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10038332-RR-62 | 10,038,332 | 27,818,008 | RR | 62 | 2173-08-09 17:18:00 | 2173-08-09 22:11:00 | EXAMINATION: MR ___ WAND W/O CONTRAST ___ MR ___ SPINE
INDICATION: ___ year old man with t10 spinal level d/t GSW in past, neurogenic
bladder, here with mdr e coli pyelonephritis and hx recurrent utis also with
weeks of neck stiffness, pain radiating to both hands, paresthesias of hands
and some weakness in bt hands// eval for c/s process to explain symptoms: djd,
discitis, abscess?
TECHNIQUE: Sagittal imaging was performed with T2, T1, and STIR technique.
Axial T2 and gradient echo imaging were next performed. After administration
of Gadavist intravenous contrast, sagittal and axial T1 weighted imaging was
performed.
COMPARISON: CT cervical spine ___ from outside facility.
FINDINGS:
Alignment is within normal limits. Vertebral body heights are preserved.
Probable small Schmorl's node is seen in the inferior endplate of C5 on the
right. There slight ___ type 1 degenerative endplate changes seen
posteriorly at C7-T1, and anteriorly at C4-5. Marrow signal is otherwise
unremarkable. The cervical spinal cord is normal in caliber and signal
intensity. No epidural collection.
Multilevel signal and height loss of cervical spine intervertebral discs is
consistent with degenerative change. Specifically:
C2-3: Posterior disc bulge causes mild spinal canal narrowing without spinal
cord contact. Mild right neural foraminal narrowing due to uncovertebral
osteophytes.
C3-4: Posterior disc osteophyte complex causing mild spinal canal narrowing
with slight cord remodeling. No cord signal abnormality. Moderate right and
mild left neural foraminal narrowing due to uncovertebral osteophytes
C4-5: Posterior disc osteophyte complex causes moderate spinal canal narrowing
with slight contact the ventral spinal cord and slight remodeling without cord
signal abnormality. Moderate right and mild left neural foraminal narrowing
due to uncovertebral facet osteophytes.
C5-6: Moderate spinal canal narrowing and remodeling of the spinal cord
without cord signal abnormality to 2 8 posterior disc osteophyte complex.
Moderate severe right and mild-to-moderate left neural foraminal narrowing due
to uncovertebral and facet osteophytes.
C6-7: Mild spinal canal narrowing due to posterior disc osteophyte complex
with slight cord remodeling but no cord contact or cord signal abnormality.
Mild right neural foraminal narrowing due to uncovertebral osteophytes.
C7-T1: Unremarkable.
No prevertebral edema. The prevertebral and paraspinal soft tissues are
unremarkable.
IMPRESSION:
1. Moderate cervical spondylosis causes spinal narrowing which is worst
(moderate) at C4-5 and C5-6, where there is slight ventral cord contact cord
remodeling in the AP dimension, without cord signal abnormality. Degenerative
neural foraminal narrowing is worst (moderate to severe) on the right at C5-6.
Further details, as above.
2. No abnormal enhancement or other acute process identified.
NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___
on the telephone on ___ at 10:10 pm, 1 minutes after discovery of the
findings.
|
10038999-RR-11 | 10,038,999 | 27,189,241 | RR | 11 | 2131-05-23 00:00:00 | 2131-05-23 10:23:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: does this gentleman have airway space disease or pleural
effusion?
TECHNIQUE: AP chest x-ray
COMPARISON: None
FINDINGS:
1 portable view. Lung volumes are low. There is hazy increased density at
the lung bases likely representing pleural fluid. The retrocardiac area is
not well penetrated and there is a suggestion of air bronchograms in the lower
right lung. The cardiac silhouette appears large although cardiac size may be
exaggerated by technical factors. Mediastinal structures are otherwise
unremarkable. An endotracheal tube is present and terminates approximately 3
cm above the carina. A nasogastric tube is in place and terminates well below
the diaphragm, off of the bottom of the image. A no other radiopaque catheter
is projected over the lower left chest, with its tip projected over the left
hilus.
IMPRESSION:
Evidence for bilateral pleural effusions and consolidation or atelectasis in
the left lower lobe. Prominent cardiac silhouette.
Repeat examination with a better inspiratory effort and lateral view would be
helpful.
|
10038999-RR-12 | 10,038,999 | 27,189,241 | RR | 12 | 2131-05-23 21:58:00 | 2131-05-24 00:15:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with pericardial effusion s/p drain. Intubated
___ agitation. Now w/ T 101.6. // Question of PNA
TECHNIQUE: Chest single view
COMPARISON: ___ 00:12
FINDINGS:
Appliances in good position. Drainage catheter in place. Left basilar
consolidation, similar. Increase cardiac silhouette, stable. Mild worsening
right basilar opacity. Small right pleural effusion, similar.
IMPRESSION:
Mild worsening right basilar opacity.
Stable left basilar consolidation
|
10038999-RR-13 | 10,038,999 | 27,189,241 | RR | 13 | 2131-05-25 15:43:00 | 2131-05-25 17:30:00 | EXAMINATION: Nongated chest CTA
INDICATION: ___ year old man with hypoxia and tachycardia. Evaluate for PE,
volume overload or consolidation.
TECHNIQUE: Axial multidetector CT images were obtained through the thorax
after the uneventful administration of intravenous contrast.
Reformatted coronal, sagittal, thin slice axial images, and oblique maximal
intensity projection images were submitted to PACS and reviewed.
DOSE: Total DLP (Body) = 345 mGy-cm.
COMPARISON: CT abdomen ___ please note that this study was
performed at ___.
FINDINGS:
The aorta and its major branch vessels are patent, with no evidence of
stenosis, occlusion, dissection, or aneurysmal formation. There is no
evidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.
Study is moderately degraded by motion. Within these limitations, the
pulmonary arteries are well opacified to the subsegmental level, with no
evidence of filling defect within the main, right, left, lobar, segmental or
subsegmental pulmonary arteries. There is evidence of leftward septal bowing,
enlargement of the right ventricle with respect to the left ventricle and
reflux of contrast to the hepatic veins suggestive of right heart strain.
There is no supraclavicular, axillary or mediastinal lymphadenopathy. The
thyroid gland appears unremarkable.
There is a large nonhemorrhagic pericardial effusion with a pericardial drain
in place. There are large bilateral nonhemorrhagic pleural effusions, which
have increased in size since ___. There is associated compressive
atelectasis bilaterally, causing complete collapse of the left lower lobe and
the posterior basal segment of the right lower lobe. There is also a linear
atelectasis noted in left upper lobe.
And endotracheal tube is visualized terminating in the trachea. An enteric
tube is also visualized in the esophagus.
Limited images of the upper abdomen are unremarkable.
No lytic or blastic osseous lesion suspicious for malignancy is identified.
IMPRESSION:
1. No evidence of pulmonary embolism within limitations of the study limited
by patient motion.
2. There is a large nonhemorrhagic pericardial effusion with pericardial
drain in place. There is associated leftward interventricular septal bowing
and contrast reflux into the hepatic veins suggestive of right ventricular
strain.
3. Bilateral nonhemorrhagic pleural effusions are larger compared to ___.
4. Bilateral compressive atelectasis with collapse of the left lower lobe and
posterior basal segment of the right lower lobe. There is also linear
atelectasis in the left upper lobe.
|
10038999-RR-14 | 10,038,999 | 27,189,241 | RR | 14 | 2131-05-26 07:59:00 | 2131-05-26 08:59:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with pericarditis and bacteremia, ventilated //
Confirm ET tube remains in correct place Confirm ET tube remains in
correct place
IMPRESSION:
Comparison to ___. The tip of the endotracheal tube projects 4 cm
above the carina. The pericardial drain was removed. Low lung volumes are
further decreased. Small bilateral pleural effusions are apparent. Mild
fluid overload but no overt pulmonary edema.
|
10038999-RR-15 | 10,038,999 | 27,189,241 | RR | 15 | 2131-05-27 08:04:00 | 2131-05-27 08:51:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with PNA and pericardial effusion.
Intubated/sedated // Interval change in PNA/pleural effusions Interval
change in PNA/pleural effusions
IMPRESSION:
In comparison with the study of ___, the right subclavian PICC line has
been pulled back so that the tip is in the lower SVC. Other monitoring
support devices are stable.
Continued low lung volumes accentuate the enlargement of the cardiac
silhouette. Bilateral layering pleural effusions with compressive basilar
atelectasis and some mild elevation of pulmonary venous pressure.
|
10038999-RR-16 | 10,038,999 | 27,189,241 | RR | 16 | 2131-05-26 18:27:00 | 2131-05-26 19:56:00 | EXAMINATION:
Portable chest x-ray
INDICATION: ___ year old man with new R PICC // R DL Power PICC 47cm ___
___ Contact name: ___: ___
TECHNIQUE: Frontal portable view of the chest.
COMPARISON: Compared to prior chest x-ray dated ___ at 08:12.
FINDINGS:
Endotracheal tube is 4 cm from the carina, unchanged from prior. A feeding
tube is noted extending below the diaphragm, however its tip is not
visualized. There has been interval insertion of a right PICC line, with its
tip within the distal SVC/right atrium. Recommend pulling back by
approximately 3 cm.
There is mild fluid overload, unchanged from prior. No focal consolidation or
pneumothorax. Small bilateral pleural effusions, stable.
This preliminary report was reviewed with Dr. ___
radiologist.
IMPRESSION:
Interval insertion of a right PICC line, with its tip within the distal
SVC/right atrium. Recommend pulling back by approximately 3 cm.
|
10038999-RR-17 | 10,038,999 | 27,189,241 | RR | 17 | 2131-05-28 07:19:00 | 2131-05-28 11:02:00 | INDICATION: Hypoxic respiratory failure, pleural effusions, and pericardial
effusion.
TECHNIQUE: Frontal chest radiograph.
COMPARISON: Chest radiographs from ___.
FINDINGS:
A right PICC terminates at the lower SVC. An endotracheal tube terminates 3
cm above the carina. An orogastric tube terminates within the stomach.
The lung volumes are very low. There is central pulmonary vascular congestion
with new mild edema since the ___ examination. Small pleural
effusions, greater on the left, are unchanged. Right and left retrocardiac
opacities are unchanged, likely atelectasis.
IMPRESSION:
1. Central pulmonary vascular congestion with new mild edema since the ___ examination.
2. The lung volumes remain low. Unchanged pleural effusions and bibasilar
atelectasis.
|
10038999-RR-18 | 10,038,999 | 27,189,241 | RR | 18 | 2131-05-28 14:38:00 | 2131-05-28 16:56:00 | INDICATION: ___ man with history of developmental delay presenting to
an outside hospital with abdominal pain found have a large pericardial
effusion on CT scan of the abdomen status post pericardiocentesis intubation
now with fever of unknown origin and worsening bilateral effusions, evaluate
for intra-abdominal or intrapelvic process.
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired
through the abdomen and pelvis following intravenous contrast administration
with split bolus technique.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Stationary Acquisition 0.5 s, 1.0 cm; CTDIvol = 1.2 mGy (Body) DLP = 1.2
mGy-cm.
2) Stationary Acquisition 4.5 s, 1.0 cm; CTDIvol = 10.4 mGy (Body) DLP =
10.4 mGy-cm.
3) Spiral Acquisition 17.4 s, 66.9 cm; CTDIvol = 16.8 mGy (Body) DLP =
1,098.9 mGy-cm.
Total DLP (Body) = 1,130 mGy-cm.
COMPARISON: Outside hospital CT abdomen ___.
FINDINGS:
LOWER CHEST: Please see separate report for intrathoracic findings from
same-day CT chest.
CT ABDOMEN:
HEPATOBILIARY: The hepatic parenchyma is diffusely heterogeneously enhancing
with a nutmeg appearance, suggestive of congestive hepatopathy in the setting
of a pericardial effusion and pericarditis and likely some component of
constrictive physiology. Otherwise, there is no focal liver lesion. There is
no intrahepatic biliary ductal dilation. The portal vein is patent.
Vicariously excreted contrast layers dependently with fluid fluid level within
the gallbladder lumen. The gallbladder is otherwise unremarkable. There is
no extrahepatic biliary ductal dilation.
PANCREAS: The pancreas enhances homogeneously. There is no peripancreatic
stranding or ductal dilation.
SPLEEN: There is no splenomegaly or focal splenic lesion.
ADRENALS: The adrenal glands are normal.
URINARY: Tiny cortically based hypodensities in the kidneys bilaterally are
too small to characterize accurately by CT. Otherwise, The kidneys enhance
normally and symmetrically. There is no hydronephrosis. There is no
perinephric abnormality.
GASTROINTESTINAL: An enteric tube terminates in the distal gastric lumen. The
stomach is otherwise unremarkable. The duodenum is normal. Non-dilated small
bowel loops are normal in course and caliber without evidence of wall
thickening or obstruction. The colon is unremarkable. The appendix is
normal.
VASCULAR AND LYMPH NODES: The abdominal aorta is normal in caliber without
evidence of aneurysm or dilation. Major proximal tributaries are patent.
There is no mesenteric or retroperitoneal lymphadenopathy by CT size criteria.
There is no free intraperitoneal air.
CT PELVIS:
The bladder is under-distended in the presence of an in situ Foley catheter,
balloon seen inflated within the bladder lumen. Mild bladder wall thickening
diffusely likely relates to underdistention. Trace nonhemorrhagic fluid
layers dependently in the rectovesical pouch. There is no pelvic sidewall,
iliac chain, or inguinal lymphadenopathy.
MUSCULOSKELETAL: There is no concerning focal subcutaneous or musculoskeletal
soft tissue abnormality. Bilateral L5 pars defects are noted, unchanged since
prior study from outside facility. The imaged thoracolumbar vertebral bodies
are normally aligned. No concerning focal lytic or sclerotic osseous lesions
are identified.
IMPRESSION:
1. Congestive hepatic hepatopathy may relate to some component of constrictive
physiology in the setting of a pericardial effusion and pericarditis.
2. Trace nonhemorrhagic free pelvic fluid is nonspecific.
3. Please see separate report for intrathoracic findings from same-day CT
chest.
|
10038999-RR-19 | 10,038,999 | 27,189,241 | RR | 19 | 2131-05-28 14:39:00 | 2131-05-28 15:52:00 | EXAMINATION: CT CHEST W/CONTRAST
INDICATION: This is a ___ with history of developmental delay who presented
to an OSH with abdominal pain was found to have a large pericardial effusion
on CT scan of the abdomen s/ppericardial drainage and intubation for agitation
now with FUO and worsening b/l pulm
TECHNIQUE: Multidetector helical scanning of the chest was coordinated with
intravenous infusion of nonionic iodinated contrast agent reconstructed as
axial, coronal , parasagittal, and ,MIPs axial images.
