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10046436-RR-12 | 10,046,436 | 21,447,783 | RR | 12 | 2156-06-18 08:37:00 | 2156-06-18 15:00:00 | INDICATION: ___ year old man with hx of prader willi s/p glass ingestion.//
monitoring for location of glass
TECHNIQUE: Portable supine abdominal radiograph was obtained.
COMPARISON: Noncontrast CT abdomen pelvis performed ___.
FINDINGS:
There are no abnormally dilated loops of large or small bowel.
Supine assessment limits detection for free air; there is no gross
pneumoperitoneum.
2.5 and 1.1 cm linear hyperdensities in the right lower quadrant correspond to
previously described radiodense glass fragments on prior CT and appear to
overly the area of the cecum and/or proximal ascending colon.
Osseous structures are notable for thoracolumbar levoscoliosis. There are
cholecystectomy clips in the right upper quadrant.
IMPRESSION:
2.5 and 1.1 cm linear hyperdensities in the right lower quadrant correspond to
previously described radiodense glass fragments on prior CT exam and appear
located in the cecum and/or proximal ascending colon.
|
10046436-RR-13 | 10,046,436 | 21,447,783 | RR | 13 | 2156-06-19 08:23:00 | 2156-06-19 11:51:00 | INDICATION: ___ year old man with prader willi with glass ingestion.// Eval
for glass location
TECHNIQUE: Portable supine abdominal radiograph was obtained.
COMPARISON: Abdominal radiographs from ___. CT abdomen pelvis
performed ___.
FINDINGS:
Again demonstrated are 2.5 and 1.1 cm hyperdensities in the right lower
quadrant that correspond to previously described radiodense glass fragments on
prior CT which appear unchanged in position, overlying the area of the cecum
and/or proximal ascending colon. There are no abnormally dilated loops of
large or small bowel.
Supine assessment limits detection for free air; there is no gross
pneumoperitoneum.
Osseous structures are notable for thoracolumbar levoscoliosis.
Cholecystectomy clips are again visualized in the right upper quadrant.
IMPRESSION:
Unchanged position of two known glass fragments in the right lower quadrant
overlying the area of the cecum and/or proximal ascending colon.
|
10046436-RR-14 | 10,046,436 | 21,447,783 | RR | 14 | 2156-06-19 18:51:00 | 2156-06-19 19:18:00 | INDICATION: ___ year old man with prader willi syndrome who is here with glass
ingestion// ?glass- had ___ w/o visualization of glass- please assess for
interval change in location of radiopaque material
TECHNIQUE: Portable supine frontal view of the abdomen.
COMPARISON: ___ 08:54
FINDINGS:
There are no abnormally dilated loops of large or small bowel.
Supine assessment limits detection for free air; there is no gross
pneumoperitoneum.
Osseous structures are unremarkable.
2 triangular radiopaque densities in the right lower quadrant, projecting over
the proximal ascending colon are grossly unchanged in position as compared to
the recent prior examination.
IMPRESSION:
Grossly unchanged position of the 2 glass fragments projecting over the
cecum/proximal ascending colon
|
10046436-RR-15 | 10,046,436 | 21,447,783 | RR | 15 | 2156-06-21 09:17:00 | 2156-06-21 18:01:00 | INDICATION: ___ year old man with Prader Willi s/p glass ingestion, benign
abdominal exam// eval for location of glass
TECHNIQUE: Abdomen supine and upright
COMPARISON: ___
FINDINGS:
The previously identified glass fragments have progressed. The larger glass
foreign body is identified in the descending colon. The smaller glass
fragment is seen at the level of the hepatic flexure. There are no abnormally
dilated loops of large or small bowel.
There is no free intraperitoneal air.
Osseous structures are unremarkable.
There are no unexplained soft tissue calcifications or radiopaque foreign
bodies.
IMPRESSION:
Larger glass fragment in the descending colon, smaller glass fragment at the
hepatic flexure.
|
10046436-RR-16 | 10,046,436 | 21,447,783 | RR | 16 | 2156-06-21 09:17:00 | 2156-06-21 10:18:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old man with Prader Willi s/p glass ingestion, benign
abdominal exam, currently with leukocytosis, cough// eval for pneumonia
eval for pneumonia
IMPRESSION:
Comparison to ___. Low lung volumes persist. Minimal retrocardiac
opacity with air bronchograms, potentially suggesting pneumonia in the
appropriate clinical setting. No evidence of free intra-abdominal air. No
pleural effusions. No pulmonary edema.
|
10046436-RR-17 | 10,046,436 | 21,447,783 | RR | 17 | 2156-06-22 09:17:00 | 2156-06-22 17:18:00 | INDICATION: ___ year old man with Prader, willi, with glass ingestion// eval
for glass
COMPARISON: Radiographs from ___. CT from ___.
FINDINGS:
6 curvilinear densities within the right upper quadrant are unchanged in
configuration since the ___ examination, and correlate to
surgical clips seen on the CT from ___. Previously seen linear
densities in the right lower quadrant from ___ examination are no
longer visualized. No new radiopaque foreign bodies are identified. There is
no bowel obstruction. No free air is detected.
IMPRESSION:
Surgical clips within the right upper quadrant are unchanged in configuration.
The ingested foreign bodies originally seen on the ___ CT
examination are no longer visualized radiographically.
|
10046436-RR-18 | 10,046,436 | 21,447,783 | RR | 18 | 2156-06-21 21:47:00 | 2156-06-21 22:09:00 | INDICATION: ___ year old man with glass shards in colon, with passage of
largest glass shard with now elevated lactate// Evaluation for perforation
TECHNIQUE: Supine and upright abdominal radiographs were obtained.
COMPARISON: Multiple prior abdominal radiographs most recently dated ___ from earlier in the day
FINDINGS:
Again demonstrated are multiple fragments of glass projecting over the right
upper quadrant. The larger glass foreign body previously seen in the
descending colon is not visible on the current study. There are no abnormally
dilated loops of large or small bowel.
There is no free intraperitoneal air.
Osseous structures are unremarkable.
IMPRESSION:
No significant interval change since the prior abdominal radiograph apart from
nonvisualization of the previously seen shard of glass within the descending
colon.
|
10046436-RR-19 | 10,046,436 | 21,447,783 | RR | 19 | 2156-06-23 12:24:00 | 2156-06-23 13:40:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old man with prader, willi, worsening glucose control,
concern for infection// eval for pneumonia
IMPRESSION:
In comparison with study of ___, there again are low lung volumes.
Cardiac silhouette is within normal limits without vascular congestion. Mild
opacification at the left base most likely reflect combination of atelectasis
and pleural fluid. However, in the appropriate clinical setting, it would be
difficult to exclude superimposed aspiration/pneumonia.
|
10046436-RR-2 | 10,046,436 | 23,594,537 | RR | 2 | 2153-12-27 04:19:00 | 2153-12-27 04:50:00 | EXAMINATION: ABDOMINAL RADIOGRAPHS
INDICATION: History: ___ with ingested glass // free air
TECHNIQUE: Supine and upright frontal radiographs of the abdomen.
COMPARISON: Outside abdominal radiographs performed at ___ 8 hr
earlier.
FINDINGS:
There are multiple layering linear hyperdensities in the left upper quadrant
appear to be within the stomach. However, there are at least 2 linear
hyperdensities on the supine frontal radiograph of the abdomen that cannot be
identified on the upright view and are not clearly within the stomach, 1 of
which measures 2 cm in the right mid abdomen and 1 of which measures 10 mm in
the left mid abdomen. Surgical clips in the right upper quadrant of the
abdomen suggest prior cholecystectomy. There is no evidence of free air
beneath either hemidiaphragm on the upright view. There is moderate levoconvex
curvature with the apex at the thoracolumbar junction.
IMPRESSION:
1. Multiple layering linear densities in the stomach corresponding to
ingested foreign materials. However, 2 linear hyperdensities seen on the
supine view cannot be identified on the upright view and are not clearly
within the stomach.
2. No evidence of free air.
NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ in
person on ___ at 4:49 AM, 5 minutes after discovery of the findings.
|
10046436-RR-3 | 10,046,436 | 23,594,537 | RR | 3 | 2153-12-27 10:32:00 | 2153-12-27 14:47:00 | EXAMINATION: PORTABLE ABDOMEN
INDICATION: ___ year old man with ingestion of glass. Eval for free air,
please perform upright.
TECHNIQUE: Portable frontal and cross-table decubitus views of the abdomen.
COMPARISON: Abdominal radiograph from earlier on the same date.
FINDINGS:
Again seen are multiple layering linear hyperdensities in the left upper
quadrant, likely in the stomach and compaible with known ingestion of glass.
Previously described linear densities in the right mid abdomen and left mid
abdomen are no longer seen. Right upper quadrant surgical clips are again
seen. There is no free intraperitoneal air.
IMPRESSION:
1. Multiple linear foreign bodies layering in the stomach.
2. No free air.
NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the
telephone on ___ at 2:40 ___, 2 minutes after the images were reviewed.
|
10046436-RR-4 | 10,046,436 | 23,594,537 | RR | 4 | 2153-12-28 08:49:00 | 2153-12-28 10:08:00 | INDICATION: Evaluate for continued presence of glass in a patient status post
glass ingestion.
COMPARISON: Abdominal radiographs from ___ and ___.
FINDINGS:
Supine and upright frontal abdominal radiographs again demonstrate linear
radiodense material. The largest collection projects over the left upper
quadrant, in an unclear location. On upright view the collection appears to
follow the contour of the stomach, but on the supine view it projects over the
transverse colon. Additional hyperdensities in are seen projecting over the
left mid and lower abdomen, as well as the right lower quadrant, consistent
with passage of at least some shards of glass. No intra-abdominal free air is
identified. Smaller, more radiodense foreign objects in the right upper
quadrant are unchanged in position and likely represent surgical clips from
prior procedures.
IMPRESSION:
Persistent collection of linear radiodense material consistent with ingested
glass, projecting over the left upper quadrant but unclear whether in the
stomach or transverse colon. There is evidence of passage of at least a few
shards of glass. No intra-abdominal free air is identified. A lateral
radiograph or CT may be helpful in more accurate localization of these foreign
bodies.
|
10046436-RR-5 | 10,046,436 | 23,594,537 | RR | 5 | 2153-12-29 10:12:00 | 2153-12-29 11:35:00 | EXAMINATION: ABDOMEN (SUPINE AND ERECT)
INDICATION: ___ year old man with glass ingestion. Assess for continued
presence of glass.
TECHNIQUE: Supine and upright views of the abdomen.
COMPARISON: Abdominal radiographs from 18, 17, and ___.
FINDINGS:
Again seen are multiple linear radiodensities consistent with known history of
ingested glass. The largest collection projects over the left mid abdomen,
presumably within the descending colon. Multiple shards also seen in the
pelvis, perhaps within the sigmoid colon. No free intraperitoneal air seen on
upright view. Unchanged right upper quadrant surigcal clips.
IMPRESSION:
Shards of glass are present in the ascending, descending, and sigmoid colon.
No free intraperitoneal air.
|
10046436-RR-6 | 10,046,436 | 23,594,537 | RR | 6 | 2153-12-30 10:02:00 | 2153-12-30 13:29:00 | EXAMINATION: ABDOMEN (SUPINE AND ERECT)
INDICATION: ___ year old man with glass ingestion. Please assess for
continued presence of glass.
TECHNIQUE: Supine and upright views of the abdomen.
COMPARISON: Abdominal radiographs from ___, and ___.
FINDINGS:
Shards of glass are identified in the mid right abdomen, perhaps within the
ascending colon. Previously described glass shards in the descending and
sigmoid colons are no longer seen. No free intraperitoneal air. Unchanged
right upper quadrant surgical clips.
IMPRESSION:
Shards of glass are seen in the mid right abdomen, perhaps within the
ascending colon. No free intraperitoneal air.
|
10046436-RR-7 | 10,046,436 | 23,594,537 | RR | 7 | 2153-12-31 09:55:00 | 2153-12-31 11:46:00 | EXAMINATION: ABDOMEN (SUPINE AND ERECT)
INDICATION: ___ year old man with glass ingestion. // please assess for
continued presence of glass
TECHNIQUE: ABDOMEN (SUPINE AND ERECT)
COMPARISON: ___
IMPRESSION:
No definitive evidence of glass seen but this same opacity projecting over the
a right mid: Are present. If clinically warranted, correlation with CT
abdomen for pre size localization of the glass might be considered
|
10046436-RR-8 | 10,046,436 | 23,594,537 | RR | 8 | 2154-01-01 13:10:00 | 2154-01-01 16:41:00 | INDICATION:
___ year old man with glass ingestion..
COMPARISON: Comparison is made to multiple abdominal radiographs dating back
to ___.
TECHNIQUE
Supine and upright view of the abdomen.
FINDINGS:
Bowel gas pattern is normal. There is no evidence of pneumatosis or free air.
Multiple calcified densities over the right upper quadrant are unchanged, and
may relate to prior surgery. A punctate hypodensity in the right lower
quadrant was not seen previously and is of unclear significance.
IMPRESSION:
Nonobstructive bowel gas pattern.
|
10046436-RR-9 | 10,046,436 | 21,447,783 | RR | 9 | 2156-06-07 23:46:00 | 2156-06-08 00:08:00 | EXAMINATION: CT abdomen and pelvis
INDICATION: ___ year old man with foreign body ingestion, reportedly glass and
radiopaque on OSH CT (uploaded), unable to be retrieved on EGD.// assess for
foreign object in GI tract post-pyloric, e/o 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 not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 4.9 s, 53.9 cm; CTDIvol = 14.3 mGy (Body) DLP = 771.9
mGy-cm.
Total DLP (Body) = 772 mGy-cm.
COMPARISON: CT dated ___
FINDINGS:
LOWER CHEST: Subsegmental atelectasis noted at the lung bases bilaterally.
There is no pleural effusion.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. 16
mm hypodensity in segment 4B is likely a hepatic cyst. No other focal liver
lesion identified within the limitations of this study. There is no evidence
of intrahepatic or extrahepatic biliary dilatation. The gallbladder is
surgically absent.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions within the limitations of an unenhanced scan. There is no
pancreatic ductal dilatation. There is no peripancreatic stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size. There is no evidence
of focal renal lesions within the limitations of an unenhanced scan. There is
no hydronephrosis. There is no nephrolithiasis. There is no perinephric
abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber and wall thickness throughout. The previously seen radiopaque
foreign object within the stomach has migrated distally and now visualized
within a loop of distal small bowel in the right lower quadrant. This
measures up to 2.2 cm in length and appears to be tenting the small bowel
wall. Another small radiopaque object is seen in the cecum measuring 9 mm.
There is no evidence of bowel perforation. 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. Mild atherosclerotic disease
is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
Left convex thoracolumbar scoliosis noted.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
Ingested radiopaque foreign body has migrated distally and is seen within a
loop of distal small bowel in the right lower quadrant. Another small
radiopaque object is noted within the cecum which may represent a detached
fragment. No evidence of bowel perforation or obstruction.
|
10046543-RR-4 | 10,046,543 | 21,402,025 | RR | 4 | 2155-03-15 17:58:00 | 2155-03-15 18:44:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: History: ___ with fall with T8/L1 fx. ant rib tenderness on
right.// cva?
TECHNIQUE: Contiguous axial images from skullbase to vertex were obtained
without intravenous contrast. Coronal and sagittal reformations and bone
algorithms reconstructions were also performed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 16.0 s, 16.0 cm; CTDIvol = 50.2 mGy (Head) DLP =
802.7 mGy-cm.
Total DLP (Head) = 803 mGy-cm.
COMPARISON: None.
