REASON FOR PROCEDURE: E78.5/Hyperlipidemia, unspecified

Admitting Diagnosis: History

PROCEDURE(S): CT CORONARY CALCIFICATION STUDY

Helical computed tomography of the heart was performed with prospective ECG gating and suspended respiration. Iterative reconstruction dose reduction techniques were utilized. Post processing was performed on a workstation to determine calcium score. Calcium scoring of the coronary arteries was performed using a standard Agatston calcium scoring protocol.

COMPARISON: None available.

RESULTS:

IMPRESSION:

This patient's total Agatston calcification score is 191 This places this patient in the 40th percentile rank for age and gender.

Visualized mediastinum: Normal.
Visualized lungs and pleural spaces: Normal.
Visualized upper abdomen: Normal.
Visualized bones: No aggressive osseous lesion.

FINDINGS:

Left Total Hip: T-Score is -2.3 . Bone mineral density is 0.715 g/cm2.
Left Femoral Neck: T-Score is -2.0 . Bone mineral density is 0.753 g/cm2.
Lumbar Spine: T-Score is -0.7 . Bone mineral density is 1.104 g/cm2.

A T-Score compares the patient's bone density to a young healthy person's optimal peak bone density. It is reported as the number of standard deviations relative to the mean. A T-Score at or above -1.0 is considered normal. A T-score between -1.0 and -2.5 is considered osteopenia. A T-score of -2.5 or less represents osteoporosis. The patient's bone mineral density is classified according to the lowest T-score among the total left hip, left femoral neck, and lumbar spine.

A Z-Score is used to compare the patient to others of the same age, weight, ethnicity, and gender.

FRAX (PER WHO FRACTURE RISK ASSESSMENT TOOL): Based on femoral neck BMD (DualFemur Left).
10-year risk of major osteoporotic fracture is 11.2%
10-year risk of hip fracture is 2.6%

FRAX generally not reported for patients with normal/osteoporotic BMD, in patients younger than 40/older than 90, in non-steroid treated patients younger than 50, in patients currently undergoing pharmacotherapy for osteoporosis, and in those patients who refuse.

Current Bone Health and Osteoporosis Foundation guidelines recommend considering pharmacologic treatment for OSTEOPENIC patients with FRAX 10-year risk scores of >20% for major osteoporotic fracture or >3% for hip fracture, to reduce fracture risk.

IMPRESSION:

Osteopenia of the left hip.

FRAX score indicates a 10-year risk of major osteoporotic fracture of 11.2% and a 10-year risk of hip fracture of 2.6%. Consider pharmacologic treatment per Bone Health and Osteoporosis Foundation guidelines.

INDICATION: 67y-old M with Atherosclerosis of native arteries of extremities with intermittent claudication, bilateral legs.

COMPARISON: MRA LWR BIL EXT WO/W CONTRAST from 06/22/2022;×

TECHNIQUE: Multiple gray-scale and color-flow images of the bilateral lower extremity arteries were obtained with ultrasound. Spectral Doppler analysis was also performed.

FINDINGS:

The right leg arterial system demonstrates the following waveforms and peak systolic velocities (m/s):

Common femoral artery: Triphasic, 1.17 (m/s)

Profunda femoral artery: Triphasic, 0.57 (m/s)

Superficial femoral artery proximal: Triphasic, 0.75 (m/s)

Superficial femoral artery mid: Triphasic, 0.90 (m/s)

Superficial femoral artery distal: Monophasic, 0.61 (m/s)

Popliteal artery proximal: Monophasic, 0.62 (m/s)

Popliteal artery distal: Monophasic, 0.62 (m/s)

Anterior tibial artery: Monophasic, 0.15 (m/s)

Posterior tibial artery: Monophasic, 0.14 (m/s)

Peroneal artery: Monophasic, 0.79 (m/s)

Dorsalis pedis artery: Monophasic, 0.23 (m/s)

The left leg arterial system demonstrates the following waveforms and peak systolic velocities (m/s):

Common femoral artery: Triphasic, 1.32 (m/s)

Profunda femoral artery: Monophasic, 1.04 (m/s)

Superficial femoral artery proximal: Triphasic, 0.85 (m/s)

Superficial femoral artery mid: Triphasic, 1.10 (m/s)

Superficial femoral artery distal: Triphasic, 0.82 (m/s)

Popliteal artery proximal: Triphasic, 0.61 (m/s)

Popliteal artery distal: Triphasic, 0.68 (m/s)

Anterior tibial artery: Monophasic, 0.38 (m/s)

Posterior tibial artery: Monophasic, 0.74 (m/s)

Peroneal artery: Monophasic, 0.82 (m/s)

Dorsalis pedis artery: Monophasic, 0.20 (m/s)

Cardiac rhythm: Regular .

IMPRESSION:

Bilateral lower extremity arterial duplex demonstrates monophasic waveforms in the distal right superficial femoral artery, popliteal artery, and tibial arteries, consistent with severe peripheral arterial disease.

Bilateral lower extremity arterial duplex demonstrates monophasic waveforms in the left tibial arteries, consistent with moderate peripheral arterial disease.

CLINICAL HISTORY: Renal artery stenosis. Hypertension.

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Sonography of the kidneys including Doppler interrogation.

COMPARISON: CT ABD/PEL WITH CNTRST from 05/29/2014;×

FINDINGS:

The right kidney measures 10.4 cm in length and left kidney measures 11.7 cm in length. The kidneys demonstrates normal cortical echogenicity. There is no hydronephrosis or contour deforming renal mass.

Peak systolic velocity within the aorta is 75.8 cm/s

Color Doppler and spectral interrogation of bilateral main renal arteries and intrarenal arteries was performed.

RIGHT

Proximal renal artery: Peak systolic velocity 126 cm/s
Mid renal artery: Peak systolic velocity 79 cm/s
Distal renal artery: Peak systolic velocity 59 cm/s

Intrarenal artery upper pole RI: 0.66
Intrarenal artery midpole RI: 0.66
Intrarenal artery lower pole RI: 0.73

LEFT

Proximal renal artery: Peak systolic velocity 126 cm/s
Mid renal artery: Peak systolic velocity 123 cm/s
Distal renal artery: Peak systolic velocity 105 cm/s

Intrarenal artery upper pole RI: 0.69
Intrarenal artery midpole RI: 0.63
Intrarenal artery lower pole RI: 0.66

The renal veins are patent.

IMPRESSION:

No evidence of hemodynamically significant renal artery stenosis.