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10022037-RR-137 | 10,022,037 | 29,052,432 | RR | 137 | 2169-02-04 15:55:00 | 2169-02-04 17:46:00 | EXAM: CHEST, FRONTAL AND LATERAL VIEWS.
CLINICAL INFORMATION: One month of weakness.
___.
FINDINGS: Frontal and lateral views of the chest were obtained. No focal
consolidation, pleural effusion, or evidence of pneumothorax is seen. The
cardiac and mediastinal silhouettes are stable and unremarkable.
IMPRESSION: No acute cardiopulmonary process.
|
10022037-RR-138 | 10,022,037 | 29,052,432 | RR | 138 | 2169-02-04 18:58:00 | 2169-02-04 21:09:00 | INDICATION: History of liver transplant, and one month of left upper quadrant
and left lower quadrant pain. Evaluate for obstruction, diverticulitis or
splenic infarct.
COMPARISONS: Abdominal ultrasound from ___. MRI of the abdomen from
___. CT of the abdomen and pelvis from ___.
TECHNIQUE: Contiguous axial MDCT images were obtained through the abdomen and
pelvis after the administration of IV contrast only. Sagittal and coronal
reformatted images were obtained and reviewed.
TOTAL DLP: 366.95 mGy-cm.
FINDINGS:
LUNG BASES: The bases of the lungs are clear. There is no discrete nodule,
consolidation or pleural effusion. The base of the heart is normal in size.
Trace pericardial fluid is likely within normal physiologic range.
ABDOMEN: The liver is normal in shape and contour. There are post-surgical
changes from a prior transplant. The hepatic veins and portal veins are
patent. Due to the phase of contrast, the arterial anatomy is not well
assessed. There are no focal hepatic lesions. There is mild prominence of
the central intrahepatic common bile duct up to 11 mm. This is unchanged from
the prior MRI. The remainder of the common bile duct is normal in caliber.
There is no intrahepatic biliary duct dilation. The gallbladder is surgically
absent. The spleen is normal in size. There are no focal splenic lesions or
evidence of splenic infarct. The pancreas is normal. The bilateral adrenal
glands are normal.
In the right kidney, there is a 26 mm hypodensity, consistent with a simple
cyst. Two other subcentimeter hypodensities in the right kidney are too small
to fully characterize, but also likely represent cysts. The right kidney is
normal in size. There is normal cortical thickness. There is no evidence of
pyelonephritis or hydronephrosis. It enhances and excretes contrast
appropriately.
The left kidney is atrophic with significant cortical thinning and scarring.
The collecting system is mildly dilated. The upper and mid ureter are normal
in caliber. There is delayed excretion. This is new from the prior exam in
___, though stable from the prior MRI in ___. This likely is from chronic
obstruction. There is no significant perirenal fat stranding. No perirenal
fluid collection is identified.
The stomach and small bowel are normal in course and caliber. There is no
evidence of obstruction. There are no acute inflammatory changes. There is
no free air or free fluid. The abdominal vasculature is normal in caliber.
There is no evidence of an abdominal aortic aneurysm. Mild atherosclerotic
calcifications are noted along the abdominal aorta. There is no periportal,
retroperitoneal or mesenteric lymphadenopathy.
PELVIS: Evaluation of the pelvis is significantly limited by metallic
artifact from the bilateral total hip arthroplasties. The imaged portions of
the sigmoid colon are mostly collapsed, which somewhat limits its evaluation.
Apparent mild wall thickening is present at the junction of the sigmoid colon
and the descending colon, and is likely due to underdistension. There is no
evidence of diverticulitis. The remainder of the large bowel is normal.
The bladder and prostate are not well visualized. The distal ureters are not
well visualized. There is no obvious free fluid in the pelvis.
OSSEOUS STRUCTURES: The patient is status post bilateral total hip
arthroplasties. There is no obvious evidence of hardware complication. There
are no concerning lytic or sclerotic osseous lesions. There are mild
degenerative changes in the lower thoracic spine with calcifications in the
T11-12 disc space. No fracture is identified. There is moderate diffuse
anasarca in the soft tissues.
IMPRESSION:
1. Significant atrophy and cortical thinning in the left kidney with mild
dilation of the collecting system, and delayed contrast excretion. This
appearance is essentially unchanged from the prior MRI in ___.
2. Mild nonspecific colonic wall thickening at the junction of the sigmoid
colon and descending colon, likely due to underdistension.
3. Status post a liver transplant with mild central intrahepatic biliary duct
prominence, unchanged from the prior MRI. It otherwise is normal in
appearance.
4. Normal spleen.
Changes to the wet read were text paged to Dr. ___ at 8:40 ___ on
___ via by Dr. ___ at the time the findings were discovered.
|
10022373-RR-10 | 10,022,373 | 22,567,635 | RR | 10 | 2150-02-28 15:57:00 | 2150-02-28 16:58:00 | INDICATION: ___ with hypotension elevated wbc // eval for pna
TECHNIQUE: AP and lateral views the chest.
COMPARISON: CT chest from ___.
FINDINGS:
Right chest wall port is seen with catheter tip at the mid SVC. The lungs are
clear without focal consolidation, effusion, or edema. The cardiomediastinal
silhouette is within normal limits. No acute osseous abnormalities. Mild
height loss of a lower thoracic vertebral body is unchanged.
IMPRESSION:
No acute cardiopulmonary process.
|
10022373-RR-15 | 10,022,373 | 27,450,651 | RR | 15 | 2150-05-18 08:52:00 | 2150-05-18 13:29:00 | EXAMINATION: CTA ABD AND PELVIS
INDICATION: ___ year old woman with pancreatic cancer encasing blood vessels
with severe abdominal pain and intractable vomiting and elevated lactate,
evaluate for ischemic colitis or other acute intra-abdominal process to
explain pain, vomiting, elevated lactate.
TECHNIQUE: Abdomen and pelvis CTA: Non-contrast and post-contrast images were
acquired through the abdomen and pelvis.
Oral contrast was not administered.
MIP reconstructions were performed on independent workstation and reviewed on
PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 4.4 s, 48.6 cm; CTDIvol = 2.1 mGy (Body) DLP = 102.4
mGy-cm.
2) Spiral Acquisition 7.3 s, 47.2 cm; CTDIvol = 6.1 mGy (Body) DLP = 285.0
mGy-cm.
Total DLP (Body) = 387 mGy-cm.
COMPARISON: CTAs of the abdomen and pelvis dated ___ and ___.
FINDINGS:
VASCULAR:
There is no abdominal aortic aneurysm. There is moderate calcium burden in
the abdominal aorta and great abdominal arteries.
LOWER CHEST: Moderate centrilobular emphysema and small bilateral pleural
effusions, right greater than left are noted at the lung bases. Scattered
areas of ___ opacity in the right lower lobe may represent aspiration
or early pneumonia (03:11, 9).
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,
without stones or gallbladder wall thickening.
PANCREAS: The ill-defined hypoattenuating mass in the uncinate process of the
pancreas continues to decrease in size, currently measuring 2.3 x 1.7 cm
(03:55), previously measuring 2.7 x 2.0 cm. Encasement and occlusion of an
early branch from the SMA is unchanged (03:51-54). Less than 180 degrees of
contact with additional early branches from the SMA is unchanged (03:56).
There is otherwise no vascular involvement. CyberKnife fiducials are in
unchanged position. There is no significant biliary or pancreatic ductal
dilatation.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions. A small accessory spleen is incidentally noted.
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 is no evidence of stones, focal renal lesions, or hydronephrosis. There
are no urothelial lesions in the kidneys or ureters. There is no perinephric
abnormality.
GASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness
and enhancement throughout. Colon and rectum are within normal limits.
Appendix contains air, has normal caliber without evidence of fat stranding.
There is no evidence of mesenteric lymphadenopathy.
RETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
evidence of pelvic or inguinal lymphadenopathy. There is no free fluid in the
pelvis.
REPRODUCTIVE ORGANS: The uterus is not visualized. No adnexal abnormality is
seen.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. No evidence of acute intra-abdominal process.
2. Unchanged appearance of hypo attenuating uncinate process pancreatic mass
with encasement of an early branch of the SMA. No abnormal bowel wall
enhancement or pneumatosis.
3. Right lower lobe areas of ___ opacity suggesting either aspiration
or early infection.
|
10022373-RR-17 | 10,022,373 | 27,450,651 | RR | 17 | 2150-05-25 13:24:00 | 2150-05-25 14:15:00 | INDICATION: ___ year old woman with pancreatic cancer, persistent n/v and
inability to tolerate PO. Assess for UGI obstruction. 1 hour post contrast
TECHNIQUE: Single portable upright frontal abdominal radiograph.
COMPARISON: CT abdomen/pelvis ___.
FINDINGS:
There are no abnormally dilated loops of large or small bowel. Large fecal
load throughout the colon. Recently ingested oral contrast is not well
visualized due to residual contrast from prior CT scan. 3 linear
radiopacities projecting over the L1 vertebral body are most consistent with
fiducial markers.There is no free intraperitoneal air.
Osseous structures are unremarkable. There are no unexplained soft tissue
calcifications or radiopaque foreign bodies.
IMPRESSION:
Recently ingested oral contrast is not well visualized due to residual
contrast from prior CT scan. Recommend increased density contrast ingestion
with repeat serial abdominal radiographs. There is a large fecal load
throughout the colon without bowel obstruction.
|
10022373-RR-18 | 10,022,373 | 27,450,651 | RR | 18 | 2150-05-25 16:22:00 | 2150-05-25 17:06:00 | INDICATION: ___ year old woman with pancreatic cancer // evaluate for UGI
obstruction, 4 hours post contrast
TECHNIQUE: Supine abdominal radiograph was obtained.
COMPARISON: Radiograph of the abdomen from ___.
FINDINGS:
There are no abnormally dilated loops of large or small bowel. Surgical clips
are not noted in the mid abdomen.
There is no free intraperitoneal air.
Osseous structures are unremarkable.
There are no unexplained soft tissue calcifications or radiopaque foreign
bodies.
IMPRESSION:
Nonobstructive bowel gas pattern.
|
10022373-RR-19 | 10,022,373 | 27,450,651 | RR | 19 | 2150-06-01 17:54:00 | 2150-06-01 23:47:00 | INDICATION: ___ woman with pancreatic cancer now presenting with
new fever.
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest PA and lateral dated ___.
FINDINGS:
The cardiomediastinal silhouette is normal. The hila are normal. There is a
large region of heterogeneous opacity extending from the mid lower to upper
lung zone likely representing pneumonia. No pleural abnormalities. No
pneumothorax. The visualized bones and soft tissues are normal. The right
port is in satisfactory position.
IMPRESSION:
There is a large region of heterogeneous opacity extending from the mid lower
to upper lung zone likely representing pneumonia.
|
10022373-RR-20 | 10,022,373 | 27,450,651 | RR | 20 | 2150-06-01 18:11:00 | 2150-06-01 18:45:00 | EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ year old woman with pancreatic cancer, chronic abdominal pain
here with worsening nausea and vomiting. Now with new fever. // Eval biliary
obstruction. Eval ascites
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: CTA of the abdomen pelvis dated ___.
FINDINGS:
LIVER: The hepatic parenchyma appears within normal limits. The contour of the
liver is smooth. There is no focal liver mass. The main portal vein is patent
with hepatopetal flow. There is no ascites.
BILE DUCTS: There is no intrahepatic biliary dilation. The CHD measures 5 mm.
GALLBLADDER: The gallbladder is decompressed. No evidence of cholelithiasis.
PANCREAS: Known mass within the uncinate process is not well seen. The body
of the pancreas appears within normal limits. The pancreatic tail is not well
seen due to the presence of overlying bowel gas.
SPLEEN: Normal echogenicity, measuring 12.1 cm.
KIDNEYS: The right kidney measures 8.8 cm. The left kidney measures 10.8 cm.
Limited views of the bilateral kidneys are grossly unremarkable. No evidence
of hydronephrosis.
RETROPERITONEUM: The visualized portions of aorta and IVC are within normal
limits.
IMPRESSION:
1. The gallbladder is decompressed. No evidence of cholelithiasis.
2. No intra or extrahepatic biliary ductal dilatation.
3. Known mass within the uncinate process of the pancreas is not well seen.
|
10022373-RR-21 | 10,022,373 | 27,450,651 | RR | 21 | 2150-06-02 14:12:00 | 2150-06-02 16:32:00 | EXAMINATION: CT of the abdomen and pelvis with contrast.
INDICATION: ___ year old woman with pancreatic cancer. Intractable nausea and
vomiting. New fever // Eval fever and intractable nausea and vomiting
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) Sequenced Acquisition 0.5 s, 0.2 cm; CTDIvol = 9.3 mGy (Body) DLP = 1.9
mGy-cm.
2) Stationary Acquisition 11.4 s, 0.2 cm; CTDIvol = 194.5 mGy (Body) DLP =
38.9 mGy-cm.
3) Spiral Acquisition 8.1 s, 52.4 cm; CTDIvol = 6.7 mGy (Body) DLP = 348.6
mGy-cm.
Total DLP (Body) = 389 mGy-cm.
COMPARISON: CT of the abdomen and pelvis from ___.
FINDINGS:
LOWER CHEST: Limited evaluation of the lung bases shows persistent tree in ___
nodules in the right lower and right middle lobes which could be related to
aspiration. There is also an unchanged 5 mm left lower lobe nodule (4:8).
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: Fiducial seeds are again noted within a 2.1 x 1.7 cm lesion in the
uncinate process of the pancreas that has not significantly changed compared
to prior (04:53), and is again noted to encase and completely occlude an
early branch of the SMA.
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 with normal nephrogram.
There is no evidence of focal renal lesions or hydronephrosis. There is no
perinephric abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Again noted is a diverticulum
arising from the third portion of the duodenum. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. Note is made of
significant amount of residual dense oral contrast in the rectum and sigmoid
colon since last study raising concern for barium impaction.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: The patient status post hysterectomy.
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.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. No significant interval changes in an uncinate process pancreatic lesion
encasing and occluding an early branch of the SMA. No abnormal wall
enhancement noted.
2. Significant amount of residual dense oral contrast in the rectum and
sigmoid colon since last study raises concern for barium impaction.
3. Persistent ___ nodules in the right lower and right middle lobes
are likely due to aspiration.
4. Unchanged 5 mm left lower lobe lung nodule should be reassessed at the time
of the follow-up.
RECOMMENDATION(S): The findings were discussed with ___, M.D. by
___, M.D. on the telephone on ___ at 4:31 ___, 10
minutes after discovery of the findings.
|
10022373-RR-22 | 10,022,373 | 27,450,651 | RR | 22 | 2150-06-04 17:00:00 | 2150-06-04 21:30:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with pancreatic cancer, abdominal pain, new
hypotension // Eval etiology hypotension Eval etiology hypotension
IMPRESSION:
Compared to chest radiographs ___ and ___ one.
Heterogeneous peribronchial opacification in the right lung has improved
consistent with decreasing pneumonia. Left lung clear. No pleural
abnormality. Normal cardiomediastinal silhouette.
Right transjugular central venous infusion catheter ends in the low SVC.
|
10022373-RR-23 | 10,022,373 | 27,450,651 | RR | 23 | 2150-06-04 17:00:00 | 2150-06-04 21:34:00 | INDICATION: ___ year old woman with pancreatic cancer, worsening abdominal
pain, now new hypotension // Eval etiology hypotension
TECHNIQUE: Two views of the abdomen and pelvis.
COMPARISON: CT abdomen pelvis ___.
FINDINGS:
No evidence of free air. Nonobstructive bowel gas pattern. Phleboliths are
noted in the pelvis. No unexplained radiopaque foreign bodies identified.
