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10051043-RR-48 | 10,051,043 | 26,563,181 | RR | 48 | 2197-06-22 11:04:00 | 2197-06-22 12:58:00 | EXAMINATION: Diagnostic cerebral angiogram
The following vessels were catheterized
Right common femoral artery
Right common carotid artery
Left vertebral artery
Left common carotid artery
INDICATION: Patient is a ___ female who presents with a subarachnoid
hemorrhage. CTA was unremarkable. Plans were made for diagnostic cerebral
angiogram for further evaluation.
ANESTHESIA: Moderate sedation was provided by administering divided doses of
Versed and fentanyl throughout the total intra service time of 35 minutes
during which the patient's hemodynamic parameters were continuously monitored
by trained independent observer. Patient received a total of 25 micrograms of
fentanyl and 0 milligram of Versed was continuously supervised by the
attending physician.
TECHNIQUE: Dr. ___ Dr. ___ physician performed the
procedure. Dr. ___ supervised the trainee during the key
component to the procedure and has reviewed and agrees with the trainee's
findings.
COMPARISON: CTA performed ___
PROCEDURE: The patient was identified and brought to the neuro radiology
suite. Patient was transferred to the fluoroscopic table supine. Moderate
sedation was administered. Bilateral groins were prepped and draped in the
standard sterile fashion. A time-out was performed to confirm the correct
patient and procedure. The right common femoral artery was identified using
radiographic anatomic and ultrasonographic data. The right common femoral
artery was accessed using standard micropuncture technique after infiltration
of local anesthetic. A short 5 ___ sheath was introduced connected to
continuous heparinized saline flush and secured with silk suture.
___ 2 diagnostic catheter was introduced. It was connected to
continuous heparinized saline flush as well as the power injector. The
catheter was advanced over an 038 glidewire through the aorta into the aortic
arch. The wire was used to select the right common carotid artery. The
catheter was positioned over the wire into the right common carotid artery.
The wire was removed. Vessel patency was confirmed via hand injection.
Standard AP, oblique and lateral views were obtained. Diagnostic catheter was
pushed into the aortic arch reconstituting the ___ shape. Using the puff
technique under constant fluoroscopic guidance the catheter was navigated into
the proximal left vertebral artery. Vessel patency was confirmed via hand
injection. Standard AP and lateral views were obtained. Diagnostic catheter
was again post into the aortic arch reconstituting the ___ shape. Using
the puff technique under constant fluoroscopic guidance the catheter was
navigated into the left common carotid artery. Standard AP and lateral views
were obtained as well as 3 dimensional rotational angiography. 3 dimensional
rotational angiography of the left common carotid artery circulation requiring
post processing on an independent workstation and concurrent attending
physician interpretation review.
Next the diagnostic catheter was removed. Right common femoral angiogram was
performed via hand injection through the sheath. The sheath was removed and
the arteriotomy site closed using a 6 ___ Perclose device. The patient was
removed from the fluoroscopy table and remained at the patient's neurologic
baseline without any evidence of complication.
FINDINGS:
Ultrasound of the right groin demonstrates a pulsatile single-lumen
non-compressible vessel over the femoral head. There is evidence of needle
access into the arterial lumen.
Right common carotid artery: Power injection of the right common carotid
artery fills the external carotid artery and its branches along with the
internal carotid artery and its branches. Vessel walls are smooth without
evidence of dissection or stenosis. Branches are smooth and tapering. No
evidence of aneurysm or vascular malformation. Venous phase is normal with
dominance of right transverse sigmoid sinus.
Left vertebral artery: Power injection left vertebral artery fills the
vertebral artery, the basilar artery, and their respective branches. Vessel
walls are smooth without evidence of dissection or stenosis. Branches are
smooth and tapering. No evidence of aneurysm or vascular malformation.
Venous phase is normal.
Left common carotid artery: Power injection left common carotid artery fills
the external carotid artery and its branches along with the internal carotid
artery and its branches. There is also flash filling into the right anterior
cerebral artery. Vessel walls are smooth without evidence of dissection or
stenosis. Branches are smooth and tapering. No evidence of aneurysm or
vascular malformation. Venous phase is normal with a dominance of the right
transverse sigmoid sinus.
Right common femoral artery: Arteriotomy is above the bifurcation. There is
good distal runoff. There is no evidence of dissection. Vascular caliber is
appropriate for closure device.
IMPRESSION:
Unremarkable diagnostic cerebral angiogram. No evidence of aneurysm or
vascular malformation to explain subarachnoid hemorrhage.
RECOMMENDATION(S):
1. Admission to ICU
|
10051043-RR-49 | 10,051,043 | 26,563,181 | RR | 49 | 2197-06-24 23:47:00 | 2197-06-25 10:32:00 | EXAMINATION: MR HEAD W AND W/O CONTRAST T___ MR HEAD
INDICATION: ___ year old woman with SAH non-aneurysmal// eval for source of
bleed. r/o amyloid.
TECHNIQUE: Sagittal and axial T1 weighted imaging were performed. After
administration of 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:
-CTA head and neck ___.
-CT head ___.
-MR head ___.
FINDINGS:
Study is moderately degraded by motion. Within these confines:
Small acute infarct, left thalamus (6: 17). No corresponding FLAIR
hyperintensity.
As seen on the recent CT, there is diffuse subarachnoid hemorrhage seen in the
sylvian fissure and left temporoparietal sulci, as well as filling the
suprasellar cistern (10:11), and extending into the interhemispheric fissure
anteriorly. Hemorrhage is also seen in a right occipital sulcus, as well as
within the temporal pole; difficult to ascertain whether this latter finding
is extra-axial or intraparenchymal within the temporal pole (10:9 and 11:9).
Again seen are multiple foci of lobar-distribution chronic microhemorrhage,
suggestive of cerebral amyloid angiopathy (for example 10:20, 17, and 15).
Bilateral periventricular and deep white matter foci of T2/FLAIR signal
hyperintensity are nonspecific but compatible with moderate changes of chronic
white matter microangiopathy. The ventricles and sulci are prominent,
compatible with global parenchymal volume loss. Left basal ganglia probable
chronic infarcts are again noted.
There is suggestion of a left sinonasal polyp protruding into the left
nasopharynx, stable from prior (11:40). Mild frontal sinus and ethmoid air
cell mucosal thickening. Mild sphenoid sinus mucosal thickening. No
air-fluid levels. Minimal bilateral maxillary sinus mucosal thickening is
present. Trace left mastoid fluid. Right mastoid clear. Major intracranial
vascular flow voids are preserved. The globes and orbits are unremarkable.
Transverse sinuses are diminutive with multiple arachnoid granulations,
however otherwise patent. Remaining major dural venous sinuses, patent. Left
frontal calvarium probable hemangioma is seen (see 03:20; 14:47).
IMPRESSION:
1. Study is moderately degraded by motion.
2. Acute left thalamic infarct without definite evidence of hemorrhagic
transformation.
3. As seen on recent CT, diffuse subarachnoid hemorrhage, worst in the
suprasellar cistern, left sylvian fissure, and left temporoparietal sulci,
with additional foci seen elsewhere, including the right occipital lobe.
4. Hemorrhage in region of right temporal pole without definite associated
enhancement, grossly similar to prior CT. Intraparenchymal versus extra-axial
location cannot be determined on the basis of this examination.
5. Suggestion of left nasal polyp protruding into the left nasopharynx,
unchanged from prior exams.
6. Multiple lobar-distribution chronic microhemorrhages, again suggestive of
cerebral amyloid angiopathy.
7. Within limits of study, no definite evidence of enhancing intracranial
mass.
8. Paranasal sinus disease , as described.
|
10051043-RR-50 | 10,051,043 | 26,563,181 | RR | 50 | 2197-06-25 21:07:00 | 2197-06-25 22:29:00 | EXAMINATION: Chest radiograph, portable AP view.
INDICATION: Fever.
COMPARISON: Prior study from ___.
FINDINGS:
Cardiac, mediastinal and hilar contours appear stable. There is no pleural
effusion or pneumothorax. Vague poorly defined heterogeneous interstitial
opacities, most striking in the right upper lobe, suggest sequela of chronic
infection or inflammation. This may also reflect chronic airway disease.
However, there has been no definite acute change.
IMPRESSION:
Findings concerning for chronic infectious process and/or underlying airway
disease. This could be reassessed with CT if needed clinically. However, no
definite superimposed acute abnormality.
|
10051043-RR-52 | 10,051,043 | 26,563,181 | RR | 52 | 2197-06-29 18:16:00 | 2197-06-29 19:17:00 | EXAMINATION: CTA HEAD AND CTA NECK Q16 CT NECK
INDICATION: ___ year old woman with ___ year old woman with paroxysmal atrial
fibrillation not on anticoagulation (due to medication non-compliance),
multiple prior ischemic strokes associated with several months of decreased
energy and activity since her most recent stroke in ___, microscopic
polyangitis (pANCA/MPO) who was admitted with SAH of unclear etiology. Severe
headache// bleed, interval change
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 4.0 s, 16.0 cm; CTDIvol = 46.7 mGy (Head) DLP =
747.6 mGy-cm.
2) Spiral Acquisition 5.5 s, 43.1 cm; CTDIvol = 13.3 mGy (Body) DLP = 573.1
mGy-cm.
3) Stationary Acquisition 0.5 s, 0.5 cm; CTDIvol = 3.0 mGy (Body) DLP = 1.5
mGy-cm.
4) Stationary Acquisition 5.0 s, 0.5 cm; CTDIvol = 29.7 mGy (Body) DLP =
14.9 mGy-cm.
Total DLP (Body) = 589 mGy-cm.
Total DLP (Head) = 748 mGy-cm.
COMPARISON: MRI head with and without contrast ___
CTA head and neck with contrast ___
CTA head and neck with contrast ___.
FINDINGS:
CT HEAD WITHOUT CONTRAST:
A focus of intraparenchymal blood is re-demonstrated in the right temporal
pole, unchanged.
There is significant improvement in the degree of subarachnoid hemorrhage,
with minimal hemorrhage seen within the left sylvian fissure.
There is encephalomalacia of the anterior limb of the left internal capsule.
The ventricle sulci are age-appropriate. Patchy periventricular hypodensities
are most consistent with chronic microvascular angiopathy.
The visualized portion of the paranasal sinuses, mastoid air cells,and middle
ear cavities are clear. The visualized portion of the orbits are unremarkable.
CTA HEAD:
A new superiorly directed 2 mm aneurysm is seen at the left carotid terminus
(series 314, image 1).
The vessels of the circle of ___ and their principal intracranial branches
appear normal without stenosis, or occlusion. The dural venous sinuses are
patent.
CTA NECK:
Atherosclerotic changes of the carotid bifurcations are seen without
narrowing of the internal carotid arteries, by NASCET criteria. The vertebral
arteries and their major branches appear normal with no evidence of stenosis
or occlusion.
OTHER:
The visualized portion of the lungs demonstrates emphysematous change,
ground-glass opacities and pulmonary scarring. The visualized portion of the
thyroid gland is within normal limits. There is no lymphadenopathy by CT size
criteria.
IMPRESSION:
1. New 2 mm superiorly directed aneurysm at the left carotid terminus. The
aneurysm was not seen previously on the CTA or cerebral angiography
examination likely secondary to thrombus within the aneurysm or less likely
development of a new aneurysm
2. Significant improvement in the degrees of subarachnoid hemorrhage with
minimal hemorrhage now seen within the left sylvian fissure.
3. Unchanged focus of intraparenchymal hematoma in the right temporal pole.
4. Normal CTA of the neck.
5. Biapical pulmonary emphysematous change, ground-glass opacities and
scarring.
|
10051043-RR-53 | 10,051,043 | 26,563,181 | RR | 53 | 2197-06-30 17:07:00 | 2197-06-30 17:56:00 | EXAMINATION: Chest radiograph, two AP portable views.
INDICATION: Central line placement.
COMPARISON: ___.
FINDINGS:
New right internal jugular central venous catheter terminates in the mid
superior vena cava. There is again leftward rotation of the heart. Cardiac,
mediastinal and hilar contours appear stable. There is no pleural effusion or
pneumothorax. Chest is hyperinflated associated with underlying airway
disease. Increased prominence of interstitial opacities at each lung apex,
right greater than left, above baseline, suggests superimposed infection
and/or lower airway inflammation upon background findings.
IMPRESSION:
New right internal jugular catheter terminating in the mid superior vena cava.
Upper lung opacities above baseline concerning for active infectious or
inflammatory process superimposed on background chronic airway disease.
|
10051043-RR-54 | 10,051,043 | 26,563,181 | RR | 54 | 2197-06-30 17:55:00 | 2197-06-30 19:14:00 | EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ year old woman with MCA aneurysm s/p clipping// Please
evaluate post-op, newly dysarthric
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 4.0 s, 16.0 cm; CTDIvol = 46.7 mGy (Head) DLP =
747.6 mGy-cm.
2) Sequenced Acquisition 1.0 s, 4.0 cm; CTDIvol = 46.7 mGy (Head) DLP =
186.9 mGy-cm.
Total DLP (Head) = 935 mGy-cm.
COMPARISON: CT head ___..
FINDINGS:
Patient is status post left frontal craniotomy with clipping of left ICA
bifurcation aneurysm. There is bilateral moderate pneumocephalus, greater on
the left than on the right with mass effect and increased effacement of the
suprasellar cistern. There also postsurgical changes including subcutaneous
gas and edema overlying the craniectomy sites. Continued evolution of focus
of intraparenchymal blood in the right temporal pole is seen. No new foci of
intracranial hemorrhage. There is rightward midline shift to 3 mm.
Increased effacement of the left hemispheric sulci and left lateral ventricle
is noted. Trace blood products are again noted along the left sylvian
fissure.
No large vascular territory infarction. Redemonstration of encephalomalacia in
the anterior limb of the left internal capsule is noted.
The visualized portion of the paranasal sinuses, mastoid air cells, and middle
ear cavities are clear. The visualized portion of the orbits are
unremarkable.
IMPRESSION:
1. Status post left frontal craniotomy with clipping of left ICA bifurcation
aneurysm with bilateral moderate pneumocephalus, left greater than right
demonstrating mass effect with 3 mm rightward midline shift and increased
effacement of the suprasellar cistern, correlate clinically. Consider
short-term follow-up if clinically indicated.
2. No new foci of intracranial hemorrhage.
NOTIFICATION: The findings were discussed with Dr. ___, M.D. by ___,
M.D. on the telephone on ___ at 7:43 pm, 20 minutes after discovery of
the findings.
|
10051074-RR-10 | 10,051,074 | 21,350,747 | RR | 10 | 2180-02-08 08:16:00 | 2180-02-08 08:53:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: History: ___ with chest pain // eval for pna
TECHNIQUE: Single portable upright AP chest radiograph
COMPARISON: None.
FINDINGS:
A right IJ central venous catheter terminates in the upper right atrium. Mild
cardiomegaly.
There is engorgement of the pulmonary vasculature, concerning for mild
pulmonary edema.
No focal consolidation to suggest pneumonia.
Possible small left pleural effusion. No right pleural effusion.
IMPRESSION:
1. Cardiomegaly.
2. Engorgement of the pulmonary vasculature, concerning for mild pulmonary
edema.
3. No focal consolidations to suggest pneumonia.
|
10051074-RR-11 | 10,051,074 | 21,350,747 | RR | 11 | 2180-02-08 16:06:00 | 2180-02-08 17:54:00 | EXAMINATION: BILAT LOWER EXT VEINS
INDICATION: ___ year old woman with afib presenting with afib with RVR and
hypoxia // eval for bilateral ___ DVT; concerned for PE but would like to
avoid IV contrast. Patient is in the CCU and critically ill. Please perform
portable.
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the bilateral lower extremity veins.
COMPARISON: None.
FINDINGS:
There is normal compressibility, flow, and augmentation of the bilateral
common femoral, femoral, and popliteal veins. Normal color flow and
compressibility are demonstrated in the posterior tibial and peroneal veins.
There is normal respiratory variation in the common femoral veins bilaterally.
No evidence of medial popliteal fossa (___) cyst.
IMPRESSION:
No evidence of deep venous thrombosis in the right or left lower extremity
veins.
|
10051074-RR-13 | 10,051,074 | 21,350,747 | RR | 13 | 2180-02-09 15:36:00 | 2180-02-09 16:10:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with ___ female with h/o afib on
Coumadin, severe diverticular disease s/p partial colectomy with end ostomy,
extensive tobacco use, and NIDDM presenting from outside hospital with chest
pain, dyspnea, nausea. Found to have AFib with RVR and NSTEMI. // Crackles on
exam. now gram + cocci in blood cultures. ? Pnuemonia? vs volume overload.
Crackles on exam. now gram + cocci in blood cultures. ? Pnuemonia? vs volume
overload.
IMPRESSION:
Comparison to ___. The signs of mild interstitial pulmonary
edema, visible on the previous radiograph, have decreased in severity.
However, a small left pleural effusion with subsequent retrocardiac
atelectasis has developed. Mild cardiomegaly persists but currently there is
no evidence of pulmonary edema. No pneumonia. Stable position of the right
internal jugular vein catheter.
|
10051074-RR-14 | 10,051,074 | 21,350,747 | RR | 14 | 2180-02-12 17:40:00 | 2180-02-12 19:07:00 | EXAMINATION: Chest radiograph
INDICATION: ___ year old woman with 47cm left arm SL power PICC // 47cm left
arm SL power PICC. ___ ___ Contact name: ___: ___
TECHNIQUE: Frontal view of the chest.
COMPARISON: Chest radiograph ___
FINDINGS:
Since comparison study, there has been interval removal of the right-sided
central venous catheter. There has been placement of a left-sided PICC which
terminates overlying the mid SVC.
The lung volumes are normal. Normal size of the cardiac silhouette. Normal
hilar and mediastinal structures. No pneumonia, no pulmonary edema. No
pleural effusions.
IMPRESSION:
Since chest radiograph ___, there has been interval removal of
right-sided central venous catheter and placement of left-sided PICC which
terminates overlying the mid SVC.
|
10051074-RR-29 | 10,051,074 | 28,928,117 | RR | 29 | 2180-07-31 05:54:00 | 2180-07-31 06:46:00 | INDICATION: History: ___ with dyspnea and chest pain// Acute abnl
TECHNIQUE: Chest AP and lateral
COMPARISON: Chest radiograph from ___
FINDINGS:
Right chest wall 3 lead pacer, aortic valve stent, and sternotomy wires appear
unchanged. There has been interval removal of a left internal jugular central
venous catheters since ___.
Lungs are moderately well expanded without evidence of focal consolidation.
Mild subsegmental lower lobe atelectasis and pulmonary vascular congestion
without frank pulmonary edema. A small left pleural effusion remains no
significant right pleural effusion.. No pneumothorax.
