DIAGNOSTIC/LABORATORY TEST

Laboratory Test #1: Hematology

Indication: To evaluate the characteristics of blood components.

Date Performed: August 29, 2019

Test Result Normal Values Significance

Hemoglobin 129 g/L 120-160 g/L Normal

Hematocrit 0.38 Vol. fr 0.41-0.47 Vol. fr Slightly decrease,

Red Blood cell 3.80 L 4.60-6.20 x1012/L Decrease, due to

Increase, due to

White blood cell 14.0 4.50-11.00 x1012/L inflammatory

response

Increase, due to

Neutrophil 0.81 0.36-0.68 inflammatory

response

Segmenter 0.81 Normal

Lymphocyte 0.19 0.24-0.44 Decrease,

Laboratory Test #2: Ultrasound

Indication: To evaluate kidneys, liver, gallbladder, pancreas, spleen and abdominal aorta.

Date Performed: July 9, 2019

WHOLE ABDOMEN ULTRASOUND

The liver is enlarged with a craniocaudal span of 16cm, increased parenchymal echogenicity

with heterogeneous echo pattern. There are multiple hypoechoic and cystic nodules with

peripheral hypodensity in the right and left hepatic lobe. There are also cystic nodules with thin

walls largest in the right measuring 2.6 x 2.4 cm and largest in the left is 2.0x 2.0 cm. There is a

solid nodule with peripheral hypodensity at the left hepatic lobe measuring 1.4 x 1.0 cm. The

common bile duct and intrahepatic ducts are not dilated the former measuring 0.5 cm. The

gallbladder is not visualized, probably contracted.

The intrahepatic vessels and inferior vena cava are unremarkable.

There is no fluid noted at the Morison’s pouch.

Pancreas and spleen are normal in size and tissue echogenicity. No focal lesion is seen.

Both kidneys are normal in sizes with increased parenchymal echogenicity with fairly defined

corticomedullary demarcations. The central echo complexes are intact.

Right kidney measures 9.4 x 4.9 x 5.0 x 1.6 cm (Lx AP x W x Cortical Thickness).

There are multiple cystic foci noted, largest measuring 2.2 x 1.7 cm at the superior pole.
Left kidney measures 10.6 x 6.0 x 5.5 x 1.4cm (L x AP x W x Cortical Thickness)

There are multiple high-intensity echoes noted, largest measuring 0.7 cm at the inferior pole.

Ureters are not delineated sonographically.

The urinary bladder is well distended with smooth walls. No intraluminal echoes noted.

The prostate gland is normal in size and measures 2.3 x 3.9 cm (L x W x AP) with an

approximate weight

Of 18.3 grams. Prostatic capsule is intact. No focal lesions are seen.

Negative for ascites.

IMPRESSIONS:

 ENLARGED LIVER WITH DIFFUSE PARENCHYMAL DISEASE

 T/C SIMPLE HEPATIC CYST, CYST METASTASES, AND SOLID METASTATIC

NODULES

 NON-VISUALIZED GALLBLADDER, PROBABLY CONTRACTED

 DIFFUSE RENAL PARENCHYMAL DISEASE, BILATERAL

 SIMPLE RENAL CYSTS, RIGHT

 NON-OBSTRUCTING NEPHROLITHIASIS, LEFT

 SONOGRAPHICALLY NORMAL COMMON BILE DUCT, PANCREAS, SPLEEN,

URINARY BLADDER

AND PROSTATE GLAND

Laboratory Test #3: Ultrasound

Indication: To assess tumor masses

Date Performed: May 1, 2019

MASS ULTRASOUND

A well-defined hypoechoic complex-predominantly solid soft tissue mass is observed at the left

Parieto-temporal measuring approx. 8.72cm x 2.53cm.

Incidental note of focal destruction (approx. 1.35 cm) of the outer table, Parieto- Temporal bone.

IMPRESSION:

COMPLEX- PREDOMINANTLY SOLID TISSUE MASS, LEFT PARIETO- TEMPORAL

AREA

FOCAL DESTRUCTION, OUTER TABLE, LEFT PARIETO- TEMPORAL BONE.

Laboratory Test #4: Radiology

Indication: To assess cardiopulmonary disease

Date Performed: August 29, 2019

ROENTOLOGICAL REPORT

There are suspicious densities in the periphery of the right upper lung.

The heart is normal in size.

The aorta is prominent.

Both hemidiaphragm, costophrenic sulci, and visualized bones are intact.

IMPRESSION:

Suspicious densities, periphery of the right upper lung. Spot view of the right upper lung

is suggested for further evaluation.

Prominent aorta.
Laboratory Test #5: MRI of the Brain without Contrast

Indication: To assess the inner structure of the brain and tumors.

Date Performed: June 17, 2019

Clinical Information: a 5-month history of an enlarging left parietal mass. S/P punch biopsy of a

left nasopharyngeal mass showing non-keratinizing squamous cell CA (05/20/19)

Findings:

Correlation is made with the CT 05/07/19, done at an outside institution.