IMPRESSION:
No free air or obstruction.
|
10022373-RR-9 | 10,022,373 | 22,567,635 | RR | 9 | 2150-02-28 14:43:00 | 2150-02-28 17:29:00 | EXAMINATION: CTA ABD AND PELVIS
INDICATION: ___ with pancreas ca p/w syncope hypotensionNO_PO contrast //
eval for worsening pancreatic cancer necrosis vs billary dilation obstrucion
TECHNIQUE: Abdomen and pelvis CTA: Non-contrast and post-contrast images were
acquired through the abdomen and pelvis.
Oral contrast was not administered.
MIP reconstructions were performed on independent workstation and reviewed on
PACS.
DOSE: DLP: 1427 mGy cm.
COMPARISON: CT abdomen pelvis from ___.
FINDINGS:
VASCULAR:
There is no abdominal aortic aneurysm. There is mild calcium burden in the
abdominal aorta and great abdominal arteries which are all patent.
LOWER CHEST: Minimal atelectasis is noted in the lung bases. There is no
pleural or pericardial effusion.
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 contracted.
PANCREAS: Hypoenhancing lesion centered at the uncinate process of the
pancreas is unchanged from exam performed 8 days prior. The pancreas
otherwise has normal attenuation throughout. There is no pancreatic ductal
dilatation.
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 with normal nephrogram.
There is no evidence of stones, focal renal lesions, or hydronephrosis. There
are no urothelial lesions in the kidneys or ureters. There is no perinephric
abnormality.
GASTROINTESTINAL: There is a small hiatal hernia. Stomach is otherwise
unremarkable. Small bowel loops demonstrate normal caliber, wall thickness
and enhancement throughout. Duodenal diverticulum is noted. Colon and rectum
are within normal limits. Appendix is not visualized. There is no evidence
of mesenteric lymphadenopathy.
RETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
evidence of pelvic or inguinal lymphadenopathy. There is no free fluid in the
pelvis.
REPRODUCTIVE ORGANS: Uterus is not visualized. No adnexal abnormalities
identified.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
Mass centered in the uncinate process of the pancreas which is unchanged from
exam 8 days prior. No evidence of acute intra-abdominal process.
|
10022500-RR-15 | 10,022,500 | 28,659,510 | RR | 15 | 2140-11-21 11:22:00 | 2140-11-21 14:51:00 | INDICATION: ___ year old man with abdominal pain after flex sig// eval
abdominal pain
TECHNIQUE: Portable supine abdominal radiograph was obtained.
COMPARISON: None available.
FINDINGS:
There are no abnormally dilated loops of large or small bowel, with an overall
paucity of small bowel gas.
Assessment for free intraperitoneal air is limited on supine radiographs. If
there is clinical concern for pneumoperitoneum, advise upright or left lateral
decubitus radiograph, or cross-sectional imaging.
Osseous structures are unremarkable.
Surgical clips are demonstrated within the pelvis. There are no unexplained
soft tissue calcifications or radiopaque foreign bodies.
IMPRESSION:
Nonobstructive bowel gas pattern with an overall paucity of bowel gas.
|
10023117-RR-39 | 10,023,117 | 24,244,087 | RR | 39 | 2174-06-07 21:41:00 | 2174-06-07 21:57:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: History: ___ with shortness of breath
TECHNIQUE: Chest PA and lateral
COMPARISON: ___ chest radiograph and ___ chest CT
FINDINGS:
Left-sided AICD device is noted with leads terminating in the regions of the
right atrium, right ventricle and coronary sinus, unchanged. Severe
cardiomegaly is again noted. Mediastinal and hilar contours are unchanged.
No pulmonary edema is demonstrated. No focal consolidation, pleural effusion
or pneumothorax is present. Atelectasis is noted in both lung bases. There
are no acute osseous abnormalities.
IMPRESSION:
Severe cardiomegaly without congestive heart failure or pneumonia.
|
10023239-RR-21 | 10,023,239 | 29,295,881 | RR | 21 | 2137-06-19 15:36:00 | 2137-06-19 16:26:00 | CHEST, TWO VIEWS: ___
HISTORY: ___ female with nausea and vomiting and shortness of breath.
COMPARISON: None.
FINDINGS: There is subtle right basilar opacity and lack of visualization of
the right heart border. There is minimal increased density projecting over
the cardiac sillouette on the lateral view. Elsewhere, the lungs are clear.
The cardiomediastinal silhouette is normal. No acute osseous abnormality is
identified.
IMPRESSION: Loss of the right heart border with subtle increased right lower
lung opacity which could represent right middle lobe pneumonia.
|
10023239-RR-27 | 10,023,239 | 21,759,936 | RR | 27 | 2140-10-03 07:54:00 | 2140-10-03 08:42:00 | EXAMINATION:
Chest: Frontal and lateral views
INDICATION: History: ___ with T1DM and ?sarcoid, in DKA// dka ?sarcoid; r/o
infection
TECHNIQUE: Chest: Frontal and Lateral
COMPARISON: CT chest ___.
FINDINGS:
Bilateral hilar lymphadenopathy, better visualized on recent CT chest which
can be seen in sarcoidosis.The lungs are clear without focal consolidation.
No pleural effusion or pneumothorax is seen. The cardiac and mediastinal
silhouettes are unremarkable.
IMPRESSION:
Bilateral hilar adenopathy, better seen on recent chest CT, can be seen in
sarcoidosis but lymphoma and other neoplastic etiologies cannot be excluded.
|
10023239-RR-28 | 10,023,239 | 21,759,936 | RR | 28 | 2140-10-04 21:17:00 | 2140-10-04 21:41:00 | EXAMINATION: Portable chest x-ray
INDICATION: ___ year old woman s/p lung bx today// ?interval change
TECHNIQUE: Portable chest x-ray
COMPARISON: Previous chest x-ray from ___.
FINDINGS:
Alveolar airspace opacity is seen in the lower aspect of the right lung,
possibly hemorrhage. The left lung appears unchanged. There is bilateral
hilar adenopathy, better visualized on a recent CT scan of the chest. The
heart is normal in size. The trachea is midline.
IMPRESSION:
New alveolar airspace opacity when compared to the previous study. Hemorrhage
as well as other etiologies should be considered in this patient who is status
post lung biopsy.
Bilateral hilar adenopathy.
|
10023239-RR-29 | 10,023,239 | 21,759,936 | RR | 29 | 2140-10-05 11:03:00 | 2140-10-05 11:20:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with recent BAL// resolution of airspace
opacities? resolution of airspace opacities?
IMPRESSION:
Comparison to ___. There is only minimal decrease in extent and
severity of the severe bilateral parenchymal opacities. The multiple
pre-existing rounded consolidations in the lung parenchyma are stable. No
evidence of pneumothorax. No pleural effusions.
|
10023239-RR-30 | 10,023,239 | 21,759,936 | RR | 30 | 2140-10-06 09:33:00 | 2140-10-06 10:35:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with EBUS/bronch biopsy with developing hypoxia
2 days post procedure// ? infiltrates ? infiltrates
IMPRESSION:
Comparison to ___. The postprocedure parenchymal opacities,
notably on the right, are unchanged as compared to the previous image and
resemble in severity those from ___. There currently is no
evidence for the presence of a pneumothorax. Stable appearance of the cardiac
silhouette.
|
10023239-RR-31 | 10,023,239 | 21,759,936 | RR | 31 | 2140-10-07 06:44:00 | 2140-10-07 09:57:00 | INDICATION: ___ year old woman with LN, fever join pain hypoxemia// Interval
change
TECHNIQUE: Portable AP radiograph of the chest.
COMPARISON: Radiograph of the chest from ___.
FINDINGS:
The moderate to severe parenchymal opacities, predominantly within the mid to
lower right lung with air bronchograms appears grossly unchanged compared to
the prior exam. Small right pleural effusion is persistent. The
cardiomediastinal silhouette otherwise appears unchanged. The visualized
osseous structures are unremarkable. There is no evidence of a pneumothorax.
IMPRESSION:
Overall, stable appearance of the moderate to severe parenchymal opacities
within the right lung compared to the prior exam from ___.
|
10023486-RR-25 | 10,023,486 | 20,530,186 | RR | 25 | 2151-07-09 16:51:00 | 2151-07-09 18:07:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ with fever, AMS// pneumonia?
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest radiograph ___.
FINDINGS:
Evaluation is mildly limited due to technique. Within this limitation, there
is mild bilateral pulmonary vascular congestion. Previously seen left lower
lobe opacity is not as well visualized. No pneumothorax. No large pleural
effusion, however evaluation of the left costophrenic angles limited and
excluded from field of view. Cardiomediastinal contours appear mildly
enlarged and similar to prior.
3 anchors are noted in the left humeral head. Fusion hardware of the lower
cervical spine is again demonstrated.
IMPRESSION:
Mild bilateral pulmonary vascular congestion. Previously seen left lower lobe
opacity is not as well visualized on this current study. No large pleural
effusion.
|
10023486-RR-26 | 10,023,486 | 20,530,186 | RR | 26 | 2151-07-09 17:47:00 | 2151-07-09 19:50:00 | EXAMINATION: CT abdomen pelvis without contrast
INDICATION: ___ s/p L nephrectomy for traumatic injury to left kidney, now
with pain and induration at ___ drain site// PLease evaluate for subcutaneous
fluid collection at ___ drain site
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 6.9 s, 54.1 cm; CTDIvol = 27.7 mGy (Body) DLP =
1,497.4 mGy-cm.
Total DLP (Body) = 1,497 mGy-cm.
COMPARISON: Outside CTA abdomen pelvis ___. ___ renal
embolization ___.
FINDINGS:
LOWER CHEST: Right basilar opacity is likely atelectasis, but may also
represent aspiration. Small left pleural effusions similar to prior. No
pericardial effusion. Mild aortic valve calcifications are noted.
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 contains layering sludge.
PANCREAS: The pancreas is atrophic without focal lesions within limits of this
noncontrast scan. There is no pancreatic ductal dilatation. There is no
peripancreatic stranding.
SPLEEN: The spleen is massively enlarged measuring up to 27.4 cm, previously
25.1 cm with normal attenuation throughout, without evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: No hydronephrosis of the right kidney. Multiple subcentimeter
hypodense lesions are noted in the right kidney, which are too small to be
characterized but may represent cysts. There is mild perinephric stranding.
Patient is status post left nephrectomy with hematoma in the left nephrectomy
bed containing area of increased density measuring up to 53 in ___ (601; 33),
unable to compared to prior as there are no postoperative images obtained.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber and wall thickness throughout. Diverticulosis throughout the
colon without evidence of diverticulitis. The appendix is normal.
PELVIS: The bladder is decompressed with a Foley catheter. Distal ureters
appear unremarkable. There is no free fluid in the pelvis.
REPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic
disease is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
Posterior fusion hardware at L2-L3 are again demonstrated without evidence of
perihardware lucency or fracture. Alignment is anatomic. Mild-to-moderate
multilevel degenerative changes are noted, most notable at L1-L2 with disc
space narrowing, Schmorl's node, and vacuum phenomenon.
SOFT TISSUES: There is a left anterior approach catheter terminating adjacent
to the spleen in the left mid abdomen. No fluid collections are noted along
the course of this catheter. Minimal soft tissue edema is noted.
Postsurgical changes are noted along the incision in the anterior abdominal
wall with air and soft tissue edema along the surgical scar.
IMPRESSION:
1. No fluid collection is noted along the course of the left anterior approach
drain terminating adjacent to the spleen in the left mid abdomen. The tip of
the drain does not terminate in a fluid collection. No substantial
subcutaneous changes are noted along its course.
2. Hematoma in the left nephrectomy bed contains area of increased density
measuring up to 53 in ___ suggestive of areas of more acute hemorrhage, but
difficult to compare as there are no postoperative images.
3. Air and soft tissue edema is noted along the tract of the surgical scar
along the mid abdomen, consistent with recent intervention
NOTIFICATION: The findings were discussed with Dr. ___. by ___,
M.D. on the telephone on ___ at 7:38 pm, 10 minutes after discovery of
the findings.
|
10023708-RR-45 | 10,023,708 | 28,410,180 | RR | 45 | 2144-08-30 13:20:00 | 2144-08-30 15:58:00 | INDICATION: ___ female with acute onset of nausea, lightheadedness,
elevated lactate. Evaluate for acute cardiopulmonary process.
COMPARISON: ___.
TECHNIQUE: PA and lateral chest radiograph.
FINDINGS: A round retrocardiac opacity with an air fluid level abutting the
left paravertebral stripe is a hiatal hernia. No other focal opacities are
noted. Cardiomnediastinal and hilar contours are unremarkable. No pleural
effusion or pneumothorax.
IMPRESSION: Hiatal hernia. Otherwise, unremarkable chest radiographic
examination.
|
10023708-RR-46 | 10,023,708 | 28,410,180 | RR | 46 | 2144-08-30 16:12:00 | 2144-08-30 18:07:00 | INDICATION: Patient with nausea, vomiting, and elevated lactate. Assess for
bowel ischemia.
COMPARISONS: None available.
TECHNIQUE: MDCT-acquired contiguous images through the abdomen and pelvis
were obtained with and without intravenous contrast. Coronally and sagittally
reformatted images were displayed.
FINDINGS:
Imaged lung bases are clear. Bibasilar atelectases is noted. There is no
pleural effusion. Minimal bronchiectasis in the lung bases is present. Heart
is normal in size with small pericardial effusion. Moderate hiatal hernia is
noted.
The liver enhances homogeneously without focal lesions. There is no evidence
of intrahepatic or extrahepatic biliary ductal dilatation. The hepatic
vasculature is patent. The spleen is unremarkable. The pancreas appears
slightly atrophic but enhances homogeneously without ductal dilatation or
peripancreatic fluid collection. The adrenal glands are normal. Kidneys
enhance and excrete contrast symmetrically without evidence of hydronephrosis
or renal masses. Bilateral focal hypodensities are too small to characterize
and likely represent renal cyst. Small and large bowel loops are normal in
caliber without evidence of bowel wall thickening or obstruction.
The intra-abdominal aorta and its branches are notable for severe calcified
atherosclerotic disease without associated aneurysmal changes. There are
scattered mesenteric and retroperitoneal lymph nodes which do not meet CT
criteria for pathologic enlargement. There is no free air or free fluid
within the abdomen.
CT OF THE PELVIS:
The bladder, distal ureters, rectum, and sigmoid colon appear unremarkable.
Uterus is normal. There is a 3.7 x 3.7 x 4 cm (4A:115, 500B:26) predominantly
solid heterogeneously enhancing left adnexal mass with small internal cystic
components. There are no pathologically enlarged pelvic or inguinal lymph
nodes. Trace amount of free fluid is seen within the pelvis. There is no
free air.
OSSEOUS STRUCTURES:
No suspicious lytic or sclerotic lesion is seen. Moderate rotatory scoliosis
of the lumbar spine is noted.
IMPRESSION:
1. No evidence of bowel ischemia.
2. Left adnexal heterogeneously enhancing solid mass, concerning for
malignancy. Further assessment by the pelvic ultrasound exams is recommended.
3. Moderate hiatal hernia.
4. Small pericardial effusion.
5. Extensive calcified atherosclerotic disease of the aorta without
associated aneurysmal changes.
|
10023708-RR-47 | 10,023,708 | 28,410,180 | RR | 47 | 2144-08-31 09:01:00 | 2144-08-31 14:05:00 | INDICATION: Weight loss, nausea, vomiting, and left adnexal mass seen on CT.
COMPARISONS: CT abdomen and pelvis ___.
FINDINGS:
A transabdominal ultrasound was performed. The lesion of concern was too high
in the pelvis to access transvaginally.
In the left adnexa is a 3.7 x 3.9 x 3.1 cm solid, heterogeneous, vascular mass
concerning for malignancy. The borders are somewhat irregular. There is no
cystic component.
