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10057482-RR-10 | 10,057,482 | 25,416,257 | RR | 10 | 2145-03-23 14:15:00 | 2145-03-23 14:42:00 | EXAMINATION: CTA CHEST WITH CONTRAST
INDICATION: History: ___ with AAA, dissection type A on OSH CTAP// Dissection
characterization
TECHNIQUE: Axial multidetector CT images were obtained through the thorax
after the uneventful administration of intravenous contrast. Reformatted
coronal, sagittal, thin slice axial images, and oblique maximal intensity
projection images were submitted to PACS and reviewed.
DOSE: Acquisition sequence:
1) Stationary Acquisition 6.0 s, 0.5 cm; CTDIvol = 36.4 mGy (Body) DLP =
18.2 mGy-cm.
2) Spiral Acquisition 4.2 s, 33.3 cm; CTDIvol = 11.0 mGy (Body) DLP = 367.6
mGy-cm.
Total DLP (Body) = 386 mGy-cm.
COMPARISON: CTA head and neck ___
FINDINGS:
HEART AND VASCULATURE: There is a type A dissection originating at the aortic
root (Series 2: Image 73) with extension into the right brachiocephalic artery
(series 2: Image 35). Immediately distal to the dissection flap extending
into the right brachiocephalic artery, a nonocclusive thrombus is demonstrated
in the proximal brachiocephalic artery (series 2: Image 26). Of note, the
imaged right common carotid artery is patent. There is further inferior
extent of the dissection to at least the superior mesenteric artery (series 2:
Image 112). Of note, the inferior most aspect of the dissection is not
included on this study; the patient obtained imaging of the abdomen/pelvis at
an outside institution. The ascending aorta is dilated up to 7.3 cm. There
is no evidence of active extravasation. There is a moderate pericardial
effusion that is of medium density which most likely represents
hemopericardium. The heart is enlarged.
AXILLA, HILA, AND MEDIASTINUM: There is blood/hematoma in the mediastinum that
is exerting mass-effect resulting in narrowing of the main left and right
pulmonary arteries. Of note, potential lymphadenopathy within the mediastinum
cannot be assessed secondary to probable blood within the mediastinum.
PLEURAL SPACES: No pleural effusion or pneumothorax.
LUNGS/AIRWAYS: The lungs are visualized in expiratory phase. Scattered blebs
and mild emphysematous changes in the bilateral upper lobes and bilateral
lower lobe atelectasis is demonstrated. Otherwise, lungs are clear without
masses or areas of parenchymal opacification. The airways are patent to the
level of the segmental bronchi bilaterally.
BASE OF NECK: Visualized portions of the base of the neck show no abnormality.
ABDOMEN: The inferior extent of the dissection is not included on this study.
In the final image of series 2 the left renal parenchyma is hypoenhancing
compared to the partially visualized upper pole of the right kidney. This
left renal parenchyma is most likely being supplied by the false lumen. In
addition, the left adrenal gland is hypoattenuating in comparison to the
right, again most likely secondary to blood supply being obtained from false
lumen. There is opacification of the collecting system of the left renal
parenchyma, from prior CT obtained at outside hospital.
BONES: No suspicious osseous abnormality is seen.? There is no acute fracture.
Degenerative changes are demonstrated throughout the thoracic spine.
IMPRESSION:
1. Type A dissection originating at the aortic root with extension into the
right brachiocephalic and extending into the abdomen, inferior extent not
included on the images. On this study, extends beyond the SMA. Relative
decreased enhancement of the left kidney and left adrenal gland suggests that
they are supplied by the false lumen.
2. Small to moderate amount of hemopericardium. Mediastinal blood/hematoma
exerts mass-effect with resultant narrowing of the main left and right
pulmonary arteries. No active extravasation seen.
|
10057482-RR-11 | 10,057,482 | 25,416,257 | RR | 11 | 2145-03-23 22:43:00 | 2145-03-24 10:21:00 | EXAMINATION: DX CHEST PORT LINE/TUBE PLCMT 1 EXAM
INDICATION: ___ year old woman with s/p Aortic Dissection Repair// cardiac
surgery fast track. eval for ptx, effusions. call ___ house officer at ___
if there is any concern with findings Contact name: ___ house officer,
___: ___
TECHNIQUE: Portable AP chest
COMPARISON: CTA chest from ___
FINDINGS:
Lung volumes are decreased with moderate pulmonary edema. Widening of the
cardiomediastinal silhouette is compatible with recent postoperative state.
Multiple support devices are new since the prior exam including chest and
mediastinal tubes, Swan-Ganz catheter, enteric tube, and ETT. Tip of the ETT
is not well seen, but the course of the ETT is seen at least as far as the
mid-trachea. Small bilateral pleural effusions are likely.
IMPRESSION:
Postoperative appearance of the chest with low lung volumes, widened
cardiomediastinal silhouette, and probable small bilateral pleural effusions.
|
10057482-RR-12 | 10,057,482 | 25,416,257 | RR | 12 | 2145-03-25 07:17:00 | 2145-03-25 10:03:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with open chest s/p Type A dissection repair//
follow up edema/effusions
TECHNIQUE: Chest AP
COMPARISON: ___
IMPRESSION:
The patient has an open chest with a sponge overlying the mediastinum.
Support lines and tubes are unchanged. Cardiomediastinal silhouette is
stable. Small to moderate left pleural effusion is also stable. Small right
pleural effusion is slightly increased in volume. Pulmonary edema is
unchanged. No pneumothorax
|
10057482-RR-13 | 10,057,482 | 25,416,257 | RR | 13 | 2145-03-26 07:13:00 | 2145-03-26 09:03:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with open chest s/p Type A repair// follow
edema/effusions
TECHNIQUE: Chest AP
COMPARISON: ___
IMPRESSION:
Patient has an open chest. Pulmonary edema has improved. Support lines and
tubes are in acceptable position. A sponge overlies the left chest. No new
consolidations. Stable bilateral effusions.
|
10057482-RR-14 | 10,057,482 | 25,416,257 | RR | 14 | 2145-03-27 07:01:00 | 2145-03-27 08:53:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman s/p type A dissection w/open chest// follow up
edema
IMPRESSION:
In comparison with the study of ___, the patient is less oblique it. The
monitoring and support devices are stable. Cardiomediastinal silhouette is
unchanged, as is the overall appearance of the heart and lungs.
|
10057482-RR-15 | 10,057,482 | 25,416,257 | RR | 15 | 2145-03-27 16:02:00 | 2145-03-27 17:00:00 | EXAMINATION: CHEST (SINGLE VIEW)
INDICATION: ___ female status post chest closure
TECHNIQUE: Chest PA and lateral
COMPARISON: Multiple prior chest radiographs, most recently ___ at
07:30
FINDINGS:
Patient is status post chest closure. No unsuspected radiopaque foreign
object is identified. Multiple median sternotomy wires are intact. Support
lines and tubes are in acceptable position. Mitral annular calcifications are
re-demonstrated. Compared to the prior study performed earlier in the day, no
significant change in lung findings.
IMPRESSION:
No radiopaque foreign object. No significant change in lung findings compared
to the study performed earlier in the same day.
NOTIFICATION: Findings discussed with ___, MD by ___, MD
___, MD at approximately 4:40 pm on ___.
|
10057482-RR-16 | 10,057,482 | 25,416,257 | RR | 16 | 2145-03-27 08:37:00 | 2145-03-27 10:22:00 | INDICATION: ___ year old woman s/p type A dissection repair with open chest//
eval if perfused from true or false lumen of aorta?
TECHNIQUE: Grey scale and color Doppler ultrasound images of the kidneys were
obtained.
COMPARISON: CTA chest, and abdomen and pelvis performed on ___.
FINDINGS:
There is no hydronephrosis, stones, or masses bilaterally. Normal cortical
echogenicity and corticomedullary differentiation are seen bilaterally.
Septated but otherwise simple appearing right lower pole renal cyst measures
1.3 x 1.7 x 2.1 cm.
Right kidney: 10.5 cm
Left kidney: 10.1 cm
Doppler waveforms of the right sided main renal artery and main renal vein
appear within normal limits. Intrarenal waveforms on the right appear within
normal limits.
While arterial and venous waveforms also appear to be preserved on the left,
there is a lower overall velocity, and low less robust vascularity seen on
color Doppler imaging.
The actual origins of the renal arteries from the aorta are difficult to
directly visualize due to inability to breath hold, bandaging, and other
technical factors.
Bladder is decompressed by Foley catheter.
IMPRESSION:
Magnitude of vascularity of the left kidney is lower on the left than on the
right, suggesting the left renal artery arises from the false lumen and right
renal artery from the true lumen as seen on prior CT imaging. However, it was
not possible to directly visualize the renal artery origins sonographically
due to poor visualization at this time.
|
10057482-RR-17 | 10,057,482 | 25,416,257 | RR | 17 | 2145-03-28 11:58:00 | 2145-03-28 13:16:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with s/p repair type A dissection. CTs d/c'd
and dob hoff placed// eval for ptx and position of new dob hoff prior to
advancement
IMPRESSION:
In comparison with the study of ___, there is been placement of a Dobhoff
tube that extends to the lower body of the stomach. Otherwise, little change.
|
10057482-RR-18 | 10,057,482 | 25,416,257 | RR | 18 | 2145-03-29 09:25:00 | 2145-03-29 10:05:00 | EXAMINATION: DX CHEST PORT LINE/TUBE PLCMT 2 EXAMS
INDICATION: ___ year old woman with s/p aortic dissection repair// evaluate
position of new dob hoff tube
TECHNIQUE: Single upright AP chest radiograph
COMPARISON: Multiple prior chest radiographs, most recently ___.
FINDINGS:
An endotracheal tube terminates 3.5 cm in the carina. An enteric tube courses
below the diaphragm and outside of the field of view. A right IJ introducer
sheath and Swan-Ganz catheter project in unchanged position. Median
sternotomy wires and mediastinal clips are unchanged.
There is increased hazy opacification of the right mid and lower lung likely
representing an increasing moderate to large pleural effusion. There is at
least a moderate left pleural effusion with associated retrocardiac
atelectasis. There is no pneumothorax.
IMPRESSION:
1. Increasing pleural effusions, moderate to large on the right and at least
moderate on the left with associated atelectasis.
2. Unchanged standard position of all support devices.
|
10057482-RR-19 | 10,057,482 | 25,416,257 | RR | 19 | 2145-03-29 14:15:00 | 2145-03-29 16:09:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with aortic dissection, status post repair.
S/p L TLC placement// ___ year old woman s/p L TLC placement
TECHNIQUE: Portable AP view of the chest.
COMPARISON: Chest radiograph obtained 4 hours prior.
FINDINGS:
Tip of endotracheal tube is 4 cm above the carina. The right IJ approach
Swan-Ganz is likely within the main pulmonary artery. Tip of right subclavian
catheter projects over the cavoatrial junction. Dobhoff tube is partially
imaged.
Aeration is largely unchanged, again demonstrating low lung volumes with
bibasilar atelectasis. Bilateral pleural effusions. There is no
pneumothorax. Cardiomediastinal silhouette is similarly enlarged.
IMPRESSION:
1. Tip of right subclavian catheter projects over the cavoatrial junction.
2. Largely unchanged aeration associated with low lung volumes, bibasilar
atelectasis, and pleural effusions.
|
10057482-RR-20 | 10,057,482 | 25,416,257 | RR | 20 | 2145-03-29 18:39:00 | 2145-03-29 19:39:00 | EXAMINATION: UNILAT UP EXT VEINS US
INDICATION: ___ year old woman with suspected left IJ clot, please perform
portably//
TECHNIQUE: Grey scale and Doppler evaluation was performed on the left upper
extremity veins.
COMPARISON: None.
FINDINGS:
There is normal flow with respiratory variation in the bilateral subclavian
veins.
There is a thrombus with complete occlusion of flow involving the mid to low
left internal jugular vein. The upper left internal jugular vein is patent.
The left axillary and brachial veins are patent, show normal color flow,
spectral doppler, and compressibility. The left basilic, and cephalic veins
are patent, compressible and show normal color flow.
IMPRESSION:
1. Deep vein thrombosis with complete occlusion of flow involving the mid to
low left internal jugular vein.
2. No evidence of additional deep vein thrombosis in the left upper extremity.
NOTIFICATION: The findings were discussed with ___, R.N. by ___
___, M.D. on the telephone on ___ at 7:35 pm, 2 minutes after discovery
of the findings.
|
10057482-RR-21 | 10,057,482 | 25,416,257 | RR | 21 | 2145-03-30 08:15:00 | 2145-03-30 10:04:00 | EXAMINATION: CHEST (PORTABLE AP) ___
INDICATION: ___ year old woman with hypoxia// ___ year old woman with hypoxia
___ year old woman with hypoxia
IMPRESSION:
Compared to chest radiographs ___ through ___.
Left lower lobe remains collapsed. Small right pleural effusion unchanged.
Heart size top-normal. No pneumothorax.
ET tube in standard placement. Feeding tube passes into the stomach and out
of view. Right subclavian line ends in the region of the superior cavoatrial
junction. Right PIC line is no longer clearly identified.
|
10057482-RR-22 | 10,057,482 | 25,416,257 | RR | 22 | 2145-03-30 21:25:00 | 2145-03-31 09:59:00 | EXAMINATION: MR HEAD W/O CONTRAST ___ MR HEAD
INDICATION: ___ year old woman with a history of amyloid angiopathy, evaluate
degree of amyloid and source of change in mental status// ___ year old woman
with a history of amyloid angiopathy, evaluate degree of amyloid and source of
change in mental status
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 ___
FINDINGS:
There are numerous, bilateral cerebral hemispheric, left thalamic and
cerebellar acute or early subacute infarcts, including a 3.0 x 1.8 cm left
frontal acute or subacute infarct (series 5, image 23). The majority of these
lesions demonstrate increased FLAIR signal abnormality.
Additional pontine, periventricular and deep white matter FLAIR
hyperintensities, which do not correspond to areas of slow diffusion, likely
represents sequela of reported microangiopathy. Prominence of the ventricles
and sulci, compatible with age-related involutional change. Bilateral lacunar
infarcts in the pons, centrum semiovale and basal ganglia are noted.
Innumerable areas of susceptibility on gradient echo imaging scattered
throughout the brain, compatible with amyloid angiopathy.
The ocular lenses have been surgically replaced. There is an air-fluid level
in the sphenoid sinuses, bilaterally and moderate mucosal thickening in the
maxillary sinuses and ethmoid air cells. The mastoid air cells are moderately
opacified bilaterally.
IMPRESSION:
1. Numerous, scattered acute or early subacute infarcts, majority of which are
punctate, however there is a larger approximately 3.0 cm left frontal area of
acute or early subacute infarct. No evidence of hemorrhagic conversion.
Chronic lacunar infarcts are also noted.
2. Innumerable areas of susceptibility on gradient echo imaging, compatible
with amyloid angiopathy.
3. Moderate paranasal sinus disease, as detailed above, including air-fluid
levels, suggestive of acute sinusitis.
NOTIFICATION: The findings were discussed with ___, M.D. by ___
___, M.D. on the telephone on ___ at 9:56 am, 10 minutes after
discovery of the findings.
|
10057482-RR-23 | 10,057,482 | 25,416,257 | RR | 23 | 2145-04-01 17:00:00 | 2145-04-01 18:10:00 | EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ year old woman with MRI showing numerous small acute to
subacute infarcts, which the largest in the L frontal area// eval for
hemorrhagic conversion on Heparin gtt
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 =
747.3 mGy-cm.
Total DLP (Head) = 747 mGy-cm.
COMPARISON: MRI brain ___. CT head and CTA head and neck ___.
FINDINGS:
There is a hypodensity in the left frontal lobe with loss of the gray-white
matter differentiation, which is consistent with an evolving acute infarct.
The additional scattered punctate infarcts in the bilateral cerebral and
cerebellar hemispheres are better appreciated on prior MRI. There is no
evidence of hemorrhagic conversion. No acute intracranial hemorrhage or
intracranial mass is identified.
There is encephalomalacia in the bilateral basal ganglia and thalami, and
right corona radiata related to remote infarcts. There is prominence of the
ventricles and sulci suggestive of involutional changes. There are
atherosclerotic calcifications of the intracranial internal carotid and left
vertebral arteries.
There is no evidence of fracture. There is a partially visualized left
nasogastric tube. Layering fluid in the sphenoid sinuses, mild mucosal
thickening of the ethmoid air cells and opacification of the bilateral mastoid
air cells is most likely secondary to intubation. There are bilateral lens
replacements. Otherwise, the orbits are unremarkable.
IMPRESSION:
1. Evolving acute infarct in the left frontal lobe. No evidence of
hemorrhagic conversion.
2. Additional smaller infarcts in the bilateral cerebral hemispheres and
cerebellar hemispheres are better appreciated on prior MRI.
|
10057482-RR-24 | 10,057,482 | 25,416,257 | RR | 24 | 2145-04-02 16:19:00 | 2145-04-02 21:15:00 | EXAMINATION: CT CHEST WITHOUT CONTRAST
INDICATION: ___ year old woman with aspergillis in sputum, unable to wean
vent// eval for infiltrate, cavitating lesion. Status post emergent type A
dissection surgery ___.
