note_id
stringlengths 13
15
| subject_id
int64 10M
20M
| hadm_id
int64 20M
30M
| note_type
stringclasses 1
value | note_seq
int64 2
851
| charttime
stringlengths 19
19
| storetime
stringlengths 19
19
| text
stringlengths 35
17.5k
|
|---|---|---|---|---|---|---|---|
10030753-RR-264 | 10,030,753 | 22,045,511 | RR | 264 | 2200-06-12 13:46:00 | 2200-06-12 15:58:00 | EXAMINATION: RENAL TRANSPLANT U.S.
INDICATION: ___ year old woman with ESRD s/p LURT ___ DMI on CellCept,
Neoral, andprednisone, CAD s/p multiple ___ recently ___,
dysautonomia, gastroparesis with chronic nausea and vomiting with worsening
renal failure and hx of needing straight cath, evaluate for hydronephrosis.
TECHNIQUE: Grey scale as well as color and spectral Doppler ultrasound images
of the renal transplant were obtained.
COMPARISON: Prior renal transplant ultrasound dated ___.
FINDINGS:
The right iliac fossa transplant renal morphology is normal. Specifically,
the cortex is of normal thickness and echogenicity, pyramids are normal, there
is no urothelial thickening, and renal sinus fat is normal. There is no
hydronephrosis and no perinephric fluid collection.
The resistive index of intrarenal arteries ranges from 0.81 to 0.87,
previously 0.84-0.88. The main renal artery shows a normal waveform, with
prompt systolic upstroke and continuous antegrade diastolic flow, with peak
systolic velocity of 76.9 cm/s. Vascularity is symmetric throughout
transplant. The transplant renal vein is patent and shows normal waveform.
IMPRESSION:
1. Elevated resistive indices similar to the prior study with differential
which may include acute tubular necrosis and rejection.
2. Patent vasculature, no hydronephrosis.
|
10030753-RR-265 | 10,030,753 | 22,045,511 | RR | 265 | 2200-06-16 10:19:00 | 2200-06-16 11:39:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ female with history of HFrEF (EF 41%) ESRD s/p LURT
___, CAD s/p multiple ___ recently ___ presents with lower
extremity swelling and weight gain, with acute on chronic HFrEF exacerbation
with worsening hypoxia and shortness of breath.// Eval for fluid overload?
Interval change? Eval for fluid overload? Interval change?
IMPRESSION:
Cardiomegaly is severe, minimally improved since previous examination. Right
pleural effusion has increased. There is no overt pulmonary edema, mild
vascular congestion is better than on ___. No pneumothorax.
|
10030753-RR-268 | 10,030,753 | 21,062,398 | RR | 268 | 2200-08-20 20:10:00 | 2200-08-20 21:17:00 | EXAMINATION: RENAL TRANSPLANT U.S.
INDICATION: ___ year old woman s/p renal transplant now with ___//
?Hydronephrosis, ?flow to transplant
TECHNIQUE: Grey scale as well as color and spectral Doppler ultrasound images
of the renal transplant were obtained.
COMPARISON: ___ renal ultrasound
FINDINGS:
The left iliac fossa transplant renal morphology is normal. Specifically, the
cortex is of normal thickness and echogenicity, pyramids are normal, there is
no urothelial thickening, and renal sinus fat is normal. There is no
hydronephrosis and no perinephric fluid collection.
No diastolic flow is detected within the intrarenal arteries with a resistive
index of 1.0. The main renal artery shows an abnormal waveform, with prompt
systolic upstroke but without continuous diastolic flow. Peak systolic
velocity of 51.8 centimeters/second is seen in the main renal artery.
Vascularity is symmetric throughout transplant. The transplant renal vein is
patent and shows normal waveform.
IMPRESSION:
1. No diastolic flow within the intrarenal arteries with resistive index of 1,
new since ___ with lack of continuous diastolic flow within the main
renal artery.
2. Patent main renal vein.
3. No hydronephrosis or perinephric fluid collection.
NOTIFICATION: The findings were discussed with ___, M.D. by ___
___, M.D. on the telephone on ___ at 9:07 pm, 1 minutes after
discovery of the findings.
|
10030753-RR-273 | 10,030,753 | 27,165,162 | RR | 273 | 2200-11-13 20:46:00 | 2200-11-13 22:24:00 | INDICATION: NO_PO contrast; History: ___ with LLQ painNO_PO contrast// NC
CTAP: eval for colitis
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 6.6 s, 52.1 cm; CTDIvol = 12.1 mGy (Body) DLP = 628.3
mGy-cm.
Total DLP (Body) = 628 mGy-cm.
COMPARISON: ___
FINDINGS:
LOWER CHEST: There are small bilateral pleural effusions overlying
atelectasis. Partially imaged lingula/inferior left upper lobe contains
scattered ground-glass opacities which could be due to infection, not fully
imaged. Coronary artery calcifications/stenting noted. The ventricular blood
pool is hypodense in relation to the myocardium, suggesting underlying anemia.
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 surgically absent
PANCREAS: Pancreas is somewhat atrophic. Previously reported pancreatic
cystic lesions were better assessed on prior study pancreatic body cystic
lesion again measures approximately 1.5 cm. Pancreatic tail lesion measures
approximately 3.1 cm. 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: Again, the bilateral native kidneys are atrophic. Left iliac fossa
transplant kidney shows no evidence of hydronephrosis. There may be very
subtle transplant kidney perinephric stranding/haziness; correlate with
urinalysis to assess for infection. There is no hydronephrosis. There is no
nephrolithiasis. The urinary bladder is collapsed around a Foley catheter.
GASTROINTESTINAL: The stomach is relatively collapsed. No bowel obstruction
or bowel wall thickening is seen. The appendix is not identified.
PELVIS: The urinary bladder is collapsed around a Foley catheter. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: The visualized reproductive organs are grossly
unremarkable.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Extensive arterial
calcifications are seen.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: Mild subcutaneous edema is seen in the abdomen and pelvis.
IMPRESSION:
1. Small bilateral pleural effusions with overlying atelectasis. Partially
imaged lingula/inferior left upper lobe contains scattered ground-glass
opacities which could be due to infection, but are not fully imaged.
2. Equivocal subtle perinephric stranding/haziness involving the left iliac
fossa transplant kidney. Correlate with urinalysis to assess for infection.
No hydronephrosis.
3. No bowel obstruction or bowel wall thickening.
4. Cardiac ventricular blood pool is hypodense in relation to the myocardium,
suggesting underlying anemia.
|
10030753-RR-274 | 10,030,753 | 27,165,162 | RR | 274 | 2200-11-14 08:19:00 | 2200-11-14 09:43:00 | INDICATION: ___ year old woman with renal transplant and hfpef// interval
changes, volume overload
TECHNIQUE: Chest AP view
COMPARISON: ___
IMPRESSION:
Lungs are low in volume. Small bilateral effusions are unchanged.
Cardiomediastinal silhouette is stable. Stents are seen within the coronary
arteries. No pneumothorax is seen. Mild interstitial edema has improved
since the prior study. No new consolidations.
|
10030753-RR-275 | 10,030,753 | 27,165,162 | RR | 275 | 2200-11-14 10:15:00 | 2200-11-14 13:14:00 | EXAMINATION: RENAL TRANSPLANT U.S.
INDICATION: ___ yo F with sig PMHx of Type 1DM, ESRD s/p LURT in ___
oncyclosporine/MMF, transfusion dependent anemia, CAD s/p ___ in
___, HFpEF with EF of 55% in ___, IPMN, HTN,scleroderma/crest, and multiple
recurrent MDR UTI who presentswith acute decompensated heart failure ___
inadequate POdiuresis, acute complicated cystitis further complicated by
alikely type 2 NSTEMI.// ?evaluation of transplant kidney I/s/o uti
TECHNIQUE: Grey scale as well as color and spectral Doppler ultrasound images
of the renal transplant were obtained.
COMPARISON: Prior renal ultrasound from ___
FINDINGS:
The left iliac fossa transplant renal morphology is normal. Specifically, the
cortex is of normal thickness and echogenicity, pyramids are normal, there is
no urothelial thickening, and renal sinus fat is normal. There is no
hydronephrosis and no perinephric fluid collection.
Diastolic flow is not detected within the intrarenal are arteries,
subsequently with a resistive index of 1. The main renal artery shows a
abnormal waveform, with prompt systolic upstroke without continued diastolic
flow. With peak systolic velocity of 25.4 cm/s. Vascularity is symmetric
throughout transplant. The transplant renal vein is patent and shows normal
waveform. A Foley catheter is placed in the bladder.
IMPRESSION:
1. Stable lack of diastolic flow within the intrarenal arteries with an
elevated resistive index of 1.
2. Patent main renal vein.
3. No hydronephrosis seen on the transplanted kidney.
|
10030753-RR-276 | 10,030,753 | 27,165,162 | RR | 276 | 2200-11-15 15:18:00 | 2200-11-15 16:03:00 | INDICATION: ___ year old woman with pneumonia// ?interval change
TECHNIQUE: Chest PA and lateral
COMPARISON: ___
IMPRESSION:
Lungs are clear. Pulmonary edema has improved. Cardiomediastinal silhouette
is stable. Bilateral effusions have also improved. No pneumothorax is seen
|
10030753-RR-277 | 10,030,753 | 27,165,162 | RR | 277 | 2200-11-19 09:14:00 | 2200-11-19 10:51:00 | INDICATION: Abdominal pain question obstruction
TECHNIQUE: Three views abdomen
COMPARISON: ___
FINDINGS:
There is a nonspecific but nonobstructive bowel gas pattern with air-filled
loops of small and large bowel. There is mild fecal loading. No
intraperitoneal free air. Clips are noted in the right upper quadrant. There
is an electric device in the left lower quadrant and clips in the right upper
quadrant and right lower quadrants.
IMPRESSION:
Nonspecific but nonobstructive bowel gas pattern.
|
10030753-RR-278 | 10,030,753 | 27,165,162 | RR | 278 | 2200-11-19 09:32:00 | 2200-11-19 10:04:00 | EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ yo F with sig PMHx of Type 1DM, ESRD s/p LURT in ___ on
cyclosporine/MMF, transfusion dependent anemia, CAD s/p ___ recently in
___, HFpEF with EF of 55% in ___, IPMN, HTN, scleroderma/crest, and multiple
recurrent MDR UTI who presented with acute decompensated heart failure, now
with altered mental status.// Concern for acute stroke/ICH
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 4.0 s, 16.0 cm; CTDIvol = 46.7 mGy (Head) DLP =
747.5 mGy-cm.
Total DLP (Head) = 748 mGy-cm.
COMPARISON: CT head from ___.
FINDINGS:
There is no evidence of acute large territorial infarction,hemorrhage,edema,or
mass. There is prominence of the ventricles and sulci suggestive of atrophy.
Periventricular white-matter hypodensities are nonspecific, but likely
represent sequela of chronic small vessel ischemic disease.
Re-demonstration of small chronic infarct of the right caudate nucleus body
(02:18) and bilateral basal ganglia calcifications.
There is no evidence of fracture. The visualized portion of the paranasal
sinuses, mastoid air cells, and middle ear cavities are clear. The visualized
portion of the orbits are unremarkable. Again seen are vascular
calcifications of the bilateral vertebral arteries and carotid siphons.
IMPRESSION:
1. No acute intracranial abnormality.
2. Re-demonstration of chronic findings, as above.
|
10030753-RR-279 | 10,030,753 | 27,165,162 | RR | 279 | 2200-11-19 09:48:00 | 2200-11-19 10:35:00 | EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ yo F with sig PMHx of Type 1DM, ESRD s/p LURT in ___ on
cyclosporine/MMF, transfusion dependent anemia, CAD s/p ___ recently in
___, HFpEF with EF of 55% in ___, IPMN, HTN, scleroderma/crest, and multiple
recurrent MDR UTI who presents with acute decompensated heart failure.// New
abd distension, abd pain, study for ascites as well as ? biliary obstruction
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: ___ CT abdomen and pelvis without IV contrast.
FINDINGS:
LIVER: The hepatic parenchyma appears coarsened. 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.
CHD: 3 mm
GALLBLADDER: The patient is status post cholecystectomy.
PANCREAS: Re-demonstrated in the pancreas are 2 hypoechoic cystic lesions
which were also seen in the prior ___ CT abdomen and pelvis. For
example there is a 1.5 x 1.5 x 2.3 cm cystic lesion at the pancreatic body and
a uncinate process 1.9 x 2.9 x 2.6 cm hypoechoic cyst with a single thin
septation adjacent to the common bile duct. The pancreatic tail is obscured
by overlying bowel gas.
SPLEEN: Normal echogenicity.
Spleen length: 10.3 cm
KIDNEYS: Limited views of the right lower quadrant transplant kidney
demonstrates no hydronephrosis.
RETROPERITONEUM: The visualized portions of aorta and IVC are within normal
limits.
Incidental note is made of a trace left pleural effusion.
IMPRESSION:
1. Coarsened liver echotexture. This can be seen in the setting of early
cirrhosis.
2. Surgically absent gallbladder.
3. At least 2 hypoechoic pancreatic cystic lesions (within the body and
uncinate process) for which non emergent outpatient MRCP further
characterization may be performed if not previously evaluated.
4. Trace left pleural effusion.
5. No ascites.
RECOMMENDATION(S): Outpatient MRCP for further evaluation of pancreatic
cysts.
|
10030753-RR-281 | 10,030,753 | 27,165,162 | RR | 281 | 2200-11-20 09:55:00 | 2200-11-20 10:39:00 | INDICATION: ___ year old woman with seizure.// Requested by neuro for seizure
workup. Please assess for pneumonia.
TECHNIQUE: Chest AP view
COMPARISON: ___
IMPRESSION:
Lungs are low volume with small bilateral pleural effusions with bibasilar
atelectasis. Interstitial edema has slightly worsened. No pneumothorax is
seen
|
10030753-RR-282 | 10,030,753 | 27,165,162 | RR | 282 | 2200-11-21 17:14:00 | 2200-11-22 08:59:00 | EXAMINATION: MRI AND MRA BRAIN, W/O CONTRAST T715 MR HEAD.
INDICATION: ___ year old woman with ESRD s/p renal txp, immunosuppressed, new
non-convulsive status epilepticus and R parietal dysfunction on exam (L
neglect, posterior apraxia of LUE)// Eval for infarction, PRES, other focal
lesions.
TECHNIQUE: 3 dimensional time-of-flight MRA was performed through the brain.
Sagittal and axial T1 weighted imaging were performed along with diffusion
imaging.
Axial imaging was performed with gradient echo, FLAIR, T2, and T1 technique.
Sagittal MPRAGE imaging was performed and re-formatted in axial and coronal
orientations.
Three dimensional maximum intensity projection and segmented images were
generated. This report is based on interpretation of all of these images.
COMPARISON: CT head without contrast dated ___.
MRA brain without contrast dated ___.
MRI head without contrast dated ___.
FINDINGS:
Examination is mildly degraded by motion.
MR BRAIN:
There are scattered patchy areas of hyperintense signal in the right frontal
and right parietal lobes on diffusion weighted images with subtle
hypointensity on the ADC map consistent with a combination of slow diffusion
and T2 shine through effect, suggesting acute/subacute on chronic
thromboembolic ischemic changes, which are more significant along the
cingulate gyrus and corpus callosum (image 1, series 22). There is no
evidence of hemorrhagic transformation. Mild prominence of the ventricles and
sulci is suggestive of involutional changes. No mass effect or midline shift.