IMPRESSION:
No acute process. Small left pleural effusion.
|
10051555-RR-4 | 10,051,555 | 22,193,102 | RR | 4 | 2170-03-01 08:12:00 | 2170-03-01 10:32:00 | HISTORY: ___ woman status post cardiac catheterization with right
retroperitoneal hematoma. Followup scan to evaluate interval change.
COMPARISON: Prior abdominal/pelvic CT from ___.
TECHNIQUE: Axial MDCT images were obtained through the abdomen and pelvis
after the uneventful administration of 100 cc of Omnipaque intravenous
contrast. No oral contrast was provided. Sagittal and coronal reformats were
generated.
FINDINGS:
The lung bases are clear. There is no pleural or pericardial effusion.
CT OF THE ABDOMEN: The liver enhances homogeneously. No focal hepatic
lesions. There is no intra or extrahepatic biliary duct dilatation. The
gallbladder is within normal limits. The adrenal glands, pancreas and spleen
are unremarkable. Bilateral kidneys enhance symmetrically and excrete
contrast without evidence of mass or hydronephrosis.
There is redemonstration of a retroperitoneal hematoma on the right extending
from the right iliac crest to the pelvis. A portion along the right hemipelvis
measures 5.4 x 3.2 cm, previously 5.9 x 3.3 cm (02:47). Within the right
hemipelvis, the largest area of hematoma measures approximately 5.8 x 3.3 cm
(02:58). In coronal images, the area retroperitoneal hematoma measures 10.7
cm (601b: 25), compared to 11.5 cm on prior examination.
The stomach is collapsed. There is no bowel obstruction. No bowel wall
abnormalities. That intra-abdominal aorta demonstrates moderate
atherosclerotic calcifications. The celiac axis, SMA, bilateral renal
arteries and ___ and ___ are patent. There is no free air.
CT OF THE PELVIS: Small amount of fat stranding within the pelvis, related to
hematoma. The uterus is within normal limits. Rectum is unremarkable. There
is no pelvic or inguinal lymphadenopathy.
OSSESOUS STRCUTURES: No blastic or lytic lesions concerning for malignancy.
Degenerative changes are noted along the lower lumbar spine.
IMPRESSION: Evolving retroperitoneal hematoma which appears more organized,
stable to slightly decreased in size since prior. No new areas of hemorrhage.
|
10051850-RR-3 | 10,051,850 | 21,845,745 | RR | 3 | 2163-12-12 01:39:00 | 2163-12-12 03:40:00 | INDICATION: ___ with known femur fracture unable to get images evaluate for
pneumonia.
TECHNIQUE: Single upright AP chest radiograph
COMPARISON: Outside hospital chest radiographs dated ___.
FINDINGS:
Low lung volumes are associated with crowding of bronchovascular structures.
There is no focal consolidation, pleural effusion, pulmonary edema, or
pneumothorax. There is bibasilar atelectasis and probable right lung base
scarring. Prominence of the right upper mediastinum may be due to a tortuous
aorta or patient positioning.
IMPRESSION:
Low lung volumes. No evidence of acute cardiopulmonary process.
|
10051850-RR-4 | 10,051,850 | 21,845,745 | RR | 4 | 2163-12-12 01:40:00 | 2163-12-12 03:37:00 | EXAMINATION: DX PELVIS AND FEMUR
INDICATION: ___ with known femur fracture unable to get images, evaluate for
femur fracture on pelvis, hip, femurcxr pre-op
TECHNIQUE: Frontal view radiograph of the pelvis with additional frontal and
frog-leg lateral views of
COMPARISON: Outside hospital hip radiographs dated ___.
FINDINGS:
There is a mildly impacted intratrochanteric fracture of the right femoral
neck, with virus and posterior angulation of the distal component. There is
an intermedullary rod within the right femur with interlocking screws.
Deformity of the distal femur is consistent with a remote well healed
fracture. There is diffuse demineralization. Moderate vascular
calcifications are noted. There is no suspicious lytic or sclerotic lesion.
There is mild bilateral hip joint osteoarthritis.
IMPRESSION:
Mildly impacted intratrochanteric fracture of the right proximal femur with
varus and posterior angulation of the distal fracture fragment.
|
10051872-RR-11 | 10,051,872 | 21,380,555 | RR | 11 | 2174-08-05 02:20:00 | 2174-08-05 03:53:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: History: ___ with DKA, possible pulmonary edema// eval for
pulmonary edema
TECHNIQUE: Portable frontal chest radiograph
COMPARISON: None
FINDINGS:
Low lung volumes exaggerate the caliber and crowding vessels and make it
difficult to distinguish micro atelectasis at the lung bases from mild
interstitial edema, but heart size is normal and there is no pleural effusion
or other reason to suspect cardiac decompensation.
Slight leftward deviation of the lower cervical trachea may be a function low
lung volumes as well, but an enlarged right thyroid lobe can have the same
appearance.
No displaced rib fractures.
IMPRESSION:
Low lung volumes. No good evidence for cardiopulmonary abnormality.
Although no acute or other chest wall lesion is seen, conventional chest
radiographs are not sufficient for detection or characterization of most such
abnormalities. If the demonstration of trauma, or other osseous soft tissue
abnormality involving the chest wall is clinically warranted, the location of
any referable focal findings should be described in the imaging request,
clearly marked, and imaged with either bone detail radiographs or Chest CT
scanning.
|
10052077-RR-23 | 10,052,077 | 21,740,946 | RR | 23 | 2143-02-01 08:46:00 | 2143-02-01 09:16:00 | CHEST RADIOGRAPHS
HISTORY: Syncope.
COMPARISONS: None.
TECHNIQUE: Chest, PA and lateral.
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. Bony structures are unremarkable.
IMPRESSION: No evidence of acute disease.
|
10052077-RR-24 | 10,052,077 | 21,740,946 | RR | 24 | 2143-02-01 10:41:00 | 2143-02-01 12:38:00 | INDICATION: Left lower quadrant abdominal pain. History of ulcerative
colitis.
TECHNIQUE: MDCT images were obtained from the lung bases to the pelvic outlet
after administration of 30 cc of saline, 150 cc of intravenous contrast.
Coronal and sagittal reformations were acquired. DLP: 288.75 mGy-cm.
No intravenous contrast is present on the acquired images. The patient
reported numbness in her left upper arm as well as inability to flex her
elbow. The patient was assessed in CT by Dr. ___ at 11:11 a.m.
The patient reported continued abdominal pain, but stated that she was numb
from the antecubital fossa up. The area was tense on exam. Peripheral pulses
were intact. Range of motion was limited in the elbow and the patient was
only able to move her fingers slightly. Dr. ___ (plastic surgery)
was informed by phone at 11:13 a.m. Dr. ___ (ED) was informed by
phone at 11:15 a.m. Nursing arrived at the scanner and placed ice at the area
with instruction to keep the area elevated. The patient was returned to her
room in order to see plastic surgery.
COMPARISON: CT abdomen and pelvis ___.
CT ABDOMEN: The lung bases are clear. The visualized portions of the heart
and pericardium are unremarkable. In the absence of intravenous contrast,
evaluation of the liver is limited, but there is no gross abnormality.
Cholecystectomy clips are noted in the gallbladder fossa. The pancreas,
spleen, and adrenals are normal. There is no nephrolithiasis or
hydronephrosis. The stomach and small bowel are unremarkable and oral
contrast passes freely into the colon. There is no free air or free fluid.
CT PELVIS: The descending colon is underdistended. Mild wall thickening is
equivocal along the descending colon (601b:28). Oral contrast reaches the
rectosigmoid junction. The appendix appears normal. The uterus is absent.
The urinary bladder and adnexa are unremarkable. There is no pelvic
lymphadenopathy or free fluid.
OSSEOUS STRUCTURES: There is no lytic or blastic lesion suspicious for
malignancy.
IMPRESSION:
1. Underdistended descending colon with equivocal wall thickening. This
raises the possibility for colitis, but may be an artifact of underdistension
and intramural debris; however colonoscopy could be considered for further
work-up if there is clinical concern regarding the possibility of mild
colitis.
2. Symptomatic extravasation of intravenous contrast (left arm).
|
10052193-RR-15 | 10,052,193 | 26,526,599 | RR | 15 | 2178-10-14 17:08:00 | 2178-10-14 19:40:00 | EXAMINATION: SHOULDER (AP, NEUTRAL AND AXILLARY) TRAUMA RIGHT
INDICATION: ___ year old woman after fall with right shoulder pain. // Assess
for traumatic injuries.
TECHNIQUE: AP in internal rotation, Grashey in external rotation, and
axillary view radiographs of the right shoulder.
COMPARISON: None
FINDINGS:
Suboptimal positioning limits the evaluation. No obvious fracture or
dislocation is detected. There is mild to moderate degenerative change at the
acromioclavicular joint. There is severe degenerative change at the
glenohumeral joint with abnormal broadened appearance of the humeral head,
joint space loss, subchondral sclerosis and marginal spurring.
IMPRESSION:
1. Suboptimal positioning limits evaluation. Within this limitation there is
no evidence of fracture or dislocation.
2. Severe degenerative changes in the right shoulder.
This preliminary report was reviewed with Dr. ___
radiologist.
|
10052340-RR-16 | 10,052,340 | 23,427,451 | RR | 16 | 2145-04-03 15:40:00 | 2145-04-03 15:54:00 | EXAMINATION: Chest radiograph
INDICATION: History: ___ with concern for CP// r/o PNA
TECHNIQUE: Portable frontal view of the chest.
COMPARISON: None.
FINDINGS:
There is moderate cardiomegaly. There is unfolding of the thoracic aorta with
vascular calcification. There is central pulmonary vascular congestion with
mild interstitial edema. Retrocardiac consolidation is difficult to exclude.
There may be a small left-sided pleural effusion. No other consolidation is
seen. There is biapical scarring.
IMPRESSION:
Mild pulmonary edema with possible retrocardiac consolidation, not well
characterized on this frontal view. A lateral view may be helpful for further
characterization.
|
10052530-RR-20 | 10,052,530 | 27,361,644 | RR | 20 | 2186-01-24 15:51:00 | 2186-01-24 16:27:00 | EXAMINATION: US APPENDIX
INDICATION: ___ with rlq pain. Eval for appendicitis.
TECHNIQUE: Grayscale ultrasound images were obtained of the right lower
quadrant.
COMPARISON: None.
FINDINGS:
Transverse and sagittal images were obtained of the structures in the right
lower quadrant. In the area of concern directed by the patient, there are
compressible air-filled loops of bowel with no evidence of wall thickening or
edema. The appendix was not visualized.
IMPRESSION:
The appendix was not visualized.
|
10052530-RR-21 | 10,052,530 | 27,361,644 | RR | 21 | 2186-01-24 18:45:00 | 2186-01-24 19:20:00 | EXAMINATION: CT abdomen and pelvis
INDICATION: ___ man with RLQ pain eval for appendicitis vs bowel
pathology // eval for appendicitis
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired
through the abdomen and pelvis following intravenous contrast administration
with split bolus technique.Oral contrast was administered.Coronal and sagittal
reformations were performed and reviewed on PACS.
DOSE: Total DLP (Body) = 507 mGy-cm.
COMPARISON: None.
FINDINGS:
LOWER CHEST: Visualized lung fields are within normal limits. There is no
evidence of pleural or pericardial effusion.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There is no evidence of focal lesions. There is no evidence of intrahepatic
or extrahepatic biliary dilatation. The gallbladder is 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.
There is no evidence of focal renal lesions or hydronephrosis. There is no
perinephric abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. The colon and
rectum are within normal limits. The retrocecal appendix is fluid-filled,
with a hyperemic and thickened wall and adjacent fat stranding concerning for
early acute appendicitis. No free air, or drainable fluid collection. Trace
fluid tracks along the right pericolic gutter.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease
is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
Early acute appendicitis. Of note, the appendix is in a retrocecal location.
|
10052875-RR-53 | 10,052,875 | 28,599,142 | RR | 53 | 2139-09-02 01:26:00 | 2139-09-02 02:06:00 | EXAMINATION: CT ABD AND PELVIS WITH CONTRAST
INDICATION: NO_PO contrast; History: ___ with history of likely inflammatory
disease. Left lower quadrant pain. Diarrhea. Had a CT scan done at the
outside hospital, but is not able to be sent electronically or via the PACS
system.NO_PO contrast// Diverticulitis, colitis
TECHNIQUE: Single phase contrast: MDCT axial images were acquired through the
abdomen and pelvis following intravenous contrast administration.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Stationary Acquisition 4.5 s, 0.5 cm; CTDIvol = 21.7 mGy (Body) DLP =
10.8 mGy-cm.
2) Spiral Acquisition 6.6 s, 51.6 cm; CTDIvol = 15.5 mGy (Body) DLP = 799.4
mGy-cm.
Total DLP (Body) = 810 mGy-cm.
COMPARISON: CT pelvis dated ___.
FINDINGS:
LOWER CHEST: The exception of bibasilar atelectasis, lung bases are clear.
ABDOMEN:
HEPATOBILIARY: The liver dome was excluded on this exam. The imaged portion
of liver demonstrates homogenous attenuation throughout. Subcentimeter
hypodensity in segment 5 is too small to characterize, most likely reflects a
simple cyst (02:12). There is no evidence of suspicious lesions. There is no
evidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder
contains gallstones without wall thickening or surrounding inflammation.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen is mildly enlarged. A subcentimeter hypodensity in the
inferior pole of the spleen is most likely a hemangioma.
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. There are 2 adjacent cysts versus a cyst with
imperceptible septation at right upper renal pole. This measures
indeterminate density. Additional subcentimeter cortical hypodensities are
too small to characterize, but are most likely cysts. There is no perinephric
abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. There is marked
wall thickening of the sigmoid colon to the rectosigmoid junction, which is
more completely seen on this study compared to the rectal MRI from 4 days
prior. There are tiny foci of gas within the thickened wall, suggestive of
penetrating disease (series 2, image 57). Involvement of the rectum appears
less severe in the sigmoid. There is extensive adjacent phlegmonous change,
but no organized fluid collection. Fat plane with the bladder is preserved.
The known perianal fistula is much better described on recent MRI. The
appendix is not definitely seen.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is
trace free fluid in the pelvis.
REPRODUCTIVE ORGANS: The uterus is unremarkable. No adnexal abnormality. An
intrauterine device is in place.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic
disease is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. Extensive inflammatory change and adjacent phlegmon involving the sigmoid
colon greater than the rectum. These findings are consistent with a severe
proctocolitis, and Crohn's disease is favored given the presence of a perianal
fistula and appearance of penetrating disease. An infectious etiology could
also be considered. The appearance and distribution are less compatible with
ischemia.
2. No fluid collection. No evidence of perforation. No intrapelvic fistula.
3. Known perianal fistula is better seen on the recent MRI performed ___.
|
10052875-RR-54 | 10,052,875 | 28,599,142 | RR | 54 | 2139-09-02 17:12:00 | 2139-09-02 19:27:00 | EXAMINATION: DX CHEST PORTABLE PICC LINE PLACEMENT
INDICATION: ___ year old woman with picc// s/p r 45cm dl picc Contact name:
___: ___
TECHNIQUE: AP portable chest radiograph
COMPARISON: ___
FINDINGS:
The tip of the right PICC projects over the distal SVC. There is no focal
consolidation, pleural effusion or pneumothorax identified. The size of the
cardiomediastinal silhouette is within normal limits.
IMPRESSION:
The tip of the right PICC projects over the distal SVC.
|
10052875-RR-56 | 10,052,875 | 28,599,142 | RR | 56 | 2139-09-03 16:43:00 | 2139-09-03 17:38:00 | EXAMINATION: CT ABD AND PELVIS WITH CONTRAST
INDICATION: ___ hx HTN, complex anal fistulas p/w fever and LLQ abdominal
pain, CT concerning for severe microperforated descending/sigmoid colitis//
Enterography due to concern for active Crohn's flare, want to assess terminal
ileal disease from inside prior to surgery
TECHNIQUE: Single phase contrast: MDCT axial images were acquired through the
abdomen and pelvis following intravenous contrast administration.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 0.5 s, 0.2 cm; CTDIvol = 9.2 mGy (Body) DLP = 1.8
mGy-cm.
2) Stationary Acquisition 10.8 s, 0.2 cm; CTDIvol = 182.2 mGy (Body) DLP =
36.4 mGy-cm.
3) Spiral Acquisition 7.2 s, 46.6 cm; CTDIvol = 14.0 mGy (Body) DLP = 643.8
mGy-cm.
Total DLP (Body) = 682 mGy-cm.
COMPARISON: Prior abdominal CT from ___.
FINDINGS:
LOWER CHEST:
Visualized lung fields are within normal limits. There is no evidence of
pleural or pericardial effusion.
ABDOMEN AND PELVIS:
Hepatobiliary: The liver demonstrates homogenous attenuation throughout.
Stable subcentimeter hypodensity in segment 5, indeterminate. There is no
evidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder
filled with biliary sludge.
Pancreas: The pancreas has normal attenuation throughout, with hypodense
nodules in the tail measuring 1.8 and 1.5 cm respectively (05:45), most likely
dilated side branch ducts. A similar lesion is noted in the pancreatic head
measuring 2.0 cm (05:47). There is no peripancreatic stranding.
Spleen: The spleen is mildly enlarged measuring 13.8 cm in craniocaudal
extension. The previously mentioned hemangioma is not well characterized into
the study.
Adrenals: The right and left adrenal glands are normal in size and shape.
Urinary: The kidneys are normal and symmetric in size with normal nephrogram.
There is no evidence of hydronephrosis. Simple cysts in the kidneys are again
noted. The largest is in the right upper pole measuring 3.0 cm (05:48) with
indeterminate density. There is no perinephric abnormality.
Gastrointestinal: Again noted is an extensive wall thickening of the sigmoid
colon associated with mucosal enhancement and surrounding phlegmon (5:95).
The known posterior perianal fistula was incompletely imaged on the current
study. The stomach, duodenum and small bowel loops are unremarkable in normal
in caliber throughout. The appendix is normal.
Pelvis: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
Reproductive Organs: The uterus has an indwelling IUD. Heterogeneous
appearance of the left adnexal region (5:108) measuring 2.8 x 1.9 cm.
Lymph Nodes: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy. Prominent left mesorectal lymph
node is unchanged (05:27), likely reactive.
Vascular: There is no abdominal aortic aneurysm. Moderate atherosclerotic
disease is noted.
Bones: There is no evidence of worrisome osseous lesions or acute fracture.
Soft Tissues: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. Redemonstration of extensive inflammatory changes associated with
surrounding phlegmon in the sigmoid colon and to a lesser extent the rectum
consistent with severe proctocolitis. No evidence of small bowel involvement.
2. Please refer to recent rectal MR for more details on the known perianal
fistula, which was incompletely evaluated today.
