note_id
stringlengths 13
15
| subject_id
int64 10M
20M
| hadm_id
int64 20M
30M
| note_type
stringclasses 1
value | note_seq
int64 2
851
| charttime
stringlengths 19
19
| storetime
stringlengths 19
19
| text
stringlengths 35
17.5k
|
|---|---|---|---|---|---|---|---|
10048262-RR-35 | 10,048,262 | 20,845,468 | RR | 35 | 2168-08-25 14:29:00 | 2168-08-25 14:59:00 | EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ year old man with advanced multiple sclerosis admitted for
___ bacteremia with uptrending LFTs // Evaluate for
gallstones and biliary system
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: CT abdomen and pelvis dated ___
FINDINGS:
LIVER: The left lobe of the liver is not adequately visualized due to
overlying bowel gas. Otherwise, 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.
CHD: 5 mm
GALLBLADDER: The gallbladder is not definitively visualized. However, there
is a rounded structure in the area of the gallbladder fossa measuring 1.2 x
1.6 x 1.0 cm, which may represent a contracted gallbladder.
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: 14.1 cm
KIDNEYS: Limited views of the kidneys show no hydronephrosis.
Right kidney: 10.0 cm
Left kidney: 9.4 cm
RETROPERITONEUM: The visualized portions of aorta and IVC are within normal
limits.
IMPRESSION:
1. No evidence of intrahepatic or extrahepatic biliary dilatation.
2. Likely contracted gallbladder.
3. Splenomegaly.
|
10048986-RR-46 | 10,048,986 | 28,592,015 | RR | 46 | 2127-04-07 02:53:00 | 2127-04-07 04:47:00 | INDICATION: The patient with abdominal pain. Assess for small bowel
obstruction or AAA.
COMPARISONS: ___.
TECHNIQUE: MDCT-acquired contiguous images through the abdomen and pelvis
were obtained with intravenous contrast at 2.5-mm slice thickness. Coronally
and sagittally reformatted images are provided.
DLP: 515 mGy-cm.
FINDINGS:
The imaged lung bases demonstrate bibasilar dependent atelectasis without
pleural effusions. Heart is top normal in size without pericardial effusion.
Small hiatal hernia is noted.
The liver demonstrates homogeneous enhancement without suspicious focal
lesions. There is no evidence of intrahepatic or extrahepatic biliary ductal
dilatation. The gallbladder is incompletely distended. There is no
gallbladder wall edema or pericholecystic fluid collection to suggest acute
inflammation. No calcified gallstones are seen within its lumen. The spleen
is unremarkable. The pancreas enhances homogeneously without ductal
dilatation or peripancreatic fluid collection. The adrenal glands are normal.
The kidneys enhance and excrete contrast symmetrically without evidence of
hydronephrosis or renal masses. Multiple renal hypodensities bilaterally are
too small to characterize and are likely cysts. The largest hypodense lesion
arising from the lower pole of the left kidney measures 5.1 x 4.8 cm with 12
Hounsfield units in attenuation, compatible with a simple cyst, unchanged.
The small and large bowel loops are normal in caliber without evidence of
bowel wall thickening or obstruction. The appendix is not visualized;
however, there are no secondary signs to suggest inflammation in the right
lower abdomen. There is no mesenteric or retroperitoneal lymphadenopathy.
The imaged intra-abdominal aorta and its branches demonstrate moderately
severe calcified atherosclerotic disease. Infrarenal aorta measures 2.8 cm in
maximum dimension, with stable-appearing focal dissection.
CT OF THE PELVIS: The bladder, distal ureters, rectum and sigmoid colon are
unremarkable. The prostate gland appears enlarged. There is no free air or
free fluid within the pelvis. Post-surgical changes related to bilateral
inguinal hernia repair are noted. There is no pelvic wall or inguinal
lymphadenopathy.
OSSEOUS STRUCTURES: No suspicious lytic or sclerotic bony lesion is seen.
IMPRESSION:
1. No acute CT findings to account for the patient's clinical presentation.
2. Calcified atherosclerotic disease of the aorta. Stable appearance of the
dilated infrarenal aorta measuring 2.8 cm in maximum dimension with stable
focal dissection.
3. Bilateral renal hypodensities, most compatible with cysts.
4. Small hiatal hernia.
|
10048986-RR-47 | 10,048,986 | 28,592,015 | RR | 47 | 2127-04-07 05:00:00 | 2127-04-07 06:16:00 | INDICATION: Chest pain.
COMPARISONS: ___ and CT chest of ___.
FINDINGS:
Frontal and lateral views of the chest demonstrate low lung volumes. There is
no focal consolidation, pleural effusion or pneumothorax. A 6-mm nodular
opacity projecting over the right upper lung is stable since priors. Hilar
and mediastinal silhouettes are unchanged. The descending aorta appears
tortuous. Heart size is top normal. Perihilar vascular congestion is noted.
There is mild intersitial pulmonary edema.
IMPRESSION:
No focal consolidation. Mild interstitial pulmonary edema.
|
10048986-RR-56 | 10,048,986 | 22,347,741 | RR | 56 | 2127-10-09 14:37:00 | 2127-10-09 15:32:00 | HISTORY: ___ male with right lower extremity pain.
COMPARISON: Lower extremity ultrasound dated ___.
TECHNIQUE: Grayscale and color Doppler ultrasound images were obtained within
the right lower extremity veins. There is normal compressibility, flow, and
augmentation of the common femoral, proximal femoral, mid femoral and distal
femoral veins. There is a non-occlusive clot identified within the partially
compressible popliteal vein. Normal color flow is demonstrated in posterior
tibial and peroneal veins. There is normal respiratory variation in the
common femoral veins bilaterally.
IMPRESSION: Non-occlusive thrombus within the popliteal right lower extremity
vein.
|
10049041-RR-43 | 10,049,041 | 25,923,317 | RR | 43 | 2164-01-10 15:53:00 | 2164-01-10 17:54:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: History: ___ with hypercarbic respiratory failure*** WARNING ***
Multiple patients with same last name!// eval consolidation
TECHNIQUE: AP frontal portable views of the chest.
COMPARISON: None
FINDINGS:
The lungs are hyperinflated, suggesting COPD. There is relative lucency of
the upper lungs, consistent with pulmonary emphysema. No focal consolidation,
pleural effusion, or evidence of large pneumothorax is seen. Tracheostomy
tube is noted. Cardiac silhouette size is not enlarged. Mediastinum is
unremarkable.
IMPRESSION:
COPD/pulmonary emphysema. No focal consolidation.
|
10049041-RR-44 | 10,049,041 | 25,923,317 | RR | 44 | 2164-01-10 20:34:00 | 2164-01-10 21:20:00 | EXAMINATION: Head CT.
INDICATION: History: ___ with recent admission, trach/gtube dependent, here w
AMS and abd distention*** WARNING *** Multiple patients with same last name!//
eval bleed, infection
TECHNIQUE: Multidetector CT images of the head were obtained without
intravenous contrast. Sagittal and coronal reformations were also performed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 16.0 s, 16.1 cm; CTDIvol = 49.9 mGy (Head) DLP =
802.7 mGy-cm.
Total DLP (Head) = 803 mGy-cm.
COMPARISON: None available.
FINDINGS:
Ventricles, cisterns and sulci appear within normal limits. There is no mass
effect, hydrocephalus, or shift of normally midline structures. Gray-white
matter distinction appears preserved. No evidence of intracranial hemorrhage.
Surrounding soft tissue structures are unremarkable. Small quantities of
fluid are found and mastoid air cells bilaterally, right greater than left.
In each maxillary sinus, as well as in the sphenoid sinus, small air-fluid
levels are noted. No evidence of fracture or bone destruction.
IMPRESSION:
1. No evidence of acute intracranial process.
2. Air-fluid levels in the sphenoid and maxillary sinuses, which can be
seen with acute sinusitis in the appropriate clinical setting. Correlation
with clinical circumstances is recommended.
|
10049041-RR-45 | 10,049,041 | 25,923,317 | RR | 45 | 2164-01-10 20:35:00 | 2164-01-10 21:17:00 | EXAMINATION: CT abdomen and pelvis
INDICATION: ___ with recent admission, trach/gtube dependent, here w AMS and
abd distention
TECHNIQUE: Multidetector CT through the abdomen pelvis performed following
oral and intravenous contrast administration with multiplanar reformations
provided.
DOSE Total DLP (Body) = 643 mGy-cm.
COMPARISON: None
FINDINGS:
LUNG BASES: Emphysema is noted in the imaged lower lungs with minimal left
lower lung atelectasis.
ABDOMEN:
Liver: A bilobed hypodensity within the superior aspect of hepatic segment 2
likely represent small cysts. A wedge-shaped area of hypodensity involving
segment 4A of the liver is of unclear etiology, possibly focal fatty
deposition. Also noted is focal fatty deposition along the periphery of
hepatic segment 4B. Main portal vein is patent. No intrahepatic biliary
ductal dilation.
Gallbladder: Unremarkable.
Spleen: Normal in size.
Adrenals: Normal bilaterally.
Pancreas: Normal.
Kidneys: Normal enhancement, no hydronephrosis or worrisome lesion.
GI: A PEG tube is noted which is positioned appropriately. The stomach is
mostly decompressed. The duodenum is unremarkable. Small bowel loops
demonstrate no signs of ileus or obstruction. The appendix is not clearly
visualized though there are no secondary signs of appendicitis. The colon is
thin walled containing contrast throughout. No signs of colonic inflammation.
No free air or free fluid.
Vascular: The aorta is mildly calcified though normal in caliber.
Lymph nodes: No adenopathy.
PELVIS: The urinary bladder is only partially distended though appears normal.
Distal ureters are normal in caliber. The prostate is unremarkable. No
pelvic sidewall or inguinal adenopathy.
BONES: No worrisome lytic or blastic osseous lesions seen.
SOFT TISSUES: The imaged body wall is unremarkable.
IMPRESSION:
1. No acute findings. No findings to account for abdominal distension.
2. PEG tube in place.
3. Areas of hepatic hypodensity, not fully characterized the thought to
represent benign cysts and likely focal fat deposition.
|
10049041-RR-46 | 10,049,041 | 22,620,123 | RR | 46 | 2164-01-18 20:21:00 | 2164-01-18 21:32:00 | EXAMINATION: CTA ABD AND PELVIS
INDICATION: ___ with abd, n/v, diffuse abd pain. Evaluate ischemia.
TECHNIQUE: Abdomen and pelvis CTA: Non-contrast and multiphasic post-contrast
images were acquired through the abdomen and pelvis.
Oral contrast was not administered.
MIP reconstructions were performed on independent workstation and reviewed on
PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 5.7 s, 44.6 cm; CTDIvol = 5.0 mGy (Body) DLP = 222.5
mGy-cm.
2) Spiral Acquisition 5.7 s, 44.8 cm; CTDIvol = 15.3 mGy (Body) DLP = 686.7
mGy-cm.
Total DLP (Body) = 909 mGy-cm.
COMPARISON: None.
FINDINGS:
VASCULAR:
There is no abdominal aortic aneurysm. There is mild calcium burden in the
abdominal aorta and great abdominal arteries.
LOWER CHEST: Minimal atelectasis is noted in the lung bases. There is no
pleural or pericardial effusion.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. A
1.2 x 0.9 cm hypoattenuating lesion at the hepatic dome may reflect a simple
hepatic cyst or biliary hamartoma (03:18). There is no evidence of
intrahepatic or extrahepatic biliary dilatation. The gallbladder is within
normal limits.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
Bilateral renal cortical hypodensities are too small to fully characterize.
No hydronephrosis. There is no perinephric abnormality.
GASTROINTESTINAL: Patient is status post PEG tube placement. Small bowel
loops demonstrate normal caliber, wall thickness and enhancement throughout.
Colon and rectum are within normal limits. There is no evidence of mesenteric
lymphadenopathy.
RETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.
PELVIS: The urinary bladder is decompressed with Foley catheter in place.
There is no evidence of pelvic or inguinal lymphadenopathy. There is no free
fluid in the pelvis.
REPRODUCTIVE ORGANS: The prostate is enlarged. Seminal vesicles are grossly
unremarkable.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: Small foci of gas in the left upper abdomen may be related to
prior injection (3:100).
IMPRESSION:
No acute findings in the abdomen or pelvis to account for patient's symptoms,
specifically no convincing signs of bowel ischemia.
|
10049041-RR-48 | 10,049,041 | 22,620,123 | RR | 48 | 2164-01-18 22:41:00 | 2164-01-18 23:50:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: History: ___ with SOB// ?PNA
TECHNIQUE: Chest PA and lateral
COMPARISON: CT of the abdomen and pelvis from 2 hours prior.
FINDINGS:
Lungs are well expanded and clear. Mild prominence of the right infrahilar
region is clear on abdominal CT and likely corresponds to normal vascular and
bronchial structures. Cardiomediastinal silhouette and hila are normal.
Tracheostomy terminates appropriately in the midline. Cardiomediastinal
silhouette is normal. No pneumothorax or pleural effusion.
IMPRESSION:
No evidence of pneumonia.
|
10049041-RR-49 | 10,049,041 | 22,620,123 | RR | 49 | 2164-01-18 23:44:00 | 2164-01-19 00:11:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ with SOB. Desating on vent.
TECHNIQUE: Portable AP chest
COMPARISON: Chest radiograph performed 1 hour prior.
FINDINGS:
Midline tracheostomy tube is unchanged. Lungs are well aerated without
evidence of focal consolidation. Stable right infrahilar prominence. No
pleural effusion or pneumothorax. The cardiomediastinal silhouette is
unchanged.
IMPRESSION:
No significant interval change.
|
10049041-RR-50 | 10,049,041 | 22,620,123 | RR | 50 | 2164-01-20 21:32:00 | 2164-01-20 21:59:00 | INDICATION: ___ year old man with trach/peg with TF, c/o abdominal fullness.
admitted with sudden onset n/v abd pain that initially resolved// stomach
distension?
TECHNIQUE: Portable supine abdominal radiograph.
COMPARISON: CT abdomen and pelvis ___.
IMPRESSION:
There is a percutaneous gastrostomy tube projecting over the left upper
quadrant of the abdomen. The stomach is slightly distended with air, similar
to prior CT. 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 are no unexplained soft tissue calcifications or radiopaque
foreign bodies.
|
10049041-RR-51 | 10,049,041 | 22,620,123 | RR | 51 | 2164-01-21 12:46:00 | 2164-01-21 13:52:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with hypoxia.// Evaluate for interval change.
IMPRESSION:
In comparison with the study of ___, the tracheostomy tube is unchanged,
as is the overall appearance of the heart and lungs.
|
10049095-RR-20 | 10,049,095 | 22,362,949 | RR | 20 | 2128-10-02 09:41:00 | 2128-10-02 10:44:00 | INDICATION: ___ with chronic left heel ulcer with increased pain// eval
underlying bony changes
TECHNIQUE: AP, lateral, oblique views of the left foot.
COMPARISON: None.
FINDINGS:
There is no fracture. No dislocation. Degenerative changes are noted at the
first metatarsophalangeal joint with joint space loss and subchondral
sclerosis. Small plantar and posterior calcaneal spurs are noted. Vascular
calcifications identified.
IMPRESSION:
No fracture. No radiographic evidence of osteomyelitis.
|
10049095-RR-21 | 10,049,095 | 22,362,949 | RR | 21 | 2128-10-02 09:58:00 | 2128-10-02 10:47:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ with vascular dementia, ___, h/o falls, p/w altered
mental status// eval ICH
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, 16.4 cm; CTDIvol = 48.9 mGy (Head) DLP =
802.7 mGy-cm.
