Question: A bone scan revealed two spots on my skull. A follow up X-Ray confirmed the findings and a CT scan was performed. My general practioner said that since the CT scan revealed something that was already there in 2013 and had not grown, they are going to monitor things going forward.

I've attached the three tests for the bone scan, X-ray, and CT. Is this a tumor in your opionion and is just monitoring it the right course of action? Thank you for your opinion. XXXX

Bone Scan

XXXXXX M ACCOUNT #:0000
MED REC #:0000 PT. LOC: OP
DOB:00/00/0000 Age/Sex:49Y x
ORDERING PROV:XXXXXX
ATTENDING PROV: XXXXXXX
OTHER PROVIDER:
CC:
EXAM DATE:12/23/2015 DOCUMENT STATUS:Final
PROCEDURE(S):NM BONE IMAGING WHOLE BODY
ORDER #:15NM2616

RIGHT/LEFT:


EXAM: NM BONE WHOLE Tchdp

CLINICIAN'S HISTORY: lt knee pain, sclerotic lesion distal femur

ADDITIONAL CLINICAL INDICATIONS: left knee pain x one month Bone scan
on December 23, 2015

COMPARISON: Left knee exam at Marengo on December 9, 2015

TECHNIQUE: 22.1 mCi of technetium 99m labeled HDP were administered
intravenously. Dynamic images of the knees were performed. Blood pool
images of the knees were performed. Whole body delayed images were
performed in the anterior and posterior projections.

Findings: The small focal sclerotic lesion in the distal diaphysis of
the left femur are seen on December 9, 2015 correlates with an area of
slightly increased activity on the bone scan. Blood flow in the
vicinity of the knees is normal and symmetrical. The blood pool images
of the knees are unremarkable.

There is an area of increased activity near the vertex of the
calvarium best seen in the posterior projection, slightly larger to
the right of midline. Correlative AP and lateral skull radiographs are
requested for further evaluation.

No other bony abnormality was demonstrated in this bone scan. There is
bilateral renal function. Minimal activity in the perineum is present
perhaps suggesting minimal incontinence.

Impression:

1. The sclerotic lesion in the distal diaphysis of the left femur as
seen on the radiographs from Marengo Memorial Hospital on December 9,
2015 correlates with a small focus of slightly increased activity. An
unusual bone island is possible. A low-grade cartilaginous lesion is
not excluded. Comparison with old knee or femur radiographs would be
exceedingly helpful. In the absence of old films, MRI of the distal
femur is requested for further evaluation.

2. An area of markedly increased activity near the vertex of the
calvarium slightly greater to the right of midline is noted.
Correlative AP and lateral plain radiographs of the skull are pending.

3. Minimal stasis of activity in the intrarenal collecting system.
Bilateral renal function is present. Perineal activity suggests
minimal urinary tract incontinence.

4. The skull radiographs demonstrated an expansile amorphous lesion in
the parietal bone of the calvarium affecting both the inner and outer
tables. It may represent an area of fibrous dysplasia. Metastatic
disease is not excluded. A CT exam of the head is requested for
further evaluation.

Electronically signed by: KUNDEL, XXXXXXX L, M.D.
Dictated: 12/23/2015 12:53:05 PM
Signed: 12/23/2015 12:55:10 PM

ST. LUKE'S HOSPITAL, CEDAR RAPIDS IA. PAGE 2 of 2

Component Results
There is no component information for this result.

General Information
Collected:
12/23/2015 10:46 AM
Resulted:
12/23/2015 12:55 PM
Ordered By:
XXXXXXX M Wauters, ARNP
Result Status:
Final result
This test result has been released by an automatic process.


