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10040284-RR-20 | 10,040,284 | 26,059,791 | RR | 20 | 2144-01-23 16:52:00 | 2144-01-23 17:06:00 | INDICATION: History: ___ with abdominal pain // eval for foreign body and
perforation
TECHNIQUE: Supine and upright AP views of the abdomen
COMPARISON: ___ abdominal radiographs
FINDINGS:
Within the left upper quadrant of the abdomen, there is a cluster of five
linear radiopaque densities noted, measuring up to 14 mm, and likely reflect
known Endoclips intervally placed within the stomach. Previously noted
radiopaque magnets within the left upper quadrant the abdomen are no longer
visualized. The bowel gas pattern is normal. No free intraperitoneal air or
pneumatosis is present. The osseous structures are unremarkable.
IMPRESSION:
Five linear radiopaque densities identified projecting over the left upper
quadrant of the abdomen compatible with known Endoclips which have been
intervally placed in the stomach. No evidence for bowel obstruction or free
intraperitoneal gas.
|
10040284-RR-21 | 10,040,284 | 26,059,791 | RR | 21 | 2144-01-23 21:37:00 | 2144-01-23 21:58:00 | EXAMINATION: CT abdomen and pelvis without contrast
INDICATION: Left upper quadrant abdominal pain in the setting of endoscopy.
Evaluate for perforation.
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 4.7 s, 51.5 cm; CTDIvol = 10.6 mGy (Body) DLP = 547.9
mGy-cm.
Total DLP (Body) = 548 mGy-cm.
COMPARISON: Abdominal radiographs ___ and ___.
FINDINGS:
Heart size is normal without significant pericardial fluid. The imaged lung
bases are clear.
CT abdomen without contrast: Liver, gallbladder, spleen, pancreas and adrenal
glands are grossly unremarkable within the context of a noncontrast
examination. The kidneys are grossly unremarkable without stone or
hydronephrosis.
The stomach is distended with ingested oral contrast. Multiple endoscopic
clips are identified in the body of the stomach. There is no adjacent
pneumoperitoneum or fluid to suggest perforation. The gastric wall itself
does not appear edematous or thickened. There is no extravasation of orally
ingested contrast material. The duodenum and small bowel loops are normal
caliber without evidence of obstruction. The large bowel is thin-walled and
unremarkable without pericolonic fat stranding or fluid collection.
The abdominal aorta is normal caliber. There is no mesenteric or
retroperitoneal lymphadenopathy by CT size criteria. There is no
pneumoperitoneum. There is a tiny fat containing umbilical hernia.
CT pelvis without contrast: The distal ureters, bladder, uterus, adnexa and
rectum are grossly unremarkable. There is small amount of likely physiologic
free pelvic fluid. There is no free air. There is no inguinal or pelvic
sidewall lymphadenopathy by CT size criteria.
Bones and soft tissues: There is no suspicious focal bone lesion.
IMPRESSION:
Endoscopic clips visualized in the gastric body. No pneumoperitoneum or
extravasation of orally ingested contrast to suggest gastric perforation.
|
10040602-RR-53 | 10,040,602 | 25,984,377 | RR | 53 | 2189-06-15 10:56:00 | 2189-06-15 11:57:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: History: ___ with cp// ? chf or pneumonia ? chf or pneumonia
IMPRESSION:
Heart size and mediastinum are stable in appearance. Vascular enlargement in
the hila is unchanged, with no evidence of acute exacerbation of congestive
heart failure on the radiograph. Postsurgical changes in the right lung are
stable. There is no pleural effusion. There is no pneumothorax.
|
10040602-RR-54 | 10,040,602 | 25,984,377 | RR | 54 | 2189-06-15 12:17:00 | 2189-06-15 14:17:00 | EXAMINATION: CTA CHEST WITH CONTRAST
INDICATION: ___ with pleuritic chest pain and elevated d-dimer// ? 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 0.5 s, 0.5 cm; CTDIvol = 3.0 mGy (Body) DLP = 1.5
mGy-cm.
2) Stationary Acquisition 0.5 s, 0.5 cm; CTDIvol = 3.0 mGy (Body) DLP = 1.5
mGy-cm.
3) Stationary Acquisition 4.5 s, 0.5 cm; CTDIvol = 27.0 mGy (Body) DLP =
13.5 mGy-cm.
4) Spiral Acquisition 4.0 s, 30.3 cm; CTDIvol = 15.3 mGy (Body) DLP = 461.6
mGy-cm.
5) Spiral Acquisition 0.6 s, 3.3 cm; CTDIvol = 18.0 mGy (Body) DLP = 59.7
mGy-cm.
Total DLP (Body) = 538 mGy-cm.
COMPARISON: Multiple prior CT chest examinations, most recent from ___
FINDINGS:
HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the
subsegmental level without filling defect to indicate a pulmonary embolus.
There is enlargement of the main, right main, and left main pulmonary
arteries, measuring up to 3.8, 3.1, and 2.8 cm, respectively. These findings
are likely suggestive of pulmonary arterial hypertension. 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: Mediastinal esophagus appears thickened
throughout its course (series 2; image 21), similar compared to prior and
suggestive of underlying chronic esophageal inflammation. Again seen in the
mediastinum, along the superior aspect of the left ventricle, adjacent to the
main pulmonary artery, there is a lobulated, homogeneous 3.4 x 2.2 cm soft
tissue density, which previously measured 3.5 x 2.0 cm. This mass is been
slowly growing since ___ and likely represent an encapsulated thymoma. It
appears to now abut the myocardium over a couple of cm. There is no axillary
lymphadenopathy. There are prominent subcarinal and right hilar lymph nodes,
which are nonspecific.
PLEURAL SPACES: No pleural effusion or pneumothorax.
LUNGS/AIRWAYS: Changes seen after right upper lobectomy. There is bibasilar
atelectasis, right greater than left, without focal consolidation concerning
for infection. Incidentally noted is an azygos lobe. 4 mm nodule in the
right upper lobe (series 3; image 84) is unchanged compared to ___
and now stable for 32 months. No additional concerning nodules are
identified.
BASE OF NECK: Visualized portions of the base of the neck show no abnormality.
ABDOMEN: Included portion of the upper abdomen is unremarkable.
BONES: No suspicious osseous abnormality is seen.? There is no acute fracture.
IMPRESSION:
1. No evidence of pulmonary embolism or acute aortic abnormality. No acute
etiology identified for pleuritic chest pain. No focal consolidation
concerning for underlying infection.
2. Enlargement of the pulmonary arterial system, consistent with pulmonary
arterial hypertension.
3. Unchanged soft tissue mass in the prevascular mediastinum, which has been
slowly growing since ___ and appears stable since ___. This is
probably an encapsulated thymoma.
4. Thickening the mediastinal esophagus is unchanged compared ___
and may be sequela of chronic esophageal inflammation. EGD could be pursued on
a nonurgent basis if clinically indicated.
|
10040721-RR-17 | 10,040,721 | 27,632,777 | RR | 17 | 2176-04-10 03:13:00 | 2176-04-10 07:04:00 | INDICATION: Status post motor vehicle accident.
COMPARISONS: CT torso of the same date.
FINDINGS:
Supine portable view of the chest demonstrates an endotracheal tube
terminating 3.7 cm above the carina. A nasogastric tube is seen coursing
through the esophagus, its tip out of view. Low lung volumes. Bibasilar
opacities are noted. Hilar and mediastinal silhouettes are unremarkable.
Heart size is top normal. There is no pulmonary edema.
IMPRESSION:
Low lung volumes. Bibasilar opacities, likely atelectasis.
|
10040721-RR-18 | 10,040,721 | 27,632,777 | RR | 18 | 2176-04-10 03:25:00 | 2176-04-10 04:46:00 | INDICATION: Patient status post motor vehicle accident with DCS score of 3,
reintubated at the scene.
COMPARISON: None available.
TECHNIQUE: MDCT-acquired contiguous images through the head were obtained
without intravenous contrast at 5-mm slice thickness. Coronally and
sagittally reformatted images were displayed.
FINDINGS:
There is no evidence of acute intracranial hemorrhage, mass effect, or shift
of normally midline structures. There is no cerebral edema or loss of
gray-white matter differentiation to suggest an acute ischemic event. The
sulci and ventricles are normal in size and configuration. The basal cisterns
are patent. There is no evidence of hydrocephalus or central herniation.
There is marked mucosal thickening of the ethmoid air cells and maxillary
sinuses. Marked mucosal thickening of the frontal air cells is also noted.
Mastoid air cells appear well aerated. Endotracheal tube is in place.
Secretions are seen at the nasopharynx. No acute fracture is noted.
IMPRESSION:
1. No evidence of acute intracranial process.
2. Acute-on-chronic pan-sinus inflammatory disease, though some of the
layering fluid may relate to intubation.
|
10040721-RR-19 | 10,040,721 | 27,632,777 | RR | 19 | 2176-04-10 03:26:00 | 2176-04-10 04:49:00 | INDICATION: Status post motor vehicle accident with DCS score of 3, intubated
at the scene.
COMPARISONS: None available.
TECHNIQUE: 2.5-mm axial slices through the cervical spine were obtained
without intravenous contrast. Coronally and sagittally reformatted images
were displayed.
FINDINGS:
Endotracheal and nasogastric tubes are in place, which limits the evaluation
of prevertebral soft tissues. There is no evidence of acute fracture or
malalignment. Vertebral body and intervertebral disc space heights appear
preserved. Moderate amount of secretions are seen at the level of the
nasopharynx.
Lung apices are notable for consolidations and ground-glass opacities,
posteriorly. No apical pneumothorax is seen.
IMPRESSION:
1. No evidence of acute fracture or malalignment.
2. Intubated with bi-apical consolidations which may represent contusion,
aspiration, atelectasis, or some combination; these findings are
better-assessed on the concurrent dedicated CECT torso.
|
10040721-RR-20 | 10,040,721 | 27,632,777 | RR | 20 | 2176-04-10 03:26:00 | 2176-04-10 06:13:00 | INDICATION: Patient is status post motor vehicle accident, intubated at the
seen.
COMPARISONS: None available.
TECHNIQUE: MDCT-acquired contiguous images from thoracic inlet to pubic
symphysis were obtained with intravenous contrast at 5-mm slice thickness.
Coronally and sagittally reformatted images were displayed.
FINDINGS:
CT OF THE CHEST:
The aorta is normal in caliber. There is no evidence of aortic dissection.
Great vessels appear unremarkable. Heart is mildly enlarged. There is no
pericardial effusion. Endotracheal tube is appropriately positioned. A
nasogastric tube is seen coursing through the esophagus. A locule of gas is
seen just anterior to left pericardium.Uncertain if this is in the pleural
cavity or pulmonary parenchyma
The tracheobronchial tree is patent to subsegmental levels. Low lung volumes
are noted. Small consolidations at the lung bases are present (2:32).
Additionally, heterogeneous ground-glass opacities are seen in the right upper
and middle lobes (2:19, 23). There is no large pleural effusion. No
pneumothorax is noted. No pathologically enlarged central lymph nodes are
seen.
CT OF THE ABDOMEN:
Suboptimal exam due to extensive streak artifact generated by arms by
patient's side. Within this limitation, liver is unremarkable. Gallbladder
is mildly distended. No calcified gallstones. Spleen appears unremarkable.
Patient is status post gastric bypass surgery, but large amount of free fluid
is seen in the excluded stomach, suggestive of gastrogastric fistula.
Pancreas is minimally atrophic; however, there is no peripancreatic fluid
collection. Adrenal glands are normal. Kidneys enhance and excrete contrast
symmetrically. There is no hydronephrosis. There is no large amount of free
fluid is seen within the abdomen. There is no free air. Intra-abdominal
aorta and its branches are normal in caliber.
CT OF THE PELVIS: The bladder, uterus, rectum and sigmoid colon are
unremarkable. There is no free fluid or free air within the pelvis. No
pathologically enlarged pelvic or inguinal lymph nodes are seen.
OSSEOUS STRUCTURES: No suspicious lytic or sclerotic lesion is seen. No
acute bony injury is identified.
IMPRESSION:
1. Suboptimal exam due to extensive streak artifact generated by patient's
arms by her side. Within this limitation, no acute intra-abdominal injury is
identified.
2. Small consolidations in the lung bases bilaterally, may reflect
aspiration, atelectasis or infection in the appropriate setting.
Additionally, there are heterogeneous ground-glass opacities in right upper
and middle lobes, which may reflect pulmonary contusions or aspiration.
3. Large amount of fluid in the excluded portion of the stomach, suggestive of
gastrogastric fistula.
4. Locule of gas seen just anterior to left pericardium, may represent
extrapleural air.
|
10040721-RR-22 | 10,040,721 | 27,632,777 | RR | 22 | 2176-04-10 03:38:00 | 2176-04-10 08:09:00 | INDICATION: Status post motor vehicle accident.
COMPARISONS: None available.
FINDINGS:
Two views of the left knee demonstrate extensive soft tissue edema. Round
lucencies projecting over knee joint, which likely correspond to patient's
lacerations at the site. No acute fracture is seen. Joint spaces are well
preserved. There is no dislocation. Bone mineralization is normal.
Two views of the left tibia and fibula demonstrate no evidence of acute
fracture. Apparent lucency involving the distal epiphysis of the tibia may
represent a fracture.
Two view of the left ankle demonstrates disrupted ankle mortise, suggestive of
underlying dislocation and/or ligamentous injury.
Two views of the right knee demonstrate extensive soft tissue edema. Rounded
linear lucencies overlying lateral aspect of the joint likely correspond to
patient's known laceration. Small knee effusion is present. There is no
fracture or dislocation. Joint spaces are well preserved. Bone
mineralization is normal.
Two views of the right tibia and fibula demonstrate no acute fracture. Soft
tissue edema is overlying lateral malleolus.
IMPRESSION:
1. No fracture or dislocation of knee joints. Extensive soft tissue edema
and linear lucencies surrounding knee joints, likely correspond to patient's
known lacerations.
2. Limited views of the ankles are suggestive of ankle dislocation and/or
ligamentous injury. Dedicated ankle views may be obtained when feasible.
|
10040721-RR-23 | 10,040,721 | 27,632,777 | RR | 23 | 2176-04-10 03:47:00 | 2176-04-10 09:14:00 | INDICATION: Patient status post motor vehicle accident.
COMPARISONS: None available.
FINDINGS:
Two views of the left humerus demonstrate no evidence of acute fracture or
dislocation. The glenohumeral articulation is preserved. Bone mineralization
is normal. No soft tissue radiopaque foreign body is noted.
Two views of the right shoulder were obtained. Overlying support devices
limit evaluation. There is no apparent displaced fracture. No definite
dislocation is seen.
IMPRESSION:
1. No acute fracture or dislocation of the left humerus.
2. Limited assessment of the right humerus. No displaced fracture or
apparent dislocation. Dedicated views of the right shoulder may be obtained,
if clinical concern remains for underlying disease.
|
10040721-RR-24 | 10,040,721 | 27,632,777 | RR | 24 | 2176-04-10 03:50:00 | 2176-04-10 10:57:00 | STUDY: CT of knees.
INDICATION: Trauma. For evaluation.
TECHNIQUE: Axial multislice imaging was acquired without contrast. Images
were reconstructed in multiple planes on an off-line workstation.
COMPARISON: Same day plain films.
REPORT:
RIGHT SIDE:
There is extensive soft tissue trauma identified, with soft tissue defects
noted particularly, laterally and posteriorly. There does not appear to be
any intraarticular extension. There is no effusion. No lipohemarthrosis.
There are symmetrical areas of subchondral sclerosis paralleling the medial
tibial plateau bilaterally, which I doubt represent any injury. There is no
definitive evidence of injury.
Air identified anterior to the quadriceps tendon and the patellofemoral tendon
does not appear to extend deep. ___ fat pad remains intact. No clear
intra-articular disruption, although CT is poor defining the same. Small
amount of medial meniscal extrusion anteriorly is suggested on reformats.
LEFT KNEE: Again identified is a small nonspecific area of subchondral
sclerosis, paralleling the articular surface of the medial tibial plateau,
symmetric to the other side, not thought likely to represent an injury.
There is no definitive fracture identified. Again the suprapatellar region
___ fat pad remain intact. The amount of soft tissue trauma is less on
the left side.
There is a small amount of fragmentation involving the superolateral aspect of
the patella on the left side. It is uncertain whether this represents a
congenital pathology or more recent injury and clinical correlation is
suggested. I Suspect it may reflect recent injury.
CONCLUSION:
Overall, there is little evidence to suggest significant bony trauma.
Extensive soft tissue trauma as described. Fragmentation in the superolateral
left patella.
|
10040721-RR-25 | 10,040,721 | 27,632,777 | RR | 25 | 2176-04-10 04:51:00 | 2176-04-10 07:07:00 | INDICATION: Assess for femur fractures.
COMPARISONS: None available.
FINDINGS:
Single portable views of bilateral femurs demonstrate no evidence of acute
fracture or dislocation. Bone mineralization is normal. No radiopaque soft
tissue foreign body is identified.
IMPRESSION:
No fracture.
|
10040721-RR-26 | 10,040,721 | 27,632,777 | RR | 26 | 2176-04-10 06:27:00 | 2176-04-10 09:34:00 | RIGHT FOOT SERIES, ___ AT 6:22
CLINICAL INDICATION: ___ with question right foot fracture status
post trauma.
AP and lateral views of the right foot dated ___ at 6:22 was submitted.
There are no comparison studies.