2) Sequenced Acquisition 1.0 s, 2.0 cm; CTDIvol = 50.2 mGy (Head) DLP =
100.3 mGy-cm.
Total DLP (Head) = 903 mGy-cm.
COMPARISON: CT head ___
FINDINGS:
There is no evidence of acute territorial infarctionhemorrhage,edema,or mass.
The ventricle and sulci are markedly prominent suggestive of cerebral atrophy.
Hypodensities of the periventricular and subcortical white matter nonspecific,
however likely represent sequelae of chronic microangiopathic ischemic
disease.
There is no evidence of fracture. There are atherosclerotic calcifications of
the bilateral carotid siphons as well as punctate calcifications in the
vertebrobasilar vessels. 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. No acute intracranial abnormality. Specifically, no evidence of acute
territorial infarction, hemorrhage, or mass.
2. Global parenchymal volume loss and other chronic findings, as above.
|
10049095-RR-22 | 10,049,095 | 22,362,949 | RR | 22 | 2128-10-02 15:30:00 | 2128-10-02 16:19:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ with AMS// eval pna
COMPARISON: Multiple prior chest radiographs dating back to ___.
FINDINGS:
AP upright and lateral views of the chest provided.
There has been interval placement of a left pectoral pacemaker with leads
overlying the right atrium and right ventricle. There is no focal
consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is
normal. Degenerative changes are noted in the bilateral acromioclavicular
joints. No displaced fractures are seen. Mild atherosclerotic calcifications
are seen in the aortic knob.
IMPRESSION:
No acute intrathoracic process.
|
10049095-RR-23 | 10,049,095 | 22,362,949 | RR | 23 | 2128-10-08 11:10:00 | 2128-10-08 13:39:00 | EXAMINATION: BILAT LOWER EXT VEINS
INDICATION: ___ year old man with leg pain, concern for DVT ___ cyst// ___
year old man with leg pain, concern for DVT ___ cyst
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the bilateral lower extremity veins.
COMPARISON: Lower extremity ultrasound from ___.
FINDINGS:
There is normal compressibility, flow, and augmentation of the bilateral
common femoral and femoral veins. Again demonstrated a duplicated distal
right femoral vein with linear intraluminal echogenic material not impeding
popliteal venous flow, probably representing extension of the duplicated right
distal femoral vein or recanalization of chronic thrombus. Normal color flow
and compressibility are demonstrated in the posterior tibial and peroneal
veins bilaterally.
There is normal respiratory variation in the common femoral veins bilaterally.
No evidence of medial popliteal fossa (___) cyst.
IMPRESSION:
Nonocclusive linear intraluminal echogenic material, may sequela from
recanalized DVT or part of the wall from the duplicated right distal femoral
vein. Otherwise, no evidence of deep venous thrombosis in the right or left
lower extremity veins.
|
10049334-RR-61 | 10,049,334 | 24,032,789 | RR | 61 | 2183-07-08 14:23:00 | 2183-07-09 00:18:00 | INDICATION: History: ___ with ___, poor historian, s/p fall from standing,
with head strike, and pain and tenderness at the right femoral head. // ___,
poor historian, s/p fall from standing, with head strike, and pain and
tenderness at the right femoral head.
TECHNIQUE: Supine AP portable views of the chest
COMPARISON: ___
FINDINGS:
There are prominent right greater than left perihilar opacities worrisome for
severe pulmonary edema. Asymmetrical increased opacity on the right as
compared to the left could be due to asymmetric pulmonary edema however,
underlying infection, and/or aspiration could be present. Pulmonary
hemorrhage not excluded. No large pleural effusion or pneumothorax is seen
although pleural effusion is seen on cervical spine CT. . The cardiac
silhouette is quite enlarged. Mediastinal contours are grossly similar Subtle
posterolateral right-sided rib deformities including right fourth through
seventh ribs consistent with rib fractures ; the right fourth and seventh rib
fractures appear old. The right fifth and sixth rib fractures are of
indeterminate age, but could be acute to subacute. Correlate with clinical
history and site of point tenderness
IMPRESSION:
Prominent right greater than left perihilar is opacities worrisome for severe
pulmonary edema. Asymmetric increased opacity on the right as compared to the
left could be due to asymmetric pulmonary edema versus underlying infection
and/ or aspiration. Pulmonary hemorrhage not excluded.
Subtle posterolateral right-sided rib deformities including right fourth
through seventh ribs consistent with rib fractures ; the right fourth and
seventh rib fractures appear old. The right fifth and sixth rib fractures are
of indeterminate age, but could be acute to subacute. Correlate with clinical
history and site of point tenderness. Findings are new since ___
|
10049334-RR-62 | 10,049,334 | 24,032,789 | RR | 62 | 2183-07-08 14:22:00 | 2183-07-08 19:03:00 | EXAMINATION: HIP (UNILAT 2 VIEW) W/PELVIS (1 VIEW) RIGHT
INDICATION: History: ___ with ___, poor historian, s/p fall from standing,
with head strike, and pain and tenderness at the right femoral head. // ___,
poor historian, s/p fall from standing, with head strike, and pain and
tenderness at the right femoral head.
TECHNIQUE: AP view of the pelvis and AP and lateral views of the right hip.
COMPARISON: None.
FINDINGS:
Comminuted right intratrochanteric fracture is seen with varus angulation of
the femoral head. No frank dislocation. There are moderate to severe
osteoarthritic changes of the right hip with joint space narrowing, marginal
sclerosis, and spurring. Mild to moderate left hip degenerative changes are
seen. Overall, there is diffuse osseous demineralization. The pubic
symphysis and sacroiliac joints are not widened. There are extensive vascular
calcifications. Surgical clips are noted projecting over the lower pelvis.
IMPRESSION:
Comminuted right intertrochanteric fracture with varus angulation of the right
femoral head.
Moderate to severe right hip osteoarthritic changes.
|
10049334-RR-63 | 10,049,334 | 24,032,789 | RR | 63 | 2183-07-08 13:53:00 | 2183-07-08 16:00:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: History: ___ with ___, poor historian, s/p fall from standing,
with head strike, and pain and tenderness at the right femoral head.
TECHNIQUE: Noncontrast enhanced MDCT images of the head were obtained.
Reformatted coronal and sagittal images were also obtained.
DOSE Acquisition sequence:
1) CT Localizer Radiograph
2) CT Localizer Radiograph
3) Sequenced Acquisition 0.7 s, 2.0 cm; CTDIvol = 49.8 mGy (Head) DLP =
99.5 mGy-cm.
4) Sequenced Acquisition 8.0 s, 8.2 cm; CTDIvol = 48.8 mGy (Head) DLP =
401.4 mGy-cm.
5) Spiral Acquisition 12.9 s, 19.1 cm; CTDIvol = 48.1 mGy (Head) DLP =
919.4 mGy-cm.
Total DLP (Head) = 1,420 mGy-cm.
COMPARISON: ___
FINDINGS:
There is no evidence of acute intracranial hemorrhage, midline shift, mass
effect, or acute large vascular territorial infarct. Prominence of the
ventricles and sulci is consistent with atrophy. Periventricular and
subcortical white matter hypodensities are likely sequelae of chronic small
vessel disease. Inferolateral right frontal hypodensity is again seen, likely
old infarct/insult. The visualized paranasal sinuses are clear. The mastoid
air cells are clear. No acute fracture is seen. Patient is status post right
craniotomy.
IMPRESSION:
Some patient motion limits the exam. No definite acute intracranial process
seen.
|
10049334-RR-64 | 10,049,334 | 24,032,789 | RR | 64 | 2183-07-08 13:54:00 | 2183-07-08 16:13:00 | EXAMINATION: CT C-SPINE W/O CONTRAST Q311 CT SPINE
INDICATION: History: ___ with ___, poor historian, s/p fall from standing,
with head strike, and pain and tenderness at the right femoral head.
TECHNIQUE: Non-contrast helical multidetector CT was performed.Soft tissue
and bone algorithm images were generated. Coronal and sagittal reformations
were then constructed.
DOSE: Acquisition sequence:
1) CT Localizer Radiograph
2) CT Localizer Radiograph
3) Spiral Acquisition 5.6 s, 21.8 cm; CTDIvol = 37.2 mGy (Body) DLP = 811.5
mGy-cm.
4) Spiral Acquisition 3.4 s, 21.9 cm; CTDIvol = 39.1 mGy (Body) DLP = 855.3
mGy-cm.
Total DLP (Body) = 1,667 mGy-cm.
COMPARISON: ___
FINDINGS:
No acute fracture or dislocation is seen. Multilevel degenerative changes are
re- demonstrated including disc space narrowing at C6/C7, and small anterior
and posterior osteophytes at this level. There is also multilevel facet
arthropathy bilaterally. No prevertebral soft tissue swelling is seen. There
are bilateral, right greater than left partially imaged simple appearing
pleural effusions. Septal thickening and ground-glass opacity at the lung
apices, most consistent with pulmonary edema.
IMPRESSION:
1. No acute fracture of the cervical spine. Multi-level degenerative changes.
2. Partially imaged right greater than left pleural effusions. Pulmonary
edema.
|
10049334-RR-65 | 10,049,334 | 24,032,789 | RR | 65 | 2183-07-08 16:10:00 | 2183-07-08 18:02:00 | INDICATION: ___ intratrochanteric hip fracture on the right side. Pre-op full
length femur films. // ___ intratrochanteric hip fracture on the right side.
Pre-op full length femur films.
TECHNIQUE: AP and lateral views of the mid to distal femur
COMPARISON: Reference made to right hip radiographs performed earlier today,
___ at 14:18
FINDINGS:
No acute fracture is seen of the mid to distal right femur. Minimal to no
suprapatellar joint effusion is seen. No dislocation at the knee joint is
identified.
IMPRESSION:
No acute fracture seen of the mid to distal right femur.
|
10049334-RR-66 | 10,049,334 | 24,032,789 | RR | 66 | 2183-07-09 08:49:00 | 2183-07-09 10:20:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man s/p fall with right hip fracture // pre-op Surg:
___ (Hip repair) pre-op
IMPRESSION:
In comparison with the study of ___, there again is enlargement of the
cardiac silhouette with asymmetric pulmonary edema. As previously, it would
be difficult to unequivocally exclude superimposed pneumonia, especially in
the absence of a lateral view.
Hazy opacifications bilaterally with poor definition of the hemi diaphragms
suggests layering pleural effusion with underlying compressive atelectasis.
No interval change. No evidence of pneumothorax.
|
10049334-RR-67 | 10,049,334 | 24,032,789 | RR | 67 | 2183-07-10 08:11:00 | 2183-07-10 10:15:00 | EXAMINATION: HIP UNILAT MIN 2 VIEWS IN O.R. RIGHT
INDICATION: ORIF RIGHT HIP
IMPRESSION:
Images from the operating suite show placement of a fixation device about
fracture of the proximal femur. Further information can be gathered from the
operative report.
|
10049334-RR-68 | 10,049,334 | 24,032,789 | RR | 68 | 2183-07-10 10:33:00 | 2183-07-10 11:36:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with increased WOB // assess for pulmonary edema
assess for pulmonary edema
COMPARISON: Chest radiographs since ___, most recently ___.
IMPRESSION:
Previous moderate pulmonary edema has improved, moderate bilateral pleural
effusions have redistributed dependently, but probably not enlarged, and now
obscure the right heart border. Opacification at the lung bases is probably a
combination of atelectasis, dependent edema overlying pleural effusion. No
pneumothorax. .
|
10049334-RR-70 | 10,049,334 | 24,032,789 | RR | 70 | 2183-07-12 08:43:00 | 2183-07-12 09:31:00 | EXAMINATION: UNILAT LOWER EXT VEINS
INDICATION: ___ year old man with R hip fracture, R leg getting more swollen,
concerned for compartment syndrome and just want to check if he has DVT //
DVT?
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the right lower extremity veins.
COMPARISON: None.
FINDINGS:
There is normal compressibility, flow and augmentation of the bilateral common
femoral, femoral, and popliteal veins. Normal color flow is demonstrated in
the tibial and peroneal veins.
There is normal respiratory variation in the common femoral veins bilaterally.
Note is made of right calf subcutaneous edema.
IMPRESSION:
1. No evidence of deep venous thrombosis in the right lower extremity veins.
2. Right calf subcutaneous edema.
|
10049681-RR-3 | 10,049,681 | 29,545,170 | RR | 3 | 2117-11-19 20:56:00 | 2117-11-20 12:25:00 | HISTORY: ___ woman with comminuted distal right humerus fracture. To
characterize fracture prior to surgery.
TECHNIQUE: Axial MDCT images were acquired in the absence of intravenous
contrast and displayed in multiplanar reformats at 2.5-mm resolution.
FINDINGS:
There is an old proximal humerus fracture which has healed. Diffuse
osteopenia is noted. Ossification in the supraspinatus tendon is also noted.
Degenerative changes at the glenohumeral joint with probable chondrocalcinosis
(2:20) versus small intra-articular fragments. The shaft of the humerus is
unremarkable in appearance, except for generalized osteopenia.
Of note, there is a comminuted intra-articular fracture of the distal humerus
with an intercondylar component involving the medial epicondyle with an
additional fracture line through the trochlea(402B:54). The ulno-trochlear
articulation is relagrossly congruent, slightly widened, with slight posterior
displacement of the trochlea with respect to the shaft of the humerus (501:2).
The radiocapitellar articulation is abnormal with anterior/volar dislocation
of the radial head (501:1). There is a small bony chip in the radiocapitellar
joint. The possibility of a subtle corner fracture off the radial head cannot
be excluded(401B:49). Soft tissue swelling and induration in this region is
consistent with a hematoma.
There is an old healed rib fracture of the right (?) fifth rib (402B:217).
Visualized portions of the lungs are unremarkable. Focal fat seen with the
deltoid muscle may represent a small intramsuclar lipoma (3:10).
IMPRESSION:
1. Comminuted intra-articular fracture of the distal humerus with a
transverse intercondylar component displacing the medial epicondyle with an
additional fracture line through the trochlea as described. Multiple
additional small fragments of bone are identified.
2. Dislocation of the radiocapitaller joint, with nearby tiny bone fragment.
Doubt but cannot entirely exclude tiny chip fracture along radial articular
surface.
3. Glenohumeral degenerative changes with ossification of the supraspinatus
tendon.
4. Probable small lipoma in the deltoid muscle, not full evaluated.
|
10049681-RR-4 | 10,049,681 | 29,545,170 | RR | 4 | 2117-11-20 17:18:00 | 2117-11-21 10:38:00 | HISTORY: ORIF distal humerus fracture.
Three views obtained in the OR of the distal humerus, 1 lateral, 2 oblique.
There has been an open reduction internal fixation of the distal humeral
fracture with a fixation plate and screws seen. The radial head dislocation
is reduced based on single lateral image available.
|
10049681-RR-5 | 10,049,681 | 29,545,170 | RR | 5 | 2117-11-21 10:05:00 | 2117-11-21 11:01:00 | HISTORY: Pain, fracture.
PELVIS, SINGLE VIEW.
Assessment of bony detail is markedly limited by overlying soft tissues and
underpenetration. Pelvic girdle is congruent, without obvious SI joint or
pubic symphysis diastasis. The sacrum is markedly obscured. No displaced
fractures identified about the pelvis or proximal femurs, but a nondisplaced
fracture would be very difficult to identify on this film. If clinical
suspicion for a proximal femur or sacral fracture remains high, then further
assessment with CT or MRI would be recommended.
|
10049681-RR-6 | 10,049,681 | 29,545,170 | RR | 6 | 2117-11-21 10:05:00 | 2117-11-21 11:07:00 | HISTORY: Pain, fracture.
