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10018081-RR-36 | 10,018,081 | 21,027,282 | RR | 36 | 2134-01-06 07:44:00 | 2134-01-06 09:30:00 | PORTABLE CHEST OF ___
COMPARISON: Radiograph of earlier the same date.
FINDINGS: Worsening left retrocardiac opacity, most likely due to
atelectasis, although coexisting infectious consolidation is possible in the
appropriate clinical setting. Otherwise, similar appearance of the chest
compared to the previous radiograph performed several hours earlier.
|
10018081-RR-37 | 10,018,081 | 21,027,282 | RR | 37 | 2134-01-05 22:16:00 | 2134-01-06 08:13:00 | PORTABLE CHEST, ___
COMPARISON: Study of earlier the same date.
FINDINGS: Dobbhoff tube has been replaced, and is malpositioned with coiling
in the mid thoracic esophagus and distal tip directed cephalad at the
cervicothoracic junction. At the time of this dictation, subsequently
obtained chest x-rays document re-positioning. Cardiomediastinal contours are
stable, and there is worsening left retrocardiac opacity adjacent to an
unchanged left pleural effusion. Patchy atelectasis at the right lung base is
new. Otherwise, no relevant short interval change.
|
10018081-RR-38 | 10,018,081 | 21,027,282 | RR | 38 | 2134-01-05 23:51:00 | 2134-01-06 09:12:00 | PORTABLE CHEST ___
COMPARISON: Study of one day earlier.
FINDINGS: Interval repositioning of Dobbhoff tube, now terminating in the
stomach. Improving left retrocardiac atelectasis, and near resolution of
patchy right basilar atelectasis. Otherwise, no relevant change since the
recent study performed about two hours earlier.
|
10018081-RR-39 | 10,018,081 | 21,027,282 | RR | 39 | 2134-01-07 22:56:00 | 2134-01-07 23:26:00 | HISTORY: Status post ileostomy and long ___, evaluate for interval
changes.
TECHNIQUE: Volumetric CT imaging was performed through the abdomen and pelvis
without IV contrast. Oral contrast was administered for the exam.
COMPARISON: CT from ___.
FINDINGS:
Abdomen: There is minimal left basilar atelectasis. The heart size is
enlarged. An NG tube is seen in the stomach. The liver, spleen, pancreas,
adrenal glands, and kidneys are normal in noncontrast appearance. The patient
is status post cholecystectomy. There is no significant biliary ductal
dilatation. There is no significant mesenteric or retroperitoneal
lymphadenopathy. There is a large left-sided abdominal wall defect with
herniation of the majority of the small bowel and mesenteric fat apparently
through a defect in the transversus abdominis muscle. This appears unchanged.
The small bowel is distended, but not dilated there are no findings to suggest
obstruction. There is no evidence of pneumoperitoneum or pneumatosis. A
right lower quadrant ileostomy is noted. There are atherosclerotic changes of
the abdominal aorta and branch vessels. The osseous structures demonstrate a
levoscoliotic curvature of the lumbar spine and degenerative changes.
Pelvis: The patient is status post right colectomy with a long ___
pouch terminating in the midline. There is colonic diverticulosis of the
colonic remnant without evidence of diverticulitis. The rectum is normal in
appearance. The bladder is markedly distended. There is a bladder
diverticulum arising off the right posterolateral wall. The prostate is
mildly enlarged. There is no significant pelvic or inguinal lymphadenopathy.
The osseous structures are unremarkable.
IMPRESSION:
Postoperative changes from previous ileostomy and right hemicolectomy without
evidence of obstruction or extraluminal fluid collection to suggest abscess.
Marked bladder distention. Consideration of Foley catheter placement is
recommended if there is a history of urinary retention.
|
10018081-RR-40 | 10,018,081 | 21,027,282 | RR | 40 | 2134-01-08 14:56:00 | 2134-01-08 17:06:00 | BRAIN MRI WITHOUT CONTRAST, ___
INDICATION: ___ man with atrial fibrillation, on Coumadin, status
post right colectomy, now with decreased mental status.
COMPARISON: Non-contrast head CT from ___.
TECHNIQUE: Sagittal T1-weighted, and axial T2-weighted, FLAIR, gradient echo,
and diffusion-weighted images of the brain were obtained.
FINDINGS: There is no acute infarction. There is no edema, mass effect,
evidence of blood products in the brain parenchyma, or pathologic extra-axial
collection. Again seen is moderate cerebral atrophy with prominent ventricles
and sulci. There are multiple small foci of high T2 signal in the
periventricular, deep, and subcortical white matter of the cerebral
hemispheres, likely sequela of chronic small vessel ischemic disease in a
patient of this age. Major arterial flow voids appear grossly preserved.
There are small foci of mucosal thickening in bilateral maxillary sinuses.
There is mucosal thickening in bilateral ethmoidal air cells. There is
partial right mastoid air cell opacification and mild mucosal thickening in
left mastoid air cells.
IMPRESSION: No acute infarction. No evidence for other acute intracranial
abnormalities.
|
10018081-RR-54 | 10,018,081 | 23,983,182 | RR | 54 | 2134-08-18 01:08:00 | 2134-08-18 01:49:00 | INDICATION: +PO contrast; History: ___ with hx of ischemic colitis s/p
iliostomy recently closed on ___ now with feculant material in surgical
site. +PO contrast // source of feculent material in surgical wound s/p
ileocolic anastamosis on ___
TECHNIQUE: CT of the Abdomen and Pelvis with IV contrast and with oral
contrast
DOSE: DLP: 1184 mGy-cm
COMPARISON: ___
FINDINGS:
LOWER CHEST: Bilateral pleural effusions are small in size, right greater than
left. Adjacent atelectasis versus aspiration. The heart is enlarged.
ABDOMEN: Normal liver. Status post cholecystectomy. Normal spleen and
adrenals. Normal pancreas. No hydronephrosis. Small hypodensities in the left
kidney are too small to characterize, but likely cysts. Abdominal aorta is
moderately calcified as are the iliacs.
The patient is status post hemicolectomy and ileal folic anastomosis. The
anastomosis is noted to be in extremely close proximity to the open wound
(02:46). Extending from the anus anastomosis are extensive surgical changes
but also multiple rim enhancing fluid collections within the abdomen, some of
which contain high attenuation material suggesting enteric contents. This
includes an approximately 10 x 2.5 by 7.5 cm collection to the right of the
anastomosis as well as a multi lobulated approximately 7.4 by 6.3 by 4.0 cm
collection located in the mid abdomen. An additional collection directly
inferior to the anastomosis is also a multi lobulated spanning grossly 6.5 by
5.6 cm. Numerous other smaller collections are present as well. Oral contrast
does seem to make it through to the colon. Small bowel loops are again seen in
large left-sided abdominal wall defect; around these loops of bowel are
hyperdense contents (2:65) representing free fluid, but the hyperdensity
suggests enteric contents.
PELVIS: Unremarkable bladder but in the pelvis, there is a 6.4 x 3.9 x 6.9 cm
rim enhancing fluid collection (02:58) behind the bladder. Prostate with
calcifications. Rectum is normal. Multiple phleboliths. No lymphadenopathy.
BONES AND SOFT TISSUES: Degenerative changes including endplate sclerosis of
the L2-L3 vertebral bodies. No suspicious bony lesions.
IMPRESSION:
Extensive intra-abdominal abscesses, some with high attenuation content
suggesting enteric content, as described above including around the
anastomosis and in the deep pelvis. Ileocolic anastomosis is directly
underneath the open wound.
|
10018081-RR-55 | 10,018,081 | 23,983,182 | RR | 55 | 2134-08-18 14:00:00 | 2134-08-18 18:46:00 | EXAMINATION: CT interventional procedure
INDICATION: ___ with recent and the bowel, requiring and ileostomy
subsequent takedown. Now with multiple abdominal fluid collections, including
with fistulous communication to the skin surface.
COMPARISON: CT abdomen pelvis dating ___ as well as ___
PROCEDURE: CT-guided drainage of 2 peritoneal collections.
OPERATORS: Dr. ___, radiology trainee and Dr. ___,
attending radiologist, who was present and supervising throughout the total
procedure time.
TECHNIQUE: The risks, benefits, and alternatives of the procedure were
explained to the patient, as well as the patient's daughter and HCP, ___.
After a detailed discussion, informed written consent was obtained. A
pre-procedure timeout using three patient identifiers was performed per ___
protocol.
The patient was placed in a supine position on the CT scan table. Limited
preprocedure CTscan of the pelvis was performed. Two sites of entry were
chosen and marked.
The first site was prepped and draped in the usual sterile fashion. 1%
lidocaine were administered to the subcutaneous and deep tissues for local
anesthetic effect. Under CT guidance, a 17 gauge coaxial needle was
introduced into the more superior and superficial collection. No significant
fluid was able to be aspirated. The tract was dilated over a wire, and ___
pigtail catheter coiled within the collection. The drain was secured to the
skin and bandaged.
The second site was then prepped and draped, in the same sterile fashion, and
local anesthesia administered. The same technique was used to approach the
second pocket, deeper and more inferior within the right hemipelvis, using a
new set of sterile equipment. With the needle tip confirmed in position by
CT, approximately 10cc of hemorrhagic fluid was aspirated. The tract was then
dilated over a wire and ___ pigtail catheter coiled within the collection.
This was also secured to the skin and bandaged.
The specimen from the second collection was sent to the laboratory for
culture.
The procedure was tolerated well and there were no immediate post-procedural
complications.
DOSE: DLP: 1090 mGy-cm
SEDATION: Moderate sedation was provided by administering divided doses of 2
mg Versed and 125 mcg fentanyl throughout the total intra-service time of 45
minutes during which patient's hemodynamic parameters were continuously
monitored by an independent trained radiology nurse.
FINDINGS:
Multiple fluid collections were again noted, 2 deemed to be accessible to
percutaneous drainage within the right hemipelvis.
IMPRESSION:
Technically successful percutaneous drainage of 2 right pelvic fluid
collections with CT guidance. 8 ___ pigtail drains are left position with
within each pocket.
|
10018081-RR-56 | 10,018,081 | 23,983,182 | RR | 56 | 2134-08-19 01:41:00 | 2134-08-19 10:31:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with fever to 102.4, ___ s/p ileostomy
takedown, returned with ?ECF // ?acute process
TECHNIQUE: CHEST (PORTABLE AP)
COMPARISON: ___
IMPRESSION:
Left PICC line tip is at the level of mid SVC. Cardiomegaly and mediastinum
are unchanged. Right basal opacity has slightly progressed. Left retrocardiac
atelectasis is unchanged. Upper zone re- distribution of the vasculature is
unchanged
|
10018081-RR-6 | 10,018,081 | 21,027,282 | RR | 6 | 2133-12-18 13:14:00 | 2133-12-18 13:42:00 | HISTORY: 2 days of mid abdominal pain. History of atrial fibrillation.
TECHNIQUE: MDCT data were acquired at ___ without oral or IV
contrast and uploaded into our institutional PACS for secondary review.
Axial, coronal, and sagittal images are provided for review.
DLP: 1,434 mGy-cm.
COMPARISON: No prior exams available at this institution.
FINDINGS:
There is a massive volume of mesenteric venous gas which originates from small
bowel across the mid abdomen. There are several areas of pneumatosis on both
sides of the abdomen (4: 60, 4: 63) bu there is no severe bowel wall
thickening. The large volume of mesenteric air courses up the SMV and there
is a large volume of portal venous air. There is a small bowel containing
right lower quadrant anterior abdominal wall hernia (4:57). Despite
mesenteric venous gas extending from this bowel loop, there is no evidence of
strangulation. The majority of the ischemic bowel disease is either
intra-abdominal or within the large left lower quadrant pannus. There is a
bowel containing wide necked left lower quadrant abdominal wall diastasis.
CT ABDOMEN: Evaluation of the abdominal viscera is limited without
intravenous or oral contrast. There are multiple small pleural-based
pulmonary nodules. That measures 5 (4: 7) points, 16) 4.3) and 12 mm (4:14).
The noncontrast appearance of the liver is unremarkable other than the
aforementioned portal venous air. Gallbladder surgically absent. The
pancreas is unremarkable. The noncontrast appearances of the spleen, adrenal
glands and kidneys are unremarkable. There are mild aortic calcifications
without evidence of aneurysm. Iliac vascular calcifications and ectasia is
more extensive. There are only mild calcifications of the proximal SMA
(4:41). Patency of the mesenteric vessels cannot be assessed without
intravenous contrast. There is no ascites or abdominal adenopathy.
CT PELVIS: The distal bowel is unremarkable. There is a calcified sigmoid
diverticulum. The prostate is enlarged to 6.3 cm transverse. The bladder is
unremarkable. There is no free pelvic fluid. There is no inguinal or pelvic
adenopathy.
There are multiple surgical clips at the site of prior cholecystectomy. There
is also a staple line from a small bowel anastomosis in the left lower
quadrant.
IMPRESSION:
Extensive mesenteric venous gas and portal venous gas is concerning for a
large territory of ischemic bowel. Ischemic bowel appears grossly in the
distribution of the SMA. The SMA calcifications are only mild. Patency of
the SMA cannot be assessed without intravenous contrast.
Findings were discussed with Dr ___ phone at ___ and Dr ___ in
person at 1330.
|
10018081-RR-7 | 10,018,081 | 21,027,282 | RR | 7 | 2133-12-18 17:17:00 | 2133-12-19 08:17:00 | CHEST RADIOGRAPH
INDICATION: New central venous access line, evaluation.
COMPARISON: Outside hospital film from ___.
FINDINGS: As compared to the previous radiograph, there is a curvilinear
lucency along the dome of the liver, likely representing free air consistent
with the recent post-operative condition. The endotracheal tube projects 1 cm
above the carina with its tip, the tube could be pulled back by approximately
2 cm. The nasogastric tube is below the diaphragm. The right internal
jugular vein catheter ends at the level of the cavoatrial junction. A large
retrocardiac opacity likely represents a combination of effusion and
atelectasis, although aspiration or infection cannot be excluded. Mild
pulmonary edema. No larger pleural effusions.
|
10018081-RR-8 | 10,018,081 | 21,027,282 | RR | 8 | 2133-12-19 05:54:00 | 2133-12-19 10:23:00 | CHEST RADIOGRAPH
INDICATION: Status post abdominal surgery, evaluation for interval change.
COMPARISON: ___, 5:56 p.m.
FINDINGS: As compared to the previous radiograph, the monitoring and support
devices are in correct position, except for the endotracheal tube that has
been pulled back. The tube now projects approximately 5 cm above the carina
with its tip.
The patient is rotated. A pre-existing right parenchymal basal opacity
therefore appears slightly more extensive than on the previous image.
Blunting of the right costophrenic sinus might be artificial. Moderate
cardiomegaly persists. Unchanged left lower lobe atelectasis.
|
10018081-RR-9 | 10,018,081 | 21,027,282 | RR | 9 | 2133-12-20 05:25:00 | 2133-12-20 09:08:00 | CHEST RADIOGRAPH
INDICATION: Ischemic bowel disease, evaluation for interval change.
COMPARISON: ___.
FINDINGS: As compared to the previous radiograph, the monitoring and support
devices are unchanged. Unchanged size of the cardiac silhouette. Unchanged
bilateral pleural effusions. Unchanged mild-to-moderate fluid overload.
|
10018297-RR-17 | 10,018,297 | 20,306,868 | RR | 17 | 2115-02-02 20:47:00 | 2115-02-02 22:51:00 | EXAMINATION: CONTRAST ENHANCED CT SCAN OF THE PELVIS
INDICATION: History: ___ with right acetabular fx seen on plain films //
Eval right acetabular fx and for bladder injury
TECHNIQUE: A contrast enhanced CT scan of the pelvis was performed with 2.5
mm thin contiguous axial sections from the iliac crests through the proximal
thighs after the uneventful intravenous administration of 130 mL of Omnipaque.
Subsequent coronal and sagittal reconstructed images were obtained.
DOSE: Total exam DLP is 277.62 mGy-cm.
COMPARISON: None.
FINDINGS:
There is normal osseous mineralization. There is a complex fracture through
the right acetabulum involving the anterior column and posterior wall with
extension into the right superior pubic ramus. There is an additional
nondisplaced fracture of the right inferior pubic ramus. No additional
fracture is seen.
Femoral head contours are maintained without evidence of osteonecrosis.
There is no dislocation. There is no pubic symphysis or sacroiliac joint
diastasis.
The femoral acetabular and sacroiliac joint spaces appear well maintained.
Visualized portions of the lower lumbar spine demonstrate no significant
abnormality.
There is asymmetric isodense expansion of the right obturator internus (series
2, image 35). No additional hematoma is seen. The muscles are otherwise
unremarkable in appearance.
Limited evaluation of the pelvis in the absence of administered enteric
contrast demonstrates a small amount of contrast within the dependent portion
of the urinary bladder. There is a small amount of hematoma above the bladder
on the right. There is no significant pelvic or inguinal station lymph
adenopathy.
The subcutaneous soft tissues are unremarkable.
IMPRESSION:
1. Complex right acetabular fracture involving the anterior column and
posterior wall with extension into the right superior pubic ramus.
2. Nondisplaced right inferior pubic ramus fracture.
3. Mild isodense expansion of the right obturator internus muscle likely
reflecting an intramuscular hematoma.
4. Small amount of hematoma in the pelvis likely related to the fracture.
Limited evaluation for bladder injury on the current exam. If there is high
clinical concern, further evaluation can be obtained with a CT cystogram.
|
10018297-RR-18 | 10,018,297 | 20,306,868 | RR | 18 | 2115-02-05 10:06:00 | 2115-02-05 10:59:00 | INDICATION: ___ year old man with R acetabular fx // right acetabular fx, has
been up and OOB with ___
COMPARISON: Compared to CT scan from ___
IMPRESSION:
Minimally displaced fractures involving the right acetabulum are identified
with lucencies projecting next to the right femoral head. No additional
fractures are seen. There is minimal degenerative changes of both hips with
mild superolateral acetabular spurring.
|
10018297-RR-30 | 10,018,297 | 25,480,562 | RR | 30 | 2119-05-03 09:48:00 | 2119-05-03 12:49:00 | EXAMINATION: HUMERUS (AP AND LAT) IN O.R. LEFT
INDICATION: ___ male status post ORIF of a left humeral fracture
TECHNIQUE: Multiple fluoroscopic spot images were acquired during ORIF of a
left humeral fracture. No radiologist was present during the acquisition of
these images. Total fluoroscopy time of 57.5 seconds.
COMPARISON: CT from ___, radiograph from ___
FINDINGS:
12 intraoperative images were acquired without a radiologist present.
Images show interval placement of hardware along the left humerus and left
ulna.