IMPRESSION:
1. Bony mineralization is within normal limits. No displaced fracture or
dislocation of the right foot is seen. No radiopaque foreign bodies are seen
within the overlying soft tissues, although there is likely mild edema along
the dorsal surface.
|
10040721-RR-28 | 10,040,721 | 27,632,777 | RR | 28 | 2176-04-10 14:27:00 | 2176-04-11 09:47:00 | STUDY: Right foot and ankle performed on ___.
CLINICAL HISTORY: Trauma, evaluate for fracture.
FINDINGS: Three views of the right ankle show soft tissue swelling, medial
greater than lateral. There are no signs for acute fractures or dislocations.
The ankle mortise is preserved. There are no osteochondral lesions.
Dedicated images of the right foot show intact bony structures without
fracture or dislocation. Incidental note is made of a type 2 os naviculare
adjacent to the navicular bone. Lisfranc interval is preserved.
|
10040721-RR-29 | 10,040,721 | 27,632,777 | RR | 29 | 2176-04-10 14:27:00 | 2176-04-10 16:36:00 | PORTABLE AP CHEST, ___ at 14:32.
CLINICAL INDICATION: ___ with pulmonary contusions, here for
followup.
Comparison is made to the patient's prior study of ___ at 3:07 a.m.
Portable AP upright chest film, ___ at 14:32 is submitted.
IMPRESSION:
1. Interval extubation and removal of the nasogastric tube. The lung volumes
remain somewhat low with patchy opacities at both bases, which could reflect
atelectasis, possibly aspiration or contusions. No pneumothorax is seen. No
evidence of pulmonary edema or pleural effusions. Overall, cardiac and
mediastinal contours are within normal limits given portable technique. No
acute bony abnormality appreciated.
|
10040721-RR-30 | 10,040,721 | 27,632,777 | RR | 30 | 2176-04-10 22:00:00 | 2176-04-11 09:41:00 | STUDY: Abdomen supine and erect films ___.
CLINICAL HISTORY: ___ woman, previous gastric bypass, now with nausea
and emesis and fever. Evaluate for obstruction.
FINDINGS: No previous studies available for direct comparison.
The bowel gas pattern is within normal limits. There is air and stool seen
throughout the mildly prominent loops of colon. Prominent amount of stool
seen within the right colon. No dilated loops of small bowel are seen. Bony
structures are intact. There is no free intra-abdominal air.
|
10040721-RR-31 | 10,040,721 | 27,632,777 | RR | 31 | 2176-04-11 12:42:00 | 2176-04-11 14:09:00 | INDICATION: ___ woman with gastric bypass, status post MVC with
persistent emesis and abdominal pain. Evaluate for leak or obstruction.
COMPARISON: CT yesterday.
FINDINGS: This exam was limited due to poor patient mobility secondary to
pain. Limited AP and RPO projections were obtained. There is no evidence of
contrast extravasation after ingestion of water-soluble Optiray contrast.
There is no obstruction. This study was not designed to evaluate for
communication between the alimentary tract and excluded stomach as was
suggested on the recent CT due to the large volume of fluid in the excluded
stomach.
IMPRESSION: No contrast leak.
|
10040721-RR-32 | 10,040,721 | 27,632,777 | RR | 32 | 2176-04-12 21:40:00 | 2176-04-13 08:34:00 | RIGHT SHOULDER RADIOGRAPHS DATED ___
CLINICAL INDICATION: ___ female status post motor vehicle collision
with right shoulder pain, assess for fracture.
COMPARISON: ___ bilateral humerus radiographs.
FINDINGS:
Internal rotation, external rotation and axillary views of the right shoulder
demonstrate no acute fracture of the humerus or dislocation. Possible
nondisplaced fracture of the acromion. The acromioclavicular joint is
maintained. The partially visualized right-sided ribs are grossly intact.
Partially seen right lung is grossly clear. Soft tissues are grossly
unremarkable.
IMPRESSION:
Possible nondisplaced fracture of the distal acromion given history of trauma
versus os acromiale. Limited assesment on current radiographs. Correlate with
direct palpation or CT for definitive assesment.
Important findings discussed via phone with Dr. ___ at pager
___ at 845 am ___ by MSK radiology fellow Dr. ___. P ___.
|
10040884-RR-18 | 10,040,884 | 23,184,027 | RR | 18 | 2162-07-20 17:32:00 | 2162-07-20 17:54:00 | HISTORY: Cough and dyspnea.
TECHNIQUE: PA and lateral views of the chest.
COMPARISON: Chest CT ___.
FINDINGS:
The heart size is normal. The aorta is mildly tortuous and demonstrates
diffuse atherosclerotic calcifications. Mediastinal and hilar contours
otherwise are unremarkable. Previously noted nodular opacity within the
lingula on CT is not clearly demonstrated on the current study. The lungs are
clear. No pleural effusion or pneumothorax is present. The pulmonary
vascularity is normal. No acute osseous abnormalities are seen.
IMPRESSION:
No acute cardiopulmonary abnormality.
|
10040884-RR-19 | 10,040,884 | 23,184,027 | RR | 19 | 2162-07-20 20:11:00 | 2162-07-20 23:12:00 | INDICATION: History of metastatic melanoma.
TECHNIQUE: Multidetector CT scan of the head was obtained without the
administration of contrast. Coronal and sagittal reformations were prepared.
COMPARISON: MRI dated ___.
FINDINGS: There is no evidence of acute hemorrhage, edema, mass effect or
recent infarction. Prominence of the ventricles and sulci is consistent with
age-related global atrophy. A hypodensity in the region of the right basal
ganglia (2:9) is consistent with a prominent perivascular space. No
concerning osseous lesion is seen. The mastoid air cells are clear. There is
mucosal thickening of the left frontal sinus, right frontoethmoidal recess,
left ethmoid air cells and sphenoid sinuses bilaterally.
IMPRESSION: No evidence of acute intracranial process. No evidence of mass
or mass effect.
|
10040984-RR-22 | 10,040,984 | 29,975,777 | RR | 22 | 2179-02-28 00:42:00 | 2179-02-28 08:51:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with colonic perforation s/p ___// Assess
for NGT location
TECHNIQUE: Single frontal view of the chest
COMPARISON: ___
IMPRESSION:
NG tube tip isat the EG junction and should be advanced for more standard
position. There are low lung volumes and bibasilar atelectasis. There is no
pneumothorax or pleural effusion. Vascular congestion has resolved. Mild
cardiomegaly is stable.
|
10040984-RR-23 | 10,040,984 | 29,975,777 | RR | 23 | 2179-02-28 23:15:00 | 2179-03-01 07:53:00 | EXAMINATION: CHEST (PORTABLE AP) IN O.R.
INDICATION: ___ year old man with NGT replaced// Assess for NGT placement
Assess for NGT placement
IMPRESSION:
In comparison with the study of ___, the new nasogastric tube appears
to extend to the mid stomach be for coiling back on itself so that the tip
points upward in the upper stomach. Cardiomediastinal silhouette is stable.
There is increase in bilateral pulmonary opacifications. Although some of
this could represent pulmonary edema, the upper lung predominance raises the
possibility multifocal pneumonia in the appropriate clinical setting.
|
10040984-RR-24 | 10,040,984 | 29,975,777 | RR | 24 | 2179-03-02 08:01:00 | 2179-03-02 09:02:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with worsening O2 requirement// Assess for
intrathoracic pathology Assess for intrathoracic pathology
IMPRESSION:
Comparison to ___. The feeding tube has been removed. Minimal
increase in extent and severity of the pre-existing left parenchymal
opacities. The right apical opacities are stable. Mild cardiomegaly. Mild
elongation of the descending aorta.
|
10040984-RR-25 | 10,040,984 | 29,975,777 | RR | 25 | 2179-03-03 09:27:00 | 2179-03-03 11:37:00 | INDICATION: ___ year old man with nausea following incarcerated left inguinal
hernia s/p ex lap sigmoid colectomy and colostomy// Please assess for evidence
of gastric bubble
TECHNIQUE: Portable supine abdominal radiograph was obtained.
COMPARISON: Pelvic radiographs dated ___.
FINDINGS:
There is moderate gaseous distention of the large bowel, predominantly
involving the cecum and ascending colon, measuring up to 8.4 cm. No definite
ileus or obstruction. No pneumatosis or free intraperitoneal air. Skin
staples overlie the midline abdomen and left hemipelvis. Bilateral hip
prostheses are noted.
IMPRESSION:
Moderate gaseous distention of the cecum and ascending colon. No definite
ileus or obstruction.
|
10040984-RR-26 | 10,040,984 | 29,975,777 | RR | 26 | 2179-03-06 15:18:00 | 2179-03-06 16:49:00 | EXAMINATION: ABDOMEN US (COMPLETE STUDY)
INDICATION: ___ year old man with ETOH cirrhosis now accumulation of ascites
s/p abdominal surgery// portal vein thrombosis?
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: Abdominal ultrasound from ___.
FINDINGS:
LIVER: The liver is coarsened and nodular in echotexture. The contour of the
liver is nodular, consistent with cirrhosis. There is no focal liver mass. The
main, left and right portal veins are patent with hepatopetal flow. There is
a large recanalized paraumbilical vein. There is a small mount of perihepatic
ascites.
BILE DUCTS: There is no intrahepatic biliary dilation. The CHD measures 4 mm.
GALLBLADDER: There is no evidence of stones or gallbladder wall thickening.
PANCREAS: The 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: The spleen is enlarged, measuring 17.3 cm, and normal in echogenicity.
KIDNEYS: The left kidney measures 12.9 cm in length. The right kidney
measures 11.1 cm in length. There is a 1.8 x 1.1 x 1.3 cm cyst in the upper
pole of the left kidney. There is mild diffuse cortical thinning bilaterally.
There is no hydronephrosis.
RETROPERITONEUM: The visualized portions of aorta and IVC are within normal
limits.
IMPRESSION:
Cirrhosis of the liver with findings of portal hypertension, including
splenomegaly and a recanalized paraumbilical vein. Small amount of
perihepatic ascites. Patent main, left, and right portal veins.
|
10040984-RR-27 | 10,040,984 | 29,975,777 | RR | 27 | 2179-03-15 12:23:00 | 2179-03-15 13:31:00 | EXAMINATION: DX CHEST PORT LINE/TUBE PLCMT 1 EXAM
INDICATION: ___ year old man with placement of feeding tube today// Please
assess placement of newly placed feeding tube Please assess placement of
newly placed feeding tube
IMPRESSION:
In Comparison with the study of ___, there is an placement of a Dobhoff
tube that extends to the mid body of the stomach. The patient has taken a
better inspiration and the areas of increased opacification primarily in the
mid and upper lungs has cleared. No evidence of acute pneumonia or vascular
congestion at this time.
|
10041312-RR-11 | 10,041,312 | 26,413,298 | RR | 11 | 2169-10-28 18:58:00 | 2169-10-28 21:54:00 | INDICATION: ___ COPD, CHF (EF 40%) s/p perc chole for acute cholecystitis
self dc'ed ___ here with perihepatic fluid s/p ___ drainage of frank bile x
2.//please place percutaneous cholecystostomy tube and perihepatic drain.
COMPARISON: CT abdomen pelvis from ___
PROCEDURE: 1. CT-guided drainage of perihepatic collection.
2. CT guided percutaneous cholecystostomy tube placement.
OPERATORS: Dr. ___, radiology trainee and Dr. ___,
attending radiologist. Dr. ___ personally supervised the trainee
during the key components of the procedure and reviewed and agrees with the
trainee's findings.
TECHNIQUE: The risks, benefits, and alternatives of the procedure were
explained to the patient. After a detailed discussion, informed written
consent was obtained. A pre-procedure timeout using three patient identifiers
was performed per ___ protocol.
PERHEPATIC COLLECTION:
The patient was placed in a supine position on the CT scan table. Limited
preprocedure CT scan was performed to localize the collection. Preprocedural
images demonstrated the pigtail catheter to be retracted into the subcutaneous
soft tissues along the abdominal wall. The original pigtail catheter was
removed. Subsequently, based on the CT findings an appropriate skin entry
site for the drain placement was chosen. The site was marked. Local
anesthesia was administered with 1% Lidocaine solution.
Using intermittent CT fluoroscopy, ___ Exodus drainage catheter was
advanced via trocar technique into the collection. A sample of fluid was
aspirated, confirming catheter position within the collection. The pigtail
was deployed. The position of the pigtail was confirmed within the collection
via CT.
Approximately 400 cc of bilious fluid was drained with a sample sent for
microbiology evaluation. The catheter was secured by a StatLock. The catheter
was attached to bag. Sterile dressing was applied.
PERCUTANEOUS CHOLECYSTOSTOMY TUBE
Attention was then directed to the gallbladder. The patient remained in a
supine position on the CT scan table. Limited preprocedure CT scan was
performed to localize the gallbladder. Based on the CT findings an
appropriate skin entry site for the drain placement was chosen. The site was
marked. Local anesthesia was administered with 1% Lidocaine solution.
Using intermittent CT fluoroscopic and ultrasound guidance, an 18-G ___
needle was inserted into the collection. A sample of fluid was aspirated,
confirming needle position within the collection. 0.038 ___ wire was
placed through the needle and needle was removed. This was followed by
placement of ___ Exodus pigtail catheter into the collection. The plastic
stiffener and the wire were removed. The pigtail was deployed. The position
of the pigtail was confirmed within the collection via CT fluoroscopy.
The catheter was secured by a StatLock. The catheter was attached to bag.
Sterile dressing was applied.
The procedure was tolerated well, and there were no immediate post-procedural
complications.
DOSE: Acquisition sequence:
1) Spiral Acquisition 8.8 s, 26.9 cm; CTDIvol = 19.9 mGy (Body) DLP = 509.8
mGy-cm.
2) Stationary Acquisition 8.7 s, 1.4 cm; CTDIvol = 90.3 mGy (Body) DLP =
130.0 mGy-cm.
3) Spiral Acquisition 8.8 s, 26.9 cm; CTDIvol = 19.6 mGy (Body) DLP = 500.1
mGy-cm.
4) Stationary Acquisition 22.4 s, 1.4 cm; CTDIvol = 233.3 mGy (Body) DLP =
336.0 mGy-cm.
5) Spiral Acquisition 7.1 s, 21.8 cm; CTDIvol = 18.4 mGy (Body) DLP = 388.3
mGy-cm.
6) Stationary Acquisition 9.0 s, 1.4 cm; CTDIvol = 94.1 mGy (Body) DLP =
135.5 mGy-cm.
7) Spiral Acquisition 7.2 s, 22.2 cm; CTDIvol = 18.9 mGy (Body) DLP = 406.5
mGy-cm.
Total DLP (Body) = 2,414 mGy-cm.
SEDATION: Moderate sedation was provided by administering divided doses of 2
mg Versed and 125 mcg fentanyl throughout the total intra-service time of 80
minutes during which patient's hemodynamic parameters were continuously
monitored by an independent trained radiology nurse.
FINDINGS:
1. Pre-procedure images demonstrated retraction of the pigtail catheter along
the abdominal wall. A moderate amount of loculated perihepatic fluid was
seen. The gallbladder also appear to be distended with mild wall thickening.
2. Postprocedural images demonstrated appropriate position of the perihepatic
pigtail catheter, with significant interval improvement in the amount of
perihepatic collection.
3. There was appropriate position of the pigtail catheter within the
gallbladder.
IMPRESSION:
1. Successful CT-guided placement of ___ pigtail catheter into the
perihepatic collection. Samples were sent for microbiology evaluation.
2. Successful CT-guided ___ percutaneous cholecystostomy tube placement.
|
10041312-RR-5 | 10,041,312 | 26,413,298 | RR | 5 | 2169-10-24 14:51:00 | 2169-10-24 16:03:00 | INDICATION: ___ COPD, CHF (EF 40%) s/p perc chole for acute cholecystitis
self dc'ed ___ here with perihepatic fluid likely from cholecystostomy site//
please review imaging, drainage of the perihepatic fluid collection and
replacement of perc chole if possible
TECHNIQUE: Ultrasound guided diagnostic paracentesis
COMPARISON: Outside CT from
FINDINGS:
Limited grayscale ultrasound imaging of the abdomen demonstrated a small
amount of ascites. A suitable target in the deepest pocket in the right upper
quadrant was selected for paracentesis. The gallbladder is stone filled with
no distention and no bile pocket to allow for percutaneous cholecystostomy.
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.
A 5 ___ catheter was advanced into the largest fluid pocket in the right
upper quadrant and 0.45 L of dark green, bilious fluid were removed. Fluid
samples were submitted to the laboratory for bilirubin and culture.
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. 0.45 L of fluid were removed.
NOTIFICATION: The findings were discussed with Dr. ___. by ___
___, M.D. on the telephone on ___ at 4:02 pm, 5 minutes after discovery
of the findings.
|
10041312-RR-6 | 10,041,312 | 26,413,298 | RR | 6 | 2169-10-25 08:37:00 | 2169-10-25 09:17:00 | EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ COPD, CHF (EF 40%) s/p perc chole for acute cholecystitis
self dc'ed ___ here with perihepatic fluid s/p ___ drainage of frank bile.
Assess for interval change in fluid collection.
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained with a limited focus to the upper abdomen.
COMPARISON: ___ ultrasound-guided paracentesis
___ abdomen and pelvis CT
FINDINGS:
The hepatic parenchyma appears within normal limits. The contour of the liver
is smooth. There is no focal liver mass. The main portal vein is patent with
hepatopetal flow.