LEFT KNEE, THREE VIEWS.
There is severe osteopenia and severe tricompartmental osteoarthritis. No
lucent fracture line, displaced fracture, or fat-fluid level is detected.
There is chondrocalcinosis. Incidental note is made of prominent tibial
tubercle.
|
10049736-RR-6 | 10,049,736 | 25,973,485 | RR | 6 | 2139-10-24 15:11:00 | 2139-10-24 09:50:00 | HISTORY: ___ female with history of ovarian cyst, now presenting with
acute right groin pain.
COMPARISON: None available.
LMP: ___
PELVIC ULTRASOUND: Transabdominal and transvaginal examinations performed,
the latter to further evaluate the endometrium and adnexal structures. The
uterus is anteverted and retroflexed and measures 10.8 x 4.4 x 6.0 cm. The
endometrium is homogeneous in echogenicity measuring 8 mm. A C-section scar
is noted.
Within the right adnexa, there is a large simple cyst measuring 6.4 x 5.0 x
6.6 cm. This likely represents a paraovarian cyst. The adjacent ovary
appears slightly edematous and measures 2.6 x 3.2 x 3.3 cm. The left ovary
measures 2.6 x 2.2 x 3.1 cm. Small follicles are noted. There is normal
arterial and venous Doppler waveforms within both ovaries. There is trace
pelvic free fluid.
IMPRESSION:
1. Slightly edematous right ovary with normal arterial and venous Doppler
waveforms. Findings are indeterminate with ovarian torsion not excluded.
Gynecologic consultation with clinical correlation is recommended.
2. Large 6.6 cm right paraovarian cyst. Follow-up pelvic ultrasound in 3
months is recommended.
Dr. ___ communicated the above results to Dr. ___
at 9:15 a.m. on ___ by telephone.
|
10049746-RR-28 | 10,049,746 | 24,332,085 | RR | 28 | 2136-11-23 09:22:00 | 2136-11-23 13:07:00 | INDICATION: ___ with periprosthetic femur fracture s/p fall// preop
TECHNIQUE: Single AP view of the chest.
COMPARISON: Chest x-ray from ___.
FINDINGS:
Lung volumes are slightly low with mild left basilar atelectasis. The
cardiomediastinal silhouette is within normal limits. No acute osseous
abnormalities. Right shoulder arthroplasty is new since ___.
IMPRESSION:
No acute cardiopulmonary process.
|
10049746-RR-29 | 10,049,746 | 24,332,085 | RR | 29 | 2136-11-23 10:56:00 | 2136-11-23 12:04:00 | INDICATION: ___ with left hip fx// please perform plain film for pre-op eval
TECHNIQUE: AP and frogleg lateral views of the left hip.
COMPARISON: Left hip films from ___.
FINDINGS:
Left total hip arthroplasty is noted. Best seen on the cross-table lateral
view is acute periprosthetic fracture at the midportion of the femoral stem.
The prosthesis is anatomically aligned. Excreted contrast is noted within the
bladder.
IMPRESSION:
Acute periprosthetic fracture at the midportion of the femoral stem of the
left hip arthroplasty.
|
10049746-RR-30 | 10,049,746 | 24,332,085 | RR | 30 | 2136-11-23 10:26:00 | 2136-11-23 11:05:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ with fall// please eval for fracture or bleed
TECHNIQUE: Contiguous axial images from skullbase to vertex were obtained
without intravenous contrast. Coronal and sagittal reformats were also
performed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 18.0 s, 18.2 cm; CTDIvol = 49.6 mGy (Head) DLP =
903.1 mGy-cm.
Total DLP (Head) = 903 mGy-cm.
COMPARISON: None.
FINDINGS:
There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or
acute major vascular territorial infarct. Gray-white matter differentiation is
preserved. Ventricles and sulci are prominent compatible with global volume
loss. Scattered periventricular and subcortical white matter hypodensities
are nonspecific but likely sequela of chronic small vessel disease.
The left frontal sinus and left ethmoid air cells are entirely opacified.
There is soft tissue perhaps arising from the ethmoid air cells extending
laterally into the extraconal space abutting the superior margin of the medial
rectus muscle. This soft tissue measures approximately 1.2 cm cc by 0.7 cm
TRV. In addition, there is apparent demineralization of the ethmoid air
cells septa and soft tissue extending into the nasal cavity.
Aerosolized debris with fluid and mucosal thickening noted in the left
maxillary sinus. Remaining paranasal sinuses are clear. (601:22) with a
IMPRESSION:
No acute intracranial process.
Complete opacification of the left frontal sinus and ethmoid air cells. Given
demineralized left ethmoid septa and soft tissue extension into the left
orbit, underlying mass lesion with secondary obstruction would be of concern.
A mucocele is less likely given lack of expansion. Dedicated nonurgent MRI
suggested.
|
10049746-RR-31 | 10,049,746 | 24,332,085 | RR | 31 | 2136-11-23 10:27:00 | 2136-11-23 11:12:00 | EXAMINATION: CT C-SPINE W/O CONTRAST
INDICATION: ___ with fall// please eval for cervical spine fx please
eval for cervical spine fx
TECHNIQUE: Contiguous axial images obtained through the cervical spine
without intravenous contrast. Coronal and sagittal reformats were reviewed.
DOSE: Acquisition sequence:
1) Spiral Acquisition 5.7 s, 22.5 cm; CTDIvol = 22.7 mGy (Body) DLP = 511.8
mGy-cm.
Total DLP (Body) = 512 mGy-cm.
COMPARISON: CT cervical spine from ___.
FINDINGS:
There is anterolisthesis of C7 on T1 though progressed since ___, this is
likely degenerative given facet joint hypertrophic changes, particularly on
the right. Remaining vertebral bodies are preserved in alignment. There is
no acute fracture. Multilevel degenerative changes notable for intervertebral
disc height loss, posterior osteophyte formation, uncovertebral joint and
facet joint hypertrophy. Intervertebral disc spacer noted C5-6. There is no
prevertebral edema.
Thyroid is not well visualized. Lung apices are clear.
IMPRESSION:
Degenerative changes without fracture or acute malalignment.
|
10049746-RR-32 | 10,049,746 | 24,332,085 | RR | 32 | 2136-11-23 10:27:00 | 2136-11-23 11:58:00 | EXAMINATION: CTA CHEST WITH CONTRAST
INDICATION: ___ with hypoxia, possible metastatic CA// please eval for 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: Total DLP (Body) = 462 mGy-cm.
COMPARISON: None
FINDINGS:
HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the
subsegmental and there is a filling defect within the segmental branch of the
left upper lobe (4:84). Apparent filling defect in a subsegmental branch of
the left lower lobe is noted though there is significant respiratory motion
which limits detailed evaluation. Given slight hypoenhancement of the
atelectatic lung at the left lung base medially this could indeed represent
additional filling defect with possible infarct. No additional filling
defects are identified.
Coronary artery and mitral annular calcifications are noted. Atherosclerotic
calcifications also noted at the aortic arch. The heart is mildly enlarged.
No pericardial effusion is seen.
AXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar
lymphadenopathy is present. No mediastinal mass.
PLEURAL SPACES: Small left and trace right pleural effusions are noted.
LUNGS/AIRWAYS: Dependent areas of atelectasis are again noted. As detailed
above, there is slight hypoenhancement at the left lung base medially which
could represent an infarct. Respiratory motion does limit detail evaluation
for tiny pulmonary nodules. The airways are patent to the level of the
segmental bronchi bilaterally.
BASE OF NECK: Visualized portions of the base of the neck show no abnormality.
ABDOMEN: Included portion of the upper abdomen is notable for partially
visualized adenopathy and numerous hypoenhancing liver lesions. These
findings are concerning for metastatic disease.
BONES: No suspicious osseous abnormality is seen.? old bilateral anterior rib
fractures are noted. In addition there are fractures of the left posterior
eighth, ninth ribs near the costovertebral junction to be correlated
clinically regarding acuity.
IMPRESSION:
1. Left upper lobe segmental pulmonary embolism. Questionable left lower
lobe subsegmental pulmonary embolism which is likely real given slight
hypoenhancement of the lung supplied by this branch which could represent
component of infarct. No right heart strain.
2. Rib fractures at the costovertebral junctions of the left eighth and ninth
ribs posteriorly to be correlated clinically regarding acuity as these may be
recent in nature.
3. Evidence of metastatic disease in the partially visualized abdomen.
|
10049746-RR-33 | 10,049,746 | 24,332,085 | RR | 33 | 2136-11-24 09:43:00 | 2136-11-24 10:28:00 | EXAMINATION: DX CHEST PORTABLE PICC LINE PLACEMENT
INDICATION: ___ year old woman with new NHL// Confirm PICC placement.
Contact name: ___ MD, ___: ___
IMPRESSION:
In comparison with the study of ___, there has been placement of a right
PICC line that extends to about the outer margin of the thoracic cavity before
turning back on itself and extending beyond the lateral margin of the image.
There are improved lung volumes. The left hemidiaphragm is not well seen,
concerning for small effusion and basilar atelectasis. Minimal atelectatic
changes are suggested at the right base.
NOTIFICATION: Doctor ___.
|
10049746-RR-34 | 10,049,746 | 24,332,085 | RR | 34 | 2136-11-24 10:51:00 | 2136-11-25 09:35:00 | INDICATION: ___ year old woman with new nonhodgkins lymphoma needs urgent
chemotherapy// R arm PICC line malpositioned, need to be replaced
COMPARISON: Chest radiograph from ___
TECHNIQUE: OPERATORS: Dr. ___ resident and Dr. ___,
___ radiologist performed the procedure. Dr. ___
supervised the trainee during the key components of the procedure and has
reviewed and agrees with the trainee's findings.
ANESTHESIA: None
MEDICATIONS: None
CONTRAST: 10 ml of Optiray contrast.
FLUOROSCOPY TIME AND DOSE: 3.9 min, 15 mGy
PROCEDURE: 1. Repositioning of right PICC.
2. Right upper extremity venogram.
PROCEDURE DETAILS: Using sterile technique, a Nitinol guidewire was introduced
into the superior vena cava (SVC) through the existing PICC line, which was
subsequently removed. A peel-away sheath was then placed over the guidewire.
A new single lumen PIC line measuring 43 cm in length was then placed through
the peel-away sheath, but was unable to be advanced beyond the level of the
brachial vein. The guidewire was removed and a venogram was performed
demonstrating a short angled communication from the smaller vein containing
the PIC to the brachial vein. The guidewire was angled slightly and
reintroduced, passing into brachial vein and into the IVC. The PIC was then
able to follow 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 right upper extremity
replaced with a new single lumen PIC line with tip in the lower SVC.
2. Short angled communication from the smaller vein containing the PIC to the
brachial vein.
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.
|
10049746-RR-35 | 10,049,746 | 24,332,085 | RR | 35 | 2136-11-25 22:19:00 | 2136-11-25 22:49:00 | INDICATION: ___ year old woman with DLBCL awaiting chemo, now with oliguria
and shortness of breath// edema? infiltrate?
TECHNIQUE: AP portable chest radiograph
COMPARISON: ___
FINDINGS:
The tip of a right PICC line projects over the distal SVC. There are lower
bilateral lung volumes. Bibasilar opacities likely reflect atelectasis.
There is a small left pleural effusion. No pneumothorax. The size of the
cardiac silhouette is unchanged.
IMPRESSION:
Interval repositioning of the right PICC line, the tip now projecting over the
distal SVC. No pneumothorax.
|
10049746-RR-36 | 10,049,746 | 24,332,085 | RR | 36 | 2136-11-26 01:22:00 | 2136-11-26 04:10:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ year old woman with DLBCL with AMS unclear if ___ steroids vs
other causes (stroke/bleed)// r/o bleed/stroke
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Acquisition sequence:
1) Stationary Acquisition 6.0 s, 22.5 cm; CTDIvol = 50.1 mGy (Head) DLP =
1,128.0 mGy-cm.
2) Stationary Acquisition 4.0 s, 15.1 cm; CTDIvol = 49.8 mGy (Head) DLP =
752.0 mGy-cm.
Total DLP (Head) = 1,880 mGy-cm.
COMPARISON: CT head on ___
FINDINGS:
There is no evidence of acute large territory infarct,hemorrhage,edema,or mass
effect. 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 are atherosclerotic calcifications in
the bilateral cavernous carotids.
There is no evidence of fracture. There is near complete opacification of the
left frontal sinus and left ethmoid air cells, similar to prior. There is
apparent demineralization of the ethmoid air cells and septa, and extension of
the left ethmoid there is slow opacification due to the extraconal space
similar to prior. Mucosal thickening in the left maxillary sinus is similar
to prior. There is likely in nasal polyps on the left. The visualized
portion of the remainder of the paranasal sinuses, mastoid air cells, and
middle ear cavities are clear. The visualized portion of the orbits are
unremarkable.
IMPRESSION:
1. No acute intracranial abnormality on noncontrast head CT. Specifically no
intracranial hemorrhage or large territory infarct.
2. Re-demonstration of complete opacification of the left frontal sinus and
ethmoid air cells with apparent demineralization of the left ethmoid septa and
extension into the left orbit, again concerning for underlying mass lesion.
Nonurgent MRI is again recommended for further evaluation.
RECOMMENDATION(S): Nonurgent MRI.
|
10049746-RR-37 | 10,049,746 | 24,332,085 | RR | 37 | 2136-11-26 01:23:00 | 2136-11-26 02:38:00 | EXAMINATION: CT ABD AND PELVIS WITH CONTRAST
INDICATION: ___ year old woman with DLBCL, now with elevated lactate/WBC/bili
and decreased UOP// r/o RP bleed, obstruction of ureters by bulky adenopathy,
infection, malignancy burden
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired
through the abdomen and pelvis following intravenous contrast administration
with split bolus technique.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 0.5 s, 0.2 cm; CTDIvol = 9.3 mGy (Body) DLP = 1.9
mGy-cm.
2) Stationary Acquisition 23.6 s, 0.2 cm; CTDIvol = 401.6 mGy (Body) DLP =
80.3 mGy-cm.
3) Spiral Acquisition 8.3 s, 53.9 cm; CTDIvol = 10.1 mGy (Body) DLP = 538.3
mGy-cm.
Total DLP (Body) = 621 mGy-cm.
COMPARISON: None.
FINDINGS:
LOWER CHEST: There are small bilateral pleural effusions with adjacent
compressive atelectasis. No evidence of a pericardial effusion.
ABDOMEN:
HEPATOBILIARY: There are innumerable hypoenhancing hepatic masses (greater
than 15). The largest in the right lobe of the liver measures up to 5.4 x 4.4
cm in VI (5:40). The largest in the left lobe of the liver measures 5.5 x 4.4
cm in segment II/III (05:29). No intrahepatic or extrahepatic biliary
dilatation. The gallbladder contains sludge and there is marked gallbladder
wall edema likely due to third spacing. There is no luminal distension or
pericholecystic fat stranding to suggest acute cholecystitis.
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.
No hydronephrosis. Subcentimeter hypodensities bilaterally are too small to
characterize. Multiple peripelvic cysts are noted on the left. There is no
perinephric abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. The colon and
rectum are within normal limits. There is a small amount of fluid surround
the tip of the appendix (07:23). However, there is air within this segment of
the distal appendix which is normal in caliber throughout. Note is made of a
punctate appendicolith(07:24).