TECHNIQUE: Axial multidetector CT images of the chest obtained without
administration of IV contrast. Coronal and sagittal reformats were provided.
DOSE: Acquisition sequence:
1) Spiral Acquisition 2.2 s, 34.2 cm; CTDIvol = 17.7 mGy (Body) DLP = 604.4
mGy-cm.
Total DLP (Body) = 604 mGy-cm.
COMPARISON: CTA chest ___
FINDINGS:
NECK, THORACIC INLET, AXILLAE, CHEST WALL: Numerous small lymph nodes in the
supraclavicular regions are not enlarged by size criteria. No axillary
lymphadenopathy. There is mild subcutaneous edema noted in the chest.
UPPER ABDOMEN: An NG tube is noted and however the tip is not included in the
field of view. A 3 mm nonobstructing stone in the superior pole of the left
kidney.
MEDIASTINUM: Widening of the mediastinum secondary to type A dissection, which
is better evaluated on prior CTA. Hyperdense material at the root of the
aorta are new since last CT and could be related to dissection repair. The
calcified walls outline the true lumen which is not significantly changed in
caliber from the level of the aortic arch to the distal thoracic aorta. Right
upper paratracheal lymphadenopathy measure up to 1.6 cm appears unchanged
since prior and reactive. There is diffuse fat stranding of the mediastinal
fat.
HILA: No hilar adenopathy with limitations of the study.
HEART and PERICARDIUM: Marked cardiomegaly appear similar to prior.
Resolution of the previous pericardial effusion. Mitral annulus
calcification, valvular aortic calcification and coronary artery
calcifications are again seen. Right-sided internal jugular catheter
terminates in the lower SVC.
PLEURA: New small bilateral pleural effusions.
LUNG:
1. PARENCHYMA: Bilateral multifocal ground-glass and nodular opacities with
consolidation in both lower lobes, worse on the left.
2. AIRWAYS: Patient is intubated and the ETT terminates in appropriate
position. Decreased AP diameter of the trachea could be secondary to
tracheomalacia. Hypodense material is noted in the bronchus to the left lower
lobe. Focal area of narrowing is noted in the bronchus to the lingula
(302:73).
3. VESSELS: Please refer to above description of the thoracic aorta. Deep
main pulmonary artery is top normal.
CHEST CAGE: New since ___ is median sternotomy with cerclage wires in
place. No suspicious osseous structures of the chest
IMPRESSION:
1. Multifocal bilateral ground-glass, nodular opacities and consolidation in
both lower lobes, worse on the left are likely secondary to multifocal
pneumonia.
2. New small bilateral pleural effusions.
3. Type A aortic dissection incompletely characterized in this study, with new
hyperdense material at the ascending aorta, likely related to the repair.
Atherosclerotic plaque CT outline the true lumen in the remainder thoracic
aorta which appears not significantly changed in caliber from prior.
|
10057482-RR-25 | 10,057,482 | 25,416,257 | RR | 25 | 2145-04-03 07:12:00 | 2145-04-03 08:23:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with as above// s/p repair of aortic dissection
w/fevers, hypoxia and hypotension, suspected VAP evaluate ?infiltrate s/p
repair of aortic dissection w/fevers, hypoxia and hypotension, suspected VAP
evaluate ?infiltrate
IMPRESSION:
Comparison to ___. Stable position of the monitoring and support
devices. Lung volumes have increased, with a resulting minimally improved
ventilation of the left lung basis. Status post aortic repair, postoperative
morphology is better visualized on the CT examination from ___.
Stable appearance of the lung parenchyma with bilateral ill-defined
parenchymal opacities, predominating in the left lung apex and at the right
lung basis. No new parenchymal opacities. Stable moderate left pleural
effusion.
|
10057482-RR-26 | 10,057,482 | 25,416,257 | RR | 26 | 2145-04-04 07:10:00 | 2145-04-04 09:56:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with as above// s/p repair of aortic dissection
w/worsening respiratory status r/o infiltrate s/p repair of aortic
dissection w/worsening respiratory status r/o infiltrate
IMPRESSION:
Right subclavian line tip is at the level of lower SVC. The up of tube tip is
in the stomach. Heart size and mediastinum are stable. Pulmonary edema is
extensive, unchanged. No pneumothorax. Left pleural effusion is present,
small to moderate, decreased as compared to previous examination.
Calcifications of the mitral annulus are severe, unchanged
|
10057482-RR-27 | 10,057,482 | 25,416,257 | RR | 27 | 2145-04-05 07:42:00 | 2145-04-05 11:10:00 | EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ year old woman with aortic dissection repair// r/o calculi,
thickened gall bladder
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: Reference abdomen CT ___ and renal ultrasound ___
FINDINGS:
LIVER: The hepatic parenchyma appears within normal limits. The contour of the
liver is smooth. There is no focal liver mass. The main portal vein is patent
with hepatopetal flow. There is no ascites. There are small bilateral pleural
effusions, greater on the left.
BILE DUCTS: There is no intrahepatic biliary dilation.
CHD: 4 mm
GALLBLADDER: No stones or sludge are visualized in the gallbladder.
PANCREAS: The pancreas is unremarkable but is only minimally visualized due to
overlying bowel gas and a surgical bandages.
SPLEEN: Normal echogenicity.
Spleen length: 7.8 cm
KIDNEYS: The right kidney measures 10.6 cm. There is mild hydronephrosis and
a moderately distended right renal pelvis which is a change compared to the
renal ultrasound of ___. The left kidney measures 10.3 cm. No
hydronephrosis in the left kidney.
IMPRESSION:
1. No gallstones. Unremarkable appearance of the liver and no biliary
dilatation.
2. Mild hydronephrosis and moderately distended right renal pelvis which is
new compared to the renal ultrasound of ___. No obstructing stone or
mass identified. No hydronephrosis in the left kidney.
3. Bilateral pleural effusions, larger on the left. No ascites visualized.
|
10057482-RR-28 | 10,057,482 | 25,416,257 | RR | 28 | 2145-04-05 14:11:00 | 2145-04-05 16:19:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman s/p reintubation// check ETT placement
COMPARISON: Multiple prior chest radiographs dating back to ___, most
recently ___.
FINDINGS:
AP portable upright view of the chest provided.
The tip of the endotracheal tube projects approximately 5 cm above the level
of the carina. An enteric tube courses below the diaphragm and out of view of
the current study. A right sided central venous catheter tip again projects
over the lower SVC. Median sternotomy wires are intact and aligned.
There has been interval increase in diffuse pulmonary interstitial opacity,
suggestive of worsening pulmonary edema. A small to moderate left pleural
effusion is unchanged. There is no focal consolidation or pneumothorax. The
cardiomediastinal silhouette is normal. Severe mitral annular calcifications
are again seen.
IMPRESSION:
1. Satisfactory placement of the endotracheal tube.
2. Interval worsening of pulmonary interstitial edema.
3. Unchanged small to moderate left pleural effusion.
|
10057482-RR-29 | 10,057,482 | 25,416,257 | RR | 29 | 2145-04-06 11:28:00 | 2145-04-06 18:35:00 | EXAMINATION: CTA TORSO
INDICATION: ___ year old woman s/p type A dissection repair, amylase and
Lipase// assess descending aorta thrombus/assess for pancreatitis
TECHNIQUE: Chest, abdomen, and pelvis CTA: Non-contrast and multiphasic
post-contrast images were acquired through chest, abdomen, and pelvis.
Oral contrast was not administered.
MIP reconstructions were performed on independent workstation and reviewed on
PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 4.8 s, 62.9 cm; CTDIvol = 8.7 mGy (Body) DLP = 544.3
mGy-cm.
2) Stationary Acquisition 0.6 s, 0.5 cm; CTDIvol = 3.3 mGy (Body) DLP = 1.7
mGy-cm.
3) Stationary Acquisition 5.4 s, 0.5 cm; CTDIvol = 29.8 mGy (Body) DLP =
14.9 mGy-cm.
Total DLP (Body) = 561 mGy-cm.
COMPARISON: None.
FINDINGS:
VASCULAR:
Status post open repair of a type A dissection of the ascending aorta. A
dissection flap is again noted and extends to the aortic bifurcation.
Unchanged focal thrombus at the aortic bifurcation.
Aorta measurement:
Aortic root: 3.6 x 3.1 cm.
Ascending aorta: 3.5 x 2.9 cm.
Aortic arch: 3.8 x 3 cm.
Proximal descending aorta: 3.6 x 3.2 cm.
Distal descending aorta: 3.3 x 3.6.5 cm.
Suprarenal abdominal aorta: 2.8 x 3.2 cm.
Infrarenal abdominal aorta: 2.4 x 2.7 cm.
Interval progression of the narrowing of the true lumen at the origin of the
celiac trunk now causing around 70% stenosis (Series 2, image 104).
Compared to prior CT chest of ___, there is new density laterally to
the ascending aorta concerning for a hematoma measuring 3.3 x 5.9 x 6.8 cm.
No active extravasation.
The heart appears overall unchanged in size. No pericardial effusion.
There is a linear small non opacification in the right internal jugular vein
which could represent a small thrombus/fibrin due to prior catheter
installation (series 2, image 4).
The internal left jugular vein is non-opacified, appears slightly expansile
and has peripheral enhancement. Patency of this vessel is questionable.
Sternotomy wires are unchanged.
Bilateral small pleural effusions with left lower lobe consolidation is again
noted, likely representing atelectasis of the left lower lobe. Segmental
atelectasis of the right lower lobe is also noted. Diffuse ground-glass
opacities in the right lower lobe are again noted however, appears slightly
improved in the interim.
An endotracheal tube is well-positioned. A right subclavian catheter is noted
with the distal tip at the atrial caval junction.
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,
without stones or gallbladder wall thickening.
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 unremarkable besides a right inferior pole cortical
cyst measuring 2.3 cm. No hydronephrosis.
GASTROINTESTINAL: No bowel obstruction. No signs of bowel ischemia. No
pneumoperitoneum. No ascites. There is a rectal tube. A Dobhoff catheter is
noted with the distal extremity at the level of the antrum of the stomach.
RETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.
PELVIS: The urinary bladder is decompressed on a Foley catheter. Fibroid
uterus.
BONES: Left-sided scoliosis is again noted with secondary degenerative changes
in the lumbar spine.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. S/p open repair of a type A aortic dissection.
2. Interval new dense collection near the ascending aorta concerning for a
hematoma. No active extravasation.
3. Interval progression of the narrowing of the true lumen of the celiac
trunk.
4. Small linear nonocclusive thrombus/fibrin in the internal right jugular
vein, likely from prior vascular catheter.
5. Questionable patency of the left internal jugular vein. Correlation to a
venous Doppler could be performed.
6. No evidence of pancreatitis. No bowel ischemia.
7. Multifocal bilateral ground-glass opacities likely representing multifocal
pneumonia/aspiration.
NOTIFICATION: The findings were discussed with ___, N.P. by ___
___, M.D. on the telephone on ___ at 17: 00, 5 minutes after discovery
of the findings.
|
10057482-RR-30 | 10,057,482 | 25,416,257 | RR | 30 | 2145-04-08 12:54:00 | 2145-04-08 14:09:00 | INDICATION: ___ year old woman with resp failure// interval change
COMPARISON: Compared to chest CT from ___
IMPRESSION:
Tracheostomy and mediastinal wires are again seen. There is widening of the
mediastinum, stable. Known aortic dissection is better assessed on the prior
CT scan. There is a small left-sided pleural effusion and a left retrocardiac
opacity. No pneumothoraces are seen.
|
10057482-RR-31 | 10,057,482 | 25,416,257 | RR | 31 | 2145-04-09 08:16:00 | 2145-04-09 10:43:00 | INDICATION: ___ year old woman with repaired type A aortic dissection now with
rising WBC counts.// New infiltrate
COMPARISON: ___
IMPRESSION:
There is a tracheostomy and mediastinal wires. Heart size is prominent but
stable. There is widening of the mediastinum consistent with known aortic
dissection. There is a left-sided pleural effusion and left retrocardiac
opacity. Cardiac valvular calcifications are again seen. There is mild
pulmonary interstitial edema. There are no pneumothoraces. Overall findings
are stable.
|
10057482-RR-32 | 10,057,482 | 25,416,257 | RR | 32 | 2145-04-10 12:44:00 | 2145-04-10 15:37:00 | EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ year old woman with new seizure-like activity on EEG, previous
CVA// ___ year old woman with new seizure-like activity on EEG, previous CVA
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 5.0 s, 20.0 cm; CTDIvol = 46.7 mGy (Head) DLP =
934.2 mGy-cm.
Total DLP (Head) = 934 mGy-cm.
COMPARISON: CT dated ___. MR dated ___
FINDINGS:
Focal cortical hyperdensity in the region of recent left frontal lobe infarct
likely represents cortical laminar necrosis (02:27). Encephalomalacia is
again noted in the bilateral basal ganglia and thalami and right corona
radiata, suggestive of remote infarct. There is no evidence of new
infarction,edema,or mass. There is prominence of the ventricles and sulci
suggestive of involutional changes. There are periventricular and subcortical
hypodensities, which may represent small vessel ischemic changes.
There is no evidence of fracture. The sphenoid sinuses are nearly completely
opacified with aerosolized fluid. There is minimal mucosal thickening of the
bilateral maxillary sinuses ethmoid air cells. The mastoid air cells are
opacified bilaterally, similar to prior. The middle ear cavities are clear.
There are bilateral lens replacements.
IMPRESSION:
1. Focal cortical hyperdensity in the region of recent left frontal lobe
infarct likely represents cortical laminar necrosis.
2. No findings to suggest new infarction.
|
10057482-RR-33 | 10,057,482 | 25,416,257 | RR | 33 | 2145-04-11 09:56:00 | 2145-04-11 12:36:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with s/p Type A dissection repair/Trach/Peg//
eval pneumonia
TECHNIQUE: Portable chest AP.
COMPARISON: Multiple chest radiographs, most recent dated ___.
FINDINGS:
Tracheostomy tube is similarly position. 7 wires are intact. Tip of right
subclavian central venous line projects over the lower SVC.
Central pulmonary vascular congestion is unchanged. Retrocardiac density
obscuring the left hemidiaphragm is largely unchanged, probably reflecting a
combination of pleural effusion and atelectasis. There is no pneumothorax.
Cardiomediastinal silhouette is similarly enlarged.
IMPRESSION:
Largely unchanged left base density likely reflecting a combination of pleural
effusion and atelectasis, though superimposed infection may have a similar
appearance.
|
10057482-RR-34 | 10,057,482 | 25,416,257 | RR | 34 | 2145-04-12 10:13:00 | 2145-04-12 12:10:00 | EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD.
INDICATION: ___ year old woman evaluate for hemorrhagic conversion// ___ year
old woman evaluate for hemorrhagic conversion.
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 5.0 s, 20.0 cm; CTDIvol = 46.7 mGy (Head) DLP =
934.2 mGy-cm.
2) Sequenced Acquisition 2.0 s, 8.0 cm; CTDIvol = 46.7 mGy (Head) DLP =
373.7 mGy-cm.
Total DLP (Head) = 1,308 mGy-cm.
COMPARISON: CT head dated ___, ___.
FINDINGS:
There is redemonstration of focal cortical hyperdensity in the region recent
left frontal lobe infarct, slightly increased in conspicuity, likely
representing an early stage of cortical laminar necrosis versus cortical
petechial changes. Encephalomalacia is again seen in the bilateral basal
ganglia and thalami and right corona radiata, suggestive of remote infarct.
There is no evidence of new infarction,edema,or mass. There is prominence of
the ventricles and sulci suggestive of involutional changes. There are
periventricular and subcortical hypodensities, which may represent small
vessel ischemic changes.
There is no evidence of fracture. Near complete opacification of the left
sphenoid sinus is unchanged. The visualized portion of the remaining
paranasal sinuses and middle ear cavitiesare essentially clear. There is
unchanged opacification of the bilateral mastoid air cells. There are
bilateral lens replacements.
IMPRESSION:
Minimal increase in focal cortical hyperdensity in the region of recent left
frontal lobe infarct suggestive of cortical laminar necrosis versus cortical
petechial changes, close attention this area is advised. No findings to
suggest acute hemorrhagic conversion.
NOTIFICATION: The findings were discussed with ___ ___, NP by ___
___, M.D. on the telephone on ___ at 12:50 pm, 5 minutes after
discovery of the findings.
|
10057482-RR-35 | 10,057,482 | 25,416,257 | RR | 35 | 2145-04-12 15:47:00 | 2145-04-12 16:31:00 | EXAMINATION: RENAL U.S.
INDICATION: ___ year old woman s/p type A dissection repair, ongoing ___ with
rising creat/bun// eval for etiology of ___, eval if perfused from true or
false lumen of aorta
TECHNIQUE: Grey scale and color Doppler ultrasound images of the kidneys were
obtained.