IMPRESSION:
Intraoperative images were obtained during ORIF of a distal left humeral
fracture. Please refer to the operative note for details of the procedure.
|
10018297-RR-31 | 10,018,297 | 25,480,562 | RR | 31 | 2119-05-04 09:10:00 | 2119-05-04 10:58:00 | EXAMINATION: ELBOW (AP, LAT AND OBLIQUE) LEFT
INDICATION: ___ year old man s/p L distal humerus ORIF// eval fx fixation
TECHNIQUE: Three views of the left elbow.
COMPARISON: ___ and prior
FINDINGS:
Redemonstrated postsurgical changes of ORIF for extensively comminuted
intra-articular distal humeral fracture, and ulnar osteotomy transfixed by a
longitudinal screw and washer.The alignment is near anatomic. There is soft
tissue swelling. Posterior skin staples and splint.There is normal osseous
mineralization.
IMPRESSION:
Extensive comminuted intra-articular distal humeral fracture status post ORIF
in near anatomic alignment and without acute hardware complication seen.
|
10018328-RR-14 | 10,018,328 | 26,706,939 | RR | 14 | 2154-02-05 20:45:00 | 2154-02-05 22:57:00 | EXAMINATION: MRI CERVICAL AND THORACIC PT21 MR SPINE
INDICATION: History: ___ with fall, t3 comp fractureIV contrast to be given
at radiologist discretion as clinically needed // cord abnormality in setting
of T3 comp fracture? cord abnormality in setting of T3 comp fracture?
TECHNIQUE: Sagittal imaging was performed with T2, T1, and STIR technique.
Axial T2 imaging was performed. Axial GRE images of the cervical spine were
performed.
COMPARISON: None.
FINDINGS:
CERVICAL:
Alignment is normal. Vertebral body and intervertebral disc signal intensity
appear normal. The spinal cord appears normal in caliber and configuration.At
cervical cranial junction and at T2-3, there is no significant spinal canal or
neural foraminal narrowing.
At C3-4, there is mild spinal canal narrowing due to uncovertebral
hypertrophy.
At C4-5, there is no significant spinal canal narrowing.
At C5-6, there is moderate spinal canal narrowing due to posterior disc
protrusion and uncovertebral hypertrophy.
At C6-7 and at C7 -T1, there is no significant spinal canal or neural
foraminal narrowing.
THORACIC:
There is no subluxation or rotation.
At T2, there is mild acute compression fracture with no significant
retropulsion of the fracture fragments.
There is mild to severe anterior and posterior vertebral body fracture of the
T3 vertebra, with mild edema in the bilateral pedicles. There is 4 mm
retropulsion of the T3 posterior vertebral body into the spinal canal. There
is mild edema pattern at the interspinous ligament at T3-4 without through and
through ligamentous interruption. There is left facet joint T2 hyperintensity
at this level. Ligamentum flavum is intact at this level.
Severe compression deformity of T5 with greater than 70% of the anterior body
height loss is likely chronic, with anterior vertebral body fusion of T4
through 6.
T2 hyper intensity within T8 vertebral body, with extension into the superior
endplate is likely from trauma. There is disruption of the anterior
longitudinal ligament at T7-T8.
There is moderate amount of pre vertebral swelling, spanning from T2-T8.
At T5-6, there is mild to moderate narrowing of the spinal canal, due to acute
kyphosis from severe anterior vertebral body height loss at T5.
Aside from T3-4 and T5-6, there is no significant thoracic spinal canal
narrowing.
At T2-3, T6-7, T8-9, T9-10, T10-11 and T11-12, there are perineural cysts at
the neural foramina, the largest at the left T10-11.
OTHER: There is a 1.1 cm simple cysts in the liver. Multiple hyperintensities
in bilateral kidneys are simple cysts, the largest measuring 1.4 cm in the
upper pole of the right kidney. There is chololithiasis without evidence of
cholecystitis (14:38). The lungs are grossly clear with mild bibasilar
atelectasis and paraseptal emphysema in the right lower lobe. There is mild
posterior pleural thickening of the right lower lobe.
IMPRESSION:
1. Acute anterior and posterior vertebral body fracture of T3 with 4 mm
retropulsion of the posterior vertebral body, moderately narrowing the
vertebral canal at the level. Possible posterior ligamentous complex
disruption at T3-4. No subluxation or rotation.
2. Moderate amount of prevertebral swelling spanning from T2-8 with likely
disruption of the anterior longitudinal ligament at T7-8.
3. Mild acute compression fracture at T2.
4. Severe chronic compression fracture at T5.
5. Cholelithiasis without evidence of cholecystitis.
6. Bilateral renal simple cysts.
|
10018328-RR-15 | 10,018,328 | 26,706,939 | RR | 15 | 2154-02-05 22:20:00 | 2154-02-05 23:10:00 | EXAMINATION: T-SPINE
INDICATION: ___ woman with T spine fracture after fall and pain
baseline films
TECHNIQUE: Frontal and lateral view radiographs of the thoracic spine.
COMPARISON: Same day thoracic spine MRI.
FINDINGS:
Again seen, is a moderate compression fracture of the T3. Known mild
compression deformity of the T2 better appreciated on MRI. A chronic
compression deformity with focal kyphosis at T5 is also re- demonstrated. No
additional fractures are identified. Views of the lungs are grossly clear.
IMPRESSION:
1. Moderate T3 and mild T2 compression fractures.
2. Chronic severe compression fracture of T5 with focal kyphosis.
|
10018328-RR-16 | 10,018,328 | 26,706,939 | RR | 16 | 2154-02-07 00:41:00 | 2154-02-07 10:30:00 | EXAMINATION: MR HEAD W AND W/O CONTRAST T___ MR HEAD
INDICATION: ___ year old woman with syncope and trauma, seen at outside
hospital, with abnormality noted on outside noncontrast head CT. Evaluate for
acute intracranial hemorrhage or intracranial mass.
TECHNIQUE: Sagittal and axial T1 weighted imaging were performed. After
administration of 7 mL of Gadavist intravenous contrast, axial imaging was
performed with gradient echo, FLAIR, diffusion, and T1 technique. Sagittal
MPRAGE imaging was performed and re-formatted in axial and coronal
orientations.
COMPARISON: ___ outside noncontrast head CT.
FINDINGS:
Study is mildly degraded by motion.
There is a 2.5 X 1.5 cm aneurysm possibly arising from the left posterior
communicating artery origin of the left internal carotid artery with at the
carotid canal, exerting mild mass-effect on the left anterior medulla and on
left the anterior temporal lobe, and mildly effacing the right ambient
cistern.
There is no acute intracranial infarction, hemorrhage or edema. Mild
prominence of the ventricles and sulci are likely due to age related
involutional changes. Periventricular and subcortical T2 and FLAIR
hyperintensities are noted, which may represent small vessel ischemic changes.
There is mild mucosal thickening in the right maxillary sinus in the anterior
ethmoid air cells.
The mastoid air cells are clear.
Aside from the aneurysm described above, the major intracranial vessels and
its major branches are patent.
Scalp hematoma at the posterior vertex is unchanged from prior exam.
IMPRESSION:
1. Study is mildly degraded by motion.
2. 2.5 X 1.5 cm aneurysm with mass effect on adjacent left temporal lobe and
midbrain, possibly arising from the left posterior communicating artery
origin. Angiogram or CTA with 3D reconstruction is recommended for further
evaluation of the aneurysm.
3. Evolving biparietal scalp soft tissue swelling.
4. Paranasal sinus disease as described.
RECOMMENDATION(S): Angiogram or CTA with 3D reconstruction is recommended for
further evaluation of the aneurysm.
NOTIFICATION: The findings were discussed with ___, M.D. by
___, M.D. on the telephone on ___ at 10:17 AM, 10 minutes after
discovery of the findings.
|
10018328-RR-18 | 10,018,328 | 26,706,939 | RR | 18 | 2154-02-07 11:53:00 | 2154-02-07 13:57:00 | EXAMINATION: CTA HEAD AND CTA NECK PQ147 CT HEAD NECK
INDICATION: ___ year old woman with HTN, HLD found to have left PCOM aneurism.
// ? PCOM aneurysm.
TECHNIQUE: Contiguous MDCT axial images were obtained through the brain
without contrast material. Subsequently, helically acquired rapid axial
imaging was performed from the aortic arch through the brain during the
infusion of Omnipaque intravenous contrast material. Three-dimensional
angiographic volume rendered, curved reformatted and segmented images were
generated on a dedicated workstation. This report is based on interpretation
of all of these images.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 16.0 s, 16.0 cm; CTDIvol = 50.2 mGy (Head) DLP =
802.7 mGy-cm.
2) Stationary Acquisition 5.0 s, 0.5 cm; CTDIvol = 54.5 mGy (Head) DLP =
27.2 mGy-cm.
3) Spiral Acquisition 4.6 s, 36.2 cm; CTDIvol = 30.9 mGy (Head) DLP =
1,118.4 mGy-cm.
Total DLP (Head) = 1,948 mGy-cm.
COMPARISON: MRI from ___.
FINDINGS:
CT HEAD WITHOUT CONTRAST:
There is no evidence of acute intracranial hemorrhage, mass, mass effect or
large territorial infarction. Periventricular and deep subcortical white
matter hypodensities are likely secondary to chronic small vessel ischemic
disease. Prominence of the ventricles and sulci is likely related to age
related involutional changes. The basilar cisterns are patent, and there is
otherwise good preservation gray-white matter differentiation.
Hyperdense curvilinear structure in the region the right MCA is likely
secondary to a stent. Scattered foci of fat lobules are seen throughout the
cranium bilaterally. No acute fracture is identified. The visualized
paranasal sinuses, mastoid air cells, and middle ear cavities are clear. The
globes are unremarkable.
CTA HEAD:
A 2.5 x 1.5 cm aneurysm is seen, with mass effect on the adjacent left
temporal lobe and midbrain likely arising from the left posterior
communicating artery, an with the neck measuring up to 5 mm. There is a fetal
type right PCA. The left PCA is patent. The right MCA demonstrates a stent,
which appears to be patent. The anterior cerebral arteries are patent. The
anterior communicating artery is visualized, without evidence of an aneurysm.
The dural venous sinuses are patent.
CTA NECK:
The carotid and vertebral arteries and their major branches appear normal with
no evidence of stenosis or occlusion. There is no evidence of internal carotid
stenosis by NASCET criteria.
OTHER:
The right thyroid gland is heterogeneous, with multiple hypodensities. The
visualized apices of lungs are clear. The globes are unremarkable. The
patient is status post posterior head laceration with skin stapling.
IMPRESSION:
1. 2.5 cm aneurysm at the left internal carotid/left posterior communicating
artery bifurcation demonstrating a 5 mm neck. No other definite aneurysms
identified.
2. Multiple scattered fat lobules within the brain bilaterally.
3. A posterior head laceration with skin stapling is seen.
4. Patent right MCA stent.
|
10018423-RR-10 | 10,018,423 | 29,366,372 | RR | 10 | 2167-05-07 12:39:00 | 2167-05-07 13:58:00 | INDICATION: ___ year old man with s/p CABG, CTs d/c'd // evaluate for
pneumothorax
COMPARISON: Radiographs from ___
IMPRESSION:
There is a right IJ central line with the distal lead tip in the distal SVC.
Bibasilar chest tubes have been removed. Heart size is enlarged but stable.
There are low lung volumes with atelectasis at the lung bases. There are no
pneumothoraces.
|
10018423-RR-11 | 10,018,423 | 29,366,372 | RR | 11 | 2167-05-08 17:21:00 | 2167-05-08 17:51:00 | EXAMINATION: PA and lateral views of the chest
INDICATION: ___ year old man with s/p CABG // f/u effusions, atx
TECHNIQUE: Chest: Frontal and Lateral
COMPARISON: Prior radiographs on ___
FINDINGS:
Postoperative mediastinal widening is unchanged after initial improvement.
Small bilateral effusions are unchanged. Bibasilar atelectasis is improved.
The right IJ central line terminates in the lower SVC. There is no
pneumothorax. Median sternotomy wires are intact.
IMPRESSION:
Stable postoperative mediastinal widening. Small bilateral effusions are
unchanged. Bibasilar atelectasis is improved.
|
10018423-RR-7 | 10,018,423 | 29,366,372 | RR | 7 | 2167-05-04 20:55:00 | 2167-05-05 06:25:00 | EXAMINATION: Chest radiograph
INDICATION: ___ year old man with 3 vessel disease, scheduled for CABG, preop
radiograph.
TECHNIQUE: Portable view of the chest.
COMPARISON: Chest radiograph ___.
FINDINGS:
Lung volumes are low without focal consolidation. Heart is mildly enlarged.
There is no pleural effusion or pneumothorax. There is no acute osseous
abnormality.
IMPRESSION:
No evidence of pneumonia.
|
10018423-RR-8 | 10,018,423 | 29,366,372 | RR | 8 | 2167-05-05 19:17:00 | 2167-05-06 00:29:00 | EXAMINATION: CHEST PORT. LINE PLACEMENT
INDICATION: ___ year old man with CAD s/p CABG. Please ___ at
___ with abnormalities. // FAST TRACK EXTUBATION CARDIAC SURGERY, ?line
placement, r/o PTX/Effusion Contact name: ___: ___
TECHNIQUE: Single frontal view of the chest
COMPARISON: ___
IMPRESSION:
There are low lung volumes. There is postoperative mediastinal widening.
There is mild vascular congestion. Moderate to severe cardiomegaly is
accentuated by the projection and low lung volumes. ET tube is in standard
position. NG tube tip is in the stomach, site port is probably at the EG
junction. Mediastinal and chest tubes are in place. There is no evident
pneumothorax. If any there is a small left effusion. Bibasilar atelectasis
are larger on the left side
|
10018423-RR-9 | 10,018,423 | 29,366,372 | RR | 9 | 2167-05-06 09:44:00 | 2167-05-06 10:20:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man s/p CABG // eval for pneumothorax s/p CT removal
TECHNIQUE: Single frontal view of the chest
COMPARISON: ___
FINDINGS:
Severe cardiomegaly is stable. Widening mediastinum and vascular congestion
have markedly improved. There is no evident pneumothorax. Small bilateral
effusions are unchanged. Right IJ catheter tip is in unchanged position.
Bilateral chest tubes are in place
IMPRESSION:
Resolved vascular congestion. There is stable small bilateral effusions.
Improved mediastinal widening
|
10018501-RR-10 | 10,018,501 | 28,479,513 | RR | 10 | 2141-07-30 19:23:00 | 2141-07-30 20:20:00 | INDICATION: ___ with MVC with left SDH and on previous CT. Assess trauma and
subdural hematoma.
TECHNIQUE: Contiguous axial MDCT images were obtained through the brain
without administration of IV contrast. Reformatted coronal, sagittal, and
thin section bone algorithm reconstructed images were generated.
DOSE: DLP: 1114.91 mGy-cm
CTDI: 55.75 mGy
COMPARISON: Outside CT head ___.
FINDINGS:
Small right extra-axial fluid collection is most consistent with a subdural
hematoma along the right frontotemporal region and measures 4 mm in maximal
width, unchanged from previous examination. No additional evidence of
hemorrhage, edema, mass effect, or acute large territorial infarction.Mild
prominence of the ventricles and sulci are consistent with age-related
cortical volume loss.The basal cisterns are patent and there is preservation
of gray-white matter differentiation.
No fracture identified. The visualized paranasal sinuses, mastoid air cells,
and middle ear cavities are clear besides fluid within a single left mastoid
air cell. The globes are notable for bilateral lens replacement.
Atherosclerotic calcification are seen in cavernous portions of bilateral
internal carotid arteries and vertebral arteries.
IMPRESSION:
1. Stable small right subdural hematoma along the right frontal temporal
region. No mass-effect or shift of midline structures.
2. No additional hemorrhage.
|
10018501-RR-11 | 10,018,501 | 28,479,513 | RR | 11 | 2141-07-30 19:26:00 | 2141-07-30 20:38:00 | EXAMINATION: CT chest without contrast.
INDICATION:
___ with MVC with left SDH and on previous CT. Assess for trauma.
TECHNIQUE: Axial multidetector CT images were obtained through the thorax
without intravenous contrast. Reformatted coronal, sagittal, thin slice axial
images, and oblique maximal intensity projection images were submitted to PACS
and reviewed.
DOSE: DLP: 694.62 mGy-cm
COMPARISON: Trauma chest radiograph ___.
FINDINGS:
No supraclavicular, axillary or mediastinal lymph node enlargement by CT size
criteria.The thyroid gland is unremarkable. The heart size is normal without
pericardial effusion. Note is made of lipomatous hypertrophy of the
interatrial septum. Atherosclerotic calcifications are seen within the
thoracic aorta and coronary arteries. The great vessels are normal caliber.
No mediastinal hematoma. No retroperitoneal hematoma. No intramural hematoma
within the aorta.
No pleural effusion.No pneumothorax. The airways are patent to the
subsegmental level. Mild centrilobular emphysema is noted. Within the lungs,
no focal opacity, pulmonary nodule, or mass seen.
OSSEOUS STRUCTURES: Along the posterior aspect of the left tenth rib there is
a cortical deformity (5:170) compatible with old fracture. No additional
displaced rib fractures. No lytic or blastic osseous lesions concerning for
malignancy.
Although this study is not designed for the evaluation of subdiaphragmatic
structures, the imaged upper abdomen is notable for fat stranding surrounding
the kidneys similar in appearance to previous examination, nonspecific. Of
note patient received IV contrast on prior CT abdomen/pelvis. Contrast is seen
within the collecting system on most recent examination without extravasation
to suggest renal pelvis injury. Small hiatal hernia noted.
IMPRESSION:
No acute intrathoracic injury. Left posterior eleventh rib fracture is
chronic.
NOTIFICATION: Updated wet read discussed with Dr. ___ by Dr. ___ at 9:10
pm on ___.
|
10018501-RR-12 | 10,018,501 | 28,479,513 | RR | 12 | 2141-07-30 22:11:00 | 2141-07-30 23:05:00 | EXAMINATION: CT ABDOMEN W/O CONTRAST
INDICATION: ___ with MVC, ?L3 fx with retropulsion. Assess OSH CT abd/pelvis,
no read, verbal report of L3 fx w/retropulsion.
TECHNIQUE: MDCT images were obtained from the lung bases to the pubic
symphysis after the administration of 97.8 cc of intravenous contrast. Axial
images were interpreted in conjunction with coronal and sagittal reformats.
Oral contrast was not administered.
DLP: 1285.3 mGy-cm
COMPARISON: None.
FINDINGS:
CHEST: Limited assessment of the lung bases are clear. No pleural effusion.
The visualized heart is normal in size without pericardial effusion. Again
seen is lipomatous hypertrophy of the intra-atrial septum. Please refer to
dedicated CT chest for further information.
ABDOMEN:
The liver is homogeneous in enhancement. No focal lesion identified.No
intrahepatic or extrahepatic biliary dilatation. The gallbladder is notable
for is small amount of layering hyperdense material most consistent with small
calcified stones. The portal vein, SMV, and splenic vein are patent.
The spleen is normal. The pancreas enhances homogenously and is without focal
lesions, peripancreatic fat stranding, or focal fluid collection. The adrenal
glands are unremarkable.
