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10062617-RR-33
10,062,617
25,754,091
RR
33
2124-03-12 10:08:00
2124-03-12 11:08:00
EXAMINATION: CHEST (PA AND LAT) INDICATION: ___ year old man with confusion, chronic aspiration, concern for PNA // please eval for possible infiltrate, aspiration please eval for possible infiltrate, aspiration IMPRESSION: Comparison to ___. Mild pulmonary edema is present on today's examination. New right basal parenchymal opacity, potentially reflecting aspiration. Stable appearance of the cardiac silhouette.
10062981-RR-15
10,062,981
24,520,789
RR
15
2191-01-31 12:13:00
2191-01-31 14:28:00
EXAMINATION: CHEST (AP upright AND LAT) INDICATION: ___ with AMS and R hip pain s/p recent fall COMPARISON: CT chest ___ FINDINGS: AP upright and lateral views of the chest provided.Again seen is a large mass projecting over the right upper lobe measuring 12.5 x 10 cm, grossly unchanged in size from prior study. Remainder of the right lung is clear. Left lung is clear. No large effusion or pneumothorax. Heart size remains within normal limits. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen. IMPRESSION: Large mass in the right upper lung. Otherwise unremarkable.
10062981-RR-16
10,062,981
24,520,789
RR
16
2191-01-31 12:13:00
2191-01-31 14:29:00
EXAMINATION: PELVIS AND RIGHT HIP RADIOGRAPHS INDICATION: ___ with AMS and R hip pain s/p recent fall TECHNIQUE: Pelvis, PA view. Right hip, two views. COMPARISON: CT abdomen and pelvis ___ FINDINGS: There is no acute fracture or dislocation. SI joints appear symmetric and normal. Lower lumbar spine degenerative disease is partially visualized. Both hips align normally with mild to moderate loss of axial joint space, right greater than left. There is mild acetabular spurring with subchondral sclerosis noted bilaterally. Femoral necks appear intact bilaterally. Dedicated views of the right hip are unrevealing. Vascular calcifications are noted. IMPRESSION: Degenerative changes without fracture.
10062981-RR-17
10,062,981
24,520,789
RR
17
2191-01-31 12:03:00
2191-01-31 12:42:00
EXAMINATION: CT HEAD W/O CONTRAST INDICATION: ___ with AMS and R hip pain s/p recent fall, known metastatic disease secondary to lung cancer. TECHNIQUE: Routine unenhanced head CT was performed and viewed in brain, intermediate and bone windows. Coronal and sagittal reformats were also performed. DOSE: Total DLP (Head) = 903 mGy-cm. COMPARISON: Prior brain MR from ___. FINDINGS: There is no intra-axial or extra-axial hemorrhage. There is slightly increased edema in the right cerebellum with mild mass-effect on the fourth ventricle. As seen on prior MRI, there is a mass within the right cerebellum best seen on series 2, image 6 measuring approximately 12 x 13 mm. There is a similar pattern of right frontal lobe edema with a small mass at the gray-white matter junction seen best on series 602b, image 22 measuring approximately 7 x 8 mm. Ventricles appear stable in size without evidence of obstructive hydrocephalus. Basilar cisterns remain patent. Minimal mucosal thickening within the ethmoid air air cells noted. Otherwise the imaged paranasal sinuses are clear as are the mastoid air cells and middle ear cavities. The bony calvarium is intact. IMPRESSION: Vasogenic edema in the right frontal lobe and right cerebellum secondary to known metastatic lesions. Mildly increased edema in the right cerebellum. No hemorrhage.