FINDINGS:
There is no evidence of acute intracranial hemorrhage, midline shift, mass
effect, or acute large vascular territorial infarct. Mild periventricular and
subcortical white matter hypodensities are nonspecific, could reflect sequela
of microangiopathy. There is prominence of the ventricles and sulci
consistent with involutional changes.
No acute fracture is seen. A mucous retention cyst is noted in the right
maxillary sinus. Otherwise, the paranasal sinuses, mastoid air cells, and
middle ear cavities are clear. Extensive calcifications are seen along the
cavernous portions of the bilateral carotid arteries. Vertebral artery
calcification is also noted.
IMPRESSION:
No acute intracranial process.
|
10046543-RR-5 | 10,046,543 | 21,402,025 | RR | 5 | 2155-03-15 17:59:00 | 2155-03-15 19:08:00 | EXAMINATION: CT C-SPINE W/O CONTRAST
INDICATION: History: ___ with fall with T8/L1 fx. ant rib tenderness on
right.// cva?
TECHNIQUE: Contiguous axial images obtained through the cervical spine
without intravenous contrast. Coronal and sagittal reformats were reviewed.
DOSE: Acquisition sequence:
1) Spiral Acquisition 5.0 s, 19.8 cm; CTDIvol = 22.8 mGy (Body) DLP = 450.9
mGy-cm.
Total DLP (Body) = 451 mGy-cm.
COMPARISON: None.
FINDINGS:
Alignment is normal. No acute fractures are identified.No significant central
canal narrowing is seen.There is no prevertebral edema. Multilevel facet
arthropathy is seen bilaterally, right greater than left.
The thyroid gland is grossly homogeneous. The included lung apices
demonstrates subtle mild septal thickening which may be due to mild pulmonary
edema. Aortic calcifications are partially imaged.
IMPRESSION:
Multilevel degenerative changes of the cervical spine without evidence of
acute fracture or traumatic malalignment.
Partially imaged lung apices demonstrates subtle mild septal thickening, may
be due to mild pulmonary edema.
|
10046543-RR-6 | 10,046,543 | 21,402,025 | RR | 6 | 2155-03-15 17:59:00 | 2155-03-15 19:56:00 | EXAMINATION: Torso CT.
INDICATION: History: ___ with fall with T8/L1 fx. ant rib tenderness on
right.// cva?
TECHNIQUE: MDCT axial images were acquired through the chest, abdomen and
pelvis following intravenous contrast administration with split bolus
technique.
IV Contrast: 130 mL Omnipaque.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 7.6 s, 59.6 cm; CTDIvol = 22.0 mGy (Body) DLP =
1,308.1 mGy-cm.
Total DLP (Body) = 1,308 mGy-cm.
COMPARISON: None.
FINDINGS:
CHEST:HEART AND VASCULATURE: The thoracic aorta is normal in caliber without
evidence of acute injury. No pericardial effusion is seen.
AXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar
lymphadenopathy is present. No mediastinal mass or hematoma.
PLEURAL SPACES: No pleural effusion or pneumothorax.
LUNGS/AIRWAYS: Increased peripheral densities and ground-glass opacities at
the depend lung bases probably reflect atelectasis. There is no focal
consolidation to suggest pneumonia or contusion. 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 lesion or laceration. 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 lesion or laceration.
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: Small hiatal hernia is noted. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. The colon and
rectum are within normal limits. The appendix is normal. There is no
evidence of mesenteric injury.
There is no free fluid or free air in the abdomen.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: There is a 2.2 cm right adnexal cyst. Otherwise, the
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 or retroperitoneal hematoma.
Moderate atherosclerotic disease is noted.
BONES: Compression deformities of the T8, T10, and L1 vertebral bodies are
compatible fractures of unknown chronicity, though the cortical disruption in
the superior endplate of L1 may be reflective of an acute/subacute fracture.
There is no significant associated retropulsion. A subtle cortical
irregularity in the anterior aspect of the right 3rd rib may reflect a
nondisplaced fracture of indeterminate age. Chronic fractures of the left
superior and inferior pubic rami are present. No other focal suspicious
osseous abnormality is identified.
SOFT TISSUES: Small subcutaneous calcifications are noted in the right breast.
The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. Compression deformities of the T8, T10, and L1 vertebral bodies compatible
fractures of unknown chronicity, though the fracture involving L1 has an
acute/subacute appearance. No significant retropulsion.
2. Subtle cortical irregularity in the anterior aspect of the right 3rd rib
may reflect a nondisplaced fracture of unknown chronicity.
3. 2.2 cm right adnexal cyst could be further assessed on outpatient pelvic
ultrasound, if clinically appropriate given patient age.
|
10046630-RR-14 | 10,046,630 | 20,836,768 | RR | 14 | 2171-04-01 13:22:00 | 2171-04-01 13:53:00 | EXAMINATION: DX PELVIS AND HIP UNILATERAL
INDICATION: History: ___ with l hip pain // eval for fx eval for fx
eval for fx
COMPARISON: CT pelvis dated ___
FINDINGS:
Minimally displaced and comminuted fractures involving the left superior and
inferior pubic rami are better depicted on CT dated ___. Degree
of displacement is similar in appearance. No new fracture is identified.
Bilateral femoral heads appears seated in the acetabulum. No significant
degenerative changes within the hip joints are present. Bowel gas obscures
the sacrum which appears grossly intact.
IMPRESSION:
Minimally displaced and comminuted fractures involving the left superior and
inferior pubic rami not significantly changed in overall appearance relative
to prior examinations dated ___. No new fracture is seen.
|
10046630-RR-15 | 10,046,630 | 20,836,768 | RR | 15 | 2171-04-01 15:24:00 | 2171-04-01 16:31:00 | EXAMINATION: Chest radiograph
INDICATION: ___ with leg pain, ams // PNA? DVT
TECHNIQUE: Single AP view
COMPARISON: None.
FINDINGS:
AP semi upright view the chest provided. Lungs are clear. The heart is
top-normal in size. The aorta appears unfolded. No pneumothorax or effusion.
Bony structures are intact.
IMPRESSION:
No acute intrathoracic process.
|
10046630-RR-16 | 10,046,630 | 20,836,768 | RR | 16 | 2171-04-01 15:22:00 | 2171-04-01 16:07:00 | EXAMINATION: UNILAT LOWER EXT VEINS LEFT
INDICATION: ___ with leg pain, ams // PNA? DVT
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the bilateral lower extremity veins.
COMPARISON: None.
FINDINGS:
There is normal compressibility, flow, and augmentation of the left common
femoral, femoral, and popliteal veins. There is nonocclusive thrombus in a
single posterior tibial vein on the left.
There is normal compressibility, flow, and augmentation of the right common
femoral, femoral, and popliteal veins. Normal color flow and compressibility
are demonstrated in the posterior tibial and peroneal veins.
There is normal respiratory variation in the common femoral veins bilaterally.
No evidence of medial popliteal fossa (___) cyst.
IMPRESSION:
1. Nonocclusive thrombus in a single posterior tibial vein on the left.
2. No evidence of deep venous thrombosis in the right lower extremity veins.
|
10046630-RR-17 | 10,046,630 | 20,836,768 | RR | 17 | 2171-04-02 09:49:00 | 2171-04-02 10:52:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ with AMS this AM, delirious, known DVT
TECHNIQUE: Routine unenhanced head CT was performed and viewed in brain,
intermediate and bone windows. Coronal and sagittal reformats were also
performed.
DOSE: Total DLP (Head) = 903 mGy-cm.
COMPARISON: None.
FINDINGS:
There is no intra-axial or extra-axial hemorrhage, edema, shift of normally
midline structures, or evidence of acute major vascular territorial
infarction. Ventricles and sulci appear prominent likely due to age related
involution. There is periventricular white matter hypodensity consistent with
chronic microvascular ischemic disease. The paranasal sinuses appear well
aerated. The mastoid air cells are clear as are the middle ears. The bony
calvarium is intact.
IMPRESSION:
No acute intracranial process. Small vessel disease with age related
involutional change.
|
10046724-RR-19 | 10,046,724 | 25,792,614 | RR | 19 | 2178-09-02 17:11:00 | 2178-09-02 18:47:00 | INDICATION: ___ with brain herniation// Preoperative
COMPARISON: None
FINDINGS:
Portable AP upright view the chest provided. Lung volumes are low. Lungs are
clear bilaterally without focal consolidation, large effusion or pneumothorax.
Cardiomediastinal silhouette appears within normal limits. Bony structures
are intact.
IMPRESSION:
No acute intrathoracic process.
|
10046724-RR-20 | 10,046,724 | 25,792,614 | RR | 20 | 2178-09-02 21:38:00 | 2178-09-02 22:37:00 | INDICATION: ___ year old man with L SDH, intubated// assess ETT
TECHNIQUE: AP portable chest radiograph
COMPARISON: ___ from earlier in the day
FINDINGS:
The tip of the endotracheal tube projects at the level of the clavicular
heads, approximately 7.4 cm from the carina and should be advanced by 2-3 cm.
No focal consolidation, pleural effusion or pneumothorax is identified. The
size of the cardiomediastinal silhouette is within normal limits.
Degenerative changes of the left glenohumeral joint are noted.
IMPRESSION:
The tip of the endotracheal tube projects at the level of the clavicular
heads, approximately 7.4 cm from the carina and should be advanced by 2-3 cm.
|
10046724-RR-21 | 10,046,724 | 25,792,614 | RR | 21 | 2178-09-03 01:10:00 | 2178-09-03 09:43:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with SDH s/p crani with ETT repositioned and new
NGT placement// ETT and NGT placement ETT and NGT placement
IMPRESSION:
Compared to chest radiographs ___.
Mild cardiomegaly is new. Mediastinal and pulmonary vessels are engorged, but
there is no pulmonary edema or appreciable pleural effusion.
ET tube in standard placement. New nasogastric drainage tube ends in the
upper portion of a nondistended stomach.
|
10046724-RR-22 | 10,046,724 | 25,792,614 | RR | 22 | 2178-09-03 03:38:00 | 2178-09-03 04:35:00 | EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ year old man with large subacute ___ s/p evacuation with
subdural drain in place; TO BE DONE AT 5AM ON ___// s/p crani for ___
evacuation with drain in place; TO BE DONE AT 5AM ON ___
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast. Coronal and sagittal reformations as well as bone algorithm
reconstructions were provided and reviewed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 16.0 s, 16.0 cm; CTDIvol = 50.2 mGy (Head) DLP =
802.7 mGy-cm.
Total DLP (Head) = 803 mGy-cm.
COMPARISON: CT head performed 13 hours prior.
FINDINGS:
Patient is status post left frontoparietal craniotomy for evacuation of
subdural hematoma with a subdural drain in place. Pneumocephalus and subdural
blood within the evacuation cavity are consistent with postoperative changes.
10 mm rightward midline shift and effacement of the left lateral ventricle
have improved. Sulci effacement in the left cerebral hemisphere has also
improved. There is no evidence of new hemorrhage. There is no evidence of
new hemorrhage, large territorial infarction, mass, or edema.
There is no evidence of fracture. Left frontoparietal subcutaneous hematoma
and emphysema are noted. The visualized portion of the paranasal sinuses,
mastoid air cells, and middle ear cavities are clear. The visualized portion
of the orbits are unremarkable. A nasogastric tube is noted.
IMPRESSION:
1. Status post left frontoparietal craniotomy for evacuation of subdural
hematoma with a subdural drain in place and expected postoperative changes
2. Improved mass effect including 10 mm rightward midline shift and effacement
of the left lateral ventricle.
3. No new hemorrhage or large territorial infarction.
|
10046724-RR-23 | 10,046,724 | 25,792,614 | RR | 23 | 2178-09-03 13:38:00 | 2178-09-03 14:39:00 | EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ year old man with s/p crani for ___ evac// post drain pull
___
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 11.0 s, 18.7 cm; CTDIvol = 48.8 mGy (Head) DLP =
911.9 mGy-cm.
Total DLP (Head) = 924 mGy-cm.
COMPARISON: Head CT from ___ at 04:14.
FINDINGS:
There has been interval removal of the extra-axial drain placed along the left
convexity following the subdural evacuation. Mild subcutaneous swelling,
emphysema and trace amount of blood products around the left frontoparietal
craniotomy site is grossly similar compared to prior exam. However, there is
interval improvement in left frontoparietal pneumocephalus, though there is
grossly stable mixed density subdural blood products and fluid within the
evacuation cavity measuring approximately 8 mm. 10 mm rightward shift of
midline structures is grossly stable. Mild effacement of sulci in the left
convexity is most notable at the frontal lobe and remain similar to improved
in degree compared to prior exam. There is no evidence of enlarging
intracranial hemorrhage or large territory infarct.
The visualized portion of the paranasal sinuses, mastoid air cells, and middle
ear cavities are clear. The visualized portion of the orbits are
unremarkable.
IMPRESSION:
1. Overall improving appearance of the left pneumocephalus with stable amount
of mixed density subdural blood products and fluid collection following
removal of the left subdural drain. Given the associated mass effect by the
pneumocephalus, underlying tension cannot be excluded.
2. Continued improvement in left convexity sulcal effacement. Stable
rightward midline shift, measuring up to 10 mm.
3. No new hemorrhage or large territory infarct.
|
10047172-RR-10 | 10,047,172 | 26,942,178 | RR | 10 | 2162-08-03 14:39:00 | 2162-08-03 17:24:00 | EXAMINATION: ABDOMEN US (COMPLETE STUDY)
INDICATION: ___ year old man with pancreatic cancer and fever. Assess for
cause of fever
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: Outside MR abdomen ___.
FINDINGS:
LIVER: The hepatic parenchyma is heterogeneous. The contour of the liver is
smooth. Multiple ill-defined hypoechoic areas are seen scattered throughout
the liver largest measuring 1.2 cm within the right hepatic lobe (previously
0.6 cm) worrisome for progression of metastatic disease. The main portal vein
is patent with hepatopetal flow. There is no ascites.
BILE DUCTS: There is no intrahepatic biliary dilation. Pneumobilia is
expected status post common bile duct stenting. The CBD measures 8 mm.
GALLBLADDER: The gallbladder is contracted with gallbladder wall edema
measuring up to 4 mm. The gallbladder is full of air and sludge.
PANCREAS: Imaged portion of the pancreas demonstrates a dilated pancreatic
duct measuring up to 8 mm with an abrupt cut off at the level of the
pancreatic head with a partially visualized hypoechoic pancreatic head mass
better characterized on ___ MR.
___: Normal echogenicity, measuring 12 cm.
KIDNEYS: The right kidney measures 11.5 cm. A 1.3 x 1.2 cm simple cyst is
seen within the interpolar region of the right kidney unchanged from prior MR.
___ left kidney measures 10.9 cm. There is a 1.7 x 1.9 x 1.6 cm
heterogeneously hyperechoic mass within the lower pole of left kidney which is
previously shown on MR to be partially hemorrhagic worrisome for renal cell
carcinoma. No stones or hydronephrosis in the kidneys.
RETROPERITONEUM: Visualized portions of the IVC are within normal limits.
IMPRESSION:
1. No ultrasound evidence to explain patient's fever.
2. Heterogeneous liver parenchyma with interval increase in size of hepatic
lesions suggesting progression of metastatic disease.
3. Expected pneumobilia and air within the gallbladder in a patient with post
common bile duct stenting. Gallbladder sludge. .
5. 1.9 cm left lower pole partially hemorrhagic renal mass concerning for
renal cell carcinoma better characterized on MR dated ___.
6. Moderate pancreatic ductal dilatation with partially visualized pancreatic
head mass better seen on recent MRI.
NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___
on the telephone on ___ at 5:23 ___, 20 minutes after discovery of the
findings.
|
10047172-RR-31 | 10,047,172 | 28,178,907 | RR | 31 | 2163-05-30 12:28:00 | 2163-05-30 15:30:00 | INDICATION: ___ year old man with metastatic pancreatic cancer and ascites.
Please contact wife, ___, ___. Would like on ___.
Has appointment in med-onc at noon. // therapeutic tap.
TECHNIQUE: Ultrasound guided diagnostic and therapeutic paracentesis
COMPARISON: US guided paracentesis ___.
FINDINGS:
Limited grayscale ultrasound imaging of the abdomen demonstrated a large
amount of ascites. A suitable target in the deepest pocket in the left lower
quadrant was selected for paracentesis.
PROCEDURE: The procedure, risks, benefits and alternatives were discussed
with the patient and written informed consent was obtained.
A preprocedure time-out was performed discussing the planned procedure,
confirming the patient's identity with 3 identifiers, and reviewing a
checklist per ___ protocol.
Under ultrasound guidance, an entrance site was selected and the skin was
prepped and draped in the usual sterile fashion. 1% lidocaine was instilled
for local anesthesia.
A 5 ___ catheter was advanced into the largest fluid pocket in the left
lower quadrant and 2.2 L of clear, straw-colored fluid was removed. Fluid
samples were submitted to the laboratory for cell count, differential,
culture, and cytology.
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:
Technically successful diagnostic and therapeutic paracentesis.Fluid samples
were submitted to the laboratory for cell count, differential, culture, and
cytology. The patient was discharged in hemodynamically stable condition.
|
10047172-RR-32 | 10,047,172 | 28,178,907 | RR | 32 | 2163-05-29 21:58:00 | 2163-05-29 22:14:00 | EXAMINATION: CHEST (AP AND LAT)
INDICATION: History: ___ with pancreatic cancer, abd distention // PICC line
position
TECHNIQUE: Upright AP and lateral views of the chest
COMPARISON: ___ chest radiograph
FINDINGS:
Left PICC tip terminates in the low SVC. Right-sided central venous catheter
tip terminates in the low SVC. Low lung volumes are present. Heart size is
normal. Mediastinal and hilar contours are unremarkable. Pulmonary
vasculature is not engorged. Patchy opacities within the lung bases likely
reflect areas of atelectasis, with no focal consolidation identified. Small
bilateral pleural effusions, more pronounced on the right, are new in the
interval. No pneumothorax is present. No acute osseous abnormality is seen.
IMPRESSION:
1. Left PICC tip in the low SVC. No pneumothorax.
2. Small bilateral pleural effusions, new in the interval, with bibasilar
atelectasis.
|
10047172-RR-9 | 10,047,172 | 26,942,178 | RR | 9 | 2162-08-02 21:29:00 | 2162-08-03 00:00:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ with fever on chemo // PNA?
COMPARISON: ___
FINDINGS:
PA and lateral views of the chest provided. Port-A-Cath resides over the
right chest wall with catheter extending into the mid SVC region. The lungs
appear clear bilaterally. There is no focal consolidation, effusion, or
pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous
structures are intact. No free air below the right hemidiaphragm is seen.
IMPRESSION:
No acute intrathoracic process.
|
10047297-RR-23 | 10,047,297 | 28,528,068 | RR | 23 | 2130-02-19 01:33:00 | 2130-02-19 03:16:00 | EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: History: ___ with altered mental status// eval for intracranial
bleed
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast. Coronal and sagittal reformations as well as bone algorithm
reconstructions were provided and reviewed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 16.0 s, 16.2 cm; CTDIvol = 49.7 mGy (Head) DLP =
802.7 mGy-cm.
2) Sequenced Acquisition 16.0 s, 16.2 cm; CTDIvol = 49.7 mGy (Head) DLP =
802.7 mGy-cm.
3) Sequenced Acquisition 3.0 s, 6.1 cm; CTDIvol = 49.7 mGy (Head) DLP =
301.0 mGy-cm.
4) Sequenced Acquisition 1.0 s, 2.0 cm; CTDIvol = 50.2 mGy (Head) DLP =
100.3 mGy-cm.
5) Sequenced Acquisition 3.0 s, 6.1 cm; CTDIvol = 49.7 mGy (Head) DLP =
301.0 mGy-cm.
6) Sequenced Acquisition 1.0 s, 2.0 cm; CTDIvol = 50.2 mGy (Head) DLP =
100.3 mGy-cm.
7) Sequenced Acquisition 8.0 s, 8.1 cm; CTDIvol = 49.7 mGy (Head) DLP =
401.4 mGy-cm.
Total DLP (Head) = 2,810 mGy-cm.
COMPARISON: CT head on ___
FINDINGS:
Exam is limited by motion despite multiple attempted repeats.
There is no evidence of infarction, hemorrhage, edema, or mass. There is
prominence of the ventricles and sulci suggestive of involutional changes.
Subcortical and periventricular white matter hypodensities are nonspecific,
however likely represent sequela of chronic small vessel ischemic disease.
There is no evidence of fracture. The visualized portion of the paranasal
sinuses, mastoid air cells, and middle ear cavities are clear. Patient is
status post bilateral lens replacement. The visualized portion of the orbits
are otherwise unremarkable.
IMPRESSION:
Exam is limited by motion despite multiple attempted repeats. Within this
limitation, there is no acute intracranial process.
|
10047297-RR-24 | 10,047,297 | 28,528,068 | RR | 24 | 2130-02-19 22:02:00 | 2130-02-19 22:32:00 | INDICATION: ___ year old woman with new O2 requirement// ?worsening pneumonia
TECHNIQUE: AP portable chest radiograph
COMPARISON: ___
FINDINGS:
The patient is rotated. Opacities in the medial right lung base are
unchanged. No pleural effusion or pneumothorax. The size of the cardiac
silhouette is within normal limits.
IMPRESSION:
The patient is rotated, limiting evaluation however persisting opacities in
the right lower lung are likely not significantly changed.
|
10047484-RR-11 | 10,047,484 | 29,910,256 | RR | 11 | 2160-10-24 16:15:00 | 2160-10-24 17:06:00 | EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ with RUQ pain, volume overload, // any echogenicity in
liver? any edematous changes?
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
FINDINGS:
LIVER: The liver is diffusely echogenic. The contour of the liver is smooth.
There is no focal liver mass. The main portal vein is patent with hepatopetal
flow. There is no ascites.
BILE DUCTS: There is no intrahepatic biliary dilation.
CHD: 8 mm
GALLBLADDER: The patient is status post cholecystectomy.
PANCREAS: The pancreas is not well visualized, largely obscured by overlying
bowel gas.
SPLEEN: Normal echogenicity.
Spleen length: 12.3 cm
KIDNEYS: Limited views of the kidneys show no hydronephrosis.
Right kidney: 12.5 cm
Left kidney: 11.5 cm
RETROPERITONEUM: Not well visualized.
IMPRESSION:
Echogenic liver consistent with steatosis. Other forms of liver disease
including steatohepatitis, hepatic fibrosis, or cirrhosis cannot be excluded
on the basis of this examination. See recommendations below.
RECOMMENDATION(S): Radiological evidence of fatty liver does not exclude
cirrhosis or significant liver fibrosis which could be further evaluated by
___. This can be requested via the ___ (FibroScan), or the
Radiology Department with MR ___, in conjunction with a GI/Hepatology
consultation" *
* Chalasani et al. The diagnosis and management of nonalcoholic fatty liver
disease: Practice guidance from the ___ Association for the Study of
Liver Diseases. Hepatology ___ 67(1):328-357
|
10047484-RR-12 | 10,047,484 | 29,910,256 | RR | 12 | 2160-10-24 16:16:00 | 2160-10-24 17:03:00 | EXAMINATION: UNILAT LOWER EXT VEINS LEFT
INDICATION: ___ with swelling, c/f dvt // any thrombus?
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the bilateral lower extremity veins.
COMPARISON: None.
FINDINGS:
There is normal compressibility, color flow, and spectral doppler of the right
common femoral, femoral, and popliteal veins. Normal color flow demonstrated
in the posterior tibial and peroneal veins. There is normal respiratory
variation of the right common femoral vein.
There is a thrombus visualized in the left common femoral vein, with only
minimal flow demonstrated anteriorly. The left femoral, popliteal, and
posterior tibial veins demonstrate complete occlusion. There is abnormal
respiratory variation of the left common femoral vein. The left peroneal vein
is not identified.
No evidence of medial popliteal fossa (___) cyst.
IMPRESSION:
Acute deep venous thrombosis of the left common femoral, femoral, popliteal
and posterior tibial veins. Minimal flow in the common femoral vein, but there
is complete occlusion of the remaining veins.
No right lower extremity deep venous thrombosis.
|
10047484-RR-13 | 10,047,484 | 29,910,256 | RR | 13 | 2160-10-24 20:13:00 | 2160-10-24 20:26:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: History: ___ with CHF exacerbation, c/f PE, now hypoxic, want to
bolus fluids. lungs CTAB // degree of pulmonary edema?
TECHNIQUE: Portable AP view of the chest
COMPARISON: Chest radiograph ___
FINDINGS:
Lung volumes remain low. Heart size is top-normal, unchanged. The
mediastinal and hilar contours are similar to prior. The pulmonary
vasculature is normal. Lungs are essentially clear without focal
consolidation. No pleural effusion or pneumothorax is seen. There are no
acute osseous abnormalities.
IMPRESSION:
No acute cardiopulmonary abnormality.
|
10047484-RR-14 | 10,047,484 | 29,910,256 | RR | 14 | 2160-10-24 20:39:00 | 2160-10-24 22:10:00 | EXAMINATION: CT ABDOMEN W/O CONTRAST
INDICATION: ___ year old man with RUQ abdominal pain, RUQUS unremarkable,
elevated lactate, LLE DVT, contrast allergy // any intra-abdominal
infection/sign of bleeding? if neg we will start heparin, pre-medicate for CTA
for eval of PE
TECHNIQUE: Multidetector CT images of the abdomen were acquired without
intravenous contrast. Non-contrast scan has several limitations in detecting
vascular and parenchymal organ abnormalities, including tumor detection.
No oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 5.3 s, 42.1 cm; CTDIvol = 27.6 mGy (Body) DLP =
1,160.7 mGy-cm.
Total DLP (Body) = 1,161 mGy-cm.
COMPARISON: Liver ultrasound ___.
FINDINGS:
LOWER CHEST: Linear opacities within the bilateral lobes and lingula likely
reflect atelectasis. No pleural or pericardial effusion. Moderate coronary
artery calcifications.
ABDOMEN:
HEPATOBILIARY: Hepatic steatosis. There is no evidence of focal lesions
within the limitations of an unenhanced scan. Mild pneumobilia within the
left hepatic lobe. There is no evidence of intrahepatic or extrahepatic
biliary dilatation. The gallbladder is surgically absent.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions within the limitations of an unenhanced scan. There is no
pancreatic ductal dilatation. There is no peripancreatic stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size. There is no suspicious
renal lesions within the limitations of an unenhanced scan. There is no
hydronephrosis. There is no nephrolithiasis. There is no perinephric
abnormality.
GASTROINTESTINAL: Small hiatal hernia. Multiple visualized small bowel loops
are fluid-filled and dilated to approximately 3.2 cm. The terminal ileum
appears relatively decompressed. Fluid is also seen within the imaged colonic
loops of bowel. Scattered colonic diverticulosis, without evidence of acute
diverticulitis. The appendix is surgically absent. Multiple surgical clips
are along the anterior abdominal wall.
LYMPH NODES: There is no evidence of retroperitoneal or mesenteric
lymphadenopathy.
VASCULAR: There is no upper abdominal aortic aneurysm. Moderate
atherosclerotic disease is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. Multiple, partially imaged small bowel loops, fluid-filled and dilated to
approximately 3.2 cm, with a relatively decompressed terminal ileum. These
findings can be seen in the setting of a gastroenteritis, particularly given
the presence of fluid within the colon, but an ileus or partial small-bowel
obstruction is not definitely excluded. Further assessment with CT imaging of
the pelvis may be helpful for further evaluation.
2. Mild pneumobilia within the left hepatic lobe, which could reflect prior
sphincterotomy and correlation with any history of endoscopy recommended.
|
10047484-RR-15 | 10,047,484 | 29,910,256 | RR | 15 | 2160-10-24 23:43:00 | 2160-10-25 01:06:00 | EXAMINATION: DX CHEST PORT LINE/TUBE PLCMT 1 EXAM
INDICATION: History: ___ with ng tube // confirm placement
TECHNIQUE: Frontal view of the chest.
COMPARISON: Chest x-ray ___.
FINDINGS:
The enteric tube extends below the level of diaphragm, with the tip projecting
over the stomach. The cardiomediastinal silhouette is similar, allowing for
differences in lung volumes. The lung volumes are low, decreased since the
prior examination. Opacities of the right lower lung likely reflect
atelectasis. No new focal consolidations. No large pleural effusions or
pneumothorax.
IMPRESSION:
The enteric tube extends below the level of diaphragm, with the tip projecting
over the stomach.
|
10047484-RR-16 | 10,047,484 | 29,910,256 | RR | 16 | 2160-10-25 00:07:00 | 2160-10-25 00:39:00 | EXAMINATION: CTA CHEST WITH CONTRAST
INDICATION: ___ year old man with DVT, c/f PE,
TECHNIQUE: Axial multidetector CT images were obtained through the thorax
after the uneventful administration of intravenous contrast. Reformatted
coronal, sagittal, thin slice axial images, and oblique maximal intensity
projection images were submitted to PACS and reviewed.
DOSE: Acquisition sequence:
1) Stationary Acquisition 3.5 s, 0.5 cm; CTDIvol = 21.3 mGy (Body) DLP =
10.6 mGy-cm.
2) Spiral Acquisition 3.4 s, 26.8 cm; CTDIvol = 17.0 mGy (Body) DLP = 456.3
mGy-cm.
Total DLP (Body) = 467 mGy-cm.
COMPARISON: None
FINDINGS:
HEART AND VASCULATURE: There is an acute, nonocclusive thrombus within the
left main pulmonary artery that extends distally to involve the left upper and
lower lobe arteries and several of their proximal segmental branches (3: 69,
79, 83, 88, 93, 105). Nonocclusive thrombi are also seen within the segmental
branches of the right pulmonary artery (3:89). There is no evidence of
interventricular septal straightening to suggest right heart strain.
The ascending thoracic aorta is ectatic, measuring approximately 4.1 cm in
diameter. There is no evidence of dissection or intramural hematoma.
Moderate atherosclerotic calcifications are seen along with atherosclerotic
disease involving the aortic arch. No pericardial effusion is seen.
AXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar
lymphadenopathy is present. No mediastinal mass.
PLEURAL SPACES: No pleural effusion or pneumothorax.
LUNGS/AIRWAYS: Linear atelectasis is seen at the lingula and bilateral lung
bases. Otherwise, the lung parenchyma is clear without evidence of masses or
areas of parenchymal opacification. The airways are patent to the level of
the segmental bronchi bilaterally.
BASE OF NECK: Visualized portions of the base of the neck show no abnormality.
ABDOMEN: Included portion of the upper abdomen is unremarkable. There is a
partially visualized enteric tube.
BONES: No suspicious osseous abnormality is seen.? There is no acute fracture.
Degenerative changes are seen involving the thoracic spine.
IMPRESSION:
1. Acute, nonocclusive thrombus within the left pulmonary artery that extends
distally to involve the left upper and lower lobe arteries and several of
their proximal segmental branches. Several nonocclusive thrombi are also seen
within the segmental branches of the right pulmonary artery.
2. No evidence of interventricular septal bowing to suggest right heart
strain.