COMPARISON: CTA torso ___
FINDINGS:
A 2.3 cm exophytic simple cyst arises from the lower pole of the right kidney.
A 0.6 cm stone is seen within the upper pole of the right kidney. No
hydronephrosis or solid masses are seen bilaterally. There is normal cortical
echogenicity and corticomedullary differentiation within the bilateral
kidneys. There is asymmetric flow within the kidneys, right greater than
left, which could be partially technical.
Right kidney: 10.8 cm
Left kidney: 10.5 cm
The bladder is moderately well distended and normal in appearance.
IMPRESSION:
1. Normal sonographic appearance of the bilateral renal parenchyma. No
hydronephrosis.
2. Asymmetric vascular flow within the kidneys, right greater than left, could
be technical and/or may be related to involvement of the left renal artery
with the false lumen of the dissection, better evaluated on the CTA of ___.
3. 0.6 cm nonobstructing right renal stone.
|
10057482-RR-36 | 10,057,482 | 25,416,257 | RR | 36 | 2145-04-13 09:24:00 | 2145-04-13 10:43:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with s/p asc aorta repair, trach- increase
wob// eval effusions, pulm edema eval effusions, pulm edema
IMPRESSION:
Comparison to ___. Lung volumes have decreased. The current image
shows signs of mild pulmonary edema. The left-sided effusion with subsequent
atelectasis is stable. The right basal atelectasis has minimally increased in
severity. Stable correct position of the tracheostomy tube and the right PICC
line.
|
10057482-RR-37 | 10,057,482 | 25,416,257 | RR | 37 | 2145-04-13 22:25:00 | 2145-04-13 22:54:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with s/p repair of aortic dissection now
w/trach and peg// decreased breath sounds on L r/o effusion/collapse
TECHNIQUE: AP portable chest radiograph
COMPARISON: ___
FINDINGS:
A tracheostomy tube is present. The patient is post median sternotomy. There
is a right central line present, the tip projecting over the mid to distal
SVC.
There is an increasing left pleural effusion with left hemithorax volume loss.
No pneumothorax. The right lung is grossly clear apart from basilar
atelectasis.
IMPRESSION:
Increasing pleural fluid in the left hemithorax and atelectasis given overall
volume loss in the left hemithorax.
|
10057482-RR-38 | 10,057,482 | 25,416,257 | RR | 38 | 2145-04-17 10:44:00 | 2145-04-17 14:34:00 | EXAMINATION: AORTA AND BRANCHES
INDICATION: ___ year old woman, evaluate for aortic bifurcation thrombus seen
on CTA// ___ year old woman, evaluate for aortic bifurcation thrombus seen on
CTA
TECHNIQUE: Grayscale and color Doppler ultrasound of the abdominal aorta was
performed.
COMPARISON: CTA ___
FINDINGS:
The aorta measures 3.5 cm in the proximal portion, 3.5 cm in mid portion and
3.4 cm in the distal abdominal aorta. There is suboptimal visualization of
the mid and distal aorta due to overlying bowel gas, tortuosity of the aorta,
and body habitus. The known aortic dissection is re-demonstrated. There is
echogenic material within the distal aorta which is consistent with thrombus,
however size comparison to prior exam is difficult due to limited sonographic
windows.
The iliac arteries are not visualized.
IMPRESSION:
Technically limited assessment of the distal abdominal aorta however
intraluminal echogenic material corresponds to the known thrombus, however
size comparison is difficult. If further comparison is desired and the
patient cannot tolerate a CTA, non-contrast MRI with multiplanar imaging could
be performed.
|
10057482-RR-39 | 10,057,482 | 25,416,257 | RR | 39 | 2145-04-17 16:30:00 | 2145-04-17 18:28:00 | EXAMINATION: CT CHEST WITHOUT CONTRAST
INDICATION: ___ year old woman with aspergillus PNA, repeat CT chest to
evaluate resolution of PNA// ___ year old woman with aspergillus PNA, repeat CT
chest to evaluate resolution of PNA
TECHNIQUE: Contiguous axial images were obtained through the chest without
intravenous contrast. Coronal, sagittal and MIP reformats were performed.
DOSE: Acquisition sequence:
1) Spiral Acquisition 8.7 s, 33.3 cm; CTDIvol = 16.0 mGy (Body) DLP = 508.5
mGy-cm.
Total DLP (Body) = 522 mGy-cm.
COMPARISON: CTA torso done ___ and CT chest ___.
FINDINGS:
NECK, THORACIC INLET, AXILLAE, CHEST WALL: Tracheostomy tube in situ with the
tip at the level of the aortic arch. Right central line terminates at the
cavoatrial junction. No supraclavicular adenopathy. Subcentimeter axillary
lymph nodes are most likely reactive.
UPPER ABDOMEN: Percutaneous gastrostomy tube in situ. A 0.5 cm right renal
calculi is incompletely imaged.
MEDIASTINUM: Mediastinal lymph nodes appear fairly similar compared to prior
imaging ranging up to 13 mm in the right lower paratracheal station.
HEART and PERICARDIUM: The patient is status post aortic root repair. Post
dissection changes are difficult to assess without IV contrast and reference
is made to prior contrast CTA torso done ___.
PLEURA: Small sized simple left pleural effusion.
LUNG:
1. PARENCHYMA: Interstitial thickening in keeping with pulmonary edema.
Nodular peribronchovascular airspace disease in the dependent aspect of the
right upper lobe and basal aspects of the right middle and lower lobes most
likely represents bronchopneumonia. These areas of airspace opacification are
slightly less confluent, but there is a slight increase in number of the
peribronchovascular nodules. The overall disease burden is slightly decreased
compared to prior (especially in the dependent aspect of the right upper
lobe). Confluent airspace opacification in the dependent aspect of the left
upper lobe and superior and basal aspects of the left lower lobe most likely
represent atelectasis, however please note that underlying pneumonia cannot be
excluded. Ground-glass airspace opacification the a left lower lobe (series
5, image 24) is nonspecific.
2. AIRWAYS: Partial collapse of the central airways may represent
tracheobronchomalacia in the correct clinical setting.
3. VESSELS: The pulmonary artery is dilated measuring 4 cm diameter
suggesting pulmonary hypertension.
CHEST CAGE: The patient is status post midline sternotomy. Old, healed left
lower posterior rib fractures. Marked degenerative changes of the thoracic
spine. No lytic/destructive bony lesions.
IMPRESSION:
1. Nodular peribronchovascular airspace disease in the dependent aspect of
the right upper lobe and basal aspects of the right middle and lower lobes
most likely represents bronchopneumonia. The overall disease burden is
decreased (especially in the dependent aspect of the right upper lobe)
compared to prior CT studies.
2. Please note that it is difficult to differentiate atelectasis from
consolidation on a non contrasted study. However, airspace opacification in
the dependent aspect of the left upper lobe and superior segment of the left
lower lobe most likely represents atelectasis. Ground-glass airspace
opacification in the left lower lobe is nonspecific.
3. Small left-sided pleural effusion.
4. Patient is status post aortic root repair. Residual post dissection
changes are difficult to assess on a noncontrast study.
|
10057482-RR-40 | 10,057,482 | 25,416,257 | RR | 40 | 2145-04-24 07:10:00 | 2145-04-24 08:27:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman s/p type A dissection// eval for pleural
effusions
IMPRESSION:
In comparison with the study ___, the monitoring support devices are
unchanged, as is the left pleural effusion with compressive basilar
atelectasis and enlargement of the cardiac silhouette. Indistinctness of
pulmonary vessels is consistent with some elevation of pulmonary venous
pressure.
|
10057482-RR-41 | 10,057,482 | 25,416,257 | RR | 41 | 2145-04-25 12:15:00 | 2145-04-25 17:34:00 | EXAMINATION: CHEST PORT. LINE PLACEMENT
INDICATION: ___ year old woman with new PICC needs tip confirmation// New Rt.
Basilic ___. 40 cm. DL ___ ___ ___ Contact name: ___: ___
TECHNIQUE: Chest AP.
COMPARISON: Chest radiographs dated ___ and most recent dated ___
FINDINGS:
Low lung volumes. There is decreased aeration the left hemithorax with
minimal aeration at the left upper lobe. No evidence of mediastinal shift.
The right hemithorax is clear. The right sided PICC line terminates at the
mid SVC. No pneumothorax. A right subclavian catheter terminates at the
distal SVC, unchanged. A tracheostomy tube projects over the upper
mediastinum. Sternal wires are intact.
IMPRESSION:
1. There is near-complete whiteout of the left hemithorax with minimal
aeration at the left upper lung. This may reflect a combination of left lung
collapse and interval increase of left pleural effusion. No mediastinal
shift.
2. Right-sided PICC terminates at the mid SVC. No evidence of pneumothorax.
NOTIFICATION: The findings were discussed with ___ , R.N. by
___, M.D. on the telephone on ___ at 4:01 pm, 15 minutes
after discovery of the findings.
|
10057482-RR-42 | 10,057,482 | 25,416,257 | RR | 42 | 2145-04-25 17:35:00 | 2145-04-25 18:11:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman s/p type a dissection// follow up L lung
collapse please check at 5pm
TECHNIQUE: AP portable chest radiograph
COMPARISON: ___ from earlier in the day
FINDINGS:
A tracheostomy tube is present. The sternotomy wires are intact. The tip of
a right PICC extends to the cavoatrial junction.
Increased aeration of the left upper and midlung with a small to moderate
residual pleural effusion and subjacent atelectasis. There is no pneumothorax
identified. The right lung demonstrates no consolidation, pleural effusion or
pneumothorax. The mediastinal structures are shifted leftward in keeping with
volume loss in the left hemithorax. Calcification of the mitral annulus is
re-demonstrated.
IMPRESSION:
Improved aeration of the left upper and midlung. Continued small pleural
effusion and left lower lobe atelectasis.
|
10057482-RR-43 | 10,057,482 | 25,416,257 | RR | 43 | 2145-04-26 10:14:00 | 2145-04-26 11:09:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman s/p asc aortic replacement// follow up L
collapse/effusion
IMPRESSION:
In comparison with the study ___, changes in obliquity of the patient
probably account for most of the interval differences. Cardiomediastinal
silhouette remains enlarged with opacification at the left base obscuring the
hemidiaphragm consistent with pleural fluid and volume loss in the left lower
lobe. In indistinctness of engorged pulmonary vessels in the mid and upper
left lung could be a reflection of gravitational edema or possibly some
re-expansion edema after significant clearing of the left lung collapse and
effusion.
The remainder of the study is unchanged.
|
10057731-RR-33 | 10,057,731 | 26,763,521 | RR | 33 | 2155-12-10 14:58:00 | 2155-12-10 17:05:00 | EXAMINATION: MRCP
INDICATION: ___ man presenting with recent development of jaundice,
equivocal findings on outside hospital CT, concern for pancreaticobiliary
mass.
TECHNIQUE: T1- and T2-weighted multiplanar images of the abdomen were
acquired in a 1.5 T magnet.
Intravenous contrast: 10 mL Gadavist.
Oral contrast: 1 cc of Gadavist mixed with 50 cc of water was administered
for oral contrast.
COMPARISON: None available.
FINDINGS:
Lower Thorax: There is no pleural or pericardial effusion.
HEPATOBILIARY: There is an ill-defined and infiltrative appearing slightly T2
hyperintense 5.9 x 3.0 x 3.6 cm hypoenhancing mass at the hepatic hilum (6:24
and 7:21). There are multifocal additional slightly T2 hyperintense,
hypoenhancing lesions seen throughout the hepatic parenchyma in both the right
and left hepatic lobes, measuring up to 2.5 cm in segment VII (for example see
series 7, image 21, as well as images 12, 13, 14, 15, and 18). These lesions
demonstrate slight restricted diffusion. The mass encases the proximal common
hepatic duct, which is not well seen. Upstream from the hilar mass there is
diffuse intrahepatic biliary ductal dilation affecting both the right and left
hepatic lobes. Additionally, there are multiple additional areas of
stenosis/obliteration with upstream dilation both in the left hepatic duct, as
well as the right anterior and posterior hepatic ducts, as well as within
multiple left and right more peripheral segmental biliary tree branches,
likely secondary to the multifocal hepatic masses. Additionally, there is
diffuse peribiliary hepatic parenchymal enhancement. The extrahepatic biliary
tree is normal in caliber. The gallbladder is decompressed.
Pancreas: There is a heterogeneous mildly T2 hyperintense centrally
nonenhancing/necrotic mass in the tail of the pancreas which measures 6.0 x
3.6 x 3.4 cm ___ and 6:20). The mass is closely adjacent to the
inferior aspect of the gastric body at its superior margin without clear
involvement (series 6 images ___. There is no extension to the splenic
hilum or evidence of direct invasion of adjacent intra-abdominal structures.
The distal pancreatic parenchyma is atrophied and the main duct is dilated
with dilated side branches. Proximally, there is mild fatty atrophy of the
pancreatic parenchyma, the more proximal/central main pancreatic duct is not
dilated.
Spleen: No splenomegaly or focal splenic lesion.
Adrenal Glands: There is a rounded 2.0 cm hypoenhancing nodule in the right
adrenal gland which demonstrates signal drop on in and out of phase images
consistent with an adrenal adenoma (10:35). The left adrenal gland is normal.
Kidneys: There are bilateral renal cortical cysts without concerning features.
Otherwise, the kidneys display normal symmetric enhancement and signal
intensity characteristics. There is no hydronephrosis.
Gastrointestinal Tract: The stomach and duodenum are unremarkable. Imaged
loops of large and small bowel are within normal limits
Lymph Nodes: There are multiple enlarged upper abdominal lymph nodes. For
example, enlarged periportal lymph nodes measure 13 mm and 14 mm (63: 88 and
89). There is a prominent celiac axis lymph node measuring 8 mm (63:65).
Vasculature: The abdominal aorta is normal in caliber without evidence of
aneurysm or dilation. Major proximal tributaries are patent. Hepatic artery
anatomy appears conventional. The splenic artery is intimately associated
with the posterior aspect of the necrotic pancreatic mass along much of its
midportion (see series 1603, images 81, 85, and 93).
The right portal vein is occluded. The left and main portal vein is patent.
The SMV is patent. The splenic vein is occluded (1603:96).
Upper abdominal varices are noted, including along the lesser curvature (for
example see series 1603, image 67). There is no ascites.
Osseous and Soft Tissue Structures: No suspicious foci of abnormal marrow
signal are seen.
IMPRESSION:
1. 6.0 cm centrally necrotic mass in the tail the pancreas obliterating the
splenic vein, intimately associated with the splenic artery, and abutting but
not clearly involving the inferior aspect of the stomach, consistent with
primary pancreatic neoplasm. No extension to the splenic hilum.
2. Numerous hepatic metastases including to the hepatic hilum causing diffuse
intrahepatic biliary ductal dilation and multifocal areas of intrahepatic
biliary ductal tree stricturing, including involving the left and right
anterior and posterior hepatic ducts as well as more distal segmental biliary
tree branches.
3. Peribiliary enhancement is concerning for superimposed cholangitis.
4. Enlarged periportal lymph nodes are concerning for nodal metastases.
5. Right portal vein is occluded. Patent left and main portal vein. Patent
SMV.
6. Upper abdominal varices are noted including along the lesser curvature of
the stomach. No splenomegaly or ascites.
7. 2 cm right adrenal adenoma. Other incidental findings, as above.
|
10058150-RR-11 | 10,058,150 | 23,585,194 | RR | 11 | 2161-11-04 10:57:00 | 2161-11-04 11:50:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old woman with history of dm htn hold presenting with
syncope and elevated dimmer // Evaluate for consolidation prior to vq scan
Evaluate for consolidation prior to vq scan
IMPRESSION:
In comparison with the study of ___, the patient has taken a better
inspiration. Again there is substantial enlargement of the cardiac silhouette
with mild engorgement of pulmonary vessels consistent with elevated pulmonary
venous pressure. No evidence of pleural effusion or acute focal pneumonia.
|
10058150-RR-12 | 10,058,150 | 23,585,194 | RR | 12 | 2161-11-04 19:10:00 | 2161-11-04 20:25:00 | INDICATION: ___ year old woman with diabetes, HTN presenting with syncope and
elevated Ddimer concerning for PE. Please note low GFR despite only mildly
elevated Cr // ? evaluation for PE
TECHNIQUE: Axial multidetector CT images were obtained through the thorax
after the uneventful administration of intravenous contrast.
Reformatted coronal, sagittal, thin slice axial images, and oblique maximal
intensity projection images were submitted to PACS and reviewed.
DOSE: Acquisition sequence:
1) Stationary Acquisition 5.0 s, 0.5 cm; CTDIvol = 15.2 mGy (Body) DLP =
7.6 mGy-cm.
2) Spiral Acquisition 3.9 s, 30.8 cm; CTDIvol = 12.0 mGy (Body) DLP = 369.9
mGy-cm.