DOSE: DLP: Reported in the concurrent abdomen CT
COMPARISON: ___.
FINDINGS:
The thyroid is normal.
Large layering left greater than right pleural effusions associated with
extensive atelectasis throughout the lungs is unchanged. Pericardial effusion
has decreased, the pericardium appears enhancing. Cardiac size is unchanged.
Is within normal limits.
Supraclavicular, axillary, and hilar lymph nodes are not enlarged.
Mediastinal lymph nodes are increased in number measuring up to 9 mm unchanged
from prior study. Aorta and pulmonary arteries are normal size.
Please refer to the concurrent abdomen CT for complete description of the
intra-abdominal findings
There are no bone findings of malignancy
ET tube is in appropriate position. There are secretions in the distal
trachea and right main bronchus NG tube is in place.
IMPRESSION:
Decrease in size of pericardial effusion.
Extensive mediastinal lymphadenopathy is unchanged, the lymph nodes are
borderline, likely reactive.
Large bilateral layering pleural effusions associated with adjacent
atelectasis are stable.
No definitive new lung abnormalities are detected.
|
10038999-RR-20 | 10,038,999 | 27,189,241 | RR | 20 | 2131-05-29 08:05:00 | 2131-05-29 10:25:00 | INDICATION: This is a ___ yoM with a PMH significant for developmental mental
delay, seizure disorder, and blindness who is being admitted to the CCU
following pericardial drainage for a moderate to large pericardial effusion.
Currently the patient is hemodynamically stable with drain in place pending
extubation and f/u investigation regarding the etiology of his pericardial
effusion. // ET tube placement
TECHNIQUE: Chest PA and lateral
COMPARISON: ___
FINDINGS:
ET tube in situ with the tip just above the medial clavicles approximately 37
mm proximal to the carina. Right-sided PICC line in situ with the tip in the
mid to distal SVC. No pneumothorax. NG tube in situ coursing out of sight
inferiorly. Bilateral pulmonary venous congestion. Left lower lobe
atelectasis with a small associated effusion. Mild right basal atelectasis
with a suspected small effusion.
IMPRESSION:
No significant interval change.
|
10038999-RR-21 | 10,038,999 | 27,189,241 | RR | 21 | 2131-05-29 08:37:00 | 2131-05-29 10:49:00 | EXAMINATION:
ULTRASOUND-GUIDED THORACOCENTESIS
INDICATION: ___ year old man with pericardial effusion s/p drain and bilateral
pleural effusions. // Has bilateral pleural effusions. Can we get a
diagnostic and therapeutic tap on the LEFT for now.
TECHNIQUE: Ultrasound guided diagnostic and therapeutic thoracocentesis.
COMPARISON: CT chest from ___
FINDINGS:
Limited grayscale ultrasound imaging of the left hemithorax demonstrated a
moderate sized pleural effusion. A suitable target was selected on the left.
PROCEDURE: The procedure, risks, benefits and alternatives were discussed
with the patient's healthcare proxy over the phone and consent was obtained.
A preprocedure time-out was performed discussing the planned procedure,
confirming the patient's identity with 3 identifiers, and reviewing a
checklist per ___ protocol.
Under ultrasound guidance, an entrance site was selected and the skin was
prepped and draped in the usual sterile fashion. 1% lidocaine was instilled
for local anesthesia.
A 5 ___ catheter was advanced into the largest fluid pocket in the left
hemithorax and 550 cc of straw-colored fluid was removed.
The samples were sent for microbiology and cytology.
The patient tolerated the procedure well without immediate complication.
Estimated blood loss was minimal.
Dr. ___ attending radiologist, was present throughout the critical
portions of the procedure.
IMPRESSION:
Technically successful left thoracocentesis removing 550 cc of straw-colored
fluid. Samples were sent for microbiology and cytology.
|
10038999-RR-22 | 10,038,999 | 27,189,241 | RR | 22 | 2131-05-30 07:30:00 | 2131-05-30 15:17:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with drained pericardial effusion, bilateral
pleural effusions // eval for interval changes
COMPARISON: ___
FINDINGS:
ET and NG tube have been removed. Right-sided PICC line overlies proximal/mid
SVC.No pneumothorax is detected.
There are low inspiratory volumes.
Cardiomediastinal silhouette is similar to prior.
There is patchy opacity at the left lung base and increased retrocardiac
density, slightly more pronounced.
Some vascular crowding is present at the right lung base.
Small effusions would be difficult to exclude.
IMPRESSION:
Low inspiratory volumes. Slight increase in opacities at the left lung base.
|
10038999-RR-23 | 10,038,999 | 27,189,241 | RR | 23 | 2131-05-29 10:56:00 | 2131-05-29 12:13:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: This is a ___ with history of developmental delay who presented
to an OSH with abdominal pain was found to have a large pericardial effusion
on CT scan of the abdomen s/p pericardial drainage and intubation for
agitation. // Post-thoracentesis film Post-thoracentesis film
IMPRESSION:
Comparison to ___. Of the thoracocentesis on the left there is a
substantial decrease in extent of the pre-existing left pleural effusion. A
minimal retrocardiac atelectasis persists but the left lung parenchyma is
better ventilated than on the previous image. Improved ventilation is also
noted on the right. Stable position of the monitoring and support devices.
Moderate cardiomegaly persists.
|
10038999-RR-24 | 10,038,999 | 27,189,241 | RR | 24 | 2131-06-02 07:11:00 | 2131-06-02 12:36:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with pericarditis and pleural effusion s/p
drainage/tap // Reaccumulation of pleural effusion?
TECHNIQUE: Single frontal view of the chest
COMPARISON: ___.
IMPRESSION:
Enlargement of the cardiomediastinal silhouette has improved. Mild vascular
congestion has improved. Small bilateral effusions have decreased. Left
lower lobe atelectasis have markedly improved. There is no evident
pneumothorax
|
10038999-RR-25 | 10,038,999 | 27,189,241 | RR | 25 | 2131-06-02 14:44:00 | 2131-06-02 16:05:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old man with pericardial effusion // eval of effusion
eval of effusion
IMPRESSION:
Compared to chest radiographs ___ through ___.
Previous pulmonary vascular congestion has resolved, but moderate enlargement
of the cardiac silhouette remains, exaggerated by very low lung volumes.
There is no mediastinal venous engorgement to suggest elevated central venous
pressure. Pleural effusions are likely, but not large. No pneumothorax.
|
10038999-RR-26 | 10,038,999 | 29,026,789 | RR | 26 | 2132-05-17 22:17:00 | 2132-05-17 22:31:00 | INDICATION: History: ___ with history of ankle fracture// Post reduction
film. Will need Mortise view
TECHNIQUE: Right ankle, three views
COMPARISON: Right ankle radiographs ___ at 17:02
FINDINGS:
Overlying splint limits fine osseous detail. Again demonstrated is a
comminuted fracture of the distal tibia with continued but decreased mild
lateral displacement of the dominant distal fracture fragment. No
intra-articular extension is demonstrated. Ankle mortise is symmetric. Talar
dome is smooth. No dislocation is present. No concerning lytic or sclerotic
osseous abnormalities are seen. Diffuse soft tissue swelling is noted about
the ankle. There are no radiopaque foreign bodies.
IMPRESSION:
Comminuted distal tibial fracture with mild lateral displacement of the
dominant distal fracture fragment, but overall in improved alignment compared
to the previous exam. Symmetric ankle mortise.
|
10038999-RR-27 | 10,038,999 | 29,026,789 | RR | 27 | 2132-05-18 10:07:00 | 2132-05-18 14:01:00 | EXAMINATION: TIB/FIB (AP AND LAT) RIGHT
INDICATION: ORIF right tibial fracture
TECHNIQUE: 4 spot fluoroscopic images obtained in the OR without radiologist
present
COMPARISON: Right ankle radiographs ___
FINDINGS:
The available images show steps related to open reduction internal fixation of
a spiral fracture of the distal tibia. An intramedullary rod is incompletely
visualized. Alignment is improved when compared to the prior study. The
ankle mortise is congruent on these nonstress views. There is mild diffuse
soft tissue swelling. Please see the operative report for further details.
|
10039110-RR-59 | 10,039,110 | 25,345,103 | RR | 59 | 2165-12-13 09:44:00 | 2165-12-13 10:39:00 | INDICATION: ___ with cough and left sided chest pain// PNA
TECHNIQUE: Frontal and lateral views the chest.
COMPARISON: Chest x-ray from ___.
FINDINGS:
Focal opacity at the right lung base seen on prior CT abdomen pelvis is
faintly visualized. The lungs are otherwise clear, no new consolidation.
There is no effusion, edema or pneumothorax.. Cardiomediastinal silhouette is
stable. No acute osseous abnormalities.
IMPRESSION:
Perhaps minimal residual opacity at the right costophrenic angle as seen on
prior CT. No new consolidation.
|
10039110-RR-60 | 10,039,110 | 25,345,103 | RR | 60 | 2165-12-13 13:17:00 | 2165-12-13 14:26:00 | EXAMINATION: CTA CHEST WITH CONTRAST
INDICATION: ___ with pleuritic chest pain// PE
TECHNIQUE: Axial multidetector CT images were obtained through the thorax
after the uneventful administration of intravenous contrast. Reformatted
coronal, sagittal, thin slice axial images, and oblique maximal intensity
projection images were submitted to PACS and reviewed.
DOSE: Acquisition sequence:
1) Stationary Acquisition 3.5 s, 0.5 cm; CTDIvol = 21.3 mGy (Body) DLP =
10.6 mGy-cm.
2) Spiral Acquisition 3.8 s, 29.8 cm; CTDIvol = 11.8 mGy (Body) DLP = 350.9
mGy-cm.
Total DLP (Body) = 362 mGy-cm.
COMPARISON: Correlation made to CT abdomen pelvis from ___.
FINDINGS:
HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the
subsegmental. There are numerous filling defects within subsegmental branches
of the bilateral lower lobes. Segmental filling defect noted in the right
middle lobe as well as within the lingula. Evaluation of the upper lobes is
limited by respiratory motion and the vessels beyond the lobar level are not
well assessed. There is no evidence of right heart strain. The thoracic
aorta is normal in caliber without evidence of dissection or intramural
hematoma. The heart, pericardium, and great vessels are within normal limits.
No pericardial effusion is seen.
AXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar
lymphadenopathy is present. No mediastinal mass.
PLEURAL SPACES: There is a small right and trace left pleural effusion.
LUNGS/AIRWAYS: Ground-glass opacity noted in the lingula most suggestive of an
infarct. There is bibasilar atelectasis in the lower lobes noting that
component of infarct is suspected on the right lungs are clear without masses
or areas of parenchymal opacification. The airways are patent to the level of
the segmental bronchi bilaterally.
BASE OF NECK: Visualized portions of the base of the neck show no abnormality.
ABDOMEN: Included portion of the upper abdomen is notable for hyperenhancing
1.2 cm focus in the right lobe, incompletely characterized, potentially flash
filling hemangioma or altered perfusion. Partially imaged changes of
Roux-en-Y gastric bypass are noted.
BONES: No suspicious osseous abnormality is seen.? There is no acute fracture.
There is a 1.5 x 1.2 cm oblong density in the upper and slightly outer aspect
of the right breast (3:86).
IMPRESSION:
1. Segmental and subsegmental pulmonary emboli in the lingula, right middle
lobe and bilateral lower lobes. Upper lobes are not particularly well
assessed due to motion. No evidence of right heart strain.
2. Findings compatible with a pulmonary infarct in the lingula. Areas of
atelectasis at the lung bases with suspected right basilar infarct as well.
3. Small right and trace left pleural effusions.
4. The rounded 1.5 cm lesion in the upper and slightly outer right breast
which likely correlates with lesion worked up by prior ultrasound in ___.
NOTIFICATION: Findings were discussed with Dr. ___ at 14:00 on ___ by Dr. ___.
|
10039708-RR-10 | 10,039,708 | 28,258,130 | RR | 10 | 2140-01-23 14:44:00 | 2140-01-23 15:38:00 | EXAMINATION: CTA ABD AND PELVIS
INDICATION: ___ with profound anemia, evaluate for GI bleed.
TECHNIQUE: Abdomen and pelvis CTA: Non-contrast and multiphasic post-contrast
images were acquired through the abdomen and pelvis.
IV Contrast: 150mL of Omnipaque
Oral contrast was not administered.
MIP reconstructions were performed on independent workstation and reviewed on
PACS.
DOSE: Acquisition sequence:
1) CT Localizer Radiograph
2) CT Localizer Radiograph
3) Spiral Acquisition 5.9 s, 46.6 cm; CTDIvol = 2.7 mGy (Body) DLP = 124.4
mGy-cm.
4) Stationary Acquisition 2.5 s, 0.5 cm; CTDIvol = 12.0 mGy (Body) DLP =
6.0 mGy-cm.
5) Spiral Acquisition 6.0 s, 46.6 cm; CTDIvol = 9.6 mGy (Body) DLP = 446.0
mGy-cm.
6) Spiral Acquisition 6.0 s, 46.6 cm; CTDIvol = 9.5 mGy (Body) DLP = 444.5
mGy-cm.
Total DLP (Body) = 1,021 mGy-cm.
COMPARISON: Abdominal ultrasound from ___
FINDINGS:
LOWER CHEST: The lung bases are clear. Hypodense blood within the cardiac
chamber compatible with anemia. There is no pleural or pericardial effusion.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates profound decreased attenuation
compatible with fatty infiltration. There is no intra or extrahepatic biliary
ductal dilatation. The gallbladder is collapsed, without stones or
gallbladder wall thickening. The portal vein is patent.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys appear heterogeneous and may have exhibit diffuse
striated nephrograms. There is no evidence of stones, focal renal lesions, or
hydronephrosis. There is no perinephric abnormality.
GASTROINTESTINAL: The patient is status post gastric bypass surgery. Small
bowel loops demonstrate normal caliber, wall thickness and enhancement
throughout. There is no active extravasation of contrast to suggest acute
active bleeding. There is wall thickening of the rectum, sigmoid, and
portions of the right and left colon which may be due to colitis versus portal
colopathy. The appendix is visualized and normal. There are mildly enlarged
periportal lymph nodes. Haziness of the mesentery and retroperitoneum are
also noted, possibly related to underlying liver disease.