There is moderate perihepatic ascites similar to the images obtained during
ultrasound-guided paracentesis 1 day prior. Additionally, there is a smaller,
loculated 5.6 x 2.0 x 5.0 cm fluid collection in the anterior midline upper
abdomen with its superior edge in very close proximity to the perihepatic
ascites comparing to the CT obtained 2 days prior, this may correspond to an
area of apparent trace fluid seen on the midline in series 602b, image 41;
series 2, image 42. This area appears to have a small connection with the
perihepatic ascites.
BILE DUCTS: There is no intrahepatic biliary dilation. The CHD measures 4 mm.
GALLBLADDER: Cholelithiasis.
SPLEEN: Normal echogenicity, measuring 5.5 cm.
IMPRESSION:
1. Reaccumulation of perihepatic ascites appears overall similar to the images
obtained prior to ultrasound-guided paracentesis 1 day prior. There is a more
loculated portion measuring 5.6 x 2.0 x 5.0 cm in the midline upper abdomen
which appears to be connected to the perihepatic ascites
2. Cholelithiasis.
|
10041312-RR-7 | 10,041,312 | 26,413,298 | RR | 7 | 2169-10-26 09:15:00 | 2169-10-26 12:17:00 | EXAMINATION: Ultrasound-guided percutaneous image guided fluid catheter
placement.
INDICATION: ___ COPD, CHF (EF 40%) s/p perc chole for acute cholecystitis
self dc'ed ___ here with perihepatic fluid s/p ___ drainage of frank bile now
with unchanged perihepatic fluid and antoher loculation// ?drainage of
perihepatic fluid and mid abdominal loculation
COMPARISON: Abdominal ultrasound from ___. CT abdomen pelvis from
___.
PROCEDURE: Ultrasound-guided drainage of the re-accumulated fluid collection
in the right upper quadrant.
OPERATORS: Dr. ___, radiology fellow and Dr. ___,
attending radiologist. Dr. ___ personally supervised the trainee
during the key components of the procedure and reviewed and agree with the
trainee's findings.
TECHNIQUE: The risks, benefits, and alternatives of the procedure were
explained to the patient. After a detailed discussion, informed written
consent was obtained. A pre-procedure timeout using three patient identifiers
was performed per ___ protocol.
The patient was placed in a supine position on the US scan table. Limited
preprocedure ultrasound was performed to localize the collection. Based on
the ultrasound findings an appropriate skin entry site for the drain placement
was chosen. The site was marked. Local anesthesia was administered with 1%
Lidocaine solution.
Using continuous sonographic guidance, attempts were made to introduce a
___ Exodus drainage catheter was advanced via trocar technique into the
collection. However, there was tenting of the peritoneum and the catheter
could not be advanced. Trocar insertion was then reattemdpted at a steeper
angle, again unsuccessful. An 18 gauge ___ needle was then introduced in
the collection, 2 cc of bile were aspirated, a0.35 ___ wire was advanced
and into the collection and the drainage catheter was then advanced over the
wire. the pigtail was deployed. The position of the pigtail was confirmed
within the collection via ultrasound.
Approximately 160 cc of dark green bilious fluid was drained. Given that
samples were recently submitted to the laboratory for bilirubin and culture
from prior paracentesis dated ___, samples were not submitted for
microbiology evaluation today. The catheter was secured by a StatLock. The
catheter was attached to bag. Sterile dressing was applied.
The procedure was tolerated well, and there were no immediate post-procedural
complications.
SEDATION: Moderate sedation was provided by administering divided doses of
1.5 mg Versed and 75 mcg fentanyl throughout the total intra-service time of
35 minutes during which patient's hemodynamic parameters were continuously
monitored by an independent trained radiology nurse.
FINDINGS:
Perihepatic fluid collection
IMPRESSION:
1. Technically successful US-guided placement of ___ pigtail catheter
into the right upper quadrant fluid collection.
2. 160 cc of dark green bilious fluid was removed.
|
10041312-RR-8 | 10,041,312 | 26,413,298 | RR | 8 | 2169-10-28 09:45:00 | 2169-10-28 12:57:00 | EXAMINATION: US ABD LIMIT, SINGLE ORGAN
INDICATION: ___ COPD, CHF (EF 40%) s/p perc chole for acute cholecystitis
self dc'ed ___ here with perihepatic fluid s/p ___ drainage of frank bile x
2.// assess fluid collection, assess drain position
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: None.
FINDINGS:
LIVER: In the right upper quadrant there is septated fluid in the perihepatic
space. Despite diligent effort the ___ drain could not be identified with
ultrasound. A right pleural effusion is also noted.
IMPRESSION:
Perihepatic fluid again identified and a small right pleural effusion is
noted. Despite effort the right upper quadrant drain could not be identified
with ultrasound. The CT is recommended for further evaluation.
RECOMMENDATION(S): CT recommended for further evaluation as the drain in
question could not be identified with ultrasound.
|
10041312-RR-9 | 10,041,312 | 26,413,298 | RR | 9 | 2169-10-28 10:41:00 | 2169-10-28 13:56:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ COPD, CHF (EF 40%) s/p perc chole for acute cholecystitis
self dc'ed ___ here with perihepatic fluid s/p ___ drainage of frank bile x 2
with continued O2 requirement.// ?pneumonia, ?effusion, ?edema, ?reason for
continued O2 requirement ?pneumonia, ?effusion, ?edema, ?reason for
continued O2 requirement
IMPRESSION:
Compared to chest radiographs since ___ most recently ___.
Moderate right pleural effusion has increased since ___, accompanied by
increasing atelectasis right middle and lower lobes. Triangular air
collection projecting to the right of the ascending thoracic aorta could be
hyperexpansion of a bulla due to transient positive pressure ventilation or
bronchial obstruction. Follow-up advised.
Moderate cardiomegaly is stable. Aside from minimal subsegmental atelectasis,
left lung is clear.
|
10041429-RR-20 | 10,041,429 | 28,466,281 | RR | 20 | 2114-03-05 13:24:00 | 2114-03-05 15:06:00 | EXAMINATION: LUMBAR SINGLE VIEW IN OR
INDICATION: L4-S1 fusion
TECHNIQUE: Screening provided in the operating room without a radiologist
present.
FINDINGS:
Images demonstrate instrumentation in the lumbar spine. Interbody devices are
seen at L4-5 and L5-S1 (presumed levels). For details of the procedure,
please consult the procedure report.
|
10041429-RR-23 | 10,041,429 | 28,466,281 | RR | 23 | 2114-03-09 08:20:00 | 2114-03-09 09:44:00 | EXAMINATION: LUMBAR SINGLE VIEW IN OR
INDICATION: L4-S1 fusion
TECHNIQUE: Screening provided knee operating room without a radiologist
present.
COMPARISON: ___
FINDINGS:
Interbody devices at the presumed L4-5 and L5-S1 levels are seen as on prior
study. Current exam demonstrates placement of transpedicular screws from L4
through S1 presumed levels. There are background degenerative changes.
IMPRESSION:
Screening for procedure guidance. Please see operative report for details.
|
10041429-RR-24 | 10,041,429 | 28,466,281 | RR | 24 | 2114-03-09 14:32:00 | 2114-03-09 15:27:00 | EXAMINATION: Chest Radiograph
INDICATION: ___ year old woman with PICC// pt had a R PICC,47cm ___ ___
Contact name: ___: ___
TECHNIQUE: Portable Chest
COMPARISON: None.
FINDINGS:
Right PICC ends in the atrium and can be pulled back 5.0 cm for positioning at
or above the cavoatrial junction. Cardiomediastinal silhouette is normal.
There is no pleural effusion or pneumothorax.
IMPRESSION:
Right PICC ends in the atrium and can be pulled back 5.0 cm for positioning at
or above the cavoatrial junction.
NOTIFICATION: Findings discussed over the telephone with ___ the IV nurse
by Dr. ___ on ___ at 15:30, 5 minutes after findings were made.
|
10041429-RR-25 | 10,041,429 | 20,403,729 | RR | 25 | 2114-04-04 03:15:00 | 2114-04-04 05:03:00 | INDICATION: ___ with recent spinal fusion surgery with fever, back in the
left lower quadrant pain. Patient also notes she has a slipped lap band. //
Lap band position? Abscess in the left lower quadrant?
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired
through the abdomen and pelvis following intravenous contrast administration
with split bolus technique.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Stationary Acquisition 8.0 s, 0.5 cm; CTDIvol = 38.5 mGy (Body) DLP =
19.3 mGy-cm.
2) Spiral Acquisition 5.0 s, 55.4 cm; CTDIvol = 9.5 mGy (Body) DLP = 524.4
mGy-cm.
Total DLP (Body) = 544 mGy-cm.
COMPARISON: None.
FINDINGS:
LOWER CHEST: Visualized lung fields are within normal limits. There is no
evidence of pleural or pericardial effusion.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There is no evidence of focal lesions. There is no evidence of intrahepatic
or extrahepatic biliary dilatation. The gallbladder is surgically absent.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
There is no evidence of focal renal lesions or hydronephrosis. There is no
perinephric abnormality.
GASTROINTESTINAL: There is a moderate hiatal hernia with prominent gastric
pouch and lap band in the left upper quadrant. The stomach is otherwise
unremarkable. Small bowel loops demonstrate normal caliber, wall thickness,
and enhancement 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 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: There is no abdominal aortic aneurysm. No atherosclerotic disease
is noted.
BONES: Post lumbar fusion with posterior transpedicle screws, anterior
fixation screws, and intervertebral spacers from L4 through S1. There is no
evidence of acute fracture.
SOFT TISSUES: A large slightly rim enhancing fluid collection posterior to the
spinal fusion hardware in the subcutaneous soft tissues measures 17.0 X 2.3 x
6.1 cm (2:50, 602b: 42).
IMPRESSION:
1. Large fluid collection in the soft tissues posterior to the lumbar fusion
surgical bed could represent abscess or post operative seroma.
2. Moderate hiatal hernia and increased stomach above the band consistent with
slipped lap band.
|
10041690-RR-40 | 10,041,690 | 23,389,330 | RR | 40 | 2139-11-22 23:28:00 | 2139-11-23 13:42:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with minimal PMH and severe hyponatremia// Eval
for infection or malignancy
TECHNIQUE: AP portable chest radiograph
COMPARISON: ___
FINDINGS:
The lungs are hyperexpanded. There is no focal consolidation, pleural
effusion or pneumothorax identified. The size of the cardiomediastinal
silhouette is within normal limits. The bony thorax is grossly intact.
IMPRESSION:
No acute cardiopulmonary abnormality.
|
10041894-RR-18 | 10,041,894 | 29,235,759 | RR | 18 | 2140-12-06 16:37:00 | 2140-12-06 16:56:00 | EXAMINATION: CHEST PORT. LINE PLACEMENT
INDICATION: ___ year old man with new L PICC // L DL Power PICC 45cm ___
___ Contact name: ___: ___ L DL Power PICC 45cm ___ ___
IMPRESSION:
No previous images. There is been placement of a left subclavian PICC line
that extends to the lower portion of the SVC. There is substantial
enlargement of the cardiac silhouette in a patient with intact midline sternal
wires. No definite vascular congestion. Mild blunting of the left
costophrenic angle with opacification at the left base suggests small pleural
effusion and atelectatic changes.
|
10041894-RR-19 | 10,041,894 | 29,235,759 | RR | 19 | 2140-12-06 20:04:00 | 2140-12-07 11:14:00 | EXAMINATION: MR ___ SPINE W/O CONTRAST ___ MR SPINE
INDICATION: ___ male with endocarditis and bacteremia experiencing
back pain and tenderness.
TECHNIQUE: Sagittal imaging was performed with T2, T1, and IDEAL technique,
followed by axial T2 imaging. Oblique coronal T1 sequences through the sacrum
was performed. Patient could not tolerate complete sacral spine imaging or
postcontrast imaging.
COMPARISON: None.
FINDINGS:
Please note, evaluation is suboptimal secondary to lack of IV contrast and
sacral imaging secondary to patient intolerance of the exam. Within this
confine:
There is normal lumbar alignment. The vertebral body heights are preserved.
There are chronic central endplate deformities consistent with Schmorl's
nodes. There is more prominent endplate deformity at L4-L5, also likely
secondary to chronic Schmorl's nodes. There multilevel heterogeneous
degenerative endplate changes with prominent ___ type 2 change at L4-L5.
There is T2 hyperintensity marginating the L3-L4 endplates with T2
hyperintensity within the L4-L5 intervertebral disc spaces, likely reflecting
degenerative change. There is no epidural fluid collection, loss of cortical
signal, or paraspinal edema to suggest an infectious process. There is
significant loss of intervertebral disc height at L5-S1. The conus
demonstrates normal signal morphology, terminating appropriately at the L1-L2
level. There is an undulating course of the cauda equina nerve roots, likely
secondary to stenoses.
At T12-L1 there is disc bulge without significant neural foramina or spinal
canal stenosis.
At L1-L2 there is disc bulge, facet osteophytes, and ligamentum flavum
thickening causing mild spinal canal narrowing and mild bilateral neural
foraminal stenosis.
At L2-L3, there is disc bulge, facet osteophytes, and ligamentum flavum
thickening causing severe spinal canal stenosis which crowds the central nerve
roots and compresses the traversing L3 nerve roots in the subarticular zones
(07:16). There is mild to moderate left and mild right neural foraminal
stenosis.
At L3-L4 there is disc bulge, facet osteophytes, and ligamentum flavum
thickening causing severe spinal canal stenosis which crowds and contacts the
central nerve roots and compresses the traversing L4 nerve roots in the
subarticular zones. There is mild-to-moderate bilateral neural foraminal
stenosis.
At L4-L5 there is disc bulge, facet osteophytes, and ligamentum flavum
thickening causing moderate spinal canal stenosis. There is mild bilateral
neural foraminal stenosis.
At L5-S1 there intervertebral and facet osteophytes and ligamentum flavum
thickening causing mild-to-moderate central canal stenosis and severe
subarticular zone stenosis which contacts the traversing S1 nerve roots
(06:18). There is moderate bilateral neural foraminal stenosis.
There are mild degenerative changes of the sacroiliac joints on the axial
coronal T1 oblique, without osseous lesion or neural foraminal stenosis.
There is colonic diverticulosis.
IMPRESSION:
1. Due to patient discomfort postcontrast imaging and multiplanar,
multisequence imaging of the sacrum were not performed.
2. L2-L3 and L3-L4 severe spinal canal stenosis which crowds the central nerve
roots and compresses the traversing L3 and L4 nerve roots in the subarticular
zones.
3. L5-S1 subarticular zone stenosis which contacts the traversing S1 nerve
roots.
4. Edema at L3-L4 articulating endplates with fluid signal within the
intervertebral disc space, likely representing degenerative type ___ ___
change. No specific findings for infection, without cortical dehiscence,
epidural fluid, or paraspinal soft tissue edema. Recommend clinical
correlation. If there is high suspicion for infection, consider follow-up
postcontrast imaging to assess for interval change.
|
10041894-RR-22 | 10,041,894 | 29,235,759 | RR | 22 | 2140-12-08 18:54:00 | 2140-12-09 08:07:00 | EXAMINATION: MR ___ SPINE WITH CONTRAST T___ MR SPINE
INDICATION: ___ year old man with bacteremia / endocarditis, also with low
back pain // pt had precontrast images last night to look for evidence of
lumbar or SI joint infectious process; still needs postcontrast images as did
not tolerate procedure yesterday; please obtain post-contrast images of lumbar
spine and SI joints and sacrum
TECHNIQUE: Sagittal and axial T1 images obtained after the uneventful
intravenous administration of mL of Gadavist contrast agent.
COMPARISON: MRI lumbar spine ___
MRI pelvis ___
FINDINGS:
There is no enhancement within the vertebral bodies, intervertebral disc
spaces, spinal cord, or nerve roots of the cauda equina. No epidural fluid
collections or masses are identified. No abnormal enhancement is identified
within the paraspinal soft tissues. The appearance of the lumbar spine is
unchanged from the prior examination.
No enhancement is seen within the visualized sacroiliac joints. Simple cysts
of the left kidney is noted.
IMPRESSION:
No enhancement to support discitis, osteomyelitis. No epidural or
prevertebral fluid collection.
|
10041894-RR-23 | 10,041,894 | 29,235,759 | RR | 23 | 2140-12-08 18:54:00 | 2140-12-09 08:37:00 | EXAMINATION: MR ___
INDICATION: ___ year old man with bacteremia and lower back pain // see rec
for MRI lumbar spine
TECHNIQUE: Following the administration of 8 mL Gadavist, multiplanar
multisequence T1 and T2 weighted images were obtained in a 1.5 Tesla magnet.
COMPARISON: MR lumbar spine dated ___
FINDINGS:
Examination is targeted to evaluation of the sacrum and SI joints.
At the extreme inferior edge of both SI joints, there are punctate areas of
high STIR signal. These are of uncertain etiology or significance, but could
represent trace amount of fluid immediately adjacent to the SI joint.
However, the remainder of the SI joints are are within normal limits. No
other fluid within the joint or adjacent to it and no areas of surrounding
marrow edema in a raise concern for infectious sacroiliitis or osteomyelitis.
The sacrum and coccyx are otherwise within normal limits.
Multilevel degenerative change is noted in the lumbar spine, No including
areas of marrow edema surrounding 1 of the lower lumbar spine discs, more
completely evaluated on L-spine MRI is examinations obtained on ___. .