3. At least 3 hypodense nodules in the pancreas likely dilated side branch
ducts, the largest measuring 2.0 cm. See recommendations below.
RECOMMENDATION(S): For pancreatic cysts measuring more than 1.5cm, patients
should be referred to the pancreas cyst clinic for consultation. These
referrals can be made by emailing ___
or by calling ___.
For cysts measuring up to 1.5 cm:
(a) These guidelines apply only to incidental findings, and not to patients
who are symptomatic, have abnormal blood tests, or have history of pancreas
neoplasm resection.
(b) Clinical decisions should be made on a case-by-case basis taking into
account patient's comorbidities, family history, willingness to undergo
treatment, and risk tolerance.
Local ___ follow-up guidelines adopted from:
___
|
10052992-RR-22 | 10,052,992 | 27,186,164 | RR | 22 | 2124-09-01 18:40:00 | 2124-09-01 23:55:00 | EXAMINATION: CT ABD AND PELVIS WITH CONTRAST
INDICATION: ___ year old man with HBV, HCV, h/o HEV, with cirrhosis, ___ s/p
partial resection who presented with small amounts of BRBPR, with stable Hgb
at 13 (above baseline), underwent colonoscopy today demonstrated
circumferential sigmoid mass. // evaluate for metastases, other abdominal
masses via CT chest, abdomen pelvis
TECHNIQUE: MDCT scanning was performed through the abdomen without contrast,
and from the lung bases to the pubic symphysis following the intravenous
administration of Omnipaque, with additional delayed images obtained through
the abdomen. Coronal and sagittal re-formatted images are provided.
DLP: 1002 mGy-cm
COMPARISON: MRI abdomen of ___
FINDINGS:
Imaged portion of lung bases show bibasilar atelectasis. Note is made of
coronary artery calcifications. Please see separately dictated chest CT report
of same date for evaluation of thoracic structures.
The liver is diffusely nodular in contour consistent with known cirrhosis.
Today's examination is not targeted for evaluation of hepatocellular
carcinoma. The lesion in segment 7 which was seen previously at MRI is
difficult to appreciate on today's CT (06:43) in the portal venous phase,
however, some washout is appreciable in the delayed phase of imaging (07:11),
spanning a region of approximately 1.4 x 1.5 cm. Scattered hepatic cysts and
or biliary hamartomas are re- demonstrated. There is diffuse hyperemia about
the gallbladder fossa. In addition, multiple patchy areas of regional hyper
enhancement are seen within the right lobe of the liver, without evidence of
washout on delayed phase imaging, likely perfusional. No definite new lesions
worrisome for hepatic metastases are identified. Enlarged periportal lymph
nodes are compatible with underlying liver disease.
The gallbladder remains distended and thick-walled with pericholecystic
stranding. New in the interval is a lobulated fluid collection along the
inferior aspect of the gallbladder fundus measuring 4.7 x 6.3 cm and
containing calcified gallstone, a finding that is consistent with perforated
cholecystitis. Some stranding extends towards the adjacent hepatic flexure of
the colon, with minimal associated wall thickening. A simple cyst measuring 2
cm is seen along the posterior aspect of segment ___.
The pancreas appears unremarkable. Spleen is within normal limits in size.
Focal thickening of the lateral limb of the right adrenal gland measuring up
to 7 mm, best seen on coronal reformation, is unchanged compared to the
earliest available outside hospital CT dated ___. Its density is low
on precontrast images (03:25), suggesting that this may represent a small
adenoma or nodular hyperplasia. An oblong structure just inferior to the
right adrenal gland measuring 1.1 x 2.1 cm containing a punctate
calcification, shows mild hyperdensity on precontrast images and does not
enhance, and might represent a chronic organized hematoma. Left adrenal gland
appears unremarkable. accessory spleens are noted.
Kidneys enhance and excrete contrast symmetrically without suspicious lesions.
A simple cyst in the upper pole of the right kidney is noted, and additional
tiny hypodensities were seen previously on MRI to represent cysts. There is
mild focal ectasia of the infrarenal aorta measuring up to 2.1 cm. Stranding
throughout the retroperitoneum and mesenteric root without pathologic lymph
node enlargement. Particular stranding is seen around the inferior mesenteric
artery which has a thick wall, hazy appearance that is unchanged since the CT
from outside hospital of ___. Fatty density with peripheral rim in
the mid abdominal mesentery consistent with sequelae of fat necrosis (07:40).
Abdominal loops of large and small bowel are normal in caliber.
A hypodensity in the inferior vena cava at the level of the renal veins is
consistent with mixing artifact and not felt to represent an intra caval
lesion.
CT of the pelvis with intravenous contrast: There is a partially
circumferential mass in the sigmoid colon extending a length of approximately
2.5-3 cm (9 b: 25) (6:90). Round lymph nodes in the adjacent mesial colon
measure up to 4 mm in diameter. Stranding extends along the inferior
mesenteric artery distribution. Given thickwalled appearance of the inferior
mesenteric artery, superimposed vasculitis is not excluded. Rectum appears
unremarkable. The appendix is normal. The prostate contains calcifications in
a linear distribution, and bladder appears within normal limits. Minimal
patulous appearance of the distal left ureter is likely reflective of normal
variation. There is no hydronephrosis. A calcified scrotal pearl is seen in
the left hemiscrotum.
Bone windows: No suspicious lytic or sclerotic osseous lesions are
identified.
IMPRESSION:
1. Interval development of a lobulated fluid collection inferior to the
inflamed gallbladder consistent with perforated cholecystitis, with gallstones
layering within the collection.
2. Approximately 2.5-3 cm partly circumferential mass in the sigmoid colon
consistent with the reported malignancy. Lymph nodes in the adjacent mesocolon
do not meet CT criteria for pathologic enlargement and mesenteric stranding is
nonspecific. No definite evidence of metastatic disease in the abdomen or
pelvis.
3. Re- demonstration of 1.5 cm lesion in hepatic segment 7, better depicted on
previous MRI, but with probable observation of washout on today's study. This
remains suspicious for ___ although today's examination does not meet criteria
to assess OPTN features.
4. 7 mm nodularity of the right adrenal gland, which might represent a tiny
adenoma, is stable. Nonenhancing possible chronic hematoma inferior to the
right adrenal gland is also stable.
5. Stranding along the inferior mesenteric artery distribution. Given
thickwalled appearance of the inferior mesenteric artery, superimposed
vasculitis is not excluded.
NOTIFICATION: Updated findings were discussed with ___ by Dr. ___ on
___ at 9 AM.
|
10052992-RR-23 | 10,052,992 | 27,186,164 | RR | 23 | 2124-09-01 19:14:00 | 2124-09-01 20:36:00 | EXAMINATION: CT CHEST W/CONTRAST
INDICATION: Colonoscopy demonstrating a circumferential sigmoid mass.
Evaluate for metastatic disease.
TECHNIQUE: Multidetector helical scanning of the chest was coordinated with
intravenous infusion of nonionic iodinated contrast agent reconstructed as
contiguous 5- and 1.25-mm thick axial, 2.5-mm thick coronal and parasagittal,
and 8 x 8 mm MIPs axial images. Acquisitions were part of a chest, abdomen and
pelvis for which abdomen and pelvis images were separated to the evaluated by
the abdominal imaging service.
DOSE: DLP: Reported separately on the abdomen and pelvis dictation.
COMPARISON: CT abdomen and pelvis ___. Chest radiograph ___.
FINDINGS:
Heterogeneous right thyroid lobe demonstrates no focal nodularity.
Though the study is not designed for cardiac chamber evaluation, it shows that
the heart is mildly enlarged. There is no significant pericardial fluid.
Aortic annular and coronary artery calcifications are mild. Thoracic aortic
arch and main pulmonary artery are normal caliber. There is no central
pulmonary embolus. Several scattered mediastinal lymph nodes measure up to 8
mm in short axis in the left paratracheal station (06:22), but are not
pathologically enlarged. There is no pathologic supraclavicular, axillary,
hilar or mediastinal lymphadenopathy.
Airways are patent to the subsegmental level. Moderate to severe paraseptal
emphysema is apical predominant, less prominent in the lung bases. Lingular,
right lower lobe and right middle lobe linear atelectasis is mild. Subpleural
nodule in the posterior segment of the right upper lobe measures 3 mm (8:130).
Lungs are clear without focal consolidation. Pleural surfaces are clear
without effusion or pneumothorax.
Bones and soft tissues: 3 mm well-circumscribed sclerotic focus in the
anterior portion of the T4 vertebral body likely represents a bone island.
Thoracic cage is intact without suspicious focal lesion. Thoracic degenerative
changes are mild.
IMPRESSION:
1. No evidence of intrathoracic metastasis.
2. 3 mm right upper lobe nodule lacks suspicious features though requires
followup examination in ___ year in this patient with a pre-existing malignancy.
3. Moderate to severe apical predominant paraseptal emphysema is less
prominent at the bases.
4. For abdomen and pelvis findings including abnormal gallbladder, please
refer to the separate dictation under clip ___.
|
10052992-RR-24 | 10,052,992 | 27,186,164 | RR | 24 | 2124-09-03 11:24:00 | 2124-09-03 13:07:00 | EXAMINATION: US INTERVENTIONAL PROCEDURE
INDICATION: ___ year old man with HBV/HCV cirrhosis, ___ s/p resection, recent
admission for cholecystitis managed medically w/ ABX planned for interval
CCY, p/w BRBPR, found to have sigmoid mass c/w colon cancer, CT torso for
staging found perforation of GB - patient's VS stable, afebrile, labs all WNL,
pain ___ // PTBD placement for perforated GB
COMPARISON: CT ___
PROCEDURE: Ultrasound-guided percutaneous cholecystostomy.
OPERATORS: Dr. ___ trainee and Dr. ___ radiologist.
Dr. ___ supervised the trainee during the key components of the
procedure and reviewed and agrees with the trainee's findings.
TECHNIQUE: The risks, benefits, and alternatives of the procedure were
explained to the patient. After a detailed discussion, informed written
consent was obtained. A pre-procedure timeout using three patient identifiers
was performed per ___ protocol.
The patient was placed in a supine position on the ultrasound table. Limited
preprocedure imaging was performed to localize the gallbladder. An
appropriate skin entry site was chosen and the site marked. Local anesthesia
was administered with 1% Lidocaine solution.
Using continuous sonographic guidance, an ___ ___ drainage catheter
was advanced via trocar technique into the gallbladder. A sample of fluid was
aspirated, confirming catheter position within the collection. The plastic
stiffener was removed. The pigtail was deployed. The position of the pigtail
was confirmed within the collection via ultrasound. Ultrasound images were
stored on PACS.
Approximately 350 cc of hemorrhagic purulent fluid was drained with a sample
sent for microbiology evaluation. The catheter was secured by a StatLock. The
catheter was attached to bag. Sterile dressing was applied.
The procedure was tolerated well, and there were no immediate post-procedural
complications.
SEDATION: Moderate sedation was provided by administering divided doses of
1.5 mg Versed and 75 mcg fentanyl throughout the total intra-service time of
17 minutes during which patient's hemodynamic parameters were continuously
monitored by an independent trained radiology nurse.
FINDINGS:
Successful ultrasound-guided placement of ___ pigtail catheter into the
gallbladder with aspiration of 350 cc hemorrhagic purulent fluid. Sample was
sent for microbiology evaluation.
IMPRESSION:
Successful ultrasound-guided placement of ___ pigtail catheter into the
gallbladder with aspiration of 350 cc hemorrhagic purulent fluid. Sample was
sent for microbiology evaluation.
|
10052992-RR-25 | 10,052,992 | 27,186,164 | RR | 25 | 2124-09-04 17:18:00 | 2124-09-04 18:00:00 | EXAMINATION: PORTABLE ABDOMEN
INDICATION: ___ year old man with percutaneous cholecystotomy for
cholecystitis, now with non-draining drain // Please evaluate for tube
malpositioning
TECHNIQUE: Portable radiographs of the abdomen
COMPARISON: Prior abdominal radiographs of ___.
FINDINGS:
The right upper quadrant pigtail catheter is coiled in the expected location
of the gallbladder. There is no evidence of tube kinking or fracture. There is
no intraperitoneal free air. There are no abnormally dilated loops of small or
large bowel. Osseous structures are unremarkable.
IMPRESSION:
Right upper quadrant pigtail catheter projects in the expected location of the
gallbladder without radiographic evidence of complication.
|
10052992-RR-77 | 10,052,992 | 21,083,113 | RR | 77 | 2128-10-19 16:59:00 | 2128-10-19 18:21:00 | EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: liver ultraousnd with dopplers.
TECHNIQUE: Gray scale, color, and spectral Doppler evaluation of the abdomen
was performed.
COMPARISON: CT abdomen pelvis ___.
FINDINGS:
Liver: Liver is diffusely nodular compatible with cirrhosis. The parenchyma
is markedly heterogeneous compatible with known malignancy. There are
multiple lesions, better evaluated on the recently performed CT abdomen
pelvis. A 2.8 cm anechoic cyst projects off the posterior aspect of the left
hepatic lobe, similar appearance to the prior CT. There is moderate volume
ascites.
Bile ducts: There is no intrahepatic biliary ductal dilation.
CHD: 5 mm
Gallbladder: The gallbladder is not well visualized.
Pancreas: The imaged portion of the pancreas appears within normal limits,
with portions of the pancreatic tail obscured by overlying bowel gas.
Spleen: The spleen demonstrates normal echotexture. The spleen measures 13.1
cm. 3.4 cm soft tissue nodule adjacent to the splenic parenchyma corresponds
to an accessory spleen seen on the prior CT.
Kidneys: No stones, masses, or hydronephrosis are identified in either kidney.
Right kidney: 10.7 cm
Left kidney: 10.1 cm
Doppler evaluation:
There is nonocclusive thrombus in the main portal vein with reversal of flow.
Main portal vein velocity is 12.2 cm/sec.
The right and left portal veins are patent. There is reversal of normal flow
in the right portal vein. There is appropriate directional flow in the left
portal vein.
The main hepatic artery is patent, with appropriate waveform.
Right, middle and left hepatic veins are patent, with appropriate waveforms.
Splenic vein and superior mesenteric vein are patent, with antegrade flow.
IMPRESSION:
1. Cirrhotic liver morphology with heterogeneous echotexture and multiple
masses compatible with known malignancy. These masses are better evaluated on
the previously performed CT abdomen pelvis.
2. Nonocclusive thrombus in the main portal vein with reversal flow. Main
portal vein velocity is 12.2 cm/s.
3. Reversal of normal directional flow in the right portal vein. There is
appropriate directional flow in the left portal vein.
4. Moderate volume ascites in all 4 abdominal quadrants.
5. Splenomegaly.
|
10053000-RR-15 | 10,053,000 | 28,772,209 | RR | 15 | 2160-11-23 16:21:00 | 2160-11-23 16:59:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ with leukocytosis vague upper abdominal pain// ?pneumonia
COMPARISON: ___
FINDINGS:
PA and lateral views of the chest provided. Linear density in the left lower
lung is similar to prior and may reflect the presence of atelectasis or
scarring. There is no consolidation concerning for pneumonia. No large
effusion or pneumothorax. No signs of edema. Cardiomediastinal silhouette is
normal. Imaged bony structures are intact. Partially visualized hardware at
the left shoulder noted.
IMPRESSION:
As above.
|
10053000-RR-16 | 10,053,000 | 28,772,209 | RR | 16 | 2160-11-23 16:38:00 | 2160-11-23 17:48:00 | EXAMINATION: CT abdomen pelvis
INDICATION: NO_PO contrast; History: ___ with RLQ and LLQ abdominal pain and
tendemnressNO_PO contrast// ?appendicitis ?diverticulitis
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were
acquired through the abdomen and pelvis following intravenous contrast
administration with split bolus technique.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Stationary Acquisition 4.0 s, 0.5 cm; CTDIvol = 19.3 mGy (Body) DLP =
9.6 mGy-cm.
2) Spiral Acquisition 6.6 s, 51.6 cm; CTDIvol = 10.1 mGy (Body) DLP = 518.2
mGy-cm.
Total DLP (Body) = 528 mGy-cm.
COMPARISON: None.
FINDINGS:
LOWER CHEST: Mild dependent atelectasis bilaterally. No pleural or
pericardial effusion.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There is no evidence of focal lesions. There is no evidence of intrahepatic
or extrahepatic biliary dilatation. The gallbladder is 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.
There is no evidence of concerning focal renal lesions or hydronephrosis.
There is no perinephric abnormality. Simple cyst in lower pole the right
kidney measures up to 1.3 cm. Left-sided parapelvic cysts are noted.
GASTROINTESTINAL: Small hiatal hernia. Stomach is otherwise unremarkable.
Small bowel loops demonstrate normal caliber, wall thickness, and enhancement
throughout. There is fat stranding and wall thickening of an approximately 6
cm segment of the ascending colon where there are numerous diverticula.
Adjacent to this there is a 1.9 x 1.9 cm area of phlegmonous change and small
foci of extraluminal air suggesting microperforation (02:49). No drainable or
focal fluid collection. The appendix is normal.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: Prostate gland is enlarged. Seminal vesicles are
unremarkable.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease
is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
Mild compression deformity of the T11 vertebral body is of indeterminate age.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits. Patient
appears to be status post bilateral inguinal hernia repair.
IMPRESSION:
1. Acute diverticulitis of the ascending colon with a 1.9 cm area of
phlegmonous changes and extraluminal foci of air suggesting microperforation.
No drainable or focal fluid collection.
2. Mild compression deformity of the T11 vertebral bodies of indeterminate
age.
|
10053139-RR-3 | 10,053,139 | 26,871,759 | RR | 3 | 2179-05-08 17:04:00 | 2179-05-08 20:36:00 | EXAMINATION: CTA PANCREAS (ABDOMEN AND PELVIS)
INDICATION: ___ year old woman with painless jaundice, head of pancreas
obscured on RUQUS at ___// r/o pancreatic cancer
TECHNIQUE: Abdomen and pelvis CTA: Non-contrast and multiphasic post-contrast
images were acquired through the abdomen and pelvis.
DOSE: Acquisition sequence:
1) Spiral Acquisition 7.3 s, 47.2 cm; CTDIvol = 18.8 mGy (Body) DLP = 874.5
mGy-cm.
Total DLP (Body) = 875 mGy-cm.
COMPARISON: None.
FINDINGS:
VASCULAR:
There is no abdominal aortic aneurysm. There is moderate 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. There
is no evidence of focal lesions. A biliary stent is in place. There is mild
intrahepatic biliary ductal dilatation, and few foci of air within the biliary
tree. The common bile duct is dilated, measuring up to 1.3 cm, with abrupt
cutoff in the pancreatic head (05:40). Gall bladder is distended. The wall
is not thickened. Hyperdense content suggests presence of stones or sludge
within the gall bladder lumen.