VASCULAR: The abdominal aorta is normal in caliber without aneurysmal
dilatation. The celiac axis, SMA, bilateral renal arteries, and ___ are
patent. Note is made of a replaced right hepatic artery arising from the SMA.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
evidence of pelvic or inguinal lymphadenopathy. There is a small amount of
free fluid in the pelvis. A right femoral central venous catheter is noted.
REPRODUCTIVE ORGANS: An IUD is noted in place within the uterus. No adnexal
masses present.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. No active extravasation of contrast to suggest active GI bleeding at this
time.
2. Profound hepatic steatosis. Enlarged periportal lymph nodes with hazy
mesentery and retroperitoneum likely reflect underlying liver disease.
3. Colonic and rectal wall thickening which may reflect colitis versus portal
colopathy.
4. Heterogeneous appearance of the kidneys with possible striated nephrograms.
Correlate with urinalysis to exclude pyelonephritis.
|
10039708-RR-11 | 10,039,708 | 28,258,130 | RR | 11 | 2140-01-24 16:46:00 | 2140-01-25 09:41:00 | EXAMINATION: DX CHEST PORTABLE PICC LINE PLACEMENT
INDICATION: ___ year old woman with new R PICC // R Dl Power PICC 39cm ___
___ Contact name: ___: ___ R Dl Power PICC 39cm ___ ___
COMPARISON: Prior chest radiographs since ___ most recently ___.
IMPRESSION:
New right PIC line ends in the upper right atrium approximately 15 mm below
the estimated location of the superior cavoatrial junction.
Severe symmetric pulmonary consolidation has developed since ___, most
likely pulmonary edema. Accompanying pleural effusions are presumed, but not
large. Heart is normal size and mediastinal veins are not engorged. There is
no pneumothorax.
NOTIFICATION: Dr. ___ reported the findings to ICU resident by telephone on
___ at 9:40 AM, one minutes after discovery of the findings.
|
10039708-RR-12 | 10,039,708 | 28,258,130 | RR | 12 | 2140-01-25 17:30:00 | 2140-01-25 19:21:00 | EXAMINATION: BILAT LOWER EXT VEINS
INDICATION: ___ year old woman with hypotension of unknown etiology s/p right
femoral line, now with significant right leg swelling // Any e/o DVT?
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the bilateral lower extremity veins.
COMPARISON: None
FINDINGS:
Right leg: There is lack of compressibility, color flow, and spectral Doppler
waveform of all deep veins of the right lower extremity from the common
femoral vein down to the calf veins.
Left leg: There is normal compressibility, flow, and augmentation of the left
common femoral, femoral, and popliteal veins. Normal color flow and
compressibility are demonstrated in the posterior tibial and peroneal veins.
IMPRESSION:
1. Occlusive thrombus of all right lower extremity deep veins from the common
femoral vein down to the calf veins.
2. Patent left lower extremity veins.
NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___
on the ___ ___ at 7:18 ___, 2 minutes after discovery of the
findings.
|
10039708-RR-13 | 10,039,708 | 28,258,130 | RR | 13 | 2140-01-25 23:23:00 | 2140-01-26 09:31:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with anemia hypotension on pressors and
worsening hypoxia // ?interval change
TECHNIQUE: Portable AP chest radiograph.
COMPARISON: Chest radiograph ___
FINDINGS:
Lung volumes are unchanged compared to the prior study. There are persistent
perihilar airspace opacities, similar in extent when compared to the prior
study. Given the rapid development, this likely reflects pulmonary edema.
There is left lower lobe atelectasis. . No pneumothorax seen. A right
internal jugular catheter terminates in the distal SVC.
IMPRESSION:
Persistent bilateral predominate perihilar airspace opacities likely
reflecting pulmonary edema. Superimposed infection cannot be excluded.
|
10039708-RR-14 | 10,039,708 | 28,258,130 | RR | 14 | 2140-01-27 04:24:00 | 2140-01-27 10:43:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with hypoxia, pulmonary edema // Please
evaluate for interval change
TECHNIQUE: Single frontal view of the chest
COMPARISON: Portable chest x-ray ___
FINDINGS:
Bilateral pulmonary edema is worsening. Heart size is unchanged. Right PICC
ends in the right atrium.
IMPRESSION:
Worsening bilateral pulmonary edema.
|
10039708-RR-15 | 10,039,708 | 28,258,130 | RR | 15 | 2140-01-28 04:05:00 | 2140-01-28 11:17:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with anemia, hypotension, continued pressor
requirement, volume overload // eval for interval change eval for
interval change
COMPARISON: Prior chest radiographs ___ through ___.
IMPRESSION:
Severe global pulmonary consolidation has a perihilar distribution, unchanged
since ___ but accompanied by increasing moderate right pleural
effusion. Pulmonary edema is the most likely explanation for the bulk of this
abnormality, cardiogenic or otherwise. Heart is obscured. It was normal size
on ___, probably larger now.
Right PIC line ends in the low SVC. No pneumothorax. Should
|
10039708-RR-18 | 10,039,708 | 28,258,130 | RR | 18 | 2140-01-29 05:15:00 | 2140-01-29 13:33:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with pulmonary edema from possible takatsubos
vs ARDS // interval change interval change
IMPRESSION:
In comparison with the study of ___, there is probably little change
in the severe pulmonary opacification is, most likely representing pulmonary
edema. In the appropriate clinical setting, superimposed pneumonia would be
impossible to exclude.
Apparent respiratory motion somewhat degrades the image.
|
10039708-RR-20 | 10,039,708 | 28,258,130 | RR | 20 | 2140-01-29 15:42:00 | 2140-01-29 16:15:00 | EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ year old woman with shock of unknown etiology requiring
pressors, DVT on heparin drip, coagulopathy with INR of 4.7, now with acute
AMS. Assess for bleed or stroke.
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Acquisition sequence:
1) CT Localizer Radiograph
2) CT Localizer Radiograph
3) Stationary Acquisition 5.0 s, 18.8 cm; CTDIvol = 45.5 mGy (Head) DLP =
855.5 mGy-cm.
Total DLP (Head) = 856 mGy-cm.
COMPARISON: Noncontrast head CT ___.
FINDINGS:
The examination is motion degraded. Within these confines:
There is no evidence of acute territorial infarction, hemorrhage, edema, or
mass. There is prominence of the ventricles and sulci, greater than would be
expected for the patient's age, which has mildly progressed since prior
examination.
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:
1. There is mild progression of global cerebral atrophy since the prior
examination of ___, greater than would be expected for the
patient's age.
2. No intracranial hemorrhage or territorial infarct.
|
10039708-RR-21 | 10,039,708 | 28,258,130 | RR | 21 | 2140-01-29 15:53:00 | 2140-01-29 16:49:00 | EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ year old woman with hx of alcohol abuse, in the ICU w/
refractory hypotension of unknown etiology and rising bilirubin and INR // any
evidence of acute process?
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: CT abdomen pelvis from ___
FINDINGS:
LIVER: The liver is diffusely echogenic. The contour of the liver is smooth.
There is no focal liver mass. The main portal vein is patent with hepatopetal
flow. There is trace ascites.
BILE DUCTS: There is no intrahepatic biliary dilation. The CBD measures 3 mm.
GALLBLADDER: There is no evidence of stones or gallbladder wall thickening.
There is a small moderate pericholecystic fluid.
PANCREAS: Imaged portion of the pancreas appears within normal limits, without
masses or pancreatic ductal dilation, with portions of the pancreatic tail
obscured by overlying bowel gas.
SPLEEN: Normal echogenicity, measuring 7.4 cm.
RETROPERITONEUM: Visualized portions of aorta and IVC are within normal
limits.
A small right pleural effusion is noted.
IMPRESSION:
1. Echogenic liver consistent with steatosis. Other forms of liver disease
including steatohepatitis, hepatic fibrosis, or cirrhosis cannot be excluded
on the basis of this examination.
2. Trace ascites and small right pleural effusion.
|
10039708-RR-22 | 10,039,708 | 28,258,130 | RR | 22 | 2140-01-30 04:58:00 | 2140-01-30 09:06:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with pulmonary edema // please eval for
interval change please eval for interval change
IMPRESSION:
Comparison to ___. Minimally improvement of the massive
centralized pulmonary edema. Normal size of the cardiac silhouette. No
pleural effusions. No pneumothorax. The position of the right PICC line is
stable.
|
10039708-RR-23 | 10,039,708 | 28,258,130 | RR | 23 | 2140-01-30 15:52:00 | 2140-01-30 17:32:00 | INDICATION: ___ year old woman with renal failure needing dialysis // Please
place temporary HD line. INR elevated, can give FFP the patient has a
history of a bariatric surgery in ___.
COMPARISON: Chest radiograph ___.
TECHNIQUE: OPERATORS: Dr. ___ and Dr.
___ radiologist performed the procedure. Dr. ___
___ supervised the trainee during the key components of the procedure
and has reviewed and agrees with the trainee's findings.
ANESTHESIA: 1% lidocaine was injected in the skin and subcutaneous tissues
overlying the access site.
MEDICATIONS: 1% lidocaine, lidocaine jelly
CONTRAST: 10 ml of Optiray contrast via the nasoenteric tube.
FLUOROSCOPY TIME AND DOSE: 4:14 min, 250 mGy
PROCEDURE:
1. Placement of a right internal jugular temporary dialysis catheter.
2. Placement of ___ nasoenteric feeding tube.
PROCEDURE DETAILS: Following the explanation of the risks, benefits and
alternatives to the procedure, written informed consent was obtained from the
healthcare proxy. The patient was then brought to the angiography suite and
placed supine on the exam table. A pre-procedure time-out was performed per
___ protocol. The neck was prepped and draped in the usual sterile fashion.
Under continuous ultrasound guidance, the patent right internal jugular vein
was compressible and accessed using a micropuncture needle. Permanent
ultrasound images were obtained before and after intravenous access, which
confirmed vein patency. Subsequently a Nitinol wire was passed into the right
atrium using fluoroscopic guidance. The needle was exchanged for a
micropuncture sheath.
The Nitinol wire was removed and a short ___ wire was advanced into the IVC.
After sequential dilation of the soft tissue tract using 12 ___ and 14
___ dilators, a triple lumen 13 ___ dialysis catheter was advanced over
the wire into the superior vena cava with the tip in the distal SVC. All
access ports were aspirated, flushed and capped. The catheter was secured to
the skin with a 0 silk suture and sterile dressings were applied. Final spot
fluoroscopic image demonstrating good alignment of the catheter and no
kinking.
The patient tolerated the procedure well without immediate complications.
The nasoenteric tube was gently inserted into the right nostril after
lubricating the tip and placing a wire inside the tube. With the patient
swallowing, the tube was then gently advanced into the stomach. The tube was
then gently advanced further into the proximal small bowel without resistance,
under fluoroscopic guidance. The wire was removed, and a contrast injection
was performed to confirm positioning. The catheter was then flushed and
capped. The catheter was secured to the skin. The patient tolerated
procedure without immediate complication.
FINDINGS:
1. Patent right internal jugular vein. Final fluoroscopic image showing triple
lumen temporary hemodialysis catheter with catheter tip terminating in the
distal superior vena cava.
2. Successful placement of ___ nasoenteric feeding tube with
tip in the small bowel. Post bariatric surgery anatomy is noted.
IMPRESSION:
1. Successful placement of a right internal jugular approach triple lumen
temporary hemodialysis catheter. The line is read to use.
2. Successful placement of ___ nasoenteric feeding tube with
tip in the small bowel. The tube is ready to use.
|
10039708-RR-24 | 10,039,708 | 28,258,130 | RR | 24 | 2140-01-31 05:05:00 | 2140-01-31 11:47:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with pulmonary edema, altered mental status //
interval change interval change
COMPARISON: Prior chest radiographs ___ through ___.
IMPRESSION:
Severe bilateral perihilar pulmonary edema has not improved. Pleural
effusions are presumed, but not large. Heart size normal. Feeding tube
passes into the stomach and out of view. Right jugular and right PICC lines
both end in the upper right atrium and would need to be withdrawn 2.0 cm for
repositioning in the low SVC, if desired.
|
10039708-RR-25 | 10,039,708 | 28,258,130 | RR | 25 | 2140-01-31 15:07:00 | 2140-01-31 16:23:00 | EXAMINATION: UNILAT LOWER EXT VEINS RIGHT
INDICATION: ___ year old woman with colagulopathy, swollen extremity // any
DVT?
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the right lower extremity veins.
COMPARISON: Right lower extremity Doppler ultrasound from ___
FINDINGS:
There has been no significant change from prior. There is lack of
compressibility and flow within the deep veins of the right lower extremity
extending from the common femoral vein, superficial femoral vein, popliteal
vein, posterior tibial and peroneal veins.
No evidence of medial popliteal fossa (___) cyst.
IMPRESSION:
No significant interval change in extensive deep venous thrombosis throughout
the right lower extremity.
|
10039708-RR-26 | 10,039,708 | 28,258,130 | RR | 26 | 2140-01-31 18:56:00 | 2140-01-31 20:49:00 | INDICATION: ___ year old woman with EtOH abuse, liver disease, hypothyroidism,
and hypertension who presents with hypotension and severe anemia with known R
femoral clot. Unable to receive systemic anticoagulation due to
thrombocytopenia and high risk bleed. // IVC placement
COMPARISON: CT abdomen and pelvis from ___
TECHNIQUE: OPERATORS: Dr. ___ and Dr.
___ radiologist performed the procedure. Dr. ___
___ supervised the trainee during the key components of the procedure
and has reviewed and agrees with the trainee's findings.
No moderate sedation was provided. Throughout the total intra-service time of
30 min the patient's hemodynamic parameters were continuously monitored by an
independent trained radiology nurse. 1% lidocaine was injected in the skin and
subcutaneous tissues overlying the access site.
CONTRAST: 20 ml of Optiray contrast.
FLUOROSCOPY TIME AND DOSE: 2.25 min, ___ cGycm2
PROCEDURE:
1. IVC venogram.
2. Infrarenal retrievable IVC filter deployment.
3. Post-filter placement venogram.
PROCEDURE DETAILS: Following the discussion of the risks, benefits and
alternatives to the procedure, written informed consent was obtained from the
healthcare proxy. The patient was then brought to the angiography suite and
placed supine on the exam table. A pre-procedure time-out was performed per
___ protocol. the right neck was prepped and draped in the usual sterile
fashion.
Under ultrasound and fluoroscopic guidance, the patent and compressible Right
internal jugular vein was punctured using a 21G micropuncture needle.