The kidneys display symmetric nephrograms and excretion of contrast. A 1.1 x
1.2 cm exophytic cyst is seen along the lower pole of the right kidney.
Perinephric fat stranding is within normal limits in a patient of this age. No
additional renal lesions. No hydronephrosis or hydroureter identified. No
renal or proximal ureter calculi.
A small hiatal hernia is noted. The stomach is grossly unremarkable in
appearance. The small bowel is normal in caliber without wall thickening. The
large bowel is normal in caliber without wall thickening, fat stranding, or
focal mass lesion. Diffuse colonic diverticulosis is present without evidence
of acute diverticulitis. The appendix is not visualized however no evidence of
acute appendicitis.
Mildly ectatic infrarenal aorta is noted. Dense calcifications noted at the
origin of the celiac axis and SMA which are otherwise patent without
aneurysmal dilatation. The ___ is patent . Large amount of atherosclerotic
calcification noted. The iliac arteries are normal in course and caliber. No
retroperitoneal hematoma.
No retroperitoneal or mesenteric lymph node enlargement by CT size criteria.
No free abdominal fluid, abdominal wall hernia, or pneumoperitoneum. No soft
tissue hematoma.
PELVIS: The bladder is notable for a 3.4 x 3.3 cm (2:73) bladder diverticulum
extending off of the left posterior bladder wall. The bladder is otherwise
unremarkable. No pelvic side-wall or inguinal lymph node enlargement by CT
size criteria. No free pelvic fluid seen. The prostate and seminal vesicles
are unremarkable. Left fat containing inguinal hernia and nonobstructed bowel
containing right inguinal hernia is noted.
OSSEOUS STRUCTURES: Multilevel, multifactorial degenerative changes are seen
within the visualized thoracolumbar spine. No focal lytic or sclerotic lesion
concerning for malignancy. Chronic healed fracture is seen along the posterior
aspect of the left tenth rib. At L2 level there is a burst fracture involving
the anterior and middle column with 5 mm of retropulsion of the superior
fracture fragment. The posterior elements are intact. An oblique fracture is
seen through the anterior aspect of the superior endplate of L2. An additional
lucency is seen through an osteophyte at the anterior aspect of L1 inferior
end-plate without displacement (8: 78).
IMPRESSION:
1. L2 burst fracture with 5 mm of retropulsion and 2 column involvement.
2. Nondisplaced fracture through L1 anterior osteophyte at inferior endplate.
Single column involvement.
3. Small calcified gallstones without evidence of acute cholecystitis.
4. Diffuse colonic diverticulosis without evidence of acute diverticulitis.
5. Left bladder diverticulum.
|
10018501-RR-13 | 10,018,501 | 28,479,513 | RR | 13 | 2141-08-03 18:24:00 | 2141-08-04 15:16:00 | EXAMINATION: MR ___ SPINE W/O CONTRAST
INDICATION: ___ year old man with L3 compression fracture with retropulsion //
evaluate for ligament injury evaluate for ligament injury
TECHNIQUE: Sagittal imaging was performed with T2, T1, and STIR technique.
Axial T2 and gradient echo imaging were performed.
COMPARISON: CT abdomen ___
FINDINGS:
There are 5 lumbar type vertebrae. Alignment is preserved. There is a
horizontally oriented fracture through the L2 vertebral body with moderate
vertebral body height loss. Marrow edema extends into the bilateral pedicles.
There is mild retropulsion. The conus is normal in appearance, terminating at
L1.
There are additional bony defects of the inferior endplate of L3 and superior
endplate of L4. These may be small fractures or Schmorl's nodes. There is
increased T2/STIR signal within the L3-4 intervertebral disc.
At L4-5, there is a left foraminal disc protrusion that compresses the left L5
nerve root between disc and facet. At L5-S1, there is a disc protrusion
contacting the bilateral S1 nerve roots.
There is a probable exophytic right renal cyst, as seen on CT abdomen and
pelvis from ___.
IMPRESSION:
1. Fracture through the L2 vertebral body causing moderate vertebral body
height loss. Marrow edema extends into the bilateral L2 pedicles. There is
mild retropulsion.
2. Additional bony defects of the inferior L3 and superior L4 endplates,
either small fractures or Schmorl's nodes. There is increased T2/STIR signal
within the L3-4 intervertebral disc that may be traumatic.
|
10018501-RR-15 | 10,018,501 | 28,479,513 | RR | 15 | 2141-07-31 10:51:00 | 2141-07-31 11:19:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ year old man with R SDH // evaluate for interval change
TECHNIQUE: Contiguous axial MDCT images were obtained from the skull base
through the vertex, without IV administration of contrast. Reformatted coronal
and sagittal and thin-section bone algorithm-reconstructed images were
acquired, and all images are viewed in brain and bone window on the
workstation.
DOSE: DLP (mGy-cm): 892
CTDIvol (mGy): 52
COMPARISON: Noncontrast head CT from ___
FINDINGS:
Allowing for differences in technique and positioning, tiny hyperdense right
extra-axial collection along the right frontotemporal convexity (2:14,
601b:39), is unchanged. There is no new hemorrhage. No edema, mass effect, or
acute vascular territorial infarction. Scattered punctate calcifications are
unchanged and may relate to vascular calcifications or old granulomatous
disease. Prominent ventricles and sulci likely reflect age related atrophy.
The basal cisterns are patent. Gray-white matter differentiation is preserved.
No fracture is identified. Partially imaged paranasal sinuses, mastoid air
cells, and middle ear cavities are clear. The orbits are unremarkable.
Bilateral vertebral and cavernous carotid calcifications are noted.
IMPRESSION:
Stable size and morphology of tiny right frontotemporal subdural hematoma.
|
10018501-RR-9 | 10,018,501 | 28,479,513 | RR | 9 | 2141-07-30 19:12:00 | 2141-07-30 21:16:00 | INDICATION: Trauma.
TECHNIQUE: Single supine view of the chest.
COMPARISON: None. Correlation made to concurrent CT chest pain
FINDINGS:
The lungs are clear. Cardiomediastinal silhouette is within normal limits. No
acute osseous abnormalities identified PA
IMPRESSION:
No acute cardiopulmonary process.
|
10018684-RR-15 | 10,018,684 | 26,649,049 | RR | 15 | 2118-09-16 00:12:00 | 2118-09-16 01:30:00 | INDICATION: History: ___ with SOB, concern for pna vs PE and DVT in RLE u/s
wt 460 lbs // History: ___ with SOB, concern for pna vs PE and DVT in RLE u/s
wt 460 lbs
TECHNIQUE: Axial multidetector CT images were obtained through the thorax
after the uneventful administration of intravenous contrast.
Reformatted coronal, sagittal, thin slice axial images, and oblique maximal
intensity projection images were submitted to PACS and reviewed.
DOSE: Acquisition sequence:
1) Stationary Acquisition 6.0 s, 0.5 cm; CTDIvol = 57.8 mGy (Body) DLP =
28.9 mGy-cm.
2) Spiral Acquisition 4.1 s, 32.1 cm; CTDIvol = 23.3 mGy (Body) DLP = 749.8
mGy-cm.
Total DLP (Body) = 779 mGy-cm.
COMPARISON: None
FINDINGS:
The exam is limited by body habitus and respiratory motion.
The aorta and its major branch vessels are patent, with no evidence of
stenosis, occlusion, dissection, or aneurysmal formation. There is no
evidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.
The pulmonary arteries are well opacified to the segmental level, with no
evidence of filling defect within the main, right, left, lobar pulmonary
arteries. Evaluation of the segmental and subsegmental pulmonary arteries is
limited by respiratory motion. The main and right pulmonary arteries are
normal in caliber, and there is no evidence of right heart strain.
There are ir mildly enlarged left prevascular lymph nodes measuring up to 1.1
cm (02:34). There is no supraclavicular, axillary, or hilar lymphadenopathy.
The thyroid gland appears unremarkable.
There is no evidence of pericardial effusion. There is no pleural effusion.
There is a 4 mm left upper lobe subpleural pulmonary nodule (02:33). The
airways are patent to the subsegmental level.
Limited images of the upper abdomen are unremarkable.
No lytic or blastic osseous lesion suspicious for malignancy is identified.
IMPRESSION:
1. Limited exam. No evidence of central pulmonary embolism. Evaluation of
the segmental and subsegmental pulmonary arteries is limited by respiratory
motion.
2. 4 mm left upper lobe pulmonary nodule.
3. Borderline enlarged mediastinal lymph nodes may be reactive. Correlate
with clinical symptoms.
RECOMMENDATION(S): Per ___ society guidelines for follow-up of
pulmonary nodules, if no risk factors for malignancy, no followup is
recommended. If risk factors, recommend followup CT in ___ year.
|
10018684-RR-16 | 10,018,684 | 26,649,049 | RR | 16 | 2118-09-16 08:51:00 | 2118-09-16 10:23:00 | EXAMINATION: CT of the abdomen and pelvis
INDICATION: ___ year old man with leg pain, tachycardia // CTV for DVT pelvis
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired
through the abdomen and pelvis following intravenous contrast administration
with split bolus technique.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Total DLP (Body) = 2,496 mGy-cm.
COMPARISON: CTA of chest ___ at 00:19 AM.
FINDINGS:
Examination is severely limited by soft tissue attenuation of the x-ray beam
and evaluation of the pelvis is limited by streak artifact from residual
contrast in the bladder from prior CTA examination.
LOWER CHEST: In the visualized lung fields there is no evidence pleural or
pericardial effusion. Bibasilar atelectasis is present. Please refer to
separate report of CT chest performed on the same day for description of the
thoracic findings.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There is no evidence of focal lesions. There is no evidence of intrahepatic
or extrahepatic biliary dilatation. The gallbladder is within normal limits.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size. There is residual
contrast in the renal collecting system from prior contrast examination.
There is no evidence of focal renal lesions or hydronephrosis. There is no
perinephric abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. The colon and
rectum are within normal limits. The appendix is not visualized.
PELVIS: Residual contrast in the bladder limits evaluation of the pelvis. The
urinary bladder and distal ureters are unremarkable. There is no free fluid
in the pelvis.
REPRODUCTIVE ORGANS: The prostate and seminal vesicles are unremarkable.
LYMPH NODES: There is no mesenteric lymphadenopathy. There are several
prominent inguinal lymph nodes largest of which is on the right and measures
15 x 26 mm (03:15). There is a mildly prominent para-aortic lymph node that
does not meet CT size criteria for pathologic enlargement (03:58).
VASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease
is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: An umbilical hernia containing fat is noted.
IMPRESSION:
No central or peripheral DVT identified although examination is moderately
limited by body habitus and evaluation of the pelvis is also limited by streak
artifact from residual contrast in the bladder.
|
10018845-RR-19 | 10,018,845 | 21,101,111 | RR | 19 | 2184-10-08 10:53:00 | 2184-10-08 15:22:00 | CAROTID STUDY DATED ___
HISTORY: Multiple falls over the last few weeks.
FINDINGS: Though not stated in the history, the patient apparently has a
right ICA stent. This is widely patent, no evidence of right ICA stenosis.
On the left, there are scattered areas of heterogeneous calcific plaque. The
peak systolic velocities on the left are 220, 198, 127, 84 and 136 cm/sec for
the proximal, mid and distal ICA and CCA and ECA respectively. The ICA/CCA
ratio is 1.1 on the right and 2.6 on the left. There is antegrade flow
involving both vertebral arteries.
IMPRESSION:
1. Widely patent right ICA stent.
2. Approximately 60 to 69% left ICA stenosis.
|
10018845-RR-20 | 10,018,845 | 21,101,111 | RR | 20 | 2184-10-08 20:02:00 | 2184-10-08 20:44:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ year old man with a left SDH now s/p 2 burr holes and
evacuation of hemorrhage. Post-operative head CT without contrast at 8 ___ to
assess for hemorrhage. // ___ year old man with a left SDH now s/p 2 burr
holes and evacuation of hemorrhage. Post-operative head CT without contrast at
8 ___ to assess for hemorrhage.
TECHNIQUE: Routine unenhanced head CT was performed and viewed in brain,
intermediate and bone windows. Coronal and sagittal reformats were also
performed.
DOSE: DLP: 891.93 mGy-cm
CTDI: 54.42 mGy
COMPARISON: Outside hospital head CT ___.
FINDINGS:
The patient is status post evacuation of a left subdural collection. Two burr
holes through the left frontal bone are noted. There is resultant
pneumocephalus with an air blood level in the left subdural space. Although
overall the left subdural collection appears decreased in size, there is a
focal area where a collection of air causes significant local mass effect on
the adjacent parenchyma, with a maximum depth of 3.5 cm from the inner table,
as compared to a maximum dimension of 2.7 cm of subdural hematoma on the
outside hospital study at a similar level. Soft tissue swelling and emphysema
in the soft tissues are noted overlying the left frontal bone. Shift of
midline structures to right has mildly improved since the prior study, now
measuring 6 mm at the level of the lateral ventricles, compared the 8 mm
previously (series 2, image 17). The basal cisterns are patent.
Periventricular white matter hypodensities are nonspecific but consistent with
small vessel ischemic changes. Encephalomalacia in the right occipital lobe is
noted.
There is no fracture. There is very minimal mucosal thickening of the right
maxillary sinus and ethmoid air cells bilaterally The visualized paranasal
sinuses, mastoid air cells, middle ear cavities are otherwise clear.
IMPRESSION:
Status post evacuation of left subdural collection with air and fluid now
occupying the left subdural space. Although overall the midline shift has
mildly decreased, there is a focal area of increased mass effect of the left
frontal lobe caused by pneumocephalus.
|
10018845-RR-21 | 10,018,845 | 21,101,111 | RR | 21 | 2184-10-10 13:14:00 | 2184-10-10 14:21:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ year old man s/p 2 burr holes and evacuation of ___ on ___.
Non-contrast head CT to be performed today to assess for residual hemorrhage.
// ___ year old man s/p 2 burr holes and evacuation of ___ on ___.
Non-contrast head CT to be performed today to assess for residual hemorrhage.
TECHNIQUE: Contiguous axial images were obtained through the head without the
administration of intravenous contrast. Coronal and sagittal reformatted
images as well as thin section images in a bone window algorithm were
generated and reviewed.
DOSE: DLP: 1003.42 mGy-cm; CTDI: 55.75 mGy
COMPARISON: NECT the head, ___.
FINDINGS:
Again seen is a large amount of extra-axial air and fluid in the surrounding
the left hemisphere with two burr holes from recent drainage. 7 mm rightward
subfalcine herniation is stable. There is no new hemorrhage. The basal
cisterns appear patent. There is an old infarct in the right occipital lobe.
Subcortical and periventricular white matter hypodensities are in keeping with
chronic small vessel ischemic disease.
The orbits and globes are unremarkable. There is still mild mucosal
thickening in the right maxillary sinus. The remaining imaged paranasal
sinuses, mastoid air cells, and middle ear cavities are clear. The bony
calvaria appear intact.
IMPRESSION:
1. Stable postoperative changes after evacuation of left subdural hematoma
including a large amount of pneumocephalus.
2. No new hemorrhage.
3. Stable mass effect including 7 mm of subfalcine herniation.
|
10018852-RR-18 | 10,018,852 | 23,361,965 | RR | 18 | 2119-06-29 17:28:00 | 2119-06-29 19:55:00 | EXAMINATION: CT ABD AND PELVIS WITH CONTRAST
INDICATION: ___ man with ulcerative colitis, status post colectomy
presenting with signs and symptoms of obstruction.
TECHNIQUE: Contiguous axial multidetector CT images through the abdomen and
pelvis with intravenous and oral contrast. Multiplanar reformations.
Total DLP: 482 mGy-cm
COMPARISON: None
FINDINGS:
Lung bases: The partially imaged lung bases are clear. There is no pleural
effusion.
CT abdomen: The liver enhances homogeneously without concerning lesions or
biliary dilatation. Gallbladder, spleen, pancreas, and adrenal glands are
within normal limits. Spleen is top-normal in size. Kidneys enhance and
excrete symmetrically without focal lesions or hydronephrosis.
Loops of distal small bowel are diffusely fluid-filled and dilated up to 3.7
cm up to the proximal pelvic anastomosis; beyond which the bowel is
decompressed. Multiple prominent mesenteric lymph nodes are likely reactive.
There is no intra abdominal free air. A small amount of fluid seen surrounding
the liver and around the small bowel loops. There is no retroperitoneal
lymphadenopathy.
CT pelvis: Bladder, seminal vesicles, and prostate gland are within normal
limits. There is no pelvic free fluid or lymphadenopathy.
Bone windows: No concerning lytic or sclerotic osseous lesion is identified.
IMPRESSION:
Small bowel obstruction with the transition point likely at the proximal
pelvic anastomosis.
|
10018862-RR-21 | 10,018,862 | 29,501,040 | RR | 21 | 2149-06-23 15:04:00 | 2149-06-23 15:48:00 | EXAMINATION: CT ABD AND PELVIS WITH CONTRAST
INDICATION: ___ with LLQ abdominal pain. Evaluate for diverticulitis.
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were
acquired through the abdomen and pelvis following intravenous contrast
administration with split bolus technique.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Stationary Acquisition 5.5 s, 0.5 cm; CTDIvol = 26.5 mGy (Body) DLP =
13.2 mGy-cm.
2) Spiral Acquisition 6.9 s, 54.1 cm; CTDIvol = 12.0 mGy (Body) DLP = 651.2
mGy-cm.
Total DLP (Body) = 664 mGy-cm.
COMPARISON: CT abdomen pelvis of ___.
FINDINGS:
LOWER CHEST: Bibasilar atelectasis is mild. There is no pericardial or
pleural effusion. A small rounded calcification or clip is identified in the
right breast.
ABDOMEN:
HEPATOBILIARY: As before, the hepatic contour is nodular compatible with
cirrhosis. It is diffusely hypoattenuating compared with the spleen,
compatible with steatosis. There is no evidence of focal lesions. There is
no evidence of intrahepatic or extrahepatic biliary dilatation. The
gallbladder is within normal limits.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen is enlarged, measuring 14.6 cm, as before.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
Bilateral renal hypodensities, compatible with cysts, are unchanged. There is
no perinephric abnormality or hydronephrosis.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. The previous
pericolonic fat stranding and hyper enhancement involving the sigmoid colon
has resolved. There is no fluid collection, free air, or adjacent
inflammatory change on the current study. There is diverticulosis of the
sigmoid colon. As before, the appendix contains dense material, which could
be calcification or previously ingested/inspissated contrast. No evidence of
periappendiceal fat stranding.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: The uterus is not visualized. A partially calcified, fat
containing density in the midline lower pelvis, just superior to the urinary
bladder (2:76) is unchanged and may represent fat necrosis from prior surgery.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease
is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
There are mild degenerative changes in the lower lumbar spine.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. Sigmoid diverticulosis with essentially complete resolution of previously
noted pericolonic fat stranding and hyperenhancement of the sigmoid colon. No
evidence of acute intra-abdominal or intrapelvic process to explain the
patient's current symptoms.