PANCREAS: The pancreatic body and tail are atrophic. The main pancreatic duct
is dilated, measuring up to 8 mm, with abrupt cutoff within the pancreatic
head (05:36). A side branch in the uncinate process is dilated to 5 mm
(05:42). There is a 6 mm hypodensity in the pancreatic head, just anterior to
the stent (03:45). No discrete masses visible, but these finding suggest
presence of an occult pancreatic masses causing biliary and pancreatic ductal
obstruction. There is no peripancreatic stranding. There is no vascular
involvement.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
There are bilateral renal cysts, measuring up to 1.5 cm in the interpolar
region of the right kidney and 2.2 cm in the interpolar region of the left
kidney, as well as additional bilateral subcentimeter hypodensities too small
to characterize by CT. There are also peripheral striations to the nephrogram
of each kidney suggesting either acute or chronic parenchymal disease versus
fairly uniform bilateral appearance of scarring. There is no renal stenosis.
There is no evidence of stones or hydronephrosis. There are no urothelial
lesions in the kidneys or ureters. There is no perinephric abnormality.
GASTROINTESTINAL: 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.
There are few prominent lymph nodes, for example, a hepatic artery lymph node
measuring 8 mm (03:30) and a porta hepatis lymph node measuring 8 mm (03:43).
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
evidence of pelvic or inguinal lymphadenopathy. There is no free fluid in the
pelvis.
REPRODUCTIVE ORGANS: Calcifications are noted within the uterus, likely
representing degenerated fibroids.
BONES: There is a mild anterior compression deformity of L2. There are
moderate multilevel degenerative changes. No suspicious bone lesions are
found.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. Mild intrahepatic biliary dilatation, and dilation of the CBD, with abrupt,
within the pancreatic head, with biliary stent in place, as well as dilation
of the main pancreatic duct and of a pancreatic side branch in the uncinate
process, also with abrupt cutoffs in the pancreatic head. Findings are highly
suggestive of an otherwise occult pancreatic head mass. There is no evidence
of local invasion or metastatic disease.
2. Mild anterior compression deformity of L2 is likely chronic.
|
10053207-RR-69 | 10,053,207 | 29,999,444 | RR | 69 | 2199-12-14 14:47:00 | 2199-12-14 15:20:00 | CHEST, TWO VIEWS: ___
HISTORY: ___ female with cough and abdominal pain.
COMPARISON: ___.
FINDINGS: Frontal and lateral views of the chest. Prior right-sided central
venous catheter is no longer visualized. Low lung volumes are again noted.
There is, however, new opacity at the right lung base. Somewhat linear left
basilar opacity is seen suggestive of atelectasis versus scarring. There is
no large effusion. Cardiomediastinal silhouette is essentially unchanged. No
acute osseous abnormality is identified. Moderately distended loops of bowel
seen below the abdomen.
IMPRESSION: Right basilar opacity likely due to at least some atelectasis,
noting that infection is also possible. Distended loops of bowel visualized
in the upper abdomen for which clinical correlation suggested regarding need
for additional imaging.
|
10053207-RR-70 | 10,053,207 | 29,999,444 | RR | 70 | 2199-12-14 16:54:00 | 2199-12-14 17:44:00 | HISTORY: Distended bowel on chest radiograph.
TECHNIQUE: Supine and upright AP views of the abdomen.
COMPARISON: Abdominal radiographs ___ and ___.
FINDINGS:
There is markedly distended air-filled loops of large bowel diffusely, as seen
on the prior radiographs from ___. The small bowel loops are
normal in caliber. No free intraperitoneal air is seen. Clips in the right
upper quadrant indicate prior cholecystectomy. No acute osseous abnormalities
seen. Elevation of the right hemidiaphragm is again noted.
IMPRESSION:
Diffuse gaseous distention of the colon. Appearances are similar compared to
the prior radiographs from ___. Findings may be suggestive of
chronic pseudoobstruction, but if there is continued concern, CT is
recommended. No small bowel obstruction.
|
10053207-RR-71 | 10,053,207 | 29,999,444 | RR | 71 | 2199-12-14 19:43:00 | 2199-12-14 20:38:00 | INDICATION: Fever, tachycardia, abdominal pain and distended bowel loops.
Evaluate for intra-abdominal process.
COMPARISON: Multiple prior abdominal radiographs, including radiograph
performed approximately three hours prior to this exam as well as radiograph
from ___ and ___.
TECHNIQUE: Axial helical MDCT images were obtained from the lung bases
through the pubic symphysis without administration of IV or oral contrast.
Coronal and sagittal reformations were generated.
DLP: 918 mGy-cm.
FINDINGS: There is a consolidation in the posterior right lung base with some
air bronchograms which may represent atelectasis, although inflammatory or
infectious processes cannot be excluded. There are no pleural effusions.
With the exception of mild coronary artery calcification, the imaged heart and
pericardium are unremarkable.
CT ABDOMEN: The non-enhanced appearance of the liver is within normal limits,
without evidence of intrahepatic biliary duct dilatation. The patient is
status post cholecystectomy. The pancreas and spleen are normal in
appearance. The right adrenal gland is within normal limits while there is a
2.4 x 1.7 cm nodule in the left adrenal gland (2:25) with an average
attenuation of 20 Hounsfield units. The kidneys appear abnormal, with a
significant amount of perinephric stranding bilaterally, left worse than
right, but no nephrolithiasis. No focal renal masses are seen allowing for
limitation of this non-contrast exam. There may be mild urothelial thickening
of the left proximal ureter which is also mildly prominent.
The small bowel is within normal limits. The large bowel is diffusely dilated
to the level of the anus, measuring up to 6 cm in the transverse colon, and
there is no evidence of a transition point. Fluid in the colon is compatible
with history of diarrhea. No bowel wall thickening is present. There is no
retroperitoneal or mesenteric lymphadenopathy. Atherosclerotic calcifications
of the aorta is present, but the aorta is non-aneurysmal. Patency of the main
intra-abdominal vessels cannot be assessed in this non-contrast CT. There is
no ascites, abdominal free air or abdominal wall hernia.
PELVIC CT: The urinary bladder is decompressed by a Foley catheter. The left
ureter distally is mildly prominent with mild adjacent stranding, but with no
calculi. The right distal ureter is normal. There is no pelvic free fluid.
There is no pelvic wall or inguinal lymphadenopathy.
OSSEOUS STRUCTURES: There are no lytic or blastic lesions concerning for
malignancy. There is grade 1 anterolisthesis of L4 on L5 with multilevel
degenerative changes noted in the lumbar spine.
IMPRESSION:
1. Perinephric stranding, left worse than right, is non-specific, but
pyelonephritis cannot be excluded. Additionally, the left proximal ureter is
mildly prominent with urothelial thickening, a finding that can also be seen
with infection.
2. Consolidation in the posterior aspect of the right lower lobe may be
secondary to atelectasis but infectious or inflammatory processes cannot be
excluded.
3. Diffuse mild colonic dilatation without wall thickening or evidence of
obstruction may be secondary to chronic pseudo-obstruction, particularly as
prior abdominal radiographs have shown a diffusely distended colon. Fluid in
the colon is compatible with a history of diarrhea.
4. Left adrenal nodule which does not meet strict criteria for an adenoma,
but in the absence of prior malignancy is likely benign. Consider follow up
adrenal CT or MRI in 12 months.
|
10053782-RR-10 | 10,053,782 | 22,388,958 | RR | 10 | 2156-06-05 05:38:00 | 2156-06-05 07:26:00 | EXAMINATION: MR HEAD W AND W/O CONTRAST
INDICATION: ___ year old woman with new cerebellar bleed, likely underlying
mass seen on CT. Left leg weakness, total body akinesia. Please evaluate for
tumor/mets in the brain and any other brain pathology.
TECHNIQUE: MRI of the brain was performed using sagittal T1, axial T1,
gradient echo, FLAIR, T2, diffusion with ADC map, and postcontrast axial T1.
Postcontrast sagittal MPRAGE with coronal and axial reformats were reviewed.
COMPARISON: CT head dated ___
FINDINGS:
Motion artifact partially degrades the study.
The left cerebellar hemorrhage measures 2.9 x 2.0 cm and exerts mild mass
effect upon the left aspect of the fourth ventricle, without evidence of
upward transtentorial herniation, tonsillar herniation, or obstructive
hydrocephalus. Scattered foci of susceptibility in the right caudate,
bilateral thalami, left globus pallidus, and within the occipital horns of the
lateral ventricles bilaterally are indicative of prior hemorrhage, and
intraventricular extension of the current hemorrhage, respectively. There is
no evidence of a mass underlying the left cerebellar hemorrhage, however the
blood products may obscure small underlying masses, and re-evaluation can be
obtained after resolution of hemorrhage. No mass lesions are seen elsewhere.
No enlarged flow voids are seen in the region of the left cerebellar
hemorrhage. No diffusion abnormality to indicate infarct. Ventricles and sulci
are mildly prominent, indicative of atrophy. The dural venous sinuses enhance
normally.
The calvaria display normal signal intensity. The paranasal sinuses, mastoid
air cells, and middle ear cavities are largely clear.
IMPRESSION:
1. Left cerebellar hemispheric hemorrhage with mild mass effect on the fourth
ventricle, but no evidence of hydrocephalus or herniation,
2. No definite underlying mass or evidence of cerebral venous thrombosis.
3. No large flow voids in the region of the hemorrhage to indicate a large
underlying vascular malformation.
Re-evaluation can be performed after resolution of blood products, which may
require ___ weeks. However, given the scattered foci of susceptibility
representing micro-bleeds, in quite typical locations, hypertensive hemorrhage
is the likely etiology of both current and previous hemorrhage.
NOTIFICATION: Findings were discussed with Dr. ___ By Dr. ___
telephone at ___ on
___.
|
10053782-RR-12 | 10,053,782 | 22,388,958 | RR | 12 | 2156-06-06 14:31:00 | 2156-06-06 19:44:00 | EXAMINATION: CTA HEAD WANDW/O C AND RECONS
INDICATION: ___ year old woman with L cerebellar hemorrhage // please eval
for aneurysm, cavernoma
TECHNIQUE: Contiguous axial images were obtained through the brain without
contrast material. Subsequently, rapid axial imaging was performed through the
brain with intravenous contrast material. Images were processed on a separate
workstation with display 3D volume rendered images, and maximum intensity
projection images.
DOSE: DLP: 1647.59 mGy-cm; CTDI: 158.6 mGy
COMPARISON: CT head ___.
FINDINGS:
Head CT: When compared to prior exam, there is stable appearance of left
cerebellar intraparenchymal hematoma which causes mild mass effect on the
fourth ventricle. There is no evidence of hydrocephalus or herniation. There
is a small amount of hemorrhage layering within the posterior horns of the
lateral ventricles. There is no evidence of new intracranial hemorrhage.
There is moderate brain parenchymal volume loss. The orbits and paranasal
sinuses are unremarkable.
Head an CTA: There is no evidence of aneurysm, hemodynamically significant
stenosis, or pathologic large arterial vessel occlusion within the vasculature
of the head. Intracranial atheromatous calcifications are noted. The left
transverse sinus is not well seen but was well visualized on post gadolinium
MR images indicating this to be on the basis of a small hypoplastic left
transverse sinus, The dural venous sinuses otherwise appear normal.
IMPRESSION:
1. Stable left cerebellar intraparenchymal hematoma with layering
intraventricular hemorrhage within the posterior horns of the lateral
ventricles.
2. No evidence of new intracranial hemorrhage or mass effect.
3. No evidence of hemodynamically significant stenosis or aneurysm within the
arterial vasculature of the head.
|
10053782-RR-13 | 10,053,782 | 22,388,958 | RR | 13 | 2156-06-07 11:35:00 | 2156-06-07 15:53:00 | INDICATION: ___ year old woman with stroke , c/f pancreatic cancer w mets
TECHNIQUE: Axial MDCT images were obtained through the abdomen and pelvis
following the administration of 130 cc of Omnipaque intravenous contrast
material and oral contrast material. Reformatted coronal and sagittal images
were obtained.
DOSE: DLP: mGy-cm.
CTDIvol: mGy.
COMPARISON: None available
FINDINGS:
THORAX: The visualized lung bases show bilateral dependent atelectasis but
are otherwise clear with no pleural effusions, pneumothorax or focal
opacities. The visualized heart and pericardium are within normal limits.
LIVER: The liver enhances homogeneously with no focal lesions. The portal and
hepatic veins are patent, and mild intrahepatic biliary duct dilation is
compatible with post cholecystectomy status.
GALLBLADDER: The patient is status post cholecystectomy.
SPLEEN: The spleen is normal in size and shape.
PANCREAS: The pancreas enhances homogeneously without focal lesions or
peripancreatic fat stranding.
ADRENALS: The adrenal glands are normal in size and shape.
KIDNEYS: The kidneys are normal in size and shape. The kidneys have
appropriate contrast enhancement and excretion bilaterally. There is no
hydronephrosis or perinephric stranding. Bilateral renal hypodensities are
compatible with renal cysts
BOWEL: There is a small hiatal hernia, and the stomach is minimally distended
and not well evaluated. The small bowel is without obstruction or focal wall
thickening. The appendix is not visualized, but there are no secondary
findings to suggest appendicitis. The large bowel contains feces without wall
thickening or evidence of obstruction. Diverticulosis is noted without
evidence of diverticulitis. There is no intraperitoneal free air or free
fluid.
LYMPH NODES: There are no pathologically enlarged retroperitoneal or
mesenteric lymph nodes by CT size criteria.
PELVIS: The bladder is decompressed with a Foley catheter in place. There is
no pelvic free fluid. There are no pathologically enlarged pelvic sidewall or
inguinal lymph nodes by CT size criteria. The rectum is unremarkable.
VESSELS & SOFT TISSUE: There is extensive atherosclerotic disease without
aneurysmal dilatation of the abdominal aorta. The aorta and its major branches
are patent. There are no hernias.
BONES: There are no suspicious lytic or sclerotic osseous lesions to suggest
malignancy. Degenerative changes are noted most prominent at L5-S1.
IMPRESSION:
1. No evidence of focal pancreatic lesion.
2. Diverticulosis without diverticulitis.
|
10053782-RR-14 | 10,053,782 | 22,388,958 | RR | 14 | 2156-06-08 19:09:00 | 2156-06-09 17:15:00 | EXAMINATION: MR cervical, thoracic, lumbar spine without intravenous contrast
INDICATION: ___ year old woman with LLE weakness, hx spine dz // ?arthritis,
?herniated disc
TECHNIQUE: MRI of the cervical, thoracic, and lumbar spine were obtained
without administration of intravenous contrast.
COMPARISON: MRI head ___.
FINDINGS:
CERVICAL SPINE: The vertebral body height and alignment is maintained. There
is a normal curvature. Marrow signal is heterogeneous but there is no
suspicious signal abnormality. Intervertebral discs are diffusely desiccated.
The posterior elements and paraspinal soft tissues are normal.
C2-C3: There is no disc herniation. There is no spinal canal or foraminal
stenosis.
C3-C4: There is a central disc protrusion causing mild spinal canal stenosis.
There is no significant foraminal stenosis.
C4-C5: There is no disc herniation. There is no spinal canal or foraminal
stenosis.
C5-C6: There is no disc herniation. There is no spinal canal or foraminal
stenosis.
C6-C7: There is a disc osteophyte complex causing mild spinal canal stenosis.
There is no significant foraminal stenosis.
C7-T1: There is no disc herniation. There is no spinal canal or foraminal
stenosis.
The cervical spinal cord demonstrates normal signal intensity and morphology.
The left cerebellar hemorrhage and surrounding edema are not significantly
changed from MRI on ___. The fourth ventricle is normal in size.
The cerebellar tonsils are normal in position.
THORACIC SPINE: The thoracic spine has normal vertebral body height and
alignment. There are scattered vertebral body low-flow venous malformations
(formerly, "hemangiomas"). There is no suspicious marrow signal abnormality.
Intervertebral discs are diffusely desiccated. There is no disc herniation, or
spinal canal or neural foraminal stenosis. The thoracic spinal cord and conus
medullaris have normal morphology and signal intensities. There are
subperineural cysts at a few levels, the largest, a 9 mm cyst at T9-10 on the
right. The posterior elements are normal.
LUMBAR SPINE: The vertebral body height and alignment is maintained. There is
a low-flow venous malformation (formerly, "hemangioma") in the L1 vertebral
body. The regional bone marrow otherwise has a normal signal intensity. There
is disc desiccation and disc space narrowing at L5-S1.
T12-L1: There is no significant spinal canal or foraminal stenosis.
L1-L2: There is no significant spinal canal or foraminal stenosis.
L2-L3: There is congenital spinal canal stenosis due to a narrow interlaminal
distance. There is no significant foraminal stenosis.
L3-L4: There is a disc bulge, facet arthropathy, and ligamentum flavum
thickening superimposed on congenital spinal canal stenosis. There is overall
moderate spinal canal stenosis. There is moderate bilateral foraminal
stenosis.
L4-L5: There is a disc bulge and facet hypertrophy. There is moderate to
severe subarticular zone stenosis impinging the traversing bilateral L5 nerve
roots, right greater than left. There is no significant foraminal stenosis.
L5-S1: There is a disc bulge. There is facet arthropathy. There is moderate
bilateral foraminal stenosis.
The conus medullaris is normal in appearance and position, terminating at L1.
There is a sacral subperineural cyst.
Incidentally noted are multiple renal cysts.
IMPRESSION:
1. Degenerative disc and joint disease of the lumbar spine superimposed on
congenital spinal canal stenosis. This is most severe at L4-5, where there is
impingement of the traversing L5 nerve roots, right more than left.
2. No disc herniation in the thoracic spine.
3. Small disc herniations at C3-4 and C6-7, without cord contact.
4. Left cerebellar hemorrhage, incompletely imaged but not significantly
changed from recent MRI on ___.
|
10053782-RR-8 | 10,053,782 | 22,388,958 | RR | 8 | 2156-06-04 12:23:00 | 2156-06-04 14:31:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: History: ___ with c/o gen weakness // ? PNA // ? PNA
TECHNIQUE: Chest PA and Lateral
COMPARISON: None
FINDINGS:
Low lung volumes contribute to crowding of the bronchovascular structures as
well as bibasilar atelectasis. There are no focal consolidations worrisome for
pneumonia. Cardiac size is borderline enlarged given the low lung volumes. No
pneumothorax. No pulmonary edema. No free air.
IMPRESSION:
Bibasilar atelectasis in the setting of low lung volumes.
|
10053782-RR-9 | 10,053,782 | 22,388,958 | RR | 9 | 2156-06-04 13:15:00 | 2156-06-04 13:29:00 | EXAMINATION:
CT HEAD W/O CONTRAST
INDICATION: History: ___ with worsening weakness/lethargy with absence of any
evidence of illness/metabolic disorder. No focal neuro findings. // Please
evaluate for CVA.