3. No evidence of parenchymal opacification to suggest pulmonary infarct.
4. Mildly ectatic ascending thoracic aorta, measuring up to 4.1 cm in
diameter.
5. Moderate coronary atherosclerotic disease.
NOTIFICATION: The findings were discussed with ___, M.D. by
___, M.D. on the telephone on ___ at 12:38 am, 5 minutes after
discovery of the findings.
|
10047484-RR-17 | 10,047,484 | 29,910,256 | RR | 17 | 2160-10-25 08:07:00 | 2160-10-25 14:55:00 | INDICATION: ___ year old man with dilated loops of bowel on CT A/P // eval
for SBO
TECHNIQUE: Frontal abdominal radiographs were obtained.
COMPARISON: CT from ___.
FINDINGS:
NG tube in the proximal stomach, consider placing it more distally. Multiple
dilated small bowel loops measuring up to 3.7 cm, containing high density
contrast. No definitive contrast is noted in the colon.
IMPRESSION:
Persistent small bowel obstruction.
|
10047484-RR-18 | 10,047,484 | 29,910,256 | RR | 18 | 2160-10-25 14:47:00 | 2160-10-25 17:16:00 | INDICATION: ___ year old man with HTN presented with acute PE, LLE DVT and
partial SBO. NGT placed with output. Tolerating clamp now and s/p
gastrograffin study. // ? resolution of pSBO?
TECHNIQUE: Frontal abdominal radiographs were obtained.
COMPARISON: Abdominal x-ray from 6 hours prior.
FINDINGS:
Persistent dilatation of the small bowel loops, currently measuring 4.4 cm.
However previously seen oral contrast in the small bowel loops now seen in the
colon. NG tube in the proximal stomach.
IMPRESSION:
1. Persistent partial small bowel obstruction as evidence by progression of
the oral contrast into the colon.
2. Suggest advancing nasogastric tube 5 cm into the stomach.
|
10047484-RR-20 | 10,047,484 | 29,910,256 | RR | 20 | 2160-10-28 15:18:00 | 2160-10-28 16:56:00 | INDICATION: ___ year old man with recent obstruction now with worsening nausea
and no BM // eval for obstruction
TECHNIQUE: Portable supine abdominal radiograph was obtained.
COMPARISON: Abdominal radiographs ___
FINDINGS:
There are no abnormally dilated loops of large or small bowel. There is a
moderate amount of colonic gas. Previously consumed PO contrast is present in
the rectum, indicating distal transit enteric contents.
Supine assessment limits detection for free air; there is no gross
pneumoperitoneum.
The imaged bones are unremarkable.
There are no unexplained soft tissue calcifications or radiopaque foreign
bodies.
IMPRESSION:
No evidence of obstruction.
|
10047484-RR-21 | 10,047,484 | 29,910,256 | RR | 21 | 2160-10-28 17:31:00 | 2160-10-28 19:05:00 | EXAMINATION: DX CHEST PORT LINE/TUBE PLCMT 2 EXAMS
INDICATION: ___ yo M with PMHx bipolar disorder and HTN who presents
withbilateral leg swelling, abdominal pain, nausea, and coffee groundemesis
found to have acute PE, extensive LLE DVT and possiblepSBO that has now
resolved. // NG tube placement location
TECHNIQUE: 2 AP portable chest radiographs were obtained
COMPARISON: CT chest dated ___
FINDINGS:
2 sequential images demonstrate advancement of an enteric tube which
ultimately extends to the stomach. There are low bilateral lung volumes.
Bibasilar opacities likely reflect atelectasis. No pneumothorax or large
pleural effusion. The size of the cardiac silhouette is mildly enlarged when
compared to prior. There is a tortuous thoracic aorta.
IMPRESSION:
2 sequential images demonstrate advancement of an enteric tube which
ultimately projects over the stomach.
|
10047484-RR-22 | 10,047,484 | 29,910,256 | RR | 22 | 2160-10-30 08:05:00 | 2160-10-30 11:41:00 | EXAMINATION: CT ABD AND PELVIS WITH CONTRAST
INDICATION: ___ year old man with history of multiple hernia repairs who
initially presented to the ED with worsening abdominal pain and evidence of
partial bowel obstruction s/p conservative treatment who continues to have
abdominal distention concerning for recurring SBO. Of note patient has allergy
to contrast and will require premedication // Rule out bowel obstruction
TECHNIQUE: Single phase contrast: MDCT axial images were acquired through the
abdomen and pelvis following intravenous contrast administration.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 4.6 s, 61.2 cm; CTDIvol = 24.2 mGy (Body) DLP =
1,482.3 mGy-cm.
2) Stationary Acquisition 0.6 s, 0.5 cm; CTDIvol = 3.4 mGy (Body) DLP = 1.7
mGy-cm.
3) Stationary Acquisition 6.6 s, 0.5 cm; CTDIvol = 36.9 mGy (Body) DLP =
18.5 mGy-cm.
Total DLP (Body) = 1,502 mGy-cm.
COMPARISON: CT of the abdomen of ___
FINDINGS:
LOWER CHEST: The lung bases are clear aside from mild dependent changes.
There is no pleural or pericardial effusion.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There is no suspicious focal lesion. There is mild pneumobilia, increased
since prior examination of ___. The common bile duct is within
normal limits and stable. The gallbladder is surgically absent. Mild
prominence of the cystic duct is similar.
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 solid renal lesions. There is no perinephric
abnormality. There is no hydronephrosis or hydroureter. The urinary bladder
is unremarkable.
GASTROINTESTINAL: An enteric tube terminates in the distal stomach, and the
stomach is decompressed. The duodenal jejunal junction does not cross the
midline however is noted to cross to the left of the superior mesenteric
vessels. The small bowel shows normal mucosal thickness and enhancement
without evidence obstruction.
Oral contrast is noted to have passed to the level of the rectum. There is a
markedly redundant sigmoid colon that can be followed from the rectum
superiorly into the right hemiabdomen, looping under the relatively
decompressed transverse colon, then inferiorly and again crossing the midline
to the left lateral abdomen. The ascending and descending colons are in
normal position. The cecum is identified in the right lateral hemiabdomen
(2:62). A partially air-filled diverticula of the sigmoid colon in the right
upper abdomen (2:46 is identified, demonstrating mildly thickened walls and
surrounding fat stranding suggestive of acute diverticulitis. Scattered
diverticulosis is present.
PELVIS: 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: Moderate atherosclerotic disease is present. There is no abdominal
aortic aneurysm.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: Few foci of subcutaneous gas in the anterior abdominal wall most
likely relate to recent injections. Small left inguinal hernia containing fat
is noted. Postsurgical change of an umbilical hernia repair are identified.
IMPRESSION:
1. Uncomplicated mild acute diverticulitis involving a diverticula along the
markedly redundant sigmoid colon in the right upper quadrant, corresponding to
site of tenderness.
2. No evidence of bowel obstruction.
3. Mild left hepatic lobe pneumobilia, slightly increased since previous
examination. Status post cholecystectomy.
RECOMMENDATION(S): The findings were discussed with Dr ___, by ___
___, M.D. in person on ___ at 10:30 am, at the time of discovery of
the findings.
|
10047484-RR-23 | 10,047,484 | 29,910,256 | RR | 23 | 2160-11-03 17:12:00 | 2160-11-03 17:34:00 | INDICATION: ___ year old man with recent pSBO who is passing flatus but no BM
// eval for stool burden
TECHNIQUE: Portable supine abdominal radiograph.
COMPARISON: CT abdomen and pelvis ___.
FINDINGS:
Oral contrast is seen within the large bowel from recent CT study. There is a
small stool burden within the colon. There are no abnormally dilated loops of
large or small bowel. There is no free intraperitoneal air, although
evaluation is limited by supine technique. There is a surgical clip in the
right upper quadrant of the abdomen and a surgical mesh projecting over the
lower abdomen.
IMPRESSION:
1. Small stool burden within the colon.
2. No dilated loops of small or large bowel.
|
10048001-RR-25 | 10,048,001 | 28,426,278 | RR | 25 | 2175-02-06 12:54:00 | 2175-02-06 13:40:00 | HISTORY: Cough and pneumonia and possible pulmonary edema.
FINDINGS: In comparison with the study of ___, the right IJ line has been
removed. Again they are extremely low lung volumes with atelectatic changes
at the bases. No evidence of congestive failure or acute pneumonia on this
quite limited study.
|
10048001-RR-26 | 10,048,001 | 28,426,278 | RR | 26 | 2175-02-07 07:27:00 | 2175-02-07 12:19:00 | AP CHEST, 7:28 A.M., ___
HISTORY: ___ man with cholangitis. Evaluate for any interval
changes.
IMPRESSION: AP chest compared to ___ and through 10:
Lung volumes are quite low. The right lung base is particularly elevated,
most likely due to right upper quadrant mass effect or fluid and/or right
subpulmonic pleural effusion. Heart is mildly enlarged. Mediastinal veins
are engorged, but I doubt that there is pulmonary edema. No pneumothorax.
|
10048001-RR-27 | 10,048,001 | 28,426,278 | RR | 27 | 2175-02-07 14:26:00 | 2175-02-07 17:54:00 | INDICATION: History of Caroli syndrome, status post stent placement for
cholangitis.
COMPARISON: CT available from ___ and abdominal ultrasound from
___ and MRCP from ___.
TECHNIQUE: Ultrasonography of the right upper quadrant.
FINDINGS: This examination was limited due to difficulty with patient
positioning in the ICU bed. Limited evaluation of the liver demonstrates no
intrahepatic bile duct dilation. The liver is echogenic and nodular in
contour, compatible with known history of cirrhosis. The main portal vein is
patent, demonstrating proper hepatopetal flow. The gallbladder is dilated, as
seen on the ___ CT examination. There is no wall thickening. A
small amount of mobile dependent sludge and tiny stones are seen. There has
been an increase in neighboring pericholecystic fluid and small amount of
ascites. A CBD stent is present.
IMPRESSION:
1. Distended gallbladder, also seen on the ___ examination. No
gallbladder wall thickening. Pericholecystic fluid and mild ascites.
2. No sonographic ___ sign.
3. If there is continued concern for cholecystitis, a HIDA scan can be
obtained for further evaluation.
|
10048001-RR-28 | 10,048,001 | 28,426,278 | RR | 28 | 2175-02-08 09:16:00 | 2175-02-08 11:09:00 | REASON FOR EXAMINATION: Cough, suspected aspiration event.
Portable AP radiograph of the chest was reviewed in comparison to ___ obtained at 07:28 p.m.
The current study continues to redemonstrate low lung volumes. There is no
evidence of pneumothorax. There is minimal amount of pleural effusion
demonstrated. The lungs are essentially clear with no definitive evidence of
new consolidation to suggest aspiration process.
|
10048001-RR-29 | 10,048,001 | 28,426,278 | RR | 29 | 2175-02-09 04:46:00 | 2175-02-09 15:53:00 | INDICATION: ___ male with possible pneumonia.
COMPARISON: Multiple chest radiographs dating back to ___ and
CT chest ___.
TECHNIQUE: AP upright portable chest radiograph.
FINDINGS: There are very low but stable lung volumes. There are no areas of
focal consolidation suspicious for infection. There is a very small
right-sided pleural effusion. Cardiomediastinal silhouette is stable and
within normal limits. There is no pneumothorax. Pleural surfaces are
unremarkable.
IMPRESSION: No evidence of pneumonia. Stable low lung volumes.
|
10048001-RR-31 | 10,048,001 | 28,426,278 | RR | 31 | 2175-02-09 15:57:00 | 2175-02-09 18:30:00 | HISTORY: ___ man with ___'s disease and cirrhosis who presents
with fever and abdominal pain, query hepatic abscess versus cholecystitis.
TECHNIQUE: Multiplanar T1- and T2-weighted images were acquired on a 1.5
Tesla magnet including dynamic 3D imaging obtained prior to, during and after
the uneventful intravenous administration of 0.1 mmol/kg (9.5 mL) of Gadavist.
NOTE: The images are somewhat suboptimal due to the presence of ascites.
COMPARISON: MR abdomen ___.
FINDINGS: The liver is diffusely nodular in contour with numerous small
T2-hyperintense foci predominantly in the right lobe, unchanged compared to
the prior study. In addition, there are larger, more focal T2 hyperintense
lesions seen in segments VII and VIII. These are minimally enlarged when
compared to prior studies, but do contain air-fluid levels consistent with
contiguity with the biliary tree given the recent ERCP. The portal vein and
hepatic veins are patent. The hepatic arterial anatomy is notable for a
replaced left hepatic arising from the left gastric artery (1601:62) and a
replaced right hepatic artery arising from the superior mesenteric artery
(1601:108). The gallbladder is distended and fluid-filled, unchanged compared
to the prior MRI. There is no pericholecystic hyperemia evident within the
liver. There is dependent T1-hyperintense material within the cystic duct
near its insertion site (14:82), likely consistent with inspissated bile.
Given the presence of air within the gallbladder, this suggests continuity
with the sphincterotomy from ERCP. There is recanalization of the umbilical
vein.
The pancreas is normal in signal intensity and morphology. The spleen is
enlarged measuring 19 cm, slightly increased compared to the prior study when
it measured 17 cm. The left kidney is displaced inferiorly by the spleen and
contains two large cysts which are unchanged compared to the prior study. The
right kidney is unremarkable in appearance. Incidental note is made of
bilateral accessory renal arteries. Both adrenal glands are unremarkable in
appearance. No upper abdominal lymphadenopathy. There is a moderate amount
of free fluid in the abdomen. Small bilateral pleural effusions.
IMPRESSION:
1. No MR evidence for a hepatic abscess.
2. The two cystic lesions in the superior aspect of the right lobe of the
liver which previously homogenously hyperintense on T2-weighted images now
contain air indicative of continuity with the biliary tree given the recent
ERCP.
3. The distended gallbladder contains gas, suggesting that air can travel
from through the sphincterotomy and biliary tree. The gallbladder is
unchanged in appearance since a prior study of ___.
4. Splenomegaly, increased since the prior study.
5. Moderate ascites.
|
10048001-RR-32 | 10,048,001 | 28,426,278 | RR | 32 | 2175-02-10 13:30:00 | 2175-02-10 13:58:00 | HISTORY: Cirrhosis with increased shortness of breath.
FINDINGS: In comparison with the study of ___, there are continued low lung
volumes with substantial elevation of the right hemidiaphragm. Bibasilar
atelectatic changes, but no evidence of acute focal pneumonia or vascular
congestion.
|
10048001-RR-33 | 10,048,001 | 28,426,278 | RR | 33 | 2175-02-12 14:32:00 | 2175-02-12 15:43:00 | REASON FOR EXAMINATION: Persistent shortness of breath and cough.
PA and lateral upright chest radiographs were reviewed in comparison to
___.
Lung volumes remain low with bibasal atelectasis and high position of right
hemidiaphragm. The imaged portion of the lungs is clear, and there is no
substantial pleural effusion. Heart size and mediastinum are stable in
appearance. No definitive evidence of infection is present. Biliary stent is
in place.
|
10048001-RR-54 | 10,048,001 | 21,687,712 | RR | 54 | 2178-04-26 14:28:00 | 2178-04-26 14:43:00 | EXAMINATION: CHEST (AP AND LATERAL)
INDICATION: History: ___ with shortness of breath
TECHNIQUE: Upright AP and lateral views of the chest
COMPARISON: ___
FINDINGS:
Lung volumes are low. The cardiac silhouette size is mildly enlarged.
Elevation of the right hemidiaphragm appears chronic. The mediastinal and
hilar contours are unremarkable. There is crowding of the bronchovascular
structures without overt pulmonary edema. Mild atelectasis is seen in the lung
bases without focal consolidation. No pleural effusion or pneumothorax is
detected. There are moderate multilevel degenerative changes seen in the
thoracic spine.