10062981-RR-18
10,062,981
24,520,789
RR
18
2191-01-31 16:19:00
2191-01-31 17:55:00
EXAMINATION: CT ABDOMEN AND PELVIS INDICATION: ___ with R hip pin with ROM s/p fall, Hct drop// RP hematoma? R hip fx? TECHNIQUE: Multidetector CT images of the abdomen and pelvis were acquired without intravenous contrast. Non-contrast scan has several limitations in detecting vascular and parenchymal organ abnormalities, including tumor detection. Oral contrast was not administered. Coronal and sagittal reformations were performed and reviewed on PACS. DOSE: Total DLP (Body) = 841 mGy-cm. COMPARISON: None. FINDINGS: LOWER CHEST: Lung base emphysema is again noted. The lung bases are otherwise unremarkable. 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 within normal limits. PANCREAS: The pancreas has normal attenuation throughout, without evidence of focal lesions within the limitations of an unenhanced scan. There is no pancreatic ductal dilatation. There is no peripancreatic stranding. SPLEEN: The spleen shows normal size and attenuation throughout, without evidence of focal lesions. ADRENALS: The right and left adrenal glands are normal in size and shape. URINARY: The kidneys are of normal and symmetric size. There is no evidence of focal renal lesions within the limitations of an unenhanced scan. There is no hydronephrosis. There is no nephrolithiasis. There is no perinephric abnormality. GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate normal caliber and wall thickness throughout. The colon and rectum are within normal limits. The appendix is normal. PELVIS: The urinary bladder and distal ureters are unremarkable. There is no free fluid in the pelvis. REPRODUCTIVE ORGANS: The reproductive organs are unremarkable. LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There is no pelvic or inguinal lymphadenopathy. VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease is noted. BONES: A large lucent bone lesion consistent with bony metastasis is seen involving the right acetabulum with cortical breakthrough, which places patient at high-risk for fracture. No additional SOFT TISSUES: The abdominal and pelvic wall is within normal limits. There is no retroperitoneal or intra-abdominal hematoma per fracture and a right IMPRESSION: 1. Large lytic bone lesion at the right acetabulum consistent with metastatic disease. Patient is at impending risk for fracture given cortical breakthrough. 2. No hematoma or other acute findings.
10062981-RR-19
10,062,981
24,520,789
RR
19
2191-02-01 18:07:00
2191-02-02 10:07:00
EXAMINATION: MR HEAD W AND W/O CONTRAST T___ MR HEAD INDICATION: ___ year old man with known metastatic lung adeno of the brain with recent cyberknife. S/p steroid taper. Now with worsening AMS and edema noted on CT. // please evaluate for progression of disease ?leptomeningeal involvement. TECHNIQUE: Sagittal and axial T1 weighted imaging were performed. After administration of 7 mL of Gadavist intravenous contrast, axial imaging was performed with gradient echo, FLAIR, diffusion, and T1 technique. Sagittal MPRAGE imaging was performed and re-formatted in axial and coronal orientations. COMPARISON: CT head ___ MRI head ___ and ___ FINDINGS: The round, and heterogeneously enhancing lesion in the right cerebellar hemisphere is unchanged in size, measuring 2.3 x 1.9 x 1.7 cm. The surrounding T2/FLAIR hyperintense signal in the right cerebellar hemisphere, extending into the cerebellar vermis and left medial cerebellar hemisphere, is unchanged in extent. The local mass effect in the right cerebellar hemisphere with partial effacement of the fourth ventricle is unchanged from the MRI head ___. The 1.1 x 1.1 x 0.9 cm round, enhancing lesion in the right frontal lobe has decreased in size in comparison to the prior examination, previously measuring 1.5 x 1.1 x 1.0 cm. The surrounding T2/FLAIR hyperintense signal in the right frontal lobe has decreased in extent. The 3 mm enhancing lesion in the left parietal lobe on 1000b:70 is less conspicuous in comparison to the prior examination. The 2 mm enhancing lesion in the right parietal lobe on 1000b:70 is unchanged from the prior examination. The 2 mm enhancing lesion in the left medial frontal lobe on 1000b:68 is minimally decreased in size from the prior examination. The 2 mm enhancing lesion in the left cerebellar vermis on 1000b:41 has decreased in size. A 4 mm enhancing lesion with associated T2/FLAIR hyperintense signal in the left postcentral gyrus on 1000b:93 and 21:11, is new from the prior examination. The T1/T2 hypointense lesion with a susceptibility and faint peripheral enhancement in the right parietal lobe is unchanged. There is no evidence of infarction or extra-axial fluid collection. The ventricles and sulci are unchanged in size in prominent, related to age-appropriate volume loss. There is no leptomeningeal enhancement. There is mild mucosal thickening in the bilateral ethmoid sinuses. The mastoid air cells are clear. The orbits are unremarkable. The major intracranial flow voids are preserved. IMPRESSION: 1. Mixed response with interval decrease in the metastatic lesions to the right frontal, left frontal, left parietal lobes and left cerebellar hemisphere, unchanged metastatic lesions in the right cerebellar hemisphere and right parietal lobe, and a new metastatic lesion in the left postcentral gyrus. 2. No evidence of leptomeningeal disease. 3. Unchanged right parietal lobe lesion with susceptibility and faint surrounding enhancement, which may represent a cavernoma.