Note is made of scattered muscle and soft tissue edema, including edema seen
in the gluteus and deep to the iliacus muscles and adjacent to the
left-greater-than-right psoas muscles. Edema is also seen in the partially
imaged adductor musculature. There is also scattered edema in the
subcutaneous and presacral fat. In the left gluteus maximus muscle near the
coccyx, there is an area of more pronounced focally more pronounced soft
tissue edema, which also demonstrates enhancement on the post-contrast images
(6:35, 7:36). This could represent an area of intramuscular phlegmon.
Assessment of intrapelvic soft tissue structures is quite limited. Allowing
for this,
there is a small amount of free fluid in the pelvis.
scattered diverticuli are noted in the sigmoid colon. There is mild
prostatomegaly. This examination is not optimized for detailed assessment of
the prostate.
No visualized lymphadenopathy by size criteria.
IMPRESSION:
1. Punctate foci of high T2 signal are seen along the inferior edge of both
SI joints. The appearance is not typical for infectious or inflammatory
sacroiliitis. Otherwise, the sacroiliac joints are within normal limits.
2. No evidence of osteomyelitis or abscess formation.
3. Diffuse soft tissue edema including small amount of pelvic free fluid, an
atypical finding in a male.
4. Focal edema and enhancement in the left gluteus muscle near the coccyx
could represent a focal area of phlegmon. The differential diagnosis could
include an site of prior intramuscular injection.
5. Please see separate report of L-spine MRI performed on ___.
|
10042037-RR-17 | 10,042,037 | 25,017,311 | RR | 17 | 2165-10-03 13:45:00 | 2165-10-03 15:17:00 | INDICATION: History of heroin abuse and leukocytosis. Evaluation for
pneumonia.
COMPARISON: None.
FINDINGS: PA and lateral chest radiographs demonstrate no focal
consolidation, pleural effusion, or pneumothorax. The cardiomediastinal
silhouette is normal.
IMPRESSION: No acute cardiopulmonary process.
|
10042350-RR-11 | 10,042,350 | 23,080,531 | RR | 11 | 2118-05-27 16:00:00 | 2118-05-27 17:22:00 | EXAMINATION: CT-guided right lower quadrant abscess drainage.
INDICATION: ___ year old man with clinical presentation, history, and
radiographic evidence of perforated appendicitis. reviewed with radiology //
please drain, leave pigtail, send for culture
COMPARISON: CT abdomen pelvis ___.
PROCEDURE: CT-guided drainage of a right lower quadrant collection with
placement of an 8 ___ drainage catheter.
OPERATORS: Dr. ___ interventional ___ fellow and Dr.
___ radiologist. Dr. ___ supervised the trainee
during the key components of the procedure and reviewed and agrees with the
trainee's findings.
TECHNIQUE: The risks, benefits, and alternatives of the procedure were
explained to the patient. After a detailed discussion, informed written
consent was obtained. A pre-procedure timeout using three patient identifiers
was performed per ___ protocol.
The patient was placed in a supine position on the CT scan table. Limited
preprocedure CTscan was performed to localize the collection. Based on the CT
findings an appropriate skin entry site for the drain placement was chosen.
The site was marked. Local anesthesia was administered with 1% Lidocaine
solution.
Using intermittent CT fluoroscopic guidance, an 18-G ___ needle was
inserted into the right lower quadrant collection. A sample of fluid was
aspirated, confirming needle position within the collection. 0.038 ___
wire was placed through the needle and needle was removed. This was followed
by placement of ___ pigtail catheter into the collection. The plastic
stiffener and the wire were removed. The pigtail was deployed. The position
of the pigtail was confirmed within the collection via CT fluoroscopy.
Approximately 60 cc of purulent fluid was aspirated with a sample sent for
microbiology evaluation. The catheter was secured by a StatLock. The catheter
was attached to bag. Sterile dressing was applied.
The procedure was tolerated well, and there were no immediate post-procedural
complications.
DOSE: DLP: 371 mGy-cm
SEDATION: Moderate sedation was provided by administering divided doses of 2
mg Versed and 150 mcg fentanyl throughout the total intra-service time of 16
minutes during which patient's hemodynamic parameters were continuously
monitored by an independent trained radiology nurse.
FINDINGS:
1. Pre-procedure CT demonstrates large right lower quadrant fluid collection
as seen on dedicated CT from ___, difficult to measure due to lack of
contrast.
2. Postprocedural CT demonstrates appropriate positioning of the catheter.
IMPRESSION:
Successful CT-guided placement of an ___ pigtail catheter into the right
lower quadrant collection with removal of 60 cc purulent fluid. Culture and
sensitivity sent.
|
10042350-RR-12 | 10,042,350 | 23,080,531 | RR | 12 | 2118-05-28 01:22:00 | 2118-05-28 11:03:00 | INDICATION: ___ y.o. M with per-appendiceal abscess, s/p ___ drain spiking
fevers // ___ y.o. M with per-appendiceal abscess, s/p ___ drain spiking fevers
TECHNIQUE: Portable erect
COMPARISON: No prior for comparison
FINDINGS:
The lungs are clear of interstitial or airspace opacity. No pleural effusions
or pneumothorax. The cardiomediastinal silhouette is not enlarged. Multiple
distended loops of colon are visualized in the upper abdomen.
IMPRESSION:
No acute intrathoracic disease.
|
10042769-RR-34 | 10,042,769 | 23,079,910 | RR | 34 | 2154-03-03 19:37:00 | 2154-03-04 00:10:00 | CT OF THE ABDOMEN AND PELVIS
HISTORY: Complex fluid in the right lower quadrant and flank.
COMPARISONS: CT studies from ___ and ___.
TECHNIQUE: Multidetector CT images of the abdomen and pelvis were obtained
with intravenous contrast, and sagittal and coronal reformations were also
performed.
FINDINGS:
CT ABDOMEN: Calcified pleural plaques are unchanged. There is a moderate
right-sided pleural effusion and a small-to-moderate left-sided effusion.
These have increased since the prior examination. Associated bibasilar
atelectasis is also present.
The patient is status post cholecystectomy. A nodule in the right adrenal
gland measures 24 x 18 mm in axial ___, not significantly changed. The
left adrenal gland is mildly thickened, but without discrete nodules and also
unchanged. The spleen is normal in size and appearance. Several cysts in the
left kidney appear unchanged and a cortical defect along the lateral left mid
upper pole is also unchanged. Along the lower pole of the right kidney, a
substantial cortical defect is likewise stable and there is a small cyst in
the interpolar region.
The stomach and small bowel appear within normal limits. Moderate sigmoid
diverticulosis is noted.
CT PELVIS: There is massive recurrent fluid collection interposed between the
right iliac wing and psoas, with heterogeneous, but predominantly low density
contents suggesting fluid. Tracks along the right femoral canal into the
upper thigh and the collection have considerable mass effect on the right
iliac and femoral vessels as well as the right psoas, which is splayed
forward. In maximum axial ___, the collection measures up to 16.7 x
9.8 cm compared to 9.7 x 16.4 previously. Several metallic density suggesting
brachytherapy seeds are present in the lower pelvis about the prostate. The
seminal vesicles and bladder are unremarkable. The common iliac arteries are
tortuous and patchy vascular calcifications are present. There is no
lymphadenopathy or ascites. In association with mass effect from large
complex fluid collection, there is diffuse swelling of the right leg and
compression of the common femoral vein.
BONE WINDOWS: The patient is status post right total hip replacement.
Moderate degenerative changes are similar along the lumbar spine. There are
no suspicious lytic or blastic bone lesions. The bones appear demineralized
to some degree.
IMPRESSION: Large fluid collection, similar to what was seen previously in
___, little if at all changed. Correlation with interval history is
recommended.
|
10042769-RR-37 | 10,042,769 | 23,079,910 | RR | 37 | 2154-03-04 13:19:00 | 2154-03-04 17:32:00 | REASON FOR THE EXAMINATION: This is a ___ man with chronic right
groin pelvic cyst that has reaccumulated and is symptomatic. The request is
to drain the fluid collection and to send the fluid to culture and Gram stain.
COMPARISON: CT of the abdomen from ___.
PROCEDURE: The risks, alternatives, and benefits of the procedure were
explained to the patient, and written informed consent was obtained. A
preprocedure timeout was performed verifying patient identity using three
patient identifiers and the procedure to be performed. The skin was prepared
and draped in standard sterile fashion. Local anesthesia was achieved via
subcutaneous injection of 1% lidocaine buffered with bicarbonate. Under
ultrasound guidance, ___ catheter was advanced into the fluid collection,
and 950 cc of blood stained fluid was aspirated. No residual fluid was
detected in the end of the procedure.
Pre-procedure limited ultrasound examination revealed large complex fluid
collection with a superior margin anterior to the right superior anterior
iliac spine and an inferior margin in the right groin. There are multiple
septations and frondlike projections consistent with synovitis and iliopsoas
bursitis.
A sample was sent to microbiology for analysis.
The patient tolerated the procedure well with no complication evident at the
time of the procedure.
The attending radiologist, Dr. ___, was present throughout the procedure.
IMPRESSION:
1. Technically successful aspiration of fluid from right iliopsoas bursa.
Microbiology is pending.
2. Findings suggestive of iliopsoas bursitis with marked synovial
proliferation.
|
10042793-RR-4 | 10,042,793 | 24,693,778 | RR | 4 | 2141-04-29 00:33:00 | 2141-04-29 01:56:00 | EXAMINATION: Chest radiograph
INDICATION: ___ with fall, fever. Evaluate for acute process.
TECHNIQUE: Frontal chest radiograph
COMPARISON: Chest radiograph from ___.
FINDINGS:
Lungs are mildly hyperinflated. No focal consolidation is seen. Heart is
mildly enlarged, unchanged from prior exam. There is no pleural effusion or
pneumothorax. Small hiatal hernia is stable. Moderate degenerative changes
of the bilateral AC joints are noted with narrowing of the acromio-humeral
interval on the right.
IMPRESSION:
No focal consolidation. Stable small hiatal hernia and mild cardiomegaly.
|
10042793-RR-5 | 10,042,793 | 24,693,778 | RR | 5 | 2141-04-29 00:33:00 | 2141-04-29 01:53:00 | EXAMINATION: PELVIS (AP ONLY)
INDICATION: ___ with hip pain. Evaluate for fracture.
TECHNIQUE: Frontal pelvic radiograph
COMPARISON: None.
FINDINGS:
Evaluation of the sacrum is limited due to overlying bowel gas. Otherwise,
there is no evidence of acute fracture or displacement. The pelvic ring is
intact. There is no diastasis of the pubic symphysis. Mild degenerative
changes of the lumbar spine and hip joints are seen. Soft tissue
calcifications are demonstrated in the gluteal regions bilaterally.
IMPRESSION:
No evidence of acute fracture or dislocation with limited evaluation of the
sacrum due to overlying bowel gas.
RECOMMENDATION(S): If concern for occult fracture, consider CT.
|
10042793-RR-6 | 10,042,793 | 24,693,778 | RR | 6 | 2141-04-29 00:33:00 | 2141-04-29 01:16:00 | EXAMINATION: WRIST(3 + VIEWS) RIGHT
INDICATION: ___ with right wrist pain, c/f fracture at OSH. Evaluate for
fracture
TECHNIQUE: Frontal, oblique, and lateral view radiographs of the right wrist.
COMPARISON: Radiograph from ___ at 20:29.
FINDINGS:
Splinting material overlying the wrist and hand limits evaluation for fine
detail. Within these limits, again seen is distal radial fracture with dorsal
angulation, overall not significantly changed in alignment compared to prior
exam. Intra-articular extension of the fracture is better seen on the prior
exam. No other acute fracture is seen. Mild degenerative changes of the
first CMC is noted. Carpal bones are well aligned.
IMPRESSION:
Status post splinting, mildly limiting evaluation. Unchanged alignment of
distal radial fracture with dorsal angulation and intra-articular extension.
|
10042793-RR-7 | 10,042,793 | 24,693,778 | RR | 7 | 2141-04-29 04:52:00 | 2141-04-29 05:14:00 | EXAMINATION: WRIST(3 + VIEWS) RIGHT
INDICATION: ___ with right wrist fracture. Postreduction.
TECHNIQUE: Frontal, oblique, and lateral view radiographs of the right wrist.
COMPARISON: Radiographs from ___ at 00:36.
FINDINGS:
Overlying cast material limits evaluation of fine detail. There is an
unchanged slightly impacted, dorsally angulated distal fracture of the radius.
As previously, intra-articular extension is better seen on the prior
radiograph. Otherwise, no significant interval changes noted.
IMPRESSION:
Unchanged overall alignment of dorsally angulated distal radial fracture with
for intra-articular extension, which is better seen on prior radiograph.
|
10042793-RR-8 | 10,042,793 | 24,693,778 | RR | 8 | 2141-04-29 06:21:00 | 2141-04-29 06:39:00 | EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: History: ___ with bilateral sah// interval progression. Please
schedule for morning ___ approximately, exact timing not important)
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Total DLP: 447 mGy-cm.
COMPARISON: CT head from ___.
FINDINGS:
Again seen is subarachnoid hemorrhage along the frontal and temporal lobes
bilaterally. The volume of hemorrhage in the right sylvian fissure appears
slightly larger than on the prior study. There is no significant shift of
midline structures. There is no evidence of infarction. The ventricles are
enlarged in an atrophic pattern, but well within the range expected for age.
Previously noted significant right frontal and periorbital swelling and
hematoma have subsided.
There is no fracture. Mild mucosal thickening of the bilateral ethmoid air
cells are stable. There is mild hyperostosis of the right maxillary wall with
mild mucosal thickening. There is hypodense appearance of the right maxillary
ridge, unchanged. Otherwise, the visualized portion of the paranasal sinuses,
mastoid air cells, and middle ear cavities are clear. Patient is status post
bilateral lens replacements. Otherwise, the visualized portion of the orbits
are unremarkable.
IMPRESSION:
Slight increase in the volume of subarachnoid hemorrhage, particularly in the
right sylvian fissure, since the prior study. Otherwise unchanged
examination.
|
10042793-RR-9 | 10,042,793 | 24,693,778 | RR | 9 | 2141-04-29 12:04:00 | 2141-04-29 13:51:00 | EXAMINATION: WRIST(3 + VIEWS) RIGHT
INDICATION: ___ year old woman with s/p fall right radius fracture s/p splint
application.// post splinting. compare to prior study post splinting.
compare to prior study
TECHNIQUE: Frontal, oblique, and lateral view radiographs of the right wrist.
COMPARISON: ___ at 04:52
IMPRESSION:
Overlying cast material obscures fine bony detail. Similar appearance of
slightly impacted, dorsally angulated distal intra-articular fracture of the
radius.
|
10042896-RR-26 | 10,042,896 | 27,960,228 | RR | 26 | 2147-11-02 16:07:00 | 2147-11-02 16:25:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: History: ___ with pleuritic right sided chest pain, evaluate for
pneumothorax
TECHNIQUE: Chest PA and lateral
COMPARISON: None.
FINDINGS:
Heart size is normal. The mediastinal and hilar contours are unremarkable.
The pulmonary vasculature is not engorged. Wedge-shaped opacity is seen
within the periphery of the right lower lobe adjacent to the costophrenic
angle. Streaky atelectasis is noted within the retrocardiac region. No
definite pleural effusion or pneumothorax is present. No acute osseous
abnormality is visualized.
IMPRESSION:
Wedge-shaped opacity within the periphery of the right lower lobe concerning
for pulmonary infarction and further assessment with chest CTA is recommended
to evaluate for pulmonary embolism. No pneumothorax.
NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___
on the telephone on ___ at 4:27 pm.
|
10042896-RR-27 | 10,042,896 | 27,960,228 | RR | 27 | 2147-11-02 17:17:00 | 2147-11-02 18:23:00 | EXAMINATION: CTA CHEST WITH CONTRAST
INDICATION: History: ___ with 2 days of pleuritic chest pain and right lower
lobe wedge-shaped infarct on CXR// any evidence of pulmonary embolism?
TECHNIQUE: Axial multidetector CT images were obtained through the thorax
after the uneventful administration of intravenous contrast. Reformatted
coronal, sagittal, thin slice axial images, and oblique maximal intensity
projection images were submitted to PACS and reviewed.
DOSE: Acquisition sequence:
1) Stationary Acquisition 2.0 s, 0.5 cm; CTDIvol = 6.1 mGy (Body) DLP = 3.0
mGy-cm.
2) Spiral Acquisition 4.0 s, 31.3 cm; CTDIvol = 10.5 mGy (Body) DLP = 327.3
mGy-cm.
Total DLP (Body) = 330 mGy-cm.
COMPARISON: Chest radiograph ___ at 16:07
FINDINGS:
HEART AND VASCULATURE: Filling defects are demonstrated within the segmental
and subsegmental branches of the right lower lobe pulmonary artery anteriorly
compatible with pulmonary emboli (3:147). No additional pulmonary emboli are
detected. The main pulmonary artery is normal in caliber. 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: Small right pleural effusion is demonstrated. There is no
pneumothorax.
LUNGS/AIRWAYS: Wedge-shaped focal opacity along the anterior periphery of the
right lower lobe is compatible with pulmonary infarction. There is dependent
bilateral lower lobe atelectasis. The airways are patent to the level of the
segmental bronchi bilaterally.
BASE OF NECK: Visualized portions of the base of the neck show clips in the
right paratracheal region compatible with prior right thyroidectomy.
ABDOMEN: Included portion of the upper abdomen demonstrates cholelithiasis.