TECHNIQUE: Routine unenhanced head CT was performed and viewed in brain,
intermediate and bone windows. Coronal and sagittal reformats were also
performed.
DOSE: DLP: 891 mGy-cm; CTDI: 52 mGy
COMPARISON: None.
FINDINGS:
There is acute hemorrhage in the left cerebellum with surrounding vasogenic
edema. The area of hemorrhage measures approximately 2.8 x 1.6 cm. Additional
hemorrhage is seen layering in the occipital horns of the lateral ventricles
bilaterally. Surrounding mass effect and vasogenic edema effaces the fourth
ventricle however there is no evidence of hydrocephalus out of proportion to
the patient's global atrophy. There is no loss of gray-white matter
differentiation. No fractures are identified. Scattered white-matter
hypodensities are the sequela of chronic small vessel ischemic disease.
Visualized paranasal sinuses demonstrate minimal ethmoid air cell
opacification. The mastoid air cells are clear.
IMPRESSION:
Acute left cerebellar intraparenchymal hemorrhage with surrounding edema.
Small amount of hemorrhage layering within the lateral ventricles. Mild
effacement of the fourth ventricle without hydrocephalus.Underlying mass is
not excluded on this study and can be further evaluated with an MRI.
|
10053810-RR-32 | 10,053,810 | 26,647,692 | RR | 32 | 2164-09-13 02:17:00 | 2164-09-13 04:54:00 | EXAMINATION: MR HEAD W AND W/O CONTRAST T___ MR HEAD
INDICATION: ___ year old woman with mass vs bleed, ams// mass vs bleed, ams
TECHNIQUE: Sagittal and axial T1 weighted imaging were performed. After
administration of 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: CTA head neck dated ___
CT head without contrast dated ___.
FINDINGS:
A 4 x 4.5 x 2.3 cm intra-axial heterogeneously T2 hyperintense lesion is seen
in the left cerebellar hemisphere demonstrating internal hemorrhage, internal
restricted diffusion and subtle enhancing foci folia. Trace surrounding edema
is seen with minimal mass effect on the left inferior cerebellar peduncle.
Mass effect on the fourth ventricle is identified.
The ventricles and sulci are prominent, consistent with global cerebral
volume loss. No definite hydrocephalus. Moderate to severe periventricular
T2 hyperintensities are most consistent with chronic microvascular angiopathy.
A small left mastoid effusion is seen. The paranasal sinuses, right mastoid
air cells and bilateral middle ear cavities are clear. The patient is status
post bilateral cataract surgery.
IMPRESSION:
1. 4 x 5 x 2.3 cm left cerebellar hemisphere focus of diffusion and gradient
echo susceptibility artifact, felt to be most compatible with late acute
infarct in hemorrhagic transformation. Associated linear foci of enhancement,
predominantly located within the cerebellar folia is felt to be secondary to
luxury perfusion rather than nodular enhancement of underlying mass lesion.
2. Associated edema pattern results in mass effect and mild effacement of the
fourth ventricle. No definite evidence of hydrocephalus. The size of the
ventricles are unchanged from outside hospital examination of ___.
3. Recommend repeat MRI head with without contrast in approximately 1 month to
document stability or resolution of linear enhancement to exclude underlying
lesion.
4. Additional findings as described above.
|
10053810-RR-33 | 10,053,810 | 26,647,692 | RR | 33 | 2164-09-14 15:06:00 | 2164-09-14 16:48:00 | EXAMINATION: BTCPS SPECTRO AND PERF TUMOR CLINIC PROTOCOL T7713 MR HEAD
INDICATION: ___ year old woman with left dysmetria// characterization of mass,
tumor vs. infectious vs. infarct
TECHNIQUE: Axial ASL, ASL perfusion, and MR spectroscopy was performed.
Single and multi voxel MR spectroscopy was performed utilizing a TE of .
Voxels were placed over the area of concern. The examination was performed
using a 3.0T MRI scanner.
COMPARISON: ___ brain MRI
FINDINGS:
Again seen is cerebellar abnormality on T1 postcontrast images, stable since
yesterday.
ASL Perfusion: There is decreased perfusion in the left inferior cerebellar
hemisphere corresponding to the left cerebellar hemisphere infarct identified
on brain MRI 1 day prior..
MR Spectroscopy: Relatively preserved spectroscopy pattern, no evidence of
tumor spectra.
IMPRESSION:
Findings consistent with left cerebellar infarct.
|
10054622-RR-19 | 10,054,622 | 20,480,182 | RR | 19 | 2155-05-07 09:29:00 | 2155-05-07 10:16:00 | EXAMINATION: PELVIS, NON-OBSTETRIC
INDICATION: ___ w/ SAB. Evaluate for retained placenta. Most fetal tissue has
passed.// ___ w/ SAB. Evaluate for retained placenta. Most fetal tissue has
passed.
TECHNIQUE: Grayscale ultrasound images of the pelvis were obtained with
transabdominal approach followed by transvaginal approach for further
delineation of uterine and ovarian anatomy.
COMPARISON: Pelvic ultrasound ___.
FINDINGS:
The uterus is anteverted. Previously noted gestational sac and fetus are no
longer present. The endometrial cavity is distended with heterogeneous
echogenic material, with vascularized products seen posteriorly at the level
of the uterine body, measuring at least 5.3 x 3.8 cm in transverse ___,
compatible with vascularized retained products of conception. In addition,
there is heterogeneous echogenic material without vascularity in the
endocervical canal concerning for blood products.
Small amount of free fluid in the pelvis. Normal ovaries bilaterally.
IMPRESSION:
Findings consistent with vascularized retained products of conception
measuring at least 5.3 x 3 8 cm in transverse ___ with additional
echogenic blood products in the endocervical canal. Small amount of free
fluid.
|
10054622-RR-20 | 10,054,622 | 20,480,182 | RR | 20 | 2155-05-07 13:07:00 | 2155-05-07 14:25:00 | EXAMINATION: Intraoperative ultrasound.
INDICATION: ___ year old woman with retained products of conception undergoing
D C// eval of retained tissue
TECHNIQUE: Intraoperative ultrasound guidance within the abdomen.
COMPARISON: Ultrasound examination from ___.
FINDINGS:
Intraoperative ultrasound guidance was provided during a D&C. A small
subcentimeter focus of blood or products of conception were identified within
the uterine fundus initially. Following curettage x 2, no vascularized
products of conception were identified. Trace blood products within the
endometrial cavity were present.
Please see the operative notes for further details.
IMPRESSION:
Intraoperative ultrasound guidance during D&C.
|
10054634-RR-10 | 10,054,634 | 25,928,444 | RR | 10 | 2181-01-28 10:10:00 | 2181-01-28 11:47:00 | EXAMINATION: DX CHEST PORTABLE PICC LINE PLACEMENT
INDICATION: ___ year old man with PICC// Pt had a L PICC,47.5cm ___ ___
Contact name: ___: ___
IMPRESSION:
In comparison with the study ___, there has been placement of a left
subclavian PICC line that extends to the midportion of the SVC. Otherwise, no
interval change and no evidence of acute cardiopulmonary disease.
|
10054634-RR-6 | 10,054,634 | 25,928,444 | RR | 6 | 2181-01-23 15:01:00 | 2181-01-23 15:56:00 | EXAMINATION:
Chest: Frontal and lateral views
INDICATION: History: ___ with c/o gen body aches and had positive cocci Bld
Cx x 2 so sent to find source// ? PNA
TECHNIQUE: Chest: Frontal and Lateral
COMPARISON: None.
FINDINGS:
The lungs are clear without focal consolidation. No pleural effusion or
pneumothorax is seen. The cardiac and mediastinal silhouettes are
unremarkable.
IMPRESSION:
No acute cardiopulmonary process.
|
10054634-RR-7 | 10,054,634 | 25,928,444 | RR | 7 | 2181-01-23 15:36:00 | 2181-01-23 16:19:00 | EXAMINATION:
CT HEAD W/O CONTRAST
INDICATION: History: ___ with fever, myalgias positive blood cultures//
assess for mass assess for mass
TECHNIQUE: Noncontrast enhanced MDCT images of the head were obtained.
Reformatted coronal and sagittal images were also obtained.
DOSE Acquisition sequence:
1) Sequenced Acquisition 16.0 s, 16.5 cm; CTDIvol = 48.6 mGy (Head) DLP =
802.7 mGy-cm.
Total DLP (Head) = 803 mGy-cm.
COMPARISON: None.
FINDINGS:
There is no evidence of acute intracranial hemorrhage, midline shift, mass
effect, or acute large vascular territory infarct. Gray-white matter
differentiation is preserved. There is no hydrocephalus. The visualized
paranasal sinuses demonstrate opacification of bilateral ethmoid air cells.
There is mucosal thickening of the very partially imaged right maxillary
sinus. The sphenoid sinuses are underpneumatized.. There is partial
opacification inferior right mastoid air cells. The majority of the right
mastoid air cells are clear. The left mastoid air cells are clear. No acute
fracture is seen.
IMPRESSION:
No acute intracranial process.
Partially imaged paranasal sinuses demonstrate bilateral ethmoid air cell
opacification.
|
10054639-RR-57 | 10,054,639 | 28,464,531 | RR | 57 | 2139-02-27 10:55:00 | 2139-02-27 11:05:00 | HISTORY: ___ female with hemoptysis.
COMPARISON: ___.
FINDINGS:
PA and lateral views of the chest. The lungs remain clear without
consolidation, effusion or edema. Mid thoracic dextroscoliosis again noted.
Cardiomediastinal silhouette is unchanged.
IMPRESSION:
No acute cardiopulmonary process.
|
10054639-RR-58 | 10,054,639 | 28,464,531 | RR | 58 | 2139-02-27 11:04:00 | 2139-02-27 13:10:00 | HISTORY: History of giant cell arteritis, with hemoptysis. Evaluation for
mass or bleeding source.
TECHNIQUE: MDCT images were obtained from the suprasternal notch to the upper
abdomen after the administration of intravenous contrast. Reformatted coronal
and sagittal images were reviewed.
COMPARISON: Comparison is made to CT of the torso from ___.
FINDINGS:
CT CHEST WITH IV CONTRAST: There is there is an ascending aortic aneurysm,
which measures a 5.1 cm in maximal diameter, slightly increased since the
prior study, when it measured approximately 4.9 cm in greatest maximal
diameter. The aneurysm originates at the aortic root and decreases in caliber
between the origins of the innominate artery and the left subclavian artery.
Note is made of a common origin of the innominate and left common carotid
arteries. The descending aorta is normal in caliber and somewhat tortuous.
There is no evidence of aortic dissection. The central pulmonary arteries are
patent. There is no evidence of filling defects within the main, left, right,
lobar, segmental or subsegmental pulmonary arteries. No focal opacity is
identified within the lungs. There is evidence of biapical scarring and
centrilobular emphysematous changes. There is no pleural or pericardial
effusion. The airways are patent to the subsegmental level bilaterally.
There is no supraclavicular, mediastinal or hilar lymph node enlargement by CT
size criteria. The thyroid enhances homogeneously.
Although the study is not intended for evaluation of intra-abdominal
structures, a subcentimeter hypodensity in the posterior right lobe of the
liver (2:44) is again seen, and is not significantly changed since the prior
study from ___. Otherwise, the solid intra-abdominal organs are
unremarkable. Note is made of a soft atheromatous plaque within the abdominal
aorta, at the level of the hiatus.
OSSEOUS STRUCTURES: No lytic or blastic lesions suspicious for malignancy is
present.
IMPRESSION:
1. No evidence of pulmonary embolism or other finding to explain the patient's
symptoms of hemoptysis.
2. Potentially slightly enlarged ascending aortic aneurysm, with no evidence
of dissection.
|
10054639-RR-59 | 10,054,639 | 28,464,531 | RR | 59 | 2139-03-01 13:49:00 | 2139-03-01 16:54:00 | HISTORY: ___ female with presumed head and neck primary malignancy.
COMPARISON: Multiple prior exams, including ___ chest CT and ___ MRI MRA brain.
TECHNIQUE: Routine enhanced MDCT images were obtained of the neck from the
orbits to the aortic arch using. Axial images were interpreted in conjunction
with coronal and sagittal reformats.
FINDINGS:
There is asymmetric soft tissue density along the left aspect of the lower
nasopharynx (2: 34). The oropharynx, trachea, and imaged portion of the
esophagus are unremarkable. No fluid or rim enhancing collection.
The parotid glands, submandibular glands, and thyroid gland are unremarkable.
There is mild thickening of the right maxillary sinus with small aerosolized
secretion. No lymphadenopathy is present by CT size criteria. The visualized
lung apices are clear.
Ascending aortic aneurysm, measuring up to 5.0 cm, similar to ___.
Tortuosity of the internal carotid arteries bilaterally is similar to ___. An infundibulum at the origin of the right posterior communicating
artery is also similar to prior. No significant stenosis or occlusion is
appreciated.
IMPRESSION:
1. Asymmetric soft tissue density along the left aspect of the lower
nasopharynx, of uncertain etiology. Direct visualization is recommended.
2. Ascending aortic aneurysm, similar to prior.
3. Infundibulum of the origin of the right posterior communicating artery,
similar to prior.
|
10054639-RR-61 | 10,054,639 | 29,496,424 | RR | 61 | 2139-04-04 13:11:00 | 2139-04-04 13:37:00 | INDICATION: ___ female with syncope. Evaluate heart size.
COMPARISON: ___.
TECHNIQUE: PA and lateral chest radiograph.
FINDINGS: The lungs are well expanded and clear. The cardiac and mediastinal
silhouettes are stable. There is no pleural effusion or pneumothorax.
Moderate dextroscoliosis centered in the mid thoracic spine is unchanged.
IMPRESSION: No evidence of acute cardiopulmonary process.
|
10054992-RR-12 | 10,054,992 | 25,004,394 | RR | 12 | 2125-02-19 13:35:00 | 2125-02-19 13:49:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ with mania, diagnosed with bipolar very late in life,
hallucinations. Evaluate for intracranial lesion.
TECHNIQUE: Routine unenhanced head CT was performed and viewed in brain,
intermediate and bone windows. Coronal and sagittal reformats were also
performed.
DOSE: Total DLP (Head) = 803 mGy-cm.
COMPARISON: None.
FINDINGS:
There is no intra-axial or extra-axial hemorrhage, edema, shift of normally
midline structures, or evidence of acute major vascular territorial
infarction. Ventricles and sulci are normal in overall size and configuration.
There is a mucus retention cyst in the left maxillary sinus with thickening of
the lateral wall of the left maxilla suggesting chronic inflammation. The
remaining imaged paranasal sinuses are clear. Mastoid air cells and middle ear
cavities are well aerated. The bony calvarium is intact.
IMPRESSION:
No acute intracranial process.
|
10054992-RR-13 | 10,054,992 | 25,004,394 | RR | 13 | 2125-02-20 18:44:00 | 2125-02-21 08:53:00 | EXAMINATION: MR HEAD W AND W/O CONTRAST T___ MR HEAD
INDICATION: ___ year old woman with questioned prior of bipolar disorder, now
with rapidly progressive paranoia, and confusion for 2 months. Evaluate for
intracranial mass or lesion.
TECHNIQUE: Sagittal and axial T1 weighted imaging were performed. After
administration of 5 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: ___ noncontrast head CT.
FINDINGS:
Study is mildly degraded by motion. There is no evidence of hemorrhage,
edema, masses, mass effect, midline shift or infarction. There is prominence
of the ventricles and sulci suggestive involutional changes. Few subcortical
T2 and FLAIR hyperintensities are noted. There is no abnormal enhancement
after contrast administration. The major vascular flow voids are preserved.
There is partial opacification of the mastoid air cells. Mucosal thickening
with an air-fluid levels noted in the left maxillary sinus. Mild mucosal
thickening of the ethmoid sinuses seen. There is a 0.9 cm Tornwaldt cyst
versus mucous retention cyst in the posterior nasopharynx. The orbits and
visualized soft tissues are otherwise normal. Nonspecific bilateral mastoid
fluid is present.
Degenerative changes are noted in the upper cervical spine.
IMPRESSION:
1. Study is mildly degraded by motion.
2. No acute intracranial abnormality.
3. Few scattered white matter signal abnormalities, likely secondary to
chronic microvascular ischemic changes.
4. Air-fluid level in the left maxillary sinus, which may represent acute
sinusitis.
|
10055072-RR-14 | 10,055,072 | 21,137,288 | RR | 14 | 2119-03-07 19:07:00 | 2119-03-08 08:53:00 | CHEST RADIOGRAPH
INDICATION: Assessment for free air and ileus.
COMPARISON: ___.
FINDINGS: No evidence of free intraperitoneal air. Minimally dilated,
gas-filled loops of small bowel are seen in the upper abdomen on two of the
four images obtained later in the study. The two images obtained three
minutes earlier do not depict the distended loops, making it unlikely that
these represent normal transit of gas as opposed to an obstruction or ileus.
The gas pattern in the colon is normal and there is residual contrast in the
ascending portion. The double-J biliary stent is present. There are
cholecystectomy clips overlaying the liver.
|
10055072-RR-15 | 10,055,072 | 21,137,288 | RR | 15 | 2119-03-07 19:08:00 | 2119-03-08 08:55:00 | CHEST RADIOGRAPH
INDICATION: Status post ERCP, assessment of free air.
COMPARISON: ___.
FINDINGS: As compared to the previous radiograph, there is no relevant change
of the chest x-ray. No free subdiaphragmatic air. Multiple linear opacities
reflecting atelectasis. Low lung volumes. No pneumonia. No pleural
effusions. No pneumothorax.
|
10055694-RR-45 | 10,055,694 | 26,718,205 | RR | 45 | 2116-10-21 16:15:00 | 2116-10-21 17:19:00 | CHEST, TWO VIEWS: ___
HISTORY: ___ female with shortness of breath, immunosuppression.
Question pneumonia.
FINDINGS: PA and lateral views of the chest are compared to previous exam
from ___.
Given differences in positioning and technique, there has been no significant
interval change. There is engorgement of the central pulmonary vasculature
with indistinctness of the vessels peripherally, not significantly changed
from prior. There is no new confluent consolidation or pleural effusion.
Cardiac silhouette is enlarged but stable compared to prior.
IMPRESSION: No significant interval change since prior.
|
10055694-RR-46 | 10,055,694 | 26,718,205 | RR | 46 | 2116-10-21 21:16:00 | 2116-10-21 23:15:00 | INDICATION: Patient with renal transplant with elevated creatinine.
COMPARISONS: Renal ultrasound exam of ___.