]X-Ray



XXXXXX M ACCOUNT #:0000
MED REC #:0000 PT. LOC: OP
DOB:00/00/0000Age/Sex:49Y M
ORDERING PROV: XXXXXXX
ATTENDING PROV: XXXXXXX
OTHER PROVIDER:
CC:
EXAM DATE:12/23/2015 DOCUMENT STATUS:Final
PROCEDURE(S):SKULL < 4 VIEWS
ORDER #:15GR54641

RIGHT/LEFT:


EXAM: DX SKULL LESS THAN 4 VIEWS

CLINICIAN'S HISTORY: skull lesion ap and lat

ADDITIONAL CLINICAL INDICATIONS: skull lesion seen on bone scan this
morning, pt denies pain AP and lateral views of the skull at 1141
hours on December 23, 2015

COMPARISON: Bone scan on December 23, 2015

Findings: The bone scan from earlier today demonstrated an area of
increased activity near the calvarial vertex in the parietal region
mostly to the right of midline. The bone scan abnormality correlates
with a somewhat ground glass area of abnormal bone density, slightly
expansile in character. The inner and outer tables of the calvarium
are no longer recognizable. I cannot exclude a neoplastic process.
Fibrous dysplasia is possible. No other abnormality affecting the
calvarium is demonstrated.

Impression: Abnormal bone lesion affecting both the inner and outer
tables of the calvarium in the parietal region just to the right of
midline, expansile in character which on bone scan exhibits bone
turnover/is hot. Neoplastic disease is not excluded excluded. Fibrous
dysplasia is possible. A CT exam of the head is requested for further
evaluation.

Electronically signed by: XXXXXXX L, M.D.
Dictated: 12/23/2015 12:41:37 PM
Signed: 12/23/2015 12:43:39 PM

ST. LUKE'S HOSPITAL, CEDAR RAPIDS IA. PAGE 1 of 1

Component Results
There is no component information for this result.

General Information
Collected:
12/23/2015 11:55 AM
Resulted:
12/23/2015 12:43 PM
Ordered By:
XXXXXXX M Wauters, ARNP
Result Status:
Final result
This test result has been released by an automatic process.
Back to the Tes


CT Scan

ARENGO MEMORIAL HOSPITAL
300 WEST MAY STREET TEL: 319-642-8037
MARENGO, IA 52301 FAX: 319-642-8062
RADIOLOGY TRANSCRIPTION REPORT
=======================================================================
PATIENT NAME: XXXX M ACCOUNT#: 0000
MED REC #: 0000
DOB: 00/00/0000AGE/SEX:49Y M
ORDERING PHY: , XXXXXXX DO
PERSONAL PHY: , XXXXXXX DO
SPECIALTY PHY:
PATIENT TYPE: OP ORDER # 15MMCT1073
PATIENT LOCAT: MMH CT
EXAM DATE: 12/24/2015 1149

================================================================

EXAM: CT HEAD WO CONTRAST


EXAM: CT HEAD W-O CONTRAST

CLINICIAN'S HISTORY: see bone scan report 1223, skull lesion noted on
bone scan (St Lukes)

ADDITIONAL CLINICAL INDICATIONS: Skull lesion on bone scan done two
days ago.

COMPARISON: 3/13/2013, as well as a nuclear bone scan dated 12/23/2015
and plain films of the skull dated 12/23/2015.

TECHNIQUE: Noncontrast axial CT images.

Findings: There is a normal and symmetric appearance to the cerebral
hemispheres and posterior fossa structures. Specifically, there is no
evidence of acute hemorrhage, focal mass, or mass effect. Ventricular
and cisternal spaces are normal. The area of abnormal uptake on the
recent bone scan and the calvarial thickening seen on plain film
corresponds to an area at the posterior right vertex where the skull
simply appears to be composed of bone of increased density and
thickness. There is less trabeculation in this area. Giving the slight
difference in angulation and slice thickness, the finding appears to
be unchanged. The adjacent parenchyma is normal. Osseous structures
are otherwise normal.

IMPRESSION: Skull at vertex on right side is slightly increased in
density and thickness. Finding is overall unchanged dating back to
3/13/2013 and corresponds to the abnormality seen on bone scan and
recent plain films. Noncontrast head CT is otherwise normal.

Electronically signed by:, XXXXXXX M, M.D.
Dictated: 12/24/2015 12:05:10 PM
Signed: 12/24/2015 12:07:12 PM
DOCUMENT STATUS: Final

Component Results
There is no component information for this result.

General Information
Collected:
12/24/2015 11:49 AM
Resulted:
12/24/2015 12:07 PM
Ordered By:
XXXXXXX M Miller, DO
Result Status:
Final result
This test result has been released by an automatic process.
Back to the Test Results L

Thank you Dr. XXXXXXX

May you have a blessed new year!