10063534-RR-21
10,063,534
26,199,018
RR
21
2151-05-22 19:19:00
2151-05-22 20:13:00
HISTORY: CHF and hypotension. COMPARISON: ___. TECHNIQUE: Portable frontal chest radiograph, single view. FINDINGS: Severe cardiomegaly with slight increase in size compared to ___. Hilar contours are unremarkable. A left anterior chest wall single-lead pacer is unchanged in position. No focal consolidation worrisome for pneumonia; however, left lung base is difficult to assess. There is no large pleural effusion or pneumothorax. IMPRESSION: 1. No acute intrathoracic process. No frank interstitial edema. 2. Severe global cardiomegaly slightly increased in size from prior examination. This could be due to pericardial effusion; however, no definite fat pad sign is seen. Conventional lateral view may be helpful to assess the left lung base.
10063534-RR-22
10,063,534
26,199,018
RR
22
2151-05-24 03:44:00
2151-05-24 10:55:00
INDICATION: CHF, pericardial effusion status post drainage. Evaluate for pulmonary edema. COMPARISON: Chest radiograph ___, ___ FINDINGS: The heart remains enlarged in size. There are new bilateral pleural effusions and moderate pulmonary edema. Worsening retrocardiac opacity persists and may represent atelectasis or pneumonia in the correct clinical setting. Single lead pacemaker defibrillator is present with tip terminating in the right ventricle. A catheter is seen projecting over the lower left hemithorax. IMPRESSION: New bilateral pleural effusions and moderate pulmonary edema. Left retrocardiac opacity may reflect atelectasis or pneumonia in the correct clinical setting.
10063534-RR-23
10,063,534
26,199,018
RR
23
2151-05-25 16:23:00
2151-05-25 17:33:00
HISTORY: Mass seen at ___ a few months ago. Presenting with pericardial effusion. ?Lung mass. COMPARISON: Multiple previous chest radiographs, most recent dated ___. TECHNIQUE: Multidetector CT of the thorax was performed without contrast. Coronal and sagittal reformats were provided for interpretation. FINDINGS: There are two nodules within the right middle lobe measuring 6 mm (5:181) and 4 mm (5:188) respectively. There are also pleural-based nodules within the right middle and lower lobes measuring 4 mm (5:175) and 6 mm (5:166) respectively. There are moderate-sized bilateral pleural effusions. There is complete atelectasis of the left lower lobe with partial atelectasis of the right lower lobe, likely secondary to compression from the effusions. There is a small pericardial effusion. A single-chamber pacemaker is noted with its tip in the right ventricle. There is mild cardiomegaly. Multiple subcentimeter mediastinal lymph nodes are noted and are likely reactive. No axillary adenopathy. The thyroid gland is unremarkable. The visualized upper abdominal viscera is unremarkable. Multilevel degenerative change is noted within the lower thoracic and upper lumbar spine. Osseous structures are otherwise unremarkable. IMPRESSION: 1. Multiple subcentimeter nodules as described within the right middle and lower lobes, with the largest measuring 6 mm. Correlation with the previous imaging would be of benefit to ensure stability. Follow-up CT in ___ months is recommended as per ___ society recommendations. 2. Moderate-sized bilateral pleural effusions. 3. Small pericardial effusion.
10063848-RR-10
10,063,848
21,345,067
RR
10
2177-07-27 12:00:00
2177-07-27 15:50:00
EXAMINATION: Chest radiograph INDICATION: ___ year old woman with desaturation// eval for acute process TECHNIQUE: Upright frontal view of the chest COMPARISON: CT abdomen pelvis ___. FINDINGS: There is central vascular engorgement and mild pulmonary edema. There is bibasilar left greater than right atelectasis. There is no definite consolidation or pneumothorax. Moderate cardiomegaly is noted. IMPRESSION: Mild pulmonary edema and bibasilar atelectasis.