Patchy areas of T2 and FLAIR hyperintense signal abnormalities in the
periventricular and subcortical white matter as well as the pons are
nonspecific, but likely reflect chronic small vessel ischemic changes.
There is mild mucosal thickening of the ethmoid sinuses. Minimal right
mastoid air cell effusion. The intraorbital contents are unremarkable.
MRA brain: There is unchanged stenosis of the left superior cerebellar artery
(image 100 of series 9, image 7 of series 104). Mild luminal in signal
irregularity of the parasellar internal carotid arteries may relate to
atherosclerotic disease. There is persistent fetal origin of the right
posterior cerebral artery. Otherwise, the intracranial vertebral and internal
carotid arteries and their major branches appear normal without evidence of
stenosis, occlusion, or aneurysm formation.
IMPRESSION:
1. Acute/subacute on chronic thromboembolic ischemic changes in the right
frontal and right parietal lobes as described detail above.
2. No acute intracranial hemorrhage.
3. Unchanged left SCA focal stenosis. Otherwise, patent circle of ___ with
no evidence of aneurysm formation.
|
10030753-RR-283 | 10,030,753 | 27,165,162 | RR | 283 | 2200-11-23 13:11:00 | 2200-11-23 14:34:00 | EXAMINATION: MRA NECK W/O CONTRAST T9___ MR NECK
INDICATION: Patient is a ___ year old woman with history of Type 1DM, CKDstage
___ s/p LURT in ___ on cyclosporine/MMF, transfusiondependent anemia, CAD s/p
___ recently in ___, and multiple recurrent MDR UTIs
who presented9/3 with acute decompensated heart failure ___ inadequate
POdiuresis, course has been complicated by acute complicatedcystitis (now s/p
7 day course of cefepime), and type 2 NSTEMI(now s/p RHC). EEG showing
nonconvulsive status, controlled with keppra, valproate. MRI head showing new
infarcts, now evaluating extra cranial vessels.
TECHNIQUE: Two dimensional time-of-flight MRA was performed without contrast
administration.
Three dimensional maximum intensity projection images were generated. This
report is based on interpretaion of all of these images.
COMPARISON: MRI MRA brain of ___ carotid ultrasound of ___, MRI MRA brain MRA neck of ___.
FINDINGS:
The mid to distal bilateral cervical internal carotid arteries are not within
the field of view of current study. Within this confines:
The common,visualized internalandvisualized externalcarotid arteries appear
unremarkable. There is no evidence of stenosis by NASCET criteria within
confines of 2D time-of-flight technique. The origins of the great vessels,
subclavian, and vertebral arteries appear normal bilaterally. The common
carotid bifurcations appear normal.
Small bilateral pleural effusions are identified.
IMPRESSION:
Within confines of 2D time-of-flight technique and limited field of view
obscuring the mid to distal bilateral cervical internal carotid arteries:
1. Unremarkable MRA of the neck without evidence of stenosis of the cervical
internal carotid arteries by NASCET criteria.
2. Additional findings as described above.
|
10030753-RR-286 | 10,030,753 | 22,300,700 | RR | 286 | 2200-12-03 16:24:00 | 2200-12-03 17:11:00 | EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ year old woman with recent admission for CVA thought likely
due to small vessel disease, seizures, now presenting with encephalopathy
thought likely due to UTI, uncontrolled hypertension, now with akathisia, new
L pronator drift, and c/f hyperactive delirium.// any e/o PRES? New CVA?
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 4.0 s, 16.0 cm; CTDIvol = 46.7 mGy (Head) DLP =
747.1 mGy-cm.
2) Sequenced Acquisition 2.0 s, 8.0 cm; CTDIvol = 46.7 mGy (Head) DLP =
373.8 mGy-cm.
Total DLP (Head) = 1,121 mGy-cm.
COMPARISON: CT head from ___. MRI and MRA brain from ___.
FINDINGS:
There is no evidence of a new large territorial infarction,hemorrhage,edema,or
mass-effect. There is prominence of the ventricles and sulci suggestive of
atrophy. Periventricular white-matter hypodensities are nonspecific, but
likely represent sequela of chronic small vessel ischemic disease.
Re-demonstration of small chronic infarct of the body of the right caudate
nucleus, right thalamus and physiologic bilateral basal ganglia
calcifications.
There is no evidence of fracture. The visualized portion of the paranasal
sinuses, mastoid air cells, and middle ear cavities are clear. The visualized
portion of the orbits are unremarkable. Vascular calcifications are again
noted.
IMPRESSION:
1. No new acute intracranial process.
2. Chronic findings, as above.
|
10030753-RR-288 | 10,030,753 | 22,300,700 | RR | 288 | 2200-12-06 01:11:00 | 2200-12-06 09:12:00 | EXAMINATION: MR HEAD W/O CONTRAST T9113 MR HEAD
INDICATION: ___ year old woman with complex medical history notable for ESRD
s/p LURT ___ on immunosuppression, CAD s/p ___ 4 (most recent ___, HFrEF
(EF 35-40% ___, T1DM, severe poorly controlled HTN, scleroderma/CREST, who
was brought to the ED by EMS after an episode of hypoglycemia and is now
admitted for altered mental status and weakness, possibly from UTI. Pt w/
recent stroke, concern for new stroke, PRES.// eval for new interval stroke,
PRES
TECHNIQUE: Sagittal T1 weighted imaging was performed. Axial imaging was
performed with gradient echo, FLAIR, diffusion, and T2 technique were then
obtained.
COMPARISON CT head on ___, MRI and MRA brain on ___, MRI head ___
FINDINGS:
Exam is mildly degraded by motion.
Compared with MRI ___, foci of diffusion signal hyperintensity
in the right frontal and parietal lobes, right corpus callosum, and right pons
are not significantly changed, however some previously seen areas of
corresponding low signal on the ADC map appear slightly increased in signal
intensity compared with prior, for example in the corpus callosum and right
pons. Few tiny foci of susceptibility in the pons are consistent with chronic
microhemorrhage. There is no new infarction or intracranial hemorrhage.
There is stable mild prominence of the ventricles and sulci consistent with
involutional changes. Subcortical, periventricular and pontine T2/FLAIR
signal hyperintensities are nonspecific, however not significantly changed
from prior, likely representing sequela of chronic small vessel ischemic
disease. Additional regions of encephalomalacia of the right parietooccipital
lobe, left occipital lobe and right middle frontal gyrus and right posterior
temporal lobe are unchanged. The major intracranial flow voids are preserved.
There is minimal mild mucosal thickening in the bilateral frontal, sphenoid
and maxillary sinuses, and ethmoid air cells. There is partial opacification
of the bilateral mastoid air cells, not significantly changed. The orbits are
grossly unremarkable.
IMPRESSION:
1. Interval evolution of subacute on chronic thromboembolic ischemic changes
in the right cerebral hemisphere and right pons.
2. No new infarct or acute intracranial hemorrhage. No evidence for PRES.
3. Additional findings as described above.
|
10030753-RR-289 | 10,030,753 | 22,300,700 | RR | 289 | 2200-12-09 18:03:00 | 2200-12-09 18:45:00 | EXAMINATION: CR - CHEST PORTABLE AP
INDICATION: ___ year old woman with AMS ___ UTI, now again altered, doing
infectious w/u// eval for e/o PNA
TECHNIQUE: AP radiograph of the chest.
COMPARISON: Chest radiograph ___.
FINDINGS:
There is no focal consolidation, pleural effusion or pneumothorax. There is
cardiomegaly, which appears decreased compared to most recent prior study. No
acute osseous abnormalities are identified. Healed right rib fractures are
again noted.
IMPRESSION:
1. No radiographic evidence of pneumonia.
2. Mild cardiomegaly, which is improved compared to prior study.
|
10030753-RR-290 | 10,030,753 | 22,300,700 | RR | 290 | 2200-12-11 13:18:00 | 2200-12-11 14:51:00 | EXAMINATION: UNILAT LOWER EXT VEINS
INDICATION: ___ year old woman with complex medical history notable for ESRD
s/p LURT ___ on immunosuppression, CAD s/p ___ 4 (most recent ___, HFrEF
(EF 35-40% ___, T1DM, severe poorly controlled HTN, scleroderma/CREST, who
was admitted for altered mental status now improved. Has RLE>LLE swelling//
eval 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 bilateral
common femoral, femoral, and popliteal veins. Normal color flow and
compressibility are demonstrated in the posterior tibial veins. Normal color
flow is demonstrated in the peroneal veins
There is normal respiratory variation in the common femoral veins bilaterally.
IMPRESSION:
No evidence of deep venous thrombosis in the rightlower extremity veins.
|
10030753-RR-291 | 10,030,753 | 22,300,700 | RR | 291 | 2200-12-14 17:22:00 | 2200-12-14 18:07:00 | EXAMINATION: CR - CHEST PORTABLE AP
INDICATION: ___ year old woman with T1DM who was admitted for DKA. Having
cough// eval for pneumonia
TECHNIQUE: AP radiograph of the chest.
COMPARISON: Chest radiograph ___.
FINDINGS:
Mild blunting of the right costophrenic angle may represent a small pleural
effusion or atelectasis. There is no focal consolidation or pneumothorax.
There is mild cardiomegaly and central pulmonary vascular congestion but no
significant pulmonary edema.
IMPRESSION:
No pneumonia or acute cardiopulmonary process.
|
10030753-RR-292 | 10,030,753 | 22,300,700 | RR | 292 | 2200-12-16 06:02:00 | 2200-12-16 11:18:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with 57 with CAD, T1DM, admitted for AMS now
with SOB, eval for cause of SOB// eval for cause of SOB eval for cause of
SOB
IMPRESSION:
Compared to chest radiograph ___.
New mild to moderate pulmonary edema. Stable moderate to severe cardiomegaly.
Pleural effusions small if any. No pneumothorax.
|
10030753-RR-294 | 10,030,753 | 22,300,700 | RR | 294 | 2200-12-19 00:14:00 | 2200-12-19 08:32:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with with complex medical history notable for
ESRD s/p LURT ___ on immunosuppression, CAD s/p ___ 4 (most recent ___,
HFrEF (EF 35-40% ___, T1DM, severe poorly controlled HTN,
scleroderma/CREST, who was brought to the ED by EMS after an episode of
hypoglycemia and is now admitted for altered mental status and weakness,
likely combo of low BS, UTI, possible seizure.// Pt has new SOB, new
consolidation or pleural effusion?
IMPRESSION:
In comparison with the study of ___, the there are lower lung volumes.
Moderate enlargement of the cardiac silhouette is again seen with moderate
pulmonary vascular congestion. Opacification at the right base silhouetting
hemidiaphragm is consistent with pleural fluid and atelectatic changes at the
base. Retrocardiac opacification suggests volume loss in the left lower lobe.
No evidence of acute focal consolidation, though this would be difficult to
unequivocally exclude in the appropriate clinical setting, especially in the
absence of a lateral view.
There is a spiculated opacification in the right upper quadrant of the
abdomen, raising the possibility of a gallstone.
|
10030753-RR-296 | 10,030,753 | 23,017,050 | RR | 296 | 2201-02-21 14:29:00 | 2201-02-21 15:55:00 | EXAMINATION: RENAL TRANSPLANT U.S. RIGHT
INDICATION: ___ year old woman with ESRD s/p renal transplant, HFrEF, admitted
for volume overload, UTI, and increase in creatinine from baseline.// eval of
transplant kidney with renal resistive index
TECHNIQUE: Grey scale as well as color and spectral Doppler ultrasound images
of the renal transplant were obtained.
COMPARISON: Renal transplant ultrasound ___
FINDINGS:
The left transplant renal morphology is normal. The transplant kidney
measures 12.6 cm. Specifically, the cortex is of normal thickness and
echogenicity, pyramids are normal, there is no urothelial thickening, and
renal sinus fat is normal. There is no hydronephrosis and no perinephric
fluid collection.
The resistive index of intrarenal arteries are similar to the prior ultrasound
ranging from 0.84 to 0.92. The main renal artery demonstrates lower
velocities and slightly slower acceleration times and absent diastolic flow.
Peak systolic velocity in the main renal artery measures 43
centimeters/second. Vascularity is symmetric throughout transplant. The
transplant renal vein is patent and shows normal waveform.
BLADDER: The bladder is partially distended. The bladder wall is noted to be
hypertrophic.
IMPRESSION:
1. Unremarkable appearance of the transplant kidney in the left lower quadrant
with no hydronephrosis.
2. Patent renal transplant vasculature. The RIs remain elevated. The main
renal artery demonstrates mild parvus tardus waveform and absent diastolic
flow.
3. Bladder wall thickening suggesting hypertrophy or neuropathic bladder
changes.
|
10030753-RR-297 | 10,030,753 | 23,017,050 | RR | 297 | 2201-02-25 16:30:00 | 2201-02-26 08:57:00 | EXAMINATION: MR HEAD W/O CONTRAST T___ MR HEAD
INDICATION: ___ year old woman with ESRD s/p transplant, hypertensive to 200s
overnight; now altered, truncal ataxia, possible pronator drift.// r/o stroke,
PRES
TECHNIQUE: Sagittal T1 weighted imaging was performed. Axial imaging was
performed with gradient echo, FLAIR, diffusion, and T2 technique were then
obtained.
COMPARISON
1. CT head ___.
2. MR head ___.
FINDINGS:
MRI HEAD:
There is a probable small acute or early subacute cortical infarct in the
right parietal lobe (series 4 and 5, image 20).
There is small acute or early subacute infarct in the right thalamus (series 4
and 5, image 15, series 11, image 12). There is a small probably acute/early
subacute infarct in the right external capsule (series 4 and 5, image 13).
Just posterolateral to this, there is a punctate focus of restricted diffusion
in the right insular cortex which is too small to definitively visualized on
ADC map, possibly an additional tiny acute or early subacute infarct.
There is a foci of right frontal encephalomalacia, likely from remote prior
(chronic) infarcts, with surrounding white matter FLAIR signal hyperintensity,
possibly gliosis (see series 11 image 17 and 12 image 11). There is an
additional small focus of encephalomalacia in the medial right parafalcine
parietal lobe, near the vertex (___). There is also encephalomalacia with
T2 shine through in the left middle cerebellar peduncle. Additional focus of
encephalomalacia, right a temporal periventricular white matter (12:9). These
areas are unchanged.
There are small chronic lacunar infarcts in the right corona radiata
periventricular white matter (11:14), unchanged.
Multiple foci of chronic hemorrhage are seen in the medial left temporal lobe,
unchanged. Pontine chronic microhemorrhages are similar, with a few possibly
new foci (13:7). Right supratentorial foci of chronic microhemorrhage, right
parietal lobe (13:17) and right frontal lobe (13:14), the latter being new,
the former unchanged.
The ventricles and sulci are prominent, compatible with global parenchymal
volume loss. Bilateral periventricular and deep white matter foci of T2/FLAIR
signal hyperintensity are nonspecific but compatible with moderate changes of
chronic white matter microangiopathy.
There is mild ethmoid air cell, sphenoid, frontal sinus mucosal thickening.
Remaining visualized paranasal sinuses appear clear. Partial bilateral
mastoid effusions. Globes and orbits unremarkable.
MRA HEAD:
Widely patent vertebrobasilar system. Fetal type right PCA, with a widely
patent right PCOM. The right P1 segment is not well seen, either diminutive
or absent. Conventional left PCA anatomy. Left PCOM is not well seen, either
diminutive or absent. Left P1 is widely patent.
Mild focal luminal narrowing, proximal right P2. Mild luminal narrowing, mid
right P3 (2:82). Left P2 and P3 PCA branches are widely patent. There is
severe luminal narrowing of a left P4 distal branch (2:96). There is
otherwise normal bilateral distal PCA runoff.