The uterus is unremarkable and measures 6.5 x 3.1 x 3.5 cm. The right adnexa
is unremarkable without large mass. There is no ascites.
IMPRESSION:
3.9 cm solid vascular mass in the left adnexa is concerning for malignancy.
|
10023948-RR-12 | 10,023,948 | 24,863,234 | RR | 12 | 2135-07-12 20:27:00 | 2135-07-12 22:07:00 | EXAMINATION: CT PELVIS W/O CONTRAST
INDICATION: ___ with chief complaint of right hip dislocation// Dislocation
position?
TECHNIQUE: Multidetector CT images of the 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 7.8 s, 38.6 cm; CTDIvol = 25.1 mGy (Body) DLP = 969.6
mGy-cm.
Total DLP (Body) = 970 mGy-cm.
COMPARISON: Hip radiograph performed ___, 11 hours prior.
FINDINGS:
PELVIS: Evaluation of the intrapelvic structures is somewhat limited in the
setting of streak artifact from bilateral hip arthroplasties. Within this
limitation, there is mild sigmoid diverticulosis without convincing evidence
of diverticulitis. No evidence of bowel obstruction. Foley catheter is
demonstrated within a somewhat decompressed bladder. There is no free fluid
in the pelvis.
REPRODUCTIVE ORGANS: The visualized portions of the uterus and bilateral
adnexal are unremarkable.
LYMPH NODES: There is no pelvic or inguinal lymphadenopathy.
VASCULAR: No atherosclerotic disease is noted.
BONES: Patient is status post bilateral hip arthroplasties with anterior
superior dislocation of the right-sided femoral component, seen anterior to
the right iliac bone. The left total hip prosthesis appears appropriately
aligned. No evidence of periprosthetic fracture. Spinal fixation hardware at
L5-S1 appears appropriately positioned, without evidence of hardware related
complication. Multilevel laminectomies of the lumbosacral junction are also
noted. There is endplate sclerosis of the endplates adjacent to the L5-S1
intervertebral disc.
SOFT TISSUES: The right iliopsoas is expanded with a 4.7 x 2.2 cm high
attenuating hematoma (03:29). Additional large right gluteal hematoma
measures up to 6.1 x 5.6 x 3.5 cm (3:61, 401:47).
IMPRESSION:
1. Anterior superior dislocation of the femoral component of the right-sided
hip arthroplasty with associated right iliopsoas and right gluteal hematomas.
No evidence of a periprosthetic fracture.
2. Normal alignment of the left hip arthroplasty.
3. Sigmoid diverticulosis without evidence of diverticulitis.
|
10023948-RR-13 | 10,023,948 | 24,863,234 | RR | 13 | 2135-07-13 10:18:00 | 2135-07-13 11:50:00 | EXAMINATION: HIP NAILING IN OR W/FILMS AND FLUORO RIGHT
INDICATION: ___ female presenting with right hip dislocation.
TECHNIQUE: Intraoperative fluoroscopic images were provided.
COMPARISON: Right hip radiograph and CT pelvis dated ___.
FINDINGS:
13 intraoperative images were acquired without a radiologist present.
Images show steps related to reduction of the dislocated right THA. The left
THA is also noted. Total intraoperative fluoroscopic time 216.1 seconds.
IMPRESSION:
Please refer to the operative note for details of the procedure.
|
10023948-RR-16 | 10,023,948 | 24,863,234 | RR | 16 | 2135-07-16 20:25:00 | 2135-07-16 21:48:00 | EXAMINATION: PELVIS AP ___ VIEWS
INDICATION: ___ year old woman s/p right hip explant antibiotic spacer
placement// shoot through lateral
TECHNIQUE: AP radiograph of the pelvis and lateral radiograph of the right
hip.
COMPARISON: CT pelvis ___.
IMPRESSION:
There has been interval removal of the right total hip arthroplasty and
placement of antibiotic spacers. There is a surgical pin in the right femur.
A left total hip arthroplasty is also noted.
|
10023948-RR-17 | 10,023,948 | 24,863,234 | RR | 17 | 2135-07-17 16:10:00 | 2135-07-17 19:30:00 | EXAMINATION: KNEE (2 VIEWS) RIGHT
INDICATION: ___ year old woman with history of R TKA, bilateral THR now with R
hip joint infection and R knee pain/tenderness and warmth// r/o loosening of
hardware R knee
TECHNIQUE: Frontal and lateral view radiographs of the right knee.
COMPARISON: None.
IMPRESSION:
Postsurgical changes from right total knee arthroplasty with patellar
resurfacing are noted. There is focal lucency long the media tibial plateau
and along the anterior bone-cement interface, which may represent
demineralization, however hardware loosening cannot be excluded. Correlation
with prior outside radiographs is recommended to assess for interval change.
A ring like metallic density projecting over the anterior tibial metadiaphysis
may represent postsurgical changes from prior ligament reconstruction. No
acute fracture is identified. Alignment is anatomic.
|
10023948-RR-18 | 10,023,948 | 24,863,234 | RR | 18 | 2135-07-19 10:29:00 | 2135-07-24 11:44:00 | EXAMINATION: US DRAIN/INJ INTERMED JOINT/BURSA W US GUID
INDICATION: ___ year old woman with history of R TKA, bilateral THR now with R
hip PJI and R knee warmth/swelling// please aspirate knee and send for cell
count, gram stain, cultures, AFB fungal and crystals
TECHNIQUE: The risks, benefits, and alternatives were explained to the
patient and written informed consent obtained.
A pre-procedure timeout confirmed three patient identifiers.
Under ultrasound guidance, an appropriate spot was marked the right lateral
knee. The area was prepared and draped in standard sterile fashion.
Three cc of 1% Lidocaine was used to achieve local anesthesia. Under
intermittent ultrasound guidance, a 19-gauge needle was advanced into the
lateral right knee joint. Approximately 2 cc of bloody non purulent fluid was
aspirated.
The needle was removed, hemostasis achieved, and a sterile bandage applied.
The patient tolerated the procedure well and left the department in good
condition. There were no immediate complications.
COMPARISON: Compared to radiographs of the right knee from ___
FINDINGS:
There is a trace amount of suprapatellar knee joint fluid. This was targeted.
There is extensive subcutaneous soft tissue edema skin thickening. The
quadriceps tendon and patellar ligament are intact
IMPRESSION:
1. Imaging Findings - as above.
2. Procedure-aspiration of 2 cc of bloody non purulent fluid from the right
knee.
|
10023948-RR-19 | 10,023,948 | 24,863,234 | RR | 19 | 2135-07-19 17:33:00 | 2135-07-19 18:11:00 | EXAMINATION: DX CHEST PORTABLE PICC LINE PLACEMENT
INDICATION: ___ year old woman with picc// r picc 40cm ___ iv ___ Contact
name: ___: ___
TECHNIQUE: AP radiograph of the chest.
COMPARISON: None.
FINDINGS:
There is a right upper extremity PICC which terminates in the lower superior
vena cava.
There is no focal consolidation, pleural effusion or pneumothorax. The
cardiomediastinal silhouette is within normal limits. No acute osseous
abnormalities are identified. Healed right rib fractures are noted. There is
partially visualized posterior spinal fusion hardware in the cervical spine
and thoracolumbar spine.
IMPRESSION:
1. The right upper extremity PICC terminates in the lower superior vena cava.
2. No pneumonia or acute cardiopulmonary process.
|
10024012-RR-45 | 10,024,012 | 23,111,013 | RR | 45 | 2134-08-12 20:03:00 | 2134-08-12 20:38:00 | INDICATION: ___ with fall// fx?
COMPARISON: Pelvis and right hip radiographs performed on same date from
outside hospital.
FINDINGS:
AP pelvis and AP and lateral views of the right femur were provided. The
previously described right subcapital femoral neck fracture is not well
visualized. No fracture is seen involving the remainder of the right femur.
Degenerative changes at the right knee are mild to moderate in extent with
marginal spurring. No joint effusion at the right knee. Vascular
calcifications are present. The bony pelvic ring appears intact. The left
hip appears to align normally.
IMPRESSION:
Right femoral neck fracture better assessed on outside hospital radiographs
performed on same date. No additional fracture is seen.
|
10024012-RR-47 | 10,024,012 | 23,111,013 | RR | 47 | 2134-08-12 19:36:00 | 2134-08-12 20:29:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ with hypoxia// hypoxia
COMPARISON: Prior chest radiograph is dated ___
FINDINGS:
AP portable upright view of the chest. Midline sternotomy wires are again
noted. There is a large retrocardiac density which is better assessed on
prior study which included a lateral view and most suggestive of a large
hiatal hernia. A prosthetic cardiac valve is again seen projecting over the
heart. There is no consolidation concerning for pneumonia. No large effusion
or pneumothorax. No overt signs of edema. Imaged bony structures are intact.
Overall cardiomediastinal silhouette appears stable. No free air below the
right hemidiaphragm.
IMPRESSION:
1. Large retrocardiac opacity likely represents known large hiatal hernia.
2. No gross signs for pneumonia or edema.
|
10024012-RR-48 | 10,024,012 | 23,111,013 | RR | 48 | 2134-08-12 22:31:00 | 2134-08-12 23:48:00 | EXAMINATION: CTA CHEST WITH CONTRAST
INDICATION: History: ___ with AF with RVR and new hypoxia// pe?
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 2.5 s, 0.5 cm; CTDIvol = 15.2 mGy (Body) DLP =
7.6 mGy-cm.
2) Spiral Acquisition 3.4 s, 26.8 cm; CTDIvol = 7.2 mGy (Body) DLP = 193.9
mGy-cm.
Total DLP (Body) = 201 mGy-cm.
COMPARISON: None available.
FINDINGS:
HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the
subsegmental level without filling defect to indicate a pulmonary embolus. The
main pulmonary artery is dilated up to 3.0 cm suggestive of but not diagnostic
of pulmonary arterial hypertension. The ascending thoracic aorta is mildly
dilated measuring up to 3.6 cm. The descending thoracic aorta is normal in
caliber. Incidental note made of an aberrant right subclavian artery, a
normal variant. No evidence of dissection or intramural hematoma. The heart
is moderately enlarged. Patient is status post aortic valve replacement.
Moderate coronary artery calcifications. No pericardial effusion.
AXILLA, HILA, AND MEDIASTINUM: Multiple prominent mediastinal lymph nodes are
noted measuring up to 0.8 cm. Scattered prominent hilar lymph nodes are also
noted on the left measuring up to 0.7 cm. No axillary lymphadenopathy. No
mediastinal mass. There is a large hiatal hernia.
PLEURAL SPACES: No pleural effusion or pneumothorax.
LUNGS/AIRWAYS: There is bilateral dependent atelectasis. Septal thickening is
consistent with mild interstitial edema. There is a 1.3 x 1.0 cm right upper
lobe nodular opacity (series 3, image 55). Subcentimeter nodular opacities
throughout the lungs, for example in the upper lobe on series 3, image 26, in
right middle and lower lobes on series 3, image 133, an in left upper lobe on
series 3, image 75. There is mild diffuse bronchial wall thickening,
concerning for infection/inflammation. Otherwise, the airways are patent to
the level of the segmental bronchi bilaterally.
BASE OF NECK: Visualized portions of the base of the neck show no abnormality.
ABDOMEN: Limited evaluation of the upper abdomen is unremarkable aside form a
large hiatal hernia.
BONES: No suspicious osseous abnormality is seen.? degenerative changes of the
thoracic spine are severe. Compression deformity of T8 indeterminate
chronicity, although no definite surrounding hematoma or fracture line
identified. Median sternotomy wires are intact. There is a 3.9 x 1.6 cm left
subscapularis lipoma.
IMPRESSION:
1. No evidence of pulmonary embolism or aortic abnormality.
2. Mild interstitial edema.
3. Multiple subpleural rule opacities throughout the lungs with the largest
measures 1.3 x 1.0 cm in the right upper lobe, which may be
infectious/inflammatory. Follow-up chest CT in 3 months is recommended to
assess resolution.
4. T8 deformity of indeterminate chronicity, although no definite surrounding
hematoma or fracture line identified.
|
10024012-RR-49 | 10,024,012 | 23,111,013 | RR | 49 | 2134-08-13 11:52:00 | 2134-08-13 14:00:00 | EXAMINATION: HIP UNILAT MIN 2 VIEWS RIGHT
INDICATION: Closed reduction pinning.
COMPARISON: Preoperative radiograph of the pelvis and both hips ___.
FINDINGS:
2 intraoperative images were acquired without a radiologist present.
Images show 3 cannulated screws placed within the right femoral neck, for
subcapital fracture.. Total fluoroscopic time 82.7 seconds.
IMPRESSION:
Please refer to the operative note for details of the procedure.
|
10024012-RR-50 | 10,024,012 | 23,111,013 | RR | 50 | 2134-08-16 12:54:00 | 2134-08-16 16:36:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with history of AF, AS s/p AVR, presenting with
R femoral neck fracture s/p ORIF, now with worsening AMS// Eval for PNA
TECHNIQUE: Portable chest radiograph
COMPARISON: CT chest dated ___
Chest radiograph dated ___
FINDINGS:
Compared to recent imaging on ___, there is interval improved
aeration of the bilateral lungs. There is no suspicious focal consolidation,
effusion, or pneumothorax. The mediastinum is unremarkable.
Large hiatus hernia partially obscures cardiac silhouette. Redemonstration of
multiple intact median sternotomy wires.
IMPRESSION:
1. No evidence of pneumonia.
2. Large hiatal hernia.
|
10024331-RR-97 | 10,024,331 | 26,698,935 | RR | 97 | 2144-02-27 16:15:00 | 2144-03-01 17:35:00 | INDICATION: ___ man with asymmetric edema of the right leg.
COMPARISON: No previous exam for comparison.
FINDINGS: On a surveillance of unread cases, this exam was discovered and is
unread from ___.
Gray-scale, color and Doppler images were obtained of the right common
femoral, femoral, popliteal and tibial veins. Normal flow, compression and
augmentation is seen in all of the vessels. There is superficial edema noted
in the right calf and in the right popliteal fossa.
IMPRESSION: No evidence of deep vein thrombosis in the right leg.
Superficial edema is seen in the right popliteal fossa and calf regions.
|
10024913-RR-55 | 10,024,913 | 27,207,228 | RR | 55 | 2164-07-22 04:17:00 | 2164-07-22 05:48:00 | INDICATION: Chest pain, evaluate for acute cardiopulmonary process.
COMPARISON: Chest radiograph on ___.
FINDINGS: PA and lateral views of the chest. There are lower lung volumes
compared to prior study, which exaggerates the size of the heart and the
interstitial markings. There is likely bibasilar atelectasis which may be
exaggerated by low lung volumes. No pleural effusion or pneumothorax is seen.
The mediastinal contours are normal. A calcified pleural plaque is again seen
in the right lower lung. The aorta is either tortuous or dilated, unchanged
compared to ___. There are significant coronary artery calcifications.
IMPRESSION: Low lung volumes and likely bibasilar atelectasis. No definite
evidence of acute cardiopulmonary process.
|
10024982-RR-18 | 10,024,982 | 24,190,442 | RR | 18 | 2203-09-17 18:30:00 | 2203-09-17 18:41:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: History: ___ with exertional chest pain and shortness of breath
TECHNIQUE: Chest PA and lateral
COMPARISON: CT chest ___ and chest radiograph ___
FINDINGS:
Patient is status post median sternotomy and CABG. A left-sided dual-lumen
pacemaker device is noted with leads terminating in the right atrium and right
ventricle. Heart size remains moderately enlarged but unchanged. Mediastinal
and hilar contours are similar. There is mild pulmonary vascular congestion
without overt pulmonary edema. Small right pleural effusion appears new in
the interval. Streaky bibasilar airspace opacities may reflect atelectasis
though infection cannot be completely excluded. No pneumothorax is detected.