10063848-RR-11
10,063,848
21,345,067
RR
11
2177-07-27 23:08:00
2177-07-28 06:48:00
INDICATION: ___ year old woman POD ___ s/p ex lap, LOA, SBR// PO CONTRAST ONLY, evaluate for leak TECHNIQUE: Multidetector CT images of the abdomen and pelvis were acquired without intravenous contrast. Non-contrast scan has several limitations in detecting vascular and parenchymal organ abnormalities, including tumor detection. Oral contrast was administered. Coronal and sagittal reformations were performed and reviewed on PACS. DOSE: Acquisition sequence: 1) Spiral Acquisition 5.1 s, 55.9 cm; CTDIvol = 16.9 mGy (Body) DLP = 942.2 mGy-cm. Total DLP (Body) = 942 mGy-cm. COMPARISON: CT abdomen pelvis dated ___. FINDINGS: LOWER CHEST: Bibasilar consolidative opacities and small bilateral pleural effusions no pericardial effusion are new over the interval. 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 surgically absent. PANCREAS: There is fatty atrophy of the pancreatic head and uncinate process. The remainder of the pancreas demonstrates normal attenuation. No evidence of focal pancreatic lesions or ductal dilatation within limitations of this noncontrast enhanced study. No peripancreatic stranding. SPLEEN: The spleen shows normal size and attenuation throughout, without evidence of focal lesions. ADRENALS: The right and left adrenal glands are normal in size and shape. URINARY: The kidneys are of normal and symmetric size. There is no evidence of focal renal lesions within the limitations of an unenhanced scan. There is no hydronephrosis. A 5 mm nonobstructing stone is seen in the lower pole of the left kidney. There is no perinephric abnormality. GASTROINTESTINAL: The stomach is unremarkable. Surgical anastomosis from recent partial small-bowel resection is seen in the mid abdomen. Loops of small bowel at and just proximal to the anastomosis demonstrate mild wall thickening. Several punctate loops of intra-abdominal free air are present, compatible with recent postoperative status. There are dilated loops of small bowel leading to up to the anastomosis, with oral contrast material seen in a decompressed loops of small bowel and colon distal to the anastomosis. This appearance is most compatible with focal small-bowel ileus. There is no evidence of extraluminal contrast to suggest anastomotic leak. A small amount of simple ascites is seen within the abdomen. The colon demonstrates normal wall thickness and caliber. The appendix is surgically absent. PELVIS: Bladder is decompressed by Foley catheter. There is a small amount of free fluid in the pelvis. A rounded calcification in the right lower quadrant may represent calcified lymph node versus torsed epiploic appendage. REPRODUCTIVE ORGANS: The uterus is not visualized. No adnexal abnormality is seen. LYMPH NODES: Several prominent retroperitoneal mesenteric lymph nodes are likely reactive in the setting of recent surgery. No enlarged pelvic sidewall or inguinal lymphadenopathy by CT size criteria. VASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic disease is noted. BONES: There is no evidence of worrisome osseous lesions or acute fracture. SOFT TISSUES: Surgical staples are seen longitudinally traversing the mid abdomen, compatible with recent postoperative status. IMPRESSION: 1. Focal small bowel ileus involving loops of small bowel leading up to the new surgical anastamosis. No bowel obstruction as suggested by distal passage of orally ingested contrast beyond the anastomosis. 2. No extraluminal contrast seen to suggest anastomotic leak. 3. New bibasilar opacities and small bilateral pleural effusions. This likely represents atelectasis, aspiration pneumonitis is also a consideration. 4. Nonobstructing 5 mm left lower pole nephrolithiasis.
10063848-RR-12
10,063,848
21,345,067
RR
12
2177-07-28 02:13:00
2177-07-28 09:50:00
EXAMINATION: Portable chest radiograph INDICATION: ___ year old woman with small bowel resection, new NGT// Confirm NGT placement TECHNIQUE: Chest AP COMPARISON: ___ FINDINGS: A nasogastric tube is now in place and terminates in the distal stomach. Lung volumes are low. Interval improvement of pulmonary edema. Slight improvement of left basilar atelectasis. Stable cardiomegaly. No pleural effusion or pneumothorax. IMPRESSION: 1. Nasogastric tube terminates in the distal stomach. 2. Interval improvement of pulmonary edema and left basilar atelectasis.
10063848-RR-13
10,063,848
21,345,067
RR
13
2177-07-28 19:05:00
2177-07-29 00:34:00
EXAMINATION: DX CHEST PORTABLE PICC LINE PLACEMENT INDICATION: ___ year old woman with PICC// Pt had a L PICC,45cm ___ ___ Contact name: ___: ___ TECHNIQUE: Chest single view COMPARISON: ___ 02:31 FINDINGS: Left PICC line is coiled at the confluence of brachiocephalic veins, should be repositioned. Increased heart size, pulmonary vascular congestion, more prominent since prior. Mild perihilar opacities, may represent edema or atelectasis. Mild bilateral pleural effusions, similar on the left, more prominent on the right. Bibasilar opacities have increased, likely atelectasis. No pneumothorax. IMPRESSION: PICC line should be repositioned.
10063848-RR-14
10,063,848
21,345,067
RR
14
2177-07-28 19:21:00
2177-07-29 00:32:00
EXAMINATION: DX CHEST PORTABLE PICC LINE PLACEMENT INDICATION: ___ year old woman with PICC repositioning// PICC position Contact name: ___: ___ TECHNIQUE: Chest single view COMPARISON: ___ 19:10 FINDINGS: Since prior, left PICC line has been advanced, tip is in mid SVC, approximately 3 cm from cavoatrial junction. Otherwise no change. IMPRESSION: Right PICC line tip in mid SVC.