BONES: No suspicious osseous abnormality is seen.? There is no acute fracture.
IMPRESSION:
1. Segmental and subsegmental pulmonary emboli within the right lower lobe
associated with pulmonary infarction in the peripheral anterior aspect of the
right lower lobe. No CT evidence for right heart strain.
2. Small right pleural effusion.
3. Cholelithiasis.
NOTIFICATION: The findings were discussed with ___, M.D. by
___, M.D. on the telephone on ___ at 5:49 pm, 5 minutes
after discovery of the findings.
|
10043039-RR-19 | 10,043,039 | 24,987,075 | RR | 19 | 2133-03-29 10:46:00 | 2133-03-29 13:28:00 | EXAMINATION: TIB/FIB (AP AND LAT) IN O.R. RIGHT
INDICATION: ORIF R TIB PLATEAU
IMPRESSION:
Intraoperative images of the tib fib ORIF are provided. Please see the
operative note for full details.
|
10043321-RR-10 | 10,043,321 | 29,686,634 | RR | 10 | 2154-01-03 18:17:00 | 2154-01-03 19:51:00 | EXAM: Chest frontal and lateral views.
CLINICAL INFORMATION: Hypoxia.
___.
FINDINGS: Frontal and lateral views of the chest were obtained. There is
minimal prominence of the interstitium which may be due to slight interstitial
edema versus atypical infection. No lobar consolidation is seen. There is no
pleural effusion or pneumothorax. The cardiac silhouette is top normal to
mildly enlarged. Mediastinal contours are stable. Degenerative changes are
seen along the spine.
IMPRESSION: Slight increase in interstitial markings could be due to minimal
interstitial edema versus atypical infection. No lobar consolidation. Mild
enlargement of the cardiac silhouette.
|
10043321-RR-11 | 10,043,321 | 29,686,634 | RR | 11 | 2154-01-04 00:25:00 | 2154-01-04 03:15:00 | HISTORY: Shortness of breath, hypoxia.
TECHNIQUE: MDCT data were acquired through the chest after administration of
intravenous contrast. Images were displayed in multiple planes. Although the
patient is listed as having a contrast allergy, the patient was interviewed by
Dr ___ confirmed that the patient only experienced nausea after
drinking oral contrast. The patient denied prior SOB, hives, itch, and throat
swelling.
COMPARISON: CT abdomen pelvis after ___
FINDINGS:
Chest CTA: Opacification of the pulmonary arterial tree is adequate for the
exclusion of pulmonary embolus to the subsegmental level. The left main
pulmonary artery is focally dilated to 2.6 cm. The aorta and great vessels
are normal caliber appearance.
Chest CT: Mild subpleural scarring is present at both lung apices. There is
a diffuse pattern mosaic attenuation of the lung parenchyma. The airways are
patent to the subsegmental level. Several small peribronchial nodules are
visualized. For example, there is a 3 mm nodule in the right upper lobe
(3:48) and a 6 mm nodule in the lingula (3: 71). Mediastinal and hilar nodes
are mildly enlarged. For example, a lower paratracheal node measures 12 cm in
short axis (2:27). The heart size is normal. There is no pericardial
effusion.
There are no concerning lytic or sclerotic bone lesions.
IMPRESSION:
1. No pulmonary embolism.
2. Mild mediastinal adenopathy.
3. Mosaic attenuation of the pulmonary parenchyma is non-specific but may
related to pulmonary edema or small airways disease.
4. Multiple peribronchial pulmonary nodules may relate to a inflammatory or
mild infectious process. The largest 6 mm nodule may be followed up in ___
months depending on risk factors.
|
10043321-RR-12 | 10,043,321 | 29,686,634 | RR | 12 | 2154-01-06 10:38:00 | 2154-01-06 13:56:00 | HISTORY: ___ with progressive shortness of breath. Obtain
inspiratory and expiratory views and prone positioning.
TECHNIQUE: Patient was scanned supine end inspiration and end expiration, and
in the prone position at full inspiration. Combination of 5 mm and 1.25 mm
thick continuous and interrupted reconstructions were made from both series.
COMPARISON: Chest CT ___.
FINDINGS:
As compared to the scan on ___, lung volumes are much improved and
previously reported nodules have resolved. There is still a generalized
heterogeneity in background density of the lung, and with expiration imaging
one sees relative retention of volume in the low density areas, indicating
small airways obstruction. The only other focal abnormalities in the lungs
are too small regions of peribronchial infiltration at the periphery of the
upper lobes where there is the suggestion of mild traction bronchiectasis.
This likely mild fibrosis is not repeated elsewhere. There is no
bronchiectasis or appreciable wall thickening in the bronchial tree.
Central lymph node enlargement is widespread but relatively mild, ranging in
diameter up to 12.5 mm in the right lower paratracheal station, 5:17, smaller
in the upper paratracheal and prevascular stations, similar size in the
subcarinal. Lymph nodes are borderline enlarged in both hila but there is no
bronchial impingement.
Main pulmonary diameter, 40 mm, is strongly associated with pulmonary arterial
hypertension. Atherosclerotic calcification is restricted to the left
anterior descending coronary. Distal esophagus is mildly distended with air
but the wall is not thickened. The study is not designed for subdiaphragmatic
evaluation heterogeneity in the unenhanced liver is best explained by fatty
infiltration.
IMPRESSION:
1. Diffuse moderate to severe small airway obstruction, but no particular
bronchial wall thickening, mucoid impaction, bronchiectasis, or atelectasis.
The explanation for small airway obstruction is not obvious radiographically.
2. Minimal regional fibrosis, both upper lobes, there is not a generalized
process.
3. Probable pulmonary arterial hypertension conceivably but not necessarily
that due to small airways obstruction.
4. Left anterior descending coronary atherosclerosis.
5. Fatty infiltration of the liver.
IMPRESSION:
|
10043622-RR-13 | 10,043,622 | 23,527,228 | RR | 13 | 2130-10-17 01:28:00 | 2130-10-17 02:08:00 | EXAMINATION: PELVIS, NON-OBSTETRIC
INDICATION: History: ___ with concern for left ovarian torsion// left ovarian
torsion
TECHNIQUE: Grayscale ultrasound images of the pelvis were obtained with
transabdominal approach followed by transvaginal approach for further
delineation of uterine and ovarian anatomy.
COMPARISON: CT abdomen/pelvis from the same day
FINDINGS:
The patient is status post supracervical hysterectomy. Multiple nabothian
cysts are noted.
The right ovary is normal in size, measuring 2.0 x 1.8 x 1.6 cm (3.1 cc), and
demonstrates normal vascularity. The left ovary, though technically within
normal size limits, is markedly larger than the right ovary, measuring 2.6 x
2.2 x 3.5 cm (10.3 cc). No vascular flow could be identified, even using
power Doppler. There is a small amount of simple left adnexal free fluid.
IMPRESSION:
Asymmetric enlargement of the left ovary compared to the right without
detection of vascular flow, concerning for ovarian torsion. Small amount of
simple left adnexal free fluid.
NOTIFICATION: The findings were discussed with ___, M.D. by
___, M.D. on the telephone on ___ at 2:00 am, 5 minutes after
discovery of the findings.
|
10043622-RR-14 | 10,043,622 | 23,527,228 | RR | 14 | 2130-10-17 01:37:00 | 2130-10-17 02:57:00 | INDICATION: History: ___ with LUQ pain// ruptured bleb, pna
TECHNIQUE: Chest PA and lateral
COMPARISON: None.
FINDINGS:
Frontal and lateral chest radiographs demonstrate a normal cardiomediastinal
silhouette and well-aerated lungs without focal consolidation, pleural
effusion, or pneumothorax.
IMPRESSION:
No acute cardiopulmonary process.
|
10043622-RR-15 | 10,043,622 | 23,527,228 | RR | 15 | 2130-10-17 08:10:00 | 2130-10-17 11:18:00 | EXAMINATION: PELVIS U.S., TRANSVAGINAL
INDICATION: History: ___ with left adnexal tenderness and pelvic ultrasound
concerning for left ovarian torsion// reassess left ovarian size and flow
TECHNIQUE: Grayscale ultrasound images of the pelvis were obtained with
transvaginal approach for further delineation of uterine and ovarian anatomy.
COMPARISON: Pelvic ultrasound from ___ and CT abdomen/pelvis
from ___.
FINDINGS:
The patient is status post supracervical hysterectomy. Nabothian cysts are
again noted.
The right ovary is normal in size, measuring 1.9 x 1.5 x 1.9 cm (2.8 cc), with
normal vascularity. The left ovary is again asymmetrically enlarged compared
to the right, measuring 2.0 x 2.5 x 3.1 cm (8.0 cc). The left ovary does not
look edematous. No vascularity is identified. Trace left adnexal free-fluid
is again seen.
IMPRESSION:
Essentially unchanged exam compared to the pelvic ultrasound from 6 hours
prior, with asymmetry of the ovaries. No detectable left ovarian vascularity.
Given no interval change, suspicion for torsion is low. Additionally, the
ovary does not look particularly edematous, and decreased or undetectable
ovarian blood flow can be seen in postmenopausal woman. I think that torsion
is unlikely though not entirely excluded.
|
10043646-RR-63 | 10,043,646 | 25,354,589 | RR | 63 | 2184-02-03 17:49:00 | 2184-02-03 18:47:00 | CHEST RADIOGRAPHS
HISTORY: Weight gain and shortness of breath.
COMPARISONS: ___.
TECHNIQUE: Chest, AP upright and lateral.
FINDINGS: The heart is mildly enlarged. Allowing for technique, the lungs
appear clear. There is no pleural effusion or pneumothorax. Moderate
degenerative changes are present along the thoracic spine.
IMPRESSION: No evidence of acute disease.
|
10044189-RR-75 | 10,044,189 | 22,028,605 | RR | 75 | 2172-11-02 14:13:00 | 2172-11-02 15:28:00 | HISTORY: Altered mental status. Evaluate for pneumonia.
TECHNIQUE: Single, AP, portable view of the chest.
COMPARISON: Comparison is made as chest radiographs dated ___.
FINDINGS:
The lung volumes are noted to be slightly low. No focal consolidation,
pleural effusion, pneumothorax, or pulmonary edema is seen. The heart size is
top normal. The ascending aorta is mildly prominent, unchanged from the prior
exam, and may be secondary to aortic tortuosity versus mild dilation.
IMPRESSION:
No radiographic evidence for acute cardiopulmonary process.
|
10044189-RR-76 | 10,044,189 | 22,028,605 | RR | 76 | 2172-11-02 14:46:00 | 2172-11-02 14:55:00 | HISTORY: Found down, now with altered mental status.
TECHNIQUE: Contiguous axial MDCT images were obtained through the brain
without the administration of IV contrast. Reformatted coronal, sagittal and
thin section bone algorithm-reconstructed images were acquired.
DLP: ___
COMPARISON: Comparison is made to CT head dated ___.
FINDINGS:
There is no evidence of acute intracranial hemorrhage, edema, mass effect, or
large territorial infarction. The ventricles and sulci are normal in size and
configuration. Prominent ventricles and sulci suggest age-related involutional
changes or atrophy. Periventricular and subcortical white matter
hypodensities are consistent with chronic small vessel ischemic disease.
The basal cisterns appear patent and there is preservation of gray-white
matter differentiation. No fracture is identified. The visualized paranasal
sinuses, mastoid air cells, and middle ear cavities are clear. The globes are
intact.
IMPRESSION:
No evidence of acute intracranial process.
|
10044189-RR-77 | 10,044,189 | 22,028,605 | RR | 77 | 2172-11-02 14:48:00 | 2172-11-02 16:04:00 | HISTORY: ___ female, with altered mental status, found down, with
profuse nausea and vomiting. Evaluation for obstruction or perforation.
COMPARISON: None available.
TECHNIQUE: Axial MDCT images were obtained through the abdomen and pelvis
after the administration of intravenous contrast. No oral contrast was given.
Reformatted coronal and sagittal images were also reviewed.
DLP: 467.6 mGy-cm.
FINDINGS:
CT ABDOMEN WITH IV CONTRAST: The bases of the lungs are clear. The
visualized heart and pericardium are unremarkable.
Multiple subcentimeter hepatic hypodensities are noted in the left and right
hepatic lobes (3:24, 3:26, 3:27, 3:34), too small to characterize, but
statistically most likely represent cysts. There is no intra- or
extra-hepatic biliary ductal dilatation. The gallbladder is unremarkable.
The spleen, pancreas, bilateral adrenal glands, and bilateral kidneys are
normal in appearance.
The stomach and proximal duodenum are massively distended with fluid, with an
abrupt transition point to relatively decompressed distal bowel loops at the
level of the third portion of the duodenum, as it crosses between the aorta
and superior mesenteric artery (3:37). Distal loops of jejunum demonstrate
relative bowel wall thickening, although incompletely evaluated secondary to
underdistension (601B:20). There is no intraperitoneal free air or free
fluid.
The aorta and its main branch vessels are well opacified, with a widely patent
celiac axis, superior mesenteric and inferior mesenteric artery. Focal
narrowing of the left renal vein as it crosses between the superior mesenteric
artery and the aorta is also noted (3:31), however, there appears to be a fat
plane between both the SMA and left renal vein as well as the SMA and the
third portion of the duodenum, at the point of focal narrowing. While this
constellation of findings can be seen in the setting of SMA syndrome, the
intervening fat plane would be a somewhat atypical appearance.
CT PELVIS WITH IV CONTRAST: The rectum and sigmoid colon are unremarkable, as
are the pelvic loops of ileum. There is no pelvic free fluid. No pelvic side
wall or inguinal lymphadenopathy is noted. The uterus and bilateral adnexa
are normal in appearance. No adnexal masses are seen.
OSSEOUS STRUCTURES: Multilevel facet arthropathy is noted in the lumbar
spine. No lytic or blastic lesion suspicious for malignancy is seen.
IMPRESSION:
1. Massively distended, fluid-filled stomach and proximal duodenum with
caliber change at the level of the third portion of the duodenum as it crosses
between the aorta and SMA, possibly due to SMA syndrome, although the
appearance is somewhat atypical given intervening fat plane between the SMA
and collapsed duodenum. No wall thickening or discrete mass seen. Focal
narrowing of the left renal vein is also noted at this level.
2. No intra-abdominal free air or free fluid.
3. Scattered subcentimeter hepatic hypodensities are too small to
characterize, but are statistically most likely to represent cysts.
4. Nonspecific apparent jejunal wall thickening is incompletely evaluated due
to underdistension and may in part relate to underdistention.
|
10044189-RR-79 | 10,044,189 | 22,028,605 | RR | 79 | 2172-11-03 13:53:00 | 2172-11-03 16:34:00 | INDICATION: Probable superior mesenteric artery syndrome, attempting to
decompress the stomach. Evaluate for interval change following placement of an
enteric catheter.
COMPARISON: CT abdomen and pelvis from ___.
FINDINGS:
A new enteric catheter ends within the mid to lower stomach. Assessment for
interval change in the degree of gastric distention is difficult, as the
stomach is fluid filled and therefore demonstrates similar attenuation
characteristics as surrounding abdominal organs. Air and stool are seen
throughout the colon. Contrast material is noted within the bladder.
IMPRESSION:
Appropriately positioned enteric catheter, ending within the stomach.
|
10044189-RR-81 | 10,044,189 | 22,028,605 | RR | 81 | 2172-11-06 16:51:00 | 2172-11-07 16:20:00 | EXAMINATION: ABDOMEN (SUPINE AND ERECT)
INDICATION: ___ year old woman with possible SMA syndrome. Evaluate for
gastric distention.
TECHNIQUE: Supine radiographs of the abdomen were obtained.
COMPARISON: ___.
FINDINGS:
An enteric tube is seen with the tip in the stomach and proximal side hole
past the gastroesophageal junction. The stomach is not dilated. There are no
abnormally dilated loops of small or large bowel. There is no evidence of
pneumoperitoneum. The visualized lung bases are clear. Osseous structures are
unremarkable.
IMPRESSION:
Unchanged position of the enteric tube with its no evidence of gastric
distention.
|
10044189-RR-82 | 10,044,189 | 22,028,605 | RR | 82 | 2172-11-07 09:32:00 | 2172-11-07 11:31:00 | INDICATION: Evaluation of patient with findings suggestive of possible SMA
syndrome for evaluation of mobility.
COMPARISON: CT abdomen and pelvis from ___.
FINDINGS: Initial fluoroscopic spot view demonstrated a Dobbhoff tube with
the tip in the stomach. Under fluoroscopic guidance, approximately 60 cc of
Gastrografin were administered via the NG tube into the stomach. There is
evidence of gastric distention with holdup of contrast material within the
stomach and moving very slowly throughout the duodenum into the small bowel
which could be consistent with increased pressure in the duodenum from
possible SMA syndrome. No other focal abnormalities are identified.
IMPRESSION: Evidence of holdup of contrast within the stomach with slow
movement throughout the duodenum into the small bowel, similar to that seen on
CT and findings, which may represent SMA syndrome.
|
10044189-RR-83 | 10,044,189 | 22,028,605 | RR | 83 | 2172-11-08 09:19:00 | 2172-11-08 15:54:00 | EXAMINATION: ABDOMEN (SUPINE ONLY)
INDICATION: ___ year old woman with possible SMA and recent UGI on ___.
Please evaluate passage of contrast.
TECHNIQUE: Supine radiographs of the abdomen were obtained.
COMPARISON: ___.