Mild degenerative changes are noted in the thoracic spine.
IMPRESSION:
Small right pleural effusion with patchy bibasilar airspace opacities,
possibly atelectasis though infection is not excluded. Mild pulmonary
vascular congestion.
|
10025647-RR-61 | 10,025,647 | 28,326,162 | RR | 61 | 2180-09-10 10:12:00 | 2180-09-10 12:26:00 | CHEST RADIOGRAPH PERFORMED ON ___
Comparison is made with prior study from ___.
CLINICAL HISTORY: ___ man with history of CHF, now with cough and
dyspnea, question pneumonia or CHF.
FINDINGS: PA and lateral views of the chest are provided. AICD device is
unchanged in position with lead tips extending to the coronary sinus and right
ventricle. The midline sternotomy wires and mediastinal clips are again
noted. There is interval development of pulmonary edema with pulmonary
vascular congestion and subtle alveolar ground-glass opacity noted. Bilateral
pleural effusions, left greater than right are noted with left basilar
atelectasis, likely compressive. Bony structures are intact. Overall,
cardiomediastinal silhouette is stable. Calcified granuloma in the left upper
lung noted.
IMPRESSION: Interval development of pulmonary edema with bilateral pleural
effusions, left greater than right.
|
10025647-RR-65 | 10,025,647 | 28,326,162 | RR | 65 | 2180-09-12 16:07:00 | 2180-09-13 11:29:00 | REASON FOR EXAMINATION: Evaluation of the patient with pulmonary edema after
diuresis.
PA and lateral upright chest radiographs were reviewed in comparison to
___.
Heart size and mediastinum are stable. There is substantial interval
improvement up to almost complete resolution of pulmonary edema. Minimal
retrocardiac opacity is noted in the left lower lung, potentially representing
atelectasis. Pacemaker leads including the abandoned lead terminate in right
atrium, right ventricle and the left ventricle epicardial location. Small
amount of pleural effusion is better appreciated on the lateral view, most
likely on the left with potentially minimal amount of right pleural effusion
demonstrated as well.
|
10025647-RR-66 | 10,025,647 | 20,302,361 | RR | 66 | 2180-11-18 08:52:00 | 2180-11-18 11:32:00 | INDICATION: Cough, flu-like symptoms. Please evaluate for pneumonia.
COMPARISON: Comparison is made to multiple prior chest radiographs, most
recently dated ___.
FINDINGS: Unchanged mediastinal and hilar borders. Heart size demonstrates
stable cardiomegaly. Multifocal opacifications throughout both lungs and may
represent atypical infectious process with a less likely consideration given
to pulmonary edema; there is relative absence of central pulmonary vessel
prominence. No pleural effusion or pneumothorax is evident. Redemonstration
of pacemaker including abandoned leads in the right atrium, right ventricle
and left ventricle epicardial location, unchanged.
IMPRESSION: Multifocal opacification throughout both lungs, possibly
representing atypical infectious process, with a less likely consideration
given to pulmonary edema.
|
10025647-RR-68 | 10,025,647 | 20,807,698 | RR | 68 | 2181-05-11 20:26:00 | 2181-05-11 21:58:00 | EXAM: Chest, frontal and lateral views.
CLINICAL INFORMATION: Shortness of breath and cough.
___.
FINDINGS: Frontal and lateral views of the chest were obtained. Triple lead
left-sided pacemaker is again seen with leads similar in position. There is
elevation of the left hemidiaphragm and slight blunting of the left
costophrenic angle which may be due to a small pleural effusion with overlying
atelectasis. Calcifications project over the left mid lung. No right pleural
effusion is seen. The right lung is clear.
IMPRESSION: Left base opacity may be due to combination of pleural effusion
and atelectasis.
|
10025647-RR-69 | 10,025,647 | 20,807,698 | RR | 69 | 2181-05-11 19:57:00 | 2181-05-11 21:30:00 | HISTORY: Coumadin, status post fall and INR of 9.
COMPARISON: Non-contrast head CT ___.
TECHNIQUE: Contiguous axial MDCT images were obtained of the head without
contrast. Multiplanar reformatted images were generated in the coronal and
sagittal planes as well as thin section bone algorithm images.
FINDINGS: There is no hemorrhage, edema, mass effect or acute vascular
territorial infarct. Prominent ventricles and sulci are suggestive of
age-related involutional change. Diffuse periventricular, subcortical and
deep white matter hypodensity is compatible with chronic small vessel ischemic
disease. The basal cisterns are patent and there is preservation of
gray-white matter differentiation. No fracture is identified. Mucosal wall
thickening is noted in the left frontal sinus. The remainder of the paranasal
sinuses, mastoid air cells and middle ear cavities are clear. Globes are
intact.
IMPRESSION: No acute intracranial abnormality.
|
10025647-RR-70 | 10,025,647 | 20,807,698 | RR | 70 | 2181-05-11 19:57:00 | 2181-05-11 21:28:00 | HISTORY: Coumadin status post fall and INR of 9.
TECHNIQUE: Axial helical MDCT images were obtained of the cervical spine
without contrast. Multiplanar reformatted images were generated in the
coronal and sagittal planes as well as thin-section bone algorithm images.
DLP: 735.03 mGy-cm.
COMPARISON: Noncontrast C-spine CT ___.
FINDINGS:
The osseous structures are grossly demineralized. No fracture or malalignment
is identified. The prevertebral soft tissues are unremarkable. There are
multilevel multifactorial degenerative changes of the cervical spine with
prominent anterior and posterior osteophytes particularly at the level of
C5/C6 which mildly indents the ventral thecal sac. Multilevel disc space
narrowing is most severe at the C5/C6. Multilevel facet joint and
uncovertebral hypertrophic changes mildly narrow the neural foramina.
A calcification is again noted in the right thyroid lobe. The thyroid is
otherwise unremarkable. The trachea is midline. The imaged lung apices are
clear. Left-sided pacer leads are partially imaged.
IMPRESSION:
No acute fracture or malalignment.
|
10025747-RR-34 | 10,025,747 | 28,292,012 | RR | 34 | 2182-12-03 15:14:00 | 2182-12-03 15:37:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: History: ___ with hypoxia, weakness//evaluate for pneumonia
TECHNIQUE: Upright AP view of the chest
COMPARISON: None.
FINDINGS:
Cardiac silhouette size is normal. Mediastinal and hilar contours are
unremarkable. The pulmonary vasculature is not engorged. Elevation of the
right hemidiaphragm is of indeterminate chronicity. Patchy opacities within
the lung bases likely reflect areas of atelectasis. No pleural effusion or
focal consolidation is noted. There are no acute osseous abnormalities. No
subdiaphragmatic free air is present.
IMPRESSION:
Elevation of the right hemidiaphragm of unknown chronicity. Patchy opacities
in lung bases may reflect atelectasis. No subdiaphragmatic free air.
|
10025747-RR-35 | 10,025,747 | 28,292,012 | RR | 35 | 2182-12-03 19:57:00 | 2182-12-03 21:48:00 | EXAMINATION: CT CHEST ABDOMEN AND PELVIS
INDICATION: ___ year old woman with abd pain and hypoxia hx of chrons. Rule
out pulmonary embolism and evaluate for acute intra-abdominal process.
TECHNIQUE: Axial multidetector CT images were obtained through the thorax
after the uneventful administration of intravenous contrast in the arterial
phase. Then, imaging was obtained through the abdomen and pelvis in the
portal venous phase. Reformatted coronal and sagittal images through the
chest, abdomen, and pelvis, and oblique maximal intensity projection images of
the chest were submitted to PACS and reviewed. Volumen oral contrast was
administered.
DOSE: Total DLP (Body) = 974 mGy-cm.
COMPARISON: None.
FINDINGS:
CHEST:
HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the
subsegmental level without filling defect to indicate a pulmonary embolus.
The thoracic aorta is normal in caliber without evidence of dissection or
intramural hematoma. The heart, pericardium, and great vessels are within
normal limits. No pericardial effusion is seen.
AXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar
lymphadenopathy is present. No mediastinal mass.
PLEURAL SPACES: No pleural effusion or pneumothorax.
LUNGS/AIRWAYS: Bilateral diaphragmatic eventration is, right greater than left
are associated with areas of atelectasis in the lower lungs. A 5 mm left
fissural nodule and 4 mm right middle lobe nodule are noted (02:49 and 02:44
respectively). The airways are patent to the level of the segmental bronchi
bilaterally.
BASE OF NECK: Visualized portions of the base of the neck show no abnormality.
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 with normal nephrogram.
There is an 8.6 x 6.2 cm cyst in the left inferior pole that measures 8.6 x
6.2 cm and is simple fluid density, although has multiple septations (2:131).
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 is
mildly dilated and fluid-filled reflecting Volumen prep. Thickening and
hyperemia of the colon extends from the proximal transverse colon through the
descending colon. The sigmoid colon appears relatively normal though slightly
dilated up to 6.8 cm in diameter. Overall appearance is most suggestive of
acute on chronic Crohn's flare. No definite bowel obstruction. There is no
free intraperitoneal fluid or free air.
PELVIS:
The urinary bladder and distal ureters are unremarkable. There is no free
fluid in the pelvis.
REPRODUCTIVE ORGANS: The uterus contains multiple hypodense rounded structures
and calcification, most likely fibroids. The adnexae are unremarkable.
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 AND SOFT TISSUES: Degenerative changes of the lumbar spine are noted.
There is no evidence of worrisome osseous lesions or acute fracture. There is
a small fat containing umbilical hernia.
IMPRESSION:
1. No pulmonary embolism or acute aortic abnormality.
2. Acute on chronic Crohn's flare with thickened hyperemic transverse and
descending colon. No definite bowel obstruction.
3. Large left upper pole renal cyst with septations may be further assessed
with non-emergent renal ultrasound.
4. Fibroid uterus.
5. Two lung nodules measuring up to 5 mm along the left fissure.
RECOMMENDATION(S): For incidentally detected multiple solid pulmonary
nodules smaller than 6mm, no CT follow-up is recommended in a low-risk
patient, and an optional CT follow-up in 12 months is recommended in a
high-risk patient.
See the ___ ___ Society Guidelines for the Management of Pulmonary
Nodules Incidentally Detected on CT" for comments and reference:
___
|
10025747-RR-36 | 10,025,747 | 28,292,012 | RR | 36 | 2182-12-05 09:04:00 | 2182-12-05 10:02:00 | EXAMINATION: Chest single view
INDICATION: ___ with a history of Crohn's onHumira presenting with
abdominal pain and leukocytosis found tohave colitis on CT, concerning for
acute-on-chronic Crohns flare.// febrile
TECHNIQUE: Chest portable AP
COMPARISON: ___
FINDINGS:
The scoliosis of the spine convex to the right. There is elevation of the
right hemidiaphragm, unchanged the previous film. The heart is not enlarged.
There is increased patchy opacity in the left base which may represent
pneumonia and which appears more prominent than on the previous radiograph
IMPRESSION:
Suspect the left lower lobe pneumonia.
|
10025747-RR-37 | 10,025,747 | 28,292,012 | RR | 37 | 2182-12-05 14:02:00 | 2182-12-05 15:25:00 | INDICATION: ___ year old woman with hx of chrons and abdominal distention//
?ileus
TECHNIQUE: Supine and upright abdominal radiographs were obtained.
COMPARISON: CT abdomen and pelvis from ___
FINDINGS:
In addition to diffuse colonic distension seen on ___, there is new
small bowel dilation in the mid abdomen. Large amount of stool is seen in the
rectum. Multiple radiopaque rounded densities are seen projecting over the
left lower lung, presumably ingested material in the esophagus.
There is no large free intraperitoneal air.
Osseous structures are unremarkable, aside from mild S shaped scoliosis.
IMPRESSION:
Interval development of small bowel dilation in addition to diffuse colonic
ileus. Multiple air-fluid levels are seen in the colon. While this
appearance is most likely due to small bowel and colonic ileus, consider
obtaining cross-sectional imaging if there is concern for obstruction.
|
10025747-RR-38 | 10,025,747 | 28,292,012 | RR | 38 | 2182-12-06 08:20:00 | 2182-12-06 16:19:00 | INDICATION: ___ year old woman with Crohn's disease, increasing distention.
Concern for obstruction.
TECHNIQUE: Frontal and left lateral decubitus views of the abdomen
COMPARISON: Abdominal x-ray from ___
CT abdomen and pelvis from ___
FINDINGS:
Diffuse colonic and small bowel dilatation. Multiple colonic air-fluid
levels.
There is no free intraperitoneal air.
Osseous structures are unremarkable.
There are no unexplained soft tissue calcifications or radiopaque foreign
bodies.
IMPRESSION:
Colonic and small bowel dilatation likely ileus, consider cross-sectional
imaging if there is concern for obstruction.
|
10025747-RR-39 | 10,025,747 | 28,292,012 | RR | 39 | 2182-12-08 10:51:00 | 2182-12-08 15:44:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old woman with active Crohns flare and LLL pneumonia.
Hypoxic to low ___ on 4L O2. Please evaluate for worsening pneumonia.// Please
evaluate for worsening pneumonia. Please evaluate for worsening pneumonia.
IMPRESSION:
Compared to chest radiographs ___ and ___.
Left basal peribronchial opacification is improved slightly. Right
hemidiaphragm remains severely elevated and is responsible for new right
middle lobe atelectasis. Upper lungs are clear. Heart size is normal.
Pleural effusions small if any. No pneumothorax.
|
10025747-RR-40 | 10,025,747 | 28,292,012 | RR | 40 | 2182-12-09 08:31:00 | 2182-12-09 12:05:00 | INDICATION: ___ year old woman with Crohn's flare, comparison to previous
abdomen film
TECHNIQUE: Frontal and left lateral decubitus radiographs of the abdomen
COMPARISON: Abdominal radiographs from ___
FINDINGS:
No significant change in multiple mildly dilated small bowel loops filled with
gas and mild gas distention of the colon. No definite free air.
IMPRESSION:
No significant change in bowel distention from the exam done two days ago. No
free air demonstrated.
|
10025747-RR-41 | 10,025,747 | 28,292,012 | RR | 41 | 2182-12-12 15:42:00 | 2182-12-12 16:11:00 | INDICATION: ___ year old woman with new hypoxia and recent CAP.// atelectasis
evolution, pulmonary edema
TECHNIQUE: Chest PA and lateral
COMPARISON: ___
FINDINGS:
There are low bilateral lung volumes. The right hemidiaphragm is again noted
to be markedly elevated in comparison to the left. Bibasilar linear opacities
likely reflect atelectasis. There is no evidence of pulmonary edema or
pleural effusions. No pneumothorax. The size of the cardiac silhouette is
within normal limits. There is an S shaped scoliosis of the thoracic spine.
IMPRESSION:
No significant interval change since the prior chest radiograph. No evidence
of pulmonary edema.
|
10025747-RR-42 | 10,025,747 | 28,292,012 | RR | 42 | 2182-12-15 17:08:00 | 2182-12-15 18:37:00 | EXAMINATION: CT abdomen and pelvis with IV and PO contrast.
INDICATION: ___ year old woman with Crohn' s and worsening leukocytosis//R/U
abscess
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) Spiral Acquisition 3.6 s, 57.7 cm; CTDIvol = 9.7 mGy (Body) DLP = 557.1
mGy-cm.
2) Stationary Acquisition 4.0 s, 0.5 cm; CTDIvol = 23.5 mGy (Body) DLP =
11.7 mGy-cm.
Total DLP (Body) = 569 mGy-cm.
COMPARISON: CT abdomen pelvis ___. Abdominal MRI ___.
FINDINGS:
LOWER CHEST: Right-greater-than-left basilar atelectasis. There is no
evidence of pleural or pericardial effusion.