Total DLP (Body) = 378 mGy-cm.
COMPARISON: None
FINDINGS:
The aorta and its major branch vessels are patent, with no evidence of
stenosis, occlusion, dissection, or aneurysmal formation. There is no
evidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.
The pulmonary arteries are well opacified to the subsegmental level, with no
evidence of filling defect within the main, right, left, lobar, segmental or
subsegmental pulmonary arteries. The main, left and right pulmonary arteries
are dilated with the main pulmonary artery measuring up to 3.5 cm.
There is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy.
The thyroid gland appears unremarkable.
There is no evidence of pericardial effusion. There is no pleural effusion.
There is mosaic attenuation of the lungs likely related to expiratory phase of
the study. Although this study is not tailored for the evaluation of the
trachea note is made of anterior motion of the posterior mammary note the
trachea trachea particularly at the level of the thoracic inlet and of the
left mainstem bronchus and right bronchus intermedius.
Limited images of the upper abdomen are notable for layering gallstones than
the gallbladder and a small hiatal hernia..
No lytic or blastic osseous lesion suspicious for malignancy is identified.
IMPRESSION:
1. No evidence of pulmonary embolism or aortic abnormality.
2. Dilated main pulmonary arteries suggestive of pulmonary artery
hypertension.
3. Although this exam is not tailored for the evaluation of the airways note
is made of anterior motion of the posterior membrane of the trachea and
narrowing of the left mainstem and right bronchus intermedius which can be
seen in the setting of tracheobronchial malacia.
4. Cholelithiasis
RECOMMENDATION(S): If further evaluation of the airways is desired could
consider a tracheal protocol CT.
NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on
the telephone on ___ at 10 AM, 5 minutes after discovery of the
findings.
|
10058150-RR-8 | 10,058,150 | 23,585,194 | RR | 8 | 2161-11-02 19:36:00 | 2161-11-02 20:18:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ with new onset AFib
COMPARISON: None
FINDINGS:
AP portable upright view of the chest. Lung volumes are low limiting
assessment. There is mild elevation of the right hemidiaphragm. Hilar
congestion is noted without frank edema. No large effusion or pneumothorax.
No convincing signs of pneumonia. Heart appears top-normal in size.
IMPRESSION:
Top normal heart size with mild hilar congestion without frank edema.
|
10058150-RR-9 | 10,058,150 | 23,585,194 | RR | 9 | 2161-11-02 22:26:00 | 2161-11-02 22:39:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ female with fall, possible seizure vs syncope.
Evaluate for subdural hematoma.
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, 16.7 cm; CTDIvol = 48.0 mGy (Head) DLP =
802.7 mGy-cm.
Total DLP (Head) = 803 mGy-cm.
COMPARISON: None.
FINDINGS:
There is no evidence of infarction, hemorrhage, edema, or mass. There is
prominence of the ventricles and sulci suggestive of involutional changes.
There is no evidence of fracture. The visualized portion of the paranasal
sinuses, mastoid air cells, and middle ear cavities are clear. Cerumen is
noted in the bilateral external auditory canals. The visualized portion of
the orbits are unremarkable.
IMPRESSION:
Mild atrophy. Otherwise normal study.
|
10058437-RR-10 | 10,058,437 | 21,570,649 | RR | 10 | 2131-08-26 06:02:00 | 2131-08-26 06:49:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ year old woman with acute on chronic left SDH. Please perform
at 0600 on ___. // ___ year old woman with acute on chronic left SDH.
Please perform at 0600 on ___.
TECHNIQUE: Contiguous axial images from skullbase to vertex were obtained
without intravenous contrast. Coronal and sagittal reformations and bone
algorithms reconstructions were also performed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 4.0 s, 16.0 cm; CTDIvol = 46.7 mGy (Head) DLP =
747.8 mGy-cm.
Total DLP (Head) = 748 mGy-cm.
COMPARISON: CT head dated ___.
FINDINGS:
There is interval increased in size of the left subdural acute on chronic
hematoma measuring up to 2.5 cm (previously measuring 2.3 cm) in maximal
thickness with slightly worsening 9 mm midline shift to the right (previously
measuring 8 mm) there is slightly worsening subfalcine herniation.
There is also a small acute right subdural collection, for example image 19 of
series 2, with dense component measuring up to approximately 3 mm, which
appears superimposed on background a probably chronic collection better seen
on the previous study, measuring approximately 5 mm. There is no significant
mass effect related to this collection.
There is diffuse brain involutional change. There is intracranial vascular
calcification. There is mild periventricular subcortical white matter
disease.
No osseous abnormalities seen. Mild mucosal thickening in the inferior aspect
of the maxillary sinuses, right more than left. The paranasal sinuses,
mastoid air cells, and middle ear cavities are clear. There are bilateral
lens replacement.
IMPRESSION:
Acute on chronic left subdural hematoma interval slightly increased in size
compared to the previous study with slightly worsening 9 mm midline shift to
the right and subfalcial herniation.
Small right-sided subdural collection again seen, which contains a small dense
component anterior to the frontal lobe also suggesting acute on chronic
subdural hematoma. No significant mass effect related to the right subdural
collection.
NOTIFICATION: The updated findings to include the right-sided subdural
collection were discussed with ___, by ___, M.D. on the
telephone on ___ at 8:36 am, 5 minutes after discovery of the findings.
|
10058437-RR-11 | 10,058,437 | 21,570,649 | RR | 11 | 2131-09-01 16:17:00 | 2131-09-01 16:51:00 | EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ year old woman with recent acute on chronic SDH with 0.8cm
midline shift, now with vomiting. // investigate worsening SDH or other bleed
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast. Coronal and sagittal reformations as well as bone algorithm
reconstructions were provided and reviewed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 5.0 s, 20.0 cm; CTDIvol = 46.7 mGy (Head) DLP =
934.8 mGy-cm.
Total DLP (Head) = 935 mGy-cm.
COMPARISON: Multiple priors, most recently from ___
FINDINGS:
There is redemonstration of the mixed density subdural hematoma overlying the
left frontoparietal convexity, measuring approximately 2.3 cm in maximum
thickness. There is associated mass effect with sulcal effacement of the left
frontoparietal lobe with 8 mm of rightward midline shift.
There is a small a right subdural hematoma overlying the right frontal
convexity measuring approximately 3 mm in maximum thickness, not significantly
changed in comparison to the prior study. There is a small density within the
right subdural suggestive of an acute on chronic component. There is no
associated mass effect.
There is no evidence of acute large territory infarction or new hemorrhage.
Ventricles and sulci are prominent, consistent with age-related global
parenchymal loss. Subcortical, periventricular and deep white matter
hypodensities are nonspecific, but likely reflect the sequela of chronic
microangiopathic ischemic disease.
There is no fracture. Small focus of soft tissue swelling over the left
parietal scalp (303:41). Mild mucosal thickening of the ethmoid air cells
lesion with a small osteoma in the anterior left ethmoid air cell. The
visualized portion of the remaining paranasal sinuses, mastoid air cells, and
middle ear cavities are otherwise clear. The visualized portion of the orbits
demonstrate prior lens surgery and are otherwise normal. There is
atherosclerotic calcification of the carotid siphons and V4 segment of the
right vertebral artery.
IMPRESSION:
1. Redemonstration of mixed density subdural hematoma overlying the left
frontoparietal convexity measuring 2.3 cm in maximum thickness, not
significantly changed in comparison to the prior study. There is associated
mass effect with unchanged sulcal effacement and 8 mm of rightward midline
shift and subfalcine herniation.
2. Small right-sided subdural hematoma overlying the right frontal convexity,
not significantly changed in comparison to the prior study.
3. No evidence of acute large territory infarction or new hemorrhage.
|
10058697-RR-14 | 10,058,697 | 23,920,871 | RR | 14 | 2126-07-06 17:56:00 | 2126-07-06 19:41:00 | INDICATION: Status post fall with right ankle pain. Evaluate for fracture.
COMPARISON: None available.
FINDINGS:
Three views of the right ankle and three views of the right foot were
obtained. There is a nondisplaced transverse fracture through the medial
malleolus, oblique fracture through the distal fibula, and a fracture through
the posterior tibia. No other fracture is identified. There is no radiopaque
foreign body. Sclerotic degenerative change at proximal interphalangeal joint
of the right big toe is noted.
IMPRESSION:
Trimalleolar fracture of the right ankle.
NOTIFICATION: These findings were discussed via telephone by Dr. ___
___ with Dr. ___ at ___ on ___.
|
10058697-RR-15 | 10,058,697 | 23,920,871 | RR | 15 | 2126-07-06 18:13:00 | 2126-07-06 19:51:00 | INDICATION: ___ with s/p fall with back pain // ?fracture ?dislocation
TECHNIQUE: Frontal and lateral views of the lumbar spine. AP view of the
pelvis.
COMPARISON: None.
FINDINGS:
Lumbar spine: There is significant lumbar dextroscoliosis. There is left
lateral subluxation of L1 on L2 and right lateral subluxation of L3 on L4.
Multilevel degenerative changes are noted with asymmetric left-sided disk
height loss and endplate osteophytes as well as facet joint hypertrophy. No
definite acute fracture identified.
Pelvis: There is no fracture. Pubic symphysis and SI joints are preserved.
IMPRESSION:
Significant lumbar dextroscoliosis with left lateral subluxation of L1 on L2
and right lateral subluxation of L3 on L4. No definite acute fracture. No
pelvic fracture.
|
10058697-RR-16 | 10,058,697 | 23,920,871 | RR | 16 | 2126-07-06 22:47:00 | 2126-07-06 23:05:00 | INDICATION: ___ with ankle fx, preop // acute cardio process/preop
TECHNIQUE: AP and lateral views of the chest.
COMPARISON: None
FINDINGS:
The lungs are clear. The cardiomediastinal silhouette is normal. No acute
osseous abnormalities identified.
IMPRESSION:
No acute cardiopulmonary process.
|
10058697-RR-17 | 10,058,697 | 23,920,871 | RR | 17 | 2126-07-06 22:47:00 | 2126-07-06 23:05:00 | INDICATION: ___ with R ankle fx // R ankle Fx
TECHNIQUE: Three views of the right ankle.
COMPARISON: Films from earlier the same day.
FINDINGS:
Overlying cast obscures fine bony detail. Fractures through the distal right
fibula, medial malleolus and posterior malleolus are not as clearly
visualized. No new displaced fractures identified.
|
10058697-RR-18 | 10,058,697 | 23,920,871 | RR | 18 | 2126-07-07 08:47:00 | 2126-07-07 10:38:00 | INDICATION: Ankle ORIF. Bimalleolar fractures.
IMPRESSION:
Several fluoroscopic images of the ankle from the operating room demonstrate
placement of a small metallic rod and syndesmotic screw within the distal
fibula. 2 lag screws are seen within the medial malleolus. There is good
anatomic alignment. There are no signs hardware complications. Please refer to
the operative note for additional details. The total intra service
fluoroscopic time was 64.8 seconds.
|
10058750-RR-22 | 10,058,750 | 28,356,091 | RR | 22 | 2149-11-10 19:21:00 | 2149-11-10 19:55:00 | EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ with hx chronic panceratitis s/p CCY. approximately ___
episode this year, unclear etiology// eval blockage, inflammation
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: CT abdomen and pelvis dated ___.
FINDINGS:
LIVER: The hepatic parenchyma appears within normal limits. The contour of the
liver is smooth. There is no focal liver mass. The main portal vein is patent
with hepatopetal flow. There is no ascites.
BILE DUCTS: There is no intrahepatic biliary dilation. There is mild
pneumobilia, predominantly in the left hepatic lobe, previously seen on CT
dated ___.
CHD: 4 mm
GALLBLADDER: The patient is status post cholecystectomy.
PANCREAS: The pancreas is not well visualized, largely obscured by overlying
bowel gas.
KIDNEYS: Limited views of the right kidney shows no hydronephrosis.
Right kidney: 11.7 cm
RETROPERITONEUM: The visualized portions of aorta and IVC are within normal
limits.
IMPRESSION:
1. No evidence of biliary ductal stone or obstruction.
2. Mild pneumobilia, previously seen on prior CT dated ___.
3. Nonvisualization of the pancreas.
|
10058750-RR-23 | 10,058,750 | 28,356,091 | RR | 23 | 2149-11-13 08:35:00 | 2149-11-13 14:02:00 | EXAMINATION: MRCP
INDICATION: ___ year old man with chronic pancreatitis, recurrent pain, s/p
cholecystectomy// Assess for post surgical damage to the pancreatic duct
orifice as a cause for chronic pancreatitis. Patient has required ___
___ scanner in the past. Claustrophobia and BMI > 30
TECHNIQUE: T1- and T2-weighted multiplanar images of the abdomen were
acquired in a 1.5 T magnet.
Intravenous contrast: 10 mL Gadavist. Additionally, 20 mcg of secretin IV was
administered.
Oral contrast: 1 cc of Gadavist mixed with 50 cc of water was administered
for oral contrast.
COMPARISON: Abdominal ultrasound on ___, CT abdomen and pelvis on
___, MRCP on ___
FINDINGS:
Lower thorax: There are trace bilateral pleural effusions.
Liver: The liver demonstrates normal morphology and signal intensity. There
is no drop in signal on out of phase imaging compared with in phase imaging to
suggest steatosis. No suspicious focal liver lesion identified.
Biliary: There is no intra or extrahepatic biliary dilatation. There is
unchanged mild pneumobilia. The gallbladder surgically absent.
Pancreas: Pancreas demonstrates decrease signal on T1 weighted images,
particularly in the head and body, however enhances homogeneously. Pancreatic
duct is normal in caliber. There is a 3 mm cystic lesion in the pancreatic
body, likely a dilated side branch which may be the sequela of prior
pancreatitis (21:18).
The pancreatic duct only minimally increases in caliber after secretin
administration, at most to 1-mm, without evidence of side duct dilatation,
indicative of decreased ductal compliance. There is evidence of pancreatic
fluid secreted into the duodenum, reaching at least the second portion of the
duodenum after secretin administration, however evaluation for passage of this
fluid past the genu within 10 minutes after secretin administration is limited
by pre-existing fluid within overlapping small bowel loops. No strictures are
seen within the main pancreatic duct. Secretion of fluid into the duodenum
after secretin administration and lack of dilation of the upstream pancreatic
duct and side branches after secretin administration makes papillary
stenosis/pancreatic duct orifice stenosis unlikely.
Spleen: The spleen is mildly enlarged, measuring 13 cm.
Adrenals: Adrenal glands are normal.
Kidneys: The kidneys enhance and excrete symmetrically without suspicious
lesions or hydronephrosis.
Bowel: There is a small hiatal hernia. Partially imaged loops of small and
large bowel are unremarkable. There is no wall thickening, adjacent
inflammatory change, or abnormal enhancement. There is no evidence of
stricture or obstruction.
Vasculature: Abdominal aorta is normal in caliber and major branch vessels are
patent. Hepatic arterial anatomy is conventional. There is an accessory left
renal artery. The portal vein, splenic vein and SMV are patent.
Lymph nodes: There is no mesenteric or retroperitoneal lymphadenopathy.
Osseous/Soft Tissue: There is no abnormal marrow signal or focal suspicious
osseous lesion. No free fluid.
IMPRESSION:
1. Findings suggestive of chronic pancreatitis with decreased normal intrinsic
T1 hyperintensity of the pancreas, 3 mm dilated side branch in the pancreatic
body, and decreased compliance of the pancreatic duct post secretin
administration.
2. No findings to suggest main pancreatic duct stricturing or findings to
suggest papillary stenosis/pancreatic duct orifice stenosis post secretin
administration.
3. No evidence of acute pancreatitis, pancreatic necrosis or peripancreatic
collection.
4. Pancreatic fluid is secreted into the second portion of the duodenum after
secretin administration, with evaluation of passage of this fluid past the
genu limited by pre-existing fluid within small bowel loops which overlap the
duodenum.
5. Mild splenomegaly and trace bilateral pleural effusions.
|
10058856-RR-10 | 10,058,856 | 29,328,838 | RR | 10 | 2127-07-20 13:06:00 | 2127-07-20 16:14:00 | INDICATION: ___ year old woman with s/p common femoral endarterectomy ___ p/w
3 days left groin pain. Now pain in LLQ. Got CT abd OSH, would like a second
opinion. WBC 20.8// Origin Left inguinal/LLQ abdominal pain.
TECHNIQUE: Second read examination of CT abdomen and pelvis without IV
contrast performed at ___, ___.
DOSE: Noncontrast examination acquired at an outside facility, DLP 497
mGy-cm.
COMPARISON: CTA performed on ___.
FINDINGS:
LOWER CHEST: Mild ground-glass opacities seen in the dependent aspect of the
right lower lobe, possibly due to atelectasis or mild inflammation. There is
no evidence of pleural or pericardial effusion.
ABDOMEN:
Note that solid parenchymal assessment is limited without IV contrast.