There is a 2 mm laterally projecting outpouching arising from the cavernous
right intracranial ICA (02:50), small infundibulum versus aneurysm.
Otherwise, the remaining portions of the bilateral intracranial internal
carotid arteries and the bilateral anterior and middle cerebral arteries are
patent with normal distal runoff.
No additional stenosis, aneurysm, or occlusion.
IMPRESSION:
1. Multiple small acute or early subacute infarcts, in the right thalamus,
right external capsule, right parietal cortex, and possibly in the right
insular cortex.
2. 2 mm laterally projecting outpouching, right cavernous intracranial ICA,
small infundibulum versus tiny aneurysm.
3. Areas of mild to severe luminal narrowing, bilateral posterior cerebral
arteries, presumably due to underlying atheromatous disease, most severely
affecting the left P4 PCA. There is nonetheless preserved distal PCA runoff
bilaterally.
4. Otherwise, patent circle of ___ vasculature. No additional stenosis,
aneurysm, or occlusion.
5. Multiple foci of supratentorial and infratentorial encephalomalacia,
compatible sequelae of remote infarction.
6. Small chronic right periventricular white matter infarcts.
7. Multiple foci of chronic microhemorrhage; although there are a few
supratentorial foci, these are most conspicuous in the brainstem, raising the
possibility of hypertensive angiopathy.
|
10030753-RR-298 | 10,030,753 | 23,017,050 | RR | 298 | 2201-02-25 11:24:00 | 2201-02-25 14:42:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with ESRD s/p transplant on immunosuppression
now with hypotension and altered mental status concerning for new infection.//
eval for PNA eval for PNA
IMPRESSION:
Compared to chest radiographs ___ through ___.
Moderate cardiomegaly is larger and pulmonary vasculature is more engorged but
there is probably no pulmonary edema. Elevation right lung base could be due
to subpulmonic pleural effusion or right basal atelectasis. Skin fold should
not be mistaken for left pneumothorax.
|
10030753-RR-299 | 10,030,753 | 23,017,050 | RR | 299 | 2201-02-25 10:38:00 | 2201-02-25 12:24:00 | EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ year old woman with DM1, renal transplant on
immunosuppression, with new confusion, left pronator drift, ataxia. Evaluate
for stroke, edema/PRES.
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast. Coronal and sagittal reformations as well as bone algorithm
reconstructions were provided and reviewed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 4.0 s, 16.0 cm; CTDIvol = 46.7 mGy (Head) DLP =
747.7 mGy-cm.
Total DLP (Head) = 748 mGy-cm.
COMPARISON: Multiple prior brain imaging studies:
Most recent MRI from ___
Most recent CT head from ___
FINDINGS:
There is no evidence of acute hemorrhage or acute major vascular territorial
infarct.
Chronic infarcts are again seen in the right body of the caudate extending
into the corona radiata and centrum semiovale, right middle frontal gyrus,
left frontal centrum semiovale, posterior temporal lobe (02:13), right
thalamus right pons (02:11), similar to the prior MRI. More ill-defined
hypodensities in the periventricular, deep, and subcortical white matter of
the cerebral hemispheres are also grossly unchanged, nonspecific but likely
sequela of chronic small vessel ischemic disease given the patient's history.
Ventricles and sulci are prominent, consistent with age-related global
parenchymal loss, similar to prior.
No evidence for concerning bone lesions. There are mucous retention cysts
within bilateral sphenoid sinuses with mild mucosal thickening in the left
sphenoid sinus. There is a fluid level in the left posterior ethmoid sinus.
A right middle ethmoid air cell is completely opacified. There is mild
mucosal thickening in other bilateral anterior ethmoid air cells and in the
inferior right frontal sinus. There is mild mucosal thickening in the left
maxillary sinus. There is no partial left mastoid air cell opacification.
IMPRESSION:
1. No evidence for acute hemorrhage or acute major vascular territorial
infarct.
2. Multiple chronic infarcts are again demonstrated.
3. Paranasal sinus disease.
|
10030753-RR-300 | 10,030,753 | 23,017,050 | RR | 300 | 2201-03-03 11:44:00 | 2201-03-03 14:31:00 | EXAMINATION: Pelvis MRA.
INDICATION: ___ year old woman with type I DM s/p renal transplant with very
labile BPs, having multiple CVAs and trying to stabilize BP swings in case it
is being mediated for functional RAS// concern for arterial stenosis to renal
transplant- trying to avoid arteriogram due to CKD. Please assess with time of
flight MRA to see if stenting will be needed
TECHNIQUE: T1- and T2-weighted multiplanar images and arterial and venous
time-of-flight image acquisitions of the pelviswere acquired in a 1.5 T
magnet.
No intravenous contrast.
COMPARISON: Unenhanced CT scan from ___.
FINDINGS:
There is a left iliac fossa renal transplant. There is no focal renal lesion.
There is no hydronephrosis. There is no perinephric fluid collection.
Arterial IFIR and time-of-flight images demonstrate two transplant renal
arteries anastomosed to the left external iliac artery. There is no evidence
of occlusion or renal artery stenosis. Visualized bilateral common, external
and internal iliac arteries are unremarkable.
Venous time-of-flight images demonstrate a decompressed but patent transplant
renal vein anastomosed to the external iliac vein. Visualized bilateral
common, external and internal iliac veins are patent.
The bladder is decompressed by Foley catheter. There is a small amount of
free fluid in the pelvis.
OSSEOUS STRUCTURES AND SOFT TISSUES: There is no aggressive osseous lesion in
the visualized bony pelvis. There is susceptibility artifact related to
postsurgical changes along the anterior left lower quadrant abdominal wall.
There is anasarca of the pelvic wall.
IMPRESSION:
1. No evidence of renal artery stenosis involving the transplant kidney.
Patent renal vein.
|
10031358-RR-34 | 10,031,358 | 29,498,981 | RR | 34 | 2158-09-04 06:41:00 | 2158-09-04 07:15:00 | INDICATION: ___ male with facial droop. Evaluate for infiltrate.
TECHNIQUE: PA and lateral chest radiographs were obtained.
COMPARISON: Chest radiograph from ___ and ___.
FINDINGS:
There has been interval removal of a left PICC. The lungs are clear without
focal consolidation, pleural effusion or pneumothorax. There is no pulmonary
edema. The heart is top normal in size, and the mediastinal contours are
normal.
IMPRESSION:
No acute cardiopulmonary process.
|
10031358-RR-35 | 10,031,358 | 29,498,981 | RR | 35 | 2158-09-04 06:41:00 | 2158-09-04 08:21:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ male with slurred speech, right facial droop.
Evaluate for cerebral vascular accident or bleeding.
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast. Coronal and sagittal reformations as well as bone algorithm
reconstructions were provided and reviewed.
DOSE: Total DLP (Head) = 903 mGy-cm.
COMPARISON: None.
FINDINGS:
There is a 13 x 8 mm hemorrhage within the left putamen, concerning for a
hypertensive hemorrhage. No evidence of infarction or mass is seen. There is
prominence of the ventricles and sulci appropriate for age.
Mucosal thickening is noted in the bilateral frontal sinuses, bilateral
ethmoid air cells, bilateral sphenoid sinuses and right maxillary sinus.
Sclerosis of the right maxillary sinus walls is reflective of chronic
inflammation, and inspissated mucus is noted in the right maxillary sinus.
There is no evidence of fracture. The visualized portion of the orbits are
unremarkable.
IMPRESSION:
1. 13 mm hemorrhage in the left putamen, compatible with hypertensive
hemorrhage.
2. Paranasal sinus inflammatory disease.
|
10031358-RR-36 | 10,031,358 | 29,498,981 | RR | 36 | 2158-09-04 20:21:00 | 2158-09-05 09:17:00 | EXAMINATION: MR HEAD W/O CONTRAST T___ MR HEAD
INDICATION: ___ year old man with L BG IPH // r/o mass, stroke
TECHNIQUE: Sagittal T1 weighted imaging was performed. Axial imaging was
performed with gradient echo, FLAIR, diffusion, and T2 technique were then
obtained.
COMPARISON CT from ___.
FINDINGS:
There is a 0.7 cm x 1.3 cm region of hemorrhage with surrounding edema in the
leftputamen with no significant mass effect.
There is no evidence of mass effect, midline shift or infarction. There is
prominence of the ventricles and sulci suggestive involutional changes.
There is prominence of the soft tissues in the posterior nasopharynx. Partial
opacification of the mastoid air cells is seen. The orbits are normal. There
is mucosal thickening in the frontal, ethmoid sphenoid and maxillary sinuses.
There is no definitive visualization of the V3 or V4 segments of the right
vertebral artery with a diminutive distal right V4 vertebral artery seen.
IMPRESSION:
1. Stable left putaminal hematoma with mild surrounding edema and no
significant effect or midline shift. No acute infarct.
2. No visualization of the right distal V3 or V4 segments of the vertebral
artery with a diminutive distal right V4 segment seen. This may represent a
diminutive vessel versus occlusion. A MRA can be acquired for further
evaluation if clinically indicated.
3. Paranasal sinus disease.
4. Prominence of the posterior nasopharyngeal soft tissues, which may
represent prominent adenoids. Recommend correlation with direct
visualization.
|
10031575-RR-25 | 10,031,575 | 27,796,946 | RR | 25 | 2171-03-19 11:36:00 | 2171-03-19 14:49:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: History: ___ with chest pain// eval for acute process
TECHNIQUE: Single frontal view of the chest
COMPARISON: ___
FINDINGS:
No definite focal consolidation is seen. There is no large pleural effusion
or pneumothorax. The cardiac and mediastinal silhouettes are stable. No
pulmonary edema is seen.
IMPRESSION:
No acute cardiopulmonary process.
|
10031575-RR-26 | 10,031,575 | 27,796,946 | RR | 26 | 2171-03-19 13:47:00 | 2171-03-19 15:11:00 | EXAMINATION: UNILAT UP EXT VEINS US LEFT
INDICATION: History: ___ with new left arm swelling for the past 2 weeks as
well sob// ?DVT
TECHNIQUE: Grey scale and Doppler evaluation was performed on the left upper
extremity veins.
COMPARISON: None.
FINDINGS:
There is normal flow with respiratory variation in the left subclavian vein.
The left internal jugular and axillary veins are patent, show normal color
flow and compressibility. The left brachial, basilic, and cephalic veins are
patent, compressible and show normal color flow and augmentation.
IMPRESSION:
No evidence of deep vein thrombosis in the left upper extremity.
|
10031575-RR-27 | 10,031,575 | 27,796,946 | RR | 27 | 2171-03-21 11:48:00 | 2171-03-21 15:25:00 | EXAMINATION: MR cardiac
INDICATION: ___ woman with HTN, IDDM, HLD with heart failure (unknown EF)
diagnosed ___ at BMC here with worsening dyspnea on exertion, lower
extremity edema c/f acute on chronic heart failure exacerbation.// Eval for
amyloidosis
TECHNIQUE: Cardiac MRI was performed by the Department of Cardiology.
COMPARISON: None.
IMPRESSION:
Please note that this report only pertains to extracardiac findings.
There are small bilateral pleural effusions.
The entirety of this Cardiac MRI is reported separately in the Electronic
Medical Record (OMR) - Cardiovascular Reports.
|
10031575-RR-29 | 10,031,575 | 27,796,946 | RR | 29 | 2171-03-25 09:26:00 | 2171-03-25 14:29:00 | EXAMINATION: THYROID U.S.
INDICATION: ___ year old woman with HFpEF, goiter on examination, TSH elevated
to 6.// evaluation/characterization of thyroid enlargement
TECHNIQUE: Grey scale and color Doppler ultrasound images of the neck were
obtained.
COMPARISON: None.
FINDINGS:
The right lobe measures: (transverse) 2.6 x (anterior-posterior) 2.7 x
(craniocaudal) 7.3 cm.
The left lobe measures: (transverse) 2.1 x (anterior-posterior) 2.3 x
(craniocaudal) 6.0 cm.
Isthmus anterior-posterior diameter is 0.9 cm.
The thyroid parenchyma is heterogeneous and has increased vascularity. The
appearance is compatible with thyroiditis.
No discrete nodules are identified.
IMPRESSION:
Heterogeneous hypervascular thyroid gland compatible with thyroiditis. No
discrete nodules identified.
|
10031575-RR-49 | 10,031,575 | 21,330,901 | RR | 49 | 2173-03-09 23:21:00 | 2173-03-10 08:33:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with fever and tachycardia with shortness of
breath.// Evaluate for consolidation
IMPRESSION:
In comparison with the study of ___, there are lower lung volumes.
Cardiomediastinal silhouette is stable and there is no vascular congestion,
pleural effusion, or acute focal pneumonia.
|
10031575-RR-50 | 10,031,575 | 21,330,901 | RR | 50 | 2173-03-11 18:24:00 | 2173-03-11 19:17:00 | EXAMINATION: CT NECK W/O CONTRAST (EG: PAROTIDS) Q21 CT NECK
INDICATION: ___ year old woman with left sided dental abscess, wondering if
any extension of abscess into soft tissue// any extension of abscess?
TECHNIQUE: MDCT acquired helical axial images were obtained from the thoracic
inlet through the skull base.
Coronal and sagittal multiplanar reformats were then produced and reviewed.
DOSE: Acquisition sequence:
1) Spiral Acquisition 3.0 s, 23.2 cm; CTDIvol = 15.8 mGy (Body) DLP = 366.7
mGy-cm.
Total DLP (Body) = 367 mGy-cm.
COMPARISON: None.
FINDINGS:
There is lucency around the root ___ 14 which was previously treated
(601:20, 2:61). There is thickening of the soft tissue abutting the
aforementioned left upper molar (301:111) and stranding and mild swelling of
the subcutaneous fat in the region (301: 111). In addition, there is subtle
thickening of the platysma and subcutaneous fat stranding overlying the left
mandible. However, there is no drainable fluid collection.
Evaluation of the aerodigestive tract demonstrates no mass and no areas of
focal mass effect.
The salivary glands are grossly without mass or adjacent fat stranding. The
thyroid gland appears mildly enlarged and heterogeneous.There are numerous
cervical lymph nodes that are mildly enlarged and increased in number,
presumably reactive. The largest lymph node is in cervical level 1 B
location, measuring up to 10 mm in the short axis with preserved fatty hilum
(301:90). 6 mm hyperdensity in the posterior aspect of the right parotid
gland is likely an intra parotid lymph node (301:116).
There is mucosal thickening of the left ethmoid air cells and moderate
opacification of the left maxillary sinus, possibly related to the dental
disease.
The imaged portion of the lung apices are clear and there are no concerning
pulmonary nodules. There are no osseous lesions.
IMPRESSION:
1. Lucency around the roots of previously treated ___ 14, with associated left
facial cellulitis. No drainable fluid collection. Reactive lymphadenopathy.
2. Mildly enlarged and heterogeneous thyroid gland. No focal nodule
identified.
3. Likely dental disease related left maxillary and ethmoid sinus
opacification.
|
10031687-RR-55 | 10,031,687 | 25,653,917 | RR | 55 | 2141-04-06 17:02:00 | 2141-04-06 17:38:00 | HISTORY: ___ man, with acute onset of atraumatic right foot pain at
the dorsum of mid foot. Assess for fracture.
COMPARISON: Right foot radiograph on ___.
RIGHT FOOT RADIOGRAPH, THREE VIEWS: There is no acute fracture or
dislocation. There is similar pes planus with a small plantar calcaneal spur.