ABDOMEN:
HEPATOBILIARY: Wedge-shaped area of relative decreased perfusion of the
superior right hepatic lobe/dome is suggestive of a hepatic infarct. This is
more conspicuous than the prior study and consistent with infarct evolution.
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 unchanged in size with normal nephrogram. No
hydronephrosis bilaterally. Large exophytic cyst arising from the upper pole
of the left kidney with thin enhancing septations measures 8.5 x 6.2 cm,
previously measured 5.1 cm. There is no perinephric abnormality.
GASTROINTESTINAL: Similar mild thickening of the lower esophagus is
nonspecific. Mild distended stomach filled with debris. Small bowel loops
demonstrate normal caliber, wall thickness, and enhancement throughout.
Interval resolution of wall thickening and fat stranding of the left colon.
Diverticulosis of the sigmoid colon is noted, without evidence of wall
thickening and fat stranding. Moderate colonic stool, consider constipation.
The appendix is not visualized. No evidence of intra-abdominal abscess.
PELVIS: Bladder is mildly distended but otherwise unremarkable. The bilateral
ureters are normal caliber. There is no free fluid in the pelvis.
REPRODUCTIVE ORGANS: There is an enlarged, fibroid uterus including a
partially calcified fibroid. No adnexal abnormality is seen.
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. IVC normal caliber. Portal vein is patent.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
Rotatory scoliosis. Degenerative change of the spine.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. No evidence of intra-abdominal abscess.
2. Interval increased conspicuity of right hepatic lobe wedge-shaped perfusion
abnormality likely representing evolving infarct.
3. Moderate colonic stool, consider constipation.
4. Mildly increased size of left renal cyst with thin enhancing septations
measuring 8.5 cm, previously measured 5.1 cm.
5. Additional findings as above.
|
10025747-RR-43 | 10,025,747 | 28,292,012 | RR | 43 | 2182-12-18 12:13:00 | 2182-12-18 19:47:00 | EXAMINATION: MRI of the Abdomen
INDICATION: ___ year old woman with crohn's flare, found to have peripheral
liver lesion suspicious for infarct, want to r/u underlying lesion//
peripheral liver lesion suspicious for liver lesion, r/u underlying lesion
TECHNIQUE: Multiplanar multisequence MR imaging of the abdomen was performed
without and with intravenous administration of 7 cc Gadavist contrast as per
___ liver mass protocol
COMPARISON: ___ abdomen and pelvis CT
FINDINGS:
Lower Thorax: A linear opacity at the right lung base, likely represents
atelectasis. There is no pleural effusion.
Liver: The liver demonstrates normal shape, contour, and signal intensity.
The enhancement is homogeneous without focal lesions. Previously seen
wedge-shaped area of hypoenhancement at the dome of the liver on recent CT is
not well appreciated on MRI.
Biliary: There is no intra or extrahepatic biliary dilatation. The
gallbladder is within normal limits.
Pancreas: The pancreas demonstrate normal signal on T1 weighted images. The
main pancreatic duct is not dilated. There is no focal lesion or
peripancreatic stranding.
Spleen: The spleen is normal.
Adrenal Glands: Adrenal glands are within normal limits.
Kidneys: The kidneys enhance and excrete symmetrically. There a simple left
renal cyst that is large and exophytic measuring 8.5 cm. An additional
millimetric left renal cyst is also noted. There is no hydronephrosis.
Gastrointestinal Tract: Visualized loops of small and large bowel are
unremarkable.
Lymph Nodes: There is no lymphadenopathy.
Vasculature: The abdominal aorta is normal in caliber. The celiac axis and
its major branches are patent. The portal vein, splenic vein, and superior
mesenteric vein are patent.
Osseous and Soft Tissue Structures: Thoracolumbar scoliosis is noted.
IMPRESSION:
Previously seen abnormality at dome of the liver is not visualized on MRI.
The liver enhances homogeneously and there is no evidence of focal mass or
infarction.
|
10025791-RR-5 | 10,025,791 | 25,012,487 | RR | 5 | 2170-11-15 13:25:00 | 2170-11-15 14:10:00 | HISTORY: ___ male with question new CHF diagnosis. Question
pulmonary edema.
COMPARISON: None.
FINDINGS:
Frontal and lateral views of the chest. The lungs are clear of consolidation,
effusion, or pulmonary vascular congestion. The cardiac silhouette slightly
enlarged and the aorta is tortuous. No acute osseous abnormality detected.
IMPRESSION:
No acute cardiopulmonary process. Note evidence of congestive failure.
|
10025981-RR-26 | 10,025,981 | 20,580,099 | RR | 26 | 2150-02-14 19:25:00 | 2150-02-14 20:20:00 | EXAMINATION: UNILAT LOWER EXT VEINS RIGHT
INDICATION: ___ with RLE swelling and pain, s/p right knee arthroplasty and
hx of dvt // please evaluate for dvt
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the right lower extremity veins.
COMPARISON: None.
FINDINGS:
There is normal compressibility, flow, and augmentation of the right common
femoral and femoral veins. There is normal color flow in the popliteal vein.
The posterior tibial and peroneal veins could not be evaluated due to patient
discomfort and habitus.
There is normal respiratory variation in the common femoral veins bilaterally.
No evidence of medial popliteal fossa (___) cyst.
IMPRESSION:
1. No evidence of deep venous thrombosis in the right common femoral, deep
and superficial femoral, and popliteal veins.
2. The peroneal and posterior tibial veins could not be assessed.
|
10025981-RR-27 | 10,025,981 | 20,580,099 | RR | 27 | 2150-02-14 21:42:00 | 2150-02-14 21:58:00 | INDICATION: ___ with right ___ pain, right knee pain // please evaluate for
bony abnormality
TECHNIQUE: AP, oblique, and lateral views of the right knee.
COMPARISON: ___ knee films.
FINDINGS:
Postoperative changes of right total knee arthroplasty are again noted. There
is no periprosthetic lucency nor fracture. Skin staples are in place. Prior
drains have been removed. Soft tissue swelling seen superior and anterior to
the patella compatible with recent surgery.
IMPRESSION:
No fracture.
|
10026246-RR-13 | 10,026,246 | 27,069,095 | RR | 13 | 2138-02-27 07:30:00 | 2138-02-27 10:04:00 | EXAMINATION: CT abdomen and pelvis without contrast
INDICATION: ___ with acute onset abd pain while in ED, tenderness. Evaluate
for small-bowel obstruction.
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: Total DLP (Body) = 390 mGy-cm.
COMPARISON: MR ___ with contrast performed ___.
FINDINGS:
LOWER CHEST: Multiple pleural plaques, several calcified reflect prior
asbestos exposure. No worrisome pulmonary nodule or mass. There is mild
pericardial thickening versus trace pericardial effusion.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout.
There is no evidence of focal lesions within the limitations of an unenhanced
scan. There is mild prominence of the intrahepatic biliary tree. No evidence
of extrahepatic biliary dilatation. The gallbladder is distended and contains
multiple layering calcified gallstones without wall thickening or evidence of
inflammation. There is no definite evidence for a common bile duct stone.
PANCREAS: The pancreas is atrophic, 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 bilateral kidneys are atrophic but symmetric in size. Simple
appearing left renal cyst in the right upper and lower pole kidney measuring
1.1 x 1.3 cm and 1.6 x 1.6 cm respectively (02: 20, 27). Otherwise, 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: Small hiatal hernia, the stomach is otherwise unremarkable.
Small bowel loops demonstrate normal caliber and wall thickness throughout.
Incidental note is made of a duodenal diverticulum (601:32). Diverticulosis
of the sigmoid colon is noted, without evidence of wall thickening and fat
stranding. The appendix is normal.
PELVIS: Herniation of the urinary bladder into the right inguinal canal
without evidence of incarceration (2:72, 601:25). Otherwise, the remaining
visualized urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: Small aneurysm of the infrarenal abdominal aorta measures 3.0 x 2.4
cm (02:29). Extensive atherosclerotic disease is noted.
BONES: Again seen, is an acute burst fracture of the L1 vertebral body with 4
mm posterior fragment retropulsion is better assessed on MR lumbar spine
performed ___. Otherwise there is mild to moderate degenerative
changes of the lumbar spine including chronic appearing decreased in height
with a superior endplate Schmorl's node at the L5 vertebral body.
SOFT TISSUES: Bladder containing right-sided inguinal hernia as described
above. Otherwise, the abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. Cholelithiasis with gallbladder distension and apparent mild intrahepatic
biliary ductal dilation raises potential concern for
choledocholithiasis/cholangitis. Please correlate clinically.
2. L1 burst fracture with 4 mm posterior fragment retropulsion, better
assessed on MR lumbar spine performed ___.
3. Extensive atherosclerotic calcifications with a small aneurysm of
infrarenal abdominal aorta measuring up to 3.0 x 2.4 cm.
4. Right inguinal hernia containing a portion of the urinary bladder,
uncomplicated.
5. Calcified pleural plaques the lung bases likely reflect prior asbestos
exposure.
RECOMMENDATION(S): Clinical correlation for possible
choledocholithiasis/cholangitis given prominence of the intrahepatic biliary
tree, gallbladder distension and gallstones.
|
10026246-RR-14 | 10,026,246 | 27,069,095 | RR | 14 | 2138-02-27 15:10:00 | 2138-02-27 15:50:00 | EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ with abdominal pain// eval for cholecystitis, cbd diameter
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: CT abdomen pelvis ___
FINDINGS:
LIVER: The hepatic parenchyma appears within normal limits. The contour of the
liver is smooth. There is no focal liver mass. The main portal vein is patent
with hepatopetal flow. There is no ascites.
BILE DUCTS: There is mild intrahepatic biliary dilation. The CHD measures 5
mm.
GALLBLADDER: The gallbladder is distended and filled with stones and sludge.
There is no gallbladder wall edema or pericholecystic fluid.
PANCREAS: The pancreas is not well visualized, largely obscured by overlying
bowel gas.
KIDNEYS: Limited views of the right kidney show no hydronephrosis.
RETROPERITONEUM: The visualized portions of aorta and IVC are within normal
limits.
IMPRESSION:
Cholelithiasis with gallbladder distension and dilation of the intrahepatic
biliary tree with normal caliber CBD. Findings raise potential concern for
Mirizzi syndrome.
|
10026255-RR-10 | 10,026,255 | 20,437,651 | RR | 10 | 2200-09-21 10:13:00 | 2200-09-21 14:08:00 | TYPE OF EXAMINATION: Chest PA and lateral.
INDICATION: ___ male patient status post fall with right-sided
pneumothorax, recent removal of right-sided pigtail catheter, evaluate for
pneumothorax.
FINDINGS: Patient's clinical condition required examination in sitting
semi-upright position using AP frontal and left lateral views. Comparison is
made with the next preceding similar chest examination of ___.
The pigtail and right-sided pleural drainage catheter had been removed already
prior to the preceding examination of ___. Consequently status of patient
is unchanged during the latest one-day examination interval. Again, there is
no evidence of pneumothorax in the apical area. No new pulmonary parenchymal
infiltrates are seen and the bilateral basal linear densities representing
atelectasis remain rather unchanged.
IMPRESSION: No pneumothorax.
|
10026255-RR-11 | 10,026,255 | 20,437,651 | RR | 11 | 2200-09-23 16:49:00 | 2200-09-24 10:10:00 | HISTORY: Shortness of breath and productive cough. History of recent fall
and rib fractures.
COMPARISON: ___.
FINDINGS:
Cardiomediastinal and hilar contours unchanged from ___. No focal
consolidation, pleural effusion or pneumothorax. Bilateral basilar
atelectasis unchanged from ___. Right lower rib fractures again
noted.
IMPRESSION:
No focal consolidation. Unchanged bilateral basal atelectasis.
|
10026255-RR-12 | 10,026,255 | 20,437,651 | RR | 12 | 2200-09-27 14:02:00 | 2200-09-27 16:30:00 | HISTORY: ___ male with a questionable history of COPD and recent
fall, evaluate pneumothorax, now with persistent dyspnea and increased oxygen
requirement.
STUDY: Chest CTA; 100 mL of Omnipaque intravenous contrast was administered
without adverse reaction or complication in the arterial phase. Coronal and
sagittal reformatted images were generated as well as right and left oblique
maximum intensity projection images.
COMPARISON: Chest CT with contrast from ___.
FINDINGS: The visualized portion of the thyroid appears unremarkable. There
is no axillary, hilar, or mediastinal lymphadenopathy. The aorta is of a
normal caliber along its course without evidence of dissection. The pulmonary
arterial tree is patent at subsegmental level, and the pulmonary arterial
trunk is of normal caliber. There is no pericardial or pleural effusion. The
lungs demonstrate diffuse emphysema with resolution of the previously
described pneumothorax. Additionally, consolidation of the left base has
progressed since prior exam.
The visualized portion of the upper abdomen shows no abnormality.
The visualized bones demonstrate partially imaged anterior cervical spine
fusion plate (401B:38). There are no aggressive-appearing lytic or sclerotic
lesions. Additionally, the bones continue to demonstrate minimally displaced
fractures of the posterior tenth as well as lateral ninth, eighth and seventh
ribs on the right.
IMPRESSION:
1. No evidence of PE or aortic injury.
2. Emphysema and resolution of previously described pneumothorax, with
worsening left lower lobe consolidation.
3. Stable right-sided minimally displaced rib fractures as described above.
|
10026255-RR-13 | 10,026,255 | 20,437,651 | RR | 13 | 2200-09-27 15:53:00 | 2200-09-27 17:14:00 | HISTORY: Prior hepatitis B and hepatitis C, evaluate liver echotexture for
mass, cirrhosis, etc.
TECHNIQUE: Grayscale and color Doppler evaluation of the upper abdomen.
COMPARISON: CT chest angiogram from same day.
FINDINGS:
Normal appearance of the head and body of the pancreas, the tail is not well
seen.
The liver demonstrates a mildly coarsened echotexture without focal liver
lesion, intrahepatic biliary dilatation or abnormal flow in the portal vein.
The gallbladder contains anechoic fluid without evidence of stone or wall
thickening.
The common bile duct measures at the upper limits of normal at 6 mm.
The spleen measures within normal limits.
No ascites.
IMPRESSION:
Mildly coarsened echotexture of the liver is nonspecific, but could be seen in
the setting of early fibrosis. No focal liver lesions identified.
|
10026255-RR-14 | 10,026,255 | 20,437,651 | RR | 14 | 2200-09-29 10:45:00 | 2200-09-29 11:21:00 | HISTORY: Left lower lobe consolidation, to compare for change.
FINDINGS: In comparison with the chest radiograph of ___, there is some
increasing opacification at the left base with slightly less opacification in
the right. Although much of this probably represents atelectasis, there is a
more consolidative aspect, consistent with the left lower lobe pneumonia seen
on the CT examination of ___.
Otherwise, little change.
|
10026255-RR-3 | 10,026,255 | 20,437,651 | RR | 3 | 2200-09-17 19:18:00 | 2200-09-17 20:06:00 | HISTORY: Right-sided chest pain, dyspnea and cough status post trauma, here
to evaluate for rib fracture or pneumothorax.
COMPARISON: No prior studies available.
Technique: PA and lateral radiographs of the chest.
FINDINGS:
There is a moderate-sized right pneumothorax without significant tension
component Streaky opacification of the right lung base most likely reflects
bronchovascular crowding and associated collapse of the lung. Small bilateral
pleural effusions are present on the right greater than the left. The lungs
are hyperexpanded with flattening of the diaphragm compatible with COPD. The
pulmonary vasculature is not engorged. Cardiac silhouette is normal in size.
The mediastinal and hilar contours are within normal limits. There are
minimally displaced fractures of the ___ anterolateral, ___ posterolateral,
and ___ anterolateral ribs. Multilevel degenerative changes are noted in the
thoracic spine.