Ultrasound images of the access was stored on PACS. An Amplatz wire was
advanced through the micropuncture sheath into the inferior vena cava. The
IVC filter kit sheath was exchanged for the micropuncture sheath and the tip
positioned in the distal IVC. An inferior vena cava venogram was performed.
Based on the results of the venogram, detailed below, a decision was made to
place a retrievable Denali filter. The sheath introducer was removed and the
sheath of the filter was advanced into the distal IVC. The filter IVC was
advanced until the cranial tip was at the level of the inferior margin of the
lower main renal vein. The sheath was then withdrawn until the filter was
deployed. The loading device was then removed through the sheath and a repeat
contrast injection was performed, confirming appropriate filter positioning.
The final image was stored on PACS.
The sheath was removed and pressure was held for 10 minutes,at which point
hemostasis was achieved. A sterile dressing was applied.
The patient tolerated the procedure well and there were no immediate post
procedure complications.
FINDINGS:
1. Patent normal sized, non-duplicated IVC with no evidence of a IVC
thrombus. A small circumaortic renal vein originating from the IVC just above
the bifurcation was noted however is very small in caliber and likely of no
clinical significance.
2. Successful deployment of an infra-renal retrievable IVC filter.
IMPRESSION:
Successful deployment of an infra-renal removable IVC filter.
RECOMMENDATION(S): The patient will be added to our department IVC filter
database for removal if indicated when/if the patient can tolerate
anticoagulation.
|
10039708-RR-27 | 10,039,708 | 28,258,130 | RR | 27 | 2140-02-01 11:16:00 | 2140-02-01 14:26:00 | INDICATION: ___ year old woman with pulmonary edema // interval change in CXR
COMPARISON: Radiographs from ___
IMPRESSION:
Feeding tube and right sided central venous line are unchanged position.
There has been improved aeration of the diffuse airspace opacities and
pulmonary edema since the prior study. Heart size is within normal limits.
There are no pneumothoraces.
|
10039708-RR-29 | 10,039,708 | 28,258,130 | RR | 29 | 2140-02-01 14:00:00 | 2140-02-01 17:34:00 | INDICATION: ___ year old woman with new hypoxia // Please eval for interval
change
IMPRESSION:
There is an endotracheal tube whose distal tip to 4 cm above the carinal. The
Dobbhoff tube and the right-sided central venous lines are unchanged in
position. There are again seen diffuse airspace opacities which are stable.
Heart size is within normal limits. There are small bilateral pleural
effusions.
|
10039708-RR-31 | 10,039,708 | 28,258,130 | RR | 31 | 2140-02-01 18:35:00 | 2140-02-01 19:53:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with respiratory distress today, pneumothorax
seen on CXR // any interval change in pneumothorax? any interval change
in pneumothorax?
IMPRESSION:
In comparison with the earlier study of this date, there is no evidence of
pneumothorax. Diffuse bilateral pulmonary opacifications are again seen,
consistent with severe pulmonary edema more prominent on the right.
Coalescent opacification at the right base could reflect superimposed
pneumonia in the appropriate clinical setting.
|
10039708-RR-32 | 10,039,708 | 28,258,130 | RR | 32 | 2140-02-02 05:05:00 | 2140-02-02 08:45:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with recent intubation for respiratory
distress. // interval change? interval change?
IMPRESSION:
In comparison with the study of ___, the monitoring and support
devices are essentially unchanged. Diffuse bilateral pulmonary opacifications
are again seen, with a pattern that is most consistent with substantial
pulmonary edema. However, in the appropriate clinical setting, it would be
difficult to exclude superimposed pneumonia, especially in the absence of a
lateral view.
|
10039708-RR-33 | 10,039,708 | 28,258,130 | RR | 33 | 2140-02-03 03:31:00 | 2140-02-03 08:44:00 | EXAMINATION: Portable chest radiograph
INDICATION: ___ year old woman with acute hypoxemia prompting intubation, c/f
aspiration vs flash pulmonary edema vs mucus plug // eval for interval change
TECHNIQUE: Portable, AP radiograph view of the chest.
COMPARISON: Chest radiograph dated ___.
FINDINGS:
ETT in standard position with the neck in extension. Right IJ catheter tip
projects over the expected region of the mid-low SVC. Right PICC line
projects over the region on expected SVC-RA junction. Enteric tube and
sideport traverses the diaphragm into the left upper quadrant beyond the scope
of this image. Bilateral perihilar opacities persist with mild
peribronchiolar cuffing. No edema. No pleural effusions. Heart size is
normal. No pneumothorax.
IMPRESSION:
Persistent bilateral airspace opacities.
|
10039708-RR-34 | 10,039,708 | 28,258,130 | RR | 34 | 2140-02-02 19:28:00 | 2140-02-02 20:33:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman s/p extubation, acute hypoxemia, reintubated
// eval ETT placement ?sudden worsening hypoxia
COMPARISON: ___ obtained at 05:15
IMPRESSION:
-ET tube terminates 2.9 cm above the carina in grossly appropriate location.
-Enteric tube courses inferiorly with distal tip projecting over the
approximate location of the gastric body, with side port seen approximately
5.3 cm distal to the GE junction.
-Unchanged appearance of bilateral diffuse airspace opacities, except for
potential progression of left lower lobe atelectasis giving the left
mediastinal shift slightly more pronounced than on the prior study.
-Right-sided central venous line and PICC line are in unchanged position.
|
10039708-RR-35 | 10,039,708 | 28,258,130 | RR | 35 | 2140-02-03 13:36:00 | 2140-02-03 15:34:00 | EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ year old woman with increased bilirubin, ?cirrhosis vs
steatosis // any evidence of acalculous cholecystitis?
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: ___
FINDINGS:
LIVER: The liver is diffusely echogenic. The contour of the liver is smooth.
There is no focal liver mass. The main portal vein is patent with hepatopetal
flow. There is small ascites. Moderate right pleural effusion is seen.
BILE DUCTS: There is no intrahepatic biliary dilation. The CBD measures 3 mm.
GALLBLADDER: No gallstones. The gallbladder is contracted with moderate wall
edema, consistent with third spacing.
PANCREAS: Imaged portion of the pancreas appears within normal limits, without
masses or pancreatic ductal dilation, with portions of the pancreatic tail
obscured by overlying bowel gas.
SPLEEN: Normal echogenicity, measuring 7.7 cm.
KIDNEYS: Survey views of the kidneys show no hydronephrosis.
RETROPERITONEUM: Visualized portions of aorta and IVC are within normal
limits.
IMPRESSION:
Echogenic liver with no focal lesions identified. Small ascites and moderate
right pleural effusion. Contracted gallbladder with wall edema consistent
with third spacing, but not suggestive of acalculous cholecystitis. No
gallstones.
|
10039708-RR-36 | 10,039,708 | 28,258,130 | RR | 36 | 2140-02-04 04:54:00 | 2140-02-04 09:37:00 | EXAMINATION: Portable chest radiograph
INDICATION: ___ year old woman with respiratory failure // Interval change
TECHNIQUE: Portable, semi upright AP radiograph view of the chest.
COMPARISON: Chest radiograph dated ___ at 15:47.
FINDINGS:
The Dobhoff tube has been advanced in the interim into the left upper quadrant
its tip is now no longer seen. Another enteric tube traverses the diaphragm
into the left upper quadrant, tip also not seen. Right IJ catheter tip
projects over in the expected region of the low SVC. Right PICC tip projects
over the expected region of the SVC-RA junction.
Extensive, bilateral diffuse airspace opacities persist. In the right lower
lobe, there is slight interval decrease compared to ___. Otherwise,
no significant interval change. No pleural effusion or pneumothorax. Heart
size is normal.
IMPRESSION:
Persistent, extensive bilateral diffuse airspace opacities with interval
decrease in right lower lobe opacities.
|
10039708-RR-37 | 10,039,708 | 28,258,130 | RR | 37 | 2140-02-03 15:23:00 | 2140-02-03 16:09:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with new dobhoff tube placement // please eval
for placement please eval for placement
IMPRESSION:
The second image obtained at 15:51 shows the course of the top of catheter
unremarkable. The tip is not included on the image. The other monitoring and
support devices are unchanged. Unchanged appearance of the bilateral
parenchymal opacities. Unchanged cardiac silhouette. No pneumothorax.
|
10039708-RR-38 | 10,039,708 | 28,258,130 | RR | 38 | 2140-02-05 04:57:00 | 2140-02-05 08:48:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with possible aspiration event, malnutrition,
coagulopathy, ___, volume overload. // interval change interval change
COMPARISON: ___
IMPRESSION:
ET tube tip is 4 cm above the carinal. After passes below the diaphragm
terminating in the stomach. Right PICC line is at the level of right atrium.
Right internal jugular line tip is at the level of cavoatrial junction. Heart
size and mediastinum are stable. Interval improvement in perihilar opacities
is seen but there is still present left basal atelectasis.
|
10039708-RR-39 | 10,039,708 | 28,258,130 | RR | 39 | 2140-02-04 13:28:00 | 2140-02-04 14:42:00 | INDICATION: ___ year old woman adm alcoholism, anemia, hypotension, acidemia,
c/b cardiomyopathy, respiratory failure refractory hypotension, noted to
have displaced L patella // please obtain sunrise view in addition to
AP/Lat/Oblique if possible (pt cannot travel). please eval for patellar
dislocation or fx
IMPRESSION:
There is a prominent spur off the superior aspect of the patella which appears
to have a lucency at its base. It is unclear if this is an acute fracture or
is chronic. There is surrounding soft tissue swelling. No fractures are seen
in the main body of the patella. Per report, patient could not tolerate a
sunrise view.There are osteophytes in the medial and lateral compartments;
however, the joint spaces are preserved on these nonweightbearing views. No
knee joint effusion is identified. Mineralization is grossly preserved.
|
10039708-RR-40 | 10,039,708 | 28,258,130 | RR | 40 | 2140-02-05 04:58:00 | 2140-02-05 10:27:00 | EXAMINATION: KNEE( (SINGLE VIEW) LEFT
INDICATION: ___ year old woman with patellar instability. Please perform
sunrise view. // ? Patellar pathology ? Patellar pathology
TECHNIQUE: Patella sunrise view.
COMPARISON: ___ at 13:48
FINDINGS:
There is severe joint space narrowing in the patellofemoral compartment large
marginal osteophytes and subchondral sclerosis. There is lateral subluxation
of the patella. No suspicious osseous lesions.
IMPRESSION:
Severe degenerative changes of the patellofemoral compartment with lateral
subluxation of the patella.
|
10039708-RR-41 | 10,039,708 | 28,258,130 | RR | 41 | 2140-02-04 17:12:00 | 2140-02-04 23:21:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman now extubated with hypoxia // Please evaluate
for interval change Please evaluate for interval change
COMPARISON: ___
IMPRESSION:
Right PICC line tip is at the level of lower SVC. Most likely hammer dialysis
catheter inserted on the right terminates at the same level. The above tube
passes below the diaphragm with its tip at least in the distal stomach. There
is no change in multifocal especially perihilar opacities but there is
interval development of left lower lobe (increase) atelectasis. Left pleural
effusion is noted.
|
10039708-RR-42 | 10,039,708 | 28,258,130 | RR | 42 | 2140-02-04 18:59:00 | 2140-02-04 22:17:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with hypoxia, now intubated // please check
for ETT placement please check for ETT placement
IMPRESSION:
Comparison to ___. The patient has been intubated. The
endotracheal tube projects 4 cm above the carina. The other monitoring and
support devices are in stable position. The size of the cardiac silhouette as
well as the perihilar opacities, left more than right, are unchanged.
|
10039708-RR-43 | 10,039,708 | 28,258,130 | RR | 43 | 2140-02-06 05:04:00 | 2140-02-06 09:56:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with resp failure, possible aspiration //
Interval change Interval change
IMPRESSION:
Comparison to ___. No relevant change. The pre-existing
perihilar opacities and the left retrocardiac atelectasis are constant. No
pleural effusions. No pneumothorax. Normal size of the heart.
|
10039708-RR-44 | 10,039,708 | 28,258,130 | RR | 44 | 2140-02-07 05:04:00 | 2140-02-07 07:52:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with respiratory failure, currently intubated,
evidence of pulmonary edema // Interval change Interval change
IMPRESSION:
Comparison to ___. The patient has been extubated. The other
monitoring and support devices, including the feeding tube, are in unchanged
position. The bilateral perihilar parenchymal opacities, as well as the
normal sized cardiac silhouette are unchanged.
|
10039708-RR-45 | 10,039,708 | 28,258,130 | RR | 45 | 2140-02-08 13:41:00 | 2140-02-08 15:20:00 | EXAMINATION: UNILAT LOWER EXT VEINS
INDICATION: ___ year old woman with a femoral line-associated DVT // Is her
line-associated DVT still present?
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the right lower extremity veins.
COMPARISON: Right lower extremity ultrasound dated ___.
FINDINGS:
Thrombus within the lumen of the right superficial femoral vein distally is
again demonstrated but appears now to have some color flow, but still is not
compressible, suggesting possible partial thrombus; yet no obvious collaterals
are visualized. Otherwise, no significant interval change from the prior
exam. No compressibility or flow within the deep veins of the right lower
extremity extending from the common femoral vein, superficial femoral vein,
popliteal vein, posterior tibial vein, and peroneal veins. There is
color-flow in the greater saphenous vein.
There is normal respiratory variation in the left common femoral vein.
IMPRESSION:
Persistent, extensive deep venous thrombosis involving the wall of the right
lower extremity veins, overall similar to ___, but now with perhaps
minimal flow in the distal right SFV.
|
10039708-RR-46 | 10,039,708 | 28,258,130 | RR | 46 | 2140-02-11 09:36:00 | 2140-02-11 11:22:00 | INDICATION: ___ year old woman with dysphagia. Please evaluate for
aspiration/swallow.
TECHNIQUE: Oropharyngeal swallowing videofluoroscopy was performed in
conjunction with the speech and swallow division. Multiple consistencies of
barium were administered.
COMPARISON: None.
FINDINGS:
Barium passes freely through the oropharynx and esophagus without evidence of
obstruction. Aspiration was noted with thin liquid consistency.
IMPRESSION:
Aspiration with thin liquid consistency.
Please refer to the speech and swallow division note in OMR for full details,
assessment, and recommendations.
|
10039708-RR-47 | 10,039,708 | 28,258,130 | RR | 47 | 2140-02-12 11:44:00 | 2140-02-12 17:41:00 | INDICATION: ___ year old woman with dobhoff that was re-placed // dobhoff
positioning?