A dorsal spurring is again noted at the talonavicular joint.
IMPRESSION: No acute fracture or dislocation.
|
10031687-RR-56 | 10,031,687 | 25,653,917 | RR | 56 | 2141-04-06 16:33:00 | 2141-04-06 17:06:00 | HISTORY: Right leg swelling.
COMPARISON: None.
TECHNIQUE: Grayscale color and spectral Doppler evaluation was performed of
the bilateral lower extremity veins.
FINDINGS: There is normal compressibility and flow of the right common and
proximal femoral vein. There is noncompressibility and lack of flow in the
right mid and distal femoral vein extending into the popliteal and one of the
posterior tibial veins. There is normal compressibility, flow, and
augmentation of the left common femoral, proximal femoral, mid femoral, distal
femoral, and popliteal veins. Normal color flow and compressibility are
demonstrated in the left posterior tibial veins. The peroneal veins are not
visualized in either lower extremity. There is normal respiratory variation
in the common femoral veins bilaterally.
IMPRESSION:
Right lower extremity DVT starting in the mid femoral vein, extending into the
popliteal vein and into one of the posterior tibial veins. Peroneal veins are
not visualized in either leg. There is no DVT in left leg.
|
10031687-RR-57 | 10,031,687 | 25,653,917 | RR | 57 | 2141-04-21 08:41:00 | 2141-04-21 09:39:00 | HISTORY: Right PICC placement.
COMPARISON: ___.
TECHNIQUE: Portable frontal chest radiograph, two views.
FINDINGS: There has been placement of a right-sided PICC with the tip
terminating in the low SVC. The cardiomediastinal silhouette and hilar
contours are unchanged. A left anterior chest wall ICD is unchanged in
position. Lungs are clear. There is no pleural effusion or pneumothorax.
IMPRESSION: Adequate positioning of right PICC in the low SVC.
The results were conveyed over the telephone to ___ of the IV
nursing team by Dr. ___ at 9:15 a.m. on ___ at the time of
initial review.
|
10031687-RR-59 | 10,031,687 | 25,653,917 | RR | 59 | 2141-04-22 15:37:00 | 2141-04-22 17:18:00 | TYPE OF THE EXAM: CT of the abdomen and pelvis without intravenous contrast.
REASON FOR THE EXAM AND MEDICAL HISTORY: Assess retroperitoneal hematoma.
___ gentleman with altered mental status, nausea and leg pain.
TECHNIQUE:
Multiple axial CT images through the chest, abdomen and pelvis up to the level
of mid thigh was obtained.
Coronal and sagittal reconstructions are available for interpretation.
COMPARISON EXAM: CT urogram from ___.
FINDINGS:
LUNG BASES: There is no evidence of focal consolidation.
Abdomen: There is a large retroperitoneal hematoma, which insinuates
throughout the entire length of the left iliopsoas muscle up to the level of
the insertion. Hematoma is seen within the left posterior pararenal space,
extending inferiorly to the extraperitoneal spaces and into the inguinal
region. There is no evidence of extension of blood into the left thigh.
Liver: There is a segment VI subcentimeter hypodense lesion and smaller
scattered foci which are not accurately assessed, may represent cysts. There
is no intrahepatic biliary dilatation. Gallbladder demonstrates no evidence
of pericholecystic fluid or radiopaque calculi. Spleen is normal in size.
Right adrenal gland is slightly nodular. Stable hypoattenuating nodular
densities lateral to the right diaphragmatic crus, which may represent
lymphangioma.
The pancreas demonstrates some peripancreatic stranding secondary to the
retroperitoneal hematoma, however, with no focal masses. There is no
pancreatic duct dilatation. Bilateral kidneys demonstrate no presence of
hydronephrosis. There is no mesenteric lymphadenopathy.
PELVIS: Prostate is normal in size. Seminal vesicles are unremarkable. No
evidence of lymphadenopathy within the pelvis. There is no free fluid.
Urinary bladder is unremarkable. Rectum, sigmoid colon, transverse colon, and
the small loops of bowel within the pelvis are unremarkable.
VASCULAR STRUCTURES: There are heavy atherosclerotic calcifications involving
the aortoiliac vessels.
OSSEOUS STRUCTURES: No evidence of acute fractures or worrisome lytic
lesions.
IMPRESSION:
Large left-sided retroperitoneal hematoma with blood insinuating throughout
the left iliopsoas muscle and anteriorly in the retroperitoneum/left anterior
pararenal space to the level of thigh.
These findings were discussed with Dr. ___ at 1615.
|
10031687-RR-60 | 10,031,687 | 25,653,917 | RR | 60 | 2141-04-22 15:37:00 | 2141-04-22 16:34:00 | HISTORY: ___ man with altered mental status, labile blood pressure,
and nausea. Evaluate for acute intracranial hemorrhage.
TECHNIQUE: MDCT acquired contiguous axial images were obtained through the
head. No contrast was administered.
COMPARISON: CT from ___.
FINDINGS:
There is no evidence of acute intracranial hemorrhage, edema, mass, mass
effect, or vascular territorial infarction. The ventricles and sulci are
proportionately prominent, consistent with age related involutional changes.
Periventricular and subcortical white matter hypodensities are suggestive of
chronic small vessel ischemic disease. No fracture is identified. The
visualized paranasal sinuses, mastoid air cells, and middle ear cavities are
clear.
IMPRESSION:
No acute intracranial process.
|
10031687-RR-61 | 10,031,687 | 25,653,917 | RR | 61 | 2141-04-22 18:37:00 | 2141-04-23 21:11:00 |
INDICATION: ___ year old man with DVT and retroperitoneal hematoma in the
setting of anticoagulation.
PROCEDURES:
1. Right common femoral venous access.
2. Preprocedure cavogram.
3. Placement of infrarenal Eclipse IVC filter.
4. Post-procedure IVC venogram.
MEDICATIONS: 1% lidocaine solution was used for local pain control.
OPERATORS: Dr. ___ (fellow) and Dr. ___ (attending
interventional radiologist).
TECHNIQUE: After discussion of the risks, benefits and alternatives to the
procedure with the patient's health care proxy, written informed consent was
obtained. The patient was brought to the angiography suite and placed supine
on the imaging table. A preprocedure timeout was performed. The right groin
was prepped and draped in the usual sterile fashion.
Following local anesthesia, the patent right common femoral vein was
accessed under ultrasound guidance near the femoral head. A 0.018 guide wire
was advanced under fluoroscopic guidance into the right common iliac vein. The
needle was exchanged for a 4.5 ___ micropuncture sheath. The inner dilator
and 0.018 wire were removed and exchanged for a 0.035 ___ wire. A 5 ___
sheath was exchanged for the microsheath, a ___ Omniflush catheter advanced in
the lower cava and an cavogram was performed. The latter demonstrated non
duplicated conventional IVC with no evidence of thrombus.
The optimal filter position was determined from the inflow of the right and
left renal veins.
The 5 ___ sheath was exchanged for a long 6 ___ sheath over the ___
wire.
The Eclipse retrievable IVC filter was loaded into the sheath and carefully
deployed under continuous fluoroscopy. Post-placement venogram via hand
injection with 5 cc of contrast was satisfactory and the sheath was
subsequently removed. Manual pressure achieved hemostasis. Sterile dressing
was applied. The patient tolerated the procedure well without immediate
complication.
FINDINGS:
1. Normal IVC anatomy without duplication or megacava.
2. No filling defects.
IMPRESSION:
1. Patent IVC without evidence of thrombosis.
2. Eclipse retrievable IVC filter placement infrarenally.
|
10031687-RR-63 | 10,031,687 | 25,653,917 | RR | 63 | 2141-04-25 11:27:00 | 2141-04-25 15:51:00 | STUDY: Left ankle, three views; and left foot, three views; ___.
CLINICAL HISTORY: ___ male with recent retroperitoneal bleed. Ankle
pain.
FINDINGS: There are no signs for acute fractures or dislocations. There are
degenerative changes with minimal spurring involving the first MTP joint.
There are no bony erosions. Lisfranc interval appears preserved. There is
mild dorsal soft tissue swelling. Focused imaging of the ankles demonstrate
well-corticated densities adjacent to the medial and lateral malleoli
suggestive of prior old avulsion-type injuries. No acute fracture is seen.
There are no osteochondral lesions. There is no ankle joint effusion.
|
10031687-RR-64 | 10,031,687 | 25,653,917 | RR | 64 | 2141-04-25 11:27:00 | 2141-04-25 13:35:00 | INDICATION: Retroperitoneal bleed with foot and knee pain.
COMPARISON: None.
THREE VIEWS LEFT KNEE
There is a small knee joint effusion. There is a small superior patellar
enthesophyte. There is mild narrowing in the medial and lateral compartments
with mild spurring. There is no erosion, fracture or suspicious lytic or
sclerotic lesion. Heavy vascular calcifications are noted.
IMPRESSION: Mild degenerative changes of the left knee and small joint
effusion. No erosions.
|
10031687-RR-65 | 10,031,687 | 25,653,917 | RR | 65 | 2141-04-25 14:14:00 | 2141-04-25 16:11:00 | HISTORY: ___ man with recent retroperitoneal bleed, now with severe
left knee and thigh pain, evaluate for fluid collection or hematoma.
COMPARISON: Bilateral leg ultrasound ___.
FINDINGS:
Transverse and sagittal images were obtained of the superficial tissues of the
left leg extending from the groin to the distal calf. There is no fluid
collection identified. There is no evidence of a hematoma.
IMPRESSION:
No fluid collection or hematoma seen in the left leg.
|
10031687-RR-66 | 10,031,687 | 25,653,917 | RR | 66 | 2141-04-25 14:14:00 | 2141-04-27 16:22:00 | STUDY: Lower extremity arterial noninvasives at rest.
REASON: Recent retroperitoneal bleed in left inguinal canal, now with right
knee pain and thigh pain.
FINDINGS: Doppler waveform analysis reveals triphasic waveforms at the common
femoral, superficial femoral, popliteal arteries bilaterally and monophasic
waveforms at the DP and ___ bilaterally. ABIs are 0.7 bilaterally.
Pulse volume recordings show normal waveforms in the thigh and calf
bilaterally. There is dampening at the ankle level bilaterally.
IMPRESSION: Bilateral tibial arterial disease.
|
10031687-RR-67 | 10,031,687 | 25,653,917 | RR | 67 | 2141-04-28 16:59:00 | 2141-04-29 09:41:00 | HISTORY: Knee pain with negative arthrocentesis and tenderness over the
medial tibial plateau with concern for osteomyelitis or bursitis.
TECHNIQUE: CT images were obtained through the knee without intravenous
contrast. Multiplanar reformations were prepared.
COMPARISON: ___.
FINDINGS:
There is no fracture or dislocation. No joint effusion is seen with
physiologic quantity of joint fluid identified. There is no bursal collection
in the region of the pes anserine tendons. A linear calcification adjacent to
the proximal tibial diaphysis medially is likely vascular or due to a tendon
calcification. Mild vascular calcification is noted throughout. No
significant skin thickening is identified. Mild superior and inferior
patellar enthesophytes are noted. There may be mild narrowing of the medial
compartment joint space with subchondral sclerosis and peripheral osteophyte
formation.
IMPRESSION:
No CT evidence of osteomyelitis. No joint effusion. No enlarged bursal
collection in the region of the pes anserine tendons.
In the setting of high clinical concern for osteomyelitis, consider bone scan
as it is more sensitive.
|
10031687-RR-68 | 10,031,687 | 25,653,917 | RR | 68 | 2141-05-01 03:24:00 | 2141-05-01 04:04:00 | HISTORY: ___ year old man with new onset left thigh pain. Please evaluate for
left thigh DVT or fluid collection
TECHNIQUE: Grayscale, color Doppler, and spectral analysis of the venous
system of the left lower extremity was performed.
___
FINDINGS:
There is normal compression and augmentation of the proximal, mid and dital
superficial femoral vein as well as the popliteal vein. The peroneal and
posterior tibial veins were visualized and demonstrate ___ to wall flow.
There is normal phasicity of the common femoral veins bilaterally.
No fluid collection identified in the site of symptoms. Subcutaneous edema is
seen in the lateral left thigh.
IMPRESSION:
No evidence of left lower extremity DVT. No fluid collection identified.
|
10031687-RR-69 | 10,031,687 | 23,811,052 | RR | 69 | 2141-06-02 12:34:00 | 2141-06-02 14:23:00 | INDICATION: ___ with DVT on the right. Retroperitoneal bleed
tracking down in the left upper thigh. Rule out DVT.
COMPARISON: ___ and ___.
TECHNIQUE: Grayscale, color and spectral Doppler evaluation was performed on
the bilateral lower extremity veins.
FINDINGS:
There is non-compressibility and echogenic thrombus noted in the right common
and proximal femoral vein extending into the proximal and distal superficial
femoral vein down to the right popliteal vein. There is normal
compressibility and flow in the right posterior tibial vein. There is normal
compressibility and flow of the left common femoral vein. There is
non-compressibility and echogenic thrombus noted in the proximal superficial
femoral vein extending into its mid portion. Distally, the left superficial
femoral vein can be compressed. However, there is echogenic thrombus and
non-compressibility noted in the left popliteal vein. There is normal
compressibility and flow in the left posterior tibial vein.
IMPRESSION:
Bilateral lower extremity DVT. On the right, it extends from the common
femoral vein down to the popliteal vein. On the left, the DVT extends from
the proximal superficial femoral vein down to the mid portion of the vein.
The distal portion of the left superficial femoral vein is patent but
echogenic thrombus is noted in the left popliteal vein.
These findings were discussed with the nurse ___ Dr. ___ on the phone
at 2 p.m. on ___.
|
10031687-RR-71 | 10,031,687 | 21,674,234 | RR | 71 | 2141-06-12 14:36:00 | 2141-06-12 15:12:00 | HISTORY: Altered mental status, on revaroxiban, history of retroperitoneal
bleed. Evaluate for bleed
TECHNIQUE: Axial helical MDCT images were obtained through the brain without
administration of IV contrast. Multiplanar reformatted images in coronal and
sagittal axes and thin-section bone algorithm reconstructed images were
acquired.
DLP: 1025.7 mGy/cm
COMPARISON: Nonenhanced head CT from ___
FINDINGS:
There is no evidence of hemorrhage, edema, mass effect or acute large vascular
territory infarction. Prominent ventricles and sulci suggest global volume
loss. Periventricular white matter hypodensities are nonspecific, but most
likely represent sequelae of chronic small vessel ischemic disease.
Hypodensities also seen in the pons, ___ ischemic. Old left thalmic
lacunar infarct also noted. The basal cisterns appear patent and there is
preservation of gray-white differentiation.
No fracture is identified. There is mucosal thickening of the ethmoid air
cells. The remaining visualized paranasal sinuses, mastoid air cells and
middle ear cavities are clear. Atherosclerotic mural calcification of the
internal carotid arteries is noted. The globes are unremarkable.
IMPRESSION:
No acute intracranial process.
|
10031687-RR-72 | 10,031,687 | 21,674,234 | RR | 72 | 2141-06-12 14:40:00 | 2141-06-12 15:42:00 | HISTORY: Fall, rule out injury.
TECHNIQUE: Axial helical MDCT images were obtained from the skullbase through
the T2 level. Multiplanar reformatted images in coronal and sagittal axes
were generated.
DLP: 762 mGy/cm
COMPARISON: CT C-spine from ___.
FINDINGS:
There is no evidence of fracture or traumatic malalignment. Mild
retrolisthesis of C5 on C6 is unchanged from prior exam, likely degenerative.