IMPRESSION:
1. Moderate-sized right pneumothorax with no significant tension component.
2. Minimally displaced right sided rib fractures of the ___ anterolateral, ___
posterolateral, and ___ anterolateral ribs.
3. Small bilateral pleural effusions on the right greater than the left.
4. Findings consistent with underlying COPD.
|
10026255-RR-5 | 10,026,255 | 20,437,651 | RR | 5 | 2200-09-18 00:17:00 | 2200-09-18 09:40:00 | PORTABLE CHEST X-RAY AT 12:18 A.M.
COMPARISON: Chest x-ray of one day earlier.
FINDINGS: Interval placement of right pigtail pleural catheter with decrease
in size of right pneumothorax with residual small right apical pneumothorax
remaining. Heart size is normal. Lungs are slightly overexpanded with
apparent upper lobe emphysema. Heterogeneous opacities at the lung bases are
present, and could reflect atelectasis, aspiration, and/or contusion. Acute
lower right rib fractures are again demonstrated.
|
10026255-RR-6 | 10,026,255 | 20,437,651 | RR | 6 | 2200-09-18 02:55:00 | 2200-09-18 09:37:00 | PORTABLE CHEST OF ___
COMPARISON: Study of earlier the same date.
FINDINGS: Right pigtail pleural catheter remains in place, with a small right
apical pneumothorax which has slightly decreased in size since the recent
study. Heart size remains normal. Worsening heterogeneous opacities at the
lung bases, which may be due to atelectasis, aspiration, and/or contusion
given known right lower rib fractures.
|
10026255-RR-7 | 10,026,255 | 20,437,651 | RR | 7 | 2200-09-18 15:13:00 | 2200-09-18 16:54:00 | HISTORY: Right pigtail placement for pneumothorax, persistent hypoxia.
Evaluate for pneumonia.
TECHNIQUE: Multidetector CT of the chest was performed with IV contrast.
Coronal and sagittal reformats were provided.
FINDINGS:
There is a pigtail catheter anteriorly within the right pleural space. There
is a tiny residual anterior right-sided pneumothorax (less than 5%). There is
a small right non-hemorrhagic pleural effusion. Throughout both lungs, there
is evidence of severe centrilobular emphysema which is most marked within the
upper lobes bilaterally. Consolidation is identified within both lung bases
and is more marked in the left lower lobe than the right. There is debris
within the right lower lobe bronchus (sequence 3 image 35). There is
hyperexpansion of the left lung in comparison to the right. No pulmonary
nodules or masses.
Subcentimeter pretracheal, precarinal and subcarinal lymph nodes are
identified and are unlikely to be of significance. No hilar or axillary
adenopathy. Cardiac size is normal. No pericardial effusion.
The visualized upper abdominal viscera are normal. There are fractures of the
lateral aspect of the right ___ - 9th ribs. No destructive osseous lesions.
IMPRESSION:
1. Tiny residual anterior right-sided pneumothorax (less than 5%) with
pigtail catheter in the anterior right pleural space.
2. Severe emphysema throughout both lungs.
3. Consolidation in both lung bases, worse on the left than the right,
consistent with pneumonia.
4. Small right pleural effusion.
5. Fractures of the lateral aspect of the right ___ to 9th ribs.
|
10026255-RR-8 | 10,026,255 | 20,437,651 | RR | 8 | 2200-09-19 16:23:00 | 2200-09-19 17:56:00 | PORTABLE CHEST X-RAY OF ___
COMPARISON: ___ radiograph.
FINDINGS: Right pleural catheter remains in place. Right apical pneumothorax
has nearly resolved. Heart size, mediastinal and hilar contours are normal.
Heterogeneous opacities at the lung bases are again demonstrated, with slight
worsening in the left lower lobe. Acute right rib fractures are again
visualized.
|
10026255-RR-9 | 10,026,255 | 20,437,651 | RR | 9 | 2200-09-20 14:28:00 | 2200-09-20 16:10:00 | CHEST RADIOGRAPH
INDICATION: Right biopsy, recent removal of the right pigtail. Evaluation.
COMPARISON: ___.
FINDINGS: As compared to the previous radiograph, the right pigtail catheter
has been removed. The opacities at the lung bases are constant. There is no
larger pleural effusion and no evidence of right pneumothorax. Unchanged
appearance of the cardiac silhouette. Unchanged vertebral stabilization
devices. No new lung parenchymal abnormality.
|
10026263-RR-27 | 10,026,263 | 26,565,360 | RR | 27 | 2139-11-28 14:10:00 | 2139-11-28 15:47:00 | INDICATION: Intermittent exertional dizziness, evaluate for pneumonia or
heart failure.
COMPARISONS: Chest radiograph ___.
PA AND LATERAL VIEWS OF THE CHEST: The cardiomediastinal, pleural and
pulmonary structures are unremarkable. There is no pleural effusion or
pneumothorax. No focal airspace consolidation is seen to suggest pneumonia.
Heart size is normal. There are mild degenerative changes of thoracic spine,
with anterior osteophytosis.
IMPRESSION: No acute cardiopulmonary process.
|
10026263-RR-30 | 10,026,263 | 24,619,264 | RR | 30 | 2140-09-28 11:37:00 | 2140-09-28 12:52:00 | HISTORY: ___ male with concern for left-sided incarcerated hernia.
TECHNIQUE: Axial CT images through the abdomen and pelvis were acquired after
administration of intravenous contrast. Coronal and sagittal reformatted
images were reviewed.
COMPARISON: ___.
FINDINGS:
Abdomen: The lung bases demonstrate minimal dependent atelectasis. No
pleural or pericardial effusion is seen.
A subcentimeter hypodensity in segment 4A of the liver likely represents a
cyst. Calcification is again seen in the spleen. An accessory spleen is
noted. The gallbladder, pancreas, adrenal glands, stomach, and small bowel
are within normal limits. Bilateral renal hypodensities most likely represent
cysts; the largest arises from the lower pole of the right kidney and measures
4.4 x 3.8 cm. Neither kidney demonstrates hydronephrosis. Colonic diverticula
do not demonstrate evidence for acute inflammation. There is no free
intraperitoneal air or ascites. Major intra-abdominal vasculature appears
patent and normal in caliber with dense calcified and non-calcified aortic
atherosclerotic plaque.
Pelvis: The prostate, seminal vesicles, and rectum demonstrate no acute
abnormalities. The bladder is distended with layering contrast. No free
fluid is seen in the pelvis. Fat containing right inguinal hernia is seen.
No left inguinal hernia is seen.
No concerning lytic or sclerotic osseous lesions are detected.
IMPRESSION:
No CT evidence for acute intra-abdominal or pelvic process or incarcerated
hernia.
|
10026404-RR-22 | 10,026,404 | 21,375,571 | RR | 22 | 2125-10-02 14:05:00 | 2125-10-02 16:21:00 | EXAMINATION: RENAL U.S.
INDICATION: ___ year old man with uncontrolled hypertension previously
requiring 4 agents. // Renal artery Doppler for evaluation of renal artery
stenosis in the setting of uncontrolled hypertension
TECHNIQUE: Grey scale and color Doppler ultrasound images of the kidneys were
obtained.
COMPARISON: None.
FINDINGS:
The right kidney measures 13.0 cm. The left kidney measures 13.7 cm. There is
no hydronephrosis, stones, or masses bilaterally. The kidneys are somewhat
lobulated in appearance however normal cortical echogenicity and
corticomedullary differentiation are seen bilaterally.
The bladder is moderately well distended and normal in appearance. The
prostate is mildly enlarged with a volume of 40-45 cc.
DOPPLER EXAMINATION: Note is made that the Doppler examination is limited due
to the patient's limited ability to hold his breath. Arterial waveforms are
seen in the right main renal artery with peak systolic flow measuring 47
cm/sec. Sharp upstrokes are seen in the left main renal artery with peak
systolic flow measuring 54 cm/sec. The main renal vein is patent bilaterally.
Resistive indices of the intraparenchymal arteries in the right kidney range
from 0.57-0.60 and within the left kidney range from 0.5 a to 0.64.
IMPRESSION:
No evidence of renal artery stenosis in the left kidney and likely no stenosis
in the right kidney however the Doppler examination is somewhat limited due to
the patient's limited ability to hold his breath.
|
10026406-RR-13 | 10,026,406 | 25,260,176 | RR | 13 | 2129-01-03 00:11:00 | 2129-01-03 02:06:00 | INDICATION: ___ with facial trauma. Assess for fracture or bleed.
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: 891.93 mGy-cm
CTDI: 50.10
COMPARISON: None available
FINDINGS:
No evidence of hemorrhage, edema, mass effect, or acute large territorial
infarction.The ventricles and sulci are normal in size and configuration.
The basal cisterns are patent and there is preservation of gray-white matter
differentiation.
No fracture identified. Mild mucosal thickening of the left maxillary sinus.
The additional visualized paranasal sinuses, mastoid air cells, and middle ear
cavities are clear. The globes are unremarkable. Small subgaleal hematoma
posteriorly (3:60).
IMPRESSION:
Small posterior subgaleal hematoma. No fracture. Otherwise normal head CT. No
intracranial hemorrhage.
|
10026406-RR-14 | 10,026,406 | 25,260,176 | RR | 14 | 2129-01-03 00:12:00 | 2129-01-03 03:07:00 | EXAMINATION: CT SINUS/MANDIBLE/MAXILLOFACIAL W/O CONTRAST
INDICATION: ___ with facial trauma. Assess for fracture or bleed.
TECHNIQUE: Helical axial images were acquired through the paranasal sinuses.
Coronal reformatted images were also obtained
DOSE: DLP: 554.55 mGy-cm
CTDI: 25.79 mGy
COMPARISON: none
FINDINGS:
Moderate mucosal thickening of the left mastoid air cells. The additional
visualized paranasal sinuses are normally aerated, without mucosal thickening
or air-fluid levels. The right ostiomeatal unit is patent. Soft tissue density
seen within the left ostiomeatal unit. The anterior skull base and cribriform
plates are intact. No bony sclerosis. Comminuted fracture of the right nasal
bone. No soft tissue hematoma.
The anterior clinoid processes are not pneumatized. The lamina papyracea is
intact. The nasal septum slightly deviates towards the left. Fracture likely
extends through the proximal most portion of the nasal septum (601b: 81). The
orbits and nasopharyngeal soft tissues are unremarkable.
Limited assessment of the brain and neck soft tissues are unremarkable.
IMPRESSION:
Deformity of the nasal bone and anterior septum due to fracture of
undetermined age. No additional fracture. No soft tissue hematoma.
|
10026406-RR-15 | 10,026,406 | 25,260,176 | RR | 15 | 2129-01-03 00:13:00 | 2129-01-03 02:40:00 | INDICATION: ___ with facial trauma. Assess for fracture or bleed.
TECHNIQUE: Axial helical MDCT images were obtained from the skull base
through the cervical spine without intravenous contrast. Sagittal, coronal,
soft tissue and thin section bone algorithm reconstructed images were
acquired.
DOSE: DLP: 934.63 mGy-cm
CTDIvol: 37.24 mGy
COMPARISON: None.
FINDINGS:
4 mm ossific fragment anterior to C5 vertebral body appears well corticated
however there is a similar-appearing donor site along the superior left C5
endplate, (602b:37 and 601b: 12). No additional fracture. No retropulsion. No
widening of the disc space appear. No compression fracture. No acute
malalignment. Multilevel degenerative changes are noted throughout the
cervical spine most notable at C1-C2 and C5-C6. Pre and paravertebral soft
tissues are normal. Visualized portions of the skullbase show no
abnormalities.
Limited assessment of the spinal canal is unremarkable.Visualized portions of
the aerodigestive tract are patent. Limited assessment of the lung apices are
clear.
IMPRESSION:
Bony oaaicle near superior endplate of C5 indicating avulsion injury of
undetermined age. . No compression fracture. No retropulsion.
|
10026406-RR-16 | 10,026,406 | 25,260,176 | RR | 16 | 2129-01-03 04:09:00 | 2129-01-03 04:55:00 | INDICATION: ___ with assault injury and pain. Assess vertebral alignment
TECHNIQUE: Four lateral views of the cervical spine in flexion and extension.
COMPARISON: CT cervical spine ___.
FINDINGS:
The spine is visualized only to the top of C7. Normal vertebral alignment and
relatively normal motion on flexion and extension. No prevertebral soft tissue
swelling or bone destruction. There are tiny osteophytic changes anterior to
C4-5 with no associated disc narrowing. This appearance suggests degenerative
disease and acute fracture is not suggested. Remainder of discs and vertebral
bodies are normal. Appearances are better assessed on accompanying CT scan
IMPRESSION:
Radiographic appearances do not suggest, in my opinion, a fracture, and
particularly not an acute fracture, although this possibility at C4-5
apparently has been raised by the accompanying CT scan
|
10026406-RR-17 | 10,026,406 | 25,260,176 | RR | 17 | 2129-01-03 06:30:00 | 2129-01-03 06:54:00 | EXAMINATION: CT ABD AND PELVIS W/O CONTRAST
INDICATION:
___ with abd pain, lumbar spine. Assess for fracture or intra-abdominal
pathology.
TECHNIQUE: MDCT images were obtained from the lung bases to the pubic
symphysis without the administration of intravenous contrast. Axial images
were interpreted in conjunction with coronal and sagittal reformats.
DLP: 592.01 mGy-cm
COMPARISON: None.
FINDINGS:
The examination is limited secondary to the lack of intravenous contrast.
CHEST: Limited assessment of lung bases demonstrates bibasilar atelectasis.
No pleural effusion or large pneumothorax. The visualized heart is normal in
size without pericardial effusion.
ABDOMEN:
The liver is diffusely hypodense consistent with hepatic steatosis. The
gallbladder is normal without calcified gallstones.
The multiple calcified granulomas are noted within the spleen which is
otherwise unremarkable. An accessory splenule is noted. The pancreas is
homogeneous without peripancreatic fat stranding or focal fluid collection.
The adrenal glands are unremarkable.
The kidneys are symmetric in size. No focal renal lesions. No hydronephrosis
or hydroureter identified. No renal or proximal ureter calculi.
The distal esophagus is normal without hiatal hernia. 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. Colonic diverticulosis is present without
evidence of acute diverticulitis. The appendix is normal without evidence of
acute appendicitis.
The abdominal aorta is normal in caliber without aneurysmal dilatation. Small
amount of atherosclerotic calcification noted. The iliac arteries are normal
in course and caliber.
No retroperitoneal or mesenteric lymph node enlargement by CT size criteria.
No free abdominal fluid, abdominal wall hernia, or pneumoperitoneum.
PELVIS: The bladder is largely distended and normal. 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.
OSSEOUS STRUCTURES: Multilevel, multifactorial degenerative changes are seen
within the visualized thoracolumbar spine. A chronic nonunion of a left L4
transverse and right L1 transverse fractures noted (02:56). A 0.6 cm (2:95)
bone island is seen within the proximal left femur. No focal lytic or
sclerotic lesion concerning for malignancy. Multiple old left posterior rib
fractures noted. No acute lower thoracic or lumbar vertebral fracture.
IMPRESSION:
1. Hepatic steatosis.
2. No acute lower thoracic or lumbar vertebral fracture.
3. Largely distended, normal-appearing bladder.
4. No acute intra-abdominal pathology. No free fluid.
|
10026479-RR-13 | 10,026,479 | 21,649,207 | RR | 13 | 2189-02-05 05:45:00 | 2189-02-05 07:59:00 | CLINICAL INFORMATION: ___ female with generalized abdominal pain in
the right lower quadrant pain, question appendicitis.
COMPARISON: None.