TECHNIQUE: Supine abdominal radiograph was obtained.
COMPARISON: None.
FINDINGS:
Patient is post gastric bypass surgery. Sutures are noted in the left upper
quadrant. The Dobhoff tube ends in the proximal jejunum.
There are no abnormally dilated loops of large or small bowel.
Supine assessment limits detection for free air; there is no gross
pneumoperitoneum.
Osseous structures are unremarkable. An IVC filter is noted. An IUD is seen
in the pelvis.
There are no unexplained soft tissue calcifications or radiopaque foreign
bodies.
IMPRESSION:
Patient is post gastric bypass surgery. The Dobbhoff tube ends in the
proximal jejunum.
|
10039708-RR-48 | 10,039,708 | 28,258,130 | RR | 48 | 2140-02-13 16:20:00 | 2140-02-13 16:39:00 | EXAMINATION: RENAL U.S.
INDICATION: ___ year old woman with renal failure, many WBCs on smear //
please evaluate for masses, fluid collections, hydronephrosis
TECHNIQUE: Grey scale ultrasound images of the kidneys were obtained.
COMPARISON: None.
FINDINGS:
The right kidney measures 9.4 cm. The left kidney measures 9.0 cm. There is no
hydronephrosis, stones, or masses bilaterally. There is diffusely increased
echogenicity throughout both kidneys.
Small bilateral pleural effusions are noted as well as a small to moderate
amount of ascites. .
The bladder is emptied by a Foley catheter.
IMPRESSION:
No evidence of hydronephrosis. Increased renal echogenicity consistent with
diffuse parenchymal renal disease.
Small bilateral effusions and small to moderate volume ascites.
|
10039708-RR-49 | 10,039,708 | 28,258,130 | RR | 49 | 2140-02-13 17:26:00 | 2140-02-14 00:38:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with new dobhoff // confirm dobhoff placement
confirm dobhoff placement
COMPARISON: Comparison to ___ at 05:15
FINDINGS:
Portable AP chest radiograph ___ at 17 52 is submitted.
IMPRESSION:
Interval placement of Dobbhoff feeding tube which has its tip projecting over
the expected location of the stomach. The right internal jugular central
catheter and right subclavian PICC line are unchanged in position. Overall
cardiac and mediastinal contours are stable. Minimal blunting of both
costophrenic angles likely reflects small effusions. Lungs are grossly clear.
No pulmonary edema or pneumothorax is appreciated, although the sensitivity to
detect pneumothorax is diminished given supine technique.
|
10039708-RR-51 | 10,039,708 | 28,258,130 | RR | 51 | 2140-02-20 13:56:00 | 2140-02-20 15:16:00 | INDICATION: ___ year old woman with temporary HD line // please tunnel HD
line
COMPARISON: ___
TECHNIQUE: OPERATORS: Dr. ___ and Dr.
___ radiologist performed the procedure. Dr. ___
supervised the trainee during the key components of the procedure and has
reviewed and agrees with the trainee's findings.
ANESTHESIA: Sedation was provided by administrating divided doses of 25 mcg of
fentanyl and 0 mg of midazolam throughout the total intra-service time of 6
minutes during which the patient's hemodynamic parameters were continuously
monitored by an independent trained radiology nurse. 1% lidocaine was injected
in the skin and subcutaneous tissues overlying the access site.
MEDICATIONS: 25 mcg fentanyl, 1% lidocaine.
CONTRAST: 0 ml of Optiray contrast.
FLUOROSCOPY TIME AND DOSE: 1 min, 2 mGy
PROCEDURE: PROCEDURE DETAILS: Following the explanation of the risks,
benefits and alternatives to the procedure, written informed consent was
obtained from the patient's healthcare proxy. The patient was then brought to
the angiography suite and placed supine on the exam table. A pre-procedure
time-out was performed per ___ protocol. The right upper chest was prepped
and draped in the usual sterile fashion.
The existing temporary hemodialysis catheter via right internal jugular vein
was accessed with a short ___ wire. After making a measurements, the ___
wire was advanced distally into the IVC.
Next, attention was turned towards creation of a tunnel over the upper
anterior chest wall. After instilling superficial and deeper local anesthesia
using lidocaine mixed with epinephrine, a small skin incision was made at the
tunnel entry site. A 19cm tip-to-cuff length catheter was selected. The
catheter was tunneled from the entry site towards the venotomy site from where
it was brought out using a tunneling device. The venotomy tract was dilated
using the introducer of the peel-away sheath supplied. Following this, the
peel-away sheath was placed over the ___ wire through which the catheter was
threaded into the right side of the heart with the tip in the right atrium.
The sheath was then peeled away. The catheter was sutured in place with 0 silk
sutures. ___ subcuticular Vicryl sutures and Steri-strips were also used to
close the venotomy incision site. Final spot fluoroscopic image demonstrating
good alignment of the catheter and no kinking. The tip is in the right atrium.
The catheter was flushed and both lumens were capped. Sterile dressings were
applied. The patient tolerated the procedure well.
FINDINGS:
Patent right internal jugular vein. Final fluoroscopic image showing
hemodialysis catheter with tip terminating in the right atrium.
IMPRESSION:
Successful exchange of a temporary hemodialysis catheter for a new 19 cm
tip-to-cuff length tunneled dialysis line. The tip of the catheter terminates
in the right atrium. The catheter is ready for use.
|
10039708-RR-52 | 10,039,708 | 28,258,130 | RR | 52 | 2140-02-26 11:49:00 | 2140-02-26 17:03:00 | INDICATION: ___ year old woman with capsule endoscopy likely retained in
esophagus. Evaluate for capsule.
TECHNIQUE: Portable AP upright chest radiograph.
COMPARISON: Chest radiographs from ___ through ___.
FINDINGS:
A radiopaque material measuring 1.6 cm, likely a capsule endoscopy given
history, is seen between the IVC filter and the armoured tip of
transesophageal tube, which is in the mid to low stomach. Left large bore
catheter terminates an right atrium, unchanged from prior. Right PICC
terminates in the mid to low SVC, unchanged from prior.
The lungs are well expanded and clear. No pleural abnormality is seen. The
heart is normal in size. The mediastinal and hilar contours are normal.
IMPRESSION:
Capsule endoscopy projecting over mid abdomen. Repeat abdominal radiographs
are recommended for documenting passage.
RECOMMENDATION(S): Repeat abdominal radiographs are recommended for
documenting passage.
NOTIFICATION: The findings were discussed by Dr. ___ with Dr.
___ on the ___ ___ at 2:22 ___, 5 minutes after discovery of
the findings.
|
10039708-RR-55 | 10,039,708 | 23,819,016 | RR | 55 | 2140-06-18 17:51:00 | 2140-06-18 18:24:00 | EXAMINATION: PELVIS, NON-OBSTETRIC
INDICATION: ___ woman with lower abdominal pain adnexal tenderness.
TECHNIQUE: Grayscale ultrasound images of the pelvis were obtained with
transabdominal approach.
COMPARISON: None.
FINDINGS:
The exam is very limited due to the lack of distention of the bladder,
overlying bowel gas and the transabdominal approach.
A Foley catheter is seen in the bladder. Non visualization of the uterus and
ovaries.
IMPRESSION:
The uterus and ovaries are not visualized. The patient declined the
transvaginal portion of the exam for further although evaluation.
|
10039708-RR-56 | 10,039,708 | 23,819,016 | RR | 56 | 2140-06-18 15:48:00 | 2140-06-18 16:12:00 | EXAMINATION: CHEST PORT. LINE PLACEMENT
INDICATION: ___ year old woman with R IJ CVL // CVL placement Contact name:
___: ___ CVL placement
IMPRESSION:
Right internal jugular line tip is most likely at the level of cavoatrial
junction, obscured by overlying L it throat. There is no pneumothorax. Heart
size and mediastinum are stable. Lungs are essentially clear, with
substantial improvement of the left retrocardiac atelectasis. . No increase
in pleural effusion is seen.
|
10039708-RR-57 | 10,039,708 | 23,819,016 | RR | 57 | 2140-06-19 14:09:00 | 2140-06-19 15:08:00 | INDICATION: ___ year old woman with abdominal/pelvic pain, and GNR bacteremia
// Evaluate for etiologies of abdominal pain, also evaluate ovaries
TECHNIQUE: Multidetector CT images of the abdomen and pelvis were acquired
without intravenous contrast. Non-contrast scan has several limitations in
detecting vascular and parenchymal organ abnormalities, including tumor
detection.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 4.2 s, 46.4 cm; CTDIvol = 7.4 mGy (Body) DLP = 344.0
mGy-cm.
Total DLP (Body) = 344 mGy-cm.
COMPARISON: ___.
FINDINGS:
LOWER CHEST: There is a 0.9 cm opacity in the right lower lobe on series 2,
___ 10. This new from prior study. There is no evidence of pleural or
pericardial effusion.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout.
There has been improvement in the density of the liver which currently
measures 44 ___, previous the -1.6 ___ There is no evidence of focal lesions
within the limitations of an unenhanced scan. Again noted are stable, small
calcifications of the liver capsule on series 2, ___ 29. Possibly
posttraumatic. There is no evidence of intrahepatic or extrahepatic biliary
dilatation. The gallbladder is within normal limits.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions within the limitations of an unenhanced scan. There is no
pancreatic ductal dilatation. There is no peripancreatic stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size. There is no evidence
of focal renal lesions within the limitations of an unenhanced scan. There is
no hydronephrosis. There is no nephrolithiasis. There is no perinephric
abnormality.
GASTROINTESTINAL: The patient is status post gastric bypass surgery. Small
bowel loops demonstrate normal caliber and wall thickness throughout. The
colon and rectum are within normal limits. The appendix is normal.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: The reproductive organs are unremarkable. An IUD is
identified. No adnexal masses is seen.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease
is noted. An IVC filter is identified.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. No etiology for the patient's pain identified. No evidence for infection
in the abdomen and pelvis. No ovarian masses.
2. 0.9 cm opacity in the right lower lobe is new from ___ and may
represent an infectious focus. Further evaluation with full chest CT is
recommended
3. Significant improvement in hepatic steatosis.
RECOMMENDATION(S): Chest CT for evaluation of new right lower lobe opacities
NOTIFICATION: The findings were discussed with ___, M.D. by
___, M.D. on the telephone on ___ at 3:07 ___, 5 minutes after
discovery of the findings.
|
10039708-RR-58 | 10,039,708 | 23,819,016 | RR | 58 | 2140-06-19 16:27:00 | 2140-06-19 16:54:00 | EXAMINATION: CT CHEST W/O CONTRAST
INDICATION: ___ year old woman with GNR bacteremia. CT A/P showing RLL opacity
concerning for infection. // pls eval chest for source of infection.
TECHNIQUE: Multidetector helical scanning of the chest was performed without
IV contrast reconstructed as axial, coronal , parasagittal, and ,MIPs axial
images.
DOSE: DLP:
Acquisition sequence:
1) Spiral Acquisition 3.8 s, 30.0 cm; CTDIvol = 5.4 mGy (Body) DLP = 162.7
mGy-cm.
Total DLP (Body) = 163 mGy-cm.
COMPARISON: Abdomen CT performed 2 hours earlier
FINDINGS:
The thyroid is normal. Supraclavicular, axillary, mediastinal and hilar lymph
nodes are not enlarged. Aorta and pulmonary arteries are normal size. Cardiac
configuration is normal and there is no appreciable coronary calcification.
There is a 2 mm subpleural nodule in the right middle lobe (4:106) could
represent an intrapulmonary lymph node. Opacity seen in the recent abdomen CT
has almost completely resolved consistent with atelectasis. There are no
worrisome lung nodules. There is no pleural or pericardial effusion.
Please refer to the concurrent abdomen CT for complete description of the
intra-abdominal findings.
There are no bone findings of malignancy
Central catheter tip is in the cavoatrial junction
IMPRESSION:
Normal Chest CT. No evidence of active intrathoracic infection or malignancy.
Right lower lobe opacity described on recent CT has almost completely resolved
consistent with resolving atelectasis
|
10039708-RR-6 | 10,039,708 | 20,572,787 | RR | 6 | 2138-10-30 20:12:00 | 2138-10-30 20:35:00 | EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ year old woman with hx EtOH p/w encephalopathic signs.
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: None.
FINDINGS:
LIVER: The hepatic parenchyma appears within normal limits. The contour of the
liver is smooth. There is no focal liver mass. Main portal vein is patent with
hepatopetal flow. There is no ascites.
BILE DUCTS: There is no intrahepatic biliary dilation. The CBD measures 3 mm.
GALLBLADDER: Cholelithiasis without gallbladder wall thickening.
PANCREAS: Imaged portion of the pancreas appears within normal limits, without
masses or pancreatic ductal dilation, with portions of the pancreatic tail
obscured by overlying bowel gas.
Limited views the right kidney are unremarkable.
RETROPERITONEUM: Visualized portions of aorta and IVC are within normal
limits.
IMPRESSION:
Normal exam. In particular, liver appears normal.
|
10039708-RR-61 | 10,039,708 | 25,864,431 | RR | 61 | 2142-03-26 03:33:00 | 2142-03-26 04:00:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: History: ___ with severe abdominal pain. Please obtain upright
portable chest// ?air under diaphragm
TECHNIQUE: Single frontal view of the chest
COMPARISON: Chest radiograph ___.
FINDINGS:
Bilateral low lung volumes. There is moderate bibasilar atelectasis. Unable
to assess cardiac size given low lung volumes. No pneumothorax or large
pleural effusion. No evidence of intraperitoneal free air.
IMPRESSION:
Bilateral low lung volumes with moderate bibasilar atelectasis. No evidence
of intraperitoneal free air.
|
10039708-RR-62 | 10,039,708 | 25,864,431 | RR | 62 | 2142-03-26 04:46:00 | 2142-03-26 05:15:00 | EXAMINATION: CT abdomen pelvis.
INDICATION: +PO contrast; History: ___ with liver and kidney dx+PO contrast//
eval intraabdominal pathology.
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 administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 6.6 s, 51.6 cm; CTDIvol = 24.6 mGy (Body) DLP =
1,270.0 mGy-cm.
Total DLP (Body) = 1,270 mGy-cm.
COMPARISON: CT abdomen pelvis ___.