There is no prevertebral soft tissue swelling. CT is unable to provide
intrathecal detail comparible to MRI, but the visualized outline of the thecal
sac is unremarkable. No lymphadenopathy is present by CT size criteria.
There is high density material within the lumen of the upper esophagus. The
left lobe of the thyroid is heterogeneous with a hypodense 4 mm nodule. There
is medialization of the left true cord and aryepiglittic fold, with
enlargement of the laryngeal ventrical suggesting paralysis of the left vocal
cord.
Multilevel degenerative changes are noted with loss of disc space and anterior
and posterior osteophytes worse at C5-6. The visualized lung apices are
clear.
IMPRESSION:
1. No evidence of fracture or traumatic malalignment.
2. Finding suggesting paralysis of the left vocal cord, correlate with
symptoms or direct visualization.
3. Heterogeneous left lobe of thyroid with 4 mm nodule for which a nonurgent
ultrasound evaluation could be performed if clinically indicated.
Changes in the wet read were discussed with Dr ___ by Dr ___
phone at 16:45 on ___.
|
10031687-RR-73 | 10,031,687 | 21,674,234 | RR | 73 | 2141-06-12 14:57:00 | 2141-06-12 15:49:00 | HISTORY: ___ female with fall.
COMPARISON: CT abdomen from ___.
FINDINGS:
Single AP view of the pelvis. There is no fracture or acute osseous
abnormality. Pubic symphysis and SI joints are preserved. Degenerative
changes are seen in the lower lumbar spine. Soft tissues are unremarkable.
IMPRESSION:
No visualized fracture.
|
10031687-RR-74 | 10,031,687 | 21,674,234 | RR | 74 | 2141-06-12 14:57:00 | 2141-06-12 16:03:00 | HISTORY: Fall, rule out injury, pain.
COMPARISON: Chest radiograph from ___
FINDINGS:
Frontal radiographs of the chest demonstrate normal heart size. The
cardiomediastinal silhouette and hilar contours are normal. The lungs are
clear. No pleural effusion or pneumothorax. No displaced rib fracture
identified. The left chest wall AICD is unchanged in position.
IMPRESSION:
Normal chest radiograph.
|
10031687-RR-75 | 10,031,687 | 21,674,234 | RR | 75 | 2141-06-13 10:06:00 | 2141-06-13 11:17:00 | HISTORY: ___ male, status post fall with left knee erythema and
warmth.
COMPARISON: Left knee radiographs from ___
LEFT KNEE RADIOGRAPHS, THREE VIEWS: There is no fracture or malalignment.
Mild narrowing of the medial compartment is similar to prior examination.
Small osteophytes along the superior aspect of the patella are unchanged.
Dense vascular calcifications are noted. Ajoint effusion is seen on the
cross-table lateral view, but no obviuos fat-fluid level is identified.
IMPRESSION: Mild degenerative changes. No fracture or dislocation detected.
s
|
10031687-RR-76 | 10,031,687 | 21,674,234 | RR | 76 | 2141-06-13 09:13:00 | 2141-06-13 10:08:00 | HISTORY: Right leg for DVT.
COMPARISON: Bilateral lower extremity ultrasound from ___.
FINDINGS:
Gray scale and color Doppler ultrasound was performed of the bilateral common
femoral, superficial femoral, popliteal, posterior tibial and peroneal veins
was performed.
Right: There is nonocclusive thrombus in the right proximal, mid and distal
superficial femoral vein and within the popliteal vein. This is slightly
improved since the prior study when the thrombus extendend up to the common
femoral vein. The posterior tibial vein and peroneal veins are partially
visualized.
Left: There is partially occlusive thrombus within the distal superficial
femoral vein extending into the popliteal vein where echogenic thrombus is
visualized. The posterior tibial and peroneal veins demonstrate normal flow
and compressibility. The previously noted thrombus within the proximal
superficial femoral vein extending into the midportion is no longer
visualized.
IMPRESSION:
Bilateral lower extremity DVT with minimal improvement since the prior study.
1. On the right the thrombus extends from the proximal superficial femoral
vein down to popliteal vein, slightly improved on the prior exam when thrombus
was also seen in the common femoral vein.
2. On the left, the thrombus extends from the distal superficial femoral vein
into the popliteal vein. The previously seen thrombus within the proximal and
mid superficial femoral vein is not visualized.
|
10031687-RR-77 | 10,031,687 | 21,674,234 | RR | 77 | 2141-06-14 11:01:00 | 2141-06-14 12:35:00 | HISTORY: Left knee pain. Evaluate for fracture.
AP PELVIS AND TWO VIEWS OF THE LEFT HIP:
No lucent or sclerotic fracture line or displaced fracture fragment is
detected. The femoral head is normal in morphology, well seated in the
acetabulum, with mild degenerative joint space narrowing and spurring. There
may be some intramedullary osteopenia. No suspicious focal lytic or sclerotic
lesion or periarticular calcification is detected. The pelvic girdle is
congruent. The sacrum is obscured by overlying bowel gas.
|
10031850-RR-59 | 10,031,850 | 28,839,328 | RR | 59 | 2137-02-11 14:36:00 | 2137-02-11 15:22:00 | INDICATION: Elevated white blood cell count and fever.
COMPARISONS: ___ and ___.
FINDINGS:
Frontal and lateral views demonstrate hyperexpanded lungs. There is no focal
consolidation, pleural effusion or pneumothorax. Hilar and mediastinal
silhouettes are unchanged. Heart size is mildly enlarged. There is no
pulmonary edema. Aortic arch calcifications are again noted. Ill-defined
bibasilar opacities are likely due to mild atelectasis and/or overlying soft
tissues. There is diffuse osteopenia. Partially imaged upper abdomen is
unremarkable.
IMPRESSION:
No evidence of acute cardiopulmonary process.
|
10031850-RR-60 | 10,031,850 | 28,839,328 | RR | 60 | 2137-02-11 15:33:00 | 2137-02-11 16:40:00 | INDICATION: Leukocytosis.
COMPARISON: CT ___.
TECHNIQUE: MDCT-acquired axial images from the lung bases to the pubic
symphysis were displayed with 5-mm slice thickness with 130 mL Omnipaque
intravenous contrast. Coronal and sagittal reformations are displayed with
5-mm slice thickness.
CT CHEST: The visualized lung bases demonstrate mild dependent bibasilar
atelectasis. There is no pleural or pericardial effusion. A 7mm left lower
lobe nodule (2:4) is unchanged from ___.
The liver is normal. Mildly prominent intra hepatic bile ducts with the common
duct upper limits of normal, measuring 10 mm, can be seen after
cholecystectomy. The spleen and pancreas are normal. The bilateral adrenal
glands are enlarged and mildly thickened, unchanged, suggestive of adrenal
hyperplasia. The kidneys enhance symmetrically and excrete contrast promptly
without hydronephrosis. Hypodensities in the kidneys bilaterally are seen,
some of which are too small to characterize, and others of which are simple
cysts measuring up to 2.8 cm in the left renal interpolar region.
The small and large bowel are normal in course and caliber without
obstruction. There is no free fluid and no free air. Atherosclerotic
calcifications are seen throughout the abdominal aorta. Intraluminal thrombus
in the infrarenal abdominal aorta is seen with approximately 50% focal
stenosis (2:38). The main portal vein, splenic vein and SMV are patent. No
pathologically enlarged mesenteric or retroperitoneal lymph nodes are
identified.
CT PELVIS: A 1.9-cm enhancing mass in the sigmoid (2:64) is concerning for a
neoplasm, and appears similar compared to the prior exam. Diverticula are seen
in the sigmoid without inflammatory changes. The rectum and bladder are
normal. The patient is status post hysterectomy. There is no free fluid and
no pelvic or inguinal lymphadenopathy.
Within the bilateral ischioanal fossa, there are two large air-fluid
collections with air extending into the perineal and left gluteal soft
tissues, new from ___. The collection on the right is approximately 7.3
x 7.5 cm and the collection on the left is approximately 6.0 x 6.8 cm. Both
collections appear connected to the anus via perianal fistulas (left 2:85,
right 2:83-85). There is no supralevator or intra-abdominal extension. No
perirectal abscess is seen.
BONE WINDOWS: No bone finding suspicious for infection or malignancy is seen.
IMPRESSION:
1. Bilateral perianal fistulas with large bilateral ischioanal fossa
abscesses and marked subcutaneous gas extending into the perineal soft tissues
and into the left gluteus, new from ___. Clinical correlation is
recommended as findings are concerning for Fournier's gangrene.
2. No acute intra-abdominal process.
3. Intraluminal aortic thrombus with approximately 50% focal stenosis,
unchanged from the prior study.
4. Sigmoid enhancing lesion is concerning for a neoplasm, unchanged from
___. Recommend correlation with colonoscopy.
5. 7mm left lower lobe pulmonary nodule. If there is no prior CT already
documenting long term stability, recommend follow up CT in 6 months from the
___ study if pt has no risk factors for malignancy. If pt has risk
factors, follow up in 3 months from the ___ study is recommended.
Findings posted to the ED dashboard at 4:30 p.m. on ___ and discussed
with Dr. ___ (surgery) in person at 5:31pm ___.
|
10031850-RR-61 | 10,031,850 | 28,839,328 | RR | 61 | 2137-02-24 13:31:00 | 2137-02-24 14:09:00 | CHEST PORT LINE PLACEMENT ___ AT 1335
INDICATION: ___ with left PICC line placement, check position.
Comparison is made to the patient's previous study dated ___ at 1444.
A portable semi-erect chest film ___ at 1335 is submitted.
IMPRESSION:
1. Interval placement of a left subclavian PICC line with its tip in the
proximal right atrium. Pullback of approximately 4 cm to place the tip in the
distal SVC would be advised. There has been interval appearance of perihilar
fullness and bibasilar patchy opacities which could reflect mild pulmonary
edema, although bibasilar aspiration or pneumonia cannot be entirely excluded.
There is likely a small left layering effusion and possibly a right effusion,
although the right costophrenic angle is not entirely included on this study.
No evidence of pneumothorax. The patient's mandible obscures the lung apices
to some extent. The IV nurse, ___, was notified of the recommendation for
re-positioning of the PICC line on ___ at 1:56 p.m. at the time of
discovery.
|
10031850-RR-62 | 10,031,850 | 28,839,328 | RR | 62 | 2137-02-25 14:31:00 | 2137-02-25 16:58:00 | PORTABLE AP CHEST FROM ___ AT 14:48
CLINICAL INDICATION: ___ status post PICC, question change in
placement.
Comparison is made to the patient's prior study of ___ at 13:35.
Portable semi-erect chest film ___ at 14:48 is submitted.
IMPRESSION:
1. The left subclavian PICC line has its tip in the mid SVC. Overall,
cardiac and mediastinal contours are difficult to assess due to marked patient
rotation on the current study as well as an increasing left basilar airspace
process. Given the focality of this finding, this either reflects partial
lower lobe atelectasis in the setting of layering effusion or
aspiration/pneumonia. Asymmetric pulmonary edema in the setting of underlying
emphysema could also have this appearance. Clinical correlation is advised.
Smaller layering right pleural effusion. No pneumothorax. The patient's
mandible obscures the lung apices. Calcification in aorta consistent with
atherosclerosis.
|
10031850-RR-63 | 10,031,850 | 28,839,328 | RR | 63 | 2137-02-27 18:03:00 | 2137-02-28 09:49:00 | SINGLE FRONTAL VIEW OF THE CHEST.
REASON FOR EXAM: Assess line.
Left PICC tip is in the mid-SVC. Mild cardiomegaly is accentuated by the
projection. There has been markedly improved, almost completely resolved
opacities in the left lung. Minimal opacities remain in the retrocardiac
region consistent with resolving atelectasis or aspiration. In the right
lower lobe, there are persistent minimal opacities. This could be due to
atelectasis or pneumonia. There is no pneumothorax. If any, there is a small
right effusion.
|
10031850-RR-65 | 10,031,850 | 28,839,328 | RR | 65 | 2137-03-02 10:30:00 | 2137-03-02 12:26:00 | PICC LINE PLACEMENT
INDICATION: IV access needed for TPN and IV antibiotics.
The procedure was explained to the patient. A timeout was performed.
RADIOLOGIST: Dr. ___, and ___ performed the procedure.
TECHNIQUE: Using sterile technique and local anesthesia, the patent right
basilic vein was punctured under direct ultrasound guidance using a
micropuncture set. Hard copies of ultrasound images were obtained before and
immediately after establishing intravenous access. A peel-away sheath was
then placed over a guidewire and a double-lumen PICC line measuring 41 cm in
length was then placed through the peel-away sheath with its tip positioned in
the SVC under fluoroscopic guidance. Position of the catheter was confirmed
by a fluoroscopic spot film of the chest.
The peel-away sheath and guidewire were then removed. The catheter was
secured to the skin, flushed, and a sterile dressing applied.
The patient tolerated the procedure well. There were no immediate
complications.
IMPRESSION: Uncomplicated ultrasound and fluoroscopically guided double-lumen
PICC line placement via the right basilic venous approach. Final internal
length is 41 cm, with the tip positioned in SVC. The line is ready to use.
|
10032176-RR-2 | 10,032,176 | 20,464,560 | RR | 2 | 2133-08-09 02:30:00 | 2133-08-09 04:22:00 | EXAMINATION: BILAT LOWER EXT VEINS
INDICATION: ___ year old woman with history of DVT now with asymmetric
bilateral ___ edema, R>L// R/o DVT (may start with R leg)
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the bilateral lower extremity veins.
COMPARISON: None.
FINDINGS:
There is normal compressibility, color flow, and spectral doppler of the
bilateral common femoral, femoral, and popliteal veins. Peroneal and
posterior tibial veins were unable to be visualized bilaterally. Subcutaneous
edema is noted in the calves bilaterally.
There is normal respiratory variation in the common femoral veins bilaterally.
No evidence of medial popliteal fossa (___) cyst.
IMPRESSION:
No evidence of deep venous thrombosis in the right or left lower extremity
veins. Subcutaneous edema is noted in the calves bilaterally.
|
10032176-RR-3 | 10,032,176 | 20,464,560 | RR | 3 | 2133-08-10 14:35:00 | 2133-08-10 16:33:00 | EXAMINATION: DX CHEST PORTABLE PICC LINE PLACEMENT
INDICATION: ___ year old woman with new R PICC// 45 cm R basilic DL PICC-
___ ___ Contact name: ___: ___ cm R basilic DL PICC-
___ ___
IMPRESSION:
Right PICC line tip is at the level of mid SVC. Heart size and mediastinum
are stable. There is mild interstitial pulmonary edema, new as compared to ___.
|
10032409-RR-114 | 10,032,409 | 20,612,017 | RR | 114 | 2129-05-03 11:55:00 | 2129-05-03 14:06:00 | INDICATION: Fall and pain.
COMPARISON: None.
THREE VIEWS OF THE LEFT WRIST: There is a comminuted intra-articular fracture
through the distal radius extending into the distal radioulnar joint. There
is neutral alignment of the distal fracture fragments. There is also a
minimally displaced fracture of the ulnar styloid. The carpal rows are
maintained. There are mild degenerative changes at the first CMC and
triscaphe joints and diffuse demineralization.
IMPRESSION:
1. Comminuted intra-articular distal radial fracture.
2. Mildly displaced ulnar styloid fracture.
Findings discussed with Dr. ___ on ___ in the afternoon
by Dr. ___.
|
10032409-RR-115 | 10,032,409 | 20,612,017 | RR | 115 | 2129-05-03 11:55:00 | 2129-05-03 13:15:00 | INDICATION: Fall and pain.