2. Cirrhotic liver with splenomegaly.
|
10018862-RR-7 | 10,018,862 | 21,851,498 | RR | 7 | 2148-12-03 13:55:00 | 2148-12-03 14:55:00 | EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: Please evaluate liver w/dopplers and biliary system. ?portal
vein thrombosis
TECHNIQUE: Gray scale, color, and spectral Doppler evaluation of the abdomen
was performed.
COMPARISON: None.
FINDINGS:
Liver: The hepatic parenchyma is coarsened with subtly nodular capsule. No
focal liver lesions are identified. There is small amount of ascites.
Bile ducts: There is no intrahepatic biliary ductal dilation. The common
hepatic duct measures 4 mm.
Gallbladder: The gallbladder appears within normal limits, without stones,
abnormal wall thickening, or edema.
Pancreas: The imaged portion of the pancreas appears within normal limits,
with portions of the pancreatic tail obscured by overlying bowel gas.
Spleen: The spleen demonstrates normal echotexture, and measures 14 1 cm,
mildly enlarged..
Kidneys: The right kidney measures cm. The left kidney measures cm. No
stones, masses, or hydronephrosis are identified in either kidney.
Doppler evaluation:
The main portal vein is patent, with flow in the appropriate direction.
Main portal vein velocity is 20 cm/sec.
Right and left portal veins are patent, with antegrade flow.
The main hepatic artery is patent, with appropriate waveform.
Right, middle and left hepatic veins are patent..
Splenic vein and superior mesenteric vein are patent, with antegrade flow.
IMPRESSION:
Patent hepatic vasculature.
Splenomegaly.
Small amount of ascites.
|
10018862-RR-8 | 10,018,862 | 21,851,498 | RR | 8 | 2148-12-04 21:00:00 | 2148-12-04 22:27:00 | EXAMINATION: CT scan of the abdomen and pelvis with oral and intravenous
contrast
INDICATION: ___ year old woman with cirrhosis, portal HTN and abdominal pain//
Pancreatitis or other pathology?
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired
through the abdomen and pelvis following intravenous contrast administration
with split bolus technique.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Stationary Acquisition 0.5 s, 1.0 cm; CTDIvol = 1.2 mGy (Body) DLP = 1.2
mGy-cm.
2) Stationary Acquisition 8.0 s, 1.0 cm; CTDIvol = 18.5 mGy (Body) DLP =
18.5 mGy-cm.
3) Spiral Acquisition 14.8 s, 50.8 cm; CTDIvol = 11.7 mGy (Body) DLP =
576.0 mGy-cm.
Total DLP (Body) = 609 mGy-cm.
COMPARISON: Ultrasound of the abdomen from ___
FINDINGS:
LOWER CHEST: Linear stranding is seen at the lung bases. There are trace
pleural effusions.
ABDOMEN: There is a small amount of ascites.
HEPATOBILIARY: The liver demonstrates a somewhat heterogeneous texture with
subtle nodularity of the border. No focal hepatic lesions are evident.
Findings are suggestive of cirrhosis. There is no evidence of intrahepatic or
extrahepatic biliary dilatation. The gallbladder is within normal limits.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. Mild peripancreatic stranding
is difficult to assess in the setting of ascites.
SPLEEN: The spleen is enlarged.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
There are several sub cm right renal hypodensities. These are too small for
accurate characterization but statistically likely represent tiny cysts.
There is no perinephric abnormality.
GASTROINTESTINAL: Gastric varices are evident. The clip is noted in the
stomach. The stomach is somewhat distended and filled with debris. Small
bowel loops demonstrate normal caliber, wall thickness, and enhancement
throughout. There are scattered colonic diverticula. The appendix has a
normal air-filled appearance.
PELVIS: The urinary bladder and distal ureters are unremarkable. Free fluid
is seen within the pelvis.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease
is noted.
BONES: Degenerative changes are evident in the spine.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. The liver has a nodular border. The spleen is enlarged. Gastric varices
are evident. There is a small amount of ascites. Findings are most
compatible with cirrhosis and portal hypertension.
2. Sub cm right renal lesions which are too small for accurate
characterization but statistically likely represent tiny cysts.
3. Diverticulosis.
|
10018862-RR-9 | 10,018,862 | 21,851,498 | RR | 9 | 2148-12-07 19:03:00 | 2148-12-07 20:09:00 | EXAMINATION: MRI of the Abdomen
INDICATION: Ms. ___ is a ___ year old woman with likely NASH Childs
Bcirrhosis c/b ascites and esophageal variceal bleeding, and T2DM who presents
with abdominal pain. Unclear etiology of pain, EGD negative, c/f chronic
pancreatitis vs biliary issue? Unclear etiology of pain, EGD negative, c/f
chronic pancreatitis vs biliary issue?
TECHNIQUE: T1- and T2-weighted multiplanar images of the abdomen were
acquired in a 1.5 T magnet.
Intravenous contrast: 7 mL Gadavist.
COMPARISON: CT abdomen and pelvis ___
FINDINGS:
Limited post contrast examination secondary to respiratory motion.
Lower Thorax: There is mild bibasilar atelectasis.
Liver: The liver demonstrates a cirrhotic morphology with a shrunken and
nodular contour. There is trace perihepatic ascites. No focal hepatic lesion
is seen.
Biliary: The gallbladder is unremarkable. No stones are seen. There is no
intra or extrahepatic biliary duct dilation.
Pancreas: The pancreas is normal in morphology and signal intensity. There is
no pancreatic duct dilation. There is no focal pancreatic lesion. There is
no. Pancreatic abnormality.
Spleen: The spleen is enlarged measuring 14.1 cm.
Adrenal Glands: The right and left adrenal glands are unremarkable.
Kidneys: The kidneys are symmetric in size. There is no hydronephrosis.
There are bilateral simple renal cysts measuring up to 1.0 cm in the right mid
pole.
Gastrointestinal Tract: There is no hiatal hernia. Susceptibility noted in
the stomach from gastric clip. Views of the small and large bowel are
otherwise unremarkable.
Lymph Nodes: There are prominent porta hepatic lymph nodes, which are not
pathologically enlarged.
Vasculature: There is no abdominal aortic aneurysm. Hepatic arterial anatomy
is conventional. The portal vein is patent. There is a recanalized
paraumbilical vein. There are intraabdominal varices
Osseous and Soft Tissue Structures: There is no suspicious bony lesion. There
is no superficial soft tissue abnormality.
IMPRESSION:
1. Cirrhotic liver morphology with sequela of portal hypertension including
splenomegaly and intra-abdominal varices.
2. No suspicious focal hepatic lesion.
3. No evidence of pancreatitis.
|
10019003-RR-27 | 10,019,003 | 27,525,946 | RR | 27 | 2153-04-13 14:20:00 | 2153-04-13 16:15:00 | EXAMINATION: Chest radiograph
INDICATION: ___ year old woman with UGI bleed // checking ETT placement
TECHNIQUE: Portable AP chest radiograph
COMPARISON: Prior chest radiographs from ___
FINDINGS:
The tip of an endotracheal tube is seen 3.8 cm above the carina. Increased
opacities is seen in the left lower lung base with left lung volume loss is
concerning for aspiration. The right lung appears clear. The heart size is
unchanged. No pneumothorax.
IMPRESSION:
1. The tip of the ETT is seen 2.8 cm above the carina. No pneumothorax
2. Increased left lower lung opacities are concerning for aspiration.
NOTIFICATION: The findings were discussed by Dr. ___ with RN ___ on
the telephoneon ___ at 4:12 ___, 5 minutes after discovery of the
findings.
|
10019003-RR-28 | 10,019,003 | 27,525,946 | RR | 28 | 2153-04-14 06:20:00 | 2153-04-14 08:56:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with h/o undifferentiated myeloproliferative
disorder admitted for aspiration event during EGD with hypoxia and fevers //
f/u aspiration f/u aspiration
IMPRESSION:
ET tube tip is 5 cm above the carinal. NG tube tip is in the stomach. There
is interval improvement of left basal atelectasis but still there is a
persistent left perihilar opacities that might represent residua of aspiration
or developing pneumonia. Reassessment of the patient in ___ hr is
recommended.
Mild vascular enlargement is not excluded.
|
10019003-RR-30 | 10,019,003 | 27,525,946 | RR | 30 | 2153-04-15 04:56:00 | 2153-04-15 10:25:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with pulmonary infiltrates, eval for infectious
foci vs. edema vs. metastatic disease // ___ year old woman with pulmonary
infiltrates, eval for infectious foci vs. edema vs. metastatic disease
TECHNIQUE: Single frontal view of the chest
COMPARISON: ___
IMPRESSION:
Left perihilar consolidation is unchanged. Retrocardiac atelectasis have
improved. Vascular congestion is stable. There is no evident pneumothorax.
Small left pleural effusion is unchanged. Cardiomediastinal contours are
stable. Left PICC tip is in the lower SVC
|
10019003-RR-31 | 10,019,003 | 27,525,946 | RR | 31 | 2153-04-14 13:03:00 | 2153-04-14 13:23:00 | EXAMINATION: DX CHEST PORTABLE PICC LINE PLACEMENT
INDICATION: ___ year old woman with new line // new left PICC 47 cm ___
___ Contact name: ___: ___ new left PICC 47 cm ___ ___
IMPRESSION:
In comparison with the earlier study of this date, there is an placement of a
left subclavian PICC line that extends to the lower SVC, close to the
cavoatrial junction.
The pulmonary vascular congestion has decreased. Otherwise little change.
|
10019003-RR-32 | 10,019,003 | 27,525,946 | RR | 32 | 2153-04-15 16:52:00 | 2153-04-15 20:52:00 | INDICATION: ___ year old woman with bleeding duodenal ulcer // duodenal ulcer,
bleeding
COMPARISON: MRI ___
TECHNIQUE: OPERATORS: Dr. ___ and Dr.
___ radiologist performed the procedure. Dr. ___
___ supervised the trainee during the key components of the procedure
and has reviewed and agrees with the trainee's findings.
ANESTHESIA: Sedation was provided by administrating divided doses of 0mcg of
fentanyl and 3 mg of midazolam throughout the total intra-service time of 2
hours 10 minutes during which the patient's hemodynamic parameters were
continuously monitored by an independent trained radiology nurse. 1% lidocaine
was injected in the skin and subcutaneous tissues overlying the access site.
MEDICATIONS: 1% lidocaine, 3 mg versed.
CONTRAST: 140 ml of Optiray contrast.
FLUOROSCOPY TIME AND DOSE: 33:04 min, ___ cGycm2
PROCEDURE:
1. Right common femoral artery access.
2. Celiac arteriogram.
3. Gastroduodenal arteriogram.
4. Right gastroepiploic arteriogram.
5. Coil embolization of the right gastroepiploic artery and post embolization
arteriogram.
6. Subselective superior pancreaticoduodenal artery catheterization and coil
embolization.
7. Coil and gel foam embolization of gastroduodenal artery and post
embolization arteriogram.
PROCEDURE DETAILS:
Following the discussion of the risks, benefits and alternatives to the
procedure, written informed consent was obtained from the patient. The patient
was then brought to the angiography suite and placed supine on the exam table.
A pre-procedure time-out was performed per ___ protocol. Both groins were
prepped and draped in the usual sterile fashion.
Using palpatory and fluoroscopic guidance, the right common femoral artery was
punctured using a micropuncture set at the level of the mid-femoral head. A
0.018 wire was passed easily into the vessel lumen. A small skin incision was
made over the needle. Then the inner dilator and wire were removed and a
___ wire was advanced under fluoroscopy into the aorta. The micropuncture
sheath was exchanged for a 5 ___ sheath which was attached to a continuous
heparinized saline side arm flush.
A C2 Cobra catheter was advanced over ___ wire into the aorta. The wire
was removed and the celiac artery was selectively cannulated and a small
contrast injection was made to confirm position. A celiac arteriogram was
performed.
A Glidewire was then advanced into the gastroduodenal artery. The C2 Cobra
catheter was advanced over the wire. The wire was removed, and the
gastroduodenal artery was injected with contrast to confirm positioning. A
gastroduodenal artery arteriogram was performed.
The Glidewire was then advanced more distally into the right gastroepiploic
artery. The C2 Cobra catheter was followed into the right gastroepiploic
artery. The wire was removed, and a contrast injection was performed to
confirm positioning. A right gastroepiploic artery arteriogram was performed.
Coil embolization of the right gastroepiploic artery was performed with 3 mm x
3 cm Hilal coils (x4) and Gelfoam. A post embolization right gastroepiploic
arteriogram was performed. After confirming distal occlusion, gel foam slurry
was injected.
The C2 Cobra catheter was then withdrawn into the upper gastroduodenal artery.
A contrast injection was performed to confirm positioning. An STC
microcatheter preloaded with a Transcend wire was then advanced into the lower
gastroduodenal artery. A superior pancriaticoduodenal artery branch of the
GDA wad then selectively catheterized with the micro catheter. Coil
embolization of the SPDA and GDA was performed while withdrawing the micro
catheter.
Coil embolization of the SPDA and gastroduodenal artery was performed first
with with 3 mm x 4 cm Hilal coils (x2), followed by 5 mm x 6 cm Hilal coils
(x4), and Concerto coils: 6 mm x 20 cm, 5 mm x 20 cm (x2), and 4 mm x 10 cm.
Gelfoam was used in between multiple coil deployments. A post embolization
gastroduodenal arteriogram was performed.
The catheter was then removed over the wire and the sheath was removed.
Hemostasis was achieved with an Angio-Seal device and manual pressure. Sterile
dressings were applied. The patient tolerated the procedure well.
FINDINGS:
1. Celiac arteriogram delineates conventional anatomy of hepatic artery and
gastroduodenal artery. No active extravasation is identified.
2. Gastroduodenal arteriogram delineates the anatomy of the gastroduodenal
artery and the gastroepiploic artery. Multiple small branches are seen
coursing to the area of the known duodenal ulcer, marked by the endoclips.
3. Right gastroepiploic arteriogram shows normal anatomy and no branches to
the area of known ulcer..
4. Coil embolization of the right gastroepiploic artery with post embolization
arteriogram demonstrating occlusion of the vessel.
5. Coil and gel foam embolization of SPDA and gastroduodenal artery and post
embolization arteriogram demonstrating occlusion of the gastroduodenal artery,
and no further visualization of small vessels branching to the area of the
known duodenal ulcer.
IMPRESSION:
Successful coil and gel foam embolization of the right gastroepiploic artery
and the gastroduodenal artery, with good angiographic result, showing
embolization of multiple small vessels that were seen coursing to the area of
the known duodenal ulcer.
RECOMMENDATION(S): Right leg straight x 2 hours. Continue to monitor for
signs of further bleeding.
|
10019003-RR-33 | 10,019,003 | 27,525,946 | RR | 33 | 2153-04-16 12:38:00 | 2153-04-16 14:49:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with past medical history of metabolic
syndrome, COPD, HTN, HLD, breast cancer (T1N0M0, ER+/PR+, HER2-) s/p
lumpectomy and adjuvant XRT, and more recently dx undifferentiated
myeloproliferative disorder (atypical CML versus CNL) who was admitted with
recurrent upper GI bleed in setting of recent duodenal ulcer with an
aspiration event requiring intubation // Eval for evolution of aspiration
event
TECHNIQUE: Single frontal view of the chest
COMPARISON: ___
IMPRESSION:
Cardiomediastinal contours are unchanged. Left perihilar and left lower lobe
consolidations are unchanged. Mild vascular congestion has improved. Left
PICC tip is in the lower SVC. There is no evident pneumothorax. Small left
effusion is unchanged.
|
10019061-RR-6 | 10,019,061 | 20,965,201 | RR | 6 | 2178-02-28 12:43:00 | 2178-03-02 19:43:00 | STUDY: Carotid series complete.
REASON: Right leg weakness status post right carotid endarterectomy.
FINDINGS: Duplex was performed of bilateral carotid arteries. There is no
significant plaque seen in the right carotid bifurcation. There is bulky
calcified plaque seen in the left carotid.
On the right, peak velocities are 105, 44 and 32 in the ICA, CCA, and ECA.
This is consistent with no stenosis.
On the left, peak velocities are 269, 119 and 258 in the ICA, CCA, and ECA.
The ICA end-diastolic velocity is 37. The ICA/CCA ratio is 2.2. This is
consistent with 60 to 69% left ICA stenosis. More severe stenosis cannot be
ruled out due to incomplete visualization secondary to calcification.
Vertebral flow is antegrade bilaterally. The left vertebral waveform is very
resistive suggesting the possibility of distal disease.
IMPRESSION: Right carotid, no stenosis. Left carotid, 60 to 69% stenosis
with heavy calcification. Cannot rule out a more significant left carotid
stenosis. Resistive left vertebral waveform suggesting distal disease.
Consider alternative imaging if clinically indicated.
|
10019061-RR-7 | 10,019,061 | 20,965,201 | RR | 7 | 2178-02-28 08:09:00 | 2178-02-28 12:09:00 | INDICATION: ___ male with right leg weakness, here to evaluate for
infarction.
COMPARISON: Outside non-contrast head CT performed at ___
___ on ___ at 17:19 p.m.
TECHNIQUE: MDCT-acquired axial images were obtained through the head without
intravenous contrast.
FINDINGS: There is a hypoattenuating region in the posterior left frontal
lobe along the falx with loss of gray-white matter differentiation extending
to the cortex, not seen on the outside study performed 17 hours earlier,
consistent with an evolving partial left ACA territory infarct. No
hemorrhagic transformation is detected, and there is no mass effect or shift
of normally midline structures. Small scattered hypodensities in the right
subcortical and periventricular region are also seen on the outside study,
consistent with age-indeterminate infarcts. Diffuse periventricular white
matter hypodensity is consistent with sequela of chronic microvascular
ischemic disease. The ventricles and sulci are prominent with prominent
temporal horns of the lateral ventricles consistent with brain atrophy and
medial temporal lobe atrophy. Atherosclerotic calcifications of the bilateral
carotid siphons are noted. There is no evidence of intracranial hemorrhage.
The visualized paranasal sinuses, middle ear cavities, and mastoid air cells
are clear bilaterally. The bony calvaria are intact.
IMPRESSION:
1. Evolving partial left ACA territorial infarct from ___ without
hemorrhagic transformation.
2. Hypoattenuating foci in the right periventricular region are consistent
with age-indeterminate infarcts. If clinically indicated, MRI is recommended
for determination of chronicity.
3. Mild brain atrophy with medial temporal lobe atrophy and evidence of
chronic microvascular ischemic disease.
|
10019061-RR-8 | 10,019,061 | 20,965,201 | RR | 8 | 2178-02-28 08:27:00 | 2178-02-28 09:39:00 | INDICATION: ___ man with possible pontine infarct, likely aspiration.