IMPRESSION:
No acute cardiopulmonary abnormality.
|
10048001-RR-55 | 10,048,001 | 21,687,712 | RR | 55 | 2178-04-26 15:13:00 | 2178-04-26 16:29:00 | EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: History: ___ with Caroli's disease.
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: Abdominal MRI ___ and liver ultrasound ___.
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 portal vein is patent with hepatopetal flow. There is no ascites.
BILE DUCTS: There is no intrahepatic biliary dilation. The CBD measures 4 mm.
GALLBLADDER: Again, there is marked distention of the gallbladder, unchanged
from ___. There is no pericholecystic fluid, gallstones, or
gallbladder wall thickening.
PANCREAS: Imaged portion of the pancreas appears within normal limits, without
masses or pancreatic ductal dilation, with portions of the pancreatic tail
obscured by overlying bowel gas.
SPLEEN: Normal echogenicity, measuring 16.2 cm.
IMPRESSION:
1. Cirrhosis with splenomegaly. No ascites.
2. Unchanged, marked distention of the gallbladder without specific evidence
for acute cholecystitis. No intrahepatic biliary ductal dilation or
gallstones.
|
10048001-RR-56 | 10,048,001 | 21,687,712 | RR | 56 | 2178-04-26 17:15:00 | 2178-04-26 19:14:00 | INDICATION: ___ with dyspnea // acute cardiopulm diseaase
TECHNIQUE: AP view of the chest.
COMPARISON: ___ at 14:33.
FINDINGS:
Lung volumes are low. Again seen is elevation of the right hemidiaphragm as on
prior. Adjacent right base linear opacity is likely due to atelectasis. There
is also likely atelectasis of the left costophrenic angle. Superiorly the
lungs are clear without consolidation. Cardiomediastinal silhouette is
stable. No acute osseous abnormalities.
IMPRESSION:
Bibasilar atelectasis, no acute cardiopulmonary process.
|
10048001-RR-57 | 10,048,001 | 21,687,712 | RR | 57 | 2178-04-27 02:37:00 | 2178-04-27 08:42:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with cirrhosis from Caroli disease --> septic
shock from likely biliary source, mild dyspnea // Evaluate for signs of
pulmonary edema and possible pneumonia
COMPARISON: ___.
IMPRESSION:
Minimally improved ventilation of the right lung basis. Mild pulmonary edema.
Moderate cardiomegaly. Unchanged elevation of the right hemidiaphragm. No
pleural effusions.
|
10048001-RR-58 | 10,048,001 | 21,687,712 | RR | 58 | 2178-04-27 10:14:00 | 2178-04-27 11:53:00 | EXAMINATION: ___ DUP EXTEXT BIL (MAP/DVT)
INDICATION:
Dyspnea, evaluate for deep vein thrombosis.
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the bilateral lower extremity veins.
COMPARISON: None.
FINDINGS:
There is normal compressibility, flow and augmentation of the bilateral common
femoral, superficial femoral, and popliteal veins. Normal color flow and
compressibility are demonstrated in the posterior tibial and peroneal veins.
There is normal respiratory variation in the common femoral veins bilaterally.
No evidence of medial popliteal fossa (___) cyst.
IMPRESSION:
No evidence of deep venous thrombosis in the bilateral lower extremity veins.
|
10048001-RR-59 | 10,048,001 | 21,687,712 | RR | 59 | 2178-04-28 11:44:00 | 2178-04-28 14:36:00 | EXAMINATION: CT CHEST WITHOUT CONTRAST
INDICATION: ___ year old man with ___'s syndrome and cirrhosis here with
septic shock from cholangitis, persistent wheezing and hypoxia, evaluate for
hepatic pulmonary syndrome.
TECHNIQUE: Axial multidetector CT images were obtained through the thorax
without the administration of IV contrast.
Reformatted coronal, sagittal, thin slice axial images, and oblique maximal
intensity projection images were submitted to PACS and reviewed.
DOSE: DLP: 580 mGy-cm
COMPARISON: CT chest from ___ and MR abdomen from ___.
FINDINGS:
There is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy.
The thyroid gland appears unremarkable.
The heart is unremarkable in appearance. There is no evidence of pericardial
effusion. There are small bilateral non-hemorrhagic pleural effusions.
The central airways are patent. There is bibasilar atelectasis. There is no
pneumothorax.
Limited images of the upper abdomen demonstrates sequelae of ___'s disease
with biliary ductal dilatation, cirrhotic liver, and splenomegaly measuring 19
cm. The gallbladder also appears distended.
No lytic or blastic osseous lesion suspicious for malignancy is identified.
IMPRESSION:
1. Bibasilar atelectasis and small bilateral non-hemorrhagic pleural
effusion.
2. Sequelae of ___'s disease with biliary duct dilatation, cirrhotic
liver, and splenomegaly as well as distended gallbladder, better characterized
on prior MRI from ___.
|
10048001-RR-60 | 10,048,001 | 21,687,712 | RR | 60 | 2178-04-29 03:56:00 | 2178-04-29 10:42:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with concern for pulmonary renal syndrome/pna //
acute process, worsening
TECHNIQUE: CHEST (PORTABLE AP)
COMPARISON: ___
IMPRESSION:
Cardiomediastinal silhouette demonstrate mild dilatation as compared to the
previous study, diffuse. There is also vascular enlargement, consistent with
pulmonary edema. New right basal opacity concerning for interval development
of atelectasis or aspiration is demonstrated.
|
10048001-RR-62 | 10,048,001 | 21,687,712 | RR | 62 | 2178-04-30 04:17:00 | 2178-04-30 11:07:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with Caroli's Disease c/b cirrhosis/cholangitis,
here with septic shock and hypoxemia // Evaluate for interval change
post-diuresis Evaluate for interval change post-diuresis as the teres this
COMPARISON: Chest radiographs since ___ most recently ___
IMPRESSION:
Lung volumes remain exceedingly low with particular elevation of the right
lung base. Volume of right pleural effusion is indeterminate, but at least
small. Pulmonary vasculature and mild interstitial edema have not improved,
but mediastinal venous engorgement has decreased. Heart size hard to assess,
severely exaggerated by low lung volumes, probably not greatly enlarged no
pneumothorax.
|
10048001-RR-63 | 10,048,001 | 21,687,712 | RR | 63 | 2178-04-30 15:37:00 | 2178-04-30 16:19:00 | INDICATION: ___ year old man with ___'s disease and cholangitis/cirrhosis,
persistent hypoxemia // Evaluate for pulmonary embolism and other lung
disease
TECHNIQUE: Multi detector CT images were obtained through the chest in
arterial phase after administration of 100 cc of IV Omnipaque contrast. Axial
images were interpreted in conjunction with coronal, sagittal, right oblique
MIP and left oblique MIP reformats.
DLP: 672 mGy-cm
COMPARISON: ___.
FINDINGS:
CHEST CTA:
The main, lobar, and segmental pulmonary arteries appear well opacified
without filling defect. Evaluation of subsegmental pulmonary artery is limited
due to motion artifact. The thoracic aorta is normal caliber without evidence
of aneurysm or dissection.
CHEST:
The thyroid is normal. Axillary, supraclavicular, mediastinal, and hilar lymph
nodes are not pathologically enlarged. The heart is unremarkable. No
pericardial effusion. Central airways are patent.
Slight interval increase in small bilateral pleural effusions with adjacent
atelectasis. Left apical ground-glass opacity is unchanged. No new focal
consolidation or pneumothorax.
The esophagus is unremarkable. Limited evaluation of the upper abdomen
demonstrates stable of appearance of the liver with ductal dilatation
consistent with ___'s disease. Nodular contour of the liver is stable,
consistent with cirrhosis. Stable splenomegaly.
OSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for
malignancy. Multilevel thoracic spine degenerative changes.
IMPRESSION:
1. No evidence of central or segmental pulmonary embolism. Evaluation of
subsegmental pulmonary artery is limited due to motion artifact.
2. Slight interval increase in small bilateral pleural effusion with adjacent
atelectasis.
3. ___'s disease with ductal dilatation, cirrhosis, and splenomegaly,
better evaluated on ___ MRI.
|
10048001-RR-73 | 10,048,001 | 24,319,281 | RR | 73 | 2182-04-10 04:02:00 | 2182-04-10 09:15:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: History: ___ with hypoxia, AMS// r/o PNA
COMPARISON: 2 cell chest CT ___
Chest radiograph ___
FINDINGS:
PA and lateral views of the chest provided.
There is chronic elevation of the right hemidiaphragm. Mild bibasilar
opacities likely reflect bibasilar atelectasis. No large pleural effusion or
pneumothorax. Cardiomediastinal silhouette is stable. Multilevel
degenerative changes with anterior bony fusion of multiple thoracic vertebral
levels.
IMPRESSION:
No focal consolidation.
|
10048001-RR-74 | 10,048,001 | 24,319,281 | RR | 74 | 2182-04-10 04:18:00 | 2182-04-10 04:57:00 | EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: History: ___ with history of caroli's with abdominal pain and
chills// eval distension, biliary dilation
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: Abdominal MRI from ___.
Abdominal ultrasound from ___
FINDINGS:
LIVER: The hepatic parenchyma appears heterogeneous. The contour of the liver
is smooth. The main portal vein is patent with hepatopetal flow. There is no
ascites. Paraumbilical vein is patent.
BILE DUCTS: No intrahepatic biliary dilation is detected.
CHD: 6 mm
GALLBLADDER: There is no evidence of stones or gallbladder wall thickening.
Gallbladder is again noted to be distended with small diverticulum, similar to
priors.
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: Normal echogenicity.
Spleen length: 18.5 cm, stable
KIDNEYS: Limited views of the kidneys show no hydronephrosis.
RETROPERITONEUM: The visualized portions of aorta and IVC are within normal
limits.
IMPRESSION:
1. No biliary dilation or gallstones. Distended gallbladder without wall
thickening, as seen previously. MRCP could further evaluate for cholangitis
and the gallbladder distention.
2. Cirrhotic liver with stable splenomegaly and redemonstrated patent
paraumbilical vein. Patent portal vein.
|
10048001-RR-76 | 10,048,001 | 24,319,281 | RR | 76 | 2182-04-10 16:27:00 | 2182-04-10 16:45:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: History: ___ with SOB// fluid overload?
TECHNIQUE: Upright AP view of the chest
COMPARISON: Chest radiograph ___ at 04:26: ___
FINDINGS:
Heart size is unchanged, appearing mildly enlarged. Lung volumes are lower
compared to the prior exam. There is mild central mediastinal venous
distension and mild pulmonary edema, new in the interval. Persistent
atelectasis is seen in the lung bases. A trace left pleural effusion is
likely present. No pneumothorax is seen. There is continued elevation of the
right hemidiaphragm. There are no acute osseous abnormalities.
IMPRESSION:
Low lung volumes with mild pulmonary edema and trace left pleural effusion.
Persistent bibasilar atelectasis.
|
10048001-RR-77 | 10,048,001 | 24,319,281 | RR | 77 | 2182-04-11 21:13:00 | 2182-04-12 09:27:00 | EXAMINATION: MRCP
INDICATION: ___ year old man with ___'s disease and multiple prior episodes
of cholangitis presenting with cholangitis and GPC bacteremia// Eval for
evidence of cholangitis, biliary obstruction, progression of ___'s disease
TECHNIQUE: T1- and T2-weighted multiplanar images of the abdomen were
acquired in a 1.5 T magnet.
Intravenous contrast: 10 mL Gadavist.
Oral contrast: 1 cc of Gadavist mixed with 50 cc of water was administered
for oral contrast.
COMPARISON: MRCP ___
FINDINGS:
Lower Thorax: There is no pleural effusion. Bibasilar subsegmental
atelectasis is noted.
Liver: Liver is dysmorphic with a nodular contour, similar to the prior MRCP
performed in ___. There is no significant drop in signal on
opposed phase imaging to suggest hepatic steatosis. There is heterogeneous
enhancement of the hepatic parenchyma. No focal hepatic lesions are
identified.
Biliary: The gallbladder is markedly distended. There is no gallbladder wall
edema or pericholecystic fat stranding to suggest acute cholecystitis. Again
seen is saccular dilation of intrahepatic bile ducts, predominantly on the
right. This appears overall similar in extent compared to ___.
There is a 4 mm T2 hypointense filling defect in the central lumen of the
distal CBD, which likely represents a flow void (06:45). No definite evidence
of choledocholithiasis.
Pancreas: Pancreas is unremarkable, without ductal dilation.
Spleen: Moderately enlarged, measuring up to 18.2 cm. No focal splenic
lesion.
Adrenal Glands: Normal in size and shape.
Kidneys: Other than bilateral renal cysts, the kidneys are unremarkable.
There is no hydronephrosis on either side.
Gastrointestinal Tract: There are no abnormally dilated bowel loops to
suggest obstruction. No ascites.
Lymph Nodes: Retroperitoneal and mesenteric lymph nodes are not enlarged by
size criteria.
Vasculature: Abdominal aorta is not aneurysmal. Celiac artery is patent.
Left hepatic artery is replaced to the left gastric artery. Superior
mesenteric artery and bilateral renal arteries are patent. Portal venous
system is patent. There is a recanalized paraumbilical vein.
Osseous and Soft Tissue Structures: No suspicious osseous lesions. Mild body
wall edema is noted.
IMPRESSION:
1. No MR evidence of acute cholangitis. Apparent 4 mm central filling defect
in the distal CBD likely represents a flow void, without definite evidence of
choledocholithiasis.
2. Well distended gallbladder without signs of acute cholecystitis, may be due
to fasting state.
3. Overall stable saccular dilation of predominantly right-sided intrahepatic
bile ducts, together with cirrhotic liver morphology and portal hypertension,
consistent with known Caroli syndrome.
|
10048001-RR-78 | 10,048,001 | 24,319,281 | RR | 78 | 2182-04-14 15:18:00 | 2182-04-14 16:21:00 | EXAMINATION: CHEST PORT. LINE PLACEMENT
INDICATION: ___ year old man with new R PICC// 42 cm R basilica SL PICC-
___ ___ Contact name: ___: ___ cm R basilica SL
PICC- ___ ___
IMPRESSION:
Comparison to ___. The patient has received a new PICC line. The
line is coiled in the axillary vein on the right. No complications, notably
no pneumothorax. Stable appearance of the low lung volumes and the cardiac
silhouette.
|
10048001-RR-79 | 10,048,001 | 24,319,281 | RR | 79 | 2182-04-14 18:29:00 | 2182-04-14 18:50:00 | EXAMINATION: DX CHEST PORTABLE PICC LINE PLACEMENT
INDICATION: ___ year old man with picc line coiled in axilla,s/p powerflush//
PICC tip placement, picc powerflushed Contact name: ___: ___
TECHNIQUE: AP radiograph of the chest.
COMPARISON: Chest radiograph ___ at 15:31
IMPRESSION:
The right upper extremity PICC now courses into the right internal jugular
vein. Repositioning is recommended. No other significant interval change.
|
10048001-RR-80 | 10,048,001 | 24,319,281 | RR | 80 | 2182-04-15 08:30:00 | 2182-04-15 10:26:00 | INDICATION: ___ year old man with cirrhosis, presented with cholangitis and
bacteremia. Needs long course of IV antibiotics.// please place PICC
TECHNIQUE:
OPERATORS: Dr. ___ Interventional ___ performed the
procedure.
ANESTHESIA: None
MEDICATIONS: None
CONTRAST: 0 ml of optiray contrast
FLUOROSCOPY TIME AND DOSE: 0 min, 0 mGy
PROCEDURE: 1. Replacement of right PICC.
