I just got a call from my doctor’s (actually Physician’s Assistant) office. It turns out that she is coming back a week sooner than I had expected. I have an appointment on Monday, Dec 23rd at 1:00pm to discuss my concerns about Alzheimer’s Disease.
Earlier that morning (at 10:00am) I have the consultation at Casper Medical Imaging about the Veinous Insufficiency issue that I have. So, it looks like I should have some of the answers to my path forward early next week.
Below are copies of the CT Scan and Venous Mapping reports. At the risk of head softening, you can read through them, but the bottom line in both reports is that there is no obvious explanation for my observed issues. It will be interesting to see what they say next Monday.
Below is a copy of the report of the CT scan.
CMS MANDATED QUALITY DATA - CT RADIATION — 436
All CT scans at this facility utilize dose modulation, iterative reconstruction, and/or weight based dosing when appropriate to reduce radiation dose to as low as reasonably achievable.
CTV abdomen and pelvis with IV contrast
INDICATION: Bilateral lower extremity discoloration
COMPARISON: None
FINDINGS: CT venous angiogram examination of the abdomen and pelvis was performed in multiple contiguous axial sections with the use of intravenous contrast enhancement. Sagittal and coronal 2-D MPR
were obtained.
Radiation Dose
Total exam DLP:
324 mGycm
Contrast: Visipaque 320 150 mL Used 0 mL Discarded
Lung: The visualized lung bases are clear of active disease.
Liver: The liver is homogeneous without biliary ductal dilatation or enhancing mass.
Gallbladder :The gallbladder and gallbladder fossa are within normal limits.
Adrenal glands:Adrenal glands are symmetric and unremarkable.
Spleen: The spleen is homogeneous and unremarkable.
Pancreas: The pancreas is unremarkable as visualized.
Kidneys: The kidneys are perfuse symmetrically without evidence of obstructive uropathy. There are bilateral renal cysts. There dominant on the right,
Bowel:The small and large bowel are normal in course and caliber. There are few scattered diverticuli without evidence of acute diverticulitis.
(Ed. note: Turns out there is a new (as of 2012) organ in the abdomen)
Mesentery: There is no gross free air, free fluid, or other gross mesenteric abnormality.
Reproductive: The prostate gland is heterogeneously enlarged causing mass effect on the posterior bladder.
Soft tissues:Soft tissues are unremarkable without abscess or subcutaneous gas.
Venous: The IVC is normal in course and caliber throughout its abdominal and hepatic course. The bilateral iliac veins are symmetric, widely patent without significant stenosis or compression.
Bones:Osseous structures are unremarkable. There is no focal pathologic bony lesion.
IMPRESSION:
1. No evidence of venous thrombosis or stenosis.
2. No acute abdominal process.
3. Diverticulosis without evidence of acute diverticulitis.
4. Prostate enlargement.
-Electronically Signed By: Ryan Bonifield
-Electronically Signed On: 11/27/2024 3:40 PM
Also below is the venous mapping report.
EXAMINATION:
Bilateral lower extremity venous mapping.
HISTORY:
74-year-old male with bilateral leg swelling and bulging venous varicosities.
TECHNIQUE:
In both the supine and standing positions the superficial and deep venous systems of the right lower extremity are evaluated with grayscale, color Doppler, and spectral Doppler sonography without and
with compression.
COMPARISON:
None
MEASUREMENTS:
The report below indicates reflux exceeding one half second (500 milliseconds) occurring in the venous branches charted below.
RIGHT
DEEP VENOUS EVALUATION:
DVT: No
Deep reflux: No
Common femoral vein: No wall thickening, endoluminal thrombosis, or luminal narrowing.
Femoral vein: No wall thickening, endoluminal thrombosis, or luminal narrowing.
Popliteal vein: No wall thickening, endoluminal thrombosis, or luminal narrowing.
Posterior tibial veins: No wall thickening, endoluminal thrombosis, or luminal narrowing.
LEFT
DEEP VENOUS EVALUATION:
DVT: No
Deep reflux: No
Common femoral vein: No wall thickening, endoluminal thrombosis, or luminal narrowing.
Femoral vein: No wall thickening, endoluminal thrombosis, or luminal narrowing.
Popliteal vein: No wall thickening, endoluminal thrombosis, or luminal narrowing.
Posterior tibial veins: No wall thickening, endoluminal thrombosis, or luminal narrowing.
SUPERFICIAL VENOUS EVALUATION:
RIGHT
VEIN DIAMETER (mm) REFLUX REFLUX (ms)
SFJ 6.8 mm no REFLUX ms
PROX GSV THIGH 4.9 mm no REFLUX ms
MID GSV THIGH 4.6 mm no REFLUX ms
DST GSV THIGH 4.4 mm none REFLUX ms
KNEE GSV 4.1 mm no REFLUX ms
PROX GSV CALF 3.9 mm no REFLUX ms
MID GSV CALF 3.2 mm none REFLUX ms
DST GSV CALF 3.7 mm no REFLUX ms
AAGSV 3.7 mm no REFLUX ms
SPJ 3.6 mm no REFLUX ms
SSV PROX 2.7 mm no REFLUX ms
SSV MID 1.4 mm no REFLUX ms
SSV DST 2.3 mm no REFLUX ms
GIACOMINI mm REFLUX ms
PERF 1 mm REFLUX ms
PERF 2 mm REFLUX ms
PERF 3 mm REFLUX ms
PERF 4 mm REFLUX ms
DOM VARIX mm
LEFT
VEIN DIAMETER (mm) REFLUX REFLUX (ms)
SFJ 8.4 mm no REFLUX ms
PROX GSV THIGH 4.3 mm no REFLUX ms
MID GSV THIGH 4.3 mm no REFLUX ms
DST GSV THIGH 4.7 mm no REFLUX ms
KNEE GSV 4 mm no REFLUX ms
PROX GSV CALF 3.9 mm no REFLUX ms
MID GSV CALF 2.9 mm no REFLUX ms
DST GSV CALF 3.3 mm no REFLUX ms
AAGSV mm REFLUX ms
SPJ 1.4 mm no REFLUX ms
SSV PROX 1.5 mm no REFLUX ms
SSV MID 1.6 mm no REFLUX ms
SSV DST 2.4 mm no REFLUX ms
GIACOMINI mm REFLUX ms
PERF 1 mm REFLUX ms
PERF 2 mm REFLUX ms
PERF 3 mm REFLUX ms
PERF 4 mm REFLUX ms
DOM VARIX mm
FINDINGS:
Right greater saphenous vein: Competent.
Right anterior accessory greater saphenous vein: Competent.
Right small saphenous vein: Competent.
Left greater saphenous vein: Competent.
Left anterior accessory greater saphenous vein: Competent.
Left small saphenous vein: Competent.
IMPRESSION:
1. No evidence of deep venous thrombosis.
2. No evidence of deep venous reflux.
3. No evidence of superficial truncal venous insufficiency.
4. If there is concern for central venous obstruction in the pelvis, recommend CT venography abdomen and pelvis for further characterization.
-Electronically Signed By: Charles Bowkley
-Electronically Signed On: 11/13/2024 5:10 PM