PELVIS: Evaluation of the pelvic structures is slightly limited by artifact
from the adjacent left hip arthroplasty. Urinary bladder is collapsed around
a Foley catheter. Trace free fluid in the pelvis.
REPRODUCTIVE ORGANS: Uterus is unremarkable in appearance.
LYMPH NODES: There are multiple enlarged upper abdominal lymph nodes. For
instance, there is a nodal conglomerate in the gastrohepatic ligament that
measures 2.6 x 2.4 cm (5:26). Multiple upper retroperitoneal lymph nodes
measuring up to 1.7 x 1.2 cm at the level of the left renal vein (05:31). A
few subcentimeter mesenteric lymph nodes in the right lower abdomen measure up
to 0.8 cm (05:55). No pelvic sidewall or inguinal adenopathy by size
criteria.
VASCULAR: There is no abdominal aortic aneurysm. Heavy atherosclerotic
disease is noted.
BONES: No suspicious lytic or sclerotic lesions are identified. Patient is
status post total left hip arthroplasty. Degenerative changes at the pubic
symphysis. Healed fractures of the left anterior sixth and seventh ribs
(5:17).
SOFT TISSUES: Small locules of air in the subcutaneous fat of the anterior
abdominal wall likely represent a sequela of medication injection. There is
mild body wall edema.
IMPRESSION:
1. No infectious source identified in the abdomen and pelvis.
2. Upper abdominal lymphadenopathy, the largest conglomerate measuring up to
2.6 x 2.4 cm in the gastrohepatic ligament, compatible with provided history
of lymphoma.
3. Multiple hypoenhancing hepatic masses, the largest measuring up to 5.5 x
4.4 cm, likely representing lymphomatous involvement.
4. Signs of excess fluid including small bilateral pleural effusions, trace
pelvic free fluid, and mild body wall edema.
|
10049746-RR-39 | 10,049,746 | 24,332,085 | RR | 39 | 2136-11-26 17:47:00 | 2136-11-26 18:31:00 | EXAMINATION: CT pelvis and left lower extremity without contrast
INDICATION: ___ year old woman with worsening anemia and left hip fracture//
eval for bleed in left hip
TECHNIQUE: Multidetector CT images of the pelvis and proximal left lower
extremity were acquired without intravenous contrast. Non-contrast scan has
several limitations in detecting vascular and parenchymal organ abnormalities,
including tumor detection.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Total DLP (Body) = 1,507 mGy-cm.
COMPARISON: CT abdomen pelvis dated ___ and radiographs of the left
hip dated ___.
FINDINGS:
PELVIS: Innumerable hypodense hepatic masses are better assessed on the recent
CT of the abdomen pelvis with contrast. Gallbladder wall edema is again
noted, similar to prior, and likely due to third spacing. Note is made of
vicarious excretion of contrast into the gallbladder. Assessment of
intrapelvic structures is slightly limited due to artifact from the left hip
arthroplasty. A Foley catheter is present, decompressing the bladder. Trace
free fluid is seen within the pelvis. Visualized loops of large and small
bowel are grossly unremarkable. The previously noted fluid surrounding the
tip of the appendix is less conspicuous on this study. There is no
retroperitoneal hematoma.
REPRODUCTIVE ORGANS: The uterus is not enlarged. No adnexal mass lesions are
identified.
LYMPH NODES: There is no pelvic or inguinal lymphadenopathy.
VASCULAR: Extensive atherosclerotic disease is noted.
BONES AND SOFT TISSUES: Patient is status post left total hip arthroplasty.
Re-demonstrated is the known oblique, mildly displaced periprosthetic fracture
along the midportion of the femoral stem. Assessment of surrounding soft
tissue structures is limited due to streak artifact from the prosthesis.
Asymmetry of the muscle bulk surrounding the periprosthetic left femoral
fracture suggests a component of intramuscular hematoma. No large hematoma is
seen separately within this region. Degenerative changes are noted in the
right femoroacetabular joint, as well as the left knee. There is a moderate
size left knee joint effusion. Posterior spinal fusion hardware is partially
imaged.
IMPRESSION:
1. Oblique, mildly displaced left femoral periprosthetic fracture is
re-demonstrated. Asymmetry of the muscle bulk surrounding the periprosthetic
fracture suggesting a component of intramuscular hematoma, however no large
hematoma is seen separate to this region. No retroperitoneal hematoma.
2. Please refer to CT of the abdomen and pelvis performed with contrast
earlier on the same day for additional details of intra pelvic structures.
|
10049746-RR-40 | 10,049,746 | 24,332,085 | RR | 40 | 2136-11-26 20:17:00 | 2136-11-26 20:57:00 | EXAMINATION: Chest radiograph
INDICATION: ___ year old woman with large b cell lymphoma, worsening work of
breathing// eval worsening work of breathing
TECHNIQUE: Portable frontal view of the chest
COMPARISON: ___
IMPRESSION:
Compared to the examination from 1 day prior, there have been increasing small
to moderate layering bilateral pleural effusions with adjacent consolidations,
nonspecific, as well as increasing central pulmonary vascular congestion with
trace interstitial edema. Consolidations likely represent atelectasis, though
pneumonia cannot be excluded in the appropriate clinical circumstance. No
other significant interval changes seen.
|
10049746-RR-41 | 10,049,746 | 24,332,085 | RR | 41 | 2136-11-27 05:03:00 | 2136-11-27 18:17:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with large b cell lymphoma, volume overload//
eval interval improvement
TECHNIQUE: 2 frontal views of the chest
COMPARISON: ___
FINDINGS:
Bibasilar hazy opacities, possibly subsegmental atelectasis, slightly improved
since prior study.
The cardio-mediastinal silhouette is stable.
Small left effusion slightly reduced. No pneumothorax. Right PICC line in
the mid SVC. Right shoulder prosthesis
IMPRESSION:
Bibasilar hazy opacities slightly improved.
|
10049746-RR-42 | 10,049,746 | 24,332,085 | RR | 42 | 2136-11-28 05:09:00 | 2136-11-28 11:24:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with recent diagnosis of DLBCL admitted ___ for
fall and discovered to have segmental and subsegmental PE started on Lovenox
now transferred from ___ for management of hypoxic respiratory failure and
tachycardia// eval for interval change
TECHNIQUE:
Chest, single AP portable view
COMPARISON:
Chest x-ray from ___ at 05:13
FINDINGS:
PICC line tip again noted over distal SVC. No pneumothorax detected.
Cardiomediastinal silhouette is grossly unchanged. Again seen is CHF, with
mild vascular plethora and bilateral effusions with underlying collapse and/or
consolidation. Opacity at the right base may be slightly more pronounced
compared 1 day earlier. Vascular plethora may also be very slightly
increased. Prominence of the aortic arch is similar to examinations from ___ and ___.
Partially imaged right total shoulder for plasty again noted.
IMPRESSION:
Vascular plethora and opacity at right base may be slightly more pronounced
compared 1 day earlier. Otherwise, doubt significant interval change.
|
10049746-RR-44 | 10,049,746 | 24,332,085 | RR | 44 | 2136-11-28 15:22:00 | 2136-11-28 16:32:00 | EXAMINATION: Ultrasound of the left hip.
INDICATION: ___ year old woman with L hip fracture and dropping hemoglobin//
assess for hematoma
TECHNIQUE: Grayscale images of the left hip.
COMPARISON: CT of the left femur ___
FINDINGS:
Abutting the left hip, there is a complex fluid collection measuring 1.8 x 1.0
x 2.5 cm without internal vascularity
IMPRESSION:
Complex fluid collection measuring 1.8 x 1.0 x 2.5 cm adjacent to the left hip
which could represent hematoma or joint effusion.
|
10049746-RR-46 | 10,049,746 | 24,332,085 | RR | 46 | 2136-11-30 12:16:00 | 2136-11-30 17:48:00 | EXAMINATION: Portable AP chest radiograph
INDICATION: ___ year old woman with DLBCL w/ worsening tachypnea, assess
interval change
TECHNIQUE: Chest PA and lateral
COMPARISON: Compared to the prior radiograph on ___
FINDINGS:
Compared to the prior radiograph on ___, right pleural effusion
appears larger with fissural encroachment while the left pleural effusion is
difficult to assess but appears similar. Left lower lobe remains
substantially atelectatic, but the lungs elsewhere are clear without
consolidation. The right-sided PICC is noted to terminate in the mid to lower
SVC. Mediastinal widening appears less pronounced. Partially imaged right
total shoulder arthroplasty again noted.
IMPRESSION:
Interval enlargement of the right pleural effusion with fissural encroachment.
Similar left pleural effusion and persistent severe left lower lobe
atelectasis..
|
10049746-RR-47 | 10,049,746 | 24,332,085 | RR | 47 | 2136-11-30 12:17:00 | 2136-11-30 17:50:00 | INDICATION: ___ year old woman with DLBCL w/worsening delirium// signs of
obstruction.
TECHNIQUE: Portable supine abdominal radiograph was obtained.
COMPARISON: CT abdomen pelvis without contrast dated ___.
FINDINGS:
There are no abnormally dilated loops of large or small bowel. There is no
evidence of obstruction.
Supine assessment limits detection for free air; there is no gross
pneumoperitoneum.
Osseous structures are unremarkable. Left hip arthroplasty is noted. Surgical
hardware noted in the lumbar spine.
There are no unexplained soft tissue calcifications or radiopaque foreign
bodies.
IMPRESSION:
No abnormally dilated loops of large or small bowel. There is no evidence of
obstruction.
|
10049746-RR-48 | 10,049,746 | 24,332,085 | RR | 48 | 2136-12-02 17:44:00 | 2136-12-02 18:13:00 | EXAMINATION: CT CHEST W/O CONTRAST
INDICATION: ___ w/DLBCL w/pleural effusion, evaluate for change in PNA.
Assess for interval change, pleural effusion, sign of PNA
TECHNIQUE: Axial helical MDCT images were obtained through the chest without
intravenous contrast. Coronal/sagittal and lung algorithm reconstructed
images were acquired.
DOSE: Acquisition sequence:
1) Spiral Acquisition 4.7 s, 30.4 cm; CTDIvol = 7.7 mGy (Body) DLP = 229.4
mGy-cm.
Total DLP (Body) = 229 mGy-cm.
COMPARISON: CTA chest ___.
CT abdomen/pelvis with contrast ___
Chest radiograph ___.
FINDINGS:
NECK, THORACIC INLET, AXILLAE, CHEST WALL: Limited evaluation of the thyroid
is unremarkable. Supraclavicular and axillary lymph nodes are nonenlarged.
Right PICC tip terminates in the low SVC.
UPPER ABDOMEN: Limited evaluation of the upper abdomen again demonstrates
multiple hypodense hepatic masses, largest in the right lobe of the liver
measuring 2.2 x 1.7 cm (02:49) within segment 5. Additional visualized
intra-structures are unremarkable.
MEDIASTINUM: The mediastinal lymph nodes are nonenlarged. No anterior
mediastinal mass. No mediastinal hematoma.
HILA: Hilar lymph nodes are nonenlarged.
HEART and PERICARDIUM: Heart is normal in size without pericardial effusion.
Coronary artery and mitral annular calcifications are noted.
PLEURA: Small bilateral non hemorrhagic pleural effusions are similar to ___ chest radiograph and slightly increased since ___ are
noted with associated compressive atelectasis.
LUNG:
1. PARENCHYMA: Bibasilar opacities again noted. No cavitary lesion. 0.3 cm
right lower lobe calcified granuloma noted (4:102). 0.3 cm right upper lobe
pulmonary nodule (4:86) is unchanged since ___. Evaluation for
subtle nodularity is degraded by respiratory motion artifact.
2. AIRWAYS: Mild lower lobe bronchial wall thickening is noted bilaterally
which can be seen in setting of small airways disease. No bronchiectasis. No
mucus plugging.
3. VESSELS: Main pulmonary artery is normal in caliber. No ascending aortic
aneurysm.
CHEST CAGE: Chronic left lateral sixth rib fracture noted. No focal lytic or
blastic lesions worrisome for malignancy.
IMPRESSION:
1. Persistent small bilateral non hemorrhagic pleural effusions, similar to ___ chest radiograph given difference of technique, though increased
since ___ chest CTA
2. Bibasilar pulmonary opacities most consistent with compressive
atelectasis. Clinical correlation for superimposed infection is recommended.
3. Small airways disease with bronchial wall thickening. No mucus plugging.
4. 0.3 cm right upper lobe pulmonary nodule, unchanged since ___.
5. Innumerable hepatic masses, better characterized on CT abdomen/pelvis from
___, most consistent with lymphomatous involvement.
|
10049746-RR-50 | 10,049,746 | 24,332,085 | RR | 50 | 2136-12-03 13:02:00 | 2136-12-03 17:59:00 | EXAMINATION: Fluoroscopic video oropharyngeal swallow.
INDICATION: ___ year old woman with lymphoma and dysphagia// Aspiration?
TECHNIQUE: Oropharyngeal swallowing videofluoroscopy was performed in
conjunction with the speech and swallow division. Multiple consistencies of
barium were administered.
DOSE: Fluoro time: 04:41 min.
COMPARISON: None.
FINDINGS:
Barium passes freely through the oropharynx and esophagus without evidence of
obstruction. There is transient penetration with thin and nectar liquids. No
aspiration. There is delayed swallow with oral holding observed and increased
timliness of swallows of solids with sips of liquid to wash it down.
IMPRESSION:
Transient penetration with thin and nectar liquids. No aspiration.
Please refer to the speech and swallow division note in OMR for full details,
assessment, and recommendations.
|
10049746-RR-52 | 10,049,746 | 24,332,085 | RR | 52 | 2136-12-08 14:59:00 | 2136-12-08 15:49:00 | EXAMINATION: HIP UNILAT MIN 2 VIEWS LEFT
INDICATION: ___ year old woman with left periprosthetic femur fracture.//
Alignment, acute changes, new fracture?
TECHNIQUE: AP pelvis, two views left femur
COMPARISON: CT left femur ___
FINDINGS:
A left total hip arthroplasty is in-situ. A periprosthetic oblique fracture
through the proximal femoral diaphysis is again noted. This is unchanged in
alignment when compared to the prior study. No significant callus formation
seen. No periprosthetic loosening seen. The distal left femur is
unremarkable in appearance except to note moderate degenerative changes in the
left knee.
IMPRESSION:
Unchanged periprosthetic left femur fracture. Degenerative changes in the
left knee.
|
10049746-RR-54 | 10,049,746 | 24,332,085 | RR | 54 | 2136-12-12 14:36:00 | 2136-12-12 16:55:00 | EXAMINATION: UNILAT LOWER EXT VEINS LEFT
INDICATION: ___ year old woman with new unilateral ___ 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.
There are 2 small fluid collections in the popliteal fossa measuring up to 2.1
x 0.7 x 2.0 cm and 2.0 x 0.6 x 1.8 cm, likely contiguous with each other and
representing a ruptured ___ cyst.
IMPRESSION:
-No evidence of deep venous thrombosis in the left lower extremity veins.
-2 small fluid collections in the popliteal fossa are likely continuous with
each other, likely representing a ruptured ___ cyst.
|
10049746-RR-56 | 10,049,746 | 24,332,085 | RR | 56 | 2136-12-19 16:08:00 | 2136-12-19 19:58:00 | INDICATION: ___ year old woman with neutropenic fever.// etiology of
neutropenic fever
TECHNIQUE: AP portable chest radiograph
COMPARISON: CT chest dated ___
FINDINGS:
The tip of a right PICC line projects over the mid to distal SVC. There is
elevation of the left hemidiaphragm possibly secondary to left lower lobe
atelectasis. Superimposed infection in the proper clinical context cannot be
excluded. There is no pleural effusion or pneumothorax identified. The size
the cardiac silhouette is within normal limits.