PROCEDURE DETAILS: Using sterile technique and local anesthesia, the existing
PICC line was aspirated and flushed and a Nitinol guidewire was introduced
into the superior vena cava (SVC). A peel-away sheath was then placed over a
guidewire. The guidewire was then advanced into the superior vena cava. A
single lumen PIC line measuring 43 cm in length was then placed through the
peel-away sheath with its tip positioned in the distal SVC under fluoroscopic
guidance. Position of the catheter was confirmed by a fluoroscopic spot film
of the chest. The peel-away sheath and guidewire were then removed. The
catheter was secured to the skin, flushed, and a sterile dressing applied.
The patient tolerated the procedure well. There were no immediate
complications.
FINDINGS:
1. Existing right arm approach PICC with tip in the IJ replaced with a new
single lumen PIC line with tip in the distal SVC
IMPRESSION:
Successful placement of a 43 cm right arm approach single lumen PowerPICC with
tip in the distal SVC.the line is ready to use.
|
10048001-RR-81 | 10,048,001 | 20,362,822 | RR | 81 | 2182-05-02 16:55:00 | 2182-05-02 17:04:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: History: ___ with dyspnea// Please r/o cardiopulmonary process
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest radiograph ___
FINDINGS:
Lung volumes are low. Heart size is top-normal. The mediastinal and hilar
contours are unremarkable. The pulmonary vasculature is normal. Chronic
elevation of the right hemidiaphragm is re-demonstrated. Linear and patchy
atelectasis is noted in the lung bases, but no focal consolidation. No
pleural effusion or pneumothorax is seen. There are no acute osseous
abnormalities. Moderate multilevel degenerative changes are seen in the
thoracic spine.
IMPRESSION:
Low lung volumes with bibasilar atelectasis.
|
10048001-RR-82 | 10,048,001 | 20,362,822 | RR | 82 | 2182-05-02 23:00:00 | 2182-05-02 23:47:00 | EXAMINATION: CTA CHEST
INDICATION: ___ year old man with ___'s syndrome c/b recurrent cholangitis
and cirrhosis presenting with acute shortness of breath and hypoxemia. CXR
same as baseline.// Eval for PE vs PNA
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) Spiral Acquisition 2.2 s, 28.7 cm; CTDIvol = 14.5 mGy (Body) DLP = 416.2
mGy-cm.
2) Stationary Acquisition 0.6 s, 0.5 cm; CTDIvol = 3.3 mGy (Body) DLP = 1.7
mGy-cm.
3) Stationary Acquisition 3.6 s, 0.5 cm; CTDIvol = 19.9 mGy (Body) DLP =
9.9 mGy-cm.
Total DLP (Body) = 428 mGy-cm.
COMPARISON: Prior chest CTs, most recently ___.
FINDINGS:
HEART AND VASCULATURE:
The heart is normal in size and shape. No pericardial effusion. No
atherosclerotic calcifications in the coronary arteries, aorta or cardiac
valves. The pulmonary arteries and aorta are normal in caliber throughout.
Large segmental pulmonary emboli in the right main pulmonary artery (301:73)
and in the left inferior pulmonary artery extending to its segmental branches
(301:70). There is mild reticulation of the interventricular septum..
NECK, THORACIC INLET, AXILLAE AND CHEST WALL:
The thyroid is not visualized. No enlarged lymph nodes in either axilla or
thoracic inlet. No abnormalities on the chest wall. No atherosclerotic
calcifications in the head and neck arteries.
MEDIASTINUM AND HILA:
The esophagus is unremarkable. Small mediastinal lymph nodes, none
pathologically enlarged by CT size criteria. No hilar lymphadenopathy.
PLEURA:
No pleural effusions. No apical scarring bilaterally.
LUNGS:
Respiratory motion artifacts impair optimal parenchymal evaluation. The
airways are patent to the subsegmental levels. No bronchial wall thickening,
bronchiectasis or mucus plugging. No grossly enlarged suspicious lung nodules
or masses. Bibasilar atelectasis.
CHEST CAGE:
Mild dorsal spondylosis. No acute fractures. No suspicious lytic or
sclerotic lesions.
UPPER ABDOMEN:
The limited sections of the upper abdomen show redemonstration of a cirrhotic
liver with biliary dilation is noted in the right hepatic lobe, as previously
described by the MRCP from ___.
IMPRESSION:
Large bilateral pulmonary emboli with evidence of right heart strain. No
signs of associated pulmonary infarct.
|
10048001-RR-83 | 10,048,001 | 20,362,822 | RR | 83 | 2182-05-03 00:49:00 | 2182-05-03 01:58:00 | EXAMINATION: BILAT LOWER EXT VEINS
INDICATION: ___ year old man with acute PE. ___ need IVC ___ DVT// eval for
___ DVT
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the bilateral lower extremity veins.
COMPARISON: None.
FINDINGS:
There is normal compressibility, color flow, and spectral doppler of the
bilateral common femoral, femoral, and popliteal veins. Normal color flow and
compressibility are demonstrated in the posterior tibial and peroneal veins.
There is normal respiratory variation in the common femoral veins bilaterally.
No evidence of medial popliteal fossa (___) cyst.
IMPRESSION:
No evidence of deep venous thrombosis in the right or left lower extremity
veins.
|
10048001-RR-84 | 10,048,001 | 20,362,822 | RR | 84 | 2182-05-03 00:50:00 | 2182-05-03 09:23:00 | EXAMINATION: UNILAT UP EXT VEINS US RIGHT
INDICATION: ___ year old man with acute PE. right sided PICC line removed on
___// eval for upper extremitiy DVt
TECHNIQUE: Grey scale and Doppler evaluation was performed on the right upper
extremity veins.
COMPARISON: None.
FINDINGS:
There is normal flow with respiratory variation in the right subclavian veins.
There is nonocclusive thrombus within the right axillary vein and proximal to
mid right basilic vein.
The right internal jugular and brachial veins are patent, show normal color
flow, spectral doppler, and compressibility. The right basilic vein distally
at the forearm and right cephalic vein are patent, compressible and show
normal color flow.
IMPRESSION:
Nonocclusive thrombus within the right axillary vein and proximal to mid right
basilic vein.
NOTIFICATION: The findings were discussed with ___, M.D. by
___, M.D. on the telephone on ___ at 2:00 am, 2 minutes
after discovery of the findings.
|
10048001-RR-85 | 10,048,001 | 20,362,822 | RR | 85 | 2182-05-03 07:59:00 | 2182-05-03 10:01:00 | EXAMINATION: DUPLEX DOPP ABD/PEL
INDICATION: eval for thrombosis, Please obtain with doppler
TECHNIQUE: Gray scale, color, and spectral Doppler evaluation of the abdomen
was performed.
COMPARISON: MRCP dated ___ and abdominal ultrasound dated ___
FINDINGS:
Liver: The hepatic parenchyma is coarse and heterogeneous.. Liver contour is
nodular. There is no ascites. There is 1.9 x 1.8 x 2.2 cm cyst in the ___
liver likely corresponding to saccular dilatation of intrahepatic ___ ducts
seen on recent MR.
___ ducts: There is no intrahepatic biliary ductal dilation.
CHD: 5 mm
Gallbladder: The gall bladder is distended, similar to priors. No evidence
of cholecystitis.
Pancreas: The imaged portion of the pancreas appears within normal limits,
with portions of the pancreatic tail obscured by overlying bowel gas.
Spleen: The spleen demonstrates normal echotexture.
Spleen length: 19.6 cm
Kidneys: No stones, masses, or hydronephrosis are identified in either kidney.
There is a 3.6 x 3.5 x 3.2 cm cyst in the left kidney, seen on recent MR.
___ kidney: 12.1 cm
Left kidney: 12.3 cm
Doppler evaluation:
Patent paraumbilical vein is re-demonstrated. The main portal vein is patent,
with flow in the appropriate direction.
Main portal vein velocity is 26.1 cm/sec.
Left portal veins is patent, with antegrade flow. The ___ anterior portal
vein is patent with retrograde flow, into the left portal vein.
The main hepatic artery is patent, with appropriate waveform.
___ and left hepatic veins are patent, with appropriate waveforms. The
___ hepatic vein is not visualized.
IMPRESSION:
1. Heterogeneous hepatic parenchyma with patent paraumbilical vein and
retrograde flow of the ___ portal vein into the left portal vein. No
evidence of thrombosis.
2. Splenomegaly, measuring 19.6 cm, previously 18.5 cm.
|
10048001-RR-86 | 10,048,001 | 20,362,822 | RR | 86 | 2182-05-03 15:22:00 | 2182-05-03 17:05:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with caroli disease, cirrhosis, here with
bilateral PE and new fevers// Pneumonia?
TECHNIQUE: CHEST (PORTABLE AP)
COMPARISON: CTA chest ___, chest radiograph ___
FINDINGS:
Lung volumes are low, decreased. Mild pulmonary edema is new. Trace
bilateral pleural effusions. Mild cardiomegaly is unchanged. Elevation of
the right hemidiaphragm is unchanged. There is no pneumothorax.
IMPRESSION:
Mild pulmonary edema, new.
|
10048001-RR-88 | 10,048,001 | 26,430,797 | RR | 88 | 2182-05-14 15:23:00 | 2182-05-14 15:39:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: History: ___ with recently diagnosed PE, hematemesis, BRPR,
hypotension.// Pneumonia? Free air?
TECHNIQUE: Portable upright AP view the chest
COMPARISON: Chest radiograph ___, CT chest ___
FINDINGS:
Lung volumes remain low. Heart size is at least mildly enlarged, similar to
prior. The mediastinal and hilar contours are unremarkable. Crowding of
bronchovascular structures is present without frank pulmonary edema. Patchy
atelectasis is seen in the lung bases without focal consolidation. Chronic
elevation of the right hemidiaphragm is re-demonstrated. No pleural effusion
or pneumothorax is seen. There are no acute osseous abnormalities. No
subdiaphragmatic free air.
IMPRESSION:
Low lung volumes with mild bibasilar atelectasis. No subdiaphragmatic free
air.
|
10048001-RR-89 | 10,048,001 | 26,430,797 | RR | 89 | 2182-05-14 17:15:00 | 2182-05-14 18:54:00 | EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: History: ___ with hx of Caroli's disease, p/w hematemesis,
melena. Please perform portal dopplers.// Evidence of portal venous clot?
Worsening cirrhosis? Ascites? Please perform portal doppler flows.
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: MRCP dated ___. liver ultrasound ___.
FINDINGS:
LIVER: The hepatic parenchyma is markedly coarsened and heterogeneous with
increased echogenicity. The contour of the liver is nodular. Re-demonstrated
is a simple cyst in the left hepatic lobe measuring up to 8 mm. There is no
focal liver mass. The main and left portal veins are patent with hepatopetal
flow. The right portal vein is patent with retrograde flow again seen. There
is no ascites. Re-demonstrated is a patent umbilical vein.
BILE DUCTS: Again seen is saccular dilatation the right-sided intrahepatic
bile ducts, similar to prior.
CHD: 5 mm
GALLBLADDER: The gallbladder is markedly distended and contains sludge.
However, there is no gallbladder wall thickening or pericholecystic fluid.
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: Normal echogenicity.
Spleen length: 19.8 cm
KIDNEYS: Limited views of the kidneys show no hydronephrosis.Incidentally
noted are multiple simple cortical cysts in the left kidney.
Right kidney: 13.2 cm
Left kidney: 11.2 cm
RETROPERITONEUM: The visualized portions of aorta and IVC are within normal
limits.
IMPRESSION:
1. Cirrhotic liver morphology with saccular intrahepatic biliary ductal
dilatation in the right hepatic lobe consistent with patient's known ___'s
syndrome. The portal veins are patent with redemonstration of reversed flow
in the right portal vein.
2. Sludge within a distended gallbladder without evidence of acute
cholecystitis.
3. Redemonstration of marked splenomegaly and patent umbilical vein.
|
10048001-RR-90 | 10,048,001 | 26,430,797 | RR | 90 | 2182-05-14 20:16:00 | 2182-05-14 20:33:00 | EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: History: ___ with head strike 2 days ago, on xarelto, pain to
left temple of head.// Intracranial bleed? Skull fracture?
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast. Coronal and sagittal reformations as well as bone algorithm
reconstructions were provided and reviewed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 16.0 s, 16.3 cm; CTDIvol = 49.2 mGy (Head) DLP =
802.7 mGy-cm.
2) Sequenced Acquisition 3.0 s, 6.1 cm; CTDIvol = 49.2 mGy (Head) DLP =
301.0 mGy-cm.
Total DLP (Head) = 1,104 mGy-cm.
COMPARISON: None.
FINDINGS:
There is no evidence of infarction, hemorrhage, edema, or mass. There is
prominence of the ventricles and sulci suggestive of involutional changes.
There is no evidence of fracture. The visualized portion of the paranasal
sinuses, mastoid air cells, and middle ear cavities are clear. The visualized
portion of the orbits are unremarkable.
IMPRESSION:
No acute intracranial abnormality. No acute fracture.
|
10048001-RR-92 | 10,048,001 | 22,128,147 | RR | 92 | 2182-05-31 14:42:00 | 2182-05-31 15:17:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ with two days DOE, dry cough, iso recently diagnosed PE// ?
volume overload
TECHNIQUE: Chest PA and lateral
COMPARISON: Most recent prior chest radiograph ___
FINDINGS:
Low lung volumes are again demonstrated, slightly improved. There is
elevation of the right hemidiaphragm relative to the left. Bronchovascular
crowding is again noted, muscle slightly improved. Platelike atelectasis seen
at the bilateral lung bases. No large pleural effusion. There is some left
retrocardiac atelectasis however no focal consolidation is demonstrated. No
pulmonary edema. No radiographic evidence of lung infarction, however this is
not sensitive or specific.
The heart size is stable.
IMPRESSION:
No interval change in cardiac silhouette size, no evidence of substantial
pulmonary vascular congestion or pulmonary edema. Overall slight improvement
in lung aeration bilaterally. No focal consolidation.
|
10048001-RR-93 | 10,048,001 | 22,128,147 | RR | 93 | 2182-05-31 16:16:00 | 2182-05-31 16:53:00 | EXAMINATION: CTA CHEST WITH CONTRAST
INDICATION: ___ with recent PE on lovenox presenting with worsening SOB, ?
worsening PE// ? worsening 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 4.5 s, 0.5 cm; CTDIvol = 27.3 mGy (Body) DLP =
13.7 mGy-cm.
2) Spiral Acquisition 4.0 s, 31.1 cm; CTDIvol = 16.5 mGy (Body) DLP = 511.9
mGy-cm.
Total DLP (Body) = 526 mGy-cm.
COMPARISON: CTA ___. MRCP from ___.
FINDINGS:
HEART AND VASCULATURE:
The main pulmonary artery is normal in caliber. The left main pulmonary
artery is dilated to 2.8 cm similar to the prior study. Since prior exam,
overall the degree of clot burden has improved. There is persistent though
smaller partially occlusive thrombus within the left distal main pulmonary
artery extending into the posterior basal and lateral basal segments (series 3
image 94). An additional area of possible thrombus is demonstrated within a
left superior subsegmental artery (series 3, image 87). No right-sided
thrombus is demonstrated.
The heart is normal in size. The thoracic aorta is normal caliber evidence of
intramural hematoma or dissection.
AXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar
lymphadenopathy is present. No mediastinal mass.
PLEURAL SPACES: No pleural effusion or pneumothorax.
LUNGS/AIRWAYS: There is moderate bibasilar atelectasis. No dense
consolidation. 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.
There are prominent venous collaterals seen along the chest wall.