Assess for pneumonia.
COMPARISONS: AP chest radiograph from ___ ___, from
___.
FINDINGS: Patchy linear opacities at the right base most likely represent
atelectasis. There is no definite focal consolidation or pleural effusion or
pneumothorax. Cardiomediastinal silhouette is stable with dense
calcifications at the thoracic aorta. There is a right chest wall pacemaker
with leads terminating in the right atrium and right ventricle. A fracture of
the left fourth posterior rib is likely not acute.
IMPRESSION: Linear opacities at the right base are likely atelectasis. No
definite aspiration or focal consolidation.
|
10019517-RR-27 | 10,019,517 | 22,863,073 | RR | 27 | 2160-05-26 03:30:00 | 2160-05-26 04:48:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: History: ___ with fall, headstrike // Eval for intracranial
hemorrhage, c-spine fracture
TECHNIQUE: Contiguous axial images images of the brain were obtained without
contrast. Coronal and sagittal as well as thin bone-algorithm reconstructed
images were obtained.
COMPARISON: None.
Head CT ___.
FINDINGS:
There is no evidence of fracture, infarction, hemorrhage, edema, or mass. The
ventricles and sulci are enlarged in an atrophic pattern. There is
periventricular white matter hypodensity, likely due to chronic small vessel
ischemia.
No osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and
middle ear cavities are clear. The orbits are unremarkable.
IMPRESSION:
Atrophy. No evidence of fracture, hemorrhage or infarction.
DOSE: DLP: 1115 mGy-cm
CTDI: 56 mGy
|
10019517-RR-28 | 10,019,517 | 22,863,073 | RR | 28 | 2160-05-26 03:31:00 | 2160-05-26 04:58:00 | EXAMINATION: CT C-SPINE W/O CONTRAST
INDICATION: ___ with fall, headstrike
TECHNIQUE: Contiguous axial images were obtained. Sagittal and coronal
reformatted images were generated. No contrast was administered.
CTDIvol: 828 mGy
DLP: 37 mGy-cm
COMPARISON: CT neck with contrast ___
FINDINGS:
9mm hypodense right thyroid nodule has increased in size from ___ (series 3,
image 55). Enlarged descending thoracic aorta measuring up to 3.4 cm,
increased in size from ___. There is no enlarged adenopathy by CT size
criteria.
There is no prevertebral soft tissue swelling. There are severe degenerative
changes of the cervical spine, which have overall progressed since ___.
Degenerative changes are most pronounced at the C2- C7 levels with interbody
and bilateral facet fusion at C3-4 and C5 - C7. Mild anterolisthesis of C2-3,
C7 on T1, T1 on T2 and T2 onT3 are unchanged . There is no evidence of
fracture.
IMPRESSION:
1. No evidence of fracture.
2. Severe degenerative changes, mildly progressed since ___.
3. 9mm right thyroid nodule increased in size from prior, a non emergent
thyroid ultrasound can be obtained if clinically indicated.
4. Enlarged descending thoracic aorta measuring up to 3.4 cm.
|
10019517-RR-29 | 10,019,517 | 22,863,073 | RR | 29 | 2160-05-26 04:28:00 | 2160-05-26 05:19:00 | INDICATION:
___ with dizziness, nausea and vomiting, evaluate for acute process..
COMPARISON: CT torso ___ CT and CT chest ___
TECHNIQUE
AP and lateral view of the chest.
FINDINGS:
The mediastinum is widened an enlarged and tortuous of the thoracic aorta.
Elevation of the right hemidiaphragm is unchanged. Heart size is normal.
There is no pleural effusion or pneumothorax. There is no evidence of focal
consolidation. Right axillary clips are again seen. Partially imaged hardware
within the lower thoracic spine. A cervical rib is noted on the right.
IMPRESSION:
No evidence of pneumonia. Dilated and tortuous thoracic aorta.
|
10020187-RR-10 | 10,020,187 | 24,104,168 | RR | 10 | 2169-01-15 11:37:00 | 2169-01-21 06:21:00 | EXAMINATION: CAROTID/CEREBRAL BILATY342HEADXA
The patient presented as grade I HH SAH. The patient was brought down for
diagnostic cerebral angiography.
The following vessels were selectively catheterize injected: Right common
carotid artery, left common carotid artery including three dimensional
rotational angiography and postprocessing on separate work station with
concurrent physician supervision with images being used for final
interpretation.
INDICATION: ___ year old woman with SAh // Assess fro aneurysm
ANESTHESIA: Local anesthesia with suppliemental IV sedation by the nursing
staff. Please see notes in record for doses and medication
.
TECHNIQUE: OPERATORS: Dr. ___ physician performed the
procedure. Dr. ___ performed the procedure and interpreted the
images.
COMPARISON: None.
PROCEDURE: The patient Was placed on the angio talbe. Bilateral groins were
prepped and draped in the usual sterile manner. Time-out procedure was
performed per institutional guidelines. Location of the right mid femoral
head was located using anatomic and radiographic landmarks. Micropuncture kit
was used to gain access to the femoral artery in serial dilation was
undertaken until a short 5 ___ groin sheath to be placed connected to a
continuous heparinized saline flush. Next the ___ catheter was
connected to a continuous heparinized saline flush and also the power
injector. It was advanced over the 0.038 glidewire through the aorta and used
to select the right innominate followed by the right common carotid artery.
Cervical biplane imaging was undertaken. Next, from the same vessel,
intracranial biplane and magnified biplane oblique views were undertaken. The
catheter was then pulled back into the aorta used to select the left common
carotid artery. Cervical biplane imaging was undertaken. Next, from the same
left common carotid artery, intracranial biplane along with 3 dimensional
rotational angiography was separate processing a 3D workstation for attending
physician final interpretation images was undertaken. The catheter was then
pulled back in the aorta used to select the left subclavian artery. AP and
lateral road map imaging was undertaken. Next, the left vertebral artery was
attempted to be selected. Several attempts were made with a pernestein ___
catheter and ___ catheter. However, the origin of the vertebral
atery was difficult to access and we felt the risk outweighed the benifit of
catheterization. The catheter was then pulled back gently into the aorta and
fully removed from the body.
The sheath was exchanged for a 6 ___ flex sheath in anticipation of
endovascular treatment of the pcomm aneurysm. The patient was transferred
back to her ICU bed and brought back up to the ICU for further observation.
At the conclusion of the procedure, there is no evidence of thromboembolic
complication.
FINDINGS:
Right common carotid artery: There is . There is significant vessel
tortuosity of the proximal and mid cervical ICA.No significant atherosclerotic
plaque was present. The intracranial views, the distal right ICA, proximal
distal MCA andACA branches are well-visualized. Vessel caliber smooth and
tapering,. There is no evidence of aneurysm or early venous drainage or
adenoma or abnormal intracranial to extracranial anastomoses orarteriovenous
shunting.
Left common carotid artery: The vessel was tortous. However there was no
significant atherosclerotic plaque at the bifucation. Of the intracranial
vessels visualized, the distal left ICA, proximal distal MCA and ACA branches
are well-visualized. There is a 4X3X2mm aneurysm arising from the medial side
of the posterior comunicating artery origin. The Pcomm vessel is fetal.
Left subclavian artery: The left vertebral artery, internal mammary artery,
thyrocervical trunk are well-visualized. There is no significant vessel origin
stenosis.
IMPRESSION:
1. 4X3X2 mm aneurysm at the origin of the left posterior comunicating artery.
I, , was personally present and participated in the entirety of the
procedure; I have reviewed the above images and generated the report.
RECOMMENDATION(S): Planned treatment of the posterior communicating artery
aneurysm.
|
10020187-RR-11 | 10,020,187 | 24,104,168 | RR | 11 | 2169-01-16 14:25:00 | 2169-01-16 19:09:00 | EXAMINATION: Left internal carotid artery angiogram.
Right common femoral artery angiogram.
INDICATION: ___ year old woman with SAH and P=comm aneurysm // embolization
of aneurysm
ANESTHESIA: General endotracheal anesthesia was maintained by separate
anesthesia provider throughout the entirety of the case. The anesthesia
provider also monitored the patient's hemodynamic and respiratory parameters.
TECHNIQUE:
Patient was brought into the angio suite, ID was confirmed via wrist band.The
patient was placed supine on fluoroscopy table and bilateral groins were
prepped and draped in the usual sterile manner. Time-out procedure was
performed per institutional guidelines. The location of the right mid femoral
head was located using anatomic and radiographic landmarks. 10 +10 cc of
subcutaneous lidocaine was infused into the tissue. Micropuncture kit was
used to gain access to the right femoral artery, serial dilation was
undertaken until a short 5 ___ groin sheath connected to a continuous
heparinized saline flush could be inserted. ___ catheter was
connected to the power injector and also to a continuous heparinized saline
flush. This was advanced over the 0.038 glidewire brought up the aorta used to
select the left internal carotid artery. Subsequently, 3D rotational images
were performed requiring post processing on an independent workstation under
concurrent physician supervision and used in the interpretation and reporting
of the procedure.
5000 units of heparin were given, and in collaboration with our colleagues in
anesthesia ACT was followed to target 250-300 subsequent doses of heparin were
given accordingly.
Diagnostic catheter was exchanged to a Benchmark Delivery Catheter under
direct fluoro guidance that was positioned in a satisfactory location in the
internal carotid artery. New road maps were obtained and working views were
adjusted accordingly. Subsequently SL 10 micro catheter was advanced over a
synchro 2 wire slowly and carefully until it was passed aneurysm neck. Then
it was pulled back slowly until it was positioned midway into the aneurysm,
the synchro 2 wire was pulled back under direct fluoro in the micro catheter
was fixed in that position. First microsphere coil was advanced slowly and
carefully until it was fully deployed into the dome of the aneurysm for
detachment we did an angio run which confirmed the patency of all artery is
involved. The coil was detached then a second microsphere coil was advanced
slowly and carefully until it occupied a good position in the middle of the
aneurysm then it was detached followed by a knee a new angio run to confirm
patency of the arteries. We attempted then to put third coil, weight we tried
different shapes slow, sizes and even we adjusted the position of the micro
catheter but each and every time we advanced a coil until the end it starts
kicking back into the internal carotid artery. This led us to back off from
our goal of complete occlusion and we were satisfied with the partial coiling
that is compatible with ___ grade 2.
The micro catheter was removed in the bench mark catheter was Re treated to
the cervical carotid and we obtained a final AP and lateral angio runs that
confirmed the patency of all the arteries of the anterior circulation with
early thromboses of the aneurysm.
The catheter was then pulled back in the aorta fully removed from the body. A
common femoral arteriogram was performed prior to use of a closure device,
subsequently Angio-Seal was put in. At the conclusion of the procedure, there
is no evidence of thromboembolic complication and the patient was at his
neurologic baseline post extubation.
Device inventory:
038" 150cm Angled Glidewire
035 x 150cm ___ Wire
___ x 25cm Terumo Sheath Set
___ Berenstein ___ 100cm Cath.
___ ___ 2 Cath. 100cm
___ Micropuncture Set
038 Angled Glidewire Exchange
___ FR 95 CM .071 Benchmark Delivery Catheter
___
Excelsior SL-10 150cm Microcatheter
Synchro2 Standard 14 200cm Wire
InZone Detachment System
Target 360 Ultra 3mm/4cm Coil ___ ___
3mm/5.4cm Micrusphere 10 Coil ___ # ___
2.5mm/3.3cm Micrusphere 10 Coil ___ # ___
360 Ultra 2mm/3cm Coil ___ # ___ (DND)
Target Helical Ultra 2mm/3cm Coil ___
___ Angio Seal Evolution Closure Device
___
FINDINGS:
Left internal carotid artery: Distal left ICA, proximal and distal MCA and
ACA branches are well-visualized. A robust PCOM likely compatible with a
fetal variant. Vessel caliber smooth and tapering. Normal arterial,
capillary, and venous phase . Partial obliteration of the left PCOM aneurysm
that is measuring 4.5 maximum diameter and 2 mm at the neck that is compatible
with ___ and ___ grade 2.
Right common femoral artery: Well-visualized with a good caliber size for
closure device.
I, Abdulrahman ___, participated in the procedure. I, ___, was
present for the entirety of the procedure and supervised all critical steps.
I, ___, have reviewed the report and agree with the fellow's
findings.
IMPRESSION:
1. Successful coiling of a left PCOM artery aneurysm compatible with ___
and ___ grade 2.
RECOMMENDATION(S):
1. We will discuss these findings and our cerebrovascular rounds and decide on
further management after.
|
10020187-RR-13 | 10,020,187 | 24,104,168 | RR | 13 | 2169-01-22 20:55:00 | 2169-01-22 22:41:00 | EXAMINATION: CTA HEAD WANDW/O C AND RECONS
INDICATION: ___ year old woman with SAH s/p coiling pcomm aneurysm. Evaluate
for vasospasm.
TECHNIQUE: Contiguous MDCT axial images were obtained through the brain
without contrast material. Next, rapid axial imaging was performed through
the brain during the uneventful infusion of 70 mL of Omnipaque intravenous
contrast material. Three-dimensional angiographic volume rendered and
segmented images were then generated on a dedicated workstation. This report
is based on interpretation of all of these images.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 7.2 s, 18.0 cm; CTDIvol = 56.1 mGy (Head) DLP =
1,009.3 mGy-cm.
2) Stationary Acquisition 4.0 s, 0.5 cm; CTDIvol = 43.6 mGy (Head) DLP =
21.8 mGy-cm.
3) Spiral Acquisition 4.5 s, 35.7 cm; CTDIvol = 31.8 mGy (Head) DLP =
1,136.4 mGy-cm.
Total DLP (Head) = 2,167 mGy-cm.
COMPARISON: CTA head and neck ___.
FINDINGS:
Study is limited by streak artifact from left posterior communicating artery
aneurysm coil and dental amalgam.
CT HEAD WITHOUT CONTRAST:
Previously seen subarachnoid hemorrhage along the left temporal lobe extending
into the left frontal lobe and the suprasellar cisterns is not well seen on
the current study. No new hemorrhage is seen.
An area of low attenuation in the left occipital lobe (03:12) not seen on the
prior head CT from ___ is likely secondary to artifact from the
recently placed hardware however ischemic cannot be ruled out.
There is no evidence of infarction, edema, or mass. The ventricles and sulci
are normal in size and configuration.
The visualized portion of the paranasal sinuses, mastoid air cells, and middle
ear cavities are clear. The visualized portion of the orbits are unremarkable.
CTA HEAD:
Patient is status post coiling of the left posterior communicating artery
aneurysm. Again seen are mild mixed plaque along the cavernous portions of
the internal carotid arteries bilaterally. In comparison to the prior CTA
from ___, the left A1 segment appears slightly attenuated which
may be artifactual however versus mild vasospasm. No clues region or aneurysm
of the vessels of the circle of ___ and their principal intracranial
branches are noted. The left transverse sinus is hypoplastic, however the
dural venous sinuses are patent.
CTA NECK:
The carotid arteries and their major branches appear normal with no evidence
of stenosis or occlusion. There is no evidence of internal carotid artery
stenosis by NASCET criteria.
Partially visualized lung apices are clear within the limits of respiratory
motion. The thyroid is grossly unremarkable. The lymph nodes are not
pathologically enlarged by size criteria.
IMPRESSION:
1. Previously seen subarachnoid hemorrhage is no longer visualized. No new
hemorrhage.
2. Hypodensity in the left occipital lead lobe new since the prior head CT is
likely streak artifact from recently placed hardware however ischemia cannot
be ruled out. Attention at follow-up is advised.
3. Mild attenuation of the left A1 segment may be artifactual versus secondary
to mild vasospasm.
NOTIFICATION: The findings were discussed with ___ , M.D. by
___, M.D. on the telephone on ___ at 5:10 ___, 15 minutes
after discovery of the findings.
|
10020187-RR-9 | 10,020,187 | 24,104,168 | RR | 9 | 2169-01-15 02:25:00 | 2169-01-15 03:24:00 | EXAMINATION: CTA HEAD AND CTA NECK Q16 CT
INDICATION: ___ female with atraumatic subarachnoid hemorrhage and
face numbness. Please evaluate for subarachnoid hemorrhage.
TECHNIQUE: Contiguous MDCT axial images were obtained through the brain
without contrast material. Subsequently, helically acquired rapid axial
imaging was performed from the aortic arch through the brain during the
infusion of 70 mL of Omnipaque intravenous contrast material.
Three-dimensional angiographic volume rendered, curved reformatted and
segmented images were generated on a dedicated workstation. This report is
based on interpretation of all of these images.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 6.4 s, 16.0 cm; CTDIvol = 56.1 mGy (Head) DLP =
897.1 mGy-cm.
2) Stationary Acquisition 0.5 s, 0.5 cm; CTDIvol = 5.4 mGy (Head) DLP = 2.7
mGy-cm.
3) Stationary Acquisition 4.5 s, 0.5 cm; CTDIvol = 49.0 mGy (Head) DLP =
24.5 mGy-cm.
4) Spiral Acquisition 4.7 s, 36.6 cm; CTDIvol = 31.8 mGy (Head) DLP =
1,166.1 mGy-cm.
5) Spiral Acquisition 2.6 s, 20.1 cm; CTDIvol = 30.9 mGy (Head) DLP = 622.2
mGy-cm.
Total DLP (Head) = 2,713 mGy-cm.
COMPARISON: ___ 22:21 outside noncontrast head CT.
FINDINGS:
Dental amalgam streak artifact limits study.
CT HEAD WITHOUT CONTRAST:
Overall, there has been no significant interval change in the extent of
subarachnoid hemorrhage along the left temporal lobe gyri, left sylvian
fissure, tracking down to the suprasellar cisterns and left ambient cistern
compared to the prior exam. Question small bifrontal subdural hemorrhages vs
artifact, measuring up to 0.6 cm on the right and 0.3 cm on the left (see
3:17). There is no evidence of significant midline shift. Prominence of the
ventricles and sulci is likely related to age related involutional changes.
There is no evidence of acute intracranial infarction.
No acute fracture is identified. The visualized mastoid air cells, and middle
ear cavities are clear. The globes are unremarkable. Bilateral maxillary
sinus mucosal thickening is present.
CTA HEAD:
At the left PCOM origin, a small 3 mm aneurysm is seen directed laterally
(5a;222) and a small 2-mm aneurysm is seen directed medially (5a;225). Mild
calcifications are seen along the cavernous portions of the internal carotid
arteries bilaterally. There is no evidence of significant stenosis. The
circle ___ is otherwise unremarkable. The anterior communicating and
bilateral posterior communicating arteries are visualized. The posterior
circulation, aside from a dominant right vertebral artery, is unremarkable.
The dural venous sinuses are patent.
CTA NECK:
The carotid arteries and their major branches appear normal with no evidence
of stenosis or occlusion. There is no evidence of internal carotid stenosis by
NASCET criteria. The right vertebral artery is dominant. The left vertebral
artery is diminutive.