FINDINGS:
Enteric tube is in the stomach with the proximal side hole past the
gastroesophageal junction. There is no contrast visualized within the small
bowel and the majority of it is in the descending and sigmoid colon. There are
no abnormally dilated loops of bowel. There is no evidence of
pneumoperitoneum. The lung bases are clear and the osseous structures are
unremarkable.
IMPRESSION:
Passage of contrast out of the small bowel, now present in the descending and
sigmoid colon.
|
10044997-RR-13 | 10,044,997 | 25,979,513 | RR | 13 | 2153-11-04 16:56:00 | 2153-11-04 20:08:00 | EXAMINATION: Right ankle radiographs, three views.
INDICATION: Right ankle pain.
COMPARISON: None.
FINDINGS:
The tibiotalar joint is moderate to severely narrowed with osteophytes and
subchondral sclerotic changes. Subtalar joint also shows fairly severe
degenerative change including joint space narrowing and marginal bony
hypertrophy. No evidence of fracture, dislocation or lysis.
IMPRESSION:
Substantial subtalar and tibiotalar degenerative changes. No evidence of
fracture or lysis.
|
10045326-RR-12 | 10,045,326 | 25,966,591 | RR | 12 | 2152-11-22 15:59:00 | 2152-11-22 17:28:00 | INDICATION: ___ year old man with poorly differentiated metastatic lung
carcinoma (to adrenal glands), concern for disease progression.
TECHNIQUE: Oncology 3 phase: Multidetector CT of the abdomen and pelvis was
done as part of CT torso without and with IV contrast. Initially the abdomen
was scanned without IV contrast. Subsequently a single bolus of IV contrast
was injected and the abdomen and pelvis were scanned in the portal venous
phase, followed by a scan of the abdomen in equilibrium (3-min delay) phase.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 2.6 s, 28.5 cm; CTDIvol = 9.1 mGy (Body) DLP = 258.9
mGy-cm.
2) Stationary Acquisition 4.0 s, 0.5 cm; CTDIvol = 19.3 mGy (Body) DLP =
9.6 mGy-cm.
3) Spiral Acquisition 7.0 s, 76.9 cm; CTDIvol = 8.9 mGy (Body) DLP = 687.5
mGy-cm.
4) Spiral Acquisition 2.6 s, 28.5 cm; CTDIvol = 8.9 mGy (Body) DLP = 253.2
mGy-cm.
Total DLP (Body) = 1,209 mGy-cm.
COMPARISON: CT torso ___.
FINDINGS:
CT ABDOMEN:
HEPATOBILIARY: The liver enhances homogeneously without evidence of concerning
focal lesion. There is no intrahepatic biliary ductal dilation. The portal
vein is patent. The gallbladder is unremarkable without evidence of wall
thickening or inflammation.
PANCREAS: The pancreas enhances homogeneously. There is no peripancreatic
stranding or ductal dilation.
SPLEEN: There is no splenomegaly or focal splenic lesion.
ADRENALS: Bilateral heterogeneously hypoenhancing adrenal metastases are
significantly larger since ___, measuring 5.5 x 5.5 cm on the
left and 6.5 x 5.2 cm on the right (previously 2.5 x 1.8 and 2.4 x 1.7 cm,
respectively).
URINARY: Several circumscribed hypodensities in the bilateral renal cortices
measuring up to 2.3 cm on the right and 3.4 cm on the left are compatible with
simple renal cysts. Smaller hypodensities elsewhere in the renal cortices are
too small to characterize accurately by CT. Otherwise, the kidneys enhance
normally and symmetrically. There is no hydronephrosis.
GASTROINTESTINAL: The stomach and duodenum are unremarkable. Non-dilated
small bowel loops are normal in course and caliber without evidence of wall
thickening or obstruction. There is scattered diverticulosis most prominent
in the sigmoid colon. Otherwise, the colon is within normal limits. The
appendix is normal
VASCULAR AND LYMPH NODES: The abdominal aorta is moderately calcified. Major
proximal tributaries are grossly patent. Retroperitoneal lymph nodes are
abnormally numerous and borderline/mildly enlarged (for example see series 3,
image 82 for a 7 mm aortocaval lymph node). There are no pathologically
enlarged mesenteric lymph nodes. There is no free intraperitoneal air or
fluid.
CT PELVIS:
The bladder and terminal ureters are within normal limits. The prostate and
seminal vesicles are unremarkable. There are no pathologic enlarged pelvic or
inguinal lymph nodes. There is no free pelvic fluid.
MUSCULOSKELETAL: A rounded 10 x 8 mm soft tissue nodule centered in in the fat
just deep to the left gluteus musculature (3, 115) is new from the prior exam.
Otherwise, there is no worrisome focal subcutaneous or musculoskeletal soft
tissue abnormality. The imaged thoracolumbar vertebral bodies are normally
aligned. There is mild to moderate multilevel degenerative change, most
pronounced at L4-5. Vertebral body heights are preserved. No concerning focal
lytic or sclerotic osseous lesions are seen.
IMPRESSION:
1. 10 x 8 mm rounded soft tissue nodule in the left buttock deep to the
gluteus musculature is new from the recent prior exam of ___,
worrisome for soft tissue metastasis.
2. Bilateral heterogeneously hypoenhancing adrenal metastases are
significantly larger since ___, now measuring up to 6.5 cm on the
right and 5.5 cm on the left (previously up to 2.4 and 2.5 cm, respectively).
3. Please see separate report for intrathoracic findings from same-day CT
chest.
NOTIFICATION: The findings were discussed with ___, M.D. by ___
___, M.D. on the telephone on ___ at 12:09 ___, 30 minutes after
discovery of the findings.
|
10045326-RR-13 | 10,045,326 | 25,966,591 | RR | 13 | 2152-11-22 16:06:00 | 2152-11-22 17:34:00 | EXAMINATION: CT CHEST W/CONTRAST
INDICATION: Poorly differentiated lung carcinoma metastatic to adrenals.
TECHNIQUE: Multi-detector helical scanning of the chest, coordinated with
intravenous infusion of nonionic, iodinated contrast agent, following oral
administration of contrast agent for selected abdominal studies, was
reconstructed as contiguous 5 mm and 1.0 or 1.25 mm thick axial, 2.5 or 5 mm
thick coronal and parasagittal, and 8 mm MIP axial images. Concurrent scanning
of the abdomen and pelvis and/or neck will be reported separately. All images
of the chest were reviewed. .
DOSE: Acquisition sequence:
1) Spiral Acquisition 2.6 s, 28.5 cm; CTDIvol = 9.1 mGy (Body) DLP = 258.9
mGy-cm.
2) Stationary Acquisition 4.0 s, 0.5 cm; CTDIvol = 19.3 mGy (Body) DLP =
9.6 mGy-cm.
3) Spiral Acquisition 7.0 s, 76.9 cm; CTDIvol = 8.9 mGy (Body) DLP = 687.5
mGy-cm.
4) Spiral Acquisition 2.6 s, 28.5 cm; CTDIvol = 8.9 mGy (Body) DLP = 253.2
mGy-cm.
Total DLP (Body) = 1,209 mGy-cm.
** Note: This radiation dose report was copied from CLIP ___ (CT ABD AND
PELVIS W AND W/O CONTRAST, ADDL SECTIONS)
COMPARISON: Chest CT performed elsewhere ___.
Supraclavicular lymph nodes are not enlarged. 9 x 15 mm right axillary and 11
x 14 mm left axillary lymph nodes are unchanged since ___ and both
have have fatty hila, usually an indication of a benign reactive node.
There are no soft tissue abnormalities in the imaged chest wall suspicious for
malignancy. Findings below the diaphragm will be reported separately.
There are no thyroid lesions warranting further imaging evaluation.
Atherosclerotic calcification is not apparent in head neck vessels, and is
present in at least left anterior descending and right coronary arteries.
Aortic valve is not calcified. Aorta and pulmonary arteries are normal size
and subject to the technical limitations of this study free of central filling
defects. There is no pericardial or pleural effusion.
Mediastinal, hilar common other intrathoracic lymph nodes are not
pathologically enlarged.
Right lung is clear.
Partially cavitated, heterogeneous and poorly enhancing spiculated left upper
lobe lesion, 22 x 31 mm was 17 x 20 mm in ___. There are linear
extensions to the mediastinal pleura but no evidence of pleural invasion.
Left lung is otherwise clear. Tracheobronchial tree is normal to subsegmental
levels.
In the chest cage, the spine is intact. However demineralization at the site
of incompletely healed fractures, lateral left ninth and tenth ribs and healed
lateral right eighth pathologic rib fracture present also present in ___
suggests they are pathologic.
FINDINGS:
Growing left upper lobe lung mass. At least 3 rib metastases responsible for
pathologic fractures, one healed and 2 not healed, were present in ___. No new metastases.
Coronary atherosclerosis. Findings below the diaphragm including large
bilateral adrenal masses will be reported separately.
|
10045326-RR-14 | 10,045,326 | 26,512,329 | RR | 14 | 2152-11-27 10:42:00 | 2152-11-27 11:10:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ with lung Cancer p/w right flank pain and hypoxia // eval
for PNA
COMPARISON: None
FINDINGS:
PA and lateral views of the chest provided. Again seen is a left upper lobe
mass without significant change from prior. Lungs otherwise are clear without
focal consolidation, large effusion or pneumothorax. Cardiomediastinal
silhouette is unchanged. Bony structures are intact. No free air below the
right hemidiaphragm.
IMPRESSION:
As above.
|
10045326-RR-15 | 10,045,326 | 26,512,329 | RR | 15 | 2152-11-27 11:22:00 | 2152-11-27 12:37:00 | INDICATION: ___ with with lung cancer on chemo p/w weakness and dyspnea, had
desaturdation to 85% on EMS arrivalNO_PO contrast // eval for PE vs
dissection
TECHNIQUE: Axial multidetector CT images were obtained through the thorax
after the uneventful administration of intravenous contrast in the arterial
phase. Then, imaging was obtained through the abdomen and pelvis in the
portal venous phase. Reformatted coronal and sagittal images through the
chest, abdomen, and pelvis, and oblique maximal intensity projection images of
the chest were submitted to PACS and reviewed.
DOSE: Total DLP (Body) = 680 mGy-cm.
COMPARISON: CT chest ___
CT abdomen pelvis ___
FINDINGS:
CHEST:
HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the
subsegmental level without filling defect to indicate a pulmonary embolus.
The thoracic aorta is normal in caliber without evidence of dissection or
intramural hematoma. The heart, pericardium, and great vessels are within
normal limits. No pericardial effusion is seen.
AXILLA, HILA, AND MEDIASTINUM: Bilateral prominent axillary lymph nodes are
unchanged in size compared to prior CT. There is no mediastinal hilar
lymphadenopathy is present. No mediastinal mass.
PLEURAL SPACES: No pleural effusion or pneumothorax.
LUNGS/AIRWAYS: A partially cavitated, heterogeneous and poorly enhancing
spiculated left upper lobe lesion is similar in size to CT from ___ measuring approximately 2.2 x 3.1 cm, however measuring 1.7 x 2.0 cm in
___. There is centrilobular emphysema. The airways are patent to the
level of the segmental bronchi bilaterally.
BASE OF NECK: Visualized portions of the base of the neck show no abnormality.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There is no evidence of focal lesions. There is no evidence of intrahepatic
or extrahepatic biliary dilatation. The gallbladder is within normal limits.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: Since prior CT in ___ there are unchanged bilateral
heterogeneously hypoenhancing adrenal metastasis measuring 6.2 x 5.3 cm on the
right and 5.5 x 5.5 cm on the left (previously measuring 2.5 x 1.8 cm and 2.4
x 1.7 cm, respectively, in ___. The right adrenal mass has mild
mass effect on the IVC which remains patent (2b:135).
URINARY: Several well-circumscribed hypodensities in bilateral renal cortices
are compatible with simple renal cysts. Smaller hypodensities elsewhere in
the renal cortices are too small to characterize but likely represent renal
cyst. Otherwise, the kidneys enhance normally and symmetrically. There is no
evidence of hydronephrosis. There is no perinephric abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. Diffuse
diverticulosis of the colon, particularly the sigmoid colon is noted, without
evidence of wall thickening and fat stranding. The appendix is normal. There
is no free intraperitoneal fluid or free air.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: The prostate and seminal vesicles are unremarkable.
LYMPH NODES: There is more conspicuous retroperitoneal lymph nodes compared to
priors with the, including at least 3 centrally necrotic lymph nodes noted the
located between the aorta and pancreas (2b:143, 139, 138). No mesenteric
lymphadenopathy. There is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic
disease is noted.
BONES AND SOFT TISSUES: A left soft tissue nodule deep to the left gluteus
musculature is slightly enlarged compared to prior CT, now measuring 1.3 x 1.0
cm, previously measuring 1.0 x 0.8 cm. The bony structures are essentially
unchanged from prior CT, including healing pathologic left ninth, tenth and
right eighth rib fractures.
IMPRESSION:
1. No evidence of acute pulmonary embolism or aortic abnormality.
2. Interval worsening and enlargement of retroperitoneal lymph nodes,
specifically with development of at least 3 centrally necrotic lymph nodes
along the posterior aspect of the pancreas.
3. Slight interval increase in size of left gluteal soft tissue nodule since ___.
4. Bilateral adrenal metastatic lesions are unchanged in size from ___ but significantly larger than ___.
5. Unchanged left upper lobe pulmonary mass.
|
10045326-RR-16 | 10,045,326 | 26,512,329 | RR | 16 | 2152-11-27 13:48:00 | 2152-11-27 15:17:00 | EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ with RUQ pain and abnormal LFTs, metastatic lung cancer with
large bilateral adrenal metastasis
TECHNIQUE: Right upper quadrant ultrasound
COMPARISON: Same-day CT abdomen pelvis
FINDINGS:
The liver appears normal in grayscale appearance and size without focal lesion
of concern. No biliary ductal dilation. Gallstones noted within the
gallbladder though there is no evidence for acute cholecystitis. Sonographic
___ sign is negative. Common bile duct measures up to 3 mm. The known
right adrenal metastasis is visualized though better characterized on same-day
CT exam. A simple appearing cyst is seen in the right kidney interpolar
region measuring 2 cm in diameter. Lymphadenopathy adjacent to the pancreas
better assessed on same-day CT. No ascites.
IMPRESSION:
1. Cholelithiasis without evidence of cholecystitis.
2. Right adrenal mass and enlarged peripancreatic nodes better assessed on
same-day CT exam.
|
10045574-RR-16 | 10,045,574 | 26,471,529 | RR | 16 | 2194-06-09 14:03:00 | 2194-06-09 15:13:00 | HISTORY: Fever.
TECHNIQUE: PA and lateral views of the chest.
COMPARISON: None.
FINDINGS:
Heart size is normal. Mediastinal and hilar contours are unremarkable. Lungs
are clear and the pulmonary vasculature is normal. No pleural effusion or
pneumothorax is seen. There are no acute osseous abnormalities.
IMPRESSION:
No acute cardiopulmonary process.
|
10045574-RR-17 | 10,045,574 | 26,471,529 | RR | 17 | 2194-06-09 15:50:00 | 2194-06-09 16:44:00 | HISTORY: Headache and fever. Evaluate for mass.
TECHNIQUE: MDCT axial images were acquired through the brain without the
administration of intravenous contrast. Coronal and sagittal reformations
were provided and reviewed.
DLP: 842 mGy/cm.
CTDIvol: 54.1 mGy.
COMPARISON: None.
FINDINGS: There is no acute hemorrhage, edema or shift of the midline
structures. The ventricles and sulci are of normal size and configuration.
The gray white matter differentiation is preserved and there is no evidence
for an acute territorial vascular infarction. The basal cisterns are patent.
There are aerosolized secretions within the posterior ethmoidal air cells and
minimal mucosal thickening involving the sphenoid and right maxillary sinuses.
The mastoid air cells are well aerated. There is no fracture. Adenoids
appear enlarged for age.
IMPRESSION:
1. No acute intracranial process. MRI is more sensitive for detecting
intracranial lesions.
2. Aerosolized secretions within the paranasal sinuses may indicate acute
sinusitis in the appropriate clinical setting.
3. Posterior nasopharyngeal mucosal thickening should be further evaluated
with direct visualization.
|
10045574-RR-18 | 10,045,574 | 26,471,529 | RR | 18 | 2194-06-11 22:53:00 | 2194-06-12 04:14:00 | HISTORY: Patient presenting with fevers, night sweats and leukocytosis.
Evaluate for evidence of lymphoproliferative disorder.
COMPARISON: Pelvic ultrasound from ___.
TECHNIQUE: Axial helical MDCT images were obtained from the suprasternal
notch to the pubic symphysis after administration of IV and oral contrast.
Coronal and sagittal reformations were generated.
DLP: 649 mGy-cm
FINDINGS:
CT THORAX: The thyroid gland is unremarkable. The airways are patent to the
subsegmental level. There is no central or axillary lymphadenopathy. The
heart and great vessels are within normal limits. There is no pericardial
effusion. The esophagus is within normal limits without evidence of wall
thickening or hiatal hernia. Lung windows do not show any focal opacity
concerning for pneumonia. There are small bilateral pleural effusions with
minimal associated bibasilar atelectasis. There is no pneumothorax.
CT ABDOMEN: The liver enhances homogeneously, without focal lesions or
intrahepatic biliary duct dilatation. The gallbladder is unremarkable and the
portal vein is patent. The pancreas, spleen, adrenal glands are within normal
limits. The kidneys show symmetric nephrograms and excretion of contrast.