FINDINGS:
The transplant kidney in the right lower quadrant measures 10.8 cm. There is
mild calyceal dilatation in the upper pole. The corticomedullary
differentiation is well preserved. The transplant kidney appears normal in
echotexture.
COLOR DOPPLER AND SPECTRAL ANALYSIS: Limited. Main renal artery and main
renal vein appear patent. The waveforms obtained were varied and unreliable
aside from a single waveform obtained in the mid pole (per sonographer) which
demonstrates brisk systolic upstroke with a resistive index value of 0.81.
IMPRESSION: Mild upper pole caliceal dilatation. No frank hydronephrosis.
Suboptimal Doppler analysis. Resistive index in the mid pole is minimally
elevated measuring 0.81. Close ultrasound followup exam is recommended.
|
10055694-RR-47 | 10,055,694 | 26,718,205 | RR | 47 | 2116-10-24 11:02:00 | 2116-10-24 13:45:00 | PA AND LATERAL CHEST, ___
HISTORY: ___ woman with cough and low-grade fevers on
immunosuppressants.
IMPRESSION: PA and lateral chest compared to ___ through ___.
Mild pulmonary edema has improved since ___ and ___, but the heart is
still severely if not chronically enlarged and hilar vessels are also
chronically dilated. There is no appreciable pleural effusion.
|
10055694-RR-64 | 10,055,694 | 25,049,824 | RR | 64 | 2118-07-21 11:00:00 | 2118-07-21 12:05:00 | HISTORY: Cough and hypoxia question pneumonia.
COMPARISON: ___.
FINDINGS:
Single frontal radiograph of the chest demonstrates enlarged cardiac
silhouette, increased compared to the prior. There is pulmonary vascular
congestion and mild pulmonary edema. Opacities in the bilateral mid lungs
could represent atelectasis or edema although a superimposed infectious
process is also possible. No large pleural effusions. No pneumothorax.
IMPRESSION:
Increased cardiomegaly with signs of volume overload. Opacities in the
bilateral mid lungs could represent atelectasis or edema; however,
superimposed infection is possible.
Telephone notification to Dr. ___ by Dr ___ at 11:45 on ___, 2
min after review
|
10055694-RR-66 | 10,055,694 | 25,049,824 | RR | 66 | 2118-07-22 07:56:00 | 2118-07-22 10:29:00 | REASON FOR EXAMINATION: Evaluation of the patient with COPD and diastolic
congestive heart failure with pulmonary edema.
Ap chest radiograph.
Since the prior study, there is progression of pre-existing pulmonary vascular
congestion and upper zone re-distribution with currently added interstitial
opacities, bronchial wall thickening and thickening of the minor fissure. No
interval increase in pleural effusion demonstrated, and no pneumothorax is
seen.
|
10055694-RR-67 | 10,055,694 | 25,049,824 | RR | 67 | 2118-07-22 09:02:00 | 2118-07-22 11:12:00 | HISTORY: End-stage renal disease status post renal transplant with projection
now presenting with acute decompensated heart failure requiring dialysis.
Evaluate transplanted kidney.
TECHNIQUE: Renal transplant ultrasound with Doppler.
COMPARISON: Renal transplant ultrasound ___.
FINDINGS: Transplanted kidney is seen in the right lower quadrant. The
transplant measures 11.5 cm, similar to prior. There is no hydronephrosis or
perinephric fluid collection. The renal sinus fat is normal in echogenicity
and the cortical thickness is unchanged. There is no nephrolithiasis or mass.
Doppler: The flow within the main renal artery and upper, mid and lower
intraparenchymal renal arteries shows a high resistance flow with reversal
during end diastole. As such, resistive indices are not applicable. The main
renal vein is patent.
IMPRESSION:
1. High resistance flow is consistent with transplant dysfunction.
2. No hydronephrosis.
|
10055694-RR-68 | 10,055,694 | 25,049,824 | RR | 68 | 2118-07-24 07:33:00 | 2118-07-24 13:48:00 | AP CHEST, 8:30 A.M., ___
HISTORY: A ___ woman with end-stage renal disease, CHF and RSV
infection.
IMPRESSION: AP chest compared to ___, 8:18 a.m.:
The widespread, asymmetric pulmonary opacification, still responsible for a
consolidation in the right upper lobe, and now more so at the right lung base.
What was probably concurrent pulmonary edema in the left lung has improved.
Small right pleural effusion has increased. Severe cardiomegaly persists,
although another indication of improved cardiac function is a decrease in
mediastinal venous engorgement. No pneumothorax.
|
10055694-RR-73 | 10,055,694 | 22,141,743 | RR | 73 | 2120-10-12 05:49:00 | 2120-10-12 06:09:00 | INDICATION: ___ woman with dyspnea, evaluate for pneumonia.
TECHNIQUE: AP chest radiograph.
COMPARISON: None available.
FINDINGS:
There is at least moderate enlargement of the cardiac silhouette. The
mediastinal contours are within normal limits. The hila are unremarkable.
Bilateral airspace opacities with a central predominance likely reflects
pulmonary vascular congestion and mild pulmonary edema, although superimposed
infection is difficult to exclude in the appropriate clinical setting. There
is no pneumothorax or pleural effusion.
IMPRESSION:
Bilateral airspace opacities with a central predominance likely reflect
pulmonary vascular congestion and mild pulmonary edema. Difficult to exclude
superimposed infection in the appropriate clinical setting.
|
10055694-RR-74 | 10,055,694 | 22,141,743 | RR | 74 | 2120-10-12 06:51:00 | 2120-10-12 09:41:00 | EXAMINATION: CTA chest
INDICATION: ___ with chest pain radiating to the back
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) = 221 mGy-cm.
COMPARISON: CT chest without contrast from ___
FINDINGS:
The thoracic aorta is normal in course and caliber with minimal
atherosclerotic calcification and widely patent major branches. No dissection
or aneurysm. The heart is moderately enlarged with biatrial enlargement. No
pericardial effusion. Main pulmonary artery is normal in caliber with normal
opacification of the pulmonary arterial tree and without filling defect to
suggest the presence of a pulmonary embolism. Innumerable mediastinal lymph
nodes are present which appear mildly enlarged, increased from the prior exam.
These nodes measure up to 12 mm in short axis. There is associated
infiltration of the mediastinal fat. Findings are of indeterminate etiology.
The airways centrally patent.
Peribronchovascular thickening likely due to central congestion. Scattered
areas of ground-glass opacity within the lungs most compatible with pulmonary
edema. There is band like consolidation in the superior segment of the left
lower lobe which is consistent with pneumonia. There is a tiny right pleural
effusion. The imaged thyroid is unremarkable.
In the visualized portion of the upper abdomen, ascites is noted.
Bones: The bones appear diffusely sclerotic likely reflecting renal
osteodystrophy.
Body wall: There is mild body wall edema.
IMPRESSION:
1. Mild pulmonary edema.
2. Cardiomegaly, moderate with biatrial chamber enlargement.
3. Innumerable mediastinal lymph nodes, mildly enlarged, indeterminate,
difficult to exclude lymphoma or other etiologies. Clinical correlation is
advised.
4. No pulmonary embolism or acute aortic dissection.
5. Partially visualized abdominal ascites.
|
10055694-RR-75 | 10,055,694 | 22,141,743 | RR | 75 | 2120-10-15 08:09:00 | 2120-10-15 11:20:00 | EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ year old woman with transaminitis, abd pain // Eval for
change in liver parenchyma, ductal dilation
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: CT abdomen pelvis dated ___ and a recent abdominal
ultrasound dated ___
FINDINGS:
LIVER: There is hepatomegaly as before. The hepatic parenchyma appears
slightly heterogeneous and coarsened. The contour of the liver is mildly
lobular. There is no focal liver mass. The main portal vein is patent with
hepatopetal flow. Prominent hepatic veins. There is trace ascites.
BILE DUCTS: There is no intrahepatic biliary dilation. The CHD measures 0.3
cm.
GALLBLADDER: The gallbladder is surgically absent.
PANCREAS: The pancreas is not well visualized, largely obscured by overlying
bowel gas.
SPLEEN: Normal echogenicity, measuring 13.2 cm.
KIDNEYS: Nonvisualized kidneys, atrophied on the most recent CT dated ___.
RETROPERITONEUM: Visualized portions of aorta and IVC are within normal
limits.
IMPRESSION:
1. Enlarged liver along with a dilated IVC and hepatic veins is concerning for
underlying fluid overload. This may also be seen in right heart failure.
2. Slightly heterogeneous and coarsened liver echotexture. No focal lesions.
No intrahepatic biliary ductal dilation.
3. Trace ascites.
|
10055694-RR-81 | 10,055,694 | 24,232,904 | RR | 81 | 2121-03-03 12:09:00 | 2121-03-03 14:55:00 | INDICATION: ___ with c/o prod cough and SOB with hypotension // ? PNA
TECHNIQUE: Single portable view of the chest.
COMPARISON: ___.
FINDINGS:
There is moderate cardiomegaly as on prior. Engorged hila and indistinct
pulmonary vascular markings suggest pulmonary edema. Given differences in
technique and positioning this is not significantly changed. No acute osseous
abnormalities. Surgical clips project over the left upper extremity.
IMPRESSION:
Mild pulmonary edema. No focal consolidation.
|
10055694-RR-82 | 10,055,694 | 24,232,904 | RR | 82 | 2121-03-03 14:57:00 | 2121-03-03 15:59:00 | EXAMINATION: CT ABD AND PELVIS WITH CONTRAST
INDICATION: ___ female with cirrhosis and ESRD (status post
transplant, now dialysis dependent), now presenting with abdominal pain and
melena.
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired
through the abdomen and pelvis following administration of 130 cc of
Omnipaque.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Total DLP (Body) = 807 mGy-cm.
COMPARISON: Noncontrast CT abdomen and pelvis ___, renal
transplant ultrasound ___
FINDINGS:
LOWER CHEST: Streaky bibasilar opacities likely represent atelectasis. There
is also heterogeneous ground-glass attenuation at the lung bases, which may
represent expiratory air trapping. Trace right pleural effusion is noted.
The heart is moderately enlarged.
ABDOMEN:
HEPATOBILIARY: The liver is enlarged, with a nodular contour. There is no
evidence of focal lesions. There is no evidence of intrahepatic or
extrahepatic biliary dilatation. The gallbladder is surgically absent.
Portal venous system is patent.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right adrenal gland is normal in size and shape. There is
nodularity of the left adrenal gland, incompletely characterized on this
contrast-enhanced exam, but statistically an adenoma.
URINARY: The native kidneys are atrophic, and contain innumerable parenchymal
cysts. Right lower quadrant transplant kidney is abnormal in appearance, with
loss of normal corticomedullary differentiation. It measures 9.5 cm in
length, previously up to 12 cm on the transplant ultrasound dated ___.
There is no hydronephrosis.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. There is
prominent intramural fat in the cecum and ascending colon, which can be seen
in the setting of chronic inflammation. Remainder of the colon and rectum are
unremarkable in appearance. Appendix is not identified. There is a moderate
amount of nonhemorrhagic ascites. No pneumoperitoneum.
PELVIS: Urinary bladder is collapsed.
REPRODUCTIVE ORGANS: Uterus is grossly unremarkable in appearance. There is
abnormal soft tissue prominence in the bilateral adnexa, right greater than
left. Right adnexal soft tissues spans an area of 5.1 x 2.4 cm (601b:43).
Left adnexa measures approximately 4.2 x 1.8 cm.
LYMPH NODES: There are multiple para-aortic lymph nodes, measuring up to a 6
mm in short axis (02:41). A right common iliac node measures up to 1 cm
(02:46), enlarged since prior previously 6 mm. There is no pelvic or inguinal
lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic
disease is noted.
BONES: No fracture. Osseous structures are diffusely sclerotic, suggestive
of renal osteodystrophy. Mild-to-moderate degenerative changes and noted
throughout the thoracolumbar spine.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits. A left
iliopsoas intramuscular lipoma is seen (2:88).
IMPRESSION:
1. Abnormal soft tissue prominence in the bilateral adnexa,
right-greater-than-left. Recommend correlation with prior clinical history
(including prior fallopian tube exploration?) and cytology results from recent
paracentesis. If results are nondiagnostic, an MRI of the pelvis with IV
contrast should be considered to exclude underlying malignancy, especially in
light of enlarged retroperitoneal lymph nodes.
2. Cirrhotic liver morphology.
3. Moderate amount of nonhemorrhagic ascites.
4. Prominent intramural fat in the cecum and ascending ___ reflect
chronic inflammation.
5. Right lower quadrant transplanted kidney is abnormal in appearance ;
atrophic with loss of normal corticomedullary differentiation.
6. Renal osteodystrophy.
RECOMMENDATION(S): Correlation with clinical history and cytology results.
Consider pelvis MRI for further evaluation.
NOTIFICATION: Updated findings and recommendation were discussed with ___
___, M.D. by ___, M.D. on the telephone on ___ at 4:13 ___, 5
minutes after discovery of the findings.
|
10055694-RR-94 | 10,055,694 | 26,271,755 | RR | 94 | 2121-09-22 08:45:00 | 2121-09-22 09:38:00 | EXAMINATION: Chest radiograph
INDICATION: History: ___ with ESRD on ED, missed today's dialysis session//
Please eval for pulmonary edema
TECHNIQUE: Chest PA and lateral
COMPARISON: ___ portable chest radiograph
FINDINGS:
The lungs are well expanded. There is diffuse interstitial opacity
bilaterally with prominence and cephalization of pulmonary vasculature and
slight blunting of the right costophrenic angle suggesting interstitial
pulmonary edema and small right pleural effusion. Linear atelectasis is also
noted in the right and left lung bases.There is no focal area of consolidation
nor pneumothorax seen. Heart remains stably enlarged. The cardiac and
mediastinal silhouette are unremarkable.
IMPRESSION:
1. Mild-to-moderate pulmonary vascular congestion, diffuse bilateral
interstitial edema, and trace right pleural effusion suggest volume overload.
2. Bilateral linear atelectasis.
|
10055694-RR-95 | 10,055,694 | 26,271,755 | RR | 95 | 2121-09-23 09:44:00 | 2121-09-23 14:20:00 | EXAMINATION: Ultrasound-guided therapeutic paracentesis.
INDICATION: ___ w/ PMH of ESRD s/p failed renal transplant on HD, AFib, COPD
on 3L O2, CHF, pulmonary HTN, cryptogenic cirrhosis, presents with ulceration
over her AV fistula.// therapeutic paracentesis. Patient was scheduled as an
outpatient for q2 week paracentesis, but was then admitted for fistula
revision
TECHNIQUE: Ultrasound guided therapeutic paracentesis.
COMPARISON: Paracentesis from ___.
FINDINGS:
Limited grayscale ultrasound imaging of the abdomen demonstrated moderate
ascites. A suitable target in the deepest pocket in the left lower quadrant
was selected for paracentesis.
PROCEDURE: The procedure, risks, benefits and alternatives were discussed
with the patient and written informed consent was obtained.
A preprocedure time-out was performed discussing the planned procedure,
confirming the patient's identity with 3 identifiers, and reviewing a
checklist per ___ protocol.
Under ultrasound guidance, an entrance site was selected and the skin was
prepped and draped in the usual sterile fashion. 1% lidocaine was instilled
for local anesthesia.
A 5 ___ catheter was advanced into the largest fluid pocket in the left
lower quadrant and 4 L of clear, straw-colored ascitic fluid were removed.
The patient tolerated the procedure well without immediate complication.
Estimated blood loss was minimal.
Dr. ___ personally supervised the trainee during the key components of
the procedure and reviewed and agrees with the trainee's findings.
IMPRESSION:
Technically successful ultrasound-guided therapeutic paracentesis, yielding 4
L of clear, straw-colored ascitic fluid.
|
10056223-RR-100 | 10,056,223 | 24,549,272 | RR | 100 | 2122-05-23 12:20:00 | 2122-05-23 12:53:00 | INDICATION: ___ male with cough. Evaluate for evidence of pneumonia.
COMPARISON: Multiple chest radiographs, most recent on ___.
TECHNIQUE: PA and lateral chest radiograph.
FINDINGS: The lungs are poorly inflated, accounting for some bronchovascular
crowding and minimal bibasilar atelectasis. No parenchymal consolidation is
noted. Cardiomediastinal and hilar contours are unremarkable. There is no
pleural effusion or pneumothorax. Old right rib fractures are seen. Clips are
noted in the right upper quadrant of the abdomen.
IMPRESSION: Low lung volumes with minimal bibasilar atelectasis.
|
10056223-RR-101 | 10,056,223 | 24,549,272 | RR | 101 | 2122-05-24 08:15:00 | 2122-05-24 08:50:00 | STUDY: FOUR-QUADRANT ULTRASOUND.
INDICATION: Assess for ascites.
TECHNIQUE: Four-quadrant ultrasound was performed.
REPORT:
There is evidence of ascites.
CONCLUSION:
No ascites.
|
10056223-RR-105 | 10,056,223 | 25,591,002 | RR | 105 | 2122-07-09 13:41:00 | 2122-07-09 15:40:00 | HISTORY: Hep C/alcoholic cirrhosis and HCC status post TACE presenting with
fullness, loss of appetite and 3 days of weakness. Question portal vein
thrombosis.
TECHNIQUE: Grayscale, color and spectral Doppler ultrasound images of the
abdomen were obtained.
COMPARISON: Liver ultrasound ___, MR abdomen ___.
FINDINGS:
There is redemonstration of course, nodular echotexture of the liver with a
small to moderate ascites as well as a recannulized umbilical vein, compatible
with patient's known diagnosis of cirrhosis. Post TACE changes in the right
lobe of the liver are similar in appearance to prior ultrasound study and are
better evaluated on prior MR. ___ is no intrahepatic biliary duct
dilatation. The common bile duct was not visualized. The main portal vein is
patent with slow hepatopetal flow without evidence of thrombosis. The hepatic
veins are patent. The gallbladder is surgically absent. The study was
limited by technique and evaluation of the portal venous branches was limited.
The pancreas is not well visualized due to overlying bowel gas. There is
redemonstration of persistent splenomegaly measuring 14.1 cm.
IMPRESSION:
1. Patent main portal vein without evidence of thrombosis.
2. Coarse liver echotexture, small to moderate ascites, splenomegaly and
recannulized umbilical vein, compatible with known diagnosis of cirrhosis.
3. Similar appearance of right hepatic lesions consistent with changes from
prior TACE and better evaluated on prior MR.
|
10056223-RR-106 | 10,056,223 | 25,591,002 | RR | 106 | 2122-07-10 15:30:00 | 2122-07-10 16:11:00 | PA AND LATERAL CHEST ___
COMPARISON: Chest x-ray of ___.
FINDINGS: Lung volumes are low. Cardiomediastinal contours are within normal
limits allowing for this factor. Lungs and pleural surfaces are clear.