COMPARISON: None.
THREE VIEWS RIGHT SHOULDER: There is no acute fracture or dislocation. The
glenohumeral joint is preserved. The acromioclavicular joint is preserved as
well. The visualized right hemithorax is clear.
IMPRESSION: No acute fracture or dislocation.
|
10032409-RR-116 | 10,032,409 | 20,612,017 | RR | 116 | 2129-05-03 11:56:00 | 2129-05-03 13:36:00 | INDICATION: Knee pain following fall.
COMPARISON: None.
THREE VIEWS, RIGHT KNEE: No acute fracture or dislocation. There is a small
joint effusion. No suspicious lytic or sclerotic lesions.
THREE VIEWS, LEFT KNEE: There is no acute fracture or dislocation. There is
a small joint effusion. No suspicious lytic or sclerotic lesions. Mild
vascular calcifications.
There is minimal lateral patellar subluxation bilaterally.
IMPRESSION: No acute fracture or dislocation.
|
10032409-RR-117 | 10,032,409 | 20,612,017 | RR | 117 | 2129-05-03 16:07:00 | 2129-05-03 18:55:00 | INDICATION: ___ female status post trauma with history concerning for
syncope.
___.
TECHNIQUE: Axial CT images through the head were acquired without intravenous
contrast. Coronal, sagittal, and thin slice bone reconstructed images were
reviewed.
FINDINGS: There is no evidence for acute intracranial hemorrhage, large mass,
mass effect, edema, or hydrocephalus. White matter hypodensity is likely
secondary to sequela of chronic small vessel ischemic disease. Mildly
prominent ventricles and sulci suggest age-related involutional changes.
There is preservation of gray-white differentiation without CT evidence for
large territorial infarct. The basal cisterns appear patent. Vascular
calcifications are noted. The visualized portions of the paranasal sinuses and
mastoid air cells are well aerated.
IMPRESSION: No CT evidence for acute intracranial process.
|
10032409-RR-118 | 10,032,409 | 20,612,017 | RR | 118 | 2129-05-03 17:28:00 | 2129-05-03 20:26:00 | EXAM: AP upright and lateral views.
CLINICAL INFORMATION: ___ female with history of episodes concerning
for arrhythmia, cardiogenic syncope.
___.
FINDINGS: Frontal and lateral views of the chest are obtained. Lungs remain
relatively hyperinflated. There is persistent mild blunting of the right
costophrenic angle, and a trace pleural effusion cannot be excluded. No focal
consolidation is seen. There is no evidence of pneumothorax. The cardiac
silhouette remains enlarged with left ventricular configuration, similar to
prior. The aorta is calcified and tortuous. Prominence of the right hilum is
stable.
|
10032409-RR-120 | 10,032,409 | 20,612,017 | RR | 120 | 2129-05-05 17:28:00 | 2129-05-06 08:59:00 | AP CHEST, 5:37 P.M., ___
HISTORY: Dementia, COPD and dyspnea.
IMPRESSION: AP chest compared to ___:
Small left pleural effusion is new. Lungs are hyperinflated, but clear.
Relative vascular deficiency in the left hemithorax has been present
previously, for example ___ and ___, probably due to more severe
COPD.
Heart size top normal, unchanged.
|
10032409-RR-129 | 10,032,409 | 25,997,537 | RR | 129 | 2129-07-26 12:55:00 | 2129-07-26 14:07:00 | CHEST RADIOGRAPHS
HISTORY: Confusion.
COMPARISONS: ___.
TECHNIQUE: Chest, AP and lateral.
FINDINGS: The heart is mildly enlarged. The aorta is mildly tortuous and
calcified. There is blunting of the right costophrenic sulcus but similar to
prior studies, suggesting scarring. To a lesser degree, there is also
blunting of the left costophrenic sulcus that appears unchanged.
Hemidiaphragms are flattened suggesting mild hyperinflation. There is no
definite pleural effusion or pneumothorax.
IMPRESSION: Stable appearance of the chest, without evidence for acute
disease.
|
10032409-RR-130 | 10,032,409 | 25,997,537 | RR | 130 | 2129-07-26 12:33:00 | 2129-07-26 13:51:00 | INDICATION: ___ female with confusion. Assess for acute bleeding.
COMPARISON: CT head on ___ and CT head on ___.
TECHNIQUE: Contiguous axial images were obtained through the brain.
FINDINGS: There is no evidence of hemorrhage, edema, mass, mass effect, or
vascular territorial infarction. Ventricles and sulci are mildly prominent,
consistent with age-related atrophy. There is confluent periventricular and
subcortical white matter hypodensity consistent with mild chronic small vessel
ischemic disease. There are more distinct hypodensities within the bilateral
thalami, left greater than right, and genu of the internal capsule on the
right representing possible old lacunar infarcts. These were already present
on ___. The visualized paranasal sinuses and mastoid air cells are
well aerated. There is no fracture identified.
IMPRESSION:
1. No acute intracranial process.
2. Chronic small vessel ischemic disease.
3. Age-related atrophy.
4. Hypodensities in the bilateral thalami, left greater than right, and genu
of the right internal capsule that are unchanged compared to ___ suggesting
small old lacunar infarcts.
|
10032409-RR-131 | 10,032,409 | 25,997,537 | RR | 131 | 2129-07-27 01:31:00 | 2129-07-27 09:53:00 | EXAM: MRI OF THE BRAIN.
CLINICAL INFORMATION: Patient with altered mental status and memory deficit
and movement disorder.
TECHNIQUE: T1 sagittal and FLAIR, T2 susceptibility and diffusion axial
images of the brain were acquired. Diffusion and T2 images were repeated
secondary to persistent motion.
FINDINGS: There is no acute infarct seen on diffusion images. Moderate brain
atrophy and moderate periventricular changes of small vessel disease are
identified. Increased signal is seen in the periventricular and white matter
extending to thalami posteriorly also appears to be due to small vessel
disease. The vascular flow voids are maintained. Chronic lacunes are seen in
the right basal ganglia region. There is no evidence of chronic blood
products but evaluation is somewhat limited by motion on the susceptibility
images.
IMPRESSION: No acute infarct seen. Moderate brain atrophy and moderate small
vessel disease. Chronic lacunes in the basal ganglia. No acute infarcts.
|
10032409-RR-133 | 10,032,409 | 22,661,627 | RR | 133 | 2130-01-12 15:57:00 | 2130-01-12 21:58:00 | CHEST RADIOGRAPH PERFORMED ON ___
___.
CLINICAL HISTORY: Diabetes, COPD, altered mental status, question pneumonia.
FINDINGS: AP upright and lateral views of the chest are provided. Evaluation
through the lower lung is limited due to underpenetrated technique. Allowing
for this, no definite signs of pneumonia or CHF. No large effusions are seen.
Aorta is unfolded. The heart size is within normal limits. The bony
structures appear intact.
IMPRESSION: Limited, negative.
|
10032409-RR-134 | 10,032,409 | 22,661,627 | RR | 134 | 2130-01-12 17:27:00 | 2130-01-12 18:38:00 | INDICATION: ___ with history of COPD, diabetes, presenting with
altered mental status. Assess for bleed.
COMPARISONS: CT head, ___.
TECHNIQUE: Contiguous axial images were obtained through the brain without
intravenous contrast. Coronal and sagittal reformations were prepared.
FINDINGS: There is no acute intracranial hemorrhage, edema, mass effect or
major vascular territorial infarction. There is no shift of normally midline
structures. Periventricular and subcortical white matter hypodensities are
compatible with chronic small vessel ischemic disease. Ventricular and sulci
are prominent, compatible with age-related involutional changes. Imaged
paranasal sinuses and mastoid air cells are well aerated. There is no
fracture.
IMPRESSION: No acute intracranial process.
|
10032409-RR-135 | 10,032,409 | 22,661,627 | RR | 135 | 2130-01-13 13:38:00 | 2130-01-13 14:23:00 | HISTORY: ___ year old woman with RUE swelling, warmth.
COMPARISON: ___.
FINDINGS:
There is normal gray scale appearance with compression, color Doppler flow,
and spectral Doppler waveforms of the right subclavian, axillary, and
brachial, basilic, and cephalic veins. Numerous thyroid cysts in the right
thyroid lobe are incompletely assessed.
IMPRESSION:
No DVT in the right upper extremity.
|
10032409-RR-136 | 10,032,409 | 22,661,627 | RR | 136 | 2130-01-15 20:42:00 | 2130-01-16 09:48:00 | AP CHEST, 9:21 A.M., ___
HISTORY: ___ woman with COPD on home oxygen, now acutely tachypneic.
IMPRESSION: AP chest compared to ___:
Lungs are hyperinflated and pulmonary vasculature is diminished. There are no
findings of cardiac decompensation. Mild-to-moderate cardiomegaly is chronic.
There is no focal pulmonary abnormality, pneumothorax or pleural effusion.
This examination neither suggests nor excludes the diagnosis of pulmonary
embolism. The findings could be due to aggressive bronchospasm.
|
10032409-RR-137 | 10,032,409 | 22,661,627 | RR | 137 | 2130-01-17 18:33:00 | 2130-01-18 08:49:00 | REASON FOR EXAMINATION: Tachypnea
Portable AP radiograph of the chest was reviewed in comparison to ___.
Heart size is top normal. Mediastinum is within normal limits. Lungs are
essentially clear. No pleural effusion or pneumothorax is seen.
IMPRESSION:
No evidence of acute cardiopulmonary abnormality demonstrated.
|
10032409-RR-138 | 10,032,409 | 22,661,627 | RR | 138 | 2130-01-18 09:59:00 | 2130-01-18 12:22:00 | INDICATION: ___ female with COPD on home O2 and significant episodes
of respiratory distress and tachycardia. Evaluate for pulmonary embolism.
COMPARISONS: Multiple prior chest CTs, most recently CTPA of ___.
TECHNIQUE: MDCT images were obtained from the thoracic inlet to the upper
abdomen before and after administration of 130 cc of IV Omnipaque contrast.
Administration of contrast was timed for opacification of the pulmonary
artery. Axial images were interpreted in conjunction with coronal, sagittal,
right oblique, and left oblique reformats.
FINDINGS:
CHEST CTA: Dense atherosclerotic mural calcifications are present along the
thoracic aorta. The aorta is of normal caliber without aneurysm or
dissection. Contrast bolus is suboptimal for evaluation of the subsegmental
pulmonary arteries. The main, lobar, and segmental pulmonary arteries are
opacified without filling defect. A linear hypodensity through a right lower
lobe medial basal subsegmental pulmonary artery (4:106, 502a:65), which is not
expanded, may be artifactual. Bovine arch is incidentally noted.
CHEST:
The visualized portion of the thyroid is unremarkable. No axillary,
supraclavicular, mediastinal, or hilar lymphadenopathy. Dense calcification
is present in the left anterior descending, circumflex, and right main
coronary arteries. The heart is mildly enlarged. Trace pericardial effusion
is similar to prior.
Mild to moderate upper zone predominant centrilobular emphysema is similar to
___. 4 mm perifissural right middle lobe nodule is stable since ___. No new pulmonary nodule. There is bibasilar dependent atelectasis,
similar to prior. No focal consolidation, pleural effusion, pneumothorax, or
pneumomediastinum.
Airways are patent to subsegmental levels. The esophagus is normal. This
study is not tailored for evaluation of the subdiaphragmatic organs. Within
this limitation, the visualized upper abdominal organs are unremarkable.
OSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for
malignancy.
IMPRESSION:
1. Quality of contrast bolus allows exclusion of pulmonary emboli up to the
segmental pulmonary arteries. Filling heterogeneities within the pulmonary
arteries beyond this level are equivocal. Curvilinear hypodensity within a
right lower lobe medial basal subsegmental pulmonary artery may be
artifactual, but a subacute pulmonary embolism is not entirely excluded.
2. Mild upper zone predominant centrilobular emphysema.
3. Mild cardiomegaly. Three-vessel coronary artery calcification.
4. 4-mm right middle lobe perifissural pulmonary nodule, with demonstrated
two year stability since ___.
Findings were communicated via phone call to Dr. ___ by ___ at
1238 pm on ___.
|
10032725-RR-33 | 10,032,725 | 20,611,640 | RR | 33 | 2143-03-22 01:23:00 | 2143-03-22 02:45:00 | HISTORY: ___ female presenting with left-sided weakness and facial
droop starting at 11:00 p.m. on ___. Patient with a history of
a pathologic fracture (likely from an endometrial cancer metastasis) and is
status post right femural ORIF.
COMPARISON: None available in the ___ system.
TECHNIQUE: ___ MDCT axial images of the brain were obtained without
intravenous contrast.
NON-CONTRAST HEAD CT: Multiple hyperdense lesions are seen throughout the
brain in both the left and right frontal regions, right and left caudate
nuclei and also within the left thalamus and posterior limb of the internal
capsule. A small hyperdense lesion is also identified within the right
occipital lobe. There is a region of hypoattenuation in the left
occipital/parietal region which likely represents vasogenic edema from an
underlying mass lesion that is not hyperdense. The majority of the lesions
demonstrate surrounding edema and local mass effect. The left caudate and
left thalamic lesions cause compression of the left lateral ventricle.
However, there is no evidence of obstructive hydrocephalus. There is no shift
of the usually midline structures. The suprasellar and basilar cisterns are
widely patent. No definite extra-axial hemorrhage is identified though
evaluation is somewhat limited for a small amount of blood due to significant
streak artifact. Along the right and left temporal convexities, there are
probable small calcified meningiomas or dural calcifications (2:18 and 2:15).
There is no scalp hematoma or acute skull fracture. There is a mild amount of
mucosal thickening within the left frontal sinus, and ethmoid air cells. The
remainder of the visualized paranasal sinuses are well aerated.
IMPRESSION: Multiple hyperdense masses involving both the superficial and
deep white matter and deep gray matter, with an area of vasogenic edema in the
left occipital lobe. Differential diagnosis is broad, though findings are
most likely secondary to hemorrhagic metastases given the clinical history.
Other possibilities, though less likely include hemorrhagic infarcts secondary
to dural venous or cortical venous thrombosis, spontaneous hemorrhage from
complication of anticoagulation (given the recent history of orthopedic
surgery), lymphoma or infection. Further characterization with MRI of the
brain is recommended.
|
10032725-RR-34 | 10,032,725 | 20,611,640 | RR | 34 | 2143-03-22 01:37:00 | 2143-03-22 08:27:00 | HISTORY: ___ female with history of endometrial cancer, concerning
for metastasis to the right femur and lungs. Patient now presenting acutely
with left-sided weakness, mental status changes, and concern for pulmonary
embolism.
COMPARISON: CT of the chest from ___.
TECHNIQUE: ___ MDCT-acquired axial images from the thoracic inlet to the upper
abdomen were displayed with 2.5-mm slice thickness. Intravenous contrast was
administered and axial phase imaging was obtained. Coronal and sagittal
reformations were prepared.
CT CHEST WITH INTRAVENOUS CONTRAST:
The imaged portion of thyroid gland is homogeneous, without focal nodule. A
punctate nodule seen on prior examination is not included in the field of view
on the current study. No supraclavicular or axillary lymphadenopathy is
identified. Previously seen mediastinal and hilar adenopathy has slightly
increased in size compared to the most recent prior examination. A large left
hilar node now measures 1.8 x 2.6 cm and previously measured 1.8 x 2.1 cm
(4:45). A subcarinal lymph node measures 2.0 x 2.7 cm and previously measured
1.9 x 2.2 cm (4:50). No new mediastinal adenopathy is identified. The heart
size is normal and there is no pericardial effusion. The thoracic aorta is
non-aneurysmal and demonstrates no signs of acute aortic syndrome. The timing
of the contrast bolus is suboptimal, however, no large central pulmonary
embolism is identified.