FINDINGS:
LOWER CHEST: There is bibasilar atelectasis. There is no evidence of pleural
or pericardial effusion.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates markedly low attenuation throughout
consistent with severe steatosis. There is large volume ascites measuring
simple in fluid attenuation. There is no evidence of focal lesions within the
limitations of an unenhanced scan. There is no evidence of intrahepatic or
extrahepatic biliary dilatation. The gallbladder is within normal limits.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions within the limitations of an unenhanced scan. There is no
pancreatic ductal dilatation. There is no peripancreatic stranding.
Calcifications within the pancreas likely from chronic pancreatitis.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size. Bilateral hypodense
lesions are too small to characterize but likely represent cysts. 1.1 cm
hyperdense lesion in the left upper pole likely represents a hyperdense cyst
(601; 49). There is no hydronephrosis. There are bilateral nonobstructing
stones measuring up to 3 mm (2; 33). There is no perinephric abnormality.
GASTROINTESTINAL: Patient is status post gastric bypass. The excluded stomach
appears edematous and thickened, new since prior (2; 24). Small bowel loops
demonstrate normal caliber and wall thickness throughout. The colon and
rectum are within normal limits. The appendix is not visualized.
PELVIS: The urinary bladder and distal ureters are unremarkable.
REPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal
limits.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: IVC filter is noted. There is no abdominal aortic aneurysm. Mild
atherosclerotic disease is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: There is diffuse anasarca.
IMPRESSION:
1. Severe hepatic steatosis with large volume ascites. No splenomegaly.
2. Post gastric bypass. The excluded stomach appears severely edematous with
thickened walls, but without dilation. This could be related to third-spacing
from liver disease (portal gastropathy).
3. Diffuse anasarca.
|
10039708-RR-63 | 10,039,708 | 25,864,431 | RR | 63 | 2142-03-26 05:49:00 | 2142-03-26 06:47:00 | EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: evaluate liver with doppler
TECHNIQUE: Gray scale, color, and spectral Doppler evaluation of the abdomen
was performed.
COMPARISON: CT abdomen pelvis performed earlier on the same day.
FINDINGS:
Liver: The hepatic parenchyma is diffusely echogenic. No focal liver
lesions are identified. There is large ascites.
Bile ducts: There is no intrahepatic biliary ductal dilation. The common
hepatic duct measures 5 mm.
Gallbladder: No cholelithiasis. Minimal gallbladder wall edema likely due to
liver disease and third spacing.
Pancreas: The pancreas is obscured by overlying bowel gas.
Spleen: Not fully visualized.
Kidneys: The right kidney measures 9.3 cm. Limited visualization of the
right kidney demonstrates no hydronephrosis.
Doppler evaluation:
The main portal vein is patent, with flow in the appropriate direction.
Main portal vein velocity is 16 cm/sec.
Right and left portal veins are patent, with antegrade flow.
The main hepatic artery is patent, with appropriate waveform.
Right and middle hepatic veins are patent, with appropriate waveforms. The
left hepatic vein is not visualized.
IMPRESSION:
1. Patent portal vasculature. Patent right and middle hepatic veins as well
as the main hepatic artery. The left hepatic vein was not visualized.
2. Echogenic liver consistent with steatosis. Other forms of liver disease
and more advanced liver disease including steatohepatitis or significant
hepatic fibrosis/cirrhosis cannot be excluded on this study.
3. Large volume ascites.
|
10039708-RR-64 | 10,039,708 | 25,864,431 | RR | 64 | 2142-03-28 14:56:00 | 2142-03-28 17:07:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with EtOH cirrhosis, large volume ascites,
decreased room air saturation. Evaluate for pneumonia or atelectasis.
TECHNIQUE: Frontal views of the chest.
COMPARISON: Chest x-ray ___.
FINDINGS:
The lung volumes remain low, accentuating the pulmonary vasculature. With
this in consideration, possible pulmonary vascular congestion is present.
Opacification of the lung bases, particularly the right, most likely reflects
moderate bibasilar atelectasis, similar to prior. No pleural effusion or
pneumothorax.
IMPRESSION:
Probable moderate bibasilar atelectasis, similar to prior, more prominent on
the right. In the appropriate clinical setting, however, aspiration/pneumonia
of the right lower lung should be considered.
|
10039708-RR-66 | 10,039,708 | 25,864,431 | RR | 66 | 2142-03-30 16:51:00 | 2142-03-30 18:19:00 | INDICATION: ___ year old woman with CKD and now suspected hepatorenal
syndrome, progressing to HD// place tunneled HD line
COMPARISON: Chest radiograph ___
TECHNIQUE: OPERATORS: Dr. ___ resident and Dr. ___
radiologist performed the procedure. Dr. ___ supervised the
trainee during the key components of the procedure and has reviewed and agrees
with the trainee's findings.
ANESTHESIA: Sedation was provided by administrating divided doses of 1 mg of
midazolam throughout the total intra-service time of 25 minutes during which
the patient's hemodynamic parameters were continuously monitored by an
independent trained radiology nurse. 1% lidocaine was injected in the skin and
subcutaneous tissues overlying the access site.
MEDICATIONS: Midazolam, lidocaine
CONTRAST: None.
FLUOROSCOPY TIME AND DOSE: 0.6 min, 1 mGy
PROCEDURE: PROCEDURE DETAILS: Following the explanation of the risks,
benefits and alternatives to the procedure, written informed consent was
obtained from the patient. The patient was then brought to the angiography
suite and placed supine on the exam table. A pre-procedure time-out was
performed per ___ protocol. The right upper chest was prepped and draped in
the usual sterile fashion.
Under continuous ultrasound guidance, the patent right internal jugular vein
was compressible and accessed using a micropuncture needle. Permanent
ultrasound images were obtained before and after intravenous access, which
confirmed vein patency. Subsequently a Nitinol wire was passed into the right
atrium using fluoroscopic guidance. The needle was exchanged for a
micropuncture sheath. The Nitinol wire was removed and a short ___ wire was
advanced to make appropriate measurements for catheter length. The ___ wire
was then passed distally into the IVC.
Next, attention was turned towards creation of a tunnel over the upper
anterior chest wall. After instilling superficial and deeper local anesthesia
using lidocaine mixed with epinephrine, a small skin incision was made at the
tunnel entry site. A 19cm tip-to-cuff length catheter was selected. The
catheter was tunneled from the entry site towards the venotomy site from where
it was brought out using a tunneling device. The venotomy tract was dilated
using the introducer of the peel-away sheath supplied. Following this, the
peel-away sheath was placed over the ___ wire through which the catheter was
threaded into the right side of the heart with the tip in the right atrium.
The sheath was then peeled away. The catheter was sutured in place with 0 silk
sutures. Steri-strips were also used to close the venotomy incision site.
Final spot fluoroscopic image demonstrating good alignment of the catheter and
no kinking. The tip is in the right atrium. The catheter was flushed and both
lumens were capped. Sterile dressings were applied. The patient tolerated the
procedure well.
FINDINGS:
Patent right internal jugular vein. Final fluoroscopic image showing 19 cm
tip to cuff tunneled hemodialysis catheter with tip terminating in the right
atrium.
IMPRESSION:
Successful placement of a 19 cm tip-to-cuff length tunneled dialysis line.
The tip of the catheter terminates in the right atrium. The catheter is ready
for use.
|
10039708-RR-67 | 10,039,708 | 25,864,431 | RR | 67 | 2142-04-03 18:39:00 | 2142-04-03 21:21:00 | EXAMINATION: UNILAT LOWER EXT VEINS RIGHT
INDICATION: ___ year old woman with h/o provoked RLE DVT, now off AC with
recurrent asymmetric swelling// eval for DVT
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the right lower extremity veins.
COMPARISON: None.
FINDINGS:
Please note that the exam is limited as the patient was not able to tolerate
the study due to pain. Within these limitations, there is normal
compressibility of the right common femoral, superficial femoral, and deep
femoral veins. Color flow and augmentation were not able to be assessed. The
right popliteal, posterior tibial, and peroneal veins were also not assessed.
There is normal respiratory variation in the common femoral veins bilaterally.
IMPRESSION:
Please note that the exam is limited as the patient was not able to tolerate
the study due to pain. Within these limitations, there is normal
compressibility of the right common femoral, superficial femoral, and deep
femoral veins.
RECOMMENDATION(S): Recommend repeat exam for complete assessment if there is
clinical concern for DVT.
|
10039708-RR-68 | 10,039,708 | 25,864,431 | RR | 68 | 2142-04-04 10:38:00 | 2142-04-04 10:48:00 | EXAMINATION: UNILAT LOWER EXT VEINS RIGHT
INDICATION: ___ year old woman with cirrhosis, renal failure, h/o RLE DVT,
unilateral RLE swelling and pain// eval for DVT
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the right lower extremity veins.
COMPARISON: Lower extremity ultrasound dated ___.
FINDINGS:
Evaluation of the popliteal veins and calf veins was performed on the right,
as recommended on the ultrasound dated ___.
There is normal compressibility, flow, and augmentation of the right popliteal
veins. Normal color flow is demonstrated in the right posterior tibial and
peroneal veins.
No evidence of medial popliteal fossa (___) cyst. Small amount of
subcutaneous edema within the popliteal fossa.
IMPRESSION:
No evidence of deep venous thrombosis in the right popliteal or right calf
veins. Small amount of subcutaneous edema within the popliteal fossa.
|
10039708-RR-69 | 10,039,708 | 25,864,431 | RR | 69 | 2142-04-05 12:37:00 | 2142-04-05 13:24:00 | EXAMINATION: DX CHEST PORT LINE/TUBE PLCMT 1 EXAM
INDICATION: ___ yoF with cirrhosis s/p ng tube placement// ___ yoF with
cirrhosis s/p ng tube placement. confirm placement
IMPRESSION:
In comparison with study of ___, there has been placement of a right
hemodialysis catheter that extends to about the cavoatrial junction. No
evidence of post procedure pneumothorax.
The nasogastric tube extends only to the esophagogastric junction. The tube
should be pushed forward at least 5-8 cm.
Improved lung volumes with no evidence of pneumonia or vascular congestion.
Streaks of atelectasis are seen at the left base.
|
10039708-RR-7 | 10,039,708 | 20,572,787 | RR | 7 | 2138-10-30 20:14:00 | 2138-10-30 21:05:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ with hx of EtOH presenting w/ 1 week dizzines s/p fall on
___. Concern for trauma and/or hepetic encephalopathy // r/o subdural and
r/o atrophy
TECHNIQUE: Routine unenhanced head CT was performed and viewed in brain,
intermediate and bone windows. Coronal and sagittal reformats were also
performed.
DOSE: DLP: 891.93 mGy-cm
COMPARISON: None.
FINDINGS:
There is no intra-axial or extra-axial hemorrhage, edema, shift of normally
midline structures, or evidence of acute major vascular territorial
infarction. Sulcal prominence especially within the cerebellum is age hands
consistent with atrophy. The ventricles are normal in overall size and
configuration. The basilar cisterns are widely patent. The imaged paranasal
sinuses are clear. Mastoid air cells and middle ear cavities are well aerated.
The bony calvarium is intact.
IMPRESSION:
No acute intracranial process. Age advanced atrophy.
|
10039708-RR-70 | 10,039,708 | 25,864,431 | RR | 70 | 2142-04-06 14:06:00 | 2142-04-06 18:29:00 | EXAMINATION: ___ enteric tube advancement
INDICATION: ___ yoF with PMHx cirrhosis now presenting with alc hep on chronic
cirrhosis and HRS.// ___ yoF with PMHx cirrhosis now presenting with alc hep on
chronic cirrhosis and HRS. Need placement of dophoff to optimize nutritional
status in setting of decompensated liver failure.
TECHNIQUE: Fluoroscopy guided nasoenteric tube advancement
DOSE: Acc air kerma: 36.0 mGy; Accum DAP: 156.8 uGym2; Fluoro time: 8 minutes
22 seconds
COMPARISON: None.
FINDINGS:
The right nare was anesthetized with lidocaine jelly. Under intermittent
fluoroscopic guidance, the existing enteric feeding tube was noted to be
coiled within the nasopharynx. After partial withdrawal, the tube was
advanced past the gastrojejunostomy using a guidewire.
15 cc of Optiray contrast were used to confirm placement. Final fluoroscopic
spot images demonstrated the tip of the feeding tube in within the jejunum,
with opacification of the alimentary limb. The tube appears to pass the
jejunojejunostomy.
The feeding tube was affixed to the patient's nose and cheek using tape.
IMPRESSION:
Successful post gastrojejunal advancement of a enteric feeding tube. The tube
is ready to use.
|
10039708-RR-71 | 10,039,708 | 25,864,431 | RR | 71 | 2142-04-08 15:22:00 | 2142-04-08 16:27:00 | EXAMINATION: Ultrasound-guided paracentesis
INDICATION: ___ yoF with worsening abdominal pain over the course of the day
and no clear tappable pocket on bedside US with leukocytosis.// ___ yoF with
worsening abdominal pain over the course of the day and no clear tappable
pocket on bedside US with leukocytosis. SBP?
TECHNIQUE: Ultrasound guided diagnostic paracentesis
COMPARISON: ___
FINDINGS:
Limited grayscale ultrasound imaging of the abdomen demonstrated a small
amount of ascites. A suitable target in the deepest pocket in the right lower
quadrant was selected for paracentesis.
PROCEDURE: The procedure, risks, benefits and alternatives were discussed
with the patient and written informed consent was obtained.
A preprocedure time-out was performed discussing the planned procedure,
confirming the patient's identity with 3 identifiers, and reviewing a
checklist per ___ protocol.
Under ultrasound guidance, an entrance site was selected and the skin was
prepped and draped in the usual sterile fashion. 1% lidocaine was instilled
for local anesthesia.
An 18 gauge spinal needle was advanced into the largest fluid pocket in the
right lower quadrant and 20 cc of clear, straw-colored fluid were removed.
The patient tolerated the procedure well without immediate complication.
Estimated blood loss was minimal.
Dr. ___ supervised the trainee during the key components of the
procedure and reviewed and agrees with the trainee's findings.
IMPRESSION:
1. Technically successful ultrasound guided diagnostic paracentesis.
2. 20 cc of clear straw-colored fluid was removed and sent for chemistry,
Hematology and microbiology.
|
10039708-RR-72 | 10,039,708 | 25,864,431 | RR | 72 | 2142-04-09 18:06:00 | 2142-04-09 18:32:00 | INDICATION: ___ yoF with PMHx of etoh cirrhosis and HRS on HD with
leukocytosis, and no focus of infection.// ___ yoF with PMHx of etoh cirrhosis
and HRS on HD with leukocytosis, and no focus of infection. Please eval for
?pna
TECHNIQUE: Chest PA and lateral
COMPARISON: ___
FINDINGS:
The tip of the feeding tube extends below the level the diaphragm but beyond
the field of view of this radiograph. A right central venous catheter tip
projects over the right atrium.