IMPRESSION:
Elevation of the left hemidiaphragm likely reflecting left lower lobe
atelectasis. Superimposed infection cannot be excluded in the proper clinical
context.
|
10049746-RR-57 | 10,049,746 | 24,332,085 | RR | 57 | 2136-12-22 12:07:00 | 2136-12-22 13:10:00 | EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ year old woman with lymphoma now with AMS// Bleed? Infection
signs?
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Acquisition sequence:
1) Stationary Acquisition 5.0 s, 18.8 cm; CTDIvol = 50.0 mGy (Head) DLP =
940.0 mGy-cm.
Total DLP (Head) = 940 mGy-cm.
COMPARISON: CT head ___.
FINDINGS:
There is no evidence of acute large territorial infarction,hemorrhage,edema,
or mass effect. There is prominence of the ventricles and sulci suggestive of
involutional changes. Nonspecific periventricular subcortical white matter
hypodensities suggest chronic small vessel ischemic changes.
There is no evidence of fracture. There is interval resolution of
opacification of the left frontal and ethmoid sinuses. 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. No acute intracranial abnormality on noncontrast head CT. Specifically no
large territory infarct or intracranial hemorrhage.
|
10049746-RR-58 | 10,049,746 | 24,332,085 | RR | 58 | 2136-12-22 12:27:00 | 2136-12-22 16:34:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old woman with lymphoma now with altered mental status.//
Infection? Fluid overload?
TECHNIQUE: PA and lateral chest
COMPARISON: Comparison to prior chest radiograph ___, previous
chest CT ___.
FINDINGS:
Right PICC appears unchanged in positioning. Once again seen is elevation of
the left hemidiaphragm with overlying hazy opacification, which may represent
atelectasis but a superimposed pneumonia cannot be excluded. There are small
bilateral pleural effusions. There is no pneumothorax. The cardiac size and
mediastinal contour are unchanged. There is a right shoulder arthroplasty.
IMPRESSION:
Likely atelectasis of the left lower lung, however a superinfectious process
cannot be excluded.
|
10049746-RR-60 | 10,049,746 | 24,332,085 | RR | 60 | 2136-12-23 17:53:00 | 2136-12-23 19:03:00 | EXAMINATION: CTA CHEST WITH CONTRAST
INDICATION: ___ year old woman with lymphoma and altered mental status.//
Infection, NEW PE's?
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) Sequenced Acquisition 0.5 s, 0.2 cm; CTDIvol = 7.2 mGy (Body) DLP = 1.4
mGy-cm.
2) Stationary Acquisition 0.8 s, 0.2 cm; CTDIvol = 13.6 mGy (Body) DLP =
2.7 mGy-cm.
3) Spiral Acquisition 4.7 s, 30.3 cm; CTDIvol = 7.3 mGy (Body) DLP = 216.1
mGy-cm.
Total DLP (Body) = 220 mGy-cm.
COMPARISON: CT chest dated ___ and CT abdomen pelvis dated ___
FINDINGS:
HEART AND VASCULATURE: Respiratory motion artifact limits assessment of the
subsegmental pulmonary arteries. Pulmonary vasculature is well opacified to
the segmental level without filling defect to indicate a pulmonary embolus.
The thoracic aorta is normal in caliber without evidence of dissection or
intramural hematoma. The heart is not enlarged. There is no pericardial
effusion. Soft and calcified atherosclerotic plaque is seen involving the
thoracic aorta. Coronary artery calcifications are present. The right and
left main pulmonary arteries are enlarged, suggesting pulmonary arterial
hypertension. 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: Airways are patent centrally. There is dependent atelectasis
bilaterally. Pleural effusions have resolved. Assessment for pulmonary
nodules is slightly limited due to respiratory motion artifact, however no
concerning pulmonary nodules are identified.
BASE OF NECK: Visualized portions of the base of the neck show no abnormality.
ABDOMEN: Known hepatic hypodense masses are better demonstrated on recent
contrast-enhanced CT of the abdomen and pelvis dated ___ due to
timing of the contrast bolus.
BONES: No suspicious osseous abnormality is seen.? chronic left lateral and
posterior rib fractures again seen.
IMPRESSION:
1. No evidence of pulmonary embolism to the segmental level or aortic
abnormality. Assessment of subsegmental pulmonary arteries is limited due to
respiratory motion artifact.
2. Interval resolution of pleural effusions.
3. Enlarged right and left main pulmonary arteries suggests pulmonary arterial
hypertension.
4. Known hepatic masses are better assessed on prior CT abdomen and pelvis
dated ___ due to timing of the contrast bolus.
|
10049746-RR-61 | 10,049,746 | 24,332,085 | RR | 61 | 2136-12-23 17:02:00 | 2136-12-23 21:01:00 | EXAMINATION: MR HEAD W AND W/O CONTRAST T___ MR HEAD
INDICATION: ___ year old woman with diffuse large B cell lymphoma and altered
mental status.// Evaluate for CNS spread of lymphoma. Also evaluate sinuses
for mass/pathology previously seen on imaging.
TECHNIQUE: Sagittal and axial T1 weighted imaging were performed. After
administration of 7 mL of Gadavist intravenous contrast, axial imaging was
performed with gradient echo, FLAIR, diffusion, and T1 technique. Sagittal
MPRAGE imaging was performed and re-formatted in axial and coronal
orientations.
COMPARISON: CT head ___.
FINDINGS:
T2/FLAIR hyperintense signal of the central pons with sparing of the periphery
and of the cortical spinal tracts is identified, demonstrating associated
diffusion-weighted hyperintense signal without evidence of enhancement. The
imaging findings are compatible with central pontine myelinolysis.
There are scattered punctate low signal on GRE in primarily bilateral temporal
lobe, the right occipital, and the right cerebellum (6; 8, 9, 10, 12)
suggestive of micro hemorrhages.
There is no evidence of midline shift or mass effect. The ventricles and
sulci are prominent in caliber and configuration, consistent with age related
atrophy.
Periventricular subcortical white matter FLAIR hyperintensities without
enhancement or abnormal diffusion are nonspecific but may suggest chronic
small vessel ischemic changes.
There is no abnormal enhancement after contrast administration. Dural venous
is appear patent. Major arterial vascular flow voids are preserved.
There is mild mucosal thickening of the right maxillary sinus and anterior
ethmoid air cells. The remaining paranasal sinuses, mastoid air cells, middle
ear cavities are clear. The orbits are unremarkable.
IMPRESSION:
1. The imaging findings are overall concerning for central pontine
myelinolysis. Differential considerations subacute infarct or other
demyelinating process is considered much less likely given the symmetric
bilateral appearance of the abnormality with classic sparing of the peripheral
pons and cortical spinal tracts.
2. Scattered foci of gradient echo susceptibility artifact, compatible with
prior micro hemorrhages in a distribution suggestive of underlying amyloid
angiopathy.
3. Prominent periventricular subcortical T2/FLAIR white matter
hyperintensities the subcortical and periventricular white matter are
nonspecific and nonenhancing, commonly seen in setting of chronic
microangiopathy in a patient of this age.
4. No evidence of abnormal enhancement to suggest intracranial metastatic
disease at this time.
5. Additional findings described above.
NOTIFICATION: The findings were discussed with The findings were discussed
with ___, M.D. by ___, M.D. on the telephone on ___ at
10:50am, 10 minutes after discovery of the findings.
|
10049746-RR-62 | 10,049,746 | 24,332,085 | RR | 62 | 2136-12-27 09:38:00 | 2136-12-27 10:05:00 | EXAMINATION:
DX PELVIS AND FEMUR
INDICATION:
___ year old woman with left femoral neck fracture, lymphoma// Fracture/
healing as compared to prior?
TECHNIQUE: AP pelvis, AP view of left hip, two views of the femur
___
IMPRESSION:
Compared to the prior study there has been no significant interval change.
The left total hip arthroplasty is again visualized. A periprosthetic oblique
fracture through the proximal feet femoral diaphysis is again noted. This is
unchanged in alignment compared to the prior study. No callus formation is
identified. No periprosthetic loosening is visualized. Degenerative changes
are again visualized in the left knee.
|
10049746-RR-63 | 10,049,746 | 24,332,085 | RR | 63 | 2136-12-28 11:08:00 | 2136-12-28 16:57:00 | EXAMINATION: MR HIP ___ CONRAST LEFT
INDICATION: ___ year old woman with left femoral neck fracture and new
lymphoma.// MRI HIP with metal subtraction to evaluate for fracture
progression/healing.
TECHNIQUE: Multiplanar multisequence images of the pelvis and left hip were
performed the without the IV administration of contrast material. Obtained
sequences include coronal T1 pelvis, coronal STIR pelvis, sagittal T1 pelvis,
axial oblique PD hip, sagittal PD hip, axial PD hip, coronal PD hip, axial
STIR hip.
COMPARISON: CT ___. X-ray ___.
FINDINGS:
Bones: Susceptibility artifact from left hip total arthroplasty obscures
surrounding tissues. Previously identified periprosthetic fracture through
the greater tuberosity and anterior aspect of the proximal femur appears
slightly more distracted than prior CT on ___ but likely similar to
x-ray from ___. There is approximately 2 cm anterior and medial
displacement.
Small right hip effusion. Moderate degenerative changes of the pubic
symphysis.
There is susceptibility from lumbar spine hardware.
Soft tissues: There is a large fluid collection posterior to the left
total-hip replacement primarily centered deep to the gluteus maximus muscle
with apparent extension to the neck of the femoral component and insinuating
between the fracture fragment and the prosthesis. Fluid collection measures
at least 6.3 x 1.7 x 7.4 cm (TRV by AP by CC). Layering low signal seen
posteriorly may represent old hemorrhagic products or layering debris.
There is a small amount of fluid deep to the hamstring insertion at the Left
ischial tuberosity may represent sequela of partial tearing and/or calcific
tendinitis as seen on prior CT (image 11:33).
There is a ovoid lesion centered within the proximal vastus intermedius/vastus
lateralis which demonstrates internal STIR heterogeneity with central T1
hypointensity but peripheral T1 hyperintensity. The rim demonstrates low
signal on STIR images this lesion measures approximately 3.7 x 2.7 by 4.1 cm
(image 11:40 and 10:13).
There is diffuse subcutaneous edema. There is prominent edema within the
gluteus minimus and medius muscles on the left. There is prominent edema
within the proximal vastus intermedius and vastus lateralis musculature.
There is prominent subcutaneous edema of the subcutaneous fat overlying the
left hip and proximal left thigh.
There is moderate muscle edema of the proximal adductor compartments
bilaterally. There is fluid underlying the bilateral iliacus muscles. There
is mild muscle edema of virtually all the muscles surrounding the pelvis.
Moderate muscle edema of the inferior paraspinous musculature.
Foley catheter is seen in place. Mild free pelvic fluid.
IMPRESSION:
1. Previously identified periprosthetic fracture appears slightly more
distracted than prior CT on ___ but likely similar to x-ray from ___.
2. There is a large fluid collection posterior to the left total-hip
replacement primarily centered deep to the gluteus maximus muscle with
apparent extension to the neck of the femoral component and insinuating
between the fracture fragment and the prosthesis.
3. Ovoid lesion centered within the proximal vastus intermedius/vastus
lateralis demonstrating internal STIR heterogeneity with central T1
hypointensity but peripheral T1 hyperintensity most likely represents a
hematoma. Follow-up imaging should be performed to ensure resolution.
4. There is a small amount of fluid deep to the hamstring insertion at the
Left ischial tuberosity which may represent sequela of partial tearing and/or
calcific tendinitis as seen on prior CT
RECOMMENDATION:
___ week follow-up MRI to ensure resolution of presumed hematoma in the
proximal thigh.
NOTIFICATION: The findings were discussed with ___, M.D. by ___
___, M.D. on the telephone on ___ at 2:55 pm, 30 minutes after
discovery of the findings.
|
10049746-RR-64 | 10,049,746 | 24,332,085 | RR | 64 | 2137-01-03 08:47:00 | 2137-01-03 15:44:00 | EXAMINATION: LUMBAR PUNCTURE (W/ FLUORO) N8 RF SPINE
INDICATION: ___ year old woman with lymphoma// Lumbar Puncture
TECHNIQUE: After informed consent was obtained from the patient explaining
the risks, benefits, and alternatives to the procedure, the patient was laid
in prone position on the fluoroscopic table. A pre-procedure time-out was
performed confirming the patient's identity, relevant history, procedure to be
performed and labs.
Puncture was performed at L2-3.
Approximately 5 cc of 1% lidocaine was administered for local anesthesia.
Under fluoroscopic guidance, a 20 gauge, 3.5 inch spinal needle was inserted
into the thecal sac. There was good return of clear CSF. 20 mls of CSF were
collected in 5 tubes.
The CSF sample was hand delivered to the laboratory by Dr. ___.
COMPARISON: ___ CT abdomen and pelvis with contrast
FINDINGS:
20 mls of CSF were collected in 5 tubes.
IMPRESSION:
1. Lumbar puncture at L2-3 without complication.
I, Dr. ___ supervised the trainee during the key components of
the above procedure and I reviewed and agree with the trainee's findings and
dictation.
|
10049897-RR-10 | 10,049,897 | 20,562,419 | RR | 10 | 2176-06-06 16:58:00 | 2176-06-06 18:04:00 | EXAMINATION: CHEST RADIOGRAPHS
INDICATION: Pre-operative for planned left hip repair.
TECHNIQUE: Chest, AP supine, two views.
COMPARISON: ___ from earlier on the same day.
FINDINGS:
The heart is normal in size. The mediastinal and hilar contours appear within
normal limits. There is no pleural effusion or pneumothorax. The lungs
appear clear.
IMPRESSION:
No evidence of acute disease.
|
10049897-RR-11 | 10,049,897 | 20,562,419 | RR | 11 | 2176-06-07 14:27:00 | 2176-06-07 17:18:00 | EXAMINATION: HIP NAILING IN OR W/FILMS AND FLUORO LEFT IN O.R.
INDICATION: Open reduction internal fixation of the left hip.
TECHNIQUE: Flouroscopic assistance provided to the surgeon in the OR without
the radiologist present.
2 Spot views obtained.
69.7 seconds of flouro time recorded on the requisition.
COMPARISON: Radiographs of the pelvis ___.
FINDINGS:
Sequential images demonstrate open reduction and internal fixation of a left
intertrochanteric femoral fracture with a dynamic screw and interlocking rod.
There is no evidence of hardware complication. Please see the operative report
for further details.
IMPRESSION:
Status post open reduction internal fixation of a left femoral
intertrochanteric fracture. Please see the operative report for further
details.
|
10049897-RR-12 | 10,049,897 | 20,562,419 | RR | 12 | 2176-06-09 14:55:00 | 2176-06-09 16:06:00 | EXAMINATION: CHEST RADIOGRAPH
INDICATION: ___ w. left intertrochanteric femoral fracture s/p fall from
bicycle. With new O2 requirement. // r/o PNA, rib fx's r/o PNA, rib fx's
TECHNIQUE: PA and lateral views of the chest.
COMPARISON: Chest radiographs from ___.
FINDINGS:
The cardiomediastinal and hilar contours are within normal limits. There is
an acute fracture in the left posterior eight rib with new small pleural
effusion and atelectasis. There is no focal consolidation concerning for
pneumonia. No pneumothorax.