CTV HEAD:
The left transverse sinus is hypoplastic, likely congenital in etiology.
Remainder the dural venous sinuses are patent.
OTHER:
The visualized portion of the lungs are clear. The visualized portion of the
thyroid gland is within normal limits. Scattered subcentimeter nonspecific
lymph nodes are noted throughout the neck bilaterally and superior mediastinum
with no lymphadenopathy by CT size criteria.
IMPRESSION:
1. Dental amalgam streak artifact limits study.
2. Laterally directed 3-mm left posterior communicating artery aneurysm.
3. Medially directed left posterior communicating artery origin 2 mm aneurysm.
4. Diminutive left vertebral artery and dominant right vertebral artery.
5. Grossly stable subarachnoid hemorrhage as described.
6. Question small bifrontal subdural hematomas versus artifact, not definitely
visualized on prior exam.
7. Hypoplastic left transverse sinus, likely congenital. The remainder the
dural venous sinuses are patent.
8. Paranasal sinus disease as described.
|
10020218-RR-13 | 10,020,218 | 22,515,625 | RR | 13 | 2177-05-06 12:54:00 | 2177-05-06 13:21:00 | INDICATION: ___ year old woman with vp shunt in place and headache, evaluate
shunt functionality.
TECHNIQUE: AP and lateral view radiographs of the skull with additional AP
view radiographs of the chest and abdomen.
COMPARISON: None available.
FINDINGS:
Patient is status post placement of a left posterior parietal approach
ventriculoperitoneal shunt. The visualized portions of the shunt appear
intact without evidence for kinking. Visualization of the shunt as it crosses
the mediastinum and upper abdomen is somewhat limited, but likely intact.
The lungs are clear without pleural effusion, pneumothorax, focal
consolidation, or pulmonary edema. The cardiomediastinal silhouette is within
normal limits.
The bowel gas pattern is unremarkable. Surgical clips are noted in the right
upper quadrant related to prior cholecystectomy.
IMPRESSION:
Radiopaque portions of the ventriculoperitoneal shunt appear intact with
slightly limited visualization as the shunt crosses the mediastinum and upper
abdomen.
|
10020218-RR-14 | 10,020,218 | 22,515,625 | RR | 14 | 2177-05-06 12:45:00 | 2177-05-06 13:16:00 | EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ with headache and hx of a VP shunt, evaluate for
hydrocephalus.
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast. Coronal and sagittal reformations as well as bone algorithm
reconstructions were provided and reviewed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 14.0 s, 14.0 cm; CTDIvol = 50.2 mGy (Head) DLP =
702.4 mGy-cm.
Total DLP (Head) = 702 mGy-cm.
COMPARISON: None.
FINDINGS:
Patient is status post left posterior parietal approach ventriculoperitoneal
shunt placement. The radiopaque portions of the shunt appear intact
throughout their course. The shunt terminates in the region of the foramen of
___. There is moderate ventriculomegaly involving the lateral ventricles
and moderate to severe ventriculomegaly of the third ventricle. There is near
complete effacement of cerebral sulci. Aside from hypodensity along the
course of the VP shunt, presumed chronic gliosis, there is no significant
transependymal flow of CSF. There is no loss of gray-white differentiation to
suggest acute infarction. There is no intracranial hemorrhage or mass effect,
including no evidence of intracranial herniation.
There is no evidence of fracture. The visualized portion of the paranasal
sinuses, mastoid air cells, and middle ear cavities are clear. The visualized
portion of the orbits are unremarkable.
IMPRESSION:
Moderate enlargement of the lateral ventricles and moderate to severe
enlargement of the third ventricle with near-complete effacement of cerebral
sulci. The chronicity and severity of hydrocephalus is difficult to judge
without a baseline post ventriculoperitoneal shunt placement study with which
to compare.
|
10020218-RR-15 | 10,020,218 | 22,515,625 | RR | 15 | 2177-05-06 15:00:00 | 2177-05-06 15:48:00 | EXAMINATION: CT abdomen and pelvis without contrast
INDICATION: NO_PO contrast; History: ___ with vp shunt now with
headache//eval for shunt blockage/ fluid collection at the end of the shunt
TECHNIQUE: Multidetector CT images of the abdomen and pelvis were acquired
without intravenous contrast. Non-contrast scan has several limitations in
detecting vascular and parenchymal organ abnormalities, including tumor
detection.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 4.2 s, 46.4 cm; CTDIvol = 8.8 mGy (Body) DLP = 409.9
mGy-cm.
Total DLP (Body) = 410 mGy-cm.
COMPARISON: None.
FINDINGS:
LOWER CHEST: Atelectasis noted in the lung bases bilaterally. There is no
evidence of pleural or pericardial effusion. There is partial visualization
of a 4.0 x 3.1 cm cystic lesion seen adjacent to the right heart, possibly a
pericardial cyst.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout.
There is no evidence of focal lesions within the limitations of an unenhanced
scan. There is no evidence of intrahepatic or extrahepatic biliary
dilatation. The gallbladder is surgically absent.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions within the limitations of an unenhanced scan. There is no
pancreatic ductal dilatation. There is no peripancreatic stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size. There is no evidence
of focal renal lesions within the limitations of an unenhanced scan. There is
no hydronephrosis. There is no nephrolithiasis. There is no perinephric
abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber and wall thickness throughout. The colon and rectum are within
normal limits. The appendix is normal.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is a
small amount of simple fluid seen in the right-sided pelvis.
REPRODUCTIVE ORGANS: The uterus appears normal. No adnexal abnormalities.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease
is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: VP shunt is seen extending along the midline anterior
subcutaneous tissues of the chest and upper abdomen, entering the peritoneum
and terminating within the left lower quadrant. There is no fluid collection
surrounding the tip of the VP shunt to indicate a CSFoma. Visualized portion
of the VP shunt appears intact. The abdominal and pelvic wall is within
normal limits.
IMPRESSION:
1. VP shunt terminates within left lower quadrant without fluid collection
surrounding the tip of the VP shunt to suggest a CSFoma. Small amount of
simple fluid is seen layering in the right pelvis.
2. Incompletely imaged cystic structure adjacent to the right heart, likely a
pericardial cyst.
|
10020218-RR-16 | 10,020,218 | 22,515,625 | RR | 16 | 2177-05-07 17:34:00 | 2177-05-07 19:40:00 | EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ woman with vp shunt revision presenting for post op
vp shunt eval. please perform @5:30pm
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 4.0 s, 16.0 cm; CTDIvol = 46.7 mGy (Head) DLP =
747.4 mGy-cm.
Total DLP (Head) = 747 mGy-cm.
COMPARISON: Head CT dated ___.
FINDINGS:
No evidence of acute infarction,hemorrhage,edema, or mass effect. Left
posterior approach VP shunt is partially imaged. The tip has advanced more
anteriorly and towards the right compared to the prior exam, now in the right
lateral ventricle anterior horn. The size of the ventricles has decreased
with interval resolution of hydrocephalus. There is a tiny amount of
hemorrhage noted dependently within the occipital horn of the left lateral
ventricle. Moderate amount of air within the left lateral anterior horn
ventricle is new, related to interval revision (series 2, image 19).
Similarly, small amount of pneumocephalus along the ventriculostomy track is
new (series 2, image 15). The basal cisterns are patent. The temporal horns
of the lateral ventricles are no longer dilated
No evidence of fracture. Postsurgical changes in the left calvarium. The
right frontal sinus is underpneumatized. The visualized portion of the
remaining paranasal sinuses, mastoid air cells, and middle ear cavities are
clear. The visualized portion of the orbits are unremarkable.
IMPRESSION:
1. Status post VP shunt revision with tip now in the anterior horn of the
right lateral ventricle with interval decrease in ventricle size. A small
amount of hemorrhage is noted dependently within the occipital horn of the
left lateral ventricle.
|
10020852-RR-63 | 10,020,852 | 23,905,070 | RR | 63 | 2177-05-19 09:10:00 | 2177-05-19 11:30:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with dyspnea and chest pain s/p bronch//
?Pneumo
TECHNIQUE: Portable AP chest
COMPARISON: CT chest ___ and chest radiograph from ___ through ___
FINDINGS:
Comparisons to prior chest radiograph, lung volumes have decreased with
bronchovascular crowding. The cardiomediastinal silhouette is stable.
Cardiomediastinal and hilar contours are notable for mild perihilar haze.
There is mild pulmonary vascular congestion. There is increased opacification
at the right lung base consistent with mild basilar atelectasis. Mild
pulmonary edema. No pneumothorax or pleural effusion.
IMPRESSION:
1. No pneumothorax status post bronchoscopy.
2. Mild pulmonary edema.
|
10020852-RR-64 | 10,020,852 | 23,905,070 | RR | 64 | 2177-05-19 18:12:00 | 2177-05-19 20:40:00 | EXAMINATION: CT sinus without contrast
INDICATION: ___ year old woman PMH THC vaping, exercise inducedasthma and
DVT/PE who presents with worsening cough and SOB x 1week, eosinophilia, acute
hypoxic resp failure, s/p bronch, would like to eval for findings c/w
granulomatosis with polyangiitis.// look for granulomas, areas of necrosis,
nasal polyps? any findings consistent with EGPA
TECHNIQUE: Axial images were acquired through the paranasal sinuses. Bone
and soft tissue reconstructed images were generated. Coronal reformatted
images were then produced.
DOSE: Acquisition sequence:
1) Spiral Acquisition 2.4 s, 15.4 cm; CTDIvol = 29.9 mGy (Head) DLP = 441.5
mGy-cm.
Total DLP (Head) = 442 mGy-cm.
COMPARISON: None.
FINDINGS:
There is partial hypodense opacification of the right frontal sinus, bilateral
anterior ethmoid air cells, and sphenoid sinuses. There is mild mucosal
thickening of the maxillary sinuses. No air-fluid levels are identified.
There is no evidence of hyperostosis or bone destruction. There is no
evidence of nasal septal destruction. There is no evidence of soft tissue
infiltration into the orbits. The cribriform plates are intact. The lamina
papyracea are intact.
IMPRESSION:
Moderate paranasal sinus opacification without air-fluid levels, hyperostosis,
or bone destruction to suggest upper respiratory manifestations of
granulomatosis with polyangiitis.
|
10020944-RR-10 | 10,020,944 | 29,974,575 | RR | 10 | 2131-02-28 11:27:00 | 2131-02-28 13:35:00 | INDICATION: ___ man with a history of COPD, pneumonia, reported
cirrhosis, now septic and intubated. Evaluate for cholecystitis, cirrhosis,
or ascites.
COMPARISON: None.
TECHNIQUE: Grayscale and color Doppler ultrasound examination of the right
upper quadrant was performed.
FINDINGS: Study is limited by poor acoustic penetration; however, the liver
does not show focal lesions. The gallbladder contains multiple shadowing
stones measuring up to 2 cm. There is no gallbladder wall thickening or
pericholecystic fluid. The gallbladder is distended. There is no intra- or
extra-hepatic biliary dilatation and the common bile duct measures 3 mm. The
spleen measures 11.3 cm in length. There is no ascites.
IMPRESSION: Distended gallbladder with gallstones. If there is concern for
acute cholecystitis, HIDA scan can be performed.
Findings conveyed to Dr. ___ on ___ @ 5:24 pm.
|
10020944-RR-11 | 10,020,944 | 29,974,575 | RR | 11 | 2131-03-01 03:18:00 | 2131-03-01 10:38:00 | INDICATION: COPD, intubated and sedated. Evaluate for pulmonary edema.
COMPARISON: ___.
FINDINGS: Portable upright chest radiograph demonstrates unchanged right
internal jugular central venous catheter and endotracheal tube, which
terminates at the level of the clavicles. The lung volumes are again low,
with partial collapse of the right middle and lower lobes. Left lung is
grossly clear. There is no pleural effusion or pneumothorax.
IMPRESSION: Continued partial collapse of the right middle and lower lobes
with no evidence of pulmonary edema.
|
10020944-RR-13 | 10,020,944 | 29,974,575 | RR | 13 | 2131-03-01 21:11:00 | 2131-03-01 22:00:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ year old man with known PEA Arrest in ___ now with
seizure-like activity. Sign on pontine infarct on recent CT. // Please eval
for acute bleed
TECHNIQUE: Contiguous axial MDCT images were obtained from the skull base
through the vertex, without IV administration of contrast. Reformatted coronal
and sagittal and thin-section bone algorithm-reconstructed images were
acquired, and all images are viewed in brain and bone window on the
workstation.
DOSE: DLP (mGy-cm): 1003.4
CTDIvol (mGy): 51.3.
COMPARISON: The study is compared with the NECT dated ___.
There is no previous cranial imaging on PACS.
FINDINGS:
There is no intracranial hemorrhage, edema, mass effect, or acute vascular
territorial infarction. The ventricles and sulci are prominent, consistent
with global age-related involutional changes. Confluent periventricular and
subcortical white matter hypodensities likely reflect the sequelae of chronic
small vessel ischemic disease. A pontine hypodensity is again seen (02:12),
compatible with prior infarct. There is no shift of normally midline
structures. The basal cisterns remain patent. Mild right maxillary sinus
mucosal thickening is again noted, along with scattered opacification of the
right mastoid air cells, likely due to intubation. The orbits are unremarkable
bilaterally.
IMPRESSION:
1. No acute intracranial process. MRI is more sensitive for the detection of
acute infarction.
2. Chronic changes, as described above.
NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___
___ medicine resident) on ___ at 9:55 ___, 5 minutes after
discovery of the findings.
|
10020944-RR-15 | 10,020,944 | 29,974,575 | RR | 15 | 2131-03-02 01:51:00 | 2131-03-02 09:12:00 | EXAMINATION: MRI AND MRA BRAIN AND MRA NECK
INDICATION: ___ year old man with PMHx of PEA arrest in setting of bowel
obstruction in ___, who presented with shortness of breath and AMS. Now
having seizure-like activity. // Please eval for cortical lesions and/or
signs of infarct
TECHNIQUE: Multiplanar, multi sequence MRI of the head was performed before
and after intravenous contrast administration. In addition, 3D time of flight
MR arteriography of the intracranial and neck vasculature was performed with
rotational reconstructions. Dynamic contrast-enhanced MR angiography of the
neck vasculature was also performed following the uncomplicated administration
of intravenous contrast.
COMPARISON: CT head without contrast ___.
FINDINGS:
MRI Head: There is no evidence of slow diffusion to suggest acute infarct.
There is no hemorrhage, intracranial mass, mass effect, or midline shift.
There is mild prominence of the ventricles and sulci, consistent with
generalized cerebral volume loss.
There are multiple patchy and confluent foci of FLAIR hyperintensity within
the subcortical, deep and periventricular white matter, most likely related to
severe chronic microvascular ischemic disease. The ___ the pons also
demonstrates T2/FLAIR hyperintensity, most likely related to chronic infarct
and/or microvascular ischemic disease.
Intracranial flow voids are maintained. There is mild mucosal thickening of
the paranasal sinuses. There is opacification of of the right greater than
left mastoid air cells. The orbits and soft tissues are grossly unremarkable.
Partially visualized orogastric and endotracheal tubes are noted with fluid
layering in the nasopharynx.
MRA Head: There is adequate flow related related enhancement of the bilateral
internal carotid, middle cerebral, anterior cerebral, vertebral, basilar and
posterior cerebral arteries. The distal left M1 and proximal M2 segments
demonstrate mildly decreased flow, compared to the right, which may be
artifactual. Distal MCA branches demonstrate adequate flow related enhancement
bilaterally. The anterior communicating artery is well visualized. The
vertebral arteries are codominant. The right posterior communicating artery is
well visualized. The left posterior communicating artery is diminutive.
No evidence of new aneurysm, stenosis or dissection. No evidence of vascular
malformation.
MRA Neck: There is a left-sided aortic arch with conventional origin of the
major arch branches. There is mild narrowing at the origin of the left
internal carotid artery. Otherwise, there is adequate contrast related
enhancement of the common carotid, internal carotid and vertebral arteries.
There is no evidence of occlusion, stenosis or dissection. There is no
significant stenosis of the internal carotid arteries by NASCET criteria.
IMPRESSION:
1. No evidence of acute intracranial process.
2. Multiple patchy and confluent regions of FLAIR hyperintensity within the
white matter are most likely sequela of severe chronic microvascular ischemic
disease. T2/FLAIR hyperintensity at the ___ the pons there is likely
related to chronic infarct and/or chronic microvascular ischemic disease.
3. No evidence of high-grade narrowing within the intracranial vasculature. No
aneurysm or occlusion identified.
4. Mild narrowing at the origin of the left internal carotid artery. Otherwise
no evidence of significant stenosis, occlusion or dissection. No significant
stenosis of the internal carotid arteries by NASCET criteria.
|
10020944-RR-16 | 10,020,944 | 29,974,575 | RR | 16 | 2131-03-02 00:02:00 | 2131-03-02 16:14:00 | INDICATION: ___ year old man with CVL (R IJ) that appears to have suddenly
malfunctioned
TECHNIQUE: A single portable AP supine view of the chest was obtained.
COMPARISON: Multiple prior chest radiographs, most recently ___ at
03:25
FINDINGS:
Endotracheal tube, right internal jugular central venous catheter, and enteric
tube are in proper position.
There is persistent collapse of the right lower lobes with expected shift of
the heart and mediastinum to the right. The cardiomediastinal silhouette is
stable. There is no focal consolidation. Mild pulmonary edema is slightly
worse. Linear opacities at the left base likely represent atelectasis. There
is no large effusion or pneumothorax.
IMPRESSION:
1. Appropriate positioning of lines and tubes.
2. Persistent collapse of the right lower lobes, unchanged.
3. Mild pulmonary edema, slightly worse.
|
10020944-RR-17 | 10,020,944 | 29,974,575 | RR | 17 | 2131-03-02 15:17:00 | 2131-03-02 15:56:00 | EXAMINATION: CHEST PORT. LINE PLACEMENT
INDICATION: ___ year old man with pi // l dl power picc 55cm, iv ping ___
Contact name: ping, ___: ___
COMPARISON: ___.
IMPRESSION:
As compared to the previous radiograph, the patient has received a left-sided
PICC line. The course of the line is unremarkable, the tip of the line
projects over the mid SVC. No evidence of pneumothorax or other
complications.
Unchanged moderate cardiomegaly with mild fluid overload and atelectasis at
the right lung bases. No larger pleural effusions.
|
10020944-RR-18 | 10,020,944 | 29,974,575 | RR | 18 | 2131-03-03 03:28:00 | 2131-03-03 11:10:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with COPD, respiratory failure, intubated,
sedated. Evaluate for interval change.
TECHNIQUE: Portable semi-upright chest radiograph
COMPARISON: ___
FINDINGS:
There has been interval removal of the right internal jugular central venous
line. The enteric tube, endotracheal tube, and left PICC line are stable.
Heart size is enlarged is stable. There is continued partial collapse of the
right lower lobes with no new parenchymal opacity.