There are low bilateral lung volumes. Linear opacities at the left lung base
likely reflect atelectasis. Increased opacities at the right lung base may
reflect atelectasis or pneumonia. No pleural effusion or pneumothorax is
identified.
IMPRESSION:
Increased opacities at the right lung base may reflect a combination of
atelectasis and pneumonia.
|
10039708-RR-73 | 10,039,708 | 25,864,431 | RR | 73 | 2142-04-09 17:36:00 | 2142-04-09 18:31:00 | EXAMINATION: DUPLEX DOPP ABD/PEL
INDICATION: ___ yoF with EtOH cirrhosis c/b ESRD on HD, now with leukocytosis
and rising Tbili. Please eval for patency of portal vasculature
TECHNIQUE: Gray scale, color, and spectral Doppler evaluation of the abdomen
was performed.
COMPARISON: Abdominal ultrasound dated ___.
FINDINGS:
Liver: The hepatic parenchyma is coarsened and nodular.. No focal liver
lesions are identified. There is small volume ascites.
Bile ducts: There is no intrahepatic biliary ductal dilation. The common
hepatic duct measures 4 mm.
Gallbladder: Gallbladder is decompressed, however there is circumferential
gallbladder wall edema, likely due to third spacing/underlying liver disease.
Pancreas: The pancreas is obscured by overlying bowel gas.
Spleen: The spleen demonstrates normal echotexture, and measures 10.6 cm.
Doppler evaluation:
The main portal vein is patent, with flow in the appropriate direction.
Main portal vein velocity is 11 cm/sec.
Intermittent reversal of flow is seen within the left portal vein. Right
portal veins are patent, with antegrade flow.
The main hepatic artery is patent, with appropriate waveform.
Right, middle and left hepatic veins are patent, with appropriate waveforms.
Splenic vein and superior mesenteric vein are patent, with antegrade flow,
although very slow.
IMPRESSION:
1. No evidence of portal vein thrombosis. Intermittent reversal flow within
the left portal vein. Slow flow within the main portal, splenic, and superior
mesenteric veins.
2. Cirrhotic liver without focal liver lesions.
3. Circumferential gallbladder wall edema, likely due to third
spacing/underlying liver disease.
4. Small volume ascites.
|
10039708-RR-8 | 10,039,708 | 20,572,787 | RR | 8 | 2138-10-30 20:53:00 | 2138-10-30 21:16:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ with hx of EtOH presenting w/ 1 week dizzines s/p fall on
___. Concern for trauma and/or hepetic encephalopathy // r/o subdural and
r/o atrophy
COMPARISON: None
FINDINGS:
PA and lateral views of the chest provided. There is no focal consolidation,
effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged
osseous structures are intact. No free air below the right hemidiaphragm is
seen.
IMPRESSION:
No acute intrathoracic process.
|
10039708-RR-9 | 10,039,708 | 28,258,130 | RR | 9 | 2140-01-23 13:43:00 | 2140-01-23 14:06:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: History: ___ with hypotension
TECHNIQUE: Supine AP view of the chest
COMPARISON: Chest radiograph ___
FINDINGS:
Heart size is normal. The mediastinal and hilar contours are normal. The
pulmonary vasculature is normal. Lungs are clear. No pleural effusion or
pneumothorax is seen. There are no acute osseous abnormalities. Chain sutures
are noted in the left upper quadrant of the abdomen.
IMPRESSION:
No acute cardiopulmonary abnormality.
|
10039708-RR-93 | 10,039,708 | 29,488,258 | RR | 93 | 2144-01-19 15:48:00 | 2144-01-19 17:44:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with decompensated HE, unclear etiology,
somnolent, eval for PNA // e/o pna
TECHNIQUE: AP radiograph of the chest.
COMPARISON: Chest radiograph ___.
FINDINGS:
Low lung volumes are noted. There is no focal consolidation, pleural effusion
or pneumothorax. The cardiac silhouette is borderline enlarged. There is no
pulmonary edema. No acute osseous abnormalities are identified.
IMPRESSION:
No pneumonia or acute cardiopulmonary process.
|
10039709-RR-14 | 10,039,709 | 22,530,397 | RR | 14 | 2136-05-13 15:48:00 | 2136-05-13 16:31:00 | INDICATION: ___ year old man with history of PE presents with chest pain //
please evaluate for PE
TECHNIQUE: Multidetector CTA of the thorax was performed using the chest pain
PE protocol following IV administration of 100 cc of Omnipaque 350.
Multiplanar reformats were obtained.
DOSE: 526 mGy-cm.
COMPARISON: No prior studies are available for comparison.
FINDINGS:
CHEST:
Adequate opacification of the pulmonary arterial tree was noted. No filling
defects are identified in the pulmonary arterial tree to the subsegmental
level. No evidence of pulmonary embolus. The main pulmonary artery is normal
in caliber. Respiratory motion artifact limits assessment of the ascending
aorta, however no aneurysmal dilation of the thoracic aorta is identified.
No intrathoracic or extrathoracic lymphadenopathy. Cardiac size is within
normal limits. No pericardial or pleural effusions are identified. Minor
bibasilar atelectasis is noted. No evidence of consolidation. No suspicious
nodules are identified. Limited assessment of the subdiaphragmatic structures
is unremarkable.
OSSEOUS STRUCTURES:
No suspicious focal osteolytic or osteoblastic lesions are identified. Mild
multilevel degenerate changes of the thoracic spine are evident.
IMPRESSION:
No evidence of acute pulmonary embolus. No abnormality identified to explain
patient's chest pain.
|
10040025-RR-13 | 10,040,025 | 27,553,957 | RR | 13 | 2145-07-24 12:59:00 | 2145-07-24 13:57:00 | INDICATION: ___ with CHF, a fib // eval infiltrate, pulm edema
TECHNIQUE: PA and lateral views of the chest.
COMPARISON: ___.
FINDINGS:
The lungs are hyperinflated but clear of focal consolidation, effusion, or
vascular congestion. Cardiomediastinal silhouette is within normal limits. No
acute osseous abnormalities identified.
IMPRESSION:
Hyperinflation without acute cardiopulmonary process.
|
10040025-RR-17 | 10,040,025 | 21,791,856 | RR | 17 | 2147-06-16 21:27:00 | 2147-06-16 22:04:00 | EXAMINATION:
Chest: Frontal and lateral views
INDICATION: History: ___ with SOB // cough SOB
TECHNIQUE: Chest: Frontal and Lateral
COMPARISON: ___
FINDINGS:
The lungs are clear without focal consolidation. No pleural effusion or
pneumothorax is seen. The cardiac and mediastinal silhouettes are stable.
There may be minimal pulmonary vascular congestion.
IMPRESSION:
Possible minimal pulmonary vascular congestion. No focal consolidation.
|
10040025-RR-18 | 10,040,025 | 21,791,856 | RR | 18 | 2147-06-17 08:48:00 | 2147-06-17 11:31:00 | EXAMINATION: RENAL U.S.
INDICATION: ___ year old woman with HFpEF, CAD, CKD III p/w dyspnea, cough,
___. // ?hydronephrosis
TECHNIQUE: Grey scale and color Doppler ultrasound images of the kidneys were
obtained.
COMPARISON: None.
FINDINGS:
The right kidney measures 9.9 cm. The left kidney measures 11.1 cm. There is
no hydronephrosis, stones, or masses bilaterally. Normal cortical
echogenicity and corticomedullary differentiation are seen bilaterally.
The bladder is collapsed.
IMPRESSION:
Normal renal ultrasound.
|
10040025-RR-19 | 10,040,025 | 21,791,856 | RR | 19 | 2147-06-19 15:41:00 | 2147-06-19 15:57:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old woman with a history of CHF, CKD, who presents with
hypoxic respiratory failure, thought COPD related, is persistently hypoxic
despite steroids and nebulizers. // Interval development of pulmonary edema?
Other acute process to explain persistent hypoxia despite seemingly
appropriate treatment?
TECHNIQUE: Chest PA and lateral
COMPARISON: ___
FINDINGS:
Cardiomediastinal contours are stable with mild cardiomegaly. The lungs are
hyperinflated. There is increase AP diameter of the chest. Increasing left
lower lobe opacities could be atelectasis, superimposed infection cannot be
excluded. There is no pneumothorax or pleural effusion. There are mild
degenerative changes in the thoracic spine.
IMPRESSION:
COPD. Increasing left lower lobe opacities could be atelectasis or pneumonia
in the appropriate clinical setting
|
10040025-RR-20 | 10,040,025 | 21,791,856 | RR | 20 | 2147-06-22 08:31:00 | 2147-06-22 11:34:00 | EXAMINATION: CT CHEST W/O CONTRAST
INDICATION: ___ year old woman with mild hypoxemia. // eval for cause of
hypoxemia
TECHNIQUE: Multidetector axial CT images of the chest were obtained without
the administration of intravenous contrast. Coronal, sagittal and axial MIP
reformats were reviewed.
DOSE: Acquisition sequence:
1) Spiral Acquisition 4.9 s, 38.5 cm; CTDIvol = 21.7 mGy (Body) DLP = 835.4
mGy-cm.
Total DLP (Body) = 835 mGy-cm.
COMPARISON: Chest radiograph ___
FINDINGS:
THYROID: Tiny calcified nodule in the left thyroid lobe (4:31).
LYMPH NODES: No supraclavicular or axillary lymphadenopathy. There are
multiple mediastinal lymph nodes, measuring up to 11 mm in the right lower
paratracheal station. A subcarinal node measures 12 mm (4:115). There is
also hilar lymphadenopathy, measuring up to 14 mm on the right (4:114). No
definite hilar adenopathy on the left, within the limitations of this
noncontrast study.
HEART AND GREAT VESSELS: Heart is normal in size, without a pericardial
effusion. Multifocal coronary artery calcifications. Mild aortic valvular
calcifications. Ascending aorta is mildly enlarged, measuring up to 41 mm
(4:117). Heavy atherosclerotic calcifications throughout the thoracic aorta,
and its major branches. Pulmonary arteries are normal in caliber.
AIRWAYS AND LUNGS: There is mild bronchial wall thickening, most pronounced
in the lung bases. Endobronchial secretions are noted in the medial segmental
bronchus of the middle lobe (4:111). Evaluation of the lung parenchyma
reveals scattered peribronchial ground-glass and nodular opacities in the
middle lobe and bilateral lower lobes. There is confluent consolidation in
the right lower lobe. Findings are suspicious for aspiration pneumonia.
Linear opacities in the lingula may represent atelectasis or scarring.
Additional note is made of a 10 mm nodule in the medial segment right middle
lobe, which contains calcification anteriorly (4:133). There is also a 10 mm
subpleural nodule in the medial right lung base (4:143), which may represent a
component of the acute aspiration pneumonia, but should be re-evaluated on
follow-up chest CT.
PLEURA: No effusion or pneumothorax.
UPPER ABDOMEN: There is a 12 x 12 mm left adrenal nodule measuring 10 ___
(2:58), likely representing an adrenal adenoma. Limited images of the upper
abdomen are otherwise unremarkable.
BONES AND SOFT TISSUES: No suspicious lytic or sclerotic lesions are
identified. Chest wall is within normal limits.
IMPRESSION:
1. Bronchial wall thickening, endobronchial secretions, and peribronchial
ground-glass and nodular opacities in the middle lobe and bilateral lower
lobes, suspicious for aspiration pneumonia.
2. At least one pulmonary nodule measuring 10 mm in the middle lobe, possibly
with a second 10 mm nodule in the right lower lobe. Recommend follow-up chest
CT in 6 weeks, after appropriate treatment.
3. Probably reactive mediastinal and hilar lymphadenopathy.
4. Mild dilation of the ascending aorta, measuring 41 mm. Mild aortic valve
calcifications.
5. Coronary calcifications.
6. 12 x 12 mm left adrenal nodule, likely representing an adenoma.
RECOMMENDATION(S): Follow-up chest CT in 6 weeks.
NOTIFICATION: The findings and recommendations were discussed with ___
___, M.D. by ___, M.D. on the telephone on ___ at 11:28 AM, 5
minutes after discovery of the findings.
|
10040025-RR-28 | 10,040,025 | 27,259,207 | RR | 28 | 2147-12-05 13:11:00 | 2147-12-05 14:20:00 | EXAMINATION: ART EXT (REST ONLY)
INDICATION: ___ year old woman with lower extremity wounds// inflow; please
acquire toe pressures
TECHNIQUE: Noninvasive evaluation of the arterial system of the lower
extremities was performed with limb the pressure measurements at the toes.
Limited study to the presence of bandages in the left calf and pain in the
lower extremities
COMPARISON: None
FINDINGS:
TBIs obtained bilaterally and measuring 0.28 in the right lower extremity and
0.19 the left lower extremity.
IMPRESSION:
Limited study. TBIs obtained as described above.
|
10040025-RR-29 | 10,040,025 | 27,259,207 | RR | 29 | 2147-12-18 08:23:00 | 2147-12-19 13:58:00 | EXAMINATION: Lower extremity venous mapping
INDICATION: ___ CAD w/ DES to LCx, HFrEF, AFib, IDDM, CKD, chronic anemia p/w
nonhealing left foot wet ulcer now s/p angio w/ long-segment SFA occlusion.//
vein mapping for OR planning (L fem-AKpop bypass)
TECHNIQUE: Real-time grayscale and Doppler ultrasound imaging of bilateral
saphenous veins was performed.
COMPARISON: None.
FINDINGS:
RIGHT:
The right great saphenous vein is patent. The vein measures 4 mm proximally
and 2 mm distally. The right small saphenous vein was not imaged due to
overlying bandages. Additional measurements are available on PACS.
LEFT:
The left great saphenous vein is patent. The vein measures 5 mm proximally
and 3 mm distally. The left small saphenous vein is patent. The vein measures
2 mm proximally and 2mm distally. Additional measurements are available on
PACS.
IMPRESSION:
Patent bilateral great and small left saphenous veins. The right small
saphenous vein was not imaged due to overlying bandages.
|
10040025-RR-34 | 10,040,025 | 27,996,267 | RR | 34 | 2148-01-23 05:16:00 | 2148-01-23 06:28:00 | EXAMINATION: CT of the left lower extremity without contrast.
