Medical image reporting (MIR) aims to generate structured clinical descriptions from radiological images. Existing methods struggle with fine-grained feature extraction, multimodal alignment, and generalization across diverse imaging types, often relying on vanilla transformers and focusing primarily on chest X-rays. We propose MicarVLMoE, a vision-language mixture-of-experts model with gated cross-aligned fusion, designed to address these limitations. Our architecture includes: (i) a multiscale vision encoder (MSVE) for capturing anatomical details at varying resolutions, (ii) a multihead dual-branch latent attention (MDLA) module for vision-language alignment through latent bottleneck representations, and (iii) a modulated mixture-of-experts (MoE) decoder for adaptive expert specialization. We extend MIR to CT scans, retinal imaging, MRI scans, and gross pathology images, reporting state-of-the-art results on COVCTR, MMR, PGROSS, and ROCO datasets. Extensive experiments and ablations confirm improved clinical accuracy, cross-modal alignment, and model interpretability. Code is available at https://github.com/AI-14/micar-vl-moe.