10063848-RR-15
10,063,848
21,345,067
RR
15
2177-07-29 12:01:00
2177-07-29 14:47:00
INDICATION: ___ year old woman s/p SBR now with a fever// ?enlarging opacities, ?pneumonia COMPARISON: Radiographs from ___ IMPRESSION: The left-sided PICC line has the distal tip in the distal SVC. Heart size is prominent but unchanged. There is again seen a left retrocardiac opacity and atelectasis at the lung bases. There is coarsening of the bronchovascular markings without overt pulmonary edema. There are no pneumothoraces.
10063848-RR-17
10,063,848
26,880,153
RR
17
2177-08-17 15:44:00
2177-08-17 17:04:00
INDICATION: ___ year old woman s/p exploratory laparotomy, LOA and resection of 90cm SM bowel. currently with low BP admitted to ICU// is there a suspicion for an anastomotic leak TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired through the abdomen and pelvis following intravenous contrast administration with split bolus technique. Oral contrast was administered. Coronal and sagittal reformations were performed and reviewed on PACS. DOSE: Acquisition sequence: 1) Stationary Acquisition 6.5 s, 0.5 cm; CTDIvol = 31.3 mGy (Body) DLP = 15.6 mGy-cm. 2) Spiral Acquisition 4.5 s, 49.4 cm; CTDIvol = 14.2 mGy (Body) DLP = 703.2 mGy-cm. Total DLP (Body) = 719 mGy-cm. COMPARISON: ___ CT abdomen pelvis FINDINGS: LOWER CHEST: Visualized lung fields demonstrate bibasilar atelectases. There is no evidence of pleural or pericardial effusion. ABDOMEN: HEPATOBILIARY: Low liver density compared to spleen suggest fatty liver. There is no evidence of focal lesions. There is no evidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder is surgically absent. PANCREAS: Fatty atrophy of the pancreatic head and uncinate process again seen. The remainder of the pancreas has normal attenuation throughout, without evidence of focal lesions or pancreatic ductal dilatation. There is no peripancreatic stranding. SPLEEN: The spleen shows normal size and attenuation throughout, without evidence of focal lesions. ADRENALS: The right and left adrenal glands are normal in size and shape. URINARY: The kidneys are of normal and symmetric size with normal nephrogram. There is no evidence of focal renal lesions or hydronephrosis. There is no perinephric abnormality. GASTROINTESTINAL: The stomach is unremarkable. Patient is status post partial small bowel resection. The re-anastomosis site in the mid abdomen is re-demonstrated. Extraluminal gas extending from the superior aspect of the anastomosis (02:54) is worrisome for perforation and/or anastomotic leak. It is possible, though unlikely, that this pocket of air connects with a collapsed loop of small bowel; however this is not well delineated. Surrounding mesenteric stranding and edema is noted. Scattered small pockets of extraluminal gas are also visualized, some of which could be secondary to dehiscence of the midline abdominal wall. Focal dilatation of the small bowel loops proximal to the anastomosis (02:40) could be secondary to postoperative ileus or partial versus early small bowel obstruction with the anastomosis sites serving as the transition point. Small bowel loops distal to the anastomosis site are decompressed. Midline dehiscence of the anterior abdominal wall is noted. Caudally it extends into the intra-abdominal cavity where a 2.5 cm fluid collection is demonstrated just deep to the dehiscence (2:68, 601b:20, 602b:40). The colon and rectum are within normal limits. The appendix is surgically absent. PELVIS: The urinary bladder and distal ureters are unremarkable. There is trace pelvic free fluid, significantly improved since ___. The calcified density in the pelvis is again noted, likely represents a calcified lymph node or large phleboliths. LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There is no pelvic or inguinal lymphadenopathy. VASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic disease is noted. BONES: There is no evidence of worrisome osseous lesions or acute fracture. SOFT TISSUES: Dehiscence midline abdominal wall, as described above. IMPRESSION: 1. Midline dehiscence of the abdominal wall; caudally it extends into the peritoneal cavity where a 2.5 cm focus of (organizing fluid) is demonstrated just deep to the dehiscence (2:68, 601b:20, 602b:40). 2. Extra luminal gas extending from the superior aspect of the anastomosis site is worrisome for perforation and/or anastomotic leak, as described above. It is possible that this pocket of air communicates with a collapsed loop of small bowel however this is not well delineated. ___ consider CT abdomen and pelvis with oral contrast if this will alter management. 3. Focal dilatation of the small bowel loop proximal to the anastomosis could be secondary to postoperative ileus or partial/early small bowel obstruction with the anastomosis site serving as the transition point. 4. Fatty liver. RECOMMENDATION(S): Extra luminal gas extending from the superior aspect of the anastomosis site is worrisome for perforation and/or anastomotic leak, as described above. It is possible that this pocket of air communicates with a collapsed loop of small bowel however this is not well delineated. ___ consider CT abdomen and pelvis with oral contrast if this will alter management. NOTIFICATION: The findings were discussed with ___, M.D. by ___ ___, M.D. on the telephone on ___ at 6:31 pm, 5 minutes after discovery of the findings.