ABDOMEN: There is splenomegaly to 17.3 cm. Intrahepatic biliary dilatation
appears similar to the prior study. Otherwise no acute findings.
BONES: No suspicious osseous abnormality is seen.? There is no acute fracture.
Healing anterolateral right seventh and eighth rib fractures are noted.
IMPRESSION:
Overall improvement in pulmonary arterial thrombus burden, with persistent
though smaller nonocclusive thrombus seen within the distal left main
pulmonary artery and basal segmental branches. No substantial clot burden in
the right pulmonary artery. Persistent dilatation of the left main pulmonary
artery to 2.8 cm, otherwise no CT evidence of right heart strain. No evidence
of underlying pulmonary infarction.
|
10048001-RR-94 | 10,048,001 | 22,128,147 | RR | 94 | 2182-06-01 09:04:00 | 2182-06-01 09:31:00 | EXAMINATION: US ABD LIMIT, SINGLE ORGAN
INDICATION: ___ year old man with cirrhosis presenting with DOE// any ascites
as reason for decompensation
TECHNIQUE: Grayscale ultrasound images were obtained of the 4 quadrants of
the abdomen.
COMPARISON: Liver ultrasound ___
FINDINGS:
Targeted grayscale ultrasound images were obtained of the 4 quadrants of the
abdomen, revealing no ascites.
IMPRESSION:
No ascites.
|
10048001-RR-95 | 10,048,001 | 22,128,147 | RR | 95 | 2182-06-02 22:38:00 | 2182-06-03 10:20:00 | EXAMINATION: MRCP
INDICATION: ___ with ___'s disease (communicating cavernous ectasia, or
congenital cystic dilatation of the intrahepatic biliary tree) cirrhosis,
recurrent cholangitis and sepsis, recent PE with RV strain on anticoagulation
with symptoms concerning for cholangitis// cholangitis
TECHNIQUE: T1- and T2-weighted multiplanar images of the abdomen were
acquired in a 1.5 T magnet.
Intravenous contrast: 10 mL Gadavist.
Oral contrast: 1 cc of Gadavist mixed with 50 cc of water was administered for
oral contrast.
COMPARISON: Multiple prior MRCP examinations most recent dated ___.
FINDINGS:
Lower Thorax: Visualized lung bases are clear. There is no pleural effusion.
Hepatobiliary: There are morphologic changes of cirrhosis. There is no
evidence of hepatic steatosis. There is no focal hepatic lesion. Saccular
dilatation of intrahepatic bile ducts are again seen involving the right
hepatic lobe, similar to prior exams and compatible with known ___'s
syndrome. No calculi are seen within the biliary tree. There is no evidence
of active cholangitis. The gallbladder is unremarkable.
Pancreas: The pancreas is normal signal intensity with no focal lesion or
ductal dilatation. There is no peripancreatic stranding.
Spleen: The spleen is markedly enlarged, measuring 21 cm.
Adrenal Glands: The adrenal glands are unremarkable.
Kidneys: There is cortical thinning/scarring of the upper pole of the left
kidney. There are multiple simple cysts in the bilateral kidneys, the largest
of which is a 4.0 cm parapelvic cyst in the left upper pole. There is no
hydronephrosis.
Gastrointestinal Tract: There is no bowel obstruction.
Lymph Nodes: There is no lymphadenopathy.
Vasculature: The hepatic veins and portal veins are patent. There is no
abdominal aortic aneurysm. There is replaced left hepatic artery arising from
the left gastric artery. Small perigastric varices are seen.
Osseous and Soft Tissue Structures: There is no suspicious osseous lesion.
Soft tissue structures of the abdominal wall are unremarkable.
IMPRESSION:
1. Cirrhosis with findings of portal hypertension, including marked
splenomegaly and perigastric varices. Saccular dilatation of the intrahepatic
bile ducts involving the right hepatic lobe, similar to prior exams,
compatible with known Caroli's syndrome. No suspicious hepatic lesion. No
evidence of active cholangitis.
|
10048001-RR-98 | 10,048,001 | 28,243,528 | RR | 98 | 2182-09-23 10:01:00 | 2182-09-23 18:03:00 | EXAMINATION: MRCP
INDICATION: ___ yo M PMHx ___'s disease c/b cirrhosis with hx varices, HE,
recurrent cholangitis and E. faecalis bacteremia, recent PE with RV strain on
LMWH presented to ED with fevers, found to have bacteremia. // Liver abscess?
TECHNIQUE: T1- and T2-weighted multiplanar images of the abdomen were
acquired in a 1.5 T magnet.
Intravenous contrast: 10 mL Gadavist.
Oral contrast: 1 cc of Gadavist mixed with 50 cc of water was administered
for oral contrast.
COMPARISON: MRCP ___, ___, and ___..
FINDINGS:
Lower Thorax: Limited assessment of the bilateral lung bases demonstrate
chronically elevated right hemidiaphragm with compressive right lower lobe
atelectasis. There is no pleural effusion. No pericardial effusion.
Liver: The liver is nodular in contour consistent with known cirrhosis. There
is no loss of signal in out of phase imaging to suggest hepatic steatosis.
Evaluation of the arterial phase of the liver is limited by respiratory
motion. Within this limitation, no suspicious focal lesion is identified.
Biliary: There is redemonstration of irregular and saccular dilatation of the
intrahepatic bile ducts involving the right hepatic lobe, similar to prior,
consistent with known history of ___'s disease. There is no abnormal
enhancement surrounding the dilated intrahepatic bile ducts. There is no
extrahepatic biliary dilatation. The gallbladder is markedly distended,
similar to priors, without evidence of gallbladder wall thickening or edema or
cholelithiasis.
Pancreas: The pancreas is normal in signal intensity without main pancreatic
ductal dilatation or focal lesion.
Spleen: The spleen is enlarged measuring 22.1 cm, previously measuring 20.6
cm. No focal lesions are identified in the visualized portions of the spleen.
Adrenal Glands: The adrenal glands appear unremarkable bilaterally.
Kidneys: The left kidney is only partially visualized due to inferior
displacement from the enlarged spleen, without hydronephrosis and demonstrates
multiple T2 hyperintense cysts measuring up to 4.3 cm in the left upper pole
(5; 32). The right kidney is visualized without hydronephrosis. There are
multiple T1 hyperintense nonenhancing cysts within the kidney measuring up to
1.3 cm in the right upper pole (5; 48).
Gastrointestinal Tract: The visualized small and large bowel appear normal in
caliber without evidence of obstruction.
Lymph Nodes: There is a prominent 1.1 cm epicardial lymph node (28; 49).
There is a prominent 1.1 cm periportal lymph node (28; 82). No
retroperitoneal or mesenteric lymphadenopathy is noted.
Vasculature: The visualized abdominal aorta is normal in caliber. Again, the
left hepatic artery is replaced from the left gastric artery. Perigastric
varices are again demonstrated.
Osseous and Soft Tissue Structures: No suspicious osseous lesion is
identified.
IMPRESSION:
1. Stable saccular dilatation of the right intrahepatic bile ducts in a
cirrhotic liver with splenomegaly and perigastric varices, consistent with
history of Caroli's disease.
2. Markedly distended gallbladder without evidence of acute cholecystitis is
similar to multiple priors.
3. No evidence of liver abscess.
|
10048001-RR-99 | 10,048,001 | 28,243,528 | RR | 99 | 2182-09-22 16:15:00 | 2182-09-22 16:58:00 | EXAMINATION: UNILAT UP EXT VEINS US RIGHT
INDICATION: ___ yo M PMHx Caroli's disease c/b cirrhosis with hx varices, HE,
recurrent cholangitis and E. faecalis bacteremia, recent PE with RV strain on
LMWH admitted for bacteremia with ampicillin-resistant enterococcus. // clot
burden
TECHNIQUE: Grey scale and Doppler evaluation was performed on the right upper
extremity veins.
COMPARISON: Ultrasound Doppler of the right upper extremity dated ___.
FINDINGS:
There is normal flow with respiratory variation in the bilateral subclavian
veins.
The right internal jugular, axillary, and brachial veins are patent, show
normal color flow, spectral doppler, and compressibility. The right basilic,
and cephalic veins are patent, compressible and show normal color flow.
The previously visualized thrombus in the right axillary and basilic veins is
resolved.
IMPRESSION:
No evidence of deep vein thrombosis in the right upper extremity.
|
10048061-RR-4 | 10,048,061 | 23,628,963 | RR | 4 | 2169-04-21 05:43:00 | 2169-04-21 06:23:00 | EXAMINATION: CT abdomen pelvis with contrast
INDICATION: History: ___ with left torso pain, hx of abscess, on
biologicsNO_PO contrast// ?abscess
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were
acquired through the abdomen and pelvis following intravenous contrast
administration with split bolus technique.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Total DLP (Body) = 1,442 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. Tiny
hypodensity in segment 6 (series 2, image 37) is too small to characterize but
likely a small cyst or hamartoma. 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.
Left renal hypodensities at the upper pole measuring 1 cm and lower pole
exophytic lesion measuring 9 mm are of indeterminate density but not well
characterized due to small size. Right kidney appears normal. There is no
evidence of hydronephrosis. There is no perinephric abnormality.
GASTROINTESTINAL: The stomach is unremarkable. A 1.6 cm soft tissue density
is visualized just distal to the duodenal jejunal junction which is suspicious
for a small bowel mass (02:37) without any adjacent soft tissue stranding and
no evidence of obstruction. The remaining 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 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. Mild atherosclerotic disease
is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. Soft tissue density just distal to the duodenal jejunal junction suspicious
for small bowel mass for which further characterization can be obtained by
endoscopy if amenable by location or MRE.
2. No acute intra-abdominal or pelvic abnormalities to correlate with
patient's symptoms, specifically no evidence of intra-abdominal abscess.
|
10048061-RR-5 | 10,048,061 | 23,628,963 | RR | 5 | 2169-04-21 11:29:00 | 2169-04-21 13:49:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with Stills disease p/w fever to 104.8 and
joint pain. Endorses dyspnea x6 months// eval for effusion, pneumonia eval
for effusion, pneumonia
IMPRESSION:
Heart size is normal. Mediastinum is normal. Lungs are clear. There is no
pleural effusion. There is no pneumothorax.
|
10048061-RR-6 | 10,048,061 | 23,628,963 | RR | 6 | 2169-04-21 21:13:00 | 2169-04-22 20:15:00 | EXAMINATION: MR ANKLE ___ CONTRAST LEFT
INDICATION: ___ year old woman with history of still's disease on
hydroxychloroquine and sulfasalazine, presenting with acute worsening of
bilateral wrist and left ankle pain and swelling// Eval for effusion possible
tenosynovitis explanation for pain/swelling
TECHNIQUE: Multiplanar images of the left ankle were performed prior to and
following the administration of intravenous contrast using a routine ankle MR
protocol in addition to postcontrast fat suppressed T1 weighted images.
COMPARISON: There are no prior studies for comparison.
FINDINGS:
Syndesmotic ligaments: Intact but appears somewhat thickened raising
possibility of prior injury. Some osseous proliferation along the
posterior-lateral aspect of the tibia also suggests prior syndesmotic injury.
ATFL: Intact, appears mildly irregular suggesting prior injury.
Calcaneofibular ligament: Intact.
Posterior talofibular ligament: Intact.
Deltoid ligament: Intact.
Sinus tarsi: There is some loss of normal signal intensity within the sinus
tarsi which may be seen in the setting of sinus tarsi syndrome.
Plantar fascia: There is thickening of the central band of the plantar fascia
compatible with plantar fasciitis. There is an associated plantar calcaneal
osseous spur.
Spring ligament: Intact.
Extensor tendons: Intact, very minimal extensor digitorum tenosynovitis.
Flexor tendons: Intact without tear or tenosynovitis.
Peroneal tendons: Intact, trace fluid but no substantial tenosynovitis in
peroneal tendon sheath.
Achilles tendon: Intact and unremarkable. There is a osseous enthesophyte at
the Achilles insertion.
Tibiotalar joint: There is full-thickness cartilage loss along the
superomedial aspect of the tibiotalar joint with subchondral edema. There is
tibiotalar osteophytosis. Post-contrast there is mild synovial hyper
enhancement involving the tibiotalar joint.
Posterior subtalar joint: Unremarkable.
Mild edema at the base of the second metatarsal may be degenerative in nature.
No discrete fracture line is identified.
Mild atrophy of the abductor digiti quinti muscle is present which may be seen
in setting of Baxter neuropathy.
Small lobulated foci of high signal intensity within the calcaneus at the neck
and distal portion may represent ___ or ganglia. There is os
trigonum.
IMPRESSION:
-Thickening of syndesmotic ligaments with some adjacent tibial cortical
irregularity posteriorly suggestive of prior syndesmotic ligament injury. The
ATFL appears slightly irregular also most likely due to prior injury. No
acute ligamentous injury is identified.
-There is tibiotalar osteoarthritis with full-thickness cartilage loss along
the superomedial aspect of the talar dome and the adjacent tibial plafond.
There is associated associated subchondral bone marrow edema, osteophytosis
and mild synovitis.
-Some stranding of the fat with loss of normal signal in sinus tarsi is
demonstrated, this may be seen in setting of sinus tarsi syndrome.
-Plantar fasciitis with associated plantar calcaneal spur.
-Mild atrophy of the abductor digiti minimi muscle which may be seen in the
setting of Baxter neuropathy.
-Minimal extensor digitorum tenosynovitis.
|
10048244-RR-106 | 10,048,244 | 21,843,889 | RR | 106 | 2121-05-23 11:12:00 | 2121-05-23 11:31:00 | INDICATION: History: ___ with liver failure, c/f hepatorenal syndrome, recent
renal biposy reportedly c/b hematoma // Eval for PNA, structural/obstructive
cause of elevated Cr evaluate for pneumonia.
TECHNIQUE: Chest PA and lateral
COMPARISON: ___
FINDINGS:
Pleural calcifications in a most notably in the right upper chest are again
noted. There is no consolidation, pleural effusion, or pneumothorax.
Cardiomediastinal and hilar silhouettes are normal size.
IMPRESSION:
No acute cardiopulmonary process. Stable pleural calcifications.
|
10048244-RR-107 | 10,048,244 | 21,843,889 | RR | 107 | 2121-05-23 10:24:00 | 2121-05-23 11:06:00 | EXAMINATION: RENAL U.S.
INDICATION: History: ___ with liver failure, c/f hepatorenal syndrome, recent
renal biposy reportedly c/b hematoma // Eval for PNA, structural/obstructive
cause of elevated Cr
TECHNIQUE: Grey scale and color Doppler ultrasound images of the kidneys were
obtained.
COMPARISON: None.
FINDINGS:
The right kidney measures 9.2 cm. The left kidney measures 9.9 cm. There is no
hydronephrosis, stones, or masses bilaterally. Normal cortical echogenicity
and corticomedullary differentiation are seen bilaterally. Left perinephric
hypoechoic fluid collection along the lower pole of the left kidney measures
7.3 x 3.7 x 3.1 cm. Ill-defined echogenicity perinephric is indeterminate and
may also reflect hematoma or perinephric fat.
The bladder is moderately well distended and normal in appearance.
IMPRESSION:
1. No hydronephrosis. Left perinephric hematoma, extent of which is not
clearly defined. Follow-up is recommended.
RECOMMENDATION(S): Recommend follow-up.
|
10048244-RR-92 | 10,048,244 | 21,880,058 | RR | 92 | 2120-08-04 16:42:00 | 2120-08-04 19:42:00 | INDICATION: ___ with fever, immunosupressed // Eval for pna
TECHNIQUE: PA and lateral views of the chest.
COMPARISON: ___.