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 distended but
otherwise grossly 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: Left kidney is grossly unremarkable, allowing for limitations of a
noncontrast examination. There is dilation of the right renal pelvis, similar
to the prior examination, which may be secondary to the UPJ obstruction. The
nephroureteral catheter which was present on the prior examination has been
removed in the interval. Surgical clip is seen just medial to the left
kidney. There does appear to be a left interpolar renal cyst measuring 19 mm.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. Diverticula seen
along the descending colon. There is mild wall thickening along the sigmoid
colon, probably sequelae from chronic diverticular disease. There is
suggestion of mild fat stranding about the sigmoid colon as well, but this
appears quite similar to the prior CT from ___. The appendix appears
normal.
PELVIS: Assessment of the pelvis is somewhat limited due to beam
hardening/streak artifact related to right hip prosthesis and left dynamic hip
screw. Foley catheter is within the bladder which is decompressed and
otherwise grossly unremarkable. There is no free fluid in the pelvis.
REPRODUCTIVE ORGANS: Uterus is atrophic and otherwise 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 to 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. There is
fat stranding and possibly a 15 mm locule fluid seen in the left groin region,
which may be related to recent intervention. Calcifications seen in the
bilateral gluteal fat likely relate to prior injection sites.
IMPRESSION:
1. Limited examination without IV contrast.
2. No imaging findings to explain left lower quadrant pain. While there is
mild thickening of the sigmoid colonic wall and equivocal adjacent fat
stranding, this is a fairly similar appearance to the prior CT from ___,
and likely related to muscular hypertrophy related to chronic diverticular
disease.
3. Small amount of fat stranding in fluid density in the left groin region
likely represent sequelae from prior intervention. Please correlate with any
prior recent interventions to the left groin.
4. Persistent dilation of the right renal collecting system.
|
10058856-RR-11 | 10,058,856 | 29,328,838 | RR | 11 | 2127-07-21 10:31:00 | 2127-07-21 11:01:00 | EXAMINATION: CHEST PORT. LINE PLACEMENT
INDICATION: ___ year old woman with new R PICC// 41 cm R basilic SL PICC-
___ ___ Contact name: ___: ___ cm R basilic SL
PICC- ___ ___
IMPRESSION:
Right PICC line tip is at the level of lower SVC. Heart size and mediastinum
are stable. Lungs are clear. There is no pleural effusion. There is no
pneumothorax.
|
10058856-RR-9 | 10,058,856 | 29,328,838 | RR | 9 | 2127-07-19 16:31:00 | 2127-07-19 17:21:00 | EXAMINATION: US EXTREMITY LIMITED SOFT TISSUE LEFT
INDICATION: ___ year old woman with left femoral endarectomy recently found to
have complex fluid filled cyst on CT scan of her pelvis.// eval abscess found
in left groin on the CT scan
TECHNIQUE: Grayscale ultrasound images were obtained of the superficial
tissues of the left groin.
COMPARISON: Outside hospital CT torso is not available for review at time of
the exam.
FINDINGS:
Transverse and sagittal images were obtained of the superficial tissues of the
left growing at the site of prior endarterectomy. There is a 2.4 x 1.2 x 0.8
cm irregular shaped fluid collection with internal debris without blood flow.
The surrounding soft tissue appears edematous.
IMPRESSION:
A2.4 x 1.2 x 0.8 cm irregular fluid collection with internal debris could
represent abscess versus hematoma. Surrounding soft tissue edema favors
abscess. Comparison can be made if prior imaging becomes available.
|
10058974-RR-40 | 10,058,974 | 26,763,452 | RR | 40 | 2189-08-09 13:52:00 | 2189-08-09 14:19:00 | INDICATION: ___ male with altered mental status. Assess for
infectious process.
COMPARISONS: None.
FINDINGS: Single AP upright radiograph of the chest was obtained. The lungs
are slightly lower in volume but clear. There is no pleural effusion or
pneumothorax. Heart is top normal in size with normal cardiomediastinal
contours.
|
10058974-RR-41 | 10,058,974 | 26,763,452 | RR | 41 | 2189-08-09 14:12:00 | 2189-08-09 17:34:00 | INDICATION: ___ male with altered mental status. Question acute
process.
COMPARISON: None available.
TECHNIQUE: Contiguous non-contrast axial images were acquired through the
brain with multiplanar reformations.
FINDINGS: There is no intracranial hemorrhage, mass effect, edema, or shift
of normally midline structures. The gray-white matter differentiation is
preserved. There is extensive periventricular and subcortical white matter
hypoattenuation, compatible with a small vessel ischemic disease. Ventricles
and sulci are prominent, compatible with age-related involution. Suprasellar
and basilar cisterns are patent.
Paranasal sinuses and mastoid air cells are well aerated. Vascular
calcifications are seen in the cavernous carotid arteries. The middle ear
structures are symmetric. Soft tissue density in bilateral external auditory
canals likely represents cerumen. Globes are intact with bilateral lens
replacement.
IMPRESSION:
1. No acute intracranial process.
2. Extensive age-related involution and small vessel ischemic disease.
3. If there is persistent clinical concern for ischemia, consider MRI if not
contraindicated.
|
10058974-RR-42 | 10,058,974 | 26,763,452 | RR | 42 | 2189-08-09 15:56:00 | 2189-08-10 00:02:00 | INDICATION: ___ male with fever, altered mental status and abdominal
pain. Question infectious process or ischemic bowel.
COMPARISON: None available.
TECHNIQUE: MDCT images were acquired from the lung bases through the pubic
symphysis following administration of intravenous and oral contrast with
multiplanar reformations.
CT ABDOMEN: There is trace bibasilar dependent atelectasis. The heart is
normal in size without pericardial effusion. Multivessel coronary arterial
calcifications are noted, with concurrent aortic valve calcification.
The liver demonstrates no focal lesion. The gallbladder, spleen, and adrenal
glands appear unremarkable. The pancreas is diffusely atrophic and
demonstrates a 9-mm cyst in the head. There is no pancreatic ductal
dilatation.
The nephrograms are symmetric. There is moderate right hydronephroureter
upstream of an 8-mm mid ureteric stone (2, 51). There is also a suggestion of
urothelial hyperenhancement upstream of the stone, suggestive of pyelitis.
There is no left-sided renal obstruction. No additional stone is seen.
Moderate stranding and free fluid is seen around the right kidney. Small and
large bowel loops are normal in caliber. Trace free fluid is seen subjacent
to the cecal tip. There is no intra-abdominal lymphadenopathy. Great vessels
are patent. Moderate atherosclerotic disease is present throughout the
descending aorta extending into branching vessels.
There are bilateral renal cysts, some of which too small to fully
characterize.
CT PELVIS: The bladder is partially distended, but demonstrates urothelial
hyperemia and mural thickening, likely reflecting presence of cystitis. There
is nondependent air and a Foley catheter in place, possibly related to recent
instrumentation. The prostate gland appears enlarged to 5.9 cm. There is
significant fecal impaction within the rectum. No inguinal or pelvic sidewall
adenopathy.
No focal concerning lesion. Multilevel lower thoracic spondylosis is present.
IMPRESSION:
1. 8-mm right mid ureteric obstructing stone with moderate upstream
hydronephroureter, as well as urothelial hyperenhancement suggestive of
pyelitis. Consider percutaneous nephrostomy placement.
2. Bladder thickening and urothelial hyperenhancement suggestive of
concurrent cystitis.
3. Bilateral renal cysts.
4. 9-mm pancreatic head cyst, statistically most likely to represent side
branch IPMN, which could be followed by MRCP.
|
10058974-RR-43 | 10,058,974 | 26,763,452 | RR | 43 | 2189-08-09 19:22:00 | 2189-08-09 22:41:00 | RIGHT PERCUTANEOUS NEPHROSTOMY CATHETER PLACEMENT
INDICATION: ___ man with right-sided obstructing ureteral stone,
urosepsis and fever.
OPERATORS: Dr. ___ (fellow) and Dr. ___
(attending physician). Dr. ___ was present throughout the procedure.
CONTRAST: Sterile 10 mL Optiray 320 in the right renal collecting system.
SEDATION/ANESTHESIA: General endotracheal anesthesia provided by the
anesthesiologist.
OTHER MEDICATION: IV 1 g ceftriaxone.
PROCEDURE AND FINDINGS: Consent was obtained from the patient's healthcare
proxy after explaining the benefits, risks and alternatives. Patient was
placed prone on the imaging table in the interventional suite. Timeout was
performed as per ___ protocol.
Initial scout fluoroscopy demonstrated contrast within the right renal
collecting system and proximal ureter, likely from the previous CT study.
Limited grayscale sonogram of the right kidney did not demonstrate
hydronephrosis. Under aseptic conditions and sonographic guidance, a 21-gauge
hollow-bore needle was placed in the right renal lower pole posterior calix.
0.018 nitinol wire was advanced through the needle and into the right proximal
ureter. After making an incision at the access site, needle was removed to
place the AccuStick system. The outer sheath was advanced into the right
proximal ureter while appropriately retaining the metallic stiffener. The
wire, stiffener and inner sheath were removed. 0.035 stiff Amplatz wire was
advanced through the outer sheath and into the right proximal ureter. The
outer sheath was then removed to dilate the tract under fluoroscopy with an 8
___ dilator. Following this, an 8 ___ nephrostomy catheter was placed.
Inner stiffener and wire were removed. Retention pigtail loop was placed in
the right renal pelvis. String was withdrawn, locked and trimmed. A small
amount of sterile contrast material was injected to confirm position.
Catheter was then flushed with saline, secured by 0 silk sutures and
Flexi-Trak, and connected to an external bag. Site was dressed in an
appropriate fashion. No immediate post-procedure complication was seen.
IMPRESSION: Uncomplicated right percutaneous nephrostomy catheter placement
under ultrasound and fluoroscopic guidance. No right hydroureteronephrosis.
High-grade obstruction in the right proximal-to-mid ureter.
|
10058974-RR-44 | 10,058,974 | 26,763,452 | RR | 44 | 2189-08-11 11:36:00 | 2189-08-11 16:31:00 | INDICATION: ___ man with ___, admitted with urosepsis and
have obstructing renal stone, status post percutaneous nephrostomy, evaluate
for migration of renal stone.
COMPARISONS: CT abdomen and pelvis from ___.
TECHNIQUE: Single portable supine abdominal radiograph was provided.
FINDINGS: There is an 8-mm main ureteral stone seen on the right which
appears to be similar in location as seen on the CT exam. Right percutaneous
nephrostomy tube catheter is in place. There is a nonspecific bowel gas
pattern with air in both the colon and small bowel. There is no evidence of
obstruction, ileus, or large amount of free air. There are degenerative
changes in the lower lumbar spine.
IMPRESSION: 8-mm right mid ureteral stone in similar position as prior CT.
|
10059917-RR-14 | 10,059,917 | 24,017,710 | RR | 14 | 2160-07-06 17:50:00 | 2160-07-06 18:09:00 | EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: History: ___ with fall, poor historian// fracture or acute
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, 16.6 cm; CTDIvol = 48.2 mGy (Head) DLP =
802.7 mGy-cm.
2) Sequenced Acquisition 2.0 s, 4.2 cm; CTDIvol = 48.2 mGy (Head) DLP =
200.7 mGy-cm.
Total DLP (Head) = 1,003 mGy-cm.
COMPARISON: None.
FINDINGS:
There is no evidence of acute territorial infarction,hemorrhage,edema, or
mass. There is prominence of the ventricles and sulci suggestive of
involutional changes. Periventricular, subcortical, and deepwhite matter
hypodensities are nonspecific, but likely reflect the sequela of chronic
microvascular infarction. Dense atherosclerotic calcifications of the
cavernous carotid arteries are noted.
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 apart from bilateral lens replacements.
IMPRESSION:
No acute intracranial abnormality.
|
10059917-RR-15 | 10,059,917 | 24,017,710 | RR | 15 | 2160-07-06 17:51:00 | 2160-07-06 18:17:00 | EXAMINATION: CT C-SPINE W/O CONTRAST Q311 CT SPINE
INDICATION: History: ___ with fall, poor historian// fracture or acute
process? fracture or acute process?
TECHNIQUE: Non-contrast helical multidetector CT was performed. Soft tissue
and bone algorithm images were generated. Coronal and sagittal reformations
were then constructed.
DOSE: Acquisition sequence:
1) Spiral Acquisition 5.3 s, 21.0 cm; CTDIvol = 22.7 mGy (Body) DLP = 476.4
mGy-cm.
2) Sequenced Acquisition 0.5 s, 2.0 cm; CTDIvol = 15.0 mGy (Body) DLP =
30.0 mGy-cm.
3) Sequenced Acquisition 0.5 s, 2.0 cm; CTDIvol = 15.0 mGy (Body) DLP =
30.0 mGy-cm.
Total DLP (Body) = 536 mGy-cm.
COMPARISON: None.
FINDINGS:
No fractures are identified.Alignment is unchanged with reversal of the normal
cervical lordosis and mild retrolisthesis of C3 on C4 and anterolisthesis of
C7 on T1. Rotation of C1 on C2 with retrolisthesis of the right C1 lateral
mass relative to the C2 vertebral body is likely due to head positioning
within the scanner. Moderate to severe multilevel degenerative changes with
intervertebral disc space narrowing, endplate sclerosis and cystic change, and
osteophyte formation is present. There is loss of the C1-2 pre dentate space
as result of severe degenerative changes. Uncovertebral spurring and facet
hypertrophy result in multilevel bilateral mild to moderate neural foraminal
stenosis. There is no evidence of high-grade spinal canal stenosis.There is
no prevertebral soft tissue swelling. There is no evidence of infection or
neoplasm.
Thyroid gland is unremarkable. Visualized lung apices are clear. Dense
atherosclerotic calcification at the left carotid bifurcation is present.
IMPRESSION:
1. No acute fracture or traumatic malalignment.
2. Moderate to severe cervical spondylosis.
|
10059952-RR-17 | 10,059,952 | 26,572,318 | RR | 17 | 2121-02-06 08:26:00 | 2121-02-06 09:19:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: History: ___ with Vtach, please perform this portable stat//
determining pacemaker placement
TECHNIQUE: Portable upright AP view of the chest
COMPARISON: Chest radiograph ___
FINDINGS:
Patient is status post median sternotomy and CABG. Left-sided AICD device is
new in the interval with leads terminating in the region of the right atrium
and right ventricle. Mild cardiomegaly is unchanged. Mediastinal and hilar
contours are normal. No pulmonary edema, focal consolidation, pleural
effusion, or pneumothorax is present. No acute osseous abnormality.
IMPRESSION:
No acute cardiopulmonary abnormality.
|
10060142-RR-11 | 10,060,142 | 25,882,608 | RR | 11 | 2155-08-06 09:50:00 | 2155-08-06 11:13:00 | HISTORY: Abdominal pain, history of necrotizing pancreatitis.
TECHNIQUE: Axial MDCT images were obtained through the abdomen and pelvis
after the administration of 130 cc of Omnipaque intravenous contrast material.
Oral contrast was administered to the patient several hours earlier at an
outside hospital. Coronal and sagittal reformats were also examined.
DLP: 329.39 mGy-cm.
COMPARISON: CT abdomen ___. Chest radiograph ___.
FINDINGS:
The lung bases are clear. The visualized heart and pericardium are
unremarkable.
The liver enhances homogeneously without focal lesion or intrahepatic biliary
ductal dilatation. The spleen is homogeneous and normal in size. The adrenal
glands are unremarkable. Several hypodensities are noted within both kidneys,
too small to characterize. The kidneys present symmetric nephrograms and
excretion of contrast.
A large pseudocyst measuring 11 x 10 x 8 cm is seen, replacing a large portion
of the body and tail of the pancreas. A collection was present in this area
on the prior study, but it is now larger and with a more distinct wall. A
second smaller pseudocyst is present in the area of the head of the pancreas.
The remaining pancreas enhances homogeneously with no signs concerning for
necrosis. Anterior to the larger pseudocyst is fat stranding and fluid. The
portal and splenic veins are patent; however there is a focal area of
narrowing within the proximal to mid splenic vein (2:21) which is likely due
to mass effect from the large pseudocyst just anterior to it. There is no
thrombus or pseudoaneurysm.
There is a moderately sized hiatal hernia. The stomach is displaced
anteriorly by the large pseudocyst. Otherwise the small and large bowel
appear unremarkable without any evidence of wall thickening or obstruction.
The aorta tapers normally without atherosclerotic calcification. There is
free fluid in the pelvis and in the right paracolic gutter. There is no
retroperitoneal or mesenteric lymphadenopathy.
The bladder and terminal ureters are unremarkable. There is no pelvic
sidewall or inguinal lymphadenopathy.
No suspicious lesion is seen in the visualized osseous structures.
IMPRESSION:
1. Two pancreatic pseudocysts, the larger measuring up to 11 cm. No other
complications from pancreatitis, specifically no necrosis.
2. Resolution of previously seen left pleural effusion and focal
consolidation seen on the previous chest radiograph.
|
10060142-RR-12 | 10,060,142 | 25,882,608 | RR | 12 | 2155-08-06 15:44:00 | 2155-08-06 16:17:00 | HISTORY: Back pancreatic pseudocyst in the tail of the pancreas. Assess
pseudocyst or debris.