10063848-RR-8
10,063,848
21,345,067
RR
8
2177-07-25 01:53:00
2177-07-25 02:41:00
EXAMINATION: CT abdomen pelvis with contrast INDICATION: NO_PO contrast; History: ___ with hx of adhesions and lysis in 1990s, with 10 episodes of vomiting and constipation, r/o bowel obstructionNO_PO contrast// Evaluate for bowel obstruction TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired through the abdomen and pelvis following intravenous contrast administration with split bolus technique. Oral contrast was not administered. Coronal and sagittal reformations were performed and reviewed on PACS. DOSE: Acquisition sequence: 1) Stationary Acquisition 3.0 s, 0.5 cm; CTDIvol = 14.4 mGy (Body) DLP = 7.2 mGy-cm. 2) Spiral Acquisition 4.6 s, 50.4 cm; CTDIvol = 15.9 mGy (Body) DLP = 802.0 mGy-cm. Total DLP (Body) = 809 mGy-cm. COMPARISON: None. FINDINGS: LOWER CHEST: There is mild bibasilar atelectasis. There is no pleural effusion or pericardial effusion. The heart is mildly enlarged. The imaged portion of the breast parenchyma is suboptimally evaluated on the current modality and would require dedicated mammography for further evaluation. ABDOMEN: HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There is no evidence of focal lesions. There is no evidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder is surgically absent. PANCREAS: The pancreas is mildly atrophic with fatty replacement of pancreatic head and the uncinate process. There is no peripancreatic stranding. SPLEEN: The spleen shows normal size and attenuation throughout, without evidence of focal lesions. ADRENALS: The right and left adrenal glands are normal in size and shape. URINARY: The kidneys are of normal and symmetric size with normal nephrogram. There is no evidence of focal renal lesions or hydronephrosis. There is no perinephric abnormality. GASTROINTESTINAL: The stomach is mildly distended with fluid. There is marked distension of the duodenum and multiple loops of the proximal jejunum, which becomes slightly decompressed with fecalized material. The fecalized loop appears to be tethered to the anterior abdominal wall. At the anterior abdominal wall, there is abrupt transition at the proximal ilium with complete collapse of the ileal loops. Gas is seen within the ascending colon, though the descending colon is near completely collapsed. Small amount fluid is seen within the rectum. The appendix is not visualized. A dropped clip is seen inferior to the liver adjacent to the ascending colon. Calcific density in the right lower quadrant may represent fat necrosis or calcified lymph node. PELVIS: The urinary bladder and distal ureters are unremarkable. There is no free fluid in the pelvis. REPRODUCTIVE ORGANS: The uterus is not visualized. No adnexal abnormality is seen. LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There is no pelvic or inguinal lymphadenopathy. VASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic disease is noted. BONES: Degenerative changes are seen in the lumbar spine. SOFT TISSUES: The abdominal and pelvic wall is within normal limits. IMPRESSION: 1. High grade small bowel obstruction likely caused by adhesions -with the transition point at the level of the umbilicus within the right anterior abdominal wall with upstream dilation of small bowel loops which are fluid filled, with complete collapse of the distal small bowel loops . Surgical consultation is recommended. 2. No bowel perforations.