IMPRESSION:
Continued volume loss at the right lung base with stable support devices.
Interval removal of right internal jugular central venous line.
|
10020944-RR-19 | 10,020,944 | 29,974,575 | RR | 19 | 2131-03-03 20:13:00 | 2131-03-04 09:43:00 | HISTORY: Self extubation, now reintubated.
FINDINGS: In comparison with study of earlier in this date, the endotracheal
tube tip is in similar position, well above the carina. Left subclavian
catheter is unchanged, as is the appearance of the heart and lungs.
|
10020944-RR-20 | 10,020,944 | 29,974,575 | RR | 20 | 2131-03-05 04:32:00 | 2131-03-05 11:41:00 | STUDY: AP chest, ___.
CLINICAL HISTORY: ___ man with pneumonia and possible sepsis.
FINDINGS: Comparison is made to prior study from ___.
Endotracheal tube and central line are unchanged in position. There has been
placement of a feeding tube with distal tip is below the field of view and is
within the stomach. There is cardiomegaly. There is atelectasis at the lung
bases. There is no overt pulmonary edema or pneumothoraces.
|
10020944-RR-21 | 10,020,944 | 29,974,575 | RR | 21 | 2131-03-06 03:58:00 | 2131-03-06 10:51:00 | STUDY: AP chest, ___.
CLINICAL HISTORY: ___ man with pneumonia.
FINDINGS: Comparison is made to prior study from ___.
There is an endotracheal tube whose tip is 5.2 cm above the carina. Feeding
tube and left subclavian central line are unchanged in position. There is
unchanged cardiomegaly. There is a left retrocardiac opacity. There is a
moderate right basilar pleural effusion. There is mild pulmonary edema and
there are no pneumothoraces.
|
10020944-RR-22 | 10,020,944 | 29,974,575 | RR | 22 | 2131-03-07 04:31:00 | 2131-03-07 08:23:00 | PORTABLE CHEST ___
COMPARISON: ___
FINDINGS: As compared to the prior study, there has been apparent interval
increase in size of a now moderate left partially layering pleural effusion.
Remainder of the exam is unchanged since the recent study.
|
10020944-RR-23 | 10,020,944 | 29,974,575 | RR | 23 | 2131-03-08 03:35:00 | 2131-03-08 13:32:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with recent hypoxic respiratory failure now s/p
extubation // please eval for interval change
TECHNIQUE: Portable upright chest radiograph
COMPARISON: ___
FINDINGS:
There has been interval extubation and removal of the enteric tube. The left
PICC line terminates in the mid SVC. Lung volumes are low and the cardiac size
is enlarged. Collapse of the right lower lobe is persistent. There is
improvement in pulmonary edema. Small right pleural effusion is unchanged. No
pneumothorax.
IMPRESSION:
Continued right lower lobe collapse. Interval extubation and enteric tube
removal. Improvement in pulmonary edema.
|
10020944-RR-26 | 10,020,944 | 29,974,575 | RR | 26 | 2131-03-10 12:27:00 | 2131-03-10 14:44:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man COPD s/p PNA and extubation // improvement
TECHNIQUE: Portable semi-upright chest radiograph
COMPARISON: ___
FINDINGS:
Unchanged left PICC. Aeration of the right lung is essentially unchanged.
Right lower lobe consolidation which may represent pneumonia, aspiration, or
atelectasis, is unchanged. Cardiomediastinal contours are stable.
IMPRESSION:
No significant change since ___.
|
10020944-RR-5 | 10,020,944 | 29,974,575 | RR | 5 | 2131-02-27 13:37:00 | 2131-02-27 14:39:00 | INDICATION: ___ man status post intubation. Evaluate for tube
placement.
COMPARISON: None available.
TECHNIQUE: Portable semi-upright chest radiograph.
FINDINGS: Assessment is limited due to rightward rotation of the patient.
Allowing for this limitation, there is opacification of the right lower lung,
likely due to a combination of atelectasis given volume loss with rightward
mediastnal shift to the right and possible pleural effusion. Small nodular
opacities are seen in the aerated portion of the right lung, potentially
vessels on end. The left lung is clear. There is no left-sided effusion.
There is no evidence of pneumothorax. Old bilateral rib fractures are
identified.
An endotracheal tube is seen ending approximately 4 cm above the carina. An
esophageal tube ends beyond the gastroesophageal junction with the tip out of
view. Artifact from external monitoring and supporting devices is present.
IMPRESSION:
1. Right lower lobe consolidation, likely a combination of atelectasis or
consolidation with pleural effusion.
2. 6 mm nodule in the aerated right upper lobe of unclear clinical
significance but attention to this area suggested on followup exams.
3. Endotracheal and esophageal tubes in appropriate position.
|
10020944-RR-6 | 10,020,944 | 29,974,575 | RR | 6 | 2131-02-27 14:24:00 | 2131-02-27 15:37:00 | INDICATION: ___ male with altered mental status and new right IJ line
placement. Evaluate.
COMPARISON: Chest radiograph performed approximately one hour prior to this
exam.
TECHNIQUE: Frontal supine chest radiograph.
FINDINGS: A new IJ line is identified, ending in the mid SVC. There is no
evidence of pneumothorax. Otherwise, there is no significant interval change
compared with the previous examination, with opacification of the right lower
lung field, likely a combination of at least some atelectasis and possible
consolidation/pleural effusion. The aerated portion of the right upper lung
shows changes of interstitial edema. The left lung is clear. There is no
change in position of the endotracheal tube. The NG tube tip is out of view.
Significant bilateral carotid calcifications are seen.
IMPRESSION: New IJ line ends in the mid SVC. No evidence of pneumothorax.
Otherwise, no significant change compared with recent chest radiographic
examination.
|
10020944-RR-7 | 10,020,944 | 29,974,575 | RR | 7 | 2131-02-27 16:05:00 | 2131-02-27 17:49:00 | HISTORY: Altered mental status and unresponsive. Evaluate for an acute
process.
TECHNIQUE: Continuous axial sections were acquired the brain without
administration IV contrast. Coronal and sagittal reformations are provided
and reviewed.
DLP: ___ mGy/cm.
COMPARISON: None.
FINDINGS: The study is somewhat limited by motion artifact. Within this
limitation, there is no acute hemorrhage, edema or shift of normally midline
structures. Prominence of the ventricles and sulci is consistent with global
age-related involutional changes. Confluent periventricular and subcortical
white matter hypodensities, while nonspecific, are presumably sequela from
chronic small vessel ischemic disease. A punctate hypodensity within the pons
likely reflects prior infarction. Otherwise, the gray-white matter
differentiation is preserved and there is no evidence for acute territorial
vascular infarction. The basal cisterns remain patent.
There is minimal mucosal thickening within the right maxillary sinus and
ethmoid air cells. The included mastoid air cells are well-aerated. Opacity
within the left external auditory canal is presumably cerumen. There is no
acute fracture. Mild irregularity of the right nasal bone may reflect prior
fracture (3:13). The lenses, globes and soft tissues are unremarkable.
IMPRESSION: No acute intracranial process.
|
10020944-RR-8 | 10,020,944 | 29,974,575 | RR | 8 | 2131-02-27 16:06:00 | 2131-02-27 17:44:00 | HISTORY: Hypoxia, hypotension and prior pulmonary embolus. Evaluate for the
presence of a pulmonary embolism.
TECHNIQUE: MDCT axial images were acquired through the chest after the
uneventful administration of intravenous contrast during the pulmonary
arterial phase of enhancement. Coronal and sagittal reformations were
provided and reviewed. Maximum intensity projection images were created and
reviewed as well.
DLP: 710.02 mGy per cm.
COMPARISON: Same day chest xray.
FINDINGS: An endotracheal tube is 3.4 cm from the carina. There is near
complete collapse of the right lung with secretions/mucus seen in the right
mainstem bronchus (2:43). A small portion of the right upper lobe remains
aerated. There is a small amount of atelectasis within the left lower lobe.
No pleural effusion, pneumothorax or focal consolidation worrisome for
pneumonia.
The pulmonary artery is enlarged, measuring 4.8 cm in cross-section. Contrast
opacifies the segmental and subsegmental vessels of the pulmonary arterial
tree, without filling defects to indicate an underlying pulmonary embolus.
The heart is normal in size and there is no pericardial effusion. Given the
substantial volume loss, the mediastinum has shifted towards the right
hemithorax.
The included thyroid is normal. There is no axillary lymphadenopathy.
Scattered mediastinal lymph nodes range up to 11 mm (2:57).
Limited views of the unenhanced liver, spleen and colon are unremarkable. An
enteric tube is partially imaged but courses into the stomach.
There are no concerning osseous lesions. Chronic appearing bilateral rib
fractures are noted and not significantly displaced. Similarly, a chronic
appearing mid-sternal fracture is noted.
IMPRESSION:
1. Near complete collapse of the right lung secondary to secretions/mucus
within the right mainstem bronchus. The substantial volume loss has resulted
in shift of the mediastinum to the right. Bronchoscopy recommended.
2. No pulmonary embolus.
3. Enlargement of the main pulmonary artery is compatible with underlying
pulmonary hypertension.
4. Mediastinal lymphadenopathy of indeterminate etiology.
|
10020944-RR-9 | 10,020,944 | 29,974,575 | RR | 9 | 2131-02-28 03:24:00 | 2131-02-28 10:01:00 | PORTABLE SUPINE CHEST, ___
Compared to previous study of ___.
FINDINGS: Interval improved aeration of the right lung, with residual partial
atelectasis of right middle and right lower lobes. Small right pleural
effusion is also present. Left lung is grossly clear except for minimal
patchy atelectasis at the base, partially improved from the prior study.
|
10021395-RR-20 | 10,021,395 | 24,726,474 | RR | 20 | 2132-12-18 17:13:00 | 2132-12-19 10:36:00 | INDICATION: ___ year old woman with dizziness// evidence of infection, acute
process
TECHNIQUE: AP and lateral views the chest.
COMPARISON: Chest x-ray from ___. chest CT from ___.
FINDINGS:
The lungs are clear without consolidation, effusion, or edema. Opacity at the
right posterior costophrenic angle on the lateral view is compatible with
previously seen Bochdalek's hernia. Cardiac silhouette is enlarged but
similar compared to prior given differences in technique and inspiratory
effort. Aortic valve replacement is again noted. No acute osseous
abnormalities.
IMPRESSION:
No acute cardiopulmonary process.
|
10021395-RR-21 | 10,021,395 | 24,726,474 | RR | 21 | 2132-12-18 18:12:00 | 2132-12-18 18:44:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ year old woman with hypertensive urgency, persistent
dizziness// ?evidence of acute process
TECHNIQUE: Contiguous axial images from skullbase to vertex were obtained
without intravenous contrast. Coronal and sagittal reformations and bone
algorithms reconstructions were also performed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 16.0 s, 16.0 cm; CTDIvol = 50.2 mGy (Head) DLP =
802.7 mGy-cm.
Total DLP (Head) = 803 mGy-cm.
COMPARISON: None.
FINDINGS:
There is no evidence of acute territory infarction, hemorrhage, edema, or mass
effect. The ventricles and sulci are prominent in size, consistent with
age-related involutional change. Multiple dural calcifications are present.
No acute fractures are seen. Aside from mild bilateral mucosal thickening in
the ethmoid air cells the paranasal sinuses, mastoid air cells, and middle ear
cavities are clear.
IMPRESSION:
No acute intracranial process.
|
10021487-RR-56 | 10,021,487 | 26,321,862 | RR | 56 | 2117-01-29 13:26:00 | 2117-01-29 17:51:00 | PROCEDURE TYPE: Percutaneous placement of a new 8 ___ drainage catheter
within a right hepatic abscess and exchange over the wire of an existing
catheter with a same-size catheter 8 ___ within inferior portion of the
hepatic abscess.
HISTORY: ___ gentleman status post motor vehicle accident with a
hematoma and necrotic abscess within the right hepatic lobe; patient is not
improving clinically and drainage has nearly stopped. As per primary team,
upsizing of the existing drain or placement of a new drain is requested.
OPERATORS: Dr. ___ Dr. ___.
TECHNIQUE: After the informed consent was obtained, the patient was brought
into the CT interventional suite in supine position. A timeout was performed
by three unique identifiers. A limited CT scan through the abdomen without
intravenous contrast demonstrated a large right hepatic lobe necrotic abscess
with an 8 ___ catheter within the most anterior and inferior aspect of it.
The decision to try to upsize the existing catheter over the wire and
reposition it in a more posterior and superior position was taken. After a
projected tract was decided, the skin was prepped and cleaned in the usual
sterile fashion. Using CT fluoroscopy guidance, wire was passed through the
existing catheter, after cutting and releasing the pigtail. The position of
the wire was checked a few times with CT fluoroscopy and it appeared that it
was coiled within the inferior aspect of the abscess without moving into the
desired superior portion. At that point, a ___ Fr KMP catheter was used to
potentially guide the wire a more superior position. This method was also
failed. We then injected diluted contrast within the abscess via the existing
catheter. A limited CT obtained afterwards demonstrated no contrast
travelling throughout the entire cavity, potentially suggesting either two
noncommunicating pockets or very tight adhesions that were preventing the
catheter and contrast to move into more superior portion. At this point, the
decision to place a new percutaneous drain in a more superior position was
taken. The skin was cleaned with peroxide and was prepped and draped again in
a sterile fashion. Using CT fluoroscopy, a new target was assigned, 10-15 cm
above the original catheter. After projected target was decided, the skin was
infiltrated with lidocaine and then subsequently an 18 gauge coaxial needle
was advanced into the abscess using a Seldinger technique. An 8 ___
catheter was put over a wire. At that point, purulent drainagevwas seen
draining from the catheter. The catheter was connected to a drainage bag and
manually 250 cc of purulent material was drained into the bag. Bag was
exchanged for a new one and the skin was cleaned and draped in the usual
fashion. The previously existing catheter was also hooked to a drainage bag,
however no material was seen draining during the procedure time. Moderate
sedation was provided by administering divided doses of 300 mcg of fentanyl
and 4 mg of Versed, throughout the total intraservice time of 1 hour 15
minutes during which the patient's hemodynamic parameters were continuously
monitored.
COMPLICATIONS: None immediate.
IMPRESSION:
1. Successful exchange over wire of an 8 ___ catheter positioned within
the most inferior anterior aspect of a right hepatic lobe abscess.
2. Successful percutaneous placement of a new drainage catheter, 8 ___
into the more superior portion of the hepatic abscess.
The patient was transferred to the floor with routine catheter maintenance
orders
Dr. ___ was present throughout the entire procedure and performed crucial
parts of the procedure.
|
10021487-RR-59 | 10,021,487 | 26,321,862 | RR | 59 | 2117-02-05 09:10:00 | 2117-02-05 18:53:00 | INDICATION: ___ male status post MVC with multiple injuries including
liver laceration and necrotic liver lesion, now with an adjoining collection
near the liver status post placement of two pigtail drainage catheters.
Drainage catheter #2 which is the inferior drain has become dislodged by 2 cm.
PROCEDURE: Removal of old dislodged drainage catheter and placement of new 8
___ drainage catheter into the right subhepatic abscess.
PHYSICIANS: Dr. ___ Dr. ___.
PROCEDURE AND FINDINGS:
CT PRE-CONTRAST: Redemonstration of para and subhepatic fluid collections,
the inferior aspect of which appears slightly more prominent than on prior
exam. There is a dislodged pigtail catheter with pigtail coil still in place
in the subcutaneous right anterior abdominal wall soft tissues. Solid and
viscous organs are otherwise unchanged since prior exam, accounting for lack
of IV contrast.
After informed consent was obtained patient was brought into the CT
interventional suite and placed in supine positioning. Timeout was performed
using three unique identifiers. Limited CT scan through the abdomen was
obtained to identify the dislodged drainage catheter and the subhepatic
abscess. Pigtail catheter was noted to be subcutaneous and extraperitoneal.
Attempt was made to feed wire into the existing drainage catheter in hopes of
uncoiling and reinserting the catheter. This was not successful. Thus the
old catheter was removed. An existing subcutaneous tract was noted and a
small dilator and wire system was utilized to access the intraabdominal
abscess. Lidocaine was administered subcutaneously for patient's comfort.
Wire was easily fed into the subhepatic fluid collection and new 8 ___
drainage catheter was placed over the wire and noted to course caudally into
the intraabdominal fluid collection. CT fluoroscopy confirmed appropriate
placement. Pigtail catheter was coiled and connected to a drainage bag.
About 90 cc of tan purulent fluid was aspirated into the drainage bag which
was left to drainage by gravity. Statlock was applied and patient was cleaned
off. Patient tolerated procedure well. No immediate complications were
noted. Post-procedure scan was obtained. Moderate sedation was provided.
CT Post-procedure: Images demonstrated successful placement of pigtail
catheter into the subhepatic fluid collection extending caudally into the
right paracolic gutter. Otherwise, no significant interval change in the
remaining surrounding solid organ and viscous hollow organs.
IMPRESSION: Successful removal of old dislodged drainage catheter and
placement of new 8 ___ drainage catheter into the right-sided subhepatic
intraabdominal abscess. Patient was transferred back to the floor with
routine catheter maintenance orders.
|
10021487-RR-85 | 10,021,487 | 27,112,038 | RR | 85 | 2117-10-25 20:13:00 | 2117-10-25 23:17:00 | INDICATION: ___ man with fever, right upper quadrant collection.
Rule out liver abscess.
COMPARISONS: Multiple prior studies, most recently CT abdomen and pelvis with
contrast from ___.
TECHNIQUE: MDCT axial imaging was obtained from lung bases to the pubic
symphysis following the administration of intravenous contrast material.
Coronal and sagittal reformats were completed.
FINDINGS:
CT ABDOMEN WITH CONTRAST: There is a trace right pleural effusion with
associated atelectasis. The previously seen posterior perihepatic collection
is nearly completely resolved, with a trace amount of residual fluid
remaining. The drain has been removed. There is now a new subhepatic
intra-abdominal collection extending up to the abdominal wall with air-fluid
level within measuring 7.5 x 3.5 x 13.3 cm (TV x AP x CC). This collection is
along the course of the prior drain. There is air seen in the subcutaneous
tissues where the drain previously exited (2:45). There is approximately a
5-mm gap between this air track and the actual collection, however, a
communication cannot be excluded. There is associated mesenteric stranding
around the collection and around the bowel in that region. The liver
otherwise enhances homogeneously without any focal lesions or intra- or
extra-hepatic biliary dilatation. The portal vein is patent. The
gallbladder, pancreas, spleen, and adrenal glands are unremarkable. The
kidneys enhance and excrete contrast symmetrically without any focal lesions
or hydronephrosis. The stomach, small and intra-abdominal large bowel are
unremarkable. The patient is status post ileocolectomy with an ileocolic
anastomosis. Evaluation of the anastomosis is slightly difficult due to the
oral contrast but there is no evidence of obstruction. There is no free air.