TECHNIQUE: Limited abdominal ultrasound focused on the pancreas.
COMPARISON: CT abdomen pelvis ___, outside hospital ultrasound ___.
FINDINGS:
In the body/tail of the pancreas there is a large cystic lesion measuring 6.7
x 6.3 x 9.4 cm which contains a large collection of anechoic fluid and only a
small amount of echogenic debris seen in the posterior aspect. The additional
cyst in the head of the pancreas was not able to be seen due to overlying
bowel gas.
IMPRESSION:
6.7 x 6.3 x 9.4 cm pseudocyst in the body/tail of the pancreas contains
primarily anechoic fluid with a small amount of debris in the posterior
aspect.
|
10060142-RR-14 | 10,060,142 | 28,331,272 | RR | 14 | 2156-01-17 20:16:00 | 2156-01-18 09:21:00 | PORTABLE AP CHEST FILM ___ AT ___
CLINICAL INDICATION: ___ with pancreatitis and pseudocyst, assess
nasogastric tube placement.
Comparison to prior study of ___.
Portable AP upright chest film ___ at ___ is submitted.
IMPRESSION:
1. Nasogastric tube is seen coursing below the diaphragm with the tip likely
within the jejunum. Lungs are well inflated without evidence of focal
airspace consolidation. No pleural effusions or pulmonary edema. No
pneumothorax. Overall cardiac and mediastinal contours are within normal
limits.
|
10060142-RR-15 | 10,060,142 | 28,331,272 | RR | 15 | 2156-01-18 18:37:00 | 2156-01-18 22:19:00 | HISTORY: ___ male with pancreatic pseudocyst and ___ jejunal tube in
place. Now clogged.
COMPARISON: CT abdomen and pelvis obtained ___.
FINDINGS:
Supine and upright images of the abdomen demonstrate contrast in nondilated
loops of large bowel. Air is seen in nondilated loops of small bowel. No
evidence of obstruction or ileus. A post pyloric ___ enteric tube is seen
which turns sharply cranially within the distal loop. A kink cannot be
excluded 10 cm proximal to the nasoenteric tube tip. No evidence of free
intraperitoneal air. Osseous structures are unremarkable. Surgical clips are
noted in the right upper quadrant.
IMPRESSION:
Post-pyloric tube identified turning sharply cranially 10 cm proximal to the
terminal tip. A kink cannot be excluded.
A wet reading by Dr. ___ was placed at 10:19 pm on ___.
|
10060142-RR-21 | 10,060,142 | 28,026,353 | RR | 21 | 2156-05-26 02:07:00 | 2156-05-26 03:41:00 | INDICATION: History of necrotizing pancreatitis who presents for evaluation
of elevated lipase. Please evaluate.
COMPARISONS: CT abdomen from ___.
TECHNIQUE: ___ MDCT images were obtained through the abdomen and pelvis after
the administration of IV contrast. Multiplanar reformatted images in coronal
and sagittal axes were generated and reviewed.
FINDINGS: The bases of the lungs are clear. There is mild dependent
atelectasis. The liver is normal without evidence of focal lesions or
intrahepatic biliary ductal dilatation. The spleen is homogeneous and normal
in size. The portal vein is patent. The patient is status post
cholecystectomy. The adrenal glands bilaterally are normal. The left kidney
demonstrates a hypodense lesion, too small to characterize by CT but likely
secondary to a simple renal cyst. The kidneys are otherwise unremarkable.
There has been an interval increase of the hypodense collection in the
body/tail of the pancreas, now measuring 9.6 cm x 9.5 cm x 9.7 cm compared to
the prior exam, at which time this measured 5.1 cm x 5.9 cm x 5.9 cm. This is
consistent with known pancreatic pseudocyst. The surrounding pancreatic
tissue otherwise enhances homogeneously without any signs of necrosis.
Minimal fat stranding is seen along the anterior pancreas.
The stomach, duodenum and small bowel are normal without evidence of wall
thickening or obstruction. The colon is stool filled. There is no
retroperitoneal or mesenteric lymphadenopathy.
CT PELVIS: The urinary bladder and prostate, seminal vesicles are
unremarkable. There is no pelvic free fluid. No pelvic wall or inguinal
lymphadenopathy is identified.
OSSEOUS STRUCTURES: No lytic or blastic lesions concerning for malignancy are
identified.
IMPRESSION: Interval increase of the pancreatic pseudocyst in the body/tail
of the pancreas, now measuring up to 9.6 cm. No other complications from
pancreatitis; however, there is mild stranding at the head of the pancreas.
These findings were discussed with Dr. ___ at 3:01 a.m. by Dr. ___ in
person on ___.
|
10060142-RR-23 | 10,060,142 | 22,361,714 | RR | 23 | 2156-07-01 11:37:00 | 2156-07-01 11:52:00 | HISTORY: Partial small bowel obstruction
TECHNIQUE: Supine and upright AP views of the abdomen.
COMPARISON: CT scan abdomen pelvis ___
FINDINGS:
Oral contrast material from previous CT exam is niow seen throughout the
colon. There are no dilated loops of small bowel or free intraperitoneal air.
Contrast from recent intravenous contrast administration is noted within the
bladder. 2 internal drains are seen within the left upper quadrant, as seen
on the prior CT. Cholecystectomy clips are noted.
IMPRESSION:
Oral contrast material now present within the colon. No dilated loops of
small bowel visualized.
|
10060142-RR-24 | 10,060,142 | 22,559,711 | RR | 24 | 2157-09-15 19:32:00 | 2157-09-16 15:38:00 | EXAMINATION: MRCP (MR ___
INDICATION: ___ year old man with history of pancreatitis with pancreatic
cyst. // characterization of pancreatic cyst
TECHNIQUE: Multiplanar T1 and T2 weighted MR images of the abdomen were
obtained on a 1.5 Tesla magnet including dynamic 3D imaging prior to, during,
and after the administration of 7 mL Gadavist gadolinium based contrast. 1 mL
Gadavist mixed with 50 mL water was also administered for oral contrast.
COMPARISON: CT scan from ___ and prior CT up to ___.
MRI from ___.
FINDINGS:
Dependent atelectasis are seen in the lung bases. There is no pleural or
pericardial effusion. Small hiatal hernia is seen.
The liver is normal in size and morphology. The signal characteristics of the
liver parenchyma are normal on T1 and T2 WI conventional arterial hepatic
anatomy is present. The portal and hepatic veins are patent.
The patient is status post cholecystectomy. The intra and extrahepatic biliary
ducts are normal in caliber.
The body of the pancreas from the level of the SMV and approximately 3.5 cm to
the left is completely atrophic, with intrinsic low signal intensity on T1WI
(11:95) and with progressive enhancement (1304:75), consistent with fibrosis.
In the tail there is scarce preserved parenchyma. The main pancreatic duct is
interrupted in the pancreatic body (10:3). The duct in the pancreatic head is
normal in caliber and appearance. Dilated and irregular pancreatic duct is
present in the tail. A T2 hyperintense tract is seen to connect the distal
pancreatic duct with the lesser curvature of the stomach (03:22). Adjacent to
the tail anteriorly an encapsulated 1.9 x 2.2 cm simple fluid collection is
demonstrated (04:30), denoted by homogeneous hyperintensity on T2 WI and
hypointensity on T1 WI, consistent with pancreatic pseudocyst. The pseudocyst
does not seem to communicate with the pancreatic duct or the stomach.
The spleen is enlarged at 15 cm in craniocaudal dimension. The splenic vein
and artery are unremarkable.
Subcentimeter cortical renal cysts are seen bilaterally. The adrenals are
normal. Single renal artery is present bilaterally.
There is small amount of free perihepatic and perisplenic fluid.
There is no concerning retroperitoneal or mesenteric lymphadenopathy.
Prominent retroperitoneal lymph nodes are seen, secondary to prior
retroperitoneal inflammation.
The bone marrow signal is normal.
IMPRESSION:
1. Sequela of acute pancreatitis, with absent pancreatic parenchyma of the
entire body of the pancreas and with disconnected pancreatic duct with
approximately 3.5 cm gap.
2. Connection between the distal pancreatic duct and the gastric lumen at the
site of the prior cyst-gastrostomy tube.
3. 2.2 cm pseudocyst adjacent anteriorly to the pancreatic tail, separate from
the duct.
4. Splenomegaly.
5. Subcentimeter cortical renal cysts.
|
10060703-RR-11 | 10,060,703 | 28,678,452 | RR | 11 | 2160-09-08 10:56:00 | 2160-09-08 12:27:00 | HISTORY: MVC.
COMPARISON: None available.
TECHNIQUE: Study requested as a second read from outside hospital. Contiguous
axial MDCT images were obtained through the head without IV contrast. Coronal
reformats were provided.
Total exam DLP: 807 mGy-cm.
CTDI: 43 mGY.
FINDINGS:
There is no hemorrhage, major vascular territory infarction, edema, mass or
shift of normally midline structures. The ventricles and sulci are normal in
size and configuration. The basal cisterns appear patent and there is
preservation of gray-white matter differentiation.
There is an acute fracture of the nasal septum, left nasal bone and superior
and medial wall of the left maxillary sinus. There is a small minimally
displaced fracture along the medial wall of the left orbit (400B: 72). The
remaining visualized paranasal sinuses, mastoid air cells and middle ear
cavities are clear. The globes are unremarkable.
IMPRESSION:
1. No acute intracranial abnormalities.
2. Facial bone fractures. Please refer to dedicated sinus/ facial bone CT
for complete report.
Findings discussed in person with Dr. ___ by ___ on ___ at 10:58, 5 min after discovery.
|
10060703-RR-12 | 10,060,703 | 28,678,452 | RR | 12 | 2160-09-08 11:08:00 | 2160-09-08 12:41:00 | HISTORY: Trauma.
COMPARISON: None available.
TECHNIQUE: Study requested as a second read from an outside hospital. Axial
MDCT images were obtained through the cervical spine without IV contrast.
Sagittal and coronal reformats were provided.
Total exam DLP: 313 mGy-cm.
CTDI: 16 mGy.
FINDINGS:
There is no acute cervical fracture or subluxation. There is no prevertebral
soft tissue swelling. CT is not able to provide intrathecal detail comparable
to MRI, however the visualized portion of the thecal sac appears unremarkable.
The thyroid is within normal limits. No lymphadenopathy is present by CT size
criteria. Small blebs are seen in the right apical region (3:132), felt less
likely to represent a pneumothorax.
IMPRESSION:
No acute cervical fracture or subluxation.
Findings discussed in person with Dr. ___ by ___ on ___ at 10:58, 5 min after discovery.
|
10060703-RR-8 | 10,060,703 | 28,678,452 | RR | 8 | 2160-09-08 10:00:00 | 2160-09-08 10:18:00 | HISTORY: Transfer with a left pneumothorax.
COMPARISON: Corrletion made to outside institution CT torso from ___.
FINDINGS: Portable semi upright frontal view of the chest. The lungs are
clear without focal opacity, pleural effusion or pneumothorax. The cardiac
and mediastinal contours are normal. No acute soft tissue or osseous
abnormality is seen. An old third left anterior rib fracture is noted. Known
nondisplaced left 5th rib fracture is not seen.
IMPRESSION: No visualized pneumothorax on this semi erect film.
|
10060703-RR-9 | 10,060,703 | 28,678,452 | RR | 9 | 2160-09-08 10:48:00 | 2160-09-08 13:05:00 | HISTORY: MVC.
COMPARISON: None available.
TECHNIQUE: Study requested as a ___ read from an outside hospital. Helical
axial images were acquired through the paranasal sinuses. Coronal reformatted
images were prepared.
Total exam DLP: 680 mGy-cm.
CTDI: 34 mGy.
FINDINGS:
There are bilateral nasal bone fractures. There is a displaced nasal septum
fracture. There is a probable left lamina papyracea fracture (2:189). There
is a fracture through the superior and medial wall of the left maxillary
sinus. Air fluid levels in the right sphenoid sinus, ethmoidal air cells and
bilateral maxillary sinuses, likely represent hemorrhage. There is a minimally
displaced fracture through the left inferior orbital rim (200b: 37). There is
however no retrobulbar hematoma. There is no proptosis. The cribriform
plates are intact. There is soft tissue swelling and subcutaneous emphysema of
the periorbital and nasal soft tissues, worse on the left. The remaining
paranasal sinuses and visualized mastoid air cells and middle ear cavities a
are normally aerated with no mucosal thickening or fluid levels identified.
IMPRESSION:
1. Multiple facial fractures as described above.
2. Air fluid levels in the right sphenoid sinus and bilateral maxillary
sinuses, likely represent hemorrhage.
Findings discussed with Dr. ___ by ___ Romna on ___ at 10:58
AM, five minutes after discovery.
|
10060733-RR-6 | 10,060,733 | 24,753,883 | RR | 6 | 2120-02-28 19:52:00 | 2120-02-29 09:01:00 | EXAMINATION: MRCP
INDICATION: ___ year old man with painless jaundice, elevated bili and LFTs//
eval for focal biliary obstruction
TECHNIQUE: T1- and T2-weighted multiplanar images of the abdomen were
acquired in a 1.5 T magnet.
Intravenous contrast: 6 mL Gadavist.
Oral contrast: 1 cc of Gadavist mixed with 50 cc of water was administered
for oral contrast.
COMPARISON: REFERENCE ULTRASOUND ___, REFERENCE CT ABDOMEN AND
PELVIS ___
FINDINGS:
Lower Thorax: There is a small left pleural effusion.
Liver: The liver is normal in morphology. There is no signal drop on
out-of-phase imaging to suggest steatosis. No focal hepatic lesions are seen.
There is trace ascites.
Biliary: Gallbladder is mildly distended without evidence of stones. There is
a small amount of pericholecystic fluid. A common bile duct stent is in
place. Enhancement and thickening of the extrahepatic and central
intrahepatic bile ducts likely relate to indwelling stent. There is mild
periportal edema. No evidence of ductal stones. Primarily left-sided
pneumobilia is present.
Pancreas: Note is made of pancreas divisum. There is a 3.0 x 2.6 cm
ill-defined area of hypointense signal in the pancreatic head with
hypoenhancement and restricted diffusion (series 14, image 69; series 16,
image 69). There is no upstream pancreatic duct dilation. There is however,
interruption of the downstream main pancreatic duct/duct of Santorini (series
4, image 30 through 36). Note is made of cystic lesion in the pancreatic head
measuring 6 mm (series 4, image 28).
Spleen: Spleen is normal in size and signal intensity.
Adrenal Glands: There is thickening of the left adrenal gland without discrete
nodularity. Right adrenal gland is unremarkable.
Kidneys: The left kidney is somewhat atrophic. A nephroureteral stent is in
place. There is no hydronephrosis. Right kidney notable for multiple simple
cysts measuring up to 1.6 x 1.7 cm in the upper pole.
Gastrointestinal Tract: Views of the small and large bowel are unremarkable.
Lymph Nodes: There is extensive retroperitoneal lymphadenopathy. Largest
conglomerate of retroperitoneal lymph nodes measures 2.2 cm in short axis
dimension (series 4, image 34).
Vasculature: The portal vein for is patent. Hepatic arterial anatomy is
conventional. There is no aortic aneurysm.
Osseous and Soft Tissue Structures: There are no suspicious bony lesions.
There are no soft tissue abnormalities.
IMPRESSION:
1. 3.0 x 2.6 cm ill-defined mass-like region of hypointense signal on T1
weighted imaging and hypoenhancement in the pancreatic head with restricted
diffusion. Findings could reflect lymphoma, especially in the setting
extensive retroperitoneal lymphadenopathy, or an inflammatory process such as
autoimmune pancreatitis. Metastatic disease or primary pancreatic malignancy
are also considerations but the latter is less likely given the absence of
upstream pancreatic ductal dilatation. Correlate with biopsy/cytology.
Depending on the results, short-term imaging follow-up may be helpful.
2. Extensive retroperitoneal adenopathy, differentials include metastatic
disease versus lymphoma.
3. Common bile duct stent in place. Enhancement of the biliary duct and
pneumobilia, likely reflect post procedural change.
4. 6 mm pancreatic cystic lesion, likely a side-branch IPMN.
5. Pancreas divisum.
RECOMMENDATION(S): Correlate with biopsy/cytology given ill-defined mass-like
region in the pancreatic head. Depending on the results, short-term imaging
follow-up is recommended.
NOTIFICATION: The findings were discussed with ___, M.D. by ___
___, M.D. on the telephone on ___ at 8:59 am, 5 minutes after
discovery of the findings.
|
10060829-RR-73 | 10,060,829 | 29,414,251 | RR | 73 | 2173-02-13 03:44:00 | 2173-02-13 05:44:00 | INDICATION: Lower quadrant abdominal pain. Evaluate for mass or abscess.