FINDINGS:
Oblong opacity projecting over the right upper lung is compatible with
calcified pleural plaque. The lungs are otherwise clear. No obvious effusion
identified noting that there is exclusion of the right lateral costophrenic
angle on the frontal view. The cardiomediastinal silhouette is stable given
differences in projection.
IMPRESSION:
No acute cardiopulmonary process.
|
10048244-RR-93 | 10,048,244 | 21,880,058 | RR | 93 | 2120-08-04 17:13:00 | 2120-08-04 17:36:00 | EXAMINATION: UNILAT LOWER EXT VEINS LEFT
INDICATION: History: ___ with LLE swelling // eval 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 posterior tibial and peroneal veins.
There is normal respiratory variation in the common femoral veins bilaterally.
No evidence of medial popliteal fossa (___) cyst.
IMPRESSION:
No evidence of deep venous thrombosis in the left lower extremity veins.
|
10048244-RR-94 | 10,048,244 | 21,880,058 | RR | 94 | 2120-08-04 19:49:00 | 2120-08-04 21:54:00 | EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ with liver transplant, infection // ?portal vein thrombosis
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: None.
FINDINGS:
LIVER: The hepatic parenchyma appears within normal limits. The contour of the
liver is smooth. There is no focal liver mass. The main portal vein is patent
with hepatopetal flow. There is no ascites.
BILE DUCTS: There is no intrahepatic biliary dilation. The common bile duct
is upper limits of normal in size currently 7 mm, stable.
GALLBLADDER: The patient is status post cholecystectomy.
PANCREAS: The pancreas is not well visualized, largely obscured by overlying
bowel gas.
KIDNEYS: The kidneys are not well visualized.
Doppler interrogation of the hepatic vasculature demonstrates patent main,
left, and right hepatic veins, normal in waveforms. The main, right, and left
portal veins are patent and normal in directional flow. The left, right, and
main hepatic arteries are patent. The left hepatic artery demonstrates normal
waveforms. The main and right hepatic arteries were not interrogated by
Doppler secondary to patient inability to remain still at the end of the exam.
IMPRESSION:
Patent portal and hepatic veins. Patent hepatic arteries, the right and main
hepatic artery not interrogated by Doppler ultrasound secondary to patient
unable to remain still for the remainder of the study. Normal left hepatic
artery waveform.
No focal hepatic lesion.
|
10048244-RR-95 | 10,048,244 | 21,880,058 | RR | 95 | 2120-08-05 17:39:00 | 2120-08-06 00:18:00 | EXAMINATION: KNEE (2 VIEWS) LEFT
INDICATION: ___ year old man with PMHx of hep C cirrhosis s/p liver transplant
complicated by recurrent cirrhosis of transplanted liver, HCC, hx of CVA with
residual right sided weakness presenting to the ED with left leg pain and
fevers, found to have ___. // Evidence of fracture? Evidence of joint
erosion?
TECHNIQUE: Two views
COMPARISON: None available.
FINDINGS:
There is mild tricompartmental degenerative change with marginal spurring. No
effusion. No acute fracture. No concerning bone lesion. There is vascular
calcification.
IMPRESSION:
Mild degenerative change. No acute fracture is seen. No effusion.
|
10048244-RR-96 | 10,048,244 | 21,880,058 | RR | 96 | 2120-08-05 17:04:00 | 2120-08-05 18:17:00 | EXAMINATION: CT ABDOMEN PELVIS WITHOUT CONTRAST.
INDICATION: ___ year old man with HCV cirrhosis s/p transplant, now with
recurrent cirrhosis, who presents with high fevers. // please evaluate for
abscess
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 19.6 s, 75.2 cm; CTDIvol = 16.1 mGy (Body) DLP =
1,185.6 mGy-cm.
Total DLP (Body) = 1,206 mGy-cm.
COMPARISON: CT ABDOMEN: ___
FINDINGS:
LOWER CHEST: Trace bilateral pleural effusions are slightly greater on the
right, with a small component tracking along the inferior right major fissure
(03:41). There is no pericardial effusion.
ABDOMEN:
HEPATOBILIARY: The patient is post hepatic transplantation, with a trace
amount of perihepatic fluid. There is no subhepatic focal fluid collection or
focal hepatic parenchymal abnormality within the limits of this unenhanced
scan. There is mild periportal edema, as seen on the prior examination,
although less well characterized given the lack of intravenous contrast.
There is no evidence of intrahepatic or extrahepatic biliary dilatation. The
gallbladder is surgically absent.
PANCREAS: There is fat stranding about the pancreatic head (3:70, 76), new
since the prior examination. There has been interval removal of common bile
duct stents. Small calcifications are again seen within the pancreatic head
(3:74, 75). There is no pancreatic ductal dilation. No focal fluid
collection is identified.
SPLEEN: The spleen remains enlarged, measuring 13.6 cm in the greatest coronal
dimension (4B: 47). No focal parenchymal abnormality is detected.
ADRENALS: The adrenal glands are unremarkable. Apparent fullness in the
region of the left adrenal gland is attributed to extensive splenic collateral
vasculature.
URINARY: A punctate nonobstructing renal stone is present in the lower pole of
the left kidney (3:78). There is no hydronephrosis or perinephric abnormality
bilaterally. There is no evidence of focal renal lesions within the
limitations of an unenhanced scan.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber and wall thickness throughout. The colon and rectum are within
normal limits. The appendix is normal.
PELVIS: The urinary bladder and distal ureters are unremarkable. A Foley
catheter is in place. There is no free fluid in the pelvis.
LYMPH NODES: Mild prominence of mesenteric lymph nodes are noted in the upper
abdomen, and measure up to 8 mm in short axis diameter (03:59). There is no
pathologic enlargement of retroperitoneal or mesenteric lymph nodes by CT size
criteria. There is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease
is noted. Perisplenic varices persist.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: Subareolar breast tissue is compatible with gynecomastia.
IMPRESSION:
1. Although the exam is somewhat limited given the lack of IV contrast,
peripancreatic fat stranding and fullness of the pancreatic head is compatible
with pancreatitis. The chronicity of this finding is difficult to accurately
assess, but is new since at least ___.
2. No focal fluid collection or intra-abdominal or pelvic abscess is
identified.
3. Prior hepatic transplant, with persistent central periportal edema,.
4. Sequelae of portal hypertension includes persistent splenomegaly and
perisplenic varices along with small volume intra-abdominal ascites.
5. Punctate, nonobstructing left lower pole renal stone.
NOTIFICATION: The findings were discussed by Dr. ___ with Dr.
___ on the ___ ___ at 7:48 ___, 20 minutes after discovery
of the findings.
|
10048244-RR-97 | 10,048,244 | 21,880,058 | RR | 97 | 2120-08-05 17:07:00 | 2120-08-05 18:51:00 | EXAMINATION: Chest CT
INDICATION:
SEE TORSO EXAM high fever, patient after liver transplantation.
TECHNIQUE: MDCT of the chest was obtained from thoracic inlet to upper
abdomen. Axial images were reviewed in conjunction with coronal and sagittal
reformats
COMPARISON: ___ and chest radiograph from ___
FINDINGS:
Aorta and pulmonary arteries are normal in diameter. Coronary calcifications
are extensive. No mediastinal, hilar or axillary lymphadenopathy is present.
No pericardial effusion is present. Small bilateral pleural effusion is
demonstrated, nonhemorrhagic with a intra fissure all component, series 3,
image 39. Diffusion is new compared to prior CT obtained ___ years ago. Image
portion of the upper abdomen will be reviewed separately is part of the CT
abdomen and corresponding report will be issued.
Airways are patent to the subsegmental level bilaterally. Right upper pleural
calcification is corresponding to the right abnormalities seen on the recent
chest radiograph. No definitive consolidation demonstrated. Bronchial wall
thickening is bilateral, similar to previous examination, does unlikely to
represent acute process. The loculation within the right major fissure is
also chronic finding.
Degenerative changes are present in the image portion of the spine but no
lytic or sclerotic lesions worrisome for infection or neoplasm demonstrated.
IMPRESSION:
No evidence of new infectious process.
Chronic abnormalities including pleural effusion, pleural calcifications and
bronchial wall thickening in the right lower lobe.
Interval decrease in the right upper lobe pneumatoceles currently less than 5
mm in diameter.
|
10048262-RR-31 | 10,048,262 | 20,845,468 | RR | 31 | 2168-08-20 18:44:00 | 2168-08-20 19:38:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: History: ___ with fever, hypoxia // pneumonia?
TECHNIQUE: Single frontal view of the chest
COMPARISON: ___
FINDINGS:
There are low lung volumes. Streaky right base opacity most likely represents
atelectasis, less likely pneumonia. No pleural effusion or pneumothorax is
seen. Cardiac and mediastinal silhouettes are unremarkable given low lung
volumes.
IMPRESSION:
Low lung volumes. Streaky right base opacity most likely represents
atelectasis, less likely pneumonia.
|
10048262-RR-32 | 10,048,262 | 20,845,468 | RR | 32 | 2168-08-20 19:54:00 | 2168-08-20 22:52:00 | EXAMINATION: CTA CHEST AND CT ABDOMEN AND PELVIS
INDICATION: History: ___ with fever, tachycardia, clear chest x-ray, hx
ulcerative colitis // PE, pneumonia, intraabdominal abscess?
TECHNIQUE: MDCT axial images were acquired through the chest, 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 1.0 s, 0.5 cm; CTDIvol = 3.0 mGy (Body) DLP = 1.5
mGy-cm.
2) Spiral Acquisition 2.9 s, 22.6 cm; CTDIvol = 14.0 mGy (Body) DLP = 315.8
mGy-cm.
3) Spiral Acquisition 7.3 s, 57.1 cm; CTDIvol = 16.1 mGy (Body) DLP = 920.1
mGy-cm.
Total DLP (Body) = 1,237 mGy-cm.
COMPARISON: MRI abdomen dated ___. CT abdomen dated ___.
FINDINGS:
CHEST:
HEART AND VASCULATURE: The thoracic aorta is normal in caliber without
evidence of acute injury. No pericardial effusion is seen.
AXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar
lymphadenopathy is present. No mediastinal mass or hematoma.
PLEURAL SPACES: No pleural effusion or pneumothorax.
LUNGS/AIRWAYS: The airways are patent to the level of the segmental bronchi
bilaterally. There are bibasilar atelectasis. There is a 1.4 cm focal
opacification in the left upper lobe (series 4, image 71) which may represent
early pneumonia.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There is no evidence of focal lesion or laceration. There is no evidence of
intrahepatic or extrahepatic biliary dilatation. The gallbladder is not
visualized.
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 lesion or laceration.
ADRENALS: The right adrenal gland is surgically removed. The left adrenal
gland is normal.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
There is no evidence of focal renal lesions or hydronephrosis. There is no
perinephric abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. There is moderate
amount of stool throughout the colon and rectum. There is equivocal mild
thickening of the distal sigmoid colon/rectosigmoid.
There is no free fluid or free air in the abdomen.
PELVIS:
There is air visualized in the urinary bladder likely secondary to recent
instrumentation. There is a Foley catheter visualized with the balloon at the
base of the penis. There is no free fluid in the pelvis.
REPRODUCTIVE ORGANS: The 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 or retroperitoneal hematoma.
No atherosclerotic disease is noted.
BONES: There is mild degenerative changes of the thoracolumbar spine. There
is left hip posterior dislocation which is likely chronic with adjacent soft
tissue thickening, adjacent joint effusion not excluded.. There is chronic
deformity of the left femoral head and left femoral head/hip degenerative
changes.. There is no evidence of bone erosion.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits. There is
a pacer versus stimulator hardware visualized in the right lower quadrant
subcutaneous soft tissue.
IMPRESSION:
1. Nonspecific 1.4 cm nodular left upper lobe opacity which may represent
pneumonia. Recommend follow-up CT chest in 3 months to assess for resolution.
Pulmonary nodule not excluded.
2. Malpositioned Foley catheter with balloon in the base of the penis.
3. Moderate amount stool in the distal sigmoid colon/rectosigmoid. Equivocal
associated mild wall thickening, possible early stercoral colitis.
4. Chronic appearing left hip dislocation with adjacent soft tissue
thickening, adjacent joint effusion not excluded..
NOTIFICATION: The findings of the study had been discussed a by Dr. ___
with Dr. ___ on ___ at 11:54 p.m.
|
10048262-RR-33 | 10,048,262 | 20,845,468 | RR | 33 | 2168-08-22 13:53:00 | 2168-08-22 17:45:00 | INDICATION: ___ year old man with advanced progressive MS and ___ bacteremia
and needs PICC for IV antibiotics. // IV access team could not place PICC.
Please see OMR for ___ referral note. Can consent this AM.
COMPARISON: CT of the chest dated ___
TECHNIQUE: OPERATORS: Dr. ___, attending Interventional
Radiologist and Dr. ___ fellow performed the
procedure. The attending(s) personally supervised the trainee during any key
components of the procedure where applicable and reviewed and agrees with the
findings as reported below.
ANESTHESIA: Moderate sedation was not administered. The patient's hemodynamic
parameters were continuously monitored by an independent trained radiology
nurse. 1% lidocaine was injected in the skin and subcutaneous tissues
overlying the access site.
MEDICATIONS: None
CONTRAST: 5 ml of Optiray contrast
FLUOROSCOPY TIME AND DOSE: 5.4 minutes, 2 mGy
PROCEDURE:
1. Double lumen PICC placement through the right brachial vein.
PROCEDURE DETAILS: Using sterile technique and local anesthesia, the right
brachial vein was punctured under direct ultrasound guidance using a
micropuncture set. Permanent ultrasound images were obtained before and after
intravenous access, which confirmed vein patency. A peel-away sheath was then
placed over a guidewire. The guidewire was then advanced into the superior
vena cava using fluoroscopic guidance. A small contrast injection was
performed to delineate venous anatomy in the right upper extremity. A double
lumen PIC line measuring 38 cm in length was then placed through the peel-away
sheath with its tip positioned in the distal SVC under fluoroscopic guidance.
Position of the catheter was confirmed by a fluoroscopic spot film of the
chest. The peel-away sheath and guidewire were then removed. The catheter was
secured to the skin, flushed, and a sterile dressing applied.
The patient tolerated the procedure well. There were no immediate
complications.
FINDINGS:
1. The accessed vein was patent and compressible.
2. Brachial venography showing vein stenosis with a dominant collateral which
was targeted for PICC placement.
3.Brachialvein approach double lumen right PICC with tip in the distal SVC.
IMPRESSION:
Successful placement of a right 38 cm cm brachial approach double lumen
PowerPICC with tip in the distal SVC. The line is ready to use.
|
10048262-RR-34 | 10,048,262 | 20,845,468 | RR | 34 | 2168-08-25 09:19:00 | 2168-08-25 14:37:00 | INDICATION: ___ year old man with advanced multiple sclerosis and no bowel
movement for 4 days with nausea and abdominal pain // Evaluate for
obstruction/ileus vs. perforation
TECHNIQUE: Supine and upright abdominal radiographs were obtained.
COMPARISON: CT of the abdomen and pelvis from ___
FINDINGS:
There are diffusely air-filled dilated loops of large bowel involving the
right and transverse colon with moderate descending and sigmoid colonic stool
burden. No dilated loops of small bowel visualized. There is no evidence of
free intraperitoneal air. Right lower abdominal wall battery pack and single
spinal stimulator lead noted overlying the right lower abdomen and pelvis.
Surgical clips in the right upper quadrant again noted. At least moderate
bilateral hip degenerative changes, incompletely assessed.
IMPRESSION:
1. No evidence of pneumoperitoneum.
2. Nonobstructive bowel gas pattern with moderate stool burden.
|
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