10063848-RR-9
10,063,848
21,345,067
RR
9
2177-07-26 00:57:00
2177-07-26 17:17:00
INDICATION: ___ s/p ex-lap, LOA, SBR for SBO, NGT advanced in PACU// ? NGT placement TECHNIQUE: Portable supine abdominal radiograph was obtained. COMPARISON: CT abdomen pelvis from ___ FINDINGS: There is a paucity of small bowel gas with no abnormally dilated loops of large or small bowel. Supine assessment limits detection for free air; there is no gross pneumoperitoneum. Osseous structures are unremarkable. An NG tube is seen with the tip terminating at the gastric antrum. There is a second catheter that projects over the superior mediastinum, unclear if this is a second NG tube or an ETT. If ETT please consider pulling back 3-4 cm and reassessing with follow-up chest radiograph. IMPRESSION: 1. Nonspecific bowel gas pattern without evidence of obstruction. 2. NG tube is visualized with the tip terminating at the gastric antrum. 3. Second catheter projecting over the superior mediastinum for which clinical correlation is recommended, as above.
10063856-RR-17
10,063,856
28,403,663
RR
17
2178-09-17 16:30:00
2178-09-17 19:08:00
EXAMINATION: CT ABD AND PELVIS W AND W/O CONTRAST, ADDL SECTIONS INDICATION: ___ woman with multiple intracranial lesions, evaluate for primary malignancy. TECHNIQUE: Contiguous axial multidetector CT images through the abdomen and pelvis with intravenous and oral contrast. Multiplanar reformations were generated and reviewed. Total DLP (Body) = 1,286 mGy-cm. COMPARISON: 1. CT abdomen ___. 2. CT pelvis ___. FINDINGS: LUNG BASES: Please see dictation for separately reported CT Chest examination. CT ABDOMEN: A 6 mm hypodensity within the caudate lobe (see series 3, image 51) is unchanged since ___, compatible with a simple renal cyst. Otherwise, the liver enhances homogeneously without evidence of focal lesions. There is no intrahepatic biliary ductal dilation. The portal vein is patent. There is some vicarious excretion of contrast layering dependently in the gallbladder lumen. The gallbladder is otherwise unremarkable. The pancreas enhances homogeneously. There is no peripancreatic stranding. Mild prominence of the main pancreatic duct in the region of the head and proximal body measuring up to 3 mm. There is no splenomegaly or focal splenic lesion. The adrenal glands are unremarkable. Multiple bilateral renal hypoattenuating lesions measuring up to 14 mm. These are new compared to the MRI abdomen dated ___ and the larger lesions demonstrate ___ ranging from 72-84. .There is normal symmetric renal enhancement bilaterally. There is a 7 mm nonobstructive calculus in the upper pole of the right kidney (03:48). The stomach and duodenum are unremarkable. Nondilated small bowel loops are normal in course and caliber without evidence of wall thickening or obstruction. Right lower quadrant end ileostomy is identified which appears patent without evidence of ischemia or obstruction. Oral contrast passes normally into the extracorporeal ostomy bag. The patient is status post total colectomy. The abdominal aorta is normal in caliber without evidence of aneurysm or dilation major proximal tributaries are patent. There is no mesenteric or retroperitoneal lymphadenopathy by CT size criteria. There is no free intraperitoneal air or fluid CT PELVIS: The bladder and terminal ureters are unremarkable. An enlarged rounded left iliac chain lymph node measures 1.4 x 1.1 x 1.3 cm (CC x TV x AP) (series 3, image 100 and series 601b, image 21), and is new since ___. No additional enlarged pelvic sidewall iliac chain or inguinal lymph nodes are seen. There is no free pelvic fluid. MUSCULOSKELETAL: Irregular sclerosis of the left T11 pedicle and lamina is unchanged since ___ (series 3, image 41). Otherwise, there is background mild to moderate thoracolumbar spine degenerative change. There is no evidence of concerning focal lytic or sclerotic osseous lesion. IMPRESSION: 1. Enlarged rounded left iliac chain lymph node measuring 1.4 x 1.1 x 1.3 cm, new since ___. 2. Multiple bilateral renal hypodense lesions measuring up to 14 mm are of intermediate density by CT, with equivocal contrast enhancement. Recommend renal ultrasound or MRI further evaluation. 3. Status post total colectomy and end ileostomy. 4. Please see separate report for intrathoracic findings from same-day CT chest. RECOMMENDATION(S): Renal ultrasound or abdominal MRI for further evaluation of indeterminate bilateral new renal hypodense lesions.