IMPRESSION:
New acute fracture in the left posterior eight rib with an associated small
pleural effusion and atelectasis.
NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___
on the telephone on ___ at 4:45 ___, 5 minutes after discovery of the
findings.
|
10049897-RR-9 | 10,049,897 | 20,562,419 | RR | 9 | 2176-06-06 16:57:00 | 2176-06-06 18:07:00 | EXAMINATION: RADIOGRAPHS OF THE LEFT HIP AND PELVIS
INDICATION: Left hip fracture.
TECHNIQUE: Left hip, foiur views, and AP pelvis.
COMPARISON: Earlier on the same day.
FINDINGS:
There is a minimally displaced complete intertrochanteric fracture of the left
proximal femur. The hip joint spaces appear preserved with small marginal
acetabular osteophytes bilaterally. Sclerosis is noted along the left side of
the pubic symphysis probably reflecting degenerative change and possibly a
bone island.
IMPRESSION:
Intertrochanteric fracture of the left femur.
|
10050755-RR-24 | 10,050,755 | 23,782,628 | RR | 24 | 2132-10-15 05:38:00 | 2132-10-15 05:54:00 | EXAMINATION: CHEST RADIOGRAPH ___
INDICATION: History: ___ with R arm weakness // eval infiltrate
TECHNIQUE: Chest PA and lateral
COMPARISON: ___.
FINDINGS:
The lungs are well-expanded, with no evidence of pleural effusion, pulmonary
edema, pneumothorax, or focal consolidation. The cardiomediastinal silhouette
is stable.
On the frontal projection, just above the posterior right sixth rib, there is
a linear opacity extending laterally, possibly a vessel, with a 4 mm nodular
density just superior to the rib, not seen on the lateral view.
IMPRESSION:
No acute cardiopulmonary process. Possible right pulmonary nodule seen on the
frontal view only may be artifactual. Non urgent shallow oblique radiographs
are recommended to resolve this finding.
|
10050755-RR-25 | 10,050,755 | 23,782,628 | RR | 25 | 2132-10-15 07:26:00 | 2132-10-15 09:40:00 | INDICATION: ___ man with right arm and facial weakness.
TECHNIQUE: Contiguous axial MDCT images were obtained through the brain
without administration of IV contrast. Reformatted coronal and sagittal and
thin section bone algorithm-reconstructed images were acquired.
DOSE: DLP: 890 mGy-cm.
CTDIvol: ___ MGy.
COMPARISON: None available.
FINDINGS:
There is no evidence of acute hemorrhage, edema, mass effect, or vascular
territorial infarction. Prominent ventricles and sulci are likely secondary
to age related atrophy. Periventricular, deep white matter and subcortical
white matter hypodensities are likely sequela of chronic small vessel ischemic
disease. Encephalomalacia within the left occipital lobe is likely secondary
to prior infarct (2:15). The basal cisterns appear patent, and there is
preservation of normal gray-white matter differentiation. No fracture is
identified. There is near complete opacification of the right sphenoid sinus.
The globes are intact.
IMPRESSION:
No acute intracranial process.
|
10050755-RR-26 | 10,050,755 | 23,782,628 | RR | 26 | 2132-10-15 21:46:00 | 2132-10-16 10:16:00 | EXAMINATION: MR HEAD W/O CONTRAST
INDICATION: ___ year old man with sudden onset of right sided weakness.
Evaluate stroke.
TECHNIQUE: Sagittal and axial T1, gradient echo, FLAIR, diffusion, and T1
imaging was performed. After administration of intravenous gadolinium, axial
T1 and sagittal MPRAGE imaging was performed and re-formatted in axial and
coronal orientations
COMPARISON: CT head ___.
FINDINGS:
There are multiple small acute infarcts within the left frontal and left
parietal lobes, most of which cortically based, though at least one of them
involves the left periventricular white matter and corona radiata. Their
distribution suggests embolic etiology. There is extensive T2/FLAIR signal
hyperintensity within the subcortical and periventricular white matter the
pons, which is nonspecific though presumably on the basis of sequelae of
chronic small vessel ischemic disease in a patient of this age. There are
areas of focal cortical volume loss/encephalomalacia within the left superior
parietal low, left occipital low, and bilateral cerebellar hemispheres (larger
on right), consistent with chronic infarcts. Additionally, there are chronic
bilateral basal ganglia lacunar infarcts as well as prominent perivascular
spaces. There is also diffuse age-related involutional change in the brain
parenchyma with prominent ventricles and sulci.
There is gradient signal hypointensity within the bilateral basal ganglia and
right thalamus indicating he chronic microhemorrhages versus mineralization.
There is questionable gradient signal hypointensity within the superior left
parietal lobe which also may represent chronic blood products, although motion
artifact limits evaluation of this area.
There is right sphenoid sinus opacification.
IMPRESSION:
1. Multiple small acute infarcts within the left frontal and left parietal
lobes, most of which are cortically based , suggesting embolic etiology.
2. Multiple chronic infarcts. Extensive supratentorial white matter and
pontine signal abnormalities, likely sequela of chronic small vessel ischemic
disease.
3. Chronic microhemorrhages (likely hypertensive) versus mineralization in
bilateral basal ganglia and right thalamus. Possible chronic blood products in
the area of the left superior parietal chronic infarct, versus artifact.
|
10050755-RR-27 | 10,050,755 | 23,782,628 | RR | 27 | 2132-10-16 11:07:00 | 2132-10-16 15:34:00 | EXAMINATION: CAROTID DOPPLER ULTRASOUND
INDICATION: ___ year old man with sudden onset right sided weakness.
TECHNIQUE: Real-time grayscale and color and spectral Doppler ultrasound
imaging of the carotid arteries was obtained.
COMPARISON: MRI brain ___.
FINDINGS:
RIGHT:
The right carotid vasculature has mild heterogeneous atherosclerotic plaque.
The right internal carotid artery has peak systolic/diastolic velocities of
47/9 cm/sec in its proximal portion, 50/19 cm/sec in its mid portion, and
65/12 cm/sec in its distal portion.
The right common carotid artery has peak systolic/diastolic velocities of
77/12 cm/sec.
The external carotid artery has peak systolic velocity of 52 cm/sec.
The vertebral artery has peak systolic velocity of 42 cm/sec with normal
antegrade flow.
The right ICA/CCA ratio is 0.84.
LEFT:
The left carotid vasculature has mild heterogeneous atherosclerotic plaque.
The left internal carotid artery has peak systolic/diastolic velocities of
46/7 cm/sec in its proximal portion, 83/17 cm/sec in its mid portion, and
90/16 cm/sec in its distal portion.
The left common carotid artery has peak systolic/diastolic velocities of 56/11
cm/sec.
The external carotid artery has peak systolic velocity of 66 cm/sec.
The vertebral artery has peak systolic velocity of 74 cm/sec with normal
antegrade flow.
The left ICA/CCA ratio is 1.6.
IMPRESSION:
Less than 40% stenoses at bilateral internal carotid arteries due to mild
heterogeneous plaque.
|
10050755-RR-28 | 10,050,755 | 26,698,047 | RR | 28 | 2134-01-03 18:01:00 | 2134-01-03 18:22:00 | EXAMINATION: CHEST (SINGLE VIEW)
INDICATION: ___ with altered mental status // eval for infection
COMPARISON: Prior exam from ___.
FINDINGS:
AP portable upright view of the chest. Lower lung consolidation is
concerning for pneumonia versus aspiration. The upper lungs remain well
aerated. No large effusion is seen. No pneumothorax. Cardiomediastinal
silhouette is unchanged. No acute osseous abnormality.
IMPRESSION:
Lower lung consolidations concerning for pneumonia versus aspiration, new from
prior.
|
10050755-RR-30 | 10,050,755 | 26,698,047 | RR | 30 | 2134-01-03 20:08:00 | 2134-01-03 20:44:00 | EXAMINATION: CTA HEAD AND CTA NECK PQ147 CT HEADNECK
INDICATION: History: ___ with RUE weakness, confusion // eval for stroke
TECHNIQUE: Contiguous MDCT axial images were obtained through the brain
without contrast material. Subsequently, helically acquired rapid axial
imaging was performed from the aortic arch through the brain during the
infusion of 70 mL of Omnipaque intravenous contrast material.
Three-dimensional angiographic volume rendered, curved reformatted and
segmented images were generated on a dedicated workstation. This report is
based on interpretation of all of these images.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 18.0 s, 18.0 cm; CTDIvol = 50.2 mGy (Head) DLP =
903.1 mGy-cm.
2) Stationary Acquisition 4.0 s, 0.5 cm; CTDIvol = 43.6 mGy (Head) DLP =
21.8 mGy-cm.
3) Spiral Acquisition 5.2 s, 41.2 cm; CTDIvol = 31.0 mGy (Head) DLP =
1,278.1 mGy-cm.
Total DLP (Head) = 2,203 mGy-cm.
COMPARISON: MRI head ___
CT head ___
FINDINGS:
CT HEAD WITHOUT CONTRAST:
There is an area of hypoattenuation in the left precentral gyrus, which was
not visualized on the prior examination. Encephalomalacia in the bilateral
occipital, left parietal, left frontal lobes is unchanged from the prior
examination. Confluent hypoattenuation in the periventricular, subcortical,
and deep white matter are also unchanged from the prior examination. No
hemorrhage, mass effect, midline shift, or extra-axial fluid collection is
identified.
There is mild mucosal thickening in the bilateral maxillary sinuses, right
greater than left, with an air-fluid level in the right maxillary sinus. The
right sphenoid sinus is nearly completely opacified. There is mild mucosal
thickening in the bilateral ethmoid and left sphenoid sinuses. The left
mastoid air cells are partially opacified. The patient is status post
bilateral cataract surgery.
CTA HEAD:
The vessels of the circle of ___ and their principal intracranial branches
are patent without stenosis, occlusion, or aneurysm formation. There are mild
atherosclerotic calcifications of the bilateral cavernous and supra clinoid
internal carotid arteries. The right vertebral artery terminates as the
posterior inferior cerebellar artery, a normal anatomic variant. The dural
venous sinuses are patent.
CTA NECK:
There is a normal 3 vessel branching pattern of the aortic arch. The origins
of the great vessels are patent. Partially calcified plaque moderately
narrows the left proximal subclavian artery. The bilateral common and
external carotid arteries are patent. There are mild to moderate
atherosclerotic calcifications of the bilateral internal carotid arteries
without evidence of internal carotid artery stenosis by NASCET criteria.
Atherosclerotic calcifications mild to moderately narrowed the origin of the
right vertebral artery. The remainder of the right vertebral artery is
patent. The left vertebral artery, including its origin, is patent. The left
vertebral artery is dominant.
OTHER:
There is a 3 mm nodule in the right lower lobe on 3:8 2 mm nodule in the left
upper lobe on 3:73 1 mm nodule in the left upper lobe on ___:43. A calcified
granuloma is noted in the right upper lobe. There is a cause 5 pleural plaque
in the left upper lobe. The visualized portion of the thyroid gland is within
normal limits. There is no lymphadenopathy by CT size criteria.
IMPRESSION:
1. Patent circle of ___.
2. Patent vasculature in the neck with no evidence of internal carotid artery
stenosis by NASCET criteria.
3. New area of hypoattenuation in the left precentral gyrus, which may
represent a chronic infarction. Unchanged chronic infarctions in the
bilateral occipital, left frontal, and left parietal lobes with probable
sequela of severe chronic small vessel ischemic disease. MRI may be obtained
for further evaluation.
4. Paranasal sinus disease.
5. Multiple pulmonary nodules, the largest measuring 3 mm in the right lower
lobe. If the patient is at low risk for malignancy, no further follow-up is
necessary. If the patient is at high risk for malignancy, CT follow-up is
recommended in 12 months. These guidelines are based upon ___
criteria.
RECOMMENDATION(S):
1. Multiple pulmonary nodules, the largest measuring 3 mm in the right lower
lobe. If the patient is at low risk for malignancy, no further follow-up is
necessary. If the patient is at high risk for malignancy, CT follow-up is
recommended in 12 months. These guidelines are based upon ___
criteria.
The ___ pulmonary nodule recommendations
are intended as guidelines for follow-up and management of newly incidentally
detected pulmonary nodules smaller than 8 mm, in patients ___ years of age or
older. Low risk patients have minimal or absent history of smoking or other
known risk factors for primary lung neoplasm. High risk patients have a
history of smoking or other known risk factors for primary lung neoplasm.
In the case of nodule size <= 4 mm: No follow-up needed in low-risk patients.
For high risk patients, recommend follow-up at 12 months and if no change, no
further imaging needed.
In the case of nodule size >4 - 6 mm: For low risk patients, follow-up at 12
months and if no change, no further imaging needed. For high risk patients,
initial follow-up CT at ___ months and then at ___ months if no change.
In the case of nodule size >6 - 8 mm: For low risk patients, initial follow-up
CT at ___ months and then at ___ months if no change. For high risk
patients - initial follow-up CT at ___ months and then at ___ and 24 months
if no change.
In the case of nodule size > 8 mm: Follow-up CTs at around 3, 9, and 24 months
or consider dynamic contrast enhanced CT, PET, and / or biopsy
|
10050755-RR-32 | 10,050,755 | 26,698,047 | RR | 32 | 2134-01-04 09:19:00 | 2134-01-04 10:10:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with NGT placement // confirm location
confirm location
IMPRESSION:
In comparison with the study of ___, there has been insertion of a
nasogastric tube that extends well into the left bronchial tree.
No change in the appearance of the heart and lungs.
NOTIFICATION: This information was recognized at 10:07 AM on ___ and
immediately telephoned to Dr. ___ will pulled ___ to.
|
10050755-RR-33 | 10,050,755 | 26,698,047 | RR | 33 | 2134-01-04 14:53:00 | 2134-01-04 15:47:00 | EXAMINATION: DX CHEST PORT LINE/TUBE PLCMT 1 EXAM
INDICATION: ___ year old man with attempted NGT placement // confirm
placement confirm placement
IMPRESSION:
In comparison with the study of earlier in this date, the malpositioned
nasogastric tube been removed from the left bronchial tree. However, it is
seen on the final image coiling within the neck.
There again are bilateral areas of opacification at the bases, more prominent
on the right, consistent with aspiration or infectious pneumonia.
NOTIFICATION: This information was telephoned to Dr. ___ states that
the nasogastric tube has been removed.
|
10050755-RR-34 | 10,050,755 | 26,698,047 | RR | 34 | 2134-01-10 13:37:00 | 2134-01-10 15:34:00 | EXAMINATION: MR HEAD W/O CONTRAST T___ MR HEAD
INDICATION: ___ year old man with a history of ___ disease, left
hemisphere ischemic strokes ___, HTN and HLD who presents to the ED with
worsening mental status and right arm weakness in the setting of a persistent
pneumonia. // evaluate for new infarct.
TECHNIQUE: Sagittal T1 weighted imaging was performed. Axial imaging was
performed with gradient echo, FLAIR, diffusion, and T2 technique were then
obtained.
COMPARISON MRI from ___
FINDINGS:
Please note the study is substantially degraded by motion.
There are multiple small regions of restricted diffusion in the left frontal,
parietal and occipital lobes, none of which definitively containing blood
products, however significantly limited evaluation given motion artifact.
There is no evidence of hemorrhage, masses, mass effect, or midline shift.
There is prominence of the ventricles and sulci suggestive involutional
changes. Confluent periventricular and subcortical T2 and FLAIR
hyperintensities are noted. There is stable focal encephalomalacia in the
left occipital lobe and throughout the cerebellum, likely a sequelae of prior
infarcts. The major vascular flow voids are preserved.
