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Click CT neuro outside study Sep 2012: 88-year-old male with IgG4-related disease. FINDINGS: A contrast-enhanced CT scan of the head and neck in the venous phase demonstrates a centrally calcified or ossified mass within the left maxillary sinus eroding into the ipsilateral infratemporal fossa. The left paranasal sinuses are largely opacified. Also note bilateral symmetrically enlarged and homogeneous lacrimal glands and infraorbital nerves. TECHNIQUE: 64-slice CT, 329 mA, 120 kVp, 75 mL Optiray 320 IV contrast, venous phase, standard algorithm, 2.5 mm slice thickness.

Click CT soft tissue neck Oct 2012: 88-year-old male with IgG4-related disease. FINDINGS: A contrast-enhanced CT scan of the head and neck in the venous phase demonstrates a centrally calcified or ossified 5.4 cm x 5.0 cm x 4.6 cm mass within the left maxillary sinus eroding into the ipsilateral infratemporal fossa. The left paranasal sinuses are largely opacified. Also note bilateral symmetrically enlarged and homogeneous lacrimal glands and infraorbital nerves. TECHNIQUE: 64-slice CT, 100-180 mA, 120 kVp, 100 mL Omnipaque 350 IV contrast at 2.5 mL/sec, venous phase, standard algorithm, 2.5 mm slice thickness.

Click Chest CT Oct 2012: 88-year-old male with IgG4-related disease. FINDINGS: A non-ECG-gated contrast-enhanced CT scan of the chest in the late arterial phase demonstrates rind-like and occasionally nodular periarterial soft tissue thickening along the proximal coronary artery segments (max 1.3 cm wall-to-wall, max 0.5 cm single wall). An irregular left lower lobe nodular lung opacity measures 1.0 cm x 1.0 cm x 1.7 cm. Other findings include atherosclerosis, conspicuous mediastinal and hilar lymph nodes, mild emphysema, sequelae of granulomatous disease notably in the upper lung zones, a nonspecific sub centimeter left thyroid lobe nodule, and a nonspecific proximal esophageal filling defect. TECHNIQUE: 64-slice CT, 300-600 mA, 100 kVp, 100 mL Omnipaque 350 IV contrast at 2.5 mL/sec, 2.6 sec scan time, late arterial phase, standard algorithm at 2.5 mm slice thickness, bone algorithm at 1.25 mm slice thickness.

Click CT abdomen/pelvis Oct 2012: 88-year-old male with IgG4-related disease. FINDINGS: A contrast-enhanced CT scan of the abdomen and pelvis in the portal venous phase demonstrates a 1.6 cm x 1.0 cm x 1.4 cm right perirectal lymph node and an infrarenal aortic aneurysm (4.0 cm x 4.4 cm in largest trans-axial dimensions) with significant soft plaque. Other findings include cholelithiasis, bilateral renal cystic structures, and prostatic hypertrophy. TECHNIQUE: 64-slice CT, 200-230 mA, 120 kVp, 100 mL Omnipaque 350 IV contrast at 2.5 mL/sec, portal venous phase, standard algorithm, 3.75 mm slice thickness.

Click PET/CT Oct 2012: 88-year-old male with IgG4-related disease. FINDINGS: A fused PET-CT shows mild FDG uptake within a left maxillary sinus mass (max SUV 2.4), a left lower lobe nodular lung opacity (max SUV 1.7), and a right perirectal lymph node (max SUV 2.1). No appreciable FDG activity is demonstrated within enlarged lacrimal glands, enlarged infraorbital nerves, along coronary arteries, or within an infrarenal aortic aneurysm. TECHNIQUE: 18.6 mCi F18-FDG, 1 hour uptake period, multi-bed 3D acquisition, low mA CT attenuation correction (mA 30-65, kVp 140), 3.27 mm slice thickness.

Click CT maxillofacial Jan 2013: 88-year-old male with IgG4-related disease. FINDINGS: Seven weeks into steroid treatment, a follow-up contrast-enhanced CT scan of the face in the venous phase demonstrates decreased size of the left maxillary sinus mass (3.5 cm x 3.4 cm x 3.3 cm) and normalization of lacrimal glands and infraorbital nerves. TECHNIQUE: 64-slice CT, 150-500 mA, 120 kVp, 100 mL Omnipaque 350 IV contrast at 2.5 mL/sec, venous phase, standard algorithm, 2.5 mm slice thickness.

Click Chest CT Jan 2013: 88-year-old male with IgG4-related disease. FINDINGS: Seven weeks into steroid treatment, a follow-up non-ECG-gated contrast-enhanced CT scan of the chest in the late arterial phase shows a reduction in wall thickness along the proximal coronary artery segments (max 0.8 cm wall-to-wall, max 0.4 cm single wall). A left lower lobe nodular lung opacity has slightly decreased in size (0.7 cm x 0.9 cm x 1.7 cm). Mediastinal and hilar lymph nodes have also decreased in size. Redemonstration of atherosclerosis, mild emphysema, sequelae of granulomatous disease, a sub centimeter left thyroid lobe nodule, and a proximal esophageal filling defect. TECHNIQUE: 64-slice CT, 200-600 mA, 100 kVp, 100 mL Omnipaque 350 IV contrast at 2.5 mL/sec, 2.6 sec scan time, late arterial phase, standard algorithm at 2.5 mm slice thickness, bone plus algorithm at 1.25 mm slice thickness.

Click CT abdomen/pelvis Jan 2013: 88-year-old male with IgG4-related disease. FINDINGS: Seven weeks into steroid treatment, a follow-up contrast-enhanced CT scan of the abdomen and pelvis in the portal venous phase demonstrates a slight decrease in size of the right perirectal lymph node (0.9 cm x 0.8 cm x 0.4 cm). The infrarenal aortic aneurysm is stable apart from increased non-calcified plaque. Redemonstration of cholelithiasis, bilateral renal cystic structures, and prostatic hypertrophy. TECHNIQUE: 64-slice CT, 210-250 mA, 120 kVp, 100 mL Omnipaque 350 IV contrast at 2.5 mL/sec, portal venous phase, standard algorithm, 3.75 mm slice thickness.