TECHNIQUE: MDCT axial images were acquired from the lung bases through the
lesser trochanters following the administration of 130 cc of intravenous
Optiray contrast material. Multiplanar reformations were performed.
COMPARISON: CT abdomen and pelvis from ___.
ABDOMEN CT: The lung bases are clear. The liver is grossly normal. There is
no intrahepatic biliary duct dilatation. The portal vein is patent. The
gallbladder is unremarkable. The spleen, adrenal glands, and kidneys are
normal. Coarse calcifications within the pancreatic head (601B:28) are likely
related to chronic pancreatitis. The pancreas is otherwise grossly normal.
The stomach, small bowel, colon, and appendix are normal aside from scattered
colonic diverticula. There is no evidence of diverticulitis. There is no
free fluid or free air in the abdomen. Prominent paraesophageal lymph nodes
measure up to 9 mm (2:4,6), not significantly changed in size compared to CT
from ___. There are no pathologically enlarged retroperitoneal
or mesenteric lymph nodes. The abdominal aorta is normal in caliber and its
main branches are patent. Scattered aortic calcifications are noted.
PELVIS CT: The bladder is grossly normal. There is no free fluid in the
pelvis. No pathologically enlarged pelvic lymph nodes are seen.
BONE WINDOW: Deformity of the posterolateral left seventh rib likely relates
to remote trauma. There are no suspicious lytic or blastic lesions. Mild
multilevel degenerative changes of the thoracolumbar spine are noted.
IMPRESSION:
1. No acute intra-abdominal or pelvic process.
2. Pancreatic head calcifications likely relate to chronic pancreatitis. No
peripancreatic fat stranding to suggest acute pancreatitis.
|
10060863-RR-31 | 10,060,863 | 29,850,213 | RR | 31 | 2192-05-06 01:03:00 | 2192-05-06 04:15:00 | HISTORY: ___ female with chest pain. Question acute process.
COMPARISON: ___.
FINDINGS: The lungs are well expanded and clear without pleural or
pericardial effusion. The cardiac silhouette is normal in size. Pectus
deformity obscures the right heart border. The mediastinal contours are
normal. The pulmonary vasculature is normal. In the left sixth anterior
interspace there is a 9mm nodular opacity.
IMPRESSION: No acute chest abnormality. Shallow obliques are recommended for
further evaluation of a possible nodule.
Recommendations were discussed with Dr. ___ the ___ at 7:45am.
|
10060863-RR-33 | 10,060,863 | 29,850,213 | RR | 33 | 2192-05-06 08:33:00 | 2192-05-06 11:26:00 | REASON FOR EXAMINATION: Evaluation of potential pulmonary nodule.
COMPARISON: Chest radiograph from ___ obtained at 1:07 a.m.
Two oblique views demonstrate no evidence of pulmonary nodule. Lungs are
essentially clear with no pleural effusion or pneumothorax.
Repeat chest radiograph in three months (PA and lateral) is recommended for
assessment of stability of this finding on the radiograph that is most likely
representing small areas of atelectasis.
|
10061468-RR-10 | 10,061,468 | 27,001,293 | RR | 10 | 2179-12-07 22:24:00 | 2179-12-08 07:44:00 | CLINICAL INDICATION: Blurred vision for one week.
TECHNIQUE: Multidetector CT scan through the head without the administration
of IV contrast. Coronal and sagittal reformatted images were obtained.
DLP: 1025.72 mGy-cm.
CTDI VOLUME: 58.79 mGy.
FINDINGS: There is no acute hemorrhage, edema, mass, mass effect, or acute
large vascular territorial infarction. The ventricles and sulci are prominent
which suggest normal age-related involutional changes. There are
periventricular white matter hypodensities consistent with the sequela of
chronic small vessel ischemic disease. The basal cisterns are patent, and
there is preservation of gray-white matter differentiation.
No fracture is identified. The paranasal sinuses and mastoid air cells are
clear. The globes are unremarkable.
IMPRESSION: No acute intracranial process.
|
10061468-RR-13 | 10,061,468 | 29,932,731 | RR | 13 | 2179-12-12 00:06:00 | 2179-12-12 01:31:00 | HISTORY: ___ female with failure to thrive and leukocytosis.
COMPARISON: None.
FINDINGS:
Frontal and lateral views of the chest were obtained. Heart size and
cardiomediastinal contours are unremarkable. Diffusely increased interstitial
markings are chronic. No focal consolidation, pleural effusion, or
pneumothorax.
IMPRESSION:
No acute cardiopulmonary process.
|
10061737-RR-20 | 10,061,737 | 25,469,970 | RR | 20 | 2126-08-19 14:25:00 | 2126-08-19 15:50:00 | EXAMINATION: MRCP
INDICATION: ___ year old woman with known cholelithiasis presenting with acute
RUQ abdominal pain, CBD dilatation, and elevated lipase concerning for biliary
obstruction, ?gallstone pancreatitis. Cr 1.5 at ___ on ___//
?biliary obstruction
TECHNIQUE: T1- and T2-weighted multiplanar images of the abdomen were
acquired in a 1.5 T magnet.
Intravenous contrast: 6 mL Gadavist.
Oral contrast: 1 cc of Gadavist mixed with 50 cc of water was administered
for oral contrast.
COMPARISON: None.
FINDINGS:
Lower Thorax: Bilateral small pleural effusions with bibasilar airspace
disease, possibly segmental atelectasis. Mild cardiomegaly. No pericardial
effusion.
Liver: Liver demonstrates normal morphology and signal characteristics. No
significant hepatic steatosis. No worrisome enhancing hepatic mass lesions.
Biliary: Gallbladder is present containing multiple gallstones. The
gallbladder is moderately distended measuring 9 x 4 cm with slightly thickened
and edematous gallbladder wall with surrounding pericholecystic inflammatory
changes and fluid in the right upper quadrant concerning for acute
cholecystitis. There is slightly increased amount of free-fluid surrounding
the gallbladder, right retroperitoneum, perihepatic space asymmetric to the
left with slight gallbladder wall irregularity at the fundus suspicious for
perforation.
There is no intrahepatic or extrahepatic biliary duct dilatation. The common
bile duct tapers normally towards the ampulla without obstructing filling
defects or choledocholithiasis.
Pancreas: Pancreas is slightly atrophic with slight prominence of the main
pancreatic duct. There is a small T2 hyperintense cystic lesion at the
pancreatic neck measuring approximately 10 mm suggestive of side branch IPMN.
The main pancreatic duct is slightly prominent, however not dilated. No
peripancreatic fluid collections.
Spleen: Spleen is normal in size and signal characteristics. It enhances
homogeneously without focal mass lesion.
Adrenal Glands: Adrenal glands are normal bilaterally without focal nodules.
Kidneys: The left kidney is not visualized, likely postsurgical given the
susceptibility artifact. The right kidney is unremarkable. There is small
amount of free-fluid within the perinephric space, likely reactive to
surrounding acute inflammatory changes in the right upper quadrant and right
anterior pararenal space.
Gastrointestinal Tract: There is a small hiatal hernia. There is a large
paraduodenal diverticulum measuring 3.1 cm. The remainder visualized small
bowel loops and colon in the upper abdomen are nonobstructed.
Lymph Nodes: No enlarged abdominal lymph nodes.
Vasculature: Abdominal aorta is normal in caliber and its major branches are
patent. The splenic vein, SMV, portal vein and hepatic veins are patent.
Osseous and Soft Tissue Structures: No aggressive osseous lesions.
IMPRESSION:
1. Cholelithiasis with marked surrounding inflammation and loculated fluid
centered around the gallbladder. The gallbladder is only moderately distended
for the degree of inflammation and there is irregularity and discontinuity of
its wall at the fundus which are findings concerning for perforated acute
cholecystitis.
2. No choledocholithiasis.
3. Large paraduodenal diverticulum measuring 3.1 cm
NOTIFICATION: The findings were discussed with ___, M.D. by ___
___, M.D. on the telephone on ___ at 3:47 pm, 10 minutes after
discovery of the findings.
|
10061737-RR-22 | 10,061,737 | 25,469,970 | RR | 22 | 2126-08-19 18:02:00 | 2126-08-19 20:17:00 | EXAMINATION: CT abdomen/pelvis
INDICATION: ___ year old woman with concern for acute cholecystitis +/-
perforated gallbladder// please assess for acute gallbladder pathology
TECHNIQUE: Multidetector CT images of the abdomen and pelvis were acquired
without intravenous contrast. Non-contrast scan has several limitations in
detecting vascular and parenchymal organ abnormalities, including tumor
detection.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Found no primary dose record and no dose record stored with the sibling
of a split exam.
!If this Fluency report was activated before the completion of the dose
transmission, please reinsert the token called CT DLP Dose to load new data.
COMPARISON: Compared to prior MRI dated ___.
FINDINGS:
LOWER CHEST: Visualized lung fields demonstrate small right pleural effusion.
There is bibasilar atelectasis.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout.
There is no evidence of focal lesions within the limitations of an unenhanced
scan. There is no evidence of intrahepatic or extrahepatic biliary
dilatation. The gallbladder is normal without gallbladder-wall thickening.
The known gallstones are not visualized by CT.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions within the limitations of an unenhanced scan. There is no
pancreatic ductal dilatation. There is no peripancreatic fluid collections.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions. Tiny focus of calcification inferiorly.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: Status post left nephrectomy. The right kidney is normal in size.
There is no evidence of focal renal lesions within the limitations of an
unenhanced scan. There is no hydronephrosis. There is no nephrolithiasis.
There is small amount of right perinephric free fluid.
GASTROINTESTINAL: The stomach is unremarkable. There is a large paraduodenal
diverticulum measuring 2.8 cm. There is extraluminal retroperitoneal gas just
lateral and posterior to the second portion of the duodenum extending
superiorly into the porta hepatis (series 1c, image 154) suggestive of a
localized duodenal perforation. The remainder of the small bowel loops
demonstrate normal caliber and wall thickness throughout. Diverticulosis of
the sigmoid colon is noted, without evidence of wall thickening and fat
stranding.
PELVIS: The urinary bladder is decompressed around a Foley catheter. There is
trace amount of free fluid in the pelvis.
REPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
are multiple focal calcifications within the mesentery that could represent
calcified lymph nodes. 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 anterolisthesis of L4 on L5 due to bilateral spondylolysis.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. Normal appearing gallbladder without evidence of acute cholecystitis.
2. Extra luminal retroperitoneal gas lateral and posterior to the second
portion of the duodenum extending superiorly into the porta hepatis with
minimal retroperitoneal and right perinephric free fluid suggestive of a
localized duodenal perforation.
NOTIFICATION: The findings were discussed with ___, M.D. by ___
___, M.D. on the telephone on ___ at 8:06 pm, 15 minutes after
discovery of the findings.
|
10061737-RR-23 | 10,061,737 | 25,469,970 | RR | 23 | 2126-08-19 21:10:00 | 2126-08-19 22:33:00 | INDICATION: ___ year old woman with perforated duodenum now s/p NGT// confirm
NGT placement
TECHNIQUE: AP portable chest radiograph
COMPARISON: None available
FINDINGS:
Sequential images demonstrate advancement of a nasogastric tube into the
stomach. Surgical clips project over the left upper quadrant.
Small bilateral pleural effusions with overlying atelectasis. No
pneumothorax. The size of the cardiac silhouette is enlarged.
IMPRESSION:
Sequential images demonstrate advancement of a nasogastric tube into the
stomach.
|
10061737-RR-24 | 10,061,737 | 25,469,970 | RR | 24 | 2126-08-20 09:36:00 | 2126-08-20 12:07:00 | EXAMINATION: CT abdomen and pelvis without contrast
INDICATION: ___ year old woman with abdominal pain, peritoneal signs on exam,
initial concern for cholecystitis but now imaging more concerning for duodenal
perforation vs duodenal diverticulitis. HAS AN NG TUBE in place// ? duodenal
perforation vs duodenal diverticulitis.
TECHNIQUE: Multidetector CT images of the abdomen were acquired without
intravenous contrast. Non-contrast scan has several limitations in detecting
vascular and parenchymal organ abnormalities, including tumor detection.
Approximately 500 cc of 1:20 diluted Isovue was administered through the
patient's nasogastric tube prior to the study.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 4.8 s, 31.4 cm; CTDIvol = 7.6 mGy (Body) DLP = 233.3
mGy-cm.
Total DLP (Body) = 233 mGy-cm.
COMPARISON: MRCP ___ CT abdomen and pelvis without contrast ___
FINDINGS:
LOWER CHEST: Right effusion with overlying atelectasis is mildly worsened when
compared to the prior examination. Left basilar atelectasis/consolidation is
not significantly changed.
ABDOMEN:
The upper abdominal organs are unchanged. Changes of left nephrectomy are
again noted.
GASTROINTESTINAL: Enteric tube noted in the proximal stomach. The stomach is
well distended with contrast. Contrast passes through the duodenum, and is
seen throughout the small bowel to the level of the cecum.
Again seen are a few duodenal diverticula around the proximal duodenum, seen
on image 32 of series 4, the largest with internal fecalized material and
surrounding soft tissue stranding, concerning for duodenal diverticulitis.
From the largest diverticulum, at the first and second portion of the
duodenum, a tract containing gas is seen leading into a pocket of loculated
gas posterior to the second portion of the duodenum, extending into the porta
hepatis, with a few foci of diluted contrast adjacent to it medially. There
is no intraperitoneal, free-fluid or additional retroperitoneal gas, therefore
it remains difficult to establish if this represents an large portion of the
diverticulum wrapping around the duodenum or contained perforated duodenal
diverticulitis, though the latter is favored.
LYMPH NODES: There is no evidence of retroperitoneal or mesenteric
lymphadenopathy.
VASCULAR: There is no upper abdominal aortic aneurysm. Mild atherosclerotic
disease is noted.
BONES: No concerning osseous lesions, again noting mild to moderate
degenerative changes with anterolisthesis of L4 on L5.
IMPRESSION:
Duodenal diverticulitis. Pockets of gas wrapping around the first and second
portion of the duodenum favor the possibility of perforated duodenal
diverticulitis over wrapping of a large diverticulum around the second portion
of the duodenum as detailed above. No pneumoperitoneum or ascites.
NOTIFICATION: Findiings discussed with Dr. ___ by ___, M.D. ___ at 11:49.
|
10061737-RR-25 | 10,061,737 | 25,469,970 | RR | 25 | 2126-08-21 12:30:00 | 2126-08-21 14:17:00 | EXAMINATION: DX CHEST PORT LINE/TUBE PLCMT 1 EXAM
INDICATION: ___ year old woman s/p Dobhoff placement// please confirm proper
positioning please confirm proper positioning
IMPRESSION:
Heart size and mediastinum are stable. There is interval increase in right
pleural effusion. Left retrocardiac consolidation has increased as well.
The up of tube tip is in the stomach. NG tube tip is in the stomach. No
pulmonary edema is seen.
|
10061737-RR-26 | 10,061,737 | 25,469,970 | RR | 26 | 2126-08-21 15:28:00 | 2126-08-21 18:21:00 | EXAMINATION: ___ intestinal tube advancement
INDICATION: ___ year old woman with perforated duodenum in need of post
pyloric feeding// Pls advance dobhoff post-pyloric. Please bridle dobhoff, its
a ___. Thank you.
DOSE: Acc air kerma: 6 mGy; Accum DAP: 92 uGym2; Fluoro time: 1 minutes 1
second
COMPARISON: Scout of CT abdomen without contrast from ___
FINDINGS:
The right nare was anesthetized with lidocaine jelly. Under intermittent
fluoroscopic guidance, the existing Dobhoff feeding tube was advanced
post-pylorically using a guidewire.
10 cc of Optiray contrast were used to confirm post pyloric placement. Final
fluoroscopic spot images demonstrated the tip of the feeding tube in the third
portion of the duodenum.
The feeding tube was secured to the patient using a bridle.
IMPRESSION:
Successful post-pyloric advancement of a Dobhoff feeding tube. The tube is
ready to use.
|
10061737-RR-27 | 10,061,737 | 25,469,970 | RR | 27 | 2126-08-22 08:14:00 | 2126-08-22 14:25:00 | INDICATION: ___ year old woman with new dobhoff placed. ?dobhoff tip location
in duodenum// dobhoff placement (?in ___ or ___ portion of duodenum)
TECHNIQUE: Supine portable AP radiograph of the abdomen.
COMPARISON: ___ intestinal tube advancement from ___
FINDINGS:
There are no abnormally dilated loops of large or small bowel. ___
intestinal tube appears to be at the junction of the second and third portions
of the duodenal, distal to the site of prior duodenal perforation.
There is no free intraperitoneal air.
Multiple surgical clips are noted in the left mid abdomen. Residual contrast
from ___ intestinal tube advancement is seen.
IMPRESSION:
___ intestinal tube tip terminates at the junction of the second and third
portion of the duodenum, distal to the site of prior duodenal perforation. No
evidence of bowel obstruction.
|
10061737-RR-28 | 10,061,737 | 25,469,970 | RR | 28 | 2126-08-22 14:05:00 | 2126-08-25 11:46:00 | EXAMINATION: ___ intestinal tube advancement
INDICATION: ___ year old woman with perforated duodenal diverticulum s/p
doboff placement with tip terminating at site of perforation.// Please advance
doboff tube past area of perforation.