TECHNIQUE: Helical MDCT images were acquired of the abdomen and pelvis
following the administration of intravenous contrast.
FINDINGS:
LUNG BASES: The lung bases are clear, with the exception of minimal bibasilar
atelectasis. There is no pleural or pericardial effusion.
ABDOMEN: Multiple hypodensities within the liver are compatible with cysts,
the largest of which measures 7.7 cm within segment VIII with rim
calcification and an imperceptible wall. Others are too small to characterize
but also are statistically likely to represent cysts. The liver is otherwise
normal in appearance. Spleen is unremarkable. The pancreas appears normal
with mild prominence of the pancreatic duct. The gallbladder is normal in
appearance without intra- or extra-hepatic biliary ductal dilatation. The
adrenal glands are normal in appearance bilaterally. The kidneys demonstrate
symmetric contrast enhancement and brisk bilateral excretion without
hydronephrosis. A hypodensity in the right mid renal pole measures 9 mm and
is too small to characterize.
The stomach is collapsed. Loops of small bowel are normal in caliber. Within
distal small bowel several air-fluid levels are seen. There is a corkscrew
appearance of vessels in the right lower quadrant, best seen in the coronal
plane on the series 601B, image 18 at the root of a massively dilated (10 cm)
portion of bowel, consistent with cecal volvulus. There is no pneumatosis.
The remainder of the colon is collapsed.
The aorta is normal in caliber along its course, its major branches appear
patent. There is no retroperitoneal lymphadenopathy.
PELVIS: The bladder, uterus, and adnexa are normal appearing. There is a
small amount of pelvic free fluid. The colon is collapsed.
BONE WINDOWS: There is no concerning lytic or blastic osseous lesion. Note
is made of disc degenerative change at L4-L5 and L5-S1.
IMPRESSION:
1. Cecal volvulus with closed loop obstruction.
2. Multiple hypodensities within the liver, the largest of which are
compatible with cysts. Others are too small to characterize but are
statistically likely to represent cysts.
These findings were discussed with Dr. ___ at 7:20 a.m. by phone.
|
10026479-RR-14 | 10,026,479 | 21,649,207 | RR | 14 | 2189-02-09 11:20:00 | 2189-02-09 18:22:00 | ABDOMEN
REASON FOR EXAM: Status post right hemicolectomy. Assess for ileus versus
partial obstruction.
Air-fluid levels in the right lower quadrant are associated with air-filled
non-dilated small bowel loops. There is air in the descending colon and
rectum.
There is a small amount of pneumoperitoneum due to recent surgery. Skin
staples are noted.
IMPRESSION: Ileus or early obstruction. Followup is recommended.
|
10026658-RR-7 | 10,026,658 | 27,625,088 | RR | 7 | 2142-03-24 16:08:00 | 2142-03-24 17:10:00 | INDICATION: Lower abdominal pain and diarrhea.
COMPARISON: None.
TECHNIQUE: Multidetector CT images of the abdomen and pelvis were obtained
without oral contrast. Intravenous contrast was administered. Sagittal and
coronal reformations were also performed.
FINDINGS:
The visualized lung bases appear clear. There are no pleural effusions.
Coronary artery calcification is present. The heart is normal in size.
The liver is hypodense consistent with fatty infiltration. There is no biliary
dilatation. The spleen is normal in size. The gallbladder, pancreas, and
adrenal glands are unremarkable. In the interpolar left kidney, a small
hypodense focus of 4 mm is too small to characterize although doubtful in
significance. A calcification is noted along the pancreatic neck which may be
postinflammatory.
The central mesentery demonstrates increased attenuation as well as several
mildly prominent but subcentimeter lymph nodes of shortest axis dimension up
to at most 6 mm for the most part suggesting mesenteric panniculitis, which is
a common incidental finding.
There is a small axial hiatal hernia. The small bowel is unremarkable.
Sigmoid diverticulosis is moderate to severe. A small quantity of ascites is
present in the lower pelvis of low density compatible with simple fluid. This
represents an abnormal finding. There are diverticula at the rectosigmoid
junction that lie along the fluid. This does not necessarily mean that
diverticulitis is the cause but that is a possibility. Diverticulosis is also
moderate along the cecum without milder diverticulosis seen more generally
throughout the rest of the colon.
Atherosclerotic disease is moderate. The lower infrarenal abdominal aorta is
mildly ectatic measuring up to 27 mm in diameter.
In this patient is status post bilateral total hip replacements, streak
artifact obscures lower pelvic structures to some extent.
There are no suspicious lytic or blastic bone lesions. The vertebral body
heights and interspaces appear preserved.
IMPRESSION:
1. Small amount of ascites in the lower pelvis which is abnormal but not
specific. Given clinical concern for diverticulitis the possibility could be
considered when it is noted that the fluid resides near as diverticula at the
rectosigmoid junction.
2. Fatty infiltration of the liver.
3. Findings consistent with mesenteric panniculitis.
4. Moderate atherosclerotic change, including mild aortic ectasia. Follow-up
ultrasound is suggested to reassess in one year.
DOSE: ___ mGy-cm.
|
10026950-RR-36 | 10,026,950 | 28,254,249 | RR | 36 | 2133-03-14 11:53:00 | 2133-03-14 14:19:00 | CHEST, TWO VIEWS, ___
HISTORY: ___ male with elevated troponins and shortness of breath.
FINDINGS: AP and lateral views of the chest are compared to study performed
at ___ from earlier the same day. There has been interval development of
indistinct pulmonary vascular markings. Small- to moderate-sized bilateral
pleural effusions are more clearly delineated on the current exam. The lung
volumes are seen. Cardiac silhouette is prominent, likely accentuated due to
AP technique and low inspiratory effort. Osseous and soft tissue structures
are unremarkable.
IMPRESSION: Findings suggestive of congestive failure and moderate bilateral
effusions.
|
10026950-RR-37 | 10,026,950 | 28,254,249 | RR | 37 | 2133-03-15 08:10:00 | 2133-03-15 11:21:00 | PORTABLE CHEST OF ___.
COMPARISON: Radiograph ___.
FINDINGS: Persistent cardiomegaly with improved pulmonary vascular congestion
but persistent moderate right and small left pleural effusion with adjacent
basilar atelectasis and/or consolidation. Diffuse haziness in upper abdomen
suggest the possibility of ascites.
|
10026950-RR-38 | 10,026,950 | 28,254,249 | RR | 38 | 2133-03-15 16:46:00 | 2133-03-15 19:51:00 | INDICATION: ___ male with new right bundle-branch block, concern for
PE, but unable to get CTA. Assess for DVT.
COMPARISONS: None.
Grayscale and color Doppler sonographic evaluation was performed of the
bilateral lower extremities. Normal compressibility and flow was seen in the
bilateral common femoral, superficial femoral, popliteal, peroneal, and
posterior tibial veins without evidence of DVT. Mild left sided subcutaneous
edema noted.
IMPRESSION: No lower extremity DVT.
|
10026950-RR-39 | 10,026,950 | 28,254,249 | RR | 39 | 2133-03-15 16:47:00 | 2133-03-15 19:53:00 | INDICATION: Hematuria and hydronephrosis, assess for hydronephrosis or clot
burden in the bladder.
COMPARISONS: CT abdomen and pelvis from ___.
RENAL ULTRASOUND: Assessment of the kidneys is somewhat limited due to body
habitus and overlying bowel gas. The right kidney measures 9.5 cm. The left
kidney was not as well seen, measuring 9.6 cm. No definite hydronephrosis is
seen bilaterally. The bladder is decompressed with a Foley catheter with a
4.4 x 3.8 cm avascular lesion within the bladder.
IMPRESSION: No definite hydronephrosis on this limited study with 4.4-cm
avascular echogenbic lesion in the bladder. This could reflect clot given the
history though a mass is not excluded. Consider contrast enhanced CT or direct
visualization.
|
10027407-RR-8 | 10,027,407 | 21,216,166 | RR | 8 | 2188-03-24 03:55:00 | 2188-03-24 04:44:00 | INDICATION: Abdominal pain with history of SBO.
TECHNIQUE: 2 frontal views of the abdomen.
COMPARISON: None.
FINDINGS:
Nonspecific bowel gas pattern with paucity of small bowel gas. Normal caliber
large bowel.
There is no free intraperitoneal air.
Osseous structures are unremarkable.
There are no unexplained soft tissue calcifications or radiopaque foreign
bodies.
IMPRESSION:
Nonspecific bowel gas pattern with paucity of small bowel gas, though no
specific plain radiographic evidence for obstruction. If SBO remains of
clinical concern, followup imaging should be considered.
|
10027407-RR-9 | 10,027,407 | 21,216,166 | RR | 9 | 2188-03-24 06:01:00 | 2188-03-24 06:32:00 | EXAMINATION: CT abdomen and pelvis with contrast
INDICATION: History of small bowel obstruction status post partial bowel
resection secondary to Crohn's disease. Presenting with abdominal pain and no
flatus.
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired
through the abdomen and pelvis following intravenous contrast administration
with split bolus technique. IV Contrast: 130 mL Omnipaque.
Coronal and sagittal reformations were performed and reviewed on PACS.
Oral contrast was not administered.
DOSE: Total DLP (Body) = 820 mGy-cm.
COMPARISON: Same day abdominal radiograph
FINDINGS:
Heart size is normal without significant pericardial fluid. Trace bibasilar
atelectasis. Imaged lung bases are otherwise clear.
CT abdomen with contrast:
Several millimetric hypodensities in the right lobe of the liver are too small
to fully characterize but likely represent biliary hamartomas. Liver
otherwise enhances homogeneously without biliary dilatation. Portal vein is
patent. Gallbladder is unremarkable.
Spleen, pancreas and adrenal glands are unremarkable. No made of small
perisplenic ascites.
Kidneys present symmetric nephrograms and excretion of contrast without focal
lesion or hydronephrosis.
Stomach is distended but otherwise unremarkable. Duodenum is unremarkable.
Mild distension of a segment of jejunum with a midabdominal transition point
(series 601, image 22) compatible with partial or early small bowel
obstruction. Trace surrounding free fluid. The large bowel is largely
decompressed and unremarkable.
Abdominal aorta is normal caliber. No mesenteric or retroperitoneal
lymphadenopathy. No pneumoperitoneum or ventral abdominal hernia.
CT pelvis with contrast:
Bladder, prostate and rectum are unremarkable. No free pelvic fluid or air.
No inguinal or pelvic sidewall lymphadenopathy.
Bones and soft tissues: No suspicious focal bone lesion.
IMPRESSION:
Mild distention of mid jejunum up to 3 cm with slight surrounding free fluid
and two proximal and distal transition points. This could be seen in setting
of partial or early small bowel obstruction or possibly enteritis, and is not
suggestive of a high-grade obstruction.
|
10027557-RR-22 | 10,027,557 | 28,332,555 | RR | 22 | 2136-02-05 14:55:00 | 2136-02-05 16:08:00 | CHEST, TWO VIEWS: ___.
HISTORY: ___ female with weakness and altered mental status.
COMPARISON: ___ and chest CT from ___.
FINDINGS: Frontal and lateral views of the chest. Relatively low lung
volumes are seen with secondary crowding of the bronchovascular markings.
There is, however, no confluent consolidation nor effusion. The
cardiomediastinal silhouette is within normal limits. No acute osseous
abnormality is identified. Surgical clips in the right upper quadrant suggest
prior cholecystectomy.
IMPRESSION: No acute cardiopulmonary process.
|
10027557-RR-23 | 10,027,557 | 28,332,555 | RR | 23 | 2136-02-06 00:32:00 | 2136-02-06 11:21:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ year old woman with HCC, AMS and ? weakness on exam concern
for possible head bleed. R/o head bleed
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 mGy-cm
COMPARISON: None.
FINDINGS:
There is no acute intracranial hemorrhage,mass or midline shift. There is no
hydrocephalus. The port introduced in the white matter including in the
subcortical white matter which most likely due to small vessel disease.
However, this study without contrast cannot exclude metastatic disease.
Visualized paranasal sinuses and mastoid air cells are clear. There is no
fracture.
IMPRESSION:
No acute abnormalities are seen. No hemorrhage identified. Small vessel
disease. The metastatic disease is concerned, coronal post enhanced CT or MRI
can help further assessment if indicated.
|
10027602-RR-37 | 10,027,602 | 28,166,872 | RR | 37 | 2201-10-30 11:01:00 | 2201-10-30 12:16:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: History: ___ with ICH, intubated // eval ETT
TECHNIQUE: Single frontal view of the chest
COMPARISON: ___ at 09:37 at outside institution
FINDINGS:
Endotracheal tube terminates approximately 2.6 cm above the level of the
carina. An enteric tube courses below the level the diaphragm, inferior aspect
not included on this study, but likely courses at least into the stomach. The
lungs are clear without focal consolidation. No large pleural effusion is
seen. There is no evidence of pneumothorax. The cardiac and mediastinal
silhouettes are unremarkable.
IMPRESSION:
Endotracheal tube terminates approximately 2.6 cm above the level of the
carina. An enteric tube courses below the level the diaphragm, inferior aspect
not included on this study, but likely courses at least into the stomach.
Clear lungs.
|
10027602-RR-39 | 10,027,602 | 28,166,872 | RR | 39 | 2201-10-30 11:40:00 | 2201-10-30 12:31:00 | EXAMINATION: Q1213
INDICATION: History: ___ with ich // ? extension of bleed
TECHNIQUE: CT of the head was acquired. Following contrast administration and
departmental protocol CT angiography of the head and neck was obtained. 3D
and curved reformatted images were obtained on the independent workstation. .
DOSE: DLP: 2319 mGy-cm
COMPARISON: Outside head CT ___
FINDINGS:
CT head shows intraventricular and subarachnoid hemorrhage which is
predominantly in the quadrigeminal cistern, unchanged from the previous
outside CT examination. There is ventriculomegaly with dilatation of the
temporal horns indicating hydrocephalus which is unchanged.
CT angiography of the neck shows normal appearance of the carotid and
vertebral arteries without stenosis or occlusion or dissection.
CT angiography of the head shows normal appearance of the arteries of the
anterior and posterior circulation without stenosis or occlusion or aneurysm
greater than 3 mm in size. No abnormal vascular structures are identified.
Small hypodensities seen in both lobes of thyroid.
IMPRESSION:
Intraventricular and subarachnoid hemorrhage is unchanged. CT vessels no
evidence of vascular occlusion, stenosis, dissection, or abnormal vascular
structures or aneurysm greater than 3 mm in size.
This report is provided without 3D and curved reformats. When these images
are available, and if additional information is obtained, then an addendum may
be given to this report.
|
10027602-RR-40 | 10,027,602 | 28,166,872 | RR | 40 | 2201-10-30 15:06:00 | 2201-10-30 16:14:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ year old woman with ICH and IVH s/p R frontal EVD placement.
TECHNIQUE: Contiguous axial MDCT images were obtained through the brain
without the administration of IV contrast. Reformatted coronal, sagittal and
thin section bone algorithm-reconstructed images were then generated.
DOSE: CTDIvol: ___ MGy
DLP: ___ MGy-cm
COMPARISON: CTA head study from ___ at 11:41.
FINDINGS:
Patient is now status post right frontal approach ventriculostomy catheter
placement, with the tip terminating just beyond the septum pellucidum in the
left lateral ventricle. There has been interval decrease in the size of the
lateral ventricles, however there is still persistent dilatation of bilateral
temporal ventricular horns. There is no evidence of hemorrhage along the
catheter path.
Since prior exam 4 hr ago, there is stable appearance of the intraventricular
hemorrhage in bilateral lateral ventricles, third ventricle, and fourth
ventricle. Subarachnoid hemorrhage that is predominantly in the quadrigeminal
cistern is unchanged. Subdural hemorrhage in the posterior falx is also
stable.