Multiple healed right rib fractures are present.
IMPRESSION: Low lung volumes. No evidence of pneumonia. If symptoms
persist, repeat radiograph with improved inspiratory level may be helpful for
more complete evaluation of the lung bases.
|
10056223-RR-111 | 10,056,223 | 23,527,958 | RR | 111 | 2122-08-28 21:34:00 | 2122-08-28 23:05:00 | INDICATION: ___ man with head pain status post fall with head strike,
here to evaluate for acute intracranial injury.
COMPARISON: Non-contrast head CT last performed on ___.
TECHNIQUE: MDCT-acquired axial images were obtained through the head without
intravenous contrast. Coronally and sagittally reformatted images as well as
thin section images in a bone window algorithm were generated and reviewed.
FINDINGS: There is no evidence of acute intracranial hemorrhage, edema, mass
effect or shift of normally midline structures. The gray-white matter
interface is preserved without evidence of acute major vascular territorial
infarct. The ventricles and sulci are normal in size and configuration for
the patient's age. The orbits and globes are unremarkable. The right
maxillary sinus is completely opacified with a few foci of air and hyperdense
material contained within it, which has progressed from the most recent prior
CT of ___. The remainder of the visualized paranasal sinuses, middle ear
cavities and mastoid air cells are clear bilaterally. The bony calvaria
appear intact. An 8 mm sclerotic and well-circumscribed lesion in the left
vertex (3:51) is unchanged from the prior CT and most likely represents a bone
island.
IMPRESSION:
1. No acute intracranial process.
2. Complete opacification of the right maxillary sinus with hyperdense
material likely represent sinusitis, possibly acute on chronic. Hyperdense
material may represent inspissated secretions or fungal colonization but
unlikely hemorrhage as there is no focal trauma according to the clinician.
NOTIFICATION: Findings were discussed by Dr. ___ with Dr. ___
telephone at 10:10 p.m. on ___.
|
10056223-RR-112 | 10,056,223 | 23,527,958 | RR | 112 | 2122-08-28 22:04:00 | 2122-08-28 22:58:00 | INDICATION: ___ male with weakness, here to evaluate for pneumonia.
COMPARISON: Chest radiograph dated ___.
TECHNIQUE: Portable upright AP radiograph of the chest.
FINDINGS: The inspiratory lung volumes remain low. As a result, the
cardiomediastinal and bronchovascular structures are accentuated. The heart
demonstrates a left ventricular configuration as before and the thoracic aorta
remains tortuous. No focal consolidation concerning for pneumonia is
identified. There is no pleural effusion or pneumothorax. Chronic rib
deformities are unchanged related to prior fracture.
IMPRESSION:
1. No focal consolidation concerning for pneumonia.
2. Unchanged healed rib fractures.
|
10056223-RR-68 | 10,056,223 | 28,021,043 | RR | 68 | 2121-11-11 21:03:00 | 2121-11-11 22:52:00 | EXAM: RIGHT UPPER QUADRANT ULTRASOUND.
CLINICAL INFORMATION: ___ with worsening mental status, history of
cirrhosis, question portal vein obstruction.
COMPARISON: Reference made to prior MRI abdomen from ___ and
prior CT abdomen and pelvis from ___ as well as ultrasound from
___.
FINDINGS: The liver is coarsened in echotexture consistent with the patient's
history of cirrhosis. In the right lobe of the liver, there is an echogenic
focus measuring at least 2.2 cm, which likely corresponds to known RFA site.
Additionally, along the medial right lobe of the liver, there is an additional
1.5 cm echogenic focus, unclear whether intra- or extra-hepatic with no clear
correlate seen on recent prior MRI or CT. The patient is status post
cholecystectomy. The main portal vein is patent with hepatopetal flow. The
common bile duct is not identified. The pancreas is obscured by overlying
bowel gas.
The umbilical vein is recanalized.
IMPRESSION:
1. Patent main portal vein with hepatopetal flow. Recanalized umbilical
vein.
2. Echogenic focus in the right lobe of the liver, most likely correlates to
patient's RFA site. Additional 1.5 cm echogenic focus along the medial edge
of the right lobe of the liver, difficult to discern whether intra- or
extra-hepatic, no clear correlate on recent prior CT/MRI. Correlate with
nonurgent, multiphase CT or MRI for better characterization.
3. Status post cholecystectomy. Common bile duct not identified.
|
10056223-RR-69 | 10,056,223 | 28,021,043 | RR | 69 | 2121-11-12 08:57:00 | 2121-11-12 11:28:00 | INDICATION: ___ man with HCV/ETOH cirrhosis and HCC, presenting with
worsening abdominal pain and AMS. Evaluation for pulmonary process.
COMPARISONS: Comparison is made to radiograph of the chest from ___.
FINDINGS: PA and lateral views of the chest demonstrate low lung volumes,
accounting for apparent atelectasis at the lung bases. There is no focal
pneumonia, pleural effusion, or evidence of pneumothorax. Remote right rib
fractures are again seen. The cardiomediastinal silhouette is unremarkable.
CONCLUSION: No acute cardiopulmonary disease.
|
10056223-RR-70 | 10,056,223 | 28,021,043 | RR | 70 | 2121-11-12 10:55:00 | 2121-11-12 11:22:00 | INDICATION: ___ man with HCV and alcoholic cirrhosis, status post
TACE and RFA, now with worsening abdominal pain, unable to tap at the bedside
due to lack of fluid pocket. Evaluate for SBP.
COMPARISON: Liver and gallbladder ultrasound ___,
LIMITED ABDOMINAL ULTRASOUND: Limited abdominal ultrasound of the four
quadrants demonstrate no evidence of ascites.
IMPRESSIN: No evidence of ascites.
|
10056223-RR-71 | 10,056,223 | 28,021,043 | RR | 71 | 2121-11-12 20:27:00 | 2121-11-13 10:12:00 | INDICATION: Cirrhosis, HCC, new liver lesion seen on ultrasound. Post-RF
ablation to lesion within segment VI/VII and chemoembolization to segment
II/III lesion.
TECHNIQUE: Multiplanar T1- and T2-weighted imaging was performed on a 1.5 T
magnet, prior to, during, and subsequent to the uneventful intravenous
administration of 0.1 mmol/kg of Gadavist (10 mL).
Comparison is made to previous MRI dated ___.
FINDINGS: Pre- and post-contrast T1-weighted imaging is degraded by motion
artifact.
There is bilateral gynecomastia. The lung bases are clear, no pleural
effusion.
The liver is of heterogeneous signal on T1- and T2-weighted imaging. It has a
diffusely nodular outline with atrophy of the right lobe and hypertrophy of
the caudate and left lobe consistent with cirrhosis. Diffuse T2 hyperintense
subcapsular reticulations which demonstrate progressive delayed enhancement
consistent with fibrotic subscapular retractions. The previously RF-ablated
lesion within segment VI/VII is of low signal on T1 weighted imaging and
heterogenous on T2-weighted imaging. It is unchanged in size measuring 3.3 x
1.3 cm.
There is patchy arterial enhancement along the margin of the ablation zone
which is unchanged in appearance and becomes isoenhancing to the liver on
delayed phase imaging. While this may represent perfusional variation it has
developed over the last number of months, however continued followup is
advised. No further areas of suspicious arterial enhancement.
Previous cholecystectomy noted with unchanged post-surgical changes in the
cholecystectomy bed. This may represent the hyperechoic area noted on the
recent ultrasound. No definite lesion seen in this region.
No intra- or extra-hepatic biliary dilatation. No intraductal filling
defects.
The hepatic and portal veins are patent. There is a replaced left hepatic
artery arising from the left gastric artery and a replaced right hepatic
artery arising from the superior mesenteric artery. There is a recanalized
umbilical vein with paraesophageal, gastrohepatic, epigastric, and left
splenorenal varices. The spleen measures 15.0 cm. Reactive subcentimeter
periportal and celiac nodes are also again noted.
The pancreas is slightly atrophic but remains of normal signal on T1- and
T2-weighted imaging. No pancreatic duct dilatation. No suspicious pancreatic
lesion.
Normal adrenal glands. The kidneys enhance symmetrically. No renal lesions
or hydronephrosis.
A lobulated 1.8-cm cystic lesion superior to the left renal vein is unchanged
in size. As previously noted, this is indeterminate in nature but remains
stable and likely represents a cystic lymphangioma. No ascites.
Normal signal within the visualized skeletal system. The visualized small and
large bowel are unremarkable.
IMPRESSION:
1. Stable size of the previously RF ablated lesion within the right lobe of
the liver. Perilesional hyperenhancement is again noted on a single arterial
phase which may be perfusional in nature; however, continued surveillance is
advised.
2. No lesions suspicious for hepatocellular carcinoma.
3. Features consistent with cirrhosis and portal hypertension.
4. Replaced left hepatic artery arising from the left gastric artery and
replaced right hepatic artery arising from the superior mesenteric artery.
5. Stable left retroperitoneal cystic lesion, likely lymphangioma.
|
10056223-RR-72 | 10,056,223 | 28,021,043 | RR | 72 | 2121-11-15 10:05:00 | 2121-11-15 12:52:00 | INDICATION: History of episodes of neck stiffness, suspicion for meningitis,
failed bed side lumbar puncture.
OPERATORS: Dr. ___ (fellow), Dr. ___ physician). Dr
___ was present in the room and supervised the procedure.
ANESTHESIA: Local anesthesia was provided with 1% buffered lidocaine.
PROCEDURE AND FINDINGS: Written informed consent was obtained prior to the
procedure, explaining the risks, benefits and alternatives. The patient was
brought to the fluoroscopic suite and placed prone on the angiography table.
A preprocedure timeout was performed per ___ protocol.
Access to the lumbar subarachnoid space was obtained with a 22-gauge spinal
needle under local anesthesia with 1% lidocaine and aseptic precautions.
Access was obtained at the level of L3/L4. Approximately 16 cc of clear CSF
were collected. Needle was removed and bandage applied.
The patient tolerated the procedure well and there were no immediate
post-procedure complications.
IMPRESSION: Successful fluoroscopic-guided lumbar puncture yielding 16 cc of
clear CSF. Samples were sent for laboratory analysis as requested.
|
10056223-RR-74 | 10,056,223 | 21,531,192 | RR | 74 | 2121-12-16 19:05:00 | 2121-12-16 20:45:00 | CHEST RADIOGRAPH PERFORMED ON ___
___.
CLINICAL HISTORY: Chest pain.
FINDINGS: PA and lateral views were provided. The lungs volumes are low.
Allowing for this, the lungs are clear. No effusion, pneumothorax seen.
Cardiomediastinal silhouette is stable. No bony abnormalities are seen. Clip
in the right upper quadrant noted.
IMPRESSION: Limited, negative.
|
10056223-RR-75 | 10,056,223 | 21,531,192 | RR | 75 | 2121-12-16 19:10:00 | 2121-12-16 21:16:00 | INDICATION: Abdominal distention for two days. Assess for portal venous
thrombosis.
COMPARISONS: ___.
FINDINGS: The liver appears coarsened and heterogeneous in overall
echotexture, compatible with known history of cirrhosis. Hyperechoic focus
within the liver parenchyma (image #14), likely relates to patient's known RFA
site. There is no evidence of intrahepatic biliary ductal dilatation. The
CBD is of normal caliber measuring 4 mm. The main portal, left and right
portal veins are patent. The hepatic veins also appear patent with
appropriate waveforms. The portal veins demonstrating hepatopetal flow. The
gallbladder is surgically absent. The spleen is enlarged, measuring 16 cm.
There is no ascites.
IMPRESSION:
1. Coarse liver echotexture, compatible with patient's history of cirrhosis.
A hyperechoic area within the liver likely relates to patient's known RFA
site. Hepatic vasculature is patent.
2. Splenomegaly. No ascites.
|
10056223-RR-76 | 10,056,223 | 21,531,192 | RR | 76 | 2121-12-16 21:03:00 | 2121-12-17 00:55:00 | INDICATION: Increasing abdominal distention.
COMPARISON: Abdominal radiograph from ___, MR abdomen from ___, CT
abdomen/pelvis from ___.
ABDOMEN, AP: Small bowel loops are mildly distended up to 4 cm, with internal
air-fluid levels. However, air is present in the colon. No free air.
Cholecystectomy clips in the right upper quadrant. Visualized heart and lung
bases are within normal limits.
IMPRESSION: Prominent small bowel loops with air-fluid levels. Early or
partial small bowel obstruction cannot be excluded.
|
10056223-RR-89 | 10,056,223 | 25,634,906 | RR | 89 | 2122-02-25 22:24:00 | 2122-02-25 23:54:00 | INDICATION: Alcoholic cirrhosis, episode of hematemesis. Evaluation for
portal vein thrombosis.
TECHNIQUE: Right upper quadrant ultrasound.
COMPARISONS: ___.
FINDINGS: The liver is coarse and nodular in echotexture consistent with
known cirrhosis. No focal liver lesion is identified. The main portal vein
is patent and displays hepatopetal flow. The gallbladder is absent. There is
no intra- or extra-hepatic biliary ductal dilatation and the common bile duct
measures 3 mm. The spleen is enlarged measuring 14.4 cm. The whole liver and
pancreas are not well seen, likely due to overlying bowel gas and limited
acoustic windows. There is no ascites.
IMPRESSION:
1. Patent main portal vein with antegrade flow.
2. Cirrhosis.
3. Splenomegaly.
|
10056612-RR-44 | 10,056,612 | 26,462,956 | RR | 44 | 2189-08-28 17:02:00 | 2189-08-28 17:39:00 | EXAMINATION: CTA HEAD AND CTA NECK PQ147 CT HEADNECK
INDICATION: History: ___ with weakness, ataxia, headache c/w prior cva //
acute process
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) CT Localizer Radiograph
2) CT Localizer Radiograph
3) Sequenced Acquisition 6.4 s, 16.4 cm; CTDIvol = 54.7 mGy (Head) DLP =
897.1 mGy-cm.
4) Stationary Acquisition 6.0 s, 0.5 cm; CTDIvol = 65.3 mGy (Head) DLP =
32.7 mGy-cm.
5) Spiral Acquisition 4.9 s, 38.8 cm; CTDIvol = 32.0 mGy (Head) DLP =
1,241.9 mGy-cm.
Total DLP (Head) = 2,172 mGy-cm.
COMPARISON: MRI head with and without contrast from ___.
FINDINGS:
CT HEAD WITHOUT CONTRAST:
The previously seen enhancing lesion in the right inferior temporal lobe is
not well visualized on the CT scan.
Again seen are extensive confluent areas of hypodensity in the
periventricular, subcortical and deep white matter with vasogenic edema in the
right temporal lobe, and relatively unchanged compared to the prior MRI
allowing for the differences in technique. Please note that evaluation for an
acute infarct is markedly limited given these extensive hypodensities. MRI
can be performed for further evaluation as clinically indicated.
There is no evidence of no evidence of acute hemorrhage. The ventricles and
sulci are patent and prominent in keeping with age-related volume loss.
The visualized portion of the paranasal sinuses, mastoid air cells, and middle
ear cavities are clear. The visualized portion of the orbits are unremarkable.
CTA HEAD:
The vessels of the circle of ___ and their principal intracranial branches
appear normal without stenosis, occlusion or aneurysm formation. The dural
venous sinuses are patent.
CTA NECK:
There is a stent within the right common and proximal internal carotid artery
which appears patent. Also seen atherosclerosis involving the left carotid
bifurcation with soft and calcified plaque causing no stenosis by NASCET
criteria.
There is absence of flow in the right external carotid artery.
There is atherosclerosis involving the V2 segment of the left vertebral artery
with focal areas of mild luminal narrowing.
The carotid and vertebral arteries and their major branches appear otherwise
unremarkable with no evidence of occlusion.
OTHER:
There is a 9 mm nodule in the right upper lobe on image 5:28, unchanged
compared to the prior CT chest from ___. The thyroid gland is either
markedly atrophic or surgically absent. There is no lymphadenopathy by CT
size criteria.
Degenerative changes involving the visualized cervical spine.
Marked atherosclerosis involving the aortic arch with penetrating
atherosclerotic ulcer as seen on image 5:27. Further evaluation with
dedicated CT of the chest can be performed as clinically indicated.
IMPRESSION:
1. Extensive periventricular and subcortical white matter hypodensities,
relatively unchanged compared to the prior MRI allowing for the differences in
technique. Please note that evaluation for an underlying acute infarct is
limited given the extensive hypodensities. MRI of the brain can be performed
for further evaluation as clinically indicated.
2. Vasogenic edema in the inferior right temporal lobe. The previously known
enhancing lesion in the right temporal lobe is not well visualized on the CT
scan.
3. Patent right internal and common carotid artery stent.
4. Atherosclerosis involving the left carotid bifurcation without any stenosis
by NASCET criteria.
5. Atherosclerosis involving V2 segment of left vertebral artery causing focal
areas of mild luminal narrowing.
6. Stable 9 mm nodule in the right upper lobe. Further evaluation with
dedicated CT of the chest can be performed as clinically indicated.
|
10056612-RR-45 | 10,056,612 | 26,462,956 | RR | 45 | 2189-08-29 11:49:00 | 2189-08-29 15:32:00 | EXAMINATION: PELVIS (AP ONLY)
INDICATION: Recent fall with left hip pain.
TECHNIQUE: Single frontal view of the pelvis.
COMPARISON: ___.
FINDINGS:
No fracture or dislocation. Bilateral hip joint spaces are relatively well
preserved with only minimal degenerative change. Pubic symphysis and SI
joints are preserved. No radiopaque foreign body. Contrast is seen within
the bladder.
IMPRESSION:
No fracture or dislocation.
RECOMMENDATION(S): If there is persistent concern for fracture, CT or MRI
can be obtained
|
10056612-RR-46 | 10,056,612 | 23,069,501 | RR | 46 | 2189-11-11 13:13:00 | 2189-11-11 14:16:00 | EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ woman with intermittent slurred speech, known right
temporal lobe lesion, evaluate for acute intracranial process.
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, 16.5 cm; CTDIvol = 48.6 mGy (Head) DLP =
802.7 mGy-cm.
Total DLP (Head) = 803 mGy-cm.
COMPARISON: CTA head from ___ and MRI brain from ___.
FINDINGS:
There is no evidence of acute hemorrhage. An area of hypodensity is again
seen in the right temporal lobe compatible with vasogenic edema surrounding a
lesion, better assessed on prior MRI. Prominence of the ventricles and sulci
are compatible with global atrophy. Periventricular and subcortical white
matter hypodensities are present, nonspecific but likely reflect sequelae of
chronic small vessel ischemic disease. Calcifications in the basal ganglia
are present.
