Richard J. Katz, M.D.

Richard J. Katz, M.D. Steven A. Albert, M.D. Stephen D. Greenberg, MD Douglas R. DeCoral°, M.D. Gavin L. Duke, M.D. Paul S. Choi, M.D. Sean K. Herman, M.D. Robert L. Ludwig, M.D. EAST RIVER MEDICAL IMAGING, PC Timothy W. Deyer, M.D. James W. Brady, M.D. Gwen N. Harris, M.D. Adam a Wilner, M.D. Mark H. PineIt M.D. George Stassa, M.D. (ret.) Morton Schneider, M.D. (ret.) Alison Bender Haines, M.D. (ret.) 5191 523 East 72nd Street • New York. NY 10021.3 East 75th Street. At Fiflh Avenue • New York. NY 10021 430 East 59th Street. Sutton Place • New York. NY 10022 Tel: BRUCE W MOSKOWITZ, M.D. 1411 NORTH FLAGLER DRIVE SUITE 7100 WEST PALM BEACH, FL 33401 Patient: EPSTEIN, JEFFREY Exam Date: 1/30/18 Acc No: 7103073 Dear Dr. Moskowitz, CT NECK Clinical History: 65 y/o male with elevated PTH, concern for parathyroid adenoma. Techniaue: MRN: 0315192 Multidetector helical CT scans of the neck were performed utilizing 4D parathyroid technique, from the superior orbital rim to the thoracic inlet using 2.5 mm slices, prior to and during the constant infusion of nonionic intravenous contrast. Multiphase postcontrast dynamic imaging was employed. Images were reconstructed at 1.25mm slice thicknesses at 1.25mm slice intervals with coronal and sagittal reformats. Comoarisom Neck MRI performed 11/30/2016 Findinas: The visualized brain parenchyma is normal. The orbital contents are partially excluded from the field of view but are grossly normal in appearance. The masticator spaces are normal. EPSTEIN, JEFFREY ACC: 7103073 Exam Date: 1/30/18 DOB: 01/20/1953 ACCESS YOUR PATIENTS IMAGES AND REPORTSC WWW.EASTRIVERIMAGING.COM PET/CT • HIGH FIELD MRI • OPEN MRI • MULTIDETECTOR VOLUME CT IVC7) • BONE DENSITY • NUCLEAR MEDICINE ULTRASOUND • DIGITAL X-RAY • CORONARY CT ANGIOGRAPHY • VIRTUAL COLONOSCOPY • CT/MR ANGIOGRAPHY EFTA00811677 The mastoid air cells and tympanic cavities are clear. Mild scattered paranasal sinus mucosal thickening is seen with areas appearing polypoid in nature. Findings are worse along the left frontal drainage pathway which is occluded. A few of the maxillary and mandibular teeth have been endodontically treated. There is a left 2nd mandibular molar dental implant. Small bilateral mandibular tori are present. The nasopharynx is normal Prominence of the bilateral palatine tonsils are seen without deep extension, likely reactive in nature. Punctate calcifications involve both palatine tonsils, likely reflecting remote inflammation. Minimal prominence of the bilateral lingual tonsils is seen without deep extension, likely reactive in nature. There is a tiny air-filled right internal laryngocele. The hypopharynx and larynx are otherwise normal. The true cords are adducted. The major salivary glands including the parotid, submandibular and sublingual glands are normal. The thyroid is mildly heterogeneous. There is a 0.5 cm enhancing nodule within the posterior right midpole of the thyroid. There are no early enhancing parathyroid nodules. No discrete parathyroid mass is present There is no evidence for a parathyroid adenoma. There is no suspicious or pathologically enlarged cervical chain lymphadenopathy. There is a partially imaged lipoma within the left supraclavicular fossa measuring 4.7 cm in greatest craniocaudad dimension and 2.5 cm in greatest AP dimension. This is unchanged. There is a bovine configuration of the great vessels arising from the aortic arch, a normal anatomic variant. There is patency of the major vessels of the neck. The pericervical musculature, scalene musculature and sternocleidomastoid muscles are normal asymmetric atrophy. The lung apices are clear. There is no suspicious mediastinal mass or evidence of ectopic parathyroid adenoma within the mediastinum on the images provided Multilevel cervical spondylosis is seen with disc hemiations and superimposed disc osteophyte complexes resulting in multilevel ventral cord impingement as well as foraminal narrowing with suspected cervical nerve root impingement. IMPRESSION No evidence for parathyroid adenoma. Mild scattered polypoid paranasal sinus mucosal thickening with an occluded left frontal drainage pathway. EPSTEIN, JEFFREY ACC:7103073 Exam Date: 1/30/18 DOB: 01/20/1953 EAST RIVER MEDICAL IMAGING, PC www.eastriverimagingcom PET/CT • HIGH FIELD URI • OPEN AIR! • MULTIDETECTOR VOLUME CT (VCT) • BONE DENSITY • NUCLEAR MEDICINE ULTRASOUND • DIGITAL X-RAY • CORONARY CT ANGIOGRAPHY • VIRTUAL COLONOSCOPY • CT/AIR ANGIOGRAPHY EFTA00811678 A 0.5 cm right midpole thyroid nodule. Left supraclavicular lipoma, unchanged. Multilevel cervical spondylosis. Very truly yours, ADAM WILNER, M.D. Electronically Signed By ADAM WILNER, M.D. Dateff ime Transcribed: 1/30/18 9:02 am Contrast: Omnipaque Contrast 350mg 100cc Creatinine 1.2mg/dI REPORT CC: CC PATIENT EPSTEIN, JEFFREY ACC:7103073 Exam Date: 1/30/18 DOB: 01/20/1953 EAST RIVER MEDICAL IMAGING, PC PET/CT • HIGH FIELD MR! • OPEN AIN • AMULTID£TECTOR VOLUME CT (VC7)• BONE DENSITY • NUCLEAR MEDICINE ULTRASOUND • DIGITAL X-RAY • CORONARY CT ANGIOGRAPHY • VIRTUAL COLONOSCOPY • (T/MRANGIOGRAPHY EFTA00811679 EAST RIVER MEDICAL IMAGING. PC 519 East 72nd Street, Suite 103 New York, NY 10021 1: 1-ZECkS1 v r_;.c.) FEB 0 5 20111 NEW YORK NY 1.1.30 FEE ':18 1 JEFFREY EPSTEIN 6100 RED HOOK QUARTERS, APT B3 SAINT THOMAS, VI 00802 00802-134823 FIRST CLASS 7103073 POSTAGE*PPNEY BOWES 02 11.1 $ ZIP 10021 000.47° 0001382394FEB 01 2010 IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII EFTA00811680