excess protein intake in Diet ( avoid non- veg food )
- avoid juices and decrease your salt intake
these points will help you in prevent further damage to kidneys
If you have any other question in your mind please revert back.
Best wishes
ADPKD, stone and high aldosterone/ renin ratio
Detailed Answer:
Hi,
After reviewing your record i could identify three basic issues.
1. ADPKD- this is a genetic disease. Your kidney function is good serum creatinine is just 1.4 so don't worry your kidney will work for you for many years. you have to monitor serum creatinine and urine routine every month and keep an eye on your blood pressure. This disease is also associated with cyst in Liver , episodes of urine infection, & kidney stones.
2. Kidney Stone - You have a single stone of 3-4 mm size, this does not require any immediate treatment. Stones which are more than 7mm in size or which are causing any obstruction require to be treated.
3. High aldosterone/renin ratio is associated with hyper aldosteronism & adrenal gland tumors which cause episode of very high blood pressure . So if you have such episodes than you need to be evaluated for the same.
In your case you need to
- keep check of your blood pressure
- avoid excess protein intake in Diet ( avoid non- veg food )
- avoid juices and decrease your salt intake
these points will help you in prevent further damage to kidneys
If you have any other question in your mind please revert back.
Best wishes
Above answer was peer-reviewed by :
Dr. Veerisetty Shyamkumar
Thank you for answering. He needs positive news. I'll share this. so is there anything other than the medication for high blood pressure he could take? And is there any medication other than ISAIDS that he should avoid?? And yes he will continue seeing the Dr he has here.
Brief Answer:
AVOID PAIN KILLERS
Detailed Answer:
Hi,
medications are for blood pressure to keep it under 130/80, vitamin D supplements, and sodium bicarbonate tablet if venous bicarbonate test is below 20.
rest he should avoid pain killers, antibiotics should be only under guidance of doctor, he should limit non-veg intake 9 meat products) so as to make protein intake 0.8 gm/kg/day.
best wishes
AVOID PAIN KILLERS
Detailed Answer:
Hi,
medications are for blood pressure to keep it under 130/80, vitamin D supplements, and sodium bicarbonate tablet if venous bicarbonate test is below 20.
rest he should avoid pain killers, antibiotics should be only under guidance of doctor, he should limit non-veg intake 9 meat products) so as to make protein intake 0.8 gm/kg/day.
best wishes
Note: For further queries related to kidney problems and comprehensive renal care, talk to a Nephrologist. Click here to Book a Consultation.
Above answer was peer-reviewed by :
Dr. Veerisetty Shyamkumar
Answered by
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