DOSE: Acc air kerma: 5 mGy; Accum DAP: 69 uGym2; Fluoro time: 31 seconds
COMPARISON: ___ intestinal tube advancement from ___ KUB from ___
FINDINGS:
The right nare was anesthetized with lidocaine jelly. Under intermittent
fluoroscopic guidance, the existing Dobhoff feeding tube was advanced
post-pylorically using a guidewire.
10 cc of Optiray contrast were used to confirm post pyloric placement. Final
fluoroscopic spot images demonstrated the tip of the feeding tube in the area
of the ligament of Treitz, significantly beyond the prior duodenal
perforation.
The feeding tube was secured to the patient using a bridle.
IMPRESSION:
Successful post-pyloric advancement of a Dobhoff feeding tube. The tube is
ready to use.
|
10061737-RR-29 | 10,061,737 | 25,469,970 | RR | 29 | 2126-08-27 13:59:00 | 2126-08-27 16:38:00 | EXAMINATION: Leaked check
INDICATION: ___ year old woman with perforation of ___ portion of duodenum now
with NGT and NJ (dobhoff) to bypass the perforation. Study for ?persistent
leak in the ___ portion of duodenum// ?persistent leak in ___ portion of
duodenum (Please use gastroview)
TECHNIQUE: Single contrast upper GI.
DOSE: Acc air kerma: 539 mGy; Accum DAP: 1433 uGym2; Fluoro time: 57 seconds
COMPARISON: None
FINDINGS:
A Dobhoff tube is noted. Water-soluble contrast (Gastrografin) was
administered through the nasogastric tube. Gastrografin was seen to pass
into the duodenum from the stomach, filling the previously noted diverticulum
of the second portion of the duodenum. In subsequent images contrast empties
from the diverticulum into the more distal bowel without evidence of
extraluminal contrast or leak.
IMPRESSION:
No evidence of leak or extraluminal contrast.
NOTIFICATION: The findings were discussed with ___, M.D. by ___
___, M.D. on the telephone on ___ at 4:19 pm, 5 minutes after
discovery of the findings.
|
10062020-RR-10 | 10,062,020 | 27,609,979 | RR | 10 | 2113-03-06 19:12:00 | 2113-03-06 19:51:00 | HISTORY: Knee pain and femoral fracture.
TECHNIQUE: 3 views of the right knee.
COMPARISON: Left femur radiographs ___ at 16:06.
FINDINGS:
The patient is status post ORIF of a distal femoral fracture as delineated on
the recent left femur radiographs obtained earlier the same day. There is no
acute fracture or dislocation otherwise seen. Tricompartmental degenerative
changes are severe with joint space narrowing, subchondral sclerosis and
osteophyte formation. A small joint effusion is noted. There are extensive
vascular calcifications. No suspicious lytic or sclerotic osseous
abnormalities otherwise visualized.
IMPRESSION:
Status post ORIF of a distal femoral fracture, better assessed on the recent
femoral radiographs. No acute fracture or dislocation otherwise seen in the
left knee. Small joint effusion. Severe tricompartmental degenerative
changes.
|
10062020-RR-11 | 10,062,020 | 27,609,979 | RR | 11 | 2113-03-06 17:43:00 | 2113-03-06 19:55:00 | HISTORY: Elevated CRP.
TECHNIQUE: PA and lateral views of the chest.
COMPARISON: None.
FINDINGS:
Study is slightly limited due to patient rotation. Additionally the left lung
apex is obscured due to overlying soft tissue from the patient's neck and
chin. The heart is mild to moderately enlarged. Calcifications of the aortic
arch are present. There is mild pulmonary vascular congestion. Patchy
opacity in the retrocardiac region could reflect atelectasis, but infection is
not excluded. Eventration of the left hemidiaphragm is noted. No large
pleural effusion or pneumothorax is seen. There is diffuse demineralization
of the osseous structures.
IMPRESSION:
Limited exam due to patient rotation. Mild pulmonary vascular congestion.
Patchy retrocardiac opacity could reflect atelectasis but infection cannot be
excluded.
|
10062020-RR-13 | 10,062,020 | 27,609,979 | RR | 13 | 2113-03-07 00:53:00 | 2113-03-07 08:54:00 | CT EXAMINATION OF THE LEFT LOWER EXTREMITY WITHOUT INTRAVENOUS CONTRAST
HISTORY: Status post open reduction internal fixation of a distal left femur
fracture. Evaluation for malunion.
TECHNIQUE: Multidetector axial CT examination of the left leg was performed
without the intravenous administration of contrast. Coronal and sagittal
reformations were performed.
COMPARISON: ___.
FINDINGS:
There is severe joint space narrowing, subchondral sclerosis, and cystic
change with osteophyte formation of the left femoroacetabular joint. There is
prominent bone demineralization. There is no acute fracture at this site.
A lateral surgical fixation plate extends along the left femur. Multiple
surgical fixation screws are in place and intact. A comminuted distal left
femur fracture is again present with marked sclerosis along the fracture
margins. There is no osseous bridging / callus formation. Periosteal
reaction is noted about the proximal fracture fragments.
There is severe medial compartment joint space narrowing of the right knee.
There is prominent subchondral cystic change within the posteromedial aspect
of the tibial plateau measuring approximately 3.4 cm TRV.
There is similar subchondral cystic change within the anteromedial aspect of
the left tibial plateau measuring 1.4 cm TRV. There is similar subchondral
cystic change within the fibular head measuring 1.9 cm TRV.
Within the shaft of the proximal tibial, there is soft tissue attenuation
material without cortical breakthrough (for example 3:213-223).
There are prominent atherosclerotic calcifications throughout the arterial
vasculature of the left leg. There is lateral subluxation of the patella
relative to the femoral trochlea. There is mild subcutaneous edema, without
drainable fluid collection.
The imaged portions of the pelvic viscera demonstrate prominent diverticula
within the sigmoid colon without evidence of diverticulitis.
IMPRESSION:
1. Nonunited comminuted distal left femur fracture. Margins of the fracture
demonstrate sclerosis. There is periosteal reactou about the proximal
fracture fragments; can not exclude underlying infection in this patient with
reported cutaneous discharge.
2. Surgical hardware is intact within the left femur with no hardware
failure.
3. Severe medial compartment degenerative joint disease of the left knee with
prominent subchondral cystic change within the tibial plateau and fibular
head, likely degenerative in etiology.
4. Soft tissue attenuation within the medullary shaft, particularly of the
tibia. This may represent red marrow but malignancy is not excluded. MR
examination would provide further imaging evaluation.
Findings conveyed to the critical results coordinator.
|
10062020-RR-15 | 10,062,020 | 27,609,979 | RR | 15 | 2113-03-08 10:36:00 | 2113-03-09 10:13:00 | HISTORY: Hardware removal.
FINDINGS: Images from the operating suite demonstrate the procedure. Further
information can be gathered from the operative report.
|
10062020-RR-16 | 10,062,020 | 27,609,979 | RR | 16 | 2113-03-09 16:31:00 | 2113-03-09 17:05:00 | HISTORY: Postop day 1 status post left femur debridement and cement spacer
placement for nonunion now with left posterior calf pain, here to evaluate for
deep venous thrombosis.
COMPARISON: Venous duplex ultrasound of the bilateral lower extremities dated
___.
TECHNIQUE: Grayscale, color and spectral Doppler evaluation was performed of
the left lower extremity veins.
FINDINGS:
There is normal compressibility, flow and augmentation of the left common
femoral, proximal femoral, mid femoral, distal femoral and popliteal veins.
Normal color flow and compressibility is demonstrated in the left posterior
tibial veins. The left peroneal veins were not visualized. There is normal
respiratory variation in the common femoral veins bilaterally.
IMPRESSION:
No evidence of deep venous thrombosis in the left lower extremity with
nonvisualization of the left peroneal veins.
|
10062020-RR-17 | 10,062,020 | 27,609,979 | RR | 17 | 2113-03-12 09:44:00 | 2113-03-12 12:43:00 | HISTORY: Left femur nonunion status post removal of hardware and antibiotic
spacer placement. Assess alignment.
COMPARISON: Left femur radiograph ___, left lower extremity CT
___, intraoperative left femur radiograph ___.
TECHNIQUE: Left femur radiograph, four views.
FINDINGS: Again appreciated is a comminuted, displaced, slightly dorsally
angulated fracture of the distal left femur. The patient is status post
hardware removal with visible screw tracks. A significant amount of
radiodense material in the area of the fracture is compatible with antibiotic
spacer placement. The angulation and displacement of the fracture looks
relatively unchanged compared to prior examination from ___ when
harder was in place. No new fracture is identified. Dense vascular
calcifications are noted. Other postoperative changes are noted including a
small amount of subcutaneous gas and overlying skin staples.
IMPRESSION: Comminuted angulated left distal femur fracture status post
removal of hardware and antibiotic spacer placement. The relative alignment
and displacement of the fracture appears similar to prior examination when
hardware was still in place.
|
10062020-RR-18 | 10,062,020 | 27,609,979 | RR | 18 | 2113-03-12 13:29:00 | 2113-03-12 14:14:00 | INDICATION: PICC line placement.
COMPARISON: Chest radiograph on ___.
FINDINGS: AP upright view of the chest. The patient is rotated to her left.
Left PICC ends in at or just below the cavoatrial junction. Mild-to-moderate
cardiomegaly is unchanged. Aortic knob calcifications are again seen. Again
seen is eventration of the left hemidiaphragm. Small to moderate left pleural
effusion is unchanged. Left lower lobe atelectasis is also unchanged. The
right lung is clear. Mild pulmonary vascular congestion.
IMPRESSION: Left PICC ends at or just below cavoatrial junction; unchanged
moderate left pleural effusion and left lower lobe atelectasis.
Findings were discussed with ___, IV nurse at 2:04 p.m. on ___
by telephone.
|
10062020-RR-19 | 10,062,020 | 27,609,979 | RR | 19 | 2113-03-13 11:10:00 | 2113-03-13 11:40:00 | INDICATION: Right PICC placement.
COMPARISON: Chest radiograph from ___.
FINDINGS: The left PICC line has been removed and there is an interval
placement of a right PICC with the tip at the mid to lower SVC. There is no
evidence of pneumothorax.
The patient appears rotated toward the left. Moderate cardiomegaly appears
stable. Aortic knob calcifications are again seen. Again noted is
eventration of the left hemidiaphragm with small left pleural effusion which
appears unchanged. Left lower lobe atelectasis is again noted. The right
lung is clear.
IMPRESSION: Right-sided PICC with the catheter tip at the lower SVC. Small
left pleural effusion with adjacent atelectasis appears stable.
|
10062020-RR-9 | 10,062,020 | 27,609,979 | RR | 9 | 2113-03-06 15:59:00 | 2113-03-06 17:31:00 | RADIOGRAPHS OF THE LEFT FEMUR
HISTORY: Status post open reduction of proximal femur with pus seen at the
wound.
COMPARISONS: None.
TECHNIQUE: Left femur, five views.
FINDINGS: The patient is status post open reduction and internal fixation of
the distal femur with a lateral fixation plate and multiple fixation screws.
Screws proximal and distal to the fracture site do not show clear evidence for
loosening, but the fracture site is not healed and shows medial displacement
of the distal fragment by almost half of a shaft width, including persistent
distraction and ineffective healing response with bony hypertrophy and
sclerosis.
The right hip joint space and medial compartment of the right knee appear
narrowed. The bones also appear, more generally, demineralized. Vascular
calcifications are present.
IMPRESSION: Status post open reduction and internal fixation with ineffective
healing and displacement.
|
10062617-RR-11 | 10,062,617 | 27,056,234 | RR | 11 | 2119-10-30 10:03:00 | 2119-10-30 17:34:00 | PORTABLE CHEST: ___.
HISTORY: ___ male with recent falls.
FINDINGS: Two portable views of the chest are compared to previous exam from
___. There are hazy bibasilar opacities suggestive of layering
effusions. There is indistinct pulmonary vascular marking superiorly
suggestive of edema. Cardiac silhouette is enlarged, not significantly
changed from prior. Dense atherosclerotic calcifications noted at the arch.
Dual-lead pacing device is again noted. Osseous and soft tissue structures
are grossly unremarkable.
IMPRESSION: Findings suggestive of congestive failure with moderate bilateral
layering effusions.
|
10062617-RR-12 | 10,062,617 | 27,056,234 | RR | 12 | 2119-10-30 08:06:00 | 2119-10-30 13:03:00 | INDICATION: ___ male with recent falls and multiple subdural
hematomas.
COMPARISON: None.
TECHNIQUE: Contiguous axial MDCT images were obtained through the brain
without administration of IV contrast. Axial images were interpreted in
conjunction with coronal and sagittal reformats.
FINDINGS: There is no evidence of hemorrhage, mass effect, or large
territorial infarction. An 8-mm hypodensity with a small central hyperdensity
is present in the left frontal lobe periventricular white matter and appears
nonacute. The ventricles and sulci are prominent, compatible with age-related
volume loss. Basal cisterns appear patent and there is preservation of
gray-white matter differentiation. No fracture is identified. The visualized
paranasal sinuses, mastoid air cells, middle ear cavities are clear.
Bilateral ocular lenses have been replaced.
IMPRESSION:
1. No intracranial hemorrhage or calvarial fracture.
2. 8-mm hypodensity with central hyperdensity in the left frontal lobe
periventricular white matter, of uncertain clinical significance and likely
nonacute. Differential includes cavernoma, other vascular anomaly, or
dystrophic calcification. Please correlate with older imaging. Otherwise,
additional imaging may be obtained when clinically appropriate.
|
10062617-RR-13 | 10,062,617 | 27,056,234 | RR | 13 | 2119-10-30 08:10:00 | 2119-10-30 13:00:00 | INDICATION: ___ male with recent falls. Evaluate for subdural
hemorrhage.
COMPARISON: None.
TECHNIQUE: 2.5 mm helical axial MDCT images were obtained from the skull base
to the inferior aspect of T2. Axial images were interpreted in conjunction
with coronal and sagittal reformats.
FINDINGS: There is no evidence of fracture. Vertebral body heights are
maintained. Multilevel degenerative changes are seen, with fusion of the
spinous processes of C2 and C3 potentailly from prior trauma, and disc space
loss at C2-3 and C5-6. Mild anterolisthesis is present of C7 on T1 with
associated facte joint chnages at this level. No prevertebral soft tissue
abnormality is present. No cervical lymphadenopathy by CT size criteria. The
thyroid is unremarkable. The lung apices are clear.
IMPRESSION:
1. Mild anterolisthesis of C7 on T1 may be degenerative. Please correlate
with symptoms at this site.
2. No fracture or prevertebral soft tissue abnormality.
|
10062617-RR-14 | 10,062,617 | 27,056,234 | RR | 14 | 2119-10-30 08:23:00 | 2119-10-30 11:08:00 | INDICATION: ___ male with left arm and left leg swelling. Rule out
DVT.
COMPARISONS: None.
FINDINGS: Grayscale, color, and spectral Doppler ultrasound examination was
performed of the left lower extremity veins. There is normal phasicity of the
common femoral veins bilaterally. There is normal compression and
augmentation of the left common femoral, proximal femoral, mid femoral, distal
femoral, popliteal, posterior tibial, and peroneal veins.
IMPRESSION: No evidence of DVT in left lower extremity.
|
10062617-RR-15 | 10,062,617 | 27,056,234 | RR | 15 | 2119-10-30 08:24:00 | 2119-10-30 11:18:00 | INDICATION: ___ male with left arm and left leg swelling. Rule out
DVT.
COMPARISONS: None.
FINDINGS: Grayscale, color, and spectral Doppler ultrasound examination was
performed of the left upper extremity veins. The subclavian veins have normal
phasicity bilaterally. Pacer wire leads are seen within the left subclavian
vein. There is normal compression and augmentation of the left internal
jugular, subclavian, axillary, paired brachial, basilic, and cephalic veins.
IMPRESSION: No evidence of DVT in the left upper extremity.
|
10062617-RR-29 | 10,062,617 | 28,840,277 | RR | 29 | 2123-07-01 07:33:00 | 2123-07-01 09:46:00 | EXAMINATION: Chest radiograph
INDICATION: ___ with fever, general weakness
TECHNIQUE: Chest PA and lateral
COMPARISON: Prior chest radiographs from ___
FINDINGS:
There is a new opacity in the right medial lung base, concerning for
pneumonia. Moderate atelectatic changes are seen in the bilateral lung bases.
Small bilateral pleural effusions are likely. Severe cardiomegaly is
unchanged since ___. A left pectoral pacemaker is noted with transvenous
leads in the region of the right atrium and right ventricle. No pneumothorax.
IMPRESSION:
New opacity at the right medial lung base is concerning for pneumonia.
|
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