The tracheobronchial tree is patent to subsegmental levels. A known solid
nodule within the medial right lower lobe measures 9 x 11 mm and previously
measured 9 x 9 mm. A left lower lobe pulmonary nodule previously measured 4
mm and now measures 5 mm (4:71). No new pulmonary nodule or mass is
identified. There is no pleural effusion.
The imaged portion of the upper abdominal viscera appears within normal
limits.
OSSEOUS STRUCTURES: No bone destructive lesion or acute fracture is
identified.
IMPRESSION:
1. Slightly increased mediastinal lymphadenopathy, findings concerning for
worsening metastatic disease from patient's known endometrial cancer.
2. Slightly increased size of both right and left lower lobe pulmonary
nodules. No new nodule or mass.
3. No pleural effusions.
4. No pulmonary embolism or evidence of acute aortic syndrome.
|
10032725-RR-36 | 10,032,725 | 20,611,640 | RR | 36 | 2143-03-22 02:56:00 | 2143-03-22 04:43:00 | HISTORY: ___ female status post right femoral surgery. Evaluation
for DVT.
COMPARISON: None available in the ___ system.
RIGHT LOWER EXTREMITY DOPPLER ULTRASOUND: Gray-scale and Doppler sonograms of
the bilateral common femoral, right superficial femoral, right popliteal,
right posterior tibial, and right peroneal veins were obtained. There is
extensive subcutaneous edema. However, there is normal flow, compressibility
and augmentation of the examined veins.
IMPRESSION: No right lower extremity DVT.
|
10032725-RR-37 | 10,032,725 | 20,611,640 | RR | 37 | 2143-03-22 03:16:00 | 2143-03-22 08:25:00 | HISTORY: ___ female presenting as an acute code stroke with recent
right femoral ORIF for pathologic fracture.
COMPARISON: Intraoperative fluoroscopic images from ___.
RIGHT FEMUR RADIOGRAPHS, FOUR IMAGES: Patient is status post ORIF of the right
femur with intramedullary rod, two hip screws, and three distal interlocking
screws. The hardware appears intact without evidence of loosening or failure.
The pathologic fracture through the distal femur is noted without evidence of
clear callus or bridging. The known large femoral lesion is not well
characterized on this examination.
IMPRESSION:
1. Intramedullary rod and screws in standard position, without evidence of
hardware loosening or failure.
2. No definite bridging callus at the site of pathologic fracture, though no
significant malalignment.
|
10032725-RR-39 | 10,032,725 | 20,611,640 | RR | 39 | 2143-03-22 10:03:00 | 2143-03-22 12:26:00 | AP CHEST 10:17 A.M. ___
HISTORY: Intubated ___ woman. Check tube placement.
IMPRESSION: AP chest compared to ___:
Tip of the endotracheal tube at the upper margin of the clavicles is no less
than 45 mm from the carina. Care should be taken that the tube does not
withdraw any further. Lungs are clear. Cardiomediastinal and hilar
silhouettes and pleural surfaces are normal.
|
10032725-RR-40 | 10,032,725 | 20,611,640 | RR | 40 | 2143-03-22 10:51:00 | 2143-03-22 13:26:00 | AP CHEST 11:05 A.M. ON ___
HISTORY: ET tube advanced.
IMPRESSION: ET tube in standard placement. The nasogastric tube ends in the
stomach. The lungs are fully expanded and clear. The heart size is normal.
Adenopathy at least in the left hilus is evident.
|
10032725-RR-41 | 10,032,725 | 20,611,640 | RR | 41 | 2143-03-22 11:34:00 | 2143-03-22 15:01:00 | INDICATION: Brain metastasis with possible hemorrhagic conversion. Now less
responsive. Evaluate for interval change.
TECHNIQUE: Contiguous axial images were obtained through the brain. No
contrast was administered.
COMPARISON: NECT of the head on ___ at 1:23 a.m. CTA of the
chest on ___.
FINDINGS: There are multiple hyperdense lesions throughout the brain in the
gray-white junction, left thalamus, caudate nuclei, left occipital lobe, and
cerebellum. These lesions appear more conspicuous when compared to NECT of the
head from 10 hours previously. This likely is due to residual intravenous
contrast from CTA of the chest performed after prior NECT of the head. The
largest lesion is in the region of the right corona radiata, measuresing
approximately 2.6 x 2.6 cm (2:19) with surrounding vasogenic edema. This
likely is due to intravenous contrast. There is no shift of midline
structures. Note is made of numerous lesions in the left thalamus and caudate
nucleus, right caudate nucleus and possibly the left pons (2:10).
There is no shift of midline structures. The ventricles and sulci are normal
in size. The lateral ventricles are effaced by hyperdense lesions in the
basal ganglia. There is a calcified extra-axial lesions in the region of the
temporal lobes that may represent a calcified meningioma (2:12,14). There are
no suspicious lesions in the calvarium or skull base. The visualized
paranasal sinuses, mastoid air cells, and middle ear cavities are clear.
IMPRESSION:
Multiple hyperdense lesions involving the gray-white junction, basal ganglia,
and cerebellum that are more conspicuous than on recent head CT from 10 hours
previously, likely due to interval administration of IV contrast for
CTA-Chest. There is no definite change in size or shift of midline
structures. These lesions are most compatible with hemorrhagic metastases.
MRI of the brain would better characterize these lesions.
The case was discussed by Dr. ___ with Dr. ___ at 12:41 p.m.
by phone on ___.
|
10033085-RR-15 | 10,033,085 | 23,404,293 | RR | 15 | 2160-10-19 15:33:00 | 2160-10-19 16:20:00 | EXAMINATION: FOOT AP,LAT AND OBL RIGHT
INDICATION: ___ year old man s/p ___ MPJ resection with abx spacer// postop
IMPRESSION:
In comparison with study of ___, there has been resection of infected
tissue and replacement with a large antibiotic spacer in the
metacarpophalangeal region of the great toe. Otherwise, little change.
|
10033085-RR-16 | 10,033,085 | 23,404,293 | RR | 16 | 2160-10-21 11:19:00 | 2160-10-21 12:11:00 | EXAMINATION: DX CHEST PORTABLE PICC LINE PLACEMENT
INDICATION: ___ year old man with right PICC// Right 46cm PICC ___ ___
Contact name: ___: ___ Right 46cm PICC ___ ___
IMPRESSION:
No prior chest radiographs available.
Right PIC line heads up into the neck and out of view.
Cardiomediastinal and hilar silhouettes and pleural surfaces are normal.
Lungs are well expanded and clear.
|
10033085-RR-17 | 10,033,085 | 23,404,293 | RR | 17 | 2160-10-21 13:39:00 | 2160-10-21 14:52:00 | EXAMINATION: Chest radiograph
INDICATION: ___ year old man with right PICC// Repeat check for PICC repo
after power flush ___ ___
TECHNIQUE: Portable AP chest
COMPARISON: Comparison is made to chest radiograph performed 2 hours prior.
FINDINGS:
Right PICC line now terminates in the mid SVC. No pneumothorax. The lungs
are clear. No consolidation or effusion. The cardiomediastinal silhouette is
normal.
IMPRESSION:
Right PICC line terminates in the mid SVC.
|
10033106-RR-20 | 10,033,106 | 28,055,712 | RR | 20 | 2166-03-26 23:28:00 | 2166-03-27 05:44:00 | INDICATION: Patient with history of pancreatitis. Assess for pleural
effusion.
COMPARISONS: Chest radiograph of ___.
FINDINGS:
Frontal and lateral views of the chest demonstrate normal lung volumes without
pleural effusion, focal consolidation or pneumothorax. Hilar and mediastinal
silhouettes are unremarkable. Heart size is normal. There is no pulmonary
edema.
IMPRESSION:
No pleural effusion.
|
10033106-RR-23 | 10,033,106 | 20,827,120 | RR | 23 | 2169-06-08 19:54:00 | 2169-06-08 22:15:00 | EXAMINATION: CT ABD AND PELVIS WITH CONTRAST
INDICATION: ___ man with a ___ history of right inguinal hernia,
evaluate infarcted right inguinal hernia.
TECHNIQUE: Contiguous axial multidetector CT images through the abdomen and
pelvis with intravenous contrast. Multiplanar reformations were generated and
reviewed.
Total DLP (Body) = 523 mGy-cm.
COMPARISON: CT abdomen ___.
FINDINGS:
LUNG BASES: Mild subsegmental atelectasis noted at the lung bases. The imaged
portion the heart is unremarkable.
CT ABDOMEN: The liver enhances normally without focal worrisome lesion. Main
portal vein is patent. Minimal intrahepatic biliary ductal dilation likely
reflect prior cholecystectomy. The pancreas appears normal. The spleen and
adrenal glands are unremarkable. The kidneys enhance symmetrically and
excrete contrast promptly. No definite signs of pyelonephritis. Tiny
hypodensities in the left renal upper pole are too small to characterize. No
perinephric collection or hydronephrosis. The abdominal aorta is normal in
caliber with calcification noted involving the distal abdominal aorta and
iliac branches. There is no retroperitoneal lymphadenopathy.
The stomach is decompressed. The duodenum appears normal.
CT PELVIS: Small bowel demonstrates no evidence of ileus or obstruction. The
appendix is normal. The colon appears thin-walled without significant fecal
loading or wall thickening.
The urinary bladder is only partially distended with thickening of the urinary
bladder wall concerning for cystitis. There is a low-density collection with
enhancing walls involving the right seminal vesicle concerning for abscess.
Overall size measures 1.9 x 2.7 x 1.9 cm. Additionally, there is hyperemia
and thickening of the right spermatic cord most notable in the right groin.
Within the scrotum, there is a small right hydrocele partially visualized as
well as mildly prominent venous plexus. There is no evidence of right
inguinal hernia.
MUSCULOSKELETAL: There is mild degenerative change of the imaged
thoracolumbar spine, with large anterior osteophytes and intervertebral vacuum
disc change. Alignment is normal. No concerning focal lytic or sclerotic
osseous lesions are seen.
IMPRESSION:
1. Findings concerning for cystitis complicated by right seminal vesicle
abscess ( 1.9 x 2.7 x 1.9 cm), inflamed right spermatic cord with infection/
inflammation extending into the scrotum. Percutaneous drainage of seminal
vesicle abscess may be considered.
2. No inguinal hernia.
3. Small right hydrocele.
|
10033106-RR-24 | 10,033,106 | 20,827,120 | RR | 24 | 2169-06-09 12:52:00 | 2169-06-09 16:43:00 | EXAMINATION: CT-guided aspiration of right seminal vesicle abscess.
INDICATION: ___ year old man with 2.7 x 1.9 cm rim-enhancing hypodense fluid
collection, concerning for abscess, in the area of the right seminal vesicle
// drain fluid collection
COMPARISON: CT abdomen and pelvis ___.
PROCEDURE: CT-guided aspiration of a right seminal vesicle abscess.
OPERATORS: Dr. ___ interventional ___ fellow. And Dr.
___ radiologist. Dr. ___ supervised the trainee
during the key components of the procedure and reviewed and agrees with the
trainee's findings.
TECHNIQUE: The risks, benefits, and alternatives of the procedure were
explained to the patient. After a detailed discussion, informed written
consent was obtained. A pre-procedure timeout using three patient identifiers
was performed per ___ protocol.
The patient was placed in a prone position on the CT scan table. Limited
preprocedure CTscan was performed to localize the collection. Based on the CT
findings an appropriate skin entry site for the needle was chosen. The site
was marked. Local anesthesia was administered with 1% Lidocaine solution.
Using intermittent CT fluoroscopic guidance, an 18-G ___ needle was
inserted into the collection. A sample of fluid was aspirated, confirming
needle position within the collection. Double fluid was aspirated.
Therefore, no drainage catheter was left in place.
Approximately 6cc of purulent fluid was aspirated with a sample sent for
microbiology evaluation. Sterile dressing was applied.
The procedure was tolerated well, and there were no immediate post-procedural
complications.
DOSE: DLP: 315 mGy-cm
SEDATION: Moderate sedation was provided by administering divided doses of 2
mg Versed and 100 mcg fentanyl throughout the total intra-service time of 25
minutes during which patient's hemodynamic parameters were continuously
monitored by an independent trained radiology nurse.
FINDINGS:
1. Preprocedural CT demonstrates a 1.9 x 2.7 cm right seminal vesicular
abscess.
2. Postprocedural CT demonstrates decreased right seminal vesicle abscess size
(difficult to measure without contrast) with no complications.
IMPRESSION:
CT-guided aspiration of right seminal vesicle abscess.
|
10033290-RR-18 | 10,033,290 | 22,588,582 | RR | 18 | 2163-07-07 21:02:00 | 2163-07-07 22:12:00 | EXAMINATION: CTA HEAD AND CTA NECK Q16 CT NECK
INDICATION: ___ patient with atrial fibrillation, right upper
extremity weakness, now asymptomatic. Evaluate for stroke and vascular
patency.
TECHNIQUE: Contiguous MDCT axial images were obtained through the brain
without contrast material. Subsequently, helically acquired rapid axial
imaging was performed from the aortic arch through the brain during the
infusion of 70 mL of Omnipaque intravenous contrast material.
Three-dimensional angiographic volume rendered, curved reformatted and
segmented images were generated on a dedicated workstation. This report is
based on interpretation of all of these images.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 18.0 s, 18.0 cm; CTDIvol = 50.2 mGy (Head) DLP =
903.1 mGy-cm.
2) Stationary Acquisition 5.5 s, 0.5 cm; CTDIvol = 59.9 mGy (Head) DLP =
30.0 mGy-cm.
3) Spiral Acquisition 5.4 s, 42.4 cm; CTDIvol = 31.1 mGy (Head) DLP =
1,319.3 mGy-cm.
Total DLP (Head) = 2,252 mGy-cm.
COMPARISON: None.
FINDINGS:
CT HEAD WITHOUT CONTRAST:
There is no evidence of infarction, hemorrhage, edema, or midline shift. The
ventricles are normal in size and configuration. There is mild mucosal
thickening of bilateral ethmoid air cells and bilateral maxillary sinuses.
CTA HEAD:
There are mild vascular calcifications of the cavernous and clinoid segments
of bilateral internal carotid arteries. Otherwise, the circle of ___ and
the principal intracranial branches appear patent without evidence of
stenosis, occlusion, dissection, are aneurysm.
CTA NECK:
There is common origin of the brachiocephalic and left common carotid artery.
There are mild vascular calcifications of the right subclavian artery, which
otherwise appear patent. The bilateral vertebral arteries appear patent
without evidence of stenosis, occlusion, or dissection. There are mild
noncalcified plaques at the bilateral carotid bifurcations without internal
carotid artery stenosis by NASCET criteria.
OTHER:
There is no evidence of lymphadenopathy per size criteria. The thyroid gland
appears unremarkable. The visualized lung apices appear clear.
IMPRESSION:
1. No evidence of infarction, hemorrhage, or edema.
2. Patency of the circle of ___ and the principal intracranial branches.
3. Mild atherosclerotic disease of the carotid bifurcations with otherwise
unremarkable CTA neck.
|
10033290-RR-20 | 10,033,290 | 22,588,582 | RR | 20 | 2163-07-08 11:57:00 | 2163-07-08 17:16:00 | EXAMINATION: HAND (PA,LAT AND OBLIQUE) RIGHT
INDICATION: ___ year old man with hand pain// eval evidence of thumb pain
TECHNIQUE: RIGHT HAND THREE VIEWS.