INDICATION: ___ year old woman s/p revascularization ___ w/ weak pulses,
clinical signs of infection// ?nec fasciitis, signs of infection/vascular
compromise
TECHNIQUE: Axial images of the left lower extremity without intravenous
contrast with coronal sagittal reconstructions.
DOSE: Total DLP (Body) = 2,508 mGy-cm.
COMPARISON: None available.
FINDINGS:
Vascular: Patency of vessels cannot be assessed in the absence of intravenous
contrast. There are extensive atherosclerotic calcifications involving the
left common femoral artery and profunda femoris, and moderate scattered
atherosclerotic calcifications involving the superficial femoral artery.
There are extensive calcified collateral vessels in the mid to distal thigh
arising from the profunda femoris. The popliteal, posterior tibial, anterior
tibial, and peroneal artery are also heavily calcified.
A left femoral-popliteal bypass is visualized coursing beneath the sartorius
muscle.
Bone: There is no evidence of fracture or malalignment. There is no
suspicious osseous lesion. There is no evidence of erosive change.
Soft tissue: There is subcutaneous stranding and a small amount of ill-defined
fluid in the left groin. There is a fluid collection with irregular margins
measuring 22.7 x 2.3 x 3.7 cm (CC x AP x TV) in the subcutaneous tissues of
the medial thigh deep to the surgical staples, postoperative in nature,
related to harvesting of the saphenous vein. There is no associated gas.
IMPRESSION:
1. Fluid collection with irregular margins measuring 22.7 x 2.3 x 3.7 cm (CC x
AP x TV) in the subcutaneous tissues of the medial thigh deep to the surgical
staples, likely simple post-operative fluid related to harvesting of the
saphenous vein.
2. Patency of vessels cannot be assessed in the absence of intravenous
contrast. Extensive atherosclerotic calcifications involving the common
femoral artery and profunda femoris, and moderate scattered atherosclerotic
calcifications involving the superficial femoral artery. Extensive calcified
collateral vessels in the mid to distal thigh, arising from the profunda
femoris. Popliteal, anterior tibial, posterior tibial and peroneal arteries
are also heavily calcified. Left femoral-popliteal bypass visualized coursing
beneath the sartorius muscle.
3. For findings in the pelvis, please see separate pelvis dictation.
|
10040025-RR-35 | 10,040,025 | 27,996,267 | RR | 35 | 2148-01-23 05:26:00 | 2148-01-23 06:13:00 | EXAMINATION: CT pelvis without intravenous contrast.
INDICATION: History: ___ with left leg pain after left fem-pop bypass on ___. Evaluate for signs of vascular compromise or necrotizing
fasciitis.
TECHNIQUE: Multidetector CT images of the abdomen and pelvis were acquired
without intravenous contrast. Non-contrast scan has several limitations in
detecting vascular and parenchymal organ abnormalities, including tumor
detection.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Total DLP (Body) = 871 mGy-cm.
COMPARISON: None.
FINDINGS:
PELVIS: There is mild colonic diverticulosis with collapsed sigmoid colon with
apparent thickening including a diverticulum and adjacent stranding in the fat
consistent with acute uncomplicated diverticulitis. Partially visualized
small bowel is unremarkable. The bladder is distended with fluid. Air in the
anti dependent portion of the bladder is likely secondary to recent Foley
catheter. There is no free fluid in the pelvis.
REPRODUCTIVE ORGANS: The uterus is grossly unremarkable. There is no adnexal
mass.
LYMPH NODES: Non pathologically enlarged large left inguinal lymph nodes are
likely reactive.
VASCULAR: Extensive atherosclerotic disease is noted in the iliofemoral
vessels. Please refer to separate report from concurrent CT of the left lower
extremity performed the same day for evaluation of the lower extremity
vasculature.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: In the left inguinal region, there is subcutaneous stranding and
small amount of ill-defined fluid, with overlying skin staples.
IMPRESSION:
1. Subcutaneous stranding in the left inguinal region and a small amount of
ill-defined fluid, with overlying skin staples - expected appearance
post-operatively.
2. Extensive atherosclerotic calcifications in the iliofemoral vessels.
Please refer to separate report from concurrent CT of the left lower extremity
performed the same day for evaluation of the lower extremity vasculature.
3. Mild uncomplicated sigmoid diverticulitis.
|
10040025-RR-36 | 10,040,025 | 27,996,267 | RR | 36 | 2148-01-24 05:39:00 | 2148-01-24 12:17:00 | EXAMINATION: CHEST PORT. LINE PLACEMENT
INDICATION: ___ year old woman with new R IJ CVL// eval line position, PTX
Contact name: ___: ___ eval line position, PTX
IMPRESSION:
Compared to chest radiographs, ___.
Severe cardiomegaly is chronic. Nevertheless there is no pulmonary vascular
or mediastinal venous engorgement and no pulmonary edema or definite pleural
effusion.. No pneumothorax.
Poor definition of the apex of the right diaphragmatic pleural surface may be
due to differences in patient positioning.
Right jugular line ends in the low SVC
|
10040025-RR-37 | 10,040,025 | 27,996,267 | RR | 37 | 2148-01-24 06:24:00 | 2148-01-24 12:39:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ w/PMH of NASH cirrhosis s/p LDLT c/b bleeding, hepatic artery
thrombosis/pseudoaneurysm s/p ___ thrombectomy + PTA/stent, bile leak s/p PTBD
+ biloma drain, bladder necrosis s/p suprapubic ___ drain. She is re-admitted
to the ICU for anuric renal failure in the s/o acute pancreatitis c/b
abdominal compartment syndrome c/b subsequent inferior epigastric bleed s/p
embolization.// new hypoxia on ABG assess for interval CXR changes, effusion,
edema, PTX new hypoxia on ABG assess for interval CXR changes, effusion,
edema, PTX
IMPRESSION:
Compared to chest radiographs since ___ most recently ___ at
05:50.
Change in patient position shows that the right lower lobe is nearly clear.
There may be a very small region of consolidation medially but previous
obscuration of the right diaphragmatic pleural surface was an artifact. Left
pleural effusion is small. Upper lungs are clear. Moderate enlargement of
cardiac silhouette is chronic. No pneumothorax.
Right jugular line ends in the low SVC.
|
10040025-RR-38 | 10,040,025 | 27,996,267 | RR | 38 | 2148-01-25 10:37:00 | 2148-01-25 13:54:00 | EXAMINATION: DX CHEST PORT LINE/TUBE PLCMT 1 EXAM
INDICATION: ___ year old woman with LLE wound s/p VAC// eval ETT placement
eval ETT placement
IMPRESSION:
Compared to chest radiographs since ___, most recently ___.
Moderate cardiomegaly is chronic. Small bilateral pleural effusions are
stable. Left lower lobe atelectasis has worsened despite interval tracheal
intubation. ET tube and right internal jugular line are in standard
placements. Upper lungs clear.
|
10040025-RR-39 | 10,040,025 | 27,996,267 | RR | 39 | 2148-01-25 16:45:00 | 2148-01-25 18:53:00 | INDICATION: ___ year old woman with ETT s/p OG tube placement// eval OGT
position
TECHNIQUE: AP portable chest radiograph
COMPARISON: ___
FINDINGS:
The tip of a right internal jugular central venous catheter projects over the
cavoatrial junction. The tip of the endotracheal tube projects at the level
of the clavicular heads. An enteric tube projects over the stomach.
There are small bilateral pleural effusions with subjacent atelectasis. No
pneumothorax is identified. The size of the cardiac silhouette is enlarged
but unchanged.
IMPRESSION:
The tip of the new feeding tube projects over the stomach. Otherwise no
significant interval change.
|
10040025-RR-40 | 10,040,025 | 27,996,267 | RR | 40 | 2148-01-26 04:55:00 | 2148-01-26 09:46:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ PMHx of CAD, multiple MIs, CHFpEF, afib, CKD stage 3, IDDM,
chronic non-healing L foot wound occluded left SFA and distal ___ s/p L
fem-AK pop w/ NRGSV, L foot ulcer debridement VAC now w LLE dehiscence s/p I
D foot ___ transferred to ICU for hemodynamic instability secondary
to acute hemorrhage s/p washout ___// eval for interval change eval for
interval change
IMPRESSION:
ET tube tip is 6 cm above the carina. Right internal jugular line tip is at
the level of lower SVC. NG tube tip is in the stomach. Heart size is
enlarged. Bilateral pleural effusions are moderate. There is mild vascular
congestion but no overt pulmonary edema. There is no pneumothorax.
|
10040025-RR-41 | 10,040,025 | 27,996,267 | RR | 41 | 2148-01-27 04:51:00 | 2148-01-27 13:48:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ PMHx of CAD, multiple MIs, CHFpEF, afib, CKD stage 3, IDDM,
chronic non-healing L foot wound occluded left SFA and distal ___ s/p L
fem-AK pop w/ NRGSV, L foot ulcer debridement VAC now w LLE dehiscence s/p I
D foot ___ transferred to ICU for hemodynamic instability secondary
to acute hemorrhage s/p washout ___// interval change
TECHNIQUE: Single frontal view of the chest
COMPARISON: Chest radiograph ___.
FINDINGS:
Right IJ line terminates in the cavoatrial junction. Interval removal of the
ET tube and enteric tube.
Cardiomediastinal contours are unchanged. There is increased bilateral
pulmonary vascular congestion and increased bilateral small pleural effusions.
There is no pneumothorax.
IMPRESSION:
Increased bilateral pulmonary vascular congestion with increased bilateral
small pleural effusions.
|
10040025-RR-42 | 10,040,025 | 27,996,267 | RR | 42 | 2148-01-30 09:03:00 | 2148-01-30 10:10:00 | EXAMINATION: DX CHEST PORTABLE PICC LINE PLACEMENT
INDICATION: ___ year old woman with new R PICC// R DL Power PICC 42cm ___
___ Contact name: ___: ___
TECHNIQUE: Single frontal view of the chest
COMPARISON: ___
IMPRESSION:
Right PICC tip is in thecavoatrial junction. Cardiomegaly is stable. Right IJ
catheter tip in the cavoatrial junction. No evident pneumothorax. Small
bilateral effusions larger on the left have decreased. Bibasilar atelectasis
left greater than right and a mild vascular congestion improved.
|
10040056-RR-11 | 10,040,056 | 27,850,323 | RR | 11 | 2145-07-20 18:45:00 | 2145-07-22 10:52:00 | EXAMINATION: MRCP.
INDICATION: PANCREATITIS. CONCERN FOR CHOLEDOCHOLITHIASIS.
TECHNIQUE: T1 and T2 weighted multiplanar images of the abdomen were acquired
within a 1.5 Tesla magnet, including 3D dynamic sequences performed prior to,
during, and following the administration of 10 cc of Gadavist intravenous
contrast. 1 cc of Gadavist mixed with 50 cc of water were administered for
oral contrast.
|
10040056-RR-12 | 10,040,056 | 27,850,323 | RR | 12 | 2145-07-20 11:02:00 | 2145-07-20 11:22:00 | INDICATION: History of metal work in injury to the eye. For pre MRI
screening.
TECHNIQUE: Two views orbits.
COMPARISON: None.
FINDINGS:
There are no radiopaque foreign bodies overlying the orbits.
|
10040149-RR-11 | 10,040,149 | 21,810,717 | RR | 11 | 2181-09-17 22:16:00 | 2181-09-17 22:44:00 | EXAMINATION: Chest and abdomen radiograph
INDICATION: ___ year old woman with bowel obstruction// eval for position of
contrast. instill 100cc gastrografin via NG tube and then clamp and take CXR
and AXR 8 hours after contrast administration ; ___ year old woman with
bowel obstruction// eval for position of contrast. Please perform 8 hours
after administration of gastrografin.
TECHNIQUE: Frontal view of the chest. Supine and lateral decubitus views of
the abdomen/pelvis.
COMPARISON: ___.
FINDINGS:
There are postoperative changes from CABG. There is central pulmonary
vascular congestion with mild edema. There is unfolding of the thoracic aorta
with vascular calcifications. There is likely atelectasis at the left lung
base. No other focal consolidation is seen. There is no large effusion or
pneumothorax.
Upper enteric tube with tip is in the proximal stomach, with the side port
just below the GE junction. Administered oral contrast has progressed to the
large bowel to the level of the proximal transverse colon. Small bowel loops
remain mildly prominent up to 3.3 cm. Large bowel appears mildly distended.
There is no free air. Aorta bi-iliac stent graft is seen.
IMPRESSION:
1. Mild pulmonary edema.
2. Oral contrast has progressed to the level of the proximal transverse colon
excluding obstruction. There remains mild distension of the small and large
bowel loops suggesting ileus.
|
10040284-RR-18 | 10,040,284 | 26,059,791 | RR | 18 | 2144-01-21 15:07:00 | 2144-01-21 15:44:00 | EXAMINATION: CHEST RADIOGRAPHS
INDICATION: History: ___ with schizophrenia, reports swallowing magents 3
days ago, initial retrosternal pain, now epigastric and LLQ pain // Eval for
ingested foreign body (magnets x3)
TECHNIQUE: Chest PA and lateral
COMPARISON: Comparison is made with concurrent abdominal plain films.
FINDINGS:
The lungs are well expanded and clear. There is no pleural effusion
pneumothorax. The cardiomediastinal silhouette is unremarkable. Three
radiopaque connected oblong structures are seen projecting over the expected
area of the stomach, likely representing ingested magnets.
IMPRESSION:
No acute cardiopulmonary process. Three radiopaque connected oblong structures
are seen projecting over the expected area of the stomach, likely representing
ingested magnets.
|
10040284-RR-19 | 10,040,284 | 26,059,791 | RR | 19 | 2144-01-21 15:07:00 | 2144-01-21 15:37:00 | INDICATION: History: ___ with schizophrenia, reports swallowing magnets 3
days ago, initial retrosternal pain, now epigastric and left lower quadrant
pain // Eval for ingested foreign body (magnets x3)
TECHNIQUE: Supine and upright AP views of the abdomen
COMPARISON: None.
FINDINGS:
3 cylindrical radiopaque densities vertically aligned end-to-end with each
other likely reflect ingested magnets, projecting in the left upper quadrant
of the abdomen, possibly within the stomach. The bowel gas pattern is normal.
No evidence of bowel obstruction or free intraperitoneal air is seen. No
acute osseous abnormalities are present.
IMPRESSION:
3 cylindrical radiopaque densities vertically aligned end-to-end with each
other likely reflective of ingested magnets in the left upper quadrant
abdomen, possibly within the stomach. No free intraperitoneal gas.
|
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