Mucosal thickening and and opacification of the ethmoid and sphenoid sinuses
is seen. There is partial opacification of the bilateral mastoid air cells.
Bilateral cataract extraction changes are seen.
IMPRESSION:
1. Please note the study is substantially degraded by motion.
2. Multiple small acute infarctions in the left MCA and PCA territory. No
definite associated hemorrhage, although markedly limited in evaluation given
motion artifact.
3. Confluent background of white matter signal abnormality, likely secondary
to extensive chronic microvascular ischemic changes.
|
10050755-RR-35 | 10,050,755 | 26,698,047 | RR | 35 | 2134-01-10 16:30:00 | 2134-01-10 16:51:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with sudden respiratory distress after lying down
in MRI machine. // eval for PTX, evidence of aspiration eval for PTX,
evidence of aspiration
IMPRESSION:
In comparison with the study of ___, the nasogastric tube has been
removed. Diffuse bilateral pulmonary opacifications are again seen, though
they and are increasing in the right mid zone, raising the possibility of
aspiration. There is no evidence of pneumothorax.
|
10050755-RR-36 | 10,050,755 | 26,698,047 | RR | 36 | 2134-01-11 12:27:00 | 2134-01-11 16:29:00 | EXAMINATION: DX CHEST PORT LINE/TUBE PLCMT 2 EXAMS
INDICATION: ___ year old man with stroke. // Eval for dobhoff placement.
Eval for dobhoff placement.
IMPRESSION:
Compared to chest radiographs ___ through ___.
2 successive chest radiographs show advancement of the esophageal feeding
tube, with the wire stylet in place from the lower esophagus to the mid
stomach.
Compared to ___ and ___, growing consolidation in the right mid and
lower lung zones is consistent with worsening pneumonia, and perhaps the
development of a lung abscess. Heart size is normal. There is no appreciable
pleural effusion.
|
10050755-RR-37 | 10,050,755 | 26,698,047 | RR | 37 | 2134-01-13 15:09:00 | 2134-01-13 16:40:00 | INDICATION: ___ year old man with encephalopathy // evaluate for Dobhoff
placement.
TECHNIQUE: Chest PA and lateral
IMPRESSION:
3 sequential radiographs were obtained for assessment of a feeding tube
placement. On the first 2 radiographs, the Dobhoff tube is coiled within the
cervical region with distal tip directed cephalad. On the third and final
radiograph of the series, the tip of the tube terminates in the proximal
stomach just beyond the gastroesophageal junction. The appearance of the
chest is otherwise remarkable for slight decrease in extent of consolidation
in the right upper and both lower lobes, likely due to improving infectious
pneumonia.
|
10050755-RR-38 | 10,050,755 | 26,698,047 | RR | 38 | 2134-01-17 15:16:00 | 2134-01-17 19:25:00 | INDICATION: ___ year old man with stroke and needs g-tube percutaneous for
feeding // g tube for feeding
COMPARISON: None available
TECHNIQUE: OPERATORS: Dr. ___, Interventional Radiology Fellow and Dr.
___, attending radiologist performed the procedure. Dr. ___
___ personally supervised the trainee during the key components of the
procedure and has reviewed and agrees with the trainee's findings.
ANESTHESIA: Moderate sedation was provided by administrating divided doses of
50 mcg of fentanyl and 1 mg of midazolam throughout the total intra-service
time of 17 minutes during which the patient's hemodynamic parameters were
continuously monitored by an independent trained radiology nurse. 1% lidocaine
was injected in the skin and subcutaneous tissues overlying the access site.
MEDICATIONS: 1 mg of intravenous glucagon.
CONTRAST: For ml of Optiray contrast.
FLUOROSCOPY TIME AND DOSE: 4.0 min, 6 mGy
PROCEDURE: 1. Placement of a ___ gastrostomy tube placement.
PROCEDURE DETAILS: Following the discussion of the risks, benefits and
alternatives to the procedure, written informed consent was obtained from the
patient. The patient was then brought to the angiography suite and placed
supine on the exam table. A pre-procedure time-out was performed per ___
protocol. The tube site was prepped and draped in the usual sterile fashion.
A scout image of the abdomen was obtained. The stomach was insufflated through
the indwelling nasogastric tube. Using a marker, the skin was marked using
palpation to feel the costal margins and the liver edge was marked using
ultrasound. Permanent ultrasound images were stored.
Under fluoroscopic guidance, 3 T fastener buttons were sequentially deployed
in a triangular position elevating the stomach to the anterior abdominal wall.
Intra-gastric position was confirmed with aspiration of air and injection of
contrast. A 19 gauge needle was introduced under fluoroscopic guidance and
position confirmed using an injection of dilute contrast. A Amplatz wire was
introduced into the stomach. A small skin incision was made along the needle
and the needle was removed.
After sequential dilation using 8, 10, and 12 ___ dilators, a ___
gastrostomy catheter was advanced over the wire into position. The catheter
was secured by forming the retaining loop in the stomach after confirming the
position of the catheter with a contrast injection. The catheter was then
flushed, capped and secured to the skin with 0-silk sutures and a stat lock
device. Sterile dressings were applied.
The patient tolerated the procedure well and there were no immediate
complications.
FINDINGS:
1. Successful placement of a ___ gastrostomy tube.
IMPRESSION:
Successful placement of a 12 ___ Wills ___ gastrostomy tube. The
catheter should not be used for 24 hours.
|
10050755-RR-39 | 10,050,755 | 26,698,047 | RR | 39 | 2134-01-20 09:13:00 | 2134-01-20 09:33:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man s/p G-tube, hospitalized since ___, with fever
100.9. // PNA? PNA?
IMPRESSION:
Heart size and mediastinum are unchanged. There is interval progression of
multifocal consolidations in the right lung, substantial as well as unchanged
or minimally worse appearance of the left middle lower lung consolidations.
The findings are concerning for multifocal infection.
|
10050755-RR-40 | 10,050,755 | 26,698,047 | RR | 40 | 2134-01-25 10:49:00 | 2134-01-25 12:49:00 | INDICATION: ___ year old man with history of recurrent aspiration / multifocal
PNA, now with increasing hypoxia // interval change, pulm edeam
COMPARISON: Radiographs from ___
IMPRESSION:
Cardiomediastinal silhouette is within normal limits. There is again seen an
area of consolidation within the right upper lobe which appears more
confluent. Additional opacities at the lung bases are unchanged. No
pneumothoraces are seen.
|
10051043-RR-17 | 10,051,043 | 24,363,293 | RR | 17 | 2192-06-24 20:36:00 | 2192-06-25 12:26:00 | TECHNIQUE: MRI of the brain without gad. MRA of the brain using 3D
time-of-flight. MRA of the neck using 3D gad technique.
HISTORY: New onset facial droop and left hand clumsiness.
FINDINGS: There is an acute infarction in the right posterior putamen and
corona radiata as well as in the left inferior caudate head. There is no
evidence for hemorrhagic transformation or significant midline shift.
Intracranial flow voids are maintained. There is no hydrocephalus.
There are additional scattered small vessel ischemic changes in the white
matter which are mild.
MRA of the circle of ___ demonstrates no evidence for high-grade vascular
stenosis or major vascular occlusion. No aneurysm within limits of the
examination.
MRA of the neck demonstrates no evidence for high-grade stenosis of the
carotid or vertebral arteries.
IMPRESSION: Acute infarction in the right putamen, corona radiata and in the
left inferior caudate head. On the ADC maps, the area of diffusion
abnormality does not appear to be hypointense suggesting that this could be a
subacute infarct up to seven days.
|
10051043-RR-18 | 10,051,043 | 24,363,293 | RR | 18 | 2192-06-25 10:59:00 | 2192-07-05 11:55:00 | Please see full dictated report for clip # ___ from ___ for
full evaluation of the MRI including ADC and DWI sequences.
|
10051043-RR-20 | 10,051,043 | 23,260,768 | RR | 20 | 2192-10-06 18:25:00 | 2192-10-06 20:55:00 | INDICATION: ___ female with diffuse bilateral infiltrates on outside
hospital chest x-ray and hemoptysis. Assess for pulmonary masses or other
cause for hemoptysis.
COMPARISON: Chest radiograph from ___ and from ___.
TECHNIQUE: MDCT axial images of the chest were obtained with intravenous
contrast. Coronal, sagittal and axial MIP reformations were prepared.
CT CHEST WITH INTRAVENOUS CONTRAST: The thyroid gland is homogeneous without
focal nodule. No supraclavicular or axillary adenopathy is identified. There
are bulky mediastinal lymph nodes; a representative precarinal node measures
up to 13 mm in short axis diameter. Subcarinal adenopathy measuring up to 16
mm (2:32) is noted. There are bulky bilateral hilar lymph nodes as well. The
thoracic aorta is non-aneurysmal and demonstrates no signs of acute aortic
syndrome. Central pulmonary arteries are patent. The heart size is normal,
and there is no pericardial effusion.
The tracheobronchial tree is patent to subsegmental levels without bronchial
wall thickening or bronchiectasis. There are multiple areas of consolidation
throughout both lungs, most severe in the left upper lobe, lingula, left lower
lobe, and right lower lobe. The right upper and middle lobes are relatively
less involved. The consolidation has mixed solid and ground-glass attenuation
and follows a peribronchovascular distribution. Areas of septal thickening
are also evident. There is no pleural effusion. Findings most likely reflect
multifocal pneumonia with reactive adenopathy, however, diffuse alveolar
hemorrhage is possible in the appropriate clinical setting. A focal 11 x 9 mm
nodule is identified arising from the medial aspect of the minor fissure
(2:36). There is no pleural effusion.
Limited views of the upper abdominal viscera appear within normal limits.
IMPRESSION:
1. Diffuse solid and ground-glass consolidations predominantly involving the
left upper and lower lobes and right lower lobe with peribronchovascular
distribution. Findings are concerning for multifocal pneumonia with
associated reactive adenopathy, though diffuse alveolar hemorrhage is possible
in the appropriate clinical setting. Neoplastic process is also not excluded.
2. 11 mm parafissural pulmonary nodule of uncertain etiology.
Would recommend followup CT examination after acute symptoms have resolved (3
months or sooner) to ensure resolution of opacities and focal nodule.
|
10051043-RR-21 | 10,051,043 | 23,260,768 | RR | 21 | 2192-10-07 10:28:00 | 2192-10-07 11:29:00 | CHEST ON ___
HISTORY: Multifocal pneumonia with worsening hypoxia.
REFERENCE EXAM: ___.
FINDINGS: Compared to the study from the prior day, there has been interval
increase in the alveolar infiltrates. This increase is in the extent of the
infiltrates and their density. Heart is moderately enlarged.
IMPRESSION: Worsened appearance of the infiltrates.
|
10051043-RR-22 | 10,051,043 | 23,260,768 | RR | 22 | 2192-10-08 14:37:00 | 2192-10-08 15:07:00 | HISTORY: Multifocal pneumonia.
___.
FINDINGS:
There has been interval worsening of the bilateral upper lobe infiltrates.
continued infiltrates iare seen in bilateral lower lobes that appear similar
or slightly improved compared to prior .right midlung infiltrate is slightly
improved. Heart size continues to be moderately enlarged.
IMPRESSION:
Changing appearance of infiltrates that are worse particularly in the upper
lobes.
|
10051043-RR-23 | 10,051,043 | 23,260,768 | RR | 23 | 2192-10-09 18:54:00 | 2192-10-10 10:00:00 | HISTORY: Pneumonia with IJ placement.
FINDINGS: In comparison with the study of ___, there has been placement of
an endotracheal tube with its tip approximately 6.5 cm above the carina.
Right IJ catheter extends to the mid portion of the SVC. There is further
increase in the diffuse bilateral pneumonia.
|
10051043-RR-24 | 10,051,043 | 23,260,768 | RR | 24 | 2192-10-09 20:22:00 | 2192-10-10 10:08:00 | AP CHEST, 8:26 P.M., ___
HISTORY: ___ woman after bronchoscopy. Has ET tube been
repositioned?
IMPRESSION: ET tube is still in standard position, cuff mildly distends the
trachea, highlights secretions pooled above it.
Severe multifocal consolidation, pneumonia, or hemorrhage has not improved.
No pneumothorax. Pleural effusions are small, if any. Heart top normal size.
Right jugular line ends centrally. No pneumothorax.
|
10051043-RR-25 | 10,051,043 | 23,260,768 | RR | 25 | 2192-10-10 05:04:00 | 2192-10-10 10:10:00 | AP CHEST, 5:03 A.M., ___
HISTORY: Alveolar hemorrhage, question interval change.
IMPRESSION: AP chest compared to ___:
Severe multifocal pulmonary consolidation, hemorrhage, and/or pneumonia have
not improved. Mild interstitial edema has developed in the uninvolved
portions of the lungs. Heart size is top normal. No pneumothorax. Pleural
effusions are small, if any. Right jugular line, ET tube, and newly placed
upper enteric drainage tube are in standard placements.
|
10051043-RR-26 | 10,051,043 | 23,260,768 | RR | 26 | 2192-10-11 05:12:00 | 2192-10-11 09:21:00 | CHEST RADIOGRAPH
INDICATION: Diffuse alveolar hemorrhage, evaluation for interval change.
COMPARISON: ___.
FINDINGS: As compared to the previous radiograph, the apical and right
predominant parenchymal opacities with air bronchograms and small foci of
consolidation are seen in unchanged manner. The nasogastric tube has been
removed, the other monitoring and support devices are in constant position.
Mild cardiomegaly, no larger pleural effusions.
|
10051043-RR-28 | 10,051,043 | 23,260,768 | RR | 28 | 2192-10-11 10:35:00 | 2192-10-11 15:05:00 | HISTORY: ___ female with abdominal pain. Evaluate for free air.
COMPARISON: Chest x-ray dated ___ and ___.
FINDINGS:
Supine and upright radiographs of the abdomen demonstrate a normal bowel gas
pattern without evidence of ileus or obstruction. There is no pneumatosis or
free air. There is moderate to severe degenerative changes seen in the lumbar
spine.
A femoral line projects over the left hemipelvis. The apical and right
predominant parenchymal opacities and small area of consolidation present
within the chest is unchanged from the prior chest x-ray. Endotracheal tube
ends 4.3 cm on the carina. A right-sided internal jugular central venous line
ends in the mid SVC.
IMPRESSION:
No intra-abdominal free air.
|
10051043-RR-29 | 10,051,043 | 23,260,768 | RR | 29 | 2192-10-11 11:06:00 | 2192-10-11 12:17:00 | NON-CONTRAST HEAD CT, ___
INDICATION: New bradycardia. Evaluate for cerebral herniation. Review of
recent imaging exams indicates that the patient is currently being treated for
diffuse alveolar hemorrhage.
COMPARISON: ___ non-contrast head CT and ___ brain
MRI.
TECHNIQUE: Non-contrast head CT with sagittal and coronal reformatted images.
Total exam DLP 842.40 mGy-cm.
FINDINGS: There is no acute intracranial hemorrhage, edema, mass effect, or
loss of gray/white matter differentiation. There is a small focus of
encephalomalacia in the right putamen and corona radiata, corresponding to
sequela of acute infarction seen in ___. A chronic infarction is
also again seen in the left putamen, unchanged since ___. Cerebral sulci,
ventricles, and basal cisterns are normal in size. There is no herniation.