There is no hydronephrosis. A 6 mm hypodensity in the lower pole of the left
kidney is too small to characterize but statistically likely a simple cyst.
The small and large bowel are within normal limits, without evidence of wall
thickening or dilatation to suggest obstruction. The appendix is visualized
and is not inflamed. The aorta and its main branches are patent and
nonaneurysmal. There is no mesenteric or retroperitoneal lymph node
enlargement by CT size criteria. There is no ascites, abdominal free air or
abdominal wall hernia.
CT PELVIS: The urinary bladder and ureters are unremarkable. The uterus is
bulky compatible with multiple fibroids with one exophytic fibroid measuring
2.2 cm originating from the left anterolateral aspect of the uterus (2: 95).
There is no pelvic wall or inguinal lymphadenopathy. No pelvic free fluid is
observed.
OSSEOUS STRUCTURES: There are no lytic or blastic lesions concerning for
malignancy.
IMPRESSION:
Fibroid uterus. Otherwise unremarkable torso CT examination. No
lymphadenopathy identified.
|
10045854-RR-3 | 10,045,854 | 22,972,246 | RR | 3 | 2121-03-16 12:16:00 | 2121-03-16 12:55:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ with CAD/CABG with anginal chest pain transferred from BI-P
for possible stenting// eval pulm edema
TECHNIQUE: Portable chest radiograph
COMPARISON: Prior radiograph ___ performed 08:36
FINDINGS:
In comparison to the prior radiograph, diffuse bilateral reticular opacities
and septal thickening are improved compared to the prior study. There is
mild-moderate persistent central pulmonary edema slightly worse on the left.
There is bronchovascular cuffing. Likely trace left pleural effusion. No
pneumothorax. No large focal consolidation. The heart is mildly enlarged.
The mediastinum is stable in size. Postsurgical changes after median
sternotomy and CABG are demonstrated.
IMPRESSION:
Overall improvement in central pulmonary edema, now mild-moderate. No focal
consolidation.
|
10045960-RR-20 | 10,045,960 | 24,068,884 | RR | 20 | 2193-07-27 04:43:00 | 2193-07-27 05:07:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ with sudden onset of difficulty breathing. Eval for PNA,
pulmonary edema
TECHNIQUE: Upright portable chest radiograph
COMPARISON: Prior chest radiograph performed ___
FINDINGS:
Elevation of the left hemidiaphragm is new compared to ___. There is
moderate pulmonary vascular congestion and edema. Bibasilar opacifications
may reflect a combination of atelectasis and edema, however a superimposed
pneumonia would be difficult to exclude. Probable small left pleural
effusion. No pneumothorax. The cardiac silhouette is slightly obscured but
remains enlarged.
IMPRESSION:
1. Moderate pulmonary vascular congestion and edema.
2. Bibasilar opacifications likely reflect a combination of atelectasis and
edema, however a superimposed pneumonia would be difficult to exclude.
3. New elevation of the left hemidiaphragm compared to ___.
4. Probable small left pleural effusion.
|
10046166-RR-19 | 10,046,166 | 20,474,438 | RR | 19 | 2132-12-06 10:06:00 | 2132-12-06 17:42:00 | INDICATION: ___ year old man with right hand numbness and weakness; evaluate
for stroke/ICH.
N.B. There is no known history of underlying malignancy.
TECHNIQUE: Multidetector CT scan of the head was obtained without the
administration of contrast. Subsequently, helical MDCT acquisition of the
head and neck was obtained after the administration of 70 cc IV Optiray
contrast. Images were processed on a separate workstation with display of
curved reformations, 3D volume-rendered images and maximum intensity
projection images.
COMPARISON: None available.
FINDINGS:
Non-contrast head CT: There is a 2.9 x 1.6 cm parenchymal hemorrhage in the
superior left frontal lobe (2:24) with surrounding vasogenic edema and sulcal
effacement. Note is made of a blood-fluid level at the lateral aspect of the
hemorrhage. An focal hypodensity within the central portion of this
hemorrhage could represent unclotted active hemorrhage; however, this is not
confirmed on post-contrast CTA images and is therefore concerning for a focal
cystic necrosis within an underlying lesion. There is no shift of normally
midline structures. The size and configuration of the ventricles and
uninvolved sulci are within normal limits for a patient of this age. No
concerning osseous lesion is seen. The visualized paranasal sinuses and
mastoid air cells are clear.
CTA: No evidence of undelying AVM or other vascular abnormality is
identified. No "CT spot sign" to raise concern for rapidly expanding
hemorrhage is seen. No evidence of cerebral venous thrombosis. The carotid
and vertebral arteries and their major branches are patent with no evidence of
flow-limiting stenosis. The left internal carotid artery is medialized, a
normal variant. There are scattered calcifications of the cavernous carotids.
Note is made of a patulous basilar tip and infundibula at the superior
cerebellar arterial origins, bilaterally, variant anatomy. No aneurysm larger
than 2 mm, or evidence of arterial dissection is seen.
The right cervical internal carotid artery Dmin measures 8 mm proximally, and
4.5 mm distally. The left cervical internal carotid artery Dmin measures 8 mm
proximally, and 4.5 mm distally.
There is a large right paratracheal mediastinal conglomerate lymph node mass
measuring up to 4.2 (AP) x 3.9 (TV) x 4.3 (CC) cm (3:59, 400:29).
Additionally there is a 2.0 x 1.7 cm right suprahilar node (3:12). The
included portions of the lung parenchyma are grossly unremarkable. No
cervical lymphadenopathy is identified. The thyroid gland is homogeneous.
IMPRESSION:
1. Left frontal lobe parenchymal hemorrhage, with no evidence of underlying
AVM or other vascular abnormality.
2. No CTA "spot sign" indicating active contrast extravasation to suggest
risk of rapid expansion.
3. Persistent central relative low-attenuation with concerning for cystic
necrosis within an underlying mass (though none is definitely seen), given the
findings, below.
4. Large superior mediastinal conglomerate lymph node mass, as well as right
hilar lymphadenopathy. Findings are concerning for underlying malignancy,
perhaps bronchogenic, with hemorrhagic brain metastasis.
COMMENT: Findings discussed with Dr. ___, by Dr. ___
telephone, at 11:05 AM on ___.
|
10046166-RR-20 | 10,046,166 | 20,474,438 | RR | 20 | 2132-12-06 19:23:00 | 2132-12-07 11:45:00 | INDICATION: ___ man presenting with right hand weakness, found to
have left intraparenchymal hemorrhage and mediastinal mass. Assessment for
underlying mass vs. amyloid intraparenchymal hemorrhage.
COMPARISON: CTA head dated ___.
TECHNIQUE: Sagittal T1 and axial T1, T2, FLAIR, gradient echo, and diffusion
with ADC map images were obtained without contrast. Following IV
administration of gadolinium, sagittal MP-RAGE and axial T1 spin echo
sequences were obtained.
FINDINGS: A T1- and T2-hypointense, ovular-shaped acute hematoma is
redemonstrated in the left frontal lobe, currently measuring 21 x 33 mm and
thus mildly progressed when compared to CT from this morning. The hemorrhage
is surrounded by relatively extensive vasogenic edema and is exerting mild
mass effect on the adjacent cerebral sulci and left lateral ventricle. A
T1-isointense, T2-hyperintense, 12 x14 mm measuring lesion is visualized
within the hematoma and demonstrates faint enhancement, most notably at its
superior aspect. Multiple additional small foci of susceptibility are noted
in a subcortical supratentorial distribution and likely represent foci of
previous microhemorrhages. There is no evidence additional enhancing cerebral
masses.
The gray-white matter differentiation is well preserved, and there is no
evidence of acute infarction. Flow voids of the major intracranial vessels
are preserved. The visualized paranasal sinuses and mastoid air cells are
clear. The orbits and osseous structures are unremarkable.
IMPRESSION:
1.Left frontal intraparenchymal hemorrhage with pronounced ___ edema
and central enhancing lesion that most likely represents a metastatic focus.
2. No evidence of additional enhancing masses.
3. Several subcortical foci of microhemorrhage for which differential
considerations include long standing anti-coagulation or amyloid disease among
others.
|
10046166-RR-21 | 10,046,166 | 20,474,438 | RR | 21 | 2132-12-07 10:28:00 | 2132-12-07 18:57:00 | INDICATION: Recent imaging of the neck with enlarged lymph nodes. Recent
small intracranial hemorrhage, possibly due to underlying mass. Evaluate for
primary malignancy.
COMPARISONS: CTA head and neck, ___.
TECHNIQUE: 5 mm axial sections were taken through the chest, abdomen, and
pelvis after the administration of IV and oral contrast. Sagittal and coronal
reformats were obtained and reviewed. DLP is 818.90 mGy-cm.
FINDINGS:
CHEST: There is no visualized supraclavicular or axillary lymphadenopathy.
Within the mediastinum is a large 40 x 33 mm heterogeneously enhancing lymph
node or conglomerate of lymph nodes (2, 17). There is a right hilar lymph
node which measures 17 x 15 mm (2, 26). There are several other smaller
prominent mediastinal lymph nodes that do not meet criteria for pathologic
enlargement. In the right lower lobe, is a 6 mm round pulmonary nodule
adjacent to the pleural surface. This is of unclear significance, but could
represent an underlying lung cancer. There is a benign-appearing densely
calcified 15-mm nodule (2, 39), which is likely secondary to old granulomatous
disease. There are also calcified hilar lymph nodes on the right, which are
likely from old granulomatous disease. There are no other nodules seen within
the lungs. There is no consolidation or pleural effusion. The heart is
normal in shape and size. There are sternotomy wires and clips within the
anterior heart. There is no pericardial effusion.
ABDOMEN: The liver enhances homogeneously without discrete mass or lesion.
There is no intra- or extra-hepatic biliary duct dilation. The portal veins
are patent. The patient is status post cholecystectomy with clips in the
gallbladder fossa. There are multiple punctate calcifications within the
spleen, likely from old granulomatous disease. The pancreas, adrenals, and
kidneys are unremarkable. The kidneys enhance and excrete contrast
appropriately. The stomach and small bowel are unremarkable. There is no
mesenteric or abdominal lymphadenopathy. The abdominal vasculature is normal
in course and caliber. There is moderate atherosclerosis.
PELVIS: The large bowel is unremarkable without mass, wall edema, or
strictures. The urinary bladder and prostate are unremarkable. There is no
pelvic or inguinal lymphadenopathy.
OSSEOUS STRUCTURES: There are no concerning lytic or sclerotic bone lesions.
IMPRESSION:
1. Large necrotic mediastinal and hilar lymph nodes.
2. Solitary non-calcified right lower lobe 6 mm pulmonary nodule.
3. Calcifications within the spleen, hilum and a pulmonary nodule are
consistent with old granulomatous disease, likely histoplasmosis.
4. Essentially normal exam of the abdomen and pelvis.
Results were discussed with Dr. ___ telephone at 4:15 p.m. on ___
by Dr. ___.
|
10046166-RR-22 | 10,046,166 | 20,474,438 | RR | 22 | 2132-12-07 10:52:00 | 2132-12-07 17:55:00 | INDICATION: New headache and new upgoing right toe in patient with frontal
intraparenchymal hemorrhage and mediastinal lymphadenopathy, thought to be due
to possible malignancy.
COMPARISON: NECT of the head from ___.
TECHNIQUE: Contiguous axial images were obtained through the brain and
displayed with 5-mm slice thickness. No contrast was administered.
FINDINGS: A focal, well-circumscribed intraparenchymal hemorrhage is again
noted in the superior left frontal lobe. The lesion now measures 3.0 x 1.3 cm
compared to 2.9 x 1.6 cm previously, with a slight change in shape and minimal
increase in size (2:20). Again noted are internal hypodense areas as well as
what appears to be a hematocrit leveling effect, both of which were present on
the prior study. The amount of sulcal effacement is largely similar to the
previous study, but there are indications of more pronounced sulcal effacement
immediately surrounding the lesion. There is no shift of midline structures.
There is no evidence of new hemorrhage, mass, or infarction. Slight asymmetry
of the frontal horns of the lateral ventricles is unlikely to be due to mass
effect from the lesion because there is no edema seen extending thus far
inferiorly. No fracture is identified. The visualized paranasal sinuses,
mastoid air cells, and middle ear cavities are clear.
IMPRESSION: Interval slight growth of intraparenchymal hemorrhage with
minimal, if any, local increase in edema and mass effect.
|
10046166-RR-23 | 10,046,166 | 20,474,438 | RR | 23 | 2132-12-07 19:16:00 | 2132-12-08 09:28:00 | REASON FOR EXAMINATION: Evaluation of the patient with intracranial
hemorrhage with chest heaviness.
AP radiograph of the chest was reviewed in comparison to CT torso from the
same day obtained earlier.
There is prominence of the right paratracheal stripe consistent with known
enlarged lymph node. Heart size and mediastinum are otherwise unchanged in
the short interim. Calcified granuloma in the right lower lobe is
redemonstrated. No new abnormalities within the lungs seen.
|
10046166-RR-24 | 10,046,166 | 20,474,438 | RR | 24 | 2132-12-08 12:58:00 | 2132-12-08 13:53:00 | HISTORY: Post-procedure, to assess for pneumothorax.
FINDINGS:
In comparison with the study of ___, there is no evidence of pneumothorax.
Continued low lung volumes with substantial mass in the right paratracheal
region.
|
10046166-RR-37 | 10,046,166 | 25,512,766 | RR | 37 | 2133-03-21 11:59:00 | 2133-03-21 13:45:00 | EXAM: Chest frontal and lateral views.
CLINICAL INFORMATION: ___ male with history of hypoglycemia.
___.
FINDINGS: Frontal and lateral views of the chest were obtained. Rounded
calcified nodule in the region of the posterior right lung base is seen and
represents calcified granuloma on CTs dating back to ___, likely
secondary to prior granulomatous disease. Previously seen pretracheal lymph
node conglomerate and right hilar lymph nodes are better seen/evaluated on CT.
No focal consolidation is seen. There is no pleural effusion or pneumothorax.
Cardiac and mediastinal silhouettes are stable with possible slight decrease
in right paratracheal prominence.
IMPRESSION: No radiographic findings to suggest pneumonia.
|
10046166-RR-44 | 10,046,166 | 22,857,894 | RR | 44 | 2133-09-19 19:34:00 | 2133-09-19 20:16:00 | INDICATION: ___ with near syncope, low blood pressure on steroids,
assess for pneumonia.
COMPARISONS: ___.
Upright AP and lateral chest radiographs were obtained. The lungs are low in
volume, which obscure the right lower lung calcified granuloma. No focal
consolidation is seen. There is no pleural effusion or pneumothorax. The
heart is normal in size with post-surgical changes including intact
mediastinal wires.
IMPRESSION: No acute intrathoracic process.
|
10046166-RR-45 | 10,046,166 | 22,857,894 | RR | 45 | 2133-09-19 19:42:00 | 2133-09-19 20:31:00 | INDICATION: ___ male with melanoma and known brain mets, presents
with syncope, assess for hemorrhage.
TECHNIQUE: Contiguous axial images were obtained through the brain without
intravenous contrast. Coronal and sagittal reformations were prepared.
COMPARISONS: MR ___, ___.
FINDINGS: New hemorrhage with a hematocrit level is seen in a 17 x 20 mm
focus of metastasis in the left frontal lobe (2:18) along with hemorrhage in a
left parietal metastasis, measuring 14 x 9 mm. Additional metastatic lesions
with and surrounding vasogenic edema are unchanged in the right frontal and
left frontoparietal and occipital lobes. Dense left periventricular
metastasis is also unchanged. No definite other metastatic deposits are seen,
though MR is more sensitive. The ventricles and sulci remain minimally
prominent, compatible with age-related involutional changes. Gray-white
matter differentiation is otherwise preserved. There is no shift of normally
midline structures. Imaged osseous structures are unremarkable with
post-craniotomy changes in the left frontoparietal region. Soft tissues are
unremarkable. Imaged paranasal sinuses and mastoid air cells are well
aerated.
IMPRESSION: Hemorrhage in left frontal and left parietal metastatic lesions
as described above.
Findings were discussed with Dr. ___ by Dr. ___ at 18:10 on ___ by
phone 5 minutes after discovery.
|
10046166-RR-47 | 10,046,166 | 22,857,894 | RR | 47 | 2133-09-20 00:32:00 | 2133-09-20 03:25:00 | INDICATION: ___ with known hemorrhage.
TECHNIQUE: CT images of the head were obtained. Axial, coronal and sagittal
reformats were acquired.
COMPARISON: CT of the head from ___ at 19:53.
FINDINGS:
The left frontal and parietal hemorrhagic metastases are unchanged compared to
the study of ___, additional metastatic lesions without surrounding
vasogenic edema in the right frontal, left frontal, parietal and occipital
lobes are also stable. There is no evidence of new hemorrhage, new mass effect
or infarction. There is no hydrocephalus, intracranial herniation or midline
shift.
IMPRESSION:
No change from the most recent prior study on ___ at 19:53.
Multiple hemorrhagic metastases again identified.
|
10046241-RR-13 | 10,046,241 | 24,019,757 | RR | 13 | 2142-05-19 10:10:00 | 2142-05-19 11:45:00 | EXAMINATION: AP chest x-ray.
INDICATION: A ___ man with hypertension, concern for pneumonia.
TECHNIQUE: Single AP upright chest radiograph.
COMPARISON: None.
