•Right ureteric impacted stone is noted at the upper part of ureter opposite L4 transverse process measuring about 7 x 5 mm in maximum CC and transverse diameters respectively and about 1045 HU dense, with subsequent proximal mild to moderate back preesure changes manifested by moderate ureteric & pelvi-calyceal dilatation

•Right ureteric impacted stone is noted at the upper part of ureter opposite L4 transverse process measuring about 7 x 4 mm in maximum CC and transverse diameters respectively and about 416 HU dense, with subsequent proximal moderate back preesure changes manifested by moderate ureteric & pelvi-calyceal dilatation

•Right lung displays patchy area of pneumonic consolidation with air-bronchogram is seen involving all lobe with patent air bronchogram likely inflammatory. For close follow-up.
•Right minimal basal pleural effusion

Impression:
• RIGHT LOWER LUNG LOBE CONSOLIDATIVE COLLAPSE LIKELY INFLAMMATORY. WITH MINIMAL BASAL PLEURAL EFFUSION FOR CLOSE FOLLOW-UP
YOURS SINCERELY,

• Moderately right renal pelvicalyceal system and ureter down to the pelvic ureter where abrupt transition in caliber seen , moreover scattered gases foci along dilated ureter and renal collection system with associated blurring of perinephric and right paracolic gutter fat planes likely urine leakage on top of forniceal rupture
• Mild mural thickening along ascending colon with prominent submucosal fat planes
• Changes related to appendectomy with not clear operative bed fat planes.
• Surgically removed GB
Opinion:
• Suspected right distal ureteric stricture/ stenosis with consequent moderate back pressure changes and superadded inflammatory process (emphysematous pyelitis) for CT enhanced study.
• Appendicectomy changes with mild operative bed inflammatory reaction
• Cholecystectomy

 A rounded shaped dense stone is seen lodged at the lower part (pelvic course) of the right ureter (opposite the acetabular roof), with minimal dilatation of the right ureter above however mild dilatation of renal pelvicalyceal system . It is seen measuring about 1 cm along its maximum dimension and attains mean CT density of about 1370 HU , associated subtle blurring of perinephric fat planes likely urine leakage on top of forniceal rupture.
 A small right renal lower calyceal stone (about 6.5 mm in maximum diameter and 875 HU in density) is also noted with no significant related backpressure changes.

Opinion:
 Right lower ureteric dense stone, with minimal right distal hydroureter and mild hydronephrosis above.
 Right renal lower calyceal stone.
Established liver cirrhosis

 Bilateral pulmonary mild diffuse interstitial reaction mainly basal showing fine reticular pattern and micro-fibro-atelectatic bands are also seen, with mild bronchial wall thickening and congested lung parenchymal vessels. However, no evidence of focal pulmonary masses, nodules or cavitations could be noted.
Opinion:
 Bilateral mild diffuse interstitial lung reactions likely chronic inflammatory reactions versus early interstitial lung disease for clinical correlation and follow up.

► Fractured left sacral ala traversing left sacro-iliac joint and extending to left posterior iliac bone with surrounding callus formation
► Left superior pubic bone and acetabular anterior column and roof fractures with surrounding callus formation
► Left l2 down to L5 transverse processes fractures in place
► Mild spondylodegenerative changes of the lumbar spine are noted, evident by tiny marginal osteophytes at the vertebral endplates
► Diffuse osteopenic texture of the examined vertebrae is seen
► Bilateral degenerative sacroileitis

 Mild bilateral ethmoidal air cells as well as maxillary antra and to less extent sphenoidal sinuses mucosal thickening has been shown  chronic sinusitis
 S-shaped deviated bony nasal septum
 Hypertrophied right nasal turbinate

The left kidney shows moderate dilatation of its pelvi-calyceal system and its ureter down to middle third uretric stone measures about 7.4 x 4.5 mms with density 980 HU opposing L3 vertebral body .

•Mild mucosal thickening of the examined paranasal sinuses sparing right frontal and right sphenoid sinsues .
• Oblitaerated both osteomeatal units .
• The nasal septum is mildly devited to left side .

IMPRESSION:-
• Mild bilateral maxillary ,ethmoidal sinusitis with obliterated both osteomeatal units.
• Mild left sphenoid and left frontal sinusitis .
• Mildly left sided deviated nasal spetum. .

• Mild mucosal thickening of both maxillary sinuses more at right side with obliterated right osetomeatal unit .
bounderies.
• Bilateral aerated middle chonca bullosa .
• Hypertrophied both inferior turbinates.
• The nasal septum is deviated to right side .
• Enlarged adenoid obliterating the nasopharyngeal airways.

• Left hyperdense vesico-ureteric junction stone is noted measures about 4.1 x 3.7 mms with density of average 346 HU showing subsequent mild left ureteric and pelvicayceal system dilatation .
• Stranding of the left peri-nephric and peri-ureteric fat stranding suggesting acute obstruction.

Evidence of comminuted fractures of the left humeral neck involving the humeral head and greater tubersoity showing incomplete healing .
-Degenerative changes of left acromio-clavicular joint.
intermuscular fat planes.
-Moderate left sided pleural effuision.
-Muliple left axillary lymphadenopathies .

OPINION:
• Commniuted fracture of the left humeral neck involiving head and greater tuberosity (may be pathological ?)with delayed healing for clinical correation and follow up .

Bilateral pulmonary mild diffuse interstitial reaction showing fine reticular pattern and ground glass veiling are also seen, with interlobular septal thickening and subpleural fibro-atelectatic bands and diffuse bronchial wall thickening. However, no evidence of focal pulmonary masses, nodules or cavitations could be noted.

Sections taken in the upper abdomen revealed advanced cirrhotic liver , splenomegaly and portal hypertension.

A dense stone is seen at the left renal middle calyceal group, measuring about 22x11 mm in maximum dimension and attaining mean CT density of about 1060 HU, with no related significant backpressure changes.
Few left renal lower calyceal stones the largest about 5.5 mm and about 540 HU dense

• Post-operative follow up status to known case of shoulder instability underwent surgical correction with hooking showing
• Secondary post-operative changes in terms of inferior glenoid labrum hooking with metallic prothesis
• Posterolateral humeral head shallow cortical depression

Impression:
• Post-operative follow up status to known case of shoulder instability with changes as described
• Favorable glenuohumeral fixation/hooking
Old hill sachs defect

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