COMPARISON: None.
FINDINGS:
Severe osteoarthritis of the first CMC and triscaphe joint and probable mild
degenerative changes of the radio scaphoid joint. Minimal degenerative change
involving the DIP joints. No fracture, dislocation, bone erosion, suspicious
lytic or sclerotic lesion, soft tissue calcification or radiopaque foreign
body identified.
IMPRESSION:
Osteoarthritis including severe osteoarthritis of the first CMC and triscaphe
joints. No fracture or bone erosion.
|
10033409-RR-10 | 10,033,409 | 21,582,131 | RR | 10 | 2111-12-05 13:59:00 | 2111-12-05 17:15:00 | EXAMINATION: MR HEAD W/O CONTRAST T___ MR HEAD
INDICATION: ___ year old woman with h/o uncontrolled DM2 c/b small vessel CVA
___, vascular dementia, recent L5 nerve root injection, frequent UTI p/w one
week AMS and nonfocal weakness likely progression of vascular dementia.//
evaluation for progression of vascular disease
TECHNIQUE: Sagittal T1 weighted imaging was performed. Axial imaging was
performed with gradient echo, FLAIR, diffusion, and T2 technique were then
obtained.
COMPARISON CT head without contrast of ___.
FINDINGS:
There is no intracranial mass or acute infarct. Punctate gradient echo
susceptibility artifact of the left frontal lobe may represent vessel en face
versus sequela of prior microhemorrhage. Otherwise, no evidence of acute
hemorrhage. The sulci, ventricles and cisterns are prominent, but within
expected limits for the degree of moderate senescent related global cerebral
volume loss. There are confluent moderate to severe subcortical and
periventricular T2/FLAIR white matter hyperintensities, which are nonspecific,
but compatible with chronic microangiopathy in a patient of this age. Left
basal ganglia chronic lacunar infarcts are re-identified.
The major intracranial flow voids are preserved. The orbits are unremarkable.
There is mild mucosal thickening of the ethmoid air cells. Trace fluid signal
is seen in the mastoid tips.
IMPRESSION:
1. No acute infarct.
2. Confluent moderate to severe subcortical and periventricular T2/FLAIR white
matter hyperintensities are nonspecific, but compatible with chronic
microangiopathy in a patient of this age.
3. Moderate cerebral volume loss.
4. Additional findings as described above.
|
10033409-RR-11 | 10,033,409 | 21,582,131 | RR | 11 | 2111-12-05 14:00:00 | 2111-12-05 18:03:00 | EXAMINATION: MRI CERVICAL, THORACIC, AND LUMBAR PT22 MR SPINE
INDICATION: ___ year old woman with h/o uncontrolled DM2 c/b small vessel CVA
___, vascular dementia, recent L5 nerve root injection, frequent UTI p/w one
week AMS and nonfocal weakness likely progression of vascular dementia.//
etiology of weakness and inability to walk etiology of weakness and
inability to walk etiology of weakness
and inability to walk etiology of
weakness and inability to walk
TECHNIQUE: Sagittal imaging was performed with T2, T1, and STIR technique.
Axial T2 imaging was performed. Axial GRE images of the cervical spine were
performed.
COMPARISON: Lumbar spine MRI without contrast of ___.
FINDINGS:
CERVICAL:
Cervical alignment is anatomic. Vertebral body heights are preserved. There
is no focal suspicious marrow lesion. Degenerative loss of disc height and
signal is mild at C5-C6 and C6-C7. The visualized posterior fossa is
unremarkable. There is no cord signal abnormality.
C2-C3: No significant spinal canal or neural foraminal narrowing.
C3-C4: Uncovertebral and facet arthropathy results in moderate bilateral
neural foraminal narrowing.
C4-C5: Small central protrusion with thickening of the ligamentum flavum
results in mild spinal canal narrowing. Uncovertebral and facet arthropathy
results in moderate bilateral neural foraminal narrowing.
C5-C6: A left central protrusion results in mild spinal canal narrowing.
Uncovertebral facet arthropathy results in moderate bilateral neural foraminal
narrowing.
C6-C7: A small central protrusion results in mild spinal canal narrowing.
Uncovertebral and facet arthropathy results in mild bilateral neural foraminal
narrowing.
C7-T1: No significant spinal canal or neural foraminal narrowing.
The visualized prevertebral and paraspinal soft tissues are unremarkable.
THORACIC:
Thoracic alignment is anatomic. Vertebral body heights are preserved. There
is no focal suspicious marrow lesion. Disc heights are preserved. Minimal
degenerative changes include small disc protrusions and thickening of the
ligamentum flavum at scattered levels without significant spinal canal or
neural foraminal narrowing. There is no signal abnormality of the thoracic
cord.
Visualized prevertebral and paraspinal soft tissues are unremarkable.
LUMBAR:
5 mm anterolisthesis of L4 on L5 and 3-4 mm anterolisthesis of L5 on S1 is
unchanged from examination of ___. Remainder lumbar alignment is
anatomic. Vertebral body heights are preserved. There is no focal suspicious
marrow lesion. Degenerative loss of disc height and signal is mild throughout
the lumbar spine. Conus medullaris terminates at the L1-L2 level, within
expected limits. There is no signal abnormality of the terminal cord.
L1-L2 and L2-L3: Small disc bulges and facet arthropathy does not
significantly narrow the spinal canal or neural foramina.
L3-L4: A disc bulge with thickening of the ligamentum flavum results in
moderate spinal canal narrowing. In combination with facet arthropathy, there
is mild bilateral neural foraminal narrowing.
L4-L5: The disc is uncovered secondary to anterolisthesis. Disc bulge with
prominent facet arthropathy results in severe spinal canal narrowing, overall
similar to prior examination. There is severe right and moderate to severe
left neural foraminal narrowing, unchanged from prior examination.
L5-S1: The disc is uncovered secondary to anterolisthesis. The disc bulge
results in mild spinal canal narrowing with crowding of the subarticular zones
which does not appear to displace traversing nerve roots. In combination with
facet arthropathy, there is moderate to severe bilateral neural foraminal
narrowing.
Mild STIR hyperintense signal of the lower paraspinal muscles likely
represents edema or strain. Visualized prevertebral and paraspinal soft
tissues are unremarkable.
IMPRESSION:
1. Lumbar spondylosis, similar from examination of ___ with
degenerative grade 1 anterolisthesis of L4 on L5 and L5 on S1, severe L4-L5
spinal canal narrowing crowding the cauda equina, severe L4-L5 right and
moderate to severe neural foraminal narrowing and bilateral L5-S1 moderate to
severe bilateral neural foraminal narrowing.
2. Cervical spondylosis results in bilateral moderate neural foraminal
narrowing at multiple levels without high-grade spinal canal narrowing.
3. No significant spinal canal or neural foraminal narrowing at the thoracic
spine.
4. No cord signal abnormality.
5. Additional findings as described above.
|
10033409-RR-9 | 10,033,409 | 21,582,131 | RR | 9 | 2111-12-02 20:55:00 | 2111-12-02 23:22:00 | EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ year old woman p/w AMS confusion, had at least one fall w/
headstrike in past 4 months.// ?SDH ?ICH
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 4.0 s, 16.0 cm; CTDIvol = 46.7 mGy (Head) DLP =
747.3 mGy-cm.
Total DLP (Head) = 747 mGy-cm.
COMPARISON: ___
FINDINGS:
Chronic lacunar infarct involving left putamen, globus pallidus, internal
capsule, caudate nucleus, stable. There are severe chronic small vessel
ischemic changes, stable since prior. There is no evidence of acute
infarction,hemorrhage,edema, or mass. Intracranial arterial calcifications.
Mild generalized brain parenchymal atrophy. No hydrocephalus.
There is no evidence of fracture. The visualized portion of the paranasal
sinuses, mastoid air cells, and middle ear cavities are clear. The visualized
portion of the orbits are unremarkable.
IMPRESSION:
No intracranial hemorrhage.
Stable chronic lacunar infarct left basal ganglia, internal capsule.
Severe chronic small vessel ischemic changes.
|
10033552-RR-34 | 10,033,552 | 21,543,627 | RR | 34 | 2132-07-01 17:41:00 | 2132-07-01 19:07:00 | INDICATION: History of right lower quadrant pain, tenderness. Please
evaluate for appendicitis.
COMPARISONS: CT from ___.
TECHNIQUE: ___ MDCT images were obtained through the abdomen and pelvis after
the administration of IV contrast. Multiplanar reformatted images in coronal
and sagittal axes were generated and reviewed.
FINDINGS: The bases of the lungs demonstrate mild atelectasis.
Subtle hypodensity in segment VIII of the liver, series 4, image 14, is too
small to characterize by CT, but likely secondary to a simple hepatic cyst.
There is a small amount of perihepatic fluid. The gallbladder is normal. The
spleen is homogenous and normal in size. The pancreas is normal. The left
adrenal gland is mildly thickened, overall similar to the prior exam from
___. Otherwise, the adrenal glands bilaterally are normal.
The stomach, duodenum and small bowel are normal without evidence of wall
thickening or obstruction. There is no retroperitoneal or mesenteric
lymphadenopathy. There is no evidence of intra-abdominal free air.
Appendix is dilated measuring up to 1.8 cm with a focus of gas at the tip and
surrounding inflammatory changes. There are adjacent local reactive lymph
nodes. There is no evidence of an abscess. There is free fluid within the
pelvis.
CT PELVIS: The urinary bladder is normal. The uterus is enlarged and
heterogeneous, concerning for fibroids. A pelvic ultrasound would be
recommended for further evaluation. Fluid is seen within the endometrial
canal. There is no pelvic wall or inguinal lymphadenopathy.
OSSEOUS STRUCTURES: No lytic or blastic lesions concerning for malignancy are
identified. Note is made of spondylolysis of the right L5/S1, without evidence
of spondylolisthesis.
IMPRESSION:
1. Findings consistent with acute appendicitis. No abscess or free air is
identified; however, note is made of a small amount of pelvic and perihepatic
free fluid.
2. Heterogeneous enlarged uterus is likely secondary to a fibroid uterus. A
pelvic ultrasound would be recommended for further evaluation.
|
10033661-RR-16 | 10,033,661 | 23,080,369 | RR | 16 | 2162-06-28 01:15:00 | 2162-06-28 01:52:00 | EXAMINATION: Chest radiograph
INDICATION: History: ___ with fall pain trauma// fall pain trauma
TECHNIQUE: Frontal chest radiograph
COMPARISON: None
FINDINGS:
Lungs are hyperinflated without focal opacity. The heart size is within
normal limits. There is no evidence of pulmonary edema. There is no pleural
effusion or pneumothorax.
IMPRESSION:
No focal opacity. No pneumothorax.
|
10033661-RR-17 | 10,033,661 | 23,080,369 | RR | 17 | 2162-06-28 01:15:00 | 2162-06-28 01:58:00 | EXAMINATION: HIP (UNILAT 2 VIEW) W/PELVIS (1 VIEW) RIGHT; FEMUR (AP AND LAT)
RIGHT
INDICATION: History: ___ with fall pain trauma// fall pain trauma
TECHNIQUE: Frontal view radiograph of the pelvis with additional frontal and
frog-leg lateral views of the right hip.
COMPARISON: None
FINDINGS:
Right hip: Patient is status post helical screw placement with short-stem
intra measure clot with an interlocking screw. There is no perihardware
fracture or evidence of loosening. Bones are diffusely demineralized,
limiting evaluation for fine bony detail. There is evidence of mildly
displaced fracture of the right superior pubic ramus. There is axial
migration of the right femoral head. Hypertrophic calcification is noted at
the lesser trochanter. There is no suspicious lytic or sclerotic lesion.
There is no soft tissue calcification or radio-opaque foreign body.
Right femur: There is no evidence of acute fracture or dislocation of the
right femur. Limited images of the right knee demonstrates unremarkable total
knee arthroplasty.
AP pelvis: Mild degenerative changes of the lower lumbar spine is seen. There
is axial migration of the left femoral head. Evaluation for sacral fracture
is limited on the current modality due to overlying bowel gas.
IMPRESSION:
Mildly displaced right superior pubic ramus fracture.
Right hip helical screw and intramedullary rod placement and right total knee
arthroplasty. No evidence of hardware failure.
Bowel gas overlies the left pubic bone limiting evaluation. Bones are
severely osteopenic.
|
10033661-RR-19 | 10,033,661 | 23,080,369 | RR | 19 | 2162-06-28 02:15:00 | 2162-06-28 02:28:00 | EXAMINATION: SECOND OPINION CT NEURO PSO1 CT
INDICATION: History: ___ with possible small parietal SAH from OSH CT read.
Neuro intact and mentating well// eval for e/o SAH
TECHNIQUE: Second opinion read was performed on the following images:
Contiguous axial images of the brain were obtained without contrast. Coronal
and sagittal reformations as well as bone algorithm reconstructions were
provided and reviewed.
DOSE: Not available
COMPARISON: None.
FINDINGS:
There is no evidence of acute infarction,definite hemorrhage,edema,or mass.
There does appear to be curvilinear hyperdensity of the left parietal lobe
(series 602, image 48), felt to be almost certainly artifactual as this is
associated with adjacent streak artifact and is not seen on any other images.
There is prominence of the ventricles and sulci suggestive of involutional
changes. Mild periventricular and subcortical white matter hypodensities are
nonspecific, however likely due to chronic small vessel ischemic disease in
this age group.
There is no evidence of acute fracture. The visualized portion of the
paranasal sinuses, mastoid air cells, and middle ear cavities are clear.
Patient is status post bilateral lens replacements. Otherwise, the visualized
portion of the orbits are unremarkable.
IMPRESSION:
1. Described possible left parietal subarachnoid hemorrhage may refer to a
subtle region of linear hyperdensity (series 602, image 48), felt to be almost
certainly artifactual. However, repeat examination could be performed to
document stability or resolution of the finding.
2. Otherwise, no definite intracranial hemorrhage. No acute large territory
infarct.
3. Global atrophy and likely sequela of chronic small vessel ischemic disease.
RECOMMENDATION(S): Repeat examination to document resolution/stability of
impression 1.
NOTIFICATION: The additional finding described in impression 1 above was
discussed with Dr. ___ by Dr. ___ on ___ at 09:47 via
the telephone 5 minutes after discovery of the finding.
|
10033661-RR-20 | 10,033,661 | 23,080,369 | RR | 20 | 2162-06-28 05:19:00 | 2162-06-28 05:40:00 | EXAMINATION: PELVIS (AP, INLET AND OUTLET)
INDICATION: History: ___ with right pelvic fx// please obtain inlet/outlet
views please obtain inlet/outlet views
TECHNIQUE: Inlet and outlet pelvic views
COMPARISON: Radiographs from ___
FINDINGS:
Again seen is mildly displaced superior ramus fracture on the right. There is
subtle lucency through the right inferior pubic ramus, concerning for
nondisplaced fracture.
Helical screw and intramedullary rod is partially imaged on the current study.
No definite periprosthetic fracture is identified. There is no evidence of
loosening.
Axial migration of bilateral femoral heads are better assessed on the pelvic
radiographs from the same day. Evaluation of the sacrum and lower lumbar
spine is limited due to overlying bowel gas.
IMPRESSION:
Mildly displaced right superior ramus fracture and possible nondisplaced right
inferior pubic ramus fracture.
|
Subsets and Splits
No saved queries yet
Save your SQL queries to embed, download, and access them later. Queries will appear here once saved.