There are fluid levels in bilateral mastoid air cells, as well as a small
amount of fluid in the right sphenoid sinus. There is mild mucosal thickening
in bilateral sphenoid sinuses. A left posterior ethmoid air cell is nearly
completely opacified, and another left posterior ethmoidal air cell
demonstrates mild mucosal thickening. There is mild mucosal thickening in the
right frontal sinus and in the imaged portion of the right maxillary sinus.
These findings may be related to prolonged supine positioning and endotracheal
intubation.
IMPRESSION: No evidence for acute intracranial abnormalities. Chronic
infarctions in bilateral basal ganglia.
|
10051043-RR-30 | 10,051,043 | 23,260,768 | RR | 30 | 2192-10-11 20:24:00 | 2192-10-12 13:00:00 | REASON FOR EXAM: ___ years old woman with DAH, on high-dose corticosteroids,
abdominal tenderness, and elevated lipase and amylase. Assess for
pancreatitis.
TECHNIQUE: Multi-detector helical scanning of the chest was obtained from
thoracic inlet to upper abdomen in supine position without administration of
IV contrast. Axial images were reviewed in conjunction with 5-mm coronal and
sagittal reformats and 1-mm axial thin helical reconstruction.
RADIATION DOSE: The total DLP is 444.50 mGy-cm.
COMPARISON: Exam is compared to chest CT of ___.
FINDINGS: The thyroid is not included in the scan range. Patient has been
intubated. The ET tube ends at 5.5 cm from carina bifurcation. There has
been interval increase of bilateral consolidations, more severe in the upper
lobes where only a few portions of the lungs are still ventilated, such as
some subsegmental areas of the anterior segment of the right upper lobe
(series 2, image 15). The right middle lobe is relatively spared by the
consolidation. Area of central mucus impaction is in the middle lobe(2:45)
and is a sign of bronchiolitis. There is also a new bibasilar non-hemorrhagic
small pleural effusion with minimal atelectasis in the posterobasal segment
of the right lower lobe (2:48).
There is no peripheral lymphadenopathy. Mediastinal nodes are still enlarged
but stable since ___ for example, right lower paratracheal node has
short axis of 13 mm; right upper paratracheal node has short axis of 9 mm
(series 2, images 19, 22). Great vessels have normal size. Heart size is
normal. Small pericardial effusion is physiologic. Low blood density is a
sign of anemia.
Even though this exam is not tailored for abdominal imaging, it shows small
amount of ascites surrounding the liver and partially the pancreas with
surrounding fat stranding which might be a sign of pancreatitis. Large
gallbladder stone measures 2.5 cm (2:75). Kidneys and adrenals are
unremarkable. There is diffuse soft tissue edema compatible with anasarca.
BONES: There are no bone lesions suspicious for malignancy or infection.
IMPRESSION:
1. Severe progression of bilateral lung parenchymal consolidations with
severe involvement of the upper lobes and apical segment of the lower lobes is
compatible with progression of diffuse alveolar hemorrhage and superimposed
pneumonia. Stable lung base involvement, characterized by diffuse
peribronchovascular ground glass opacity due to pneumonia.
2. Central lymphadenopathy is stable since ___ and is likely
reactive.
3. New bibasilar non-hemorrhagic pleural effusion layering posteriorly with
small compression atelectasis of the posterobasal segment of the right lower
lobe.
4. Patient has been intubated. The ET tube ends 5.5 cm from carina.
5. There is new ascites and anasarca with minimal peripancreatic fat
stranding, compatible mild pancreatitis.
|
10051043-RR-31 | 10,051,043 | 23,260,768 | RR | 31 | 2192-10-12 04:31:00 | 2192-10-12 09:13:00 | CHEST RADIOGRAPH
INDICATION: Evaluation for interval change.
COMPARISON: ___.
FINDINGS: As compared to the previous radiograph, no relevant change is seen.
The massive bilateral parenchymal opacities are constant in appearance and
SEVERITY. Unchanged size of the cardiac silhouette. Unchanged monitoring and
support devices.
|
10051043-RR-32 | 10,051,043 | 23,260,768 | RR | 32 | 2192-10-12 12:14:00 | 2192-10-12 13:45:00 | HISTORY: New NG tube.
COMPARISON: Chest radiograph 5:03 today.
FRONTAL CHEST RADIOGRAPH: The endotracheal tube is 4.9 cm above the carina.
Please note that the tube is directed towards the left lateral wall of the
trachea, a change from prior.
The right internal jugular catheter terminates in the upper SVC. A newly
placed enteric tube courses into the stomach and out of the field of view.
The extensive bilateral opacities from severe pneumonia are unchanged from
earlier today. Lucency seen around the aortic knob is consistent with
spared/aerated lung as shown on the prior CT, rather than free air. There is
no pleural effusion. Heart size is normal.
|
10051043-RR-33 | 10,051,043 | 23,260,768 | RR | 33 | 2192-10-12 13:57:00 | 2192-10-12 16:43:00 | HISTORY: ___ woman with and a vasculitis was intubated. Acute
pancreatitis. Evaluate liver /gallbladder for cholestasis/gallstones.
COMPARISON: Recent CT chest from ___.
FINDINGS:
Limited sonographic exam of the right upper quadrant of the abdomen were
performed. The liver demonstrates normal echotexture and morphology. No
focal hepatic lesions are identified. Portal vein demonstrates hepatopetal
flow. A prominent 2.6 cm echogenic shadowing calculus is identified within
the gallbladder. There is mild focal gallbladder wall edema, however no
pericholecystic fluid is identified. The CBD measures 0.6 cm. Small
perihepatic ascites is noted. A right pleural effusion is seen incidentally.
Midline structures including pancreas are not assessed owing to overlying
bowel gas.
To the extent visualized the IVC and aorta are unremarkable. Survey view of
the right kidney is unremarkable.
IMPRESSION:
1. Cholelithiasis. Mild focal gallbladder wall edema, however no
pericholecystic fluid. No evidence of cholecystitis.
2. Small perihepatic ascites. Right pleural effusion.
|
10051043-RR-34 | 10,051,043 | 23,260,768 | RR | 34 | 2192-10-11 16:53:00 | 2192-10-13 08:35:00 | REASON FOR EXAM: ___ years old woman with DAH, on high-dose corticosteroids,
abdominal tenderness, and elevated lipase and amylase. Assess for
pancreatitis.
TECHNIQUE: Multi-detector helical scanning of the chest was obtained from
thoracic inlet to upper abdomen in supine position without administration of
IV contrast. Axial images were reviewed in conjunction with 5-mm coronal and
sagittal reformats and 1-mm axial thin helical reconstruction.
RADIATION DOSE: The total DLP is 444.50 mGy-cm.
COMPARISON: Exam is compared to chest CT of ___.
FINDINGS: The thyroid is not included in the scan range. Patient has been
intubated. The ET tube ends at 5.5 cm from carina bifurcation. There has
been interval increase of bilateral consolidations, more severe in the upper
lobes where only a few portions of the lungs are still ventilated, such as
some subsegmental areas of the anterior segment of the right upper lobe(series
2, image 15). The right middle lobe is relatively spared by the
consolidation. Area of central mucus impaction is in the middle lobe(2:45)and
is a sign of bronchiolitis. There is also a new bibasilar non-hemorrhagic
small pleural effusion with minimal atelectasis in the posterobasal segment
of the right lower lobe (2:48).
There is no peripheral lymphadenopathy. Mediastinal nodes are still enlarged
but stable since ___ for example, right lower paratracheal node has
short axis of 13 mm; right upper paratracheal node has short axis of 9 mm
(series 2, images 19, 22). Great vessels have normal size. Heart size is
normal. Small pericardial effusion is physiologic. Low blood density is a
sign of anemia.
Even though this exam is not tailored for abdominal imaging, it shows small
amount of ascites surrounding the liver and partially the pancreas with
surrounding fat stranding which might be a sign of pancreatitis. Large
gallbladder stone measures 2.5 cm (2:75). Kidneys and adrenals are
unremarkable. There is diffuse soft tissue edema compatible with anasarca.
BONES: There are no bone lesions suspicious for malignancy or infection.
IMPRESSION:
1. Severe progression of bilateral lung parenchymal consolidations with
severe involvement of the upper lobes and apical segment of the lower lobes is
compatible with progression of diffuse alveolar hemorrhage and superimposed
pneumonia. Stable lung base involvement, characterized by diffuse
peribronchovascular ground glass opacity due to pneumonia.
2. Central lymphadenopathy is stable since ___ and is likely
reactive.
3. New bibasilar non-hemorrhagic pleural effusion layering posteriorly with
small compression atelectasis of the posterobasal segment of the right lower
lobe.
4. Patient has been intubated. The ET tube ends 5.5 cm from carina.
5. There is new ascites and anasarca with minimal peripancreatic fat
stranding, compatible mild pancreatitis.
|
10051043-RR-35 | 10,051,043 | 23,260,768 | RR | 35 | 2192-10-14 04:48:00 | 2192-10-14 08:48:00 | PORTABLE CHEST, ___
COMPARISON: ___ radiograph.
FINDINGS: Support and monitoring devices remain in standard position, and
cardiomediastinal contours are stable. Multifocal bilateral areas of
heterogeneous consolidation have worsened in the interval, suggestive of a
progressive multifocal pneumonia coexisting with diffuse alveolar hemorrhage.
A rounded lucency in the right upper lobe may reflect a region of spared lung
parenchyma, but attention to this region on short-term followup radiograph
would be helpful to exclude developing cavitation from necrotizing pneumonia.
|
10051043-RR-36 | 10,051,043 | 23,260,768 | RR | 36 | 2192-10-13 11:11:00 | 2192-10-13 13:08:00 | AP CHEST, 11:15 A.M., ___
HISTORY: A ___ woman with ARDS and respiratory failure.
IMPRESSION: AP chest compared to ___:
Widespread multifocal pulmonary consolidation has not changed appreciably over
the past several days. It may have improved slightly since ___.
There is no pneumothorax. Heart size is top normal. Endotracheal tube and
right internal jugular line are in standard placements and an upper enteric
tube passes into the stomach and out of view.
|
10051043-RR-37 | 10,051,043 | 23,260,768 | RR | 37 | 2192-10-15 04:37:00 | 2192-10-15 09:54:00 | PORTABLE CHEST ___
COMPARISON: Radiograph ___.
FINDINGS: Interval extubation and removal of nasogastric tube.
Cardiomediastinal contours are stable. Multifocal areas of airspace
consolidation involving the right lung to a greater degree than the left have
increased in severity, and may be due to a combination of multifocal pneumonia
and diffuse alveolar hemorrhage. Coexisting interstitial opacities have also
slightly worsened with increasing peripheral septal lines bilaterally.
|
10051043-RR-38 | 10,051,043 | 23,260,768 | RR | 38 | 2192-10-16 04:21:00 | 2192-10-16 11:12:00 | AP CHEST, 4:49 A.M. ___
HISTORY: A ___ woman with diffuse alveolar hemorrhage. Is it
worsening.
IMPRESSION: AP chest compared to ___ through ___:
There is severe widespread pulmonary consolidation probably worsened since
___ following earlier extubation. Right jugular line ends centrally.
Pleural effusions small to moderate on the right, unchanged since ___,
probably increased since ___. Heart size is normal. Component of mild
pulmonary edema would be difficult to detect radiographically.
|
10051043-RR-39 | 10,051,043 | 23,260,768 | RR | 39 | 2192-10-17 04:33:00 | 2192-10-25 17:06:00 | CHEST RADIOGRAPH
HISTORY: Diffuse alveolar hemorrhage.
COMPARISONS: ___.
TECHNIQUE: Chest, semi-upright AP portable.
FINDINGS:
This study is presented on ___ for dictation.
A right internal central jugular venous catheter again terminates in the
superior vena cava. There is overall slightly better aeration of the chest
but similar heterogeneous multifocal opacities with suspected pleural
effusions. Some improvement may be due to decrease in edema.
IMPRESSION:
Mild improvement in aeration, possibly due to decreased edema superimposed on
severe bilateral heterogeneous opacification which is otherwise unchanged.
|
10051043-RR-47 | 10,051,043 | 26,563,181 | RR | 47 | 2197-06-22 10:13:00 | 2197-06-22 10:50:00 | EXAMINATION: CTA HEAD AND CTA NECK PQ147 CT HEADNECK
INDICATION: History: ___ with atraumatic SAH// aneurysm
TECHNIQUE: Contiguous MDCT axial images were obtained through the brain
without contrast material. Subsequently, helically acquired rapid axial
imaging was performed from the aortic arch through the brain during the
infusion of intravenous contrast material. Three-dimensional angiographic
volume rendered, curved reformatted and segmented images were generated on a
dedicated workstation. This report is based on interpretation of all of these
images.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 18.0 s, 18.0 cm; CTDIvol = 50.2 mGy (Head) DLP =
903.1 mGy-cm.
2) Stationary Acquisition 3.5 s, 0.5 cm; CTDIvol = 17.4 mGy (Body) DLP =
8.7 mGy-cm.
3) Spiral Acquisition 5.5 s, 43.2 cm; CTDIvol = 15.3 mGy (Body) DLP = 659.9
mGy-cm.
Total DLP (Body) = 669 mGy-cm.
Total DLP (Head) = 903 mGy-cm.
COMPARISON: MR head and without contrast ___, MR brain without
contrast ___, CT CTA neck/head ___.
FINDINGS:
CT HEAD:
There is a slight interval increase in the diffuse bilateral subarachnoid
hemorrhage that fills the suprasellar cistern, bilateral insula, and anterior
inter-hemispheric fissures bilaterally. There are chronic lacunar infarcts
within the basal ganglia bilaterally. Mild periventricular and subcortical
white matter hypodensities are nonspecific, but most likely related to chronic
small vessel ischemia. There is no evidence of large territorial
infarction,edema,ormass. The ventricles and sulci are within expected limits
in size and configuration.
There is mild opacification of the ethmoid sinuses bilaterally. The remaining
visualized portion of the paranasal sinuses, mastoid air cells,and middle ear
cavities are clear. There are degenerative changes within temporomandibular
joint on the right. The visualized portion of the orbits are unremarkable.
CTA HEAD:
The vessels of the circle of ___ and their principal intracranial branches
appear unremarkable without stenosis, occlusion, or aneurysm formation. The
dural venous sinuses are patent.
CTA NECK:
The carotidandvertebral arteries and their major branches appear normal with
no evidence of stenosis or occlusion. There is no evidence of stenosis in the
bilateral internal carotid arteries by NASCET criteria.
OTHER:
There is peribronchovascular scarring and diffuse bilateral ground glass
opacities which could be seen in the setting of an atypical infectious
process. 8 mm opacification at the bifurcation of an ectatic left lower lobe
bronchus (series 3, image 83), may represent mucous plugging. The visualized
portion of the thyroid gland is within normal limits. There is no
lymphadenopathy by CT size criteria. No suspicious osseous lesions.
IMPRESSION:
1. Unremarkable CTA head without stenosis, occlusion, or aneurysm formation to
explain subarachnoid hemorrhage.
2. Unremarkable CTA neck with no evidence of stenosis or occlusion in the
carotid and vertebral arteries bilaterally.
3. Slight interval increase in diffuse bilateral subarachnoid hemorrhage that
fills the suprasellar cistern, bilateral insula, and anterior interhemispheric
fissures bilaterally.
4. Peribronchovascular scarring and diffuse bilateral ground-glass opacities
which could be seen in the setting of an atypical infectious process.
5. There is a 8 mm opacification at the bifurcation of an ectatic left lower
lobe bronchus, which may represent mucous plugging. Recommend CT chest
follow-up examination to document resolution or stability in 3 months.
|
Subsets and Splits
No community queries yet
The top public SQL queries from the community will appear here once available.