There is an expansile causing extensive cortical destruction of the left parietal and occipital

bones, with an enhancing multiseptated, multiloculated soft tissue component, measuring 9.1 x

5.2 x 9.7 cm (AP/T/CC). The intracranial component appears predominantly extradural, although

there are small portions of the dura that are equivocal for dehiscence. There is moderate

comprehension of the adjacent parietal and posterior temporal lobes and left cerebellar

hemisphere, with no evident edema or abnormal parenchymal enhancement. There is resultant

compression of the left lateral ventricle and left to right midline shift of about 6 mm. There are

punctate signal abnormalities involving the parietal white matter bilaterally, with no associated

mass effect, consistent with chronic small vessel ischemic changes. No other parenchymal

abnormalities are demonstrated in the cerebral hemispheres or posterior fossa structures. There is

no evidence of hydrocephalus.

Partially visualized is an ill-defined, heterogeneously enhancing mass involving the left

nasopharyngeal mucosa and pharyngeal space, involving the left medial and, to lesser extent,
pterygoid muscles, the left longus capitis muscle, and the prevertebral space. It also extends

inferiorly to the left oropharynx and soft palate. It invades the left side of sella and left cavernous

sinus, mildly displacing the left medial temporal lobe, and encroaches on the distal-most portion

of the left orbital apex. It further involves the petrous apex., clivus and left occipital condyle. The

distal cervical, petrous and cavernous portions of the left ICA are encased. This corresponds to

known nasopharyngeal malignancy. There is non-enhancing fluid signal involving the left

mastoid air cells, consistent with obstructive mastoid disease. Abnormal signal and enhancement

is seen involving the left side of the atlas, as well as the odontoid process, which may represent

osseous metastasis. There are partially visualized prominent and enhancing left level II cervical

lymph nodes.

IMPRESSION:

1. Expansile lesion causing extensive cortical destruction of the left parietal occipital bones,

with an enhancing multiseptated, multiloculated soft tissue component, with features and

mass effects. Consistent with a malignant neoplasm, probably metastasis from biopsy-

proven malignancy.

2. Mild chronic small vessel ischemic changes involving the parietal white matter

bilaterally.

3. No other brain parenchymal abnormalities demonstrated.

4. Partially visualized ill-defined, heterogeneously enhancing left nasopharyngeal mass,

corresponding to the biopsy proven malignancy.

5. Non-enhancing fluid signal involving the left mastoid air cells, consistent with

obstructive Mastoid disease.

 6. Abnormal signal and enhancement involving the left side of the atlas, as well as the

odontoid process, which may represent osseous metastasis. Partially visualized prominent

and enhancing left level II cervical lymph nodes.

Laboratory Test #6: X-ray

Indication: To assess cardiopulmonary disease

Date Performed: July 6, 2019

X-RAY RESULT:

There is haziness in the right paracardiac area

Heart is not enlarged.

Aorta is prominent.

The pulmonary vascular markings are exaggerated

Trachea is at midline

Hemidiaphragms and costophrenic angles are intact.

Soft tissues and osseous structures are unremarkable.

IMPRESSION:

 PNEUMONIA VS VESSEL CROWDING, RIGHT PARACARDIAC AREA

 PROMINENT AORTA

 PLEASE CORRELATE CLINICALLY

Laboratory Test #7: Clinical Chemistry

Indication: To evaluate different compounds in blood and urine.

Date Performed: August 29, 2019

EXAMINATION RESULT REFERENCE RANGE

CREATININE 58.2 80.00-115.00 umol/L

UREA NITROGEN 3.22 2.83-7.17 mmol/L

SGPT 35.4 4.00- 36.00 U/L

SODIUM 132.1 135.00- 148.00 mmol/L

POTASSIUM 3.00 3.50-5.30 mmol/ L

Laboratory Test #8: Ultrasound

Indication: To assess the size, location, and shape of the kidneys and related structures such as

ureters and bladder and to detect cysts, tumors, obstructions and infection within the kidneys.

Date Performed: June 28, 2019

URINARY- TRACT SONOGRAPHY: Right kidney is normal in size but with 2.3 X 1.3 – cm

and 2.2 x 1.7-cm cysts at the lower pole and cortex, respectively. Left kidney is normal in size

but hyperechoic. Right and left kidney measure 10.2 x 3.6cm and 10.6 x 4.7-cm respectively.

Calices, pelves and ureters are not dilated. Urinary bladder is physiologically distended with

normal anechoic lumen. Remainder is unremarkable.

IMPRESSION:

Renal cysts, multiple, right.

Parenchymal renal disease left.

INCIDENTAL NOTE: Hepatic cysts, left.

Laboratory Test #9: Radiology

Indication: To assess the bones of the skull, facial bones, the nose and sinuses.

Date Performed: May 1, 2019

RADIOLOGY REPORT

Skull APL views reveal no gross evidence of fracture.

Cranial sutures are intact.

Note of a lytic change at the left temporal area.

The visualized facial bones appear unremarkable

IMPRESSION: *AS DESCRIBED