FINDINGS:
The cardiomediastinal silhouettes are normal. The bilateral hila are normal. A
linear opacity in the right lower lung is compatible with platelike
atelectasis. Otherwise, the lungs are clear. There is no pneumothorax or
effusion.
IMPRESSION:
No acute cardiopulmonary process.
|
10046241-RR-14 | 10,046,241 | 24,019,757 | RR | 14 | 2142-05-19 13:12:00 | 2142-05-19 14:20:00 | EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ with elevated bilirubin // ?obstruction
COMPARISON: None
FINDINGS:
The liver is diffusely echogenic with poor acoustic penetration limiting
assessment. There is suggestion of mild intrahepatic biliary ductal dilation
in the left hepatic lobe. Evaluation the right lobe is limited. The common
bile duct could not be visualized. The gallbladder is partially distended
containing sludge though no discrete shadowing gallstone is identified.
Sonographic ___ sign is negative. Main portal vein is patent with
hepatopetal flow. The IVC is patent. A normal waveform is seen within the main
hepatic artery. There is no pericholecystic fluid. The spleen is normal in
size and echotexture.
IMPRESSION:
1. Mild intrahepatic biliary ductal dilation partially imaged without
evidence of acute cholecystitis. Gallbladder sludge without definite stones
seen. GI consultation advised with possible MRCP or ERCP to further assess
potential cause for biliary obstruction.
2. Markedly echogenic liver likely due to fatty deposition. Please note, more
advanced forms of liver disease cannot be excluded on the basis of this
appearance.
|
10046241-RR-15 | 10,046,241 | 24,019,757 | RR | 15 | 2142-05-19 13:12:00 | 2142-05-19 14:11:00 | EXAMINATION: RENAL U.S.
INDICATION: ___ with new renal failure // ?hydro
COMPARISON: None.
FINDINGS:
The right kidney measures 10.9cm. The left kidney measures 12.3cm. There is no
hydronephrosis or worrisome renal lesion. The urinary bladder is decompressed
around the Foley catheter.
IMPRESSION:
No hydronephrosis or focal renal lesion.
|
10046241-RR-16 | 10,046,241 | 24,019,757 | RR | 16 | 2142-05-20 08:24:00 | 2142-05-22 10:02:00 | EXAMINATION: MRCP without intravenous contrast
INDICATION: ___ year old man with 2 weeks of vomiting, nausea, weakness,
fatigue, found to have elevated bili and AST/ALT, acute renal failure and mild
biliary duct obstruction on RUQUS // ?evidence of biliary duct obstruction?
TECHNIQUE: T1 and T2 weighted multiplanar images of the abdomen were acquired
within a 1.5 T magnet, including 3D dynamic sequences obtained without the
administration of intravenous contrast.
COMPARISON: Abdominal ultrasound ___.
FINDINGS:
MRCP WITHOUT IV CONTRAST:
Evaluation is limited due to lack of intravenous contrast. There is a band of
atelectasis in the right lower lobe (3:2).
Signal loss on opposed phase imaging technique is consistent with hepatic
steatosis. There is no evidence of liver mass on these noncontrast images.
Mild intrahepatic left lobe biliary ductal dilatation is again visualized
(03:24). Increased T1 signal within the right and left bile ducts is
suggestive of hematobilia.
Detailed evaluation of hepatic arterial and venous vasculature cannot be
performed due to lack of intravenous contrast.
The gallbladder is moderately distended. There is a trace amount of
pericholecystic fluid, however there is no evidence of gallbladder wall
thickening or gallstones. The common duct measures up to 9 mm. The distal
common duct at the level of the pancreatic head is not visualized.
Pancreatic head is heterogeneous in signal intensity including high T1 signal
intensity suggestive of hemorrhage suggestion areas of hemorrhage tracking
along the mesentery, the duodenum and along lesser curvature. No discrete
solid pancreatic mass visualized. The pancreatic duct is not visualized.
The spleen is not enlarged. Visualized portions of the kidneys are
unremarkable without evidence of mass or hydronephrosis. The adrenal glands
are within normal limits.
IMPRESSION:
1. Findings suggestive of hemorrhage within the pancreatic head tracking
along the mesentery and duodenum may be secondary to pancreatitis, however
underlying pancreatic mass cannot be excluded.
2. Increased T1 signal within the right and left bile ducts suggestive of
hemobilia.
3. Diffuse hepatic steatosis.
NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the
telephone on ___ at 9:59 AM, 20 minutes after discovery of the findings.
|
10046241-RR-17 | 10,046,241 | 24,019,757 | RR | 17 | 2142-05-24 16:30:00 | 2142-05-24 17:51:00 | EXAMINATION: CT ABD WANDW/O C
INDICATION: ___ year old man with history of alcoholism, HTN, new diagnosis of
diabetes here with 2 weeks of generalized weakness, malaise, and 1 week of
vomiting and diarrhea. Found to have acute renal failure, transaminitis and
hyperbilirubinemia s/p ERCP. // ?Hemosuccus pancreaticus vs. necrotizing
pancreatitis
TECHNIQUE: MDCT axial images were acquired through the abdomen before and
after the administration of intravenous contrast administration with split
bolus technique. Coronal and sagittal reformations were performed and
submitted to PACS for review. No oral contrast was administered.
DOSE: DLP: 962.97 mGy-cm (abdomen)
COMPARISON: MRI ___, ultrasound ___.
FINDINGS:
LOWER CHEST: Consolidation with volume loss at the right lung base is noted.
No pleural or pericardial effusion. Hypoattenuation of the blood pool relative
cardiac musculature is compatible with anemia.
ABDOMEN:
HEPATOBILIARY: No focal liver lesion is identified. A stent is noted within
the common bile duct without intrahepatic bile duct dilation. There is no
pneumobilia. The gallbladder is distended, but without wall edema or
radiopaque stones identified. Trace pericholecystic fluid is nonspecific in
the setting of intra-abdominal ascites.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
PANCREAS: A large rounded non-enhancing area is seen within the pancreatic
head, compatible with necrotizing pancreatitis with minimal residual
pancreatic tissue remaining. There is mild hyperdensity in the necrosed
portion (2:30), which may represent a hemorhagic component as seen on the
prior MRI. Associated inflammation extends to the lesser curve of the stomach
and encompasses the duodenum. Fluid extends from the pancreas into the
mesenteric root. Nonocclusive thrombus is noted within the splenic vein
(03:29) with nonocclusive thrombus in the main portal vein extending into the
right and left portal veins (401b:35, 03:25, 3:23). The SMV/portal vein
confluence is not visualized, likely occluded, with reconstitution of the
distal SMV (03:41). Linear hypodensity within the SMV (3:43) may represent
nonocclusive thrombus versus mixing artifact. No discrete fluid collection is
identified. No arterial pseudoaneurysm is identified. The distal pancreatic
body and tail are atrophic. The pancreatic duct within the body and tail is
not significantly dilated.
ADRENALS: The right and left adrenal glands are normal.
URINARY: The kidneys enhance symmetrically and excrete contrast promptly
without hydronephrosis.
GASTROINTESTINAL: The imaged portions of small and large bowel are normal in
course and caliber without obstruction. Diverticula are seen in the ascending
colon. There is severe duodenitis secondary to pancreatitis as above.
MESENTERY AND RETROPERITONEUM: Small mesenteric lymph nodes are not enlarged
by CT size criteria, likely reactive. No retroperitoneal lymphadenopathy is
identified. There is no free intraperitoneal air. Small perihepatic ascites is
noted.
VASCULAR: There is no abdominal aortic aneurysm. There is no calcium burden in
the abdominal aorta and great abdominal arteries. No arterial pseudoaneurysm
is identified. There are extensive perigastric and paraesophageal varices. The
hepatic veins are patent. Nonocclusive thrombus in the main portal vein,
splenic vein and possibly the SMV as detailed above with occlusion of the
SMV/portal venous confluence.
BONES AND SOFT TISSUES: No bone finding suspicious for infection or malignancy
is seen. Abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. Necrotizing pancreatitis, predominately involving the pancreatic head.
Underlying neoplasm cannot be excluded and repeat imaging is suggested after
acute issues resolve. Extensive surrounding inflammation with duodenitis. No
discrete fluid collection.
2. Nonocclusive thrombus within the main portal vein, intrahepatic portal
venous branches, splenic vein and possibly the SMV with occlusion of the
portal confluence. Perigastric and paraesophageal varices.
3. No evidence of arterial pseudoaneurysm.
NOTIFICATION: Findings discussed with Dr. ___ by Dr. ___
telephone on ___ at 17:49 5 min after they were made.
|
10046241-RR-22 | 10,046,241 | 27,535,359 | RR | 22 | 2142-06-10 16:06:00 | 2142-06-10 16:42:00 | EXAMINATION: CTA chest
INDICATION: Persistent tachycardia and history of a predisposition to
clotting.
TECHNIQUE: Axial multidetector CT images were obtained through the thorax
after the uneventful administration of 100 cc of Omnipaque intravenous
contrast.
Reformatted coronal, sagittal, thin slice axial images, and oblique maximal
intensity projection images were submitted to PACS and reviewed.
DOSE: DLP: 148.8 mGy-cm
COMPARISON: Chest radiograph ___.
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.
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. The main and right pulmonary arteries are
normal in caliber, and there is no evidence of right heart strain.
There is no evidence of pericardial effusion.
There is no evidence of pulmonary parenchymal abnormality. Bibasilar
atelectasis is mild. There is no pleural effusion. The airways are patent to
the subsegmental level.
There is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy.
The thyroid gland appears unremarkable.
Limited images of the upper abdomen demonstrate partial visualization of of a
distended gallbladder, central biliary dilatation as well as several
perigastric varices.
No lytic or blastic osseous lesion suspicious for malignancy is identified.
IMPRESSION:
1. No evidence of pulmonary embolism or aortic abnormality.
2. Clear lungs.
3. Distended gallbladder, biliary dilation and varices formation better
characterized on recent dedicated abdominal study.
|
10046362-RR-22 | 10,046,362 | 25,444,237 | RR | 22 | 2189-02-02 02:05:00 | 2189-02-02 03:09:00 | EXAMINATION: MR ___ AND W/O CONTRAST
INDICATION: ___ with concern for fluid collection near laminectomy location//
? abnormality
TECHNIQUE: Sagittal imaging was performed with T2, T1, and STIR technique.
Axial T2 imaging was performed. After the uneventful administration of 15 mL
of Gadavist contrast agent, additional axial and sagittal T1 images were
obtained.
COMPARISON: MRI lumbar spine ___
FINDINGS:
Patient has transitional anatomy at the lumbosacral junction. To remain
consistent with patient's history of L4-5 laminectomy, the numbering system is
assigned in a similar fashion, and this is assuming partial sacralization of
L5.
The patient is status post interval left L4-L5 hemilaminectomy with a
well-defined irregular-shaped T2 hyperintense fluid collection within the
postsurgical bed, lateral to the thecal sac at L4-L5, extending linearly
through the left paraspinal soft tissues and to the skin. This fluid
collection measures approximately 1.4 x 6.0 x 3.7 cm and demonstrates a thin
rim of peripheral enhancement. The fluid collection does not exert any
mass-effect upon the thecal sac. T1/T2 hyperintense and STIR hypointense
signal at the endplates of L1-L2 and L4-L5 represent degenerative type ___ ___
changes. The height of the vertebral bodies are maintained. The
intervertebral disc spaces of L1-L2 and L4-L5 are severely narrowed. The
intervertebral disc space of L5-S1 is mildly narrowed. The intervertebral
discs are diffusely desiccated. The conus medullaris terminates at T12-L1.
The spinal cord is normal in signal. There is no enhancement within the
spinal cord or nerve roots of the cauda equina.
At T12-L1, there is disc bulge without spinal canal or neural foraminal
stenosis, unchanged from the prior examination.
At L1-L2, disc bulge and bilateral facet arthropathy cause mild to moderate
left neural foraminal stenosis, unchanged from the prior examination. There
is subarticular recess narrowing bilaterally without spinal canal stenosis.
At L2-3, disc bulge, ligamentum flavum thickening, and bilateral facet
arthropathy cause moderate left neural foraminal stenosis, unchanged from the
prior examination. There is no spinal canal stenosis.
At L3-L4, disc bulge, ligamentum flavum thickening, and bilateral facet
arthropathy cause moderate right neural foraminal stenosis, unchanged from the
prior examination. There is significant subarticular recess narrowing, which
is worse on the left crowding the traversing L4 nerve roots. There is minimal
spinal canal stenosis. Overall, findings are similar compared to prior.
At L4-5, disc bulge and right facet arthropathy cause moderate right neural
foraminal stenosis, unchanged from the prior examination. See above for
description of the fluid collection in the postoperative bed. Enhancement is
seen in the region of the subarticular recess and neural foramen suggestive of
granulation tissue (09:24, 25)
At L5-S1, there is bilateral facet arthropathy without spinal canal or neural
foraminal stenosis, unchanged from the prior examination.
OTHER: A uterine C-section scar is noted. A homogeneously T2 hyperintense
cyst in the left adnexa measures 3.6 x 2.2 cm and is likely physiologic in a
mestruating female.
IMPRESSION:
1. Status post left L4-L5 hemilaminectomy with an irregular but well -defined
fluid collection within the postoperative bed, most likely representing a
seroma. Infection is felt to be less likely, but should be correlated
clinically.
2. Stable multilevel degenerative changes in the remainder of the lumbar
spine.
|
10046362-RR-23 | 10,046,362 | 25,444,237 | RR | 23 | 2189-02-04 10:54:00 | 2189-02-04 16:54:00 | EXAMINATION: UNILAT LOWER EXT VEINS
INDICATION: ___ woman with left calf pain and swelling. Evaluate for
DVT.
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the left lower extremity veins.
COMPARISON: None.
FINDINGS:
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 left posterior tibial and peroneal veins.
There is normal respiratory variation in the common femoral veins bilaterally.
IMPRESSION:
No evidence of deep venous thrombosis in the left lower extremity veins.
|
10046436-RR-10 | 10,046,436 | 21,447,783 | RR | 10 | 2156-06-10 13:35:00 | 2156-06-10 15:57:00 | EXAMINATION: CT abdomen and pelvis without IV contrast
INDICATION: ___ year old man with glass ingestion// evaluate for 2.1 cm piece
of glass
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) = 1,028 mGy-cm.
COMPARISON: CT abdomen and pelvis dated ___.
FINDINGS:
LOWER CHEST: Mild dependent atelectasis. No focal consolidations. No pleural
or pericardial effusion.
ABDOMEN:
HEPATOBILIARY: 1.6 cm hypodense lesion within segment IVB is unchanged
compared to prior, likely a hepatic cyst. Otherwise, the liver demonstrates
homogeneous attenuation throughout. There is no evidence of intrahepatic or
extrahepatic biliary dilatation. The patient is status post cholecystectomy.
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 previously visualized 2.6 cm radiopaque foreign object
has migrated into the cecum (series 602, image 31). The smaller 9 mm
radiopaque remains within the cecum. There is no bowel wall thickening, fat
stranding, or pneumoperitoneum to suggest perforation. The stomach is
unremarkable. Small bowel loops demonstrate normal caliber and wall thickness
throughout. Otherwise, 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 visualized reproductive organs are unremarkable.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease
is noted.
BONES: Moderate levoconvex scoliosis of the spine is unchanged. There is no
evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: Small fat containing umbilical hernia. A small focus of fat
stranding within the left anterior abdominal wall is likely due to injections.
Otherwise, the abdominal and pelvic wall is within normal limits.
IMPRESSION:
Both of the radiopaque foreign objects are now within the cecum, measuring 2.6
cm and 0.9 cm. No evidence of perforation or bowel obstruction.
|
10046436-RR-11 | 10,046,436 | 21,447,783 | RR | 11 | 2156-06-15 18:47:00 | 2156-06-15 19:15:00 | EXAMINATION: CT abdomen and pelvis without contrast
INDICATION: ___ year old man with Prader willi syndrome here w/ glass
ingestion// ?glass progression
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 3.2 s, 51.2 cm; CTDIvol = 18.8 mGy (Body) DLP = 963.4
mGy-cm.
Total DLP (Body) = 963 mGy-cm.
COMPARISON: CT abdomen and pelvis ___.
FINDINGS:
LOWER CHEST: Heart size is normal without significant pericardial effusion.
The imaged lung bases are grossly clear.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout.
There is no evidence of focal lesions within the limitations of an unenhanced
scan. There is no evidence of intrahepatic or extrahepatic biliary
dilatation. The gallbladder surgically absent
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions within the limitations of an unenhanced scan. There is no
pancreatic ductal dilatation. There is no peripancreatic stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size. There is no evidence
of focal renal lesions within the limitations of an unenhanced scan. There is
no hydronephrosis. There is no nephrolithiasis. There is no perinephric
abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber and wall thickness throughout. 2 adjacent linear radiodense
objects measuring 25 and 10 mm are essentially unchanged in position with the
longer object within the cecal base and the shorter object within the proximal
appendix the colon and rectum are otherwise within normal limits. Despite the
radiodense object sitting within the appendiceal base, the appendix itself is
nondilated and there is no surrounding inflammatory change. There is no
adjacent wall thickening, fluid, or pneumoperitoneum.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease
is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: There is a tiny fat containing umbilical hernia.
IMPRESSION:
Unchanged position of the 2 radiodense objects with the 25 mm fragment within
the cecal base and the 10 mm fragment within the appendiceal base. Given
location, especially the fragment within the appendiceal base, these are felt
unlikely to progress distally. No bowel rupture or adjacent colonic
irritation.
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