There is no shift in midline structures. Gray-white matter is well
differentiated without evidence of acute large territorial infarction.
The paranasal sinuses, mastoid air cells, and middle ear cavities are clear.
IMPRESSION:
1. Right frontal approach ventriculostomy catheter in appropriate position
with interval decrease in the lateral ventricle sizes. No evidence of new
hemorrhage.
2. Stable multi-compartment intracranial hemorrhage.
|
10027602-RR-41 | 10,027,602 | 28,166,872 | RR | 41 | 2201-10-30 14:47:00 | 2201-10-30 16:58:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman s/p ETT and NGT // confirm placement of ETT
and NGT
COMPARISON: ___
IMPRESSION:
No relevant change as compared to the previous examination. Normal lung
volumes. Unchanged monitoring and support devices no pneumothorax. No
pulmonary edema. No pleural effusions.
|
10027602-RR-42 | 10,027,602 | 28,166,872 | RR | 42 | 2201-10-30 16:37:00 | 2201-10-30 17:07:00 | EXAMINATION: CHEST PORT. LINE PLACEMENT
INDICATION: ___ year old woman with new line placement // evaluate new line
Contact name: ___: ___
COMPARISON: ___
IMPRESSION:
As compared to the previous radiograph, the patient has received the new left
subclavian line. The course of the line is unremarkable, the tip of the line
projects over the cavoatrial junction. No complications, notably no
pneumothorax. Unchanged position of nasogastric tube and endotracheal tube.
|
10027602-RR-43 | 10,027,602 | 28,166,872 | RR | 43 | 2201-11-02 01:43:00 | 2201-11-02 14:25:00 | EXAMINATION: MRI AND MRA BRAIN
INDICATION: ___ year old woman with IVH // for prognostication
TECHNIQUE: Sagittal T1, axial T1 pre and postcontrast, diffusion weighted,
gradient echo, FLAIR, T2, sagittal MP rage postcontrast sequences of the
brain. 3D time-of-flight angiography of the brain with rotational reformats. 7
cc Gadavist.
COMPARISON: CT head without contrast ___, CTA with and without
contrast of ___.
FINDINGS:
MRI HEAD: Right frontal burr hole and ventriculostomy shunt is noted, the tip
terminating at the level of the foramen ___. Again noted is
intraventricular hemorrhage within the frontal horn of the right lateral
ventricle, body of the left lateral ventricle, bilateral posterior horns,
third ventricle, cerebral aqueduct and fourth ventricle, essentially unchanged
in size and configuration from prior CT examinations of ___.
There is diffuse ventriculomegaly, also essentially unchanged in size from
prior exam. FLAIR hyperintense signal capping the ventricles is noted,
consistent with transependymal flow.
Gyriform focus of the slow diffusion of the medial left frontal lobe (series
8, image 25) is noted, with mild associated FLAIR hyperintense signal,
compatible with the acute to subacute infarct. An additional periventricular
punctate focus of slow diffusion along the posterior horn of the left lateral
ventricle (series 8, image 18) is also noted, also likely representing a focus
of acute infarct.
The major intracranial flow voids are preserved. The paranasal sinuses are
essentially clear. The orbits are unremarkable. Fluid signal is seen in the
bilateral mastoids.
HEAD MRA: Evaluation is slightly limited by motion artifact, particular at the
level of the body of the lateral ventricles. Allowing for this limitation
however normal flow related signal is seen in the intracranial internal
carotid, middle cerebral and anterior cerebral arteries without significant
mural irregularity or stenosis. There is normal symmetric arborization of the
MCA branches. There is no aneurysm greater than 3 mm. Normal flow related
signal is seen in the codominant intracranial vertebral arteries, the basilar
artery, and the bilateral superior cerebellar and posterior cerebral arteries.
Intraventricular hemorrhage within the third ventricles, anterior horn of the
right lateral ventricle, body of the left lateral ventricle, bilateral
posterior horns, cerebral aqueduct and fourth ventricle is noted, similar in
configuration from a CTA examination of ___.
IMPRESSION:
1. Diffuse intraventricular hemorrhage, unchanged in configuration from prior
CT examinations. There is ventriculomegaly, unchanged from exam of ___ but significantly increased since exam of ___.
2. There are foci of slow diffusion involving the left frontal medial cortex
as well as along the white matter of the posterior horn of the left lateral
ventricle, likely representing late acute to subacute infarcts.
NOTIFICATION: The findings were discussed by Dr. ___ with NP
___ on the telephone on ___ at 2:18 ___, 20 minutes
after discovery of the findings.
|
10027602-RR-45 | 10,027,602 | 28,166,872 | RR | 45 | 2201-11-01 04:53:00 | 2201-11-01 09:43:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with IVH // evaluate for pulmonary process
TECHNIQUE: Single frontal view of the chest
COMPARISON: ___
IMPRESSION:
Cardiac size is top normal. Bibasilar atelectasis have increased. If any there
are small stable bilateral pleural effusions. ET tube is in standard position.
Left subclavian catheter tip is at the cavoatrial junction. NG tube tip is in
the stomach. There is no pneumothorax.
|
10027602-RR-46 | 10,027,602 | 28,166,872 | RR | 46 | 2201-11-03 11:03:00 | 2201-11-04 05:16:00 | CLINICAL HISTORY: Patient is a ___ lady who presented with sudden
onset of unconsciousness, fall and intraventricular and subarachnoid
hemorrhage. Her CT angiography was suspected to have a vascular malformation.
This is her first cerebral angiography for confirming any vascular
abnormality.
ATTENDING PHYSICIAN: Dr. ___.
ASSISTANT: Dr. ___.
PROCEDURE PERFORMED: Left common carotid artery roadmap angiography, left
common carotid artery cerebral angiography, right common carotid artery
roadmap angiography, right common carotid artery cerebral angiography, left
vertebral artery angiography, right vertebral artery angiography.
SEDATION: Moderate conscious sedation was provided by administering divided
doses of 100 mcg of fentanyl and 2 mg of midazolam throughout the total
intraservice time of 55 minutes during which the patient's hemodynamic
parameters were continuously monitored.
DESCRIPTION OF THE PROCEDURE: An informed consent was signed by the patient's
daughter.
The patient was brought to the angiography unit intubated and connected to
ventilator. She was transferred to the angiography unit. After settling down
her EVD and other vascular lines, a moderate conscious sedation was inducted
as described below. Subsequently, using usual sterile techniques, the
bilateral groins were prepped and draped. Subsequently, using a micropuncture
set access to the right common femoral artery was obtained in a modified
Seldinger technique. A 5 ___ sheath was inserted into the right common
femoral artery. Subsequently, a 4 ___ Berenstein 2 catheter was connected
to a continuous heparinized saline and a power injector and this catheter over
the 0.035-inch Terumo wire was advanced into the aortic arch and left common
carotid artery was navigated and this catheter was parked at the proximal left
CCA. Subsequently, by injecting into this artery a roadmap angiography was
performed to see the carotid bifurcation. Then by injecting into this artery,
a cranial angiography of the internal and external carotid arteries in AP,
lateral and oblique projections were performed. Then, the catheter was pulled
down to the aortic arch and left vertebral artery was navigated using a
roadmap by injecting into the left subclavian artery. The catheter was
advanced into the proximal left vertebral artery and by injecting into this
artery, the cranial angiography of the vertebrobasilar system was performed in
the AP, lateral and oblique projections.
Then the catheter was advanced into the right common carotid artery and a
roadmap angiography was performed to the carotid bifurcation. Then by
injecting into this artery, the cranial angiography of the right ICA and ECA
are obtained in AP, lateral and oblique projections. Finally the catheter was
pulled down into the aortic arch and the right vertebral artery was also
navigated and catheter was advanced into this artery. By injecting into this
artery the right vertebrobasilar angiography was also performed in AP, lateral
and oblique projections.
At the end, we exchanged the 5 ___ short femoral sheath with a 6 ___
easy flex femoral sheath and we kept a line for tomorrow's embolization
procedure. We fixed the femoral sheath in place using a stitch and connect it
to heparinized saline flush and also recommended to be transfused.
No procedure-related complication was noted.
FINDINGS: The left common carotid artery angiogram showed opacification of
the left ICA and ECA in normal size and shape without significant carotid
stenosis. The intracranial angiography of the left internal carotid artery
shows very well opacification of its petrous, cavernous and supraclinoid along
with its terminal MCA and ACA branches. There is no evidence of aneurysm or
arteriovenous malformation in this territory. The left ICA and ECA are not
contributed in any dural AV fistula. The cranial branches of the left
internal carotid arteries also seen very well without any evidence of
participating into a dural AV fistula.
Injection into the left subclavian artery and obtaining a roadmap angiogram
showed normal origin of the left vertebral artery from the subclavian artery.
The cranial vertebrobasilar angiogram shows very well opacification of the V4
segment of the vertebral artery, basilar artery along with its ICA and
superior cerebellar artery and PCA branches. It is obviously seen that the
posterior meningeal artery has hypertrophied and finally at the tentorial edge
is connecting into the small venous pouch which found to be fistulous area and
this venous pouch is finally draining via a single vein into the straight
sinus. Moreover as it is seen in the lateral angiogram some posterior
cerebral artery branches are also connecting into this fistulous connection
which signifies the dual feeding into this artery. It is not very well clear,
however it sounds that the middle branch from the left superior cerebral
artery is also involving this dural AV fistula.
As the arteriovenous abnormal connection is at the level of the cortical vein,
therefore, this is considered as a type 3 Cognard dural AV fistula.
Injection into the right vertebral artery shows opacification of a ___, AICA
and superior cerebellar artery and PCAs with retrograde filling of the left
vertebral artery and therefore a posterior meningeal artery which results in
opacification of the dural AV fistula by injecting in this side also. No
other vascular abnormality is seen in this angiogram.
Injection into the right common carotid artery shows unremarkable carotid
bifurcation with very tortuous cervical part of the ICA and ECA. The cranial
angiography of the right internal carotid artery shows opacification of its
petrous, cavernous and supraclinoid segments along with the ACA and MCA
branches. The anterior communicating artery and contralateral A2 is not
filling through this angiogram and just right ACA is seen along with its
recurrent Heubner. The cranial branches of the external carotid artery
including middle meningeal artery and superficial temporal artery are also
seen very well without any obvious contribution into the dural AV fistula. No
aneurysm or AVM or other vascular abnormalities seen by injecting into the
right common artery. The capillary and venous phase of this angiogram also
looks normal. Also there is no contribution from these arteries into the
dural AV fistula was noted.
No procedure-related thromboembolic complication was noted.
IMPRESSION:
A cerebral angiography on this ___ lady who had a recent collapse, IVH
and subsequent hemorrhage showed a dural AV fistula is found that the left
posterior tentorial edge fed mainly by a posterior meningeal branch of the
left vertebral artery. Other contributions are seen into this dural AV
fistula are from the left posterior cerebral artery and probably from the left
superior cerebral artery. At this arteriovenous connection is at the level of
a cortical vein which finally drains into the straight sinus. This is
considered to type 3 Cognard dural AV fistula. Patient has been considered
for attempt embolization tomorrow.
No procedure-related complication was noted.
This procedure was performed by Dr. ___ and Dr. ___.
|
10027602-RR-47 | 10,027,602 | 28,166,872 | RR | 47 | 2201-10-31 18:19:00 | 2201-10-31 18:37:00 | EXAMINATION:
CT HEAD W/O CONTRAST
INDICATION: ___ year old woman with IVH, now posturing // evaluate for
interval change, please obtain STAT
TECHNIQUE: Routine unenhanced head CT was performed and viewed in brain,
intermediate and bone windows. Coronal and sagittal reformats were also
performed.
DOSE: Please see PACs
___
FINDINGS:
There is extensive intraventricular hemorrhage within the lateral ventricles,
third ventricle and fourth ventricle. The basal cisterns are patent. No
intraparenchymal hemorrhage is noted. A ventriculostomy catheter terminates at
the foramen of ___. The ventricles are prominent size suggesting
hydrocephalus. No extra-axial collections. Midline structures are midline.
Gray-white matter differentiation is preserved. No evidence of acute vascular
territory infarct.
IMPRESSION:
Diffuse intraventricular hemorrhage. Increase in ventricular size
particularly of the temporal horns slightly compared with the previous CT of
___.
|
10027602-RR-48 | 10,027,602 | 28,166,872 | RR | 48 | 2201-11-04 08:41:00 | 2201-11-06 16:02:00 | PREOPERATIVE DIAGNOSIS: Dural AV fistula with hemorrhage.
PROCEDURES PERFORMED: Left vertebral artery arteriogram, left posterior
meningeal artery arteriogram, left external carotid artery arteriogram, left
common carotid artery arteriogram, right external carotid artery arteriogram.
Rotational angiography of left vertebral artery with post-processing on a
separate workstation with concurrent physician ___. Final images used
for interpretation and for guidance of interventional procedure.
INTERVENTIONAL PROCEDURE PERFORMED: Onyx embolization of left posterior
meningeal artery.
ATTENDING PHYSICIAN: ___, M.D.
ASSISTANT: ___, M.D.
ANESTHESIA: General.
DETAILS OF THE PROCEDURE: The patient was brought to the angiography suite.
IV sedation was given. Following this, both groins were prepped and draped in
a sterile fashion. Access was gained to the right common femoral artery using
a Seldinger technique and a 5 ___ vascular sheath was placed in the right
common femoral artery. We now catheterized the left vertebral artery and AP,
lateral filming was done along with three-dimensional rotational angiography.
This demonstrated that the posterior meningeal artery was the main supply to
the dural AV fistula. At this point, I catheterized the left vertebral artery
with a 6 ___ Neuron catheter and this was connected to a continuous saline
flush. We now catheterized the left posterior meningeal artery with a
Marathon catheter and this demonstrated a dural AV fistula with a large
draining vein coursing to the vein of ___. Several attempts were made to
pass the catheter more distally; however, this was unsuccessful and therefore
Onyx embolization was performed from the posterior meningeal artery. Though
the posterior meningeal artery was obliterated, we were unable to get distal
enough to penetrate the fistulous communication itself. At this point, we did
a left common carotid artery arteriogram and a left external carotid artery
arteriogram, which did not show any significant supply from the common carotid
artery. A right vertebral artery arteriogram was done which showed no new
areas of supply to the fistula. Right common carotid artery arteriogram and a
right external carotid artery arteriogram was done. This revealed supply from
the right middle meningeal artery. We attempted to catheterize the right
middle meningeal artery; however, this was prevented by severe spasm of the
internal maxillary artery secondary to the initial Glidewire. Therefore, we
stopped the procedure, planning to bring her back on another day. The right
common femoral artery sheath was removed and manual pressure applied for
closure of the site.
Left vertebral artery arteriogram shows that the left posterior meningeal
artery supplies the dural AV fistula.
Left posterior meningeal artery shows that there is significant supply going
along the branch, which courses along the tentorium and then seen a fistulous
communication into vein that drains along with the straight sinus into the
torcula.
Left external carotid artery arteriogram shows no evidence of supply to the
dural AV fistula.
Left common carotid artery arteriogram again demonstrates no evidence of
dural AV fistula, specifically there are no tentorial branches supplying the
fistula.
Right vertebral artery arteriogram demonstrates that there is no evidence of
supply to the dural AV fistula.
The right external carotid artery arteriogram shows supply to the dural AV
fistula, most likely through branches of the middle meningeal artery. Because
of the severe spasm, the opacification of the fistula is not apparent.
IMPRESSION: ___ underwent cerebral angiography and
embolization of posterior meningeal artery, which was supplying dural AV
fistula. The veins predominantly drain into the vein ___ system and
into the straight sinus and into the torcula. The patient tolerated the
procedure well. There were no complications. She will be brought back for
additional embolization to the right middle meningeal artery.
|
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