CT PELVIS: The bladder, prostate gland, rectum, and sigmoid colon are
unremarkable. There is no free fluid, free air, or lymphadenopathy within the
pelvis. Bilateral fat-containing inguinal hernias are noted.
OSSEOUS STRUCTURES: No concerning osseous lesions. Again seen are multiple
healed rib fractures.
IMPRESSION:
1. New 7.5 x 3.5 x 13.3 cm (TV x AP x CC) subhepatic collection extending up
to the anterolateral abdominal wall in the region of the prior drain.
2. Previous perihepatic collection located more posteriorly is nearly
resolved with a small amount of residual fluid remaining.
|
10021487-RR-86 | 10,021,487 | 27,112,038 | RR | 86 | 2117-10-26 08:28:00 | 2117-10-26 13:32:00 | CT INTERVENTIONAL PROCEDURE
INDICATION: Patient with liver abscess MVC with liver laceration, persistent
fluid collection now with abscess from JP drain.
COMPARISON: Abdominal CT done yesterday.
PHYSICIANS: ___ and ___.
The procedure, risks, and benefits and alternatives were discussed with the
patient and written informed consent was obtained. A preprocedure timeout was
performed, discussing the planned procedure, confirming the patient's identity
with three identifiers, and reviewing a checklist per ___ protocol.
The patient was placed on the CT table to access the right mid abdominal
collection. An opening at the skin was done at the site of the scar of the
old JP drain. Contrast was injected inside the collection and show no
communication with the adjacent bowel. It was prepped and draped in usual
sterile fashion. 10 cc of lidocaine 1% was sent for local anesthesia.
___ wire, an 8 ___ catheter was inserted into the collection.
60 cc of pus was removed and sent to microbiology.
Moderate sedation was provided by administering divided doses of 100 mcg of
fentanyl and 2 mg of Versed throughout the total intraservice time of 10
minutes during which the patient's hemodynamic parameters were continuously
monitored by radiology nursing personnel. There was no complication after the
procedure.
IMPRESSION:
CT-guided replacement of an 8 ___ catheter inside right mid abdomen
abscess. No communication of the adjacent bowel was demonstrated on a later
sinogram. Debris was removed from the collection and sent to microbiology.
|
10021621-RR-11 | 10,021,621 | 29,271,862 | RR | 11 | 2169-03-12 05:11:00 | 2169-03-12 05:56:00 | EXAMINATION: DX ELBOW AND FOREARM
INDICATION: History: ___ with splint// eval post splint
TECHNIQUE: Three views of the right forearm
COMPARISON: None
FINDINGS:
Presence of cast overlying the right forearm. Comminuted, displaced spiral
fracture through the mid to distal radial shaft with 1 shaft width dorsal and
volar displacement of the distal fracture fragments, with possible overlying
laceration, could represent open fracture. The distal radioulnar joint
remains congruent, arguing against a Galeazzi fracture.
IMPRESSION:
Comminuted displaced fracture through the distal third of the radial shaft.
|
10021621-RR-13 | 10,021,621 | 29,271,862 | RR | 13 | 2169-03-12 13:23:00 | 2169-03-12 15:15:00 | EXAMINATION: WRIST(3 + VIEWS) RIGHT
INDICATION: Intraoperative fluoroscopic guidance during ORIF
TECHNIQUE: Fluoroscopy in the operative suite., A total of 19 seconds
continuous fluoroscopic time was employed.
COMPARISON: Prior study performed earlier today.
FINDINGS:
13 intraoperative images were acquired without a radiologist present.
Images show volar plate and screw fixation of the mid and distal shaft of the
right radius. The comminuted fracture of the distal shaft of the right radius
is noted.
IMPRESSION:
Intraoperative images were obtained during ORIF . Please refer to the
operative note for details of the procedure.
|
10021704-RR-5 | 10,021,704 | 29,777,036 | RR | 5 | 2132-03-19 21:15:00 | 2132-03-19 22:56:00 | EXAMINATION: Chest: Frontal and lateral views
INDICATION: ___ with hx HCAP requiring ICU/ETT 10d/a; now with new pna
transfer from OSH with only lateral film.// evaluate for infection
TECHNIQUE: Chest: Frontal and Lateral
COMPARISON: Chest radiograph ___.
FINDINGS:
There is extensive multilobar ground-glass and interstitial opacities with
scattered distribution bilaterally and volume loss suggestive of infectious or
inflammatory etiology. Presumably small bilateral pleural effusions. No
pneumothorax is seen. The cardiac and mediastinal silhouettes are
unremarkable.
IMPRESSION:
Extensive multi lobar interstitial opacities with background ground-glass
opacities bilaterally with volume loss, suggestive of infectious or
inflammatory etiology. Correlate with outside hospital course in prior
disease and sputum culture.
|
10021704-RR-6 | 10,021,704 | 29,777,036 | RR | 6 | 2132-03-20 17:04:00 | 2132-03-20 18:49:00 | EXAMINATION: CT CHEST W/O CONTRAST
INDICATION: ___ yoM with previous hx of acute PNA, with persistent O2
requirement and no clear infectious etiology and previous extensive interstial
changes on CT at OSH.// ****INSTERSTITIAL LUNG DISEASE PROTOCOL**** ___ yoM
with previous hx of CAD and acute PNA, with persistent O2 requirement and no
clear infectious etiology and previous extensive interstial changes on CT at
OSH. Eval for interstial lung disease. Planning for bronch tomorrow
TECHNIQUE: Axial helical MDCT images were obtained through the chest.
Coronal, sagittal, and lung algorithm reconstructed images were acquired.
DOSE: Acquisition sequence:
1) Spiral Acquisition 2.3 s, 36.2 cm; CTDIvol = 19.5 mGy (Body) DLP = 704.4
mGy-cm.
2) Spiral Acquisition 2.1 s, 33.7 cm; CTDIvol = 17.4 mGy (Body) DLP = 586.0
mGy-cm.
Total DLP (Body) = 1,290 mGy-cm.
COMPARISON: CT trachea ___.
Chest radiograph ___.
FINDINGS:
NECK, THORACIC INLET, AXILLAE, CHEST WALL: Partially visualized thyroid is
notable for a 0.8 cm left thyroid lobe nodule (2:4). Cervical lymph nodes are
nonenlarged.
UPPER ABDOMEN: Limited evaluation of the upper abdomen is unremarkable.
MEDIASTINUM: Few subcentimeter mediastinal lymph nodes are again noted,
similar to ___ and likely reactive, largest measuring 1 cm in the
subcarinal region (02:26). No anterior mediastinal mass. No mediastinal
hematoma.
HILA: Hilar lymph nodes are nonenlarged.
HEART and PERICARDIUM: Heart is normal in size without pericardial effusion.
Severe atherosclerotic calcifications involving the coronary arteries are
noted.
PLEURA: No pleural effusion, pleural calcifications, or pneumothorax.
LUNG:
1. PARENCHYMA: No air trapping noted. Again seen is mild centrilobular
emphysema, unchanged since prior. In comparison to ___ there are multiple
new subpleural interstitial opacities with associated honeycombing and more
confluent components involving the lower lobes and lingula..
2. AIRWAYS: Diffuse bronchial wall thickening predominantly involving the
upper and central airways is unchanged, consistent with small airways disease.
The airways are otherwise patent to the subsegmental level. There is mild
central and right lower lobe traction bronchiectasis (302:133). No evidence
of tracheobronchiomalacia on expiratory phase.
3. VESSELS: Thoracic aorta and main pulmonary artery are normal in caliber.
CHEST CAGE: No focal lytic or blastic lesions worrisome for malignancy. No
acute fracture.
IMPRESSION:
1. Findings suspicious for idiopathic pulmonary fibrosis.
2. Mild centrilobular emphysema.
3. Small airways disease.
RECOMMENDATION(S): Correlation for superimposed infection is recommended.
|
10021704-RR-7 | 10,021,704 | 29,777,036 | RR | 7 | 2132-04-01 15:55:00 | 2132-04-01 16:49:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old man with COP// baseline CXR for ongoing treatment
IMPRESSION:
In comparison with the study of ___, there has been substantial
clearing of the diffuse interstitial disease involving both lungs. However,
there still is a substantial residual of interstitial fibrosis.
No evidence of acute focal consolidation.
|
10021927-RR-81 | 10,021,927 | 25,202,388 | RR | 81 | 2177-12-21 02:53:00 | 2177-12-21 05:21:00 | INDICATION: ___ female with diffuse abdominal pain and rising
lactate. Assess for mesenteric ischemia.
COMPARISON: CT abdomen and pelvis from ___ and CT torso from
___ and MRI abdomen from ___.
TECHNIQUE: MDCT axial images of the abdomen and pelvis were obtained with and
without intravenous contrast. Initial axial images were acquired without
contrast using a low-dose technique. Subsequently, arterial phase imaging was
acquired. Coronal and sagittal reformations were prepared.
CT ABDOMEN WITH AND WITHOUT INTRAVENOUS CONTRAST: Atelectasis is identified
at the lung bases, right greater than left. There is moderate cardiomegaly,
though no pericardial effusion.
The liver is homogeneous in attenuation without discrete lesion. Layering
sludge/stones are seen within a mildly distended gallbladder. No intra- or
extra-hepatic biliary ductal dilatation is identified. The spleen, pancreas,
and adrenal glands appear normal. The stomach and small bowel loops are
normal in caliber and configuration without evidence of obstruction or
inflammation. There is no free air. The stomach and small bowel loops are
normal in caliber and configuration without evidence of obstruction or
inflammation.
There is nonspecific fat stranding and mild fluid surrounding the bilateral
kidneys with mild thickening of the anterior pararenal fascia bilaterally.
The adjacent colon and kidneys appear normal without evident of infection or
inflammation. Findings likely reflect mild third spacing due to congestive
heart failure.
Multiple hypodense lesions within both kidneys were previously characterized
as simple cysts on prior MRI from ___. However, a solid lesion
within the lower pole of the right kidney measuring 7 mm appears stable in
size compared to prior examination. This could not be definitively
characterized as a benign entity on prior MRI, therefore a 12-month followup
MRI was recommended at that time.
CT PELVIS WITH INTRAVENOUS CONTRAST: The bladder is distended and appears
normal. The patient is status post hysterectomy. No adnexal mass lesion is
identified. There is no pelvic free fluid. No abdominal or pelvic adenopathy
is identified.
CTA: The abdominal aorta and branch vessels are non-aneurysmal and widely
patent. No significant atherosclerotic plaque is identified. The celiac
axis, SMA, single bilateral renal arteries, and ___ are widely patent.
Minimal atherosclerotic plaque is seen within the infrarenal abdominal aorta.
There is normal conventional anatomy.
BONES AND SOFT TISSUES: No bone destructive lesion or acute fracture is
identified. Degenerative changes of the lower lumbar spine are noted.
IMPRESSION:
1. Widely patent abdominal arterial vasculature. No evidence of mesenteric
ischemia.
2. Nonspecific fat stranding in the retroperitoneum may be due to mild third
spacing in the setting of congestive heart failure.
3. Cholelithiasis
4. Unchanged size of a 7-mm right renal solid lesion. MRI followup continues
to be recommended as per report from MR abdomen on ___.
|
10021927-RR-82 | 10,021,927 | 25,202,388 | RR | 82 | 2177-12-21 04:25:00 | 2177-12-21 10:07:00 | PATIENT HISTORY: ___ years old woman with hypotension. Please assess for
pneumonia.
COMPARISON: Exam is compared to a chest x-ray of ___.
FINDINGS: AP portable single-view chest x-ray of the chest shows reduced lung
volume and new mild vascular engorgement. Left lung base is not fully
assessable, because obscured by midly enlarged heart. Aorta is elongated.
There is no pleural effusion or pneumothorax.
|
10021927-RR-83 | 10,021,927 | 25,202,388 | RR | 83 | 2177-12-22 14:43:00 | 2177-12-22 17:31:00 | HISTORY: GERD/gastritis with ___ esophagus, esophageal dysmotility,
presents with dysphagia of solids. Assess swallowing a barium pill.
COMPARISON: None.
FINDINGS: Limited study as double contrast upper GI was subsequently switched
over to single contrast with thin barium given patient limitations. Thin
barium passes freely to the stomach with tertiary contractions in the
esophagus. There is a small hiatal hernia and mild reflux to the lower and
mid esophagus. A 13 mm barium tablet was given which passed freely into the
stomach. No evidence of stricture or narrowing within the esophagus.
IMPRESSION:
1. Small hiatal hernia.
2. Mild reflux.
3. No stricture within the esophagus with free passage of a 13 mm barium
tablet to stomach.
4. Mild esophageal dysmotility with tertiary contractions.
|
10021927-RR-84 | 10,021,927 | 25,202,388 | RR | 84 | 2177-12-23 13:55:00 | 2177-12-23 16:06:00 | HISTORY: GERD, gastritis, ___ esophagus, presenting with dysphagia with
solids and electrolyte abnormalities. Assess for esophageal dysmotility.
COMPARISON: Upper GI, ___.
TECHNIQUE: Oropharyngeal swallowing videofluoroscopy was performed in
conjunction with the speech and swallow division. Multiple consistencies of
barium were administered.
FINDINGS: Barium passes freely through the oropharynx and esophagus without
evidence of obstruction. There was no gross aspiration. Trace penetration
with nectar which cleared spontaneously. No upper esophageal sphincter
dysfunction. For details, please refer to the speech and swallow division
note in OMR.
IMPRESSION:
1. Trace penetration with nectar which cleared spontaneously. No aspiration.
2. No upper esophageal sphincter dysfunction.
|
10021927-RR-85 | 10,021,927 | 23,373,975 | RR | 85 | 2178-01-11 14:53:00 | 2178-01-11 15:47:00 | CHEST, TWO VIEWS: ___
HISTORY: ___ female with productive cough and chills.
COMPARISON: Chest x-rays from ___ and ___.
FINDINGS: Frontal and lateral views of the chest. There are bibasilar
opacities identified, similar to prior exam. Some irregular linear component
is seen at the lateral aspect at the left lung base which is more conspicuous
than on ptiot. Superiorly, the lungs are clear. There is no pulmonary
vascular congestion. Trace bilateral effusions likely present given blunting
of the posterior costophrenic angles. The cardiomediastinal silhouette is
unchanged, notable for mild cardiomegaly. No acute osseous abnormality is
detected.
IMPRESSION: Bibasilar opacities more conspicuous linear opacities at the left
lung base. Findings may be due to pneumonia. Recommend repeat after
treatment to document resolution of the findings.
|
10021930-RR-26 | 10,021,930 | 20,480,646 | RR | 26 | 2177-01-10 04:32:00 | 2177-01-10 18:12:00 | CLINICAL HISTORY: A ___ man with a history of metastatic renal cell
cancer with torso CT showing new lytic lesion at T2 with extension into the
spinal canal. Evaluate for cord compression at T2 level.
TECHNIQUE: A thoracic and lumbar spine MRIs obtained pre- and
post-intravenous administration of 10 cc of Gadavist contrast.
COMPARISON: Compared to a lumbar spine MRI from ___ and a thoracic
spine MRI from ___.
FINDINGS:
THORACIC SPINE: Compared to the thoracic spine MRI of ___, the
T2 pathologic compression fracture has progressed. There is mild bony
retropulsion with suggestion of enhancing epidural disease at this level.
There is no cord signal abnormality.
The T7 heterogeneously hyperintense lesion on the T2 and STIR images has also
increased in size. There is no bony retropulsion at this level. The
hypointense lesion at the inferior endplate of T11 vertebral body posteriorly
is stable in size when compared to the lumbar spine MRI from ___.
The remainder of the thoracic vertebral bodies are unremarkable.
Compared to the ___, there is new anterior and posterior
enhancing epidural metastatic disease from the T10 through the L1 level.
There is moderate canal stenosis at these levels.
LUMBAR SPINE:
The patient is status post laminectomies from L3 through S1. There is high
signal within the vertebral bodies on T1 compatible with fatty bone marrow
replacement from prior radiation. Again noted are multiple metastatic lesions
seen from T11 through the sacrum and iliac wings that are grossly stable from
___. The conus ends at T12-L1 level.
There is stable appearance of the L2 vertebral body, which is largely replaced
by tumor and has mild vertebral body height loss. There is moderate canal
stenosis due to small retropulsion of the metastatic lesion into the epidural
space.
There are stable multilevel degenerative disc disease, most notably at the
L3-L4 where there is severe spinal canal narrowing decompressed by posterior
laminectomy. There is severe bilateral neural foraminal narrowing with
compression of the exiting L3 nerve roots.
IMPRESSION:
Compared with the prior thoracic spine MRI of ___, there is
further collapse of the T2 pathologic fracture with likely epidural extension
of metastatic disease . Also, metastatic lesion within the T7 vertebral body
has increased in size. There is new enhancing anterior and posterior epidural
metastatic disease from T10 through L1 levels.
There is stable extensive metastatic disease within the lumbar spine and
pelvis as described above.
|
10021938-RR-20 | 10,021,938 | 23,112,364 | RR | 20 | 2181-10-13 00:12:00 | 2181-10-13 02:32:00 | INDICATION: History of end-stage renal disease. Evaluate for evidence of
congestive heart failure.
COMPARISON: None.
FINDINGS: A single frontal portable radiograph of the chest was acquired.
The heart is mildly enlarged. There are diffuse interstitial opacities
radiating from the hila as well as Kerley B lines and vascular cephalization,
consistent with mild interstitial pulmonary edema. A 15-mm nodular opacity
projects just superior to the right costophrenic angle. The mediastinal
contours are normal. The right hilus is bulbous in appearance. There are no
pleural effusions. No pneumothorax is seen.
IMPRESSION:
1. Mild cardiomegaly with mild interstitial pulmonary edema.
2. 15-mm nodular opacity superior to the right costophrenic angle, possibly a
calcified pulmonary nodule. Further assessment with conventional radiographs
should be performed once the patient's fluid status has normalized.
3. Bulbous appearance of the right hilus should be reassessed on the same
conventional radiographs as recommended in impression point #2.
Findings and recommendations were discussed with Dr. ___ by Dr. ___ at
7:41 a.m. via telehpone on ___.
|
10021938-RR-21 | 10,021,938 | 23,112,364 | RR | 21 | 2181-10-14 13:33:00 | 2181-10-14 14:04:00 | HISTORY: ESRD on hemodialysis with previous chest x-ray showing nodular
opacity. Assess lung opacity.
COMPARISON: ___.
FINDINGS: Frontal and lateral radiographs of the chest. Compared to the
prior radiograph, the patient's fluid overload status has improved and there
is no evidence of pulmonary edema. No pleural effusion or pneumothorax is
appreciated. The cardiomediastinal contour has improved in the interval.
Tortuous aorta is again noted. The previously noted opacities at the right
lung base may have been a function of engorge vasculature, and are no longer
seen.
IMPRESSION: Interval resolution of pulmonary edema with no longer visualized
right lower lobe opacities which may have been engorged vessels.
|
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