There is no evidence of fracture. The visualized portion of the paranasal
sinuses, mastoid air cells, and middle ear cavities are clear. The visualized
portion of the orbits are unremarkable. Atherosclerotic calcifications of the
bilateral carotid siphons are noted.
IMPRESSION:
1. No acute intracranial hemorrhage.
2. Hypodensity in the right temporal lobe compatible with vasogenic edema
surrounding the known lesion, which itself is not clearly seen on CT.
|
10056612-RR-58 | 10,056,612 | 24,412,612 | RR | 58 | 2191-01-01 17:19:00 | 2191-01-01 19:09:00 | EXAMINATION: MR HEAD W AND W/O CONTRAST T___ MR HEAD
INDICATION: ___ patient with laryngeal cancer and right temporal lobe
mass, presenting with headaches and hypertensive urgency. Evaluate for
intracranial metastasis.
TECHNIQUE: Sagittal and axial T1 weighted imaging were performed. After
administration of 6 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: MRI head ___, and CT head ___
FINDINGS:
There is a new small focus of restricted diffusion within the left posterior
inferior cerebellar hemisphere (502:6) with corresponding T2/FLAIR
hyperintensity, without associated hemorrhage or contrast enhancement,
consistent with an evolving acute or early subacute infarction.
The extra-axial mass along the floor of the right middle cranial fossa,
adjacent to the medial right temporal lobe, measures 0.7 cm TV x 1.3 cm AP x
0.9 cm SI, stable compared to ___ and ___.
There is a stable small area of leptomeningeal contrast enhancement and
leptomeningeal FLAIR hyperintensity in the medial right occipital lobe, images
10:15 and 7:15, which has been present dating back to ___.
Again seen are chronic infarcts within bilateral cerebellar hemispheres and
left pons. There is also unchanged diffuse T2 hyperintensity in bilateral
pons and bilateral middle cerebellar peduncles. There is extensive confluent
T2/FLAIR hyperintensity in the right temporal white matter, and in bilateral
frontal and parietal white matter, as well as multiple discontinuous areas of
T2 hyperintensity in the left temporal white matter, deep white matter, and
basal ganglia, unchanged compared to the recent prior studies, likely sequela
of post treatment changes and chronic small vessel ischemic changes.
There is unchanged global parenchymal volume loss with prominent ventricles
and sulci.
An unchanged punctate focus of susceptibility artifact is again seen within
the left putamen, consistent with a chronic microhemorrhage.
Again seen is a developmental venous anomaly within the left frontal lobe
(900:105). The major visualized arterial vascular flow voids are preserved.
Dural venous sinuses are patent on postcontrast MP RAGE images.
Again seen is a T1 hyperintense lesion within the left superior frontal
calvarium, likely a hemangioma (4:22, 900:125).
There is mild mucosal thickening of the ethmoid air cells. There is mild
partial right mastoid air cell opacification.
IMPRESSION:
1. New small evolving acute or early subacute infarct within the left
posterior inferior cerebellar hemisphere.
2. Stable enhancing extraaxial mass along the medial right temporal lobe.
3. Stable small area of leptomeningeal enhancement along the medial right
occipital lobe dating back to ___, etiology uncertain.
4. Stable chronic infarctions within bilateral cerebellar hemispheres and left
pons.
5. Stable extensive confluent white matter changes in right greater than left
temporal white matter, and bilateral frontal and parietal white matter, as
well as in the middle cerebellar peduncles and bilateral pons, likely a
combination of posttreatment changes and sequela of chronic small vessel
ischemic disease.
6. Stable left frontal developmental venous anomaly.
NOTIFICATION: The acute/early subacute infarct was discussed with ___,
___, M.D. by ___, M.D. on the telephone on ___ at
8:35 am, 2 minutes after discovery of the findings.
|
10056612-RR-59 | 10,056,612 | 24,412,612 | RR | 59 | 2191-01-05 16:21:00 | 2191-01-05 21:10:00 | EXAMINATION: MRV HEAD W/O CONTRAST T___ MR HEAD
INDICATION: History of laryngeal cancer with severe headaches of unclear
etiology. Evaluate for cerebral venous thrombosis.
TECHNIQUE: 3D phase-contrast MRV of the head was obtained. Sagittal T1
weighted imaging was performed. After administration of 6 mL of Gadavist
intravenous contrast, sagittal MPRAGE imaging was performed and re-formatted
in axial and coronal orientations. Three dimensional maximum intensity
projection and segmented images of the MRV were then generated. This report is
based on interpretation of all of these images.
COMPARISON: Multiple MR head examinations from ___ through ___.
CTA head and neck from ___.
Noncontrast head CTs from ___.
FINDINGS:
MRV:
Normal flow signal is demonstrated within the superior sagittal sinus,
straight sinus, transverse sinuses, and sigmoid sinuses. The jugular bulbs and
proximal jugular veins are patent. Evaluation of the deep venous systems
reveals normal flow signal in the internal cerebral veins. The vein ___
is also unremarkable.
PRE AND POSTCONTRAST T1 BRAIN IMAGING:
Dural venous sinuses are patent on postcontrast MP RAGE images.
13 x 7 mm enhancing extra-axial lesion of the right middle cranial fossa
posteriorly is unchanged (700:66). Previously noted subtle area of right
medial occipital leptomeningeal enhancement is not well appreciated on the
current examination, likely due to difference in timing. A left frontal
developmental venous anomaly is unchanged. No new enhancing lesion is
identified.
Re-identified are multiple areas of volume loss from chronic infarcts of the
right caudate head, left putamen, left pons and bilateral cerebellar
hemispheres. There is no significant mass effect or midline shift. There is
mild prominence of the ventricles and sulci suggestive of involutional change.
Confluent areas of periventricular, subcortical, deep and pontine white matter
T1 hypointensity, correspond to the FLAIR signal abnormality on the prior
examination, are nonspecific but likely the sequela of chronic small vessel
ischemic disease.
IMPRESSION:
1. No evidence of dural venous thrombosis.
2. Unchanged 13 x 7 mm enhancing right middle cranial fossa extra-axial
lesion.
3. Previously noted subtle area of right medial occipital leptomeningeal
enhancement is not well appreciated on the current examination, likely due to
difference in scan timing.
4. No new enhancing lesion.
5. Multiple chronic infarcts are again demonstrated in the basal ganglia and
posterior fossa.
6. Confluent areas of white matter signal abnormality are again seen,
nonspecific but likely sequela of chronic small vessel ischemic disease in
this age group.
|
10056612-RR-60 | 10,056,612 | 20,943,307 | RR | 60 | 2191-01-15 00:03:00 | 2191-01-15 06:58:00 | EXAMINATION:
Chest: Frontal and lateral views
INDICATION: History: ___ with dizziness, recent CVA// Acute process
TECHNIQUE: Chest: Frontal and Lateral
COMPARISON: Chest radiograph ___.
FINDINGS:
The lungs are clear without focal consolidation. No pleural effusion or
pneumothorax is seen. Heart is mildly enlarged. The aorta is diffusely
calcified and tortuous as seen on prior studies.
IMPRESSION:
No acute cardiopulmonary process.
|
10056612-RR-61 | 10,056,612 | 20,943,307 | RR | 61 | 2191-01-15 02:01:00 | 2191-01-15 04:59:00 | EXAMINATION: CTA HEAD AND CTA NECK Q16 CT NECK
INDICATION: ___ patient with headache and dizziness. Evaluate for
stroke and vascular patency.
TECHNIQUE: Contiguous MDCT axial images were obtained through the brain
without contrast material. Subsequently, helically acquired rapid axial
imaging was performed from the aortic arch through the brain during the
infusion of 70 mL of Omnipaque intravenous contrast material.
Three-dimensional angiographic volume rendered, curved reformatted and
segmented images were generated on a dedicated workstation. This report is
based on interpretation of all of these images.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 16.0 s, 16.0 cm; CTDIvol = 50.2 mGy (Head) DLP =
802.7 mGy-cm.
2) Stationary Acquisition 4.5 s, 0.5 cm; CTDIvol = 98.0 mGy (Head) DLP =
49.0 mGy-cm.
3) Spiral Acquisition 5.1 s, 40.0 cm; CTDIvol = 31.0 mGy (Head) DLP =
1,242.4 mGy-cm.
Total DLP (Head) = 2,094 mGy-cm.
COMPARISON: MR head ___, CTA head and neck ___
FINDINGS:
CT HEAD WITHOUT CONTRAST:
There is no evidence of intracranial hemorrhage. There is evolution of
previously seen left posterior inferior cerebellar infarction with
re-demonstration of chronic infarcts within bilateral cerebellar hemispheres
and left pons. An extra-axial right temporal lobe mass is better assessed on
prior MRI. Again seen are extensive nonspecific periventricular and
subcortical white matter hypodensities, which may be a sequela of post
treatment changes or chronic small vessel ischemic disease. The ventricles
are normal in size without midline shift. The paranasal sinuses and bilateral
mastoid air cells appear clear.
CTA HEAD:
There are moderate vascular calcifications of the cavernous and clinoid
segments of bilateral internal carotid arteries. There are additional
vascular calcifications of the petrous segment of the right ICA causing
mild-to-moderate luminal narrowing (3:195). There is a hypoplastic left
vertebral artery, with areas of luminal irregularity, which may be related to
atherosclerotic disease. There is moderate to severe narrowing of the
proximal to mid basilar artery (3:221). Otherwise, there is no evidence of
significant stenosis, occlusion, or aneurysm.
CTA NECK:
Patient is status post right common/internal carotid artery stent with
re-demonstration of decreased contrast opacification of the right external
carotid artery. There is contrast opacification throughout the course of the
stent. There is atherosclerotic vascular calcification at the left carotid
bifurcation resulting in less than 25% luminal narrowing by NASCET criteria.
There are scattered vascular calcifications along the course of the left
vertebral artery causing mild luminal narrowing. There are vascular
calcifications at the aortic arch.
OTHER:
There are stable 1 cm and 0.3 cm right upper lobe pulmonary nodules (03:34,
18). There are biapical paraseptal emphysematous changes. There are
multilevel degenerative changes of the cervical spine. There is no evidence
of lymphadenopathy per size criteria. The thyroid gland is difficult to
properly delineate. There are nonspecific small lucent foci within the
cervical spine (3:108, 121, 152), likely related to osteopenia.
IMPRESSION:
1. No evidence of intracranial hemorrhage. Evolution of previously seen left
cerebellar infarction, without definite evidence of new infarction. However,
if clinically concerned, MRI is a more sensitive means for further assessment.
2. Extensive white matter changes again seen, likely representing post
treatment changes or chronic small vessel ischemic disease.
3. Atherosclerotic vascular calcifications resulting in mild-to-moderate
luminal narrowing of the petrous segment of the right ICA, similar to the
prior study. Moderate luminal narrowing of the proximal to mid basilar artery
again seen, likely atherosclerotic.
4. Status post right common/internal carotid artery stent with contrast
opacification through the course of the stent.
5. Again seen is occlusion of the proximal right external carotid artery its
origin with diminished contrast opacification of the distal branches.
6. Atherosclerotic disease at the left carotid bifurcation with less than 25%
luminal narrowing by NASCET criteria.
7. Stable right upper lobe pulmonary nodules measuring up to 1 cm with
biapical paraseptal emphysematous changes. The ___ Society guidelines
for pulmonary nodule guidelines suggest for pulmonary nodules greater than 8
mm, follow-up CTs at 3 months or consider dynamic contrast enhanced CT, PET,
and/ or biopsy.
|
10056612-RR-62 | 10,056,612 | 20,943,307 | RR | 62 | 2191-01-15 21:31:00 | 2191-01-15 22:15:00 | EXAMINATION: MR HEAD W/O CONTRAST
INDICATION: ___ year old woman with left dysmetria with finger to nose
testing// ?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 of the head from ___.
FINDINGS:
Foci of slow diffusion with associated FLAIR signal abnormality are seen in
the right parieto-occipital lobe (302;18), left parietal lobe, and right
cerebellum. Possible punctate focus of increased signal on the
diffusion-weighted images is seen within the left cerebellum, (series 302,
image 5). The patient's known extra-axial mass along the floor of the right
middle cranial fossa adjacent to the medial right temporal lobe, is difficult
to discern on the non contrast images however measures at least 1 cm.
Abnormal leptomeningeal enhancement along the right parasagittal occipital
lobe on prior exam is not delineated without contrast.
Bilateral chronic infarcts within the cerebellar hemispheres, pons, bilateral
middle cerebellar peduncle and right frontal lobe appear similar to the prior
exam. Extensive confluent T2/FLAIR hyperintensity within the right temporal
white matter and the bilateral frontoparietal white matter as well as
discontinuous areas of T2 hyperintensity within the left temporal white
matter, deep white matter, basal ganglia are overall unchanged compared to the
prior exam, and may be sequelae of post treatment changes as well as chronic
small vessel ischemic changes.
Prominence of the ventricles and sulci is likely related to age related
involutional changes. A punctate focus of low signal on the susceptibility
weighted images within the left putamen as well as along the left anterior
falx appear grossly similar to the prior exam consistent with chronic
microhemorrhage and possible dural calcification respectively. T1
hyperintense lesion within the left superior frontal calvarium likely
secondary to a hemangioma appears grossly unchanged compared to the prior
exam.
Mild mucosal sinus thickening is seen involving the ethmoid air cells. The
remainder the visualized paranasal sinuses, mastoid air cells, and middle ear
cavities are clear. The globes are unremarkable. The principal vascular flow
voids appear to be well preserved.
IMPRESSION:
1. Acute to subacute infarction is seen involving the right parieto-occipital
lobe, left parietal lobe, and right cerebellum. Possible punctate focus of
infarction is seen within the left cerebellum. Distribution appears to be
embolic in etiology.
2. Previously noted enhancing extra-axial mass along the medial right temporal
lobe, is incompletely evaluated on this noncontrast exam. Abnormal
leptomeningeal enhancement in the right occipital region, similarly, is not
seen on this unenhanced scan.
3. Stable chronic infarctions within the bilateral cerebellar hemispheres and
pons.
4. Stable extensive confluent white matter changes, right greater than left
temporal white matter, bilateral frontoparietal white matter as well as middle
cerebellar peduncles likely combination of posttreatment changes and sequelae
of chronic small vessel ischemic disease.
NOTIFICATION: The findings were discussed with Dr. ___. by ___
___, M.D. on the telephone on ___ at 10:11 am, 10 minutes after
discovery of the findings.
|
10057005-RR-21 | 10,057,005 | 24,537,613 | RR | 21 | 2175-02-19 18:58:00 | 2175-02-20 01:07:00 | INDICATION: ___ year old man with ngt // ngt placement
COMPARISON: ___
FINDINGS:
Nasogastric tube tip terminates at the thoracoabdominal junction, with the
side port several cm above this level. Cardiomediastinal contours are stable
in appearance with persistent tortuosity of the thoracic aorta. Lungs are
grossly clear, and there are no pleural effusions or pneumothoraces
|
10057005-RR-22 | 10,057,005 | 24,537,613 | RR | 22 | 2175-02-20 12:35:00 | 2175-02-20 15:56:00 | INDICATION: ___ year old man with NG tube advanced // evaluate NG tube
palcement after advancement
FINDINGS:
As compared to the recent radiograph of 1 day prior, a nasogastric tube has
been advanced into the stomach, but the side port is still above the level of
the diaphragm. No other changes since recent study.
|
10057005-RR-23 | 10,057,005 | 24,537,613 | RR | 23 | 2175-02-20 16:37:00 | 2175-02-20 18:44:00 | EXAMINATION: CHEST (PORTABLE AP)CHEST (PORTABLE AP)i
INDICATION: ___ year old man with NG tube // assess NG tube position after
advancement
COMPARISON: Chest radiograph since ___ most recently ___.
IMPRESSION:
Nasogastric tube is been advanced, now ends in the upper stomach with also
reports beyond the gastroesophageal junction. Heart normal. Lungs clear. No
pleural abnormality. Bilateral pectoral generators send leads superiorly and
of view.
|
10057005-RR-24 | 10,057,005 | 24,537,613 | RR | 24 | 2175-02-21 10:32:00 | 2175-02-21 12:21:00 | INDICATION: ___ y/o male w ___ yr hx of parkinsons with recent decline, DBS
batteries interrogated and need replacement // KUB for planning of gtube
COMPARISON: None.
TECHNIQUE: Single supine view of the abdomen.
FINDINGS:
The bowel gas pattern is normal without dilated loops of small or large bowel
to suggest obstruction. No pneumatosis or pneumoperitoneum. An NG tube
terminates within the stomach. Osseous structures are unremarkable.
IMPRESSION:
NG tube terminates in the stomach. No evidence of bowel obstruction.
|
10057005-RR-25 | 10,057,005 | 24,537,613 | RR | 25 | 2175-02-26 05:14:00 | 2175-02-26 10:09:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man s/p PEG placement now with probably aspiration of
Tube Feed. Chest X-ray to assess for PNA. // ___ year old man s/p PEG
placement now with probably aspiration of Tube Feed. Chest X-ray to assess for
PNA.
IMPRESSION:
As compared to ___ radiograph, pulmonary vascular congestion has
developed. Additionally, a new patchy bibasilar opacities are present, and may
correspond to provided clinical history of acute aspiration event. Followup
radiographs are suggested to evaluate for resolution.
|
10057005-RR-26 | 10,057,005 | 24,537,613 | RR | 26 | 2175-02-27 01:29:00 | 2175-02-27 09:29:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with bibasilar opacities // ?evolution
?evolution
COMPARISON: Comparison to prior study ___ at 05:19
FINDINGS:
Portable semi-erect chest film ___ at 01:43 is submitted.
IMPRESSION:
There has been interval appearance of mild pulmonary and interstitial edema.
In addition, there is increasing consolidation in the retrocardiac region
which would be concerning for aspiration pneumonia. There is likely a small
left effusion. No pneumothorax. Overall cardiac and mediastinal contours are
unchanged. Stimulator generators overlie both upper lungs limiting evaluation
in this vicinity.
|
10057009-RR-22 | 10,057,009 | 28,491,028 | RR | 22 | 2150-02-10 14:51:00 | 2150-02-10 15:28:00 | EXAMINATION: Chest PA and lateral
INDICATION: ___ with cough. Evaluate for pneumonia.
TECHNIQUE: Chest PA and lateral
COMPARISON: ___
FINDINGS:
The patient is severely kyphotic and is rotated. The lungs are clear with no
definite focal consolidation. Atelectasis is seen at the right base. There
is a probable hiatal hernia not seen on prior. Cardiomediastinal silhouette
is stable in configuration. There is no pneumothorax or pleural effusion.
Severe compression deformity of likely L1 with retrolisthesis of the vertebral
body above is similar compared to prior.
IMPRESSION:
Limited exam without definite acute cardiopulmonary process. Specifically, no
visualized focal consolidation concerning for pneumonia.
|
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