10063856-RR-18
10,063,856
28,403,663
RR
18
2178-09-18 01:48:00
2178-09-18 12:21:00
EXAMINATION: MR HEAD W AND W/O CONTRAST T___ MR HEAD INDICATION: ___ year old woman with multiple intracranial lesions, larges in L cerebellum. // MRI to further qualify lesions. TECHNIQUE: Sagittal and axial T1 weighted imaging were performed. After administration of 7 mL of Gadavist intravenous contrast, axial imaging was performed with gradient echo, FLAIR, diffusion, and T1 technique. Sagittal MPRAGE imaging was performed and re-formatted in axial and coronal orientations. COMPARISON: Outside reference contrast-enhanced head CT from ___ FINDINGS: There are multiple ring-enhancing lesions with intense surrounding FLAIR signal abnormality and associated slow diffusion in the ___ the lesion, involving both cerebral and cerebellar hemispheres, the largest in the left cerebellum measuring 2.7 x 2.4 cm on image ___. Only 1 of the lesions in the right posterior parietal lobe demonstrates susceptibility with increased T1 signal abnormality suggesting hemorrhage or mineralization. These are nonspecific and possible differential diagnosis includes intracranial abscess, intracranial metastasis or toxoplasmosis if the patients is immunocompromised. There is focal left frontal dural thickening and enhancement on image ___,, which is suggestive of meningioma vs leptomeningeal disease. No acute intracranial hemorrhage or infarct is seen. The ventricles, cistern and sulci are patent and symmetric. No midline shift is seen. The orbits are unremarkable. There is mild mucosal thickening in bilateral ethmoidal air cells. The remaining visualized paranasal sinuses and mastoid air cells are clear. Intracranial flow voids are maintained. Visualized osseous structures are unremarkable. IMPRESSION: 1. Multiple ring-enhancing lesions in bilateral cerebral and cerebellar hemispheres with associated FLAIR signal abnormality, and restricted diffusion. One lesion demonstrates increased susceptibility, which could be secondary to hemorrhage or mineralization. Differential diagnosis is broad an includes metastatic disease, intracranial abscess, intracranial and toxoplasmosis if patient is immunocompromised. 2. Focal left frontal dural thickening and enhancement, meningioma vs leptomeningeal disease.
10063856-RR-19
10,063,856
28,403,663
RR
19
2178-09-17 16:30:00
2178-09-17 19:47:00
EXAMINATION: CHEST CTA INDICATION: ___ woman with multiple intracranial lesions, evaluation for a primary malignancy. TECHNIQUE: Axial helical MDCT images were obtained from the suprasternal notch to the upper abdomen in early arterial phase scanning after the uneventful administration of IV Omnipaque contrast. Reformatted coronal, sagittal, thin slice axial images were submitted to PACS and reviewed. Total DLP (Body) = 1,286 mGy-cm. ** Note: This radiation dose report was copied from CLIP ___ (CT ABD AND PELVIS W AND W/O CONTRAST, ADDL SECTIONS) COMPARISON: None. FINDINGS: CT THORAX: The right thyroid lobe is unremarkable. The left thyroid lobe is likely surgically absent. The esophagus is unremarkable throughout its imaged course. There is no hiatus hernia. There is no cardiomegaly. The aorta demonstrates normal caliber throughout the chest without evidence of intramural hematoma or dissection. There is no pericardial effusion. There is a heterogeneously enhancing mass in the anterior left upper lobe causing obliteration of the left upper lobe bronchus (series 3, image 25) with secondary distal collapse. Areas of the collapsed upper lobe demonstrate hypoenhancement, possibly reflective of necrosis (for example see series 3, image 27). There is narrowing of the left main pulmonary artery, anterior and posterior branches due to extrinsic encasement by the mass (series 3, image 22). The fat plane with the left half of the pericardium is lost and the mass appears to invade into the adjacent middle mediastinum. There is bulky anterior and middle mediastinal lymphadenopathy ; in particular, multiple enlarged subcarinal lymph nodes measure up to 3.3 cm demonstrate peripheral enhancement with central areas of hypodensity, compatible with necrosis (for example see series 3, image 29). Enlarged and abnormal appearing AP window lymph nodes are also seen, measuring up to 11 mm (for example see series 3, image 22). Overall, findings are concerning for a primary lung mass, invading into the adjacent left half of the mediastinum with regional metastatic lymphadenopathy and resultant obliteration of the left upper lobe bronchus with secondary left upper lobe collapse and narrowing of the left main pulmonary artery. There is left lower lobe bronchial wall thickening, possibly encasement without narrowing or obstruction (series 3, image 26). There is a small to moderate left layering simple pleural effusion with adjacent subsegmental atelectasis of the left lower lobe. Aside from some platelike atelectasis involving the right lower lobe, the right lung is clear. There is no right pleural effusion or pneumothorax. MUSCULOSKELETAL: S-shaped scoliosis of the thoracolumbar ___ in the mid thoracic spine. There is mild thoracic spine degenerative change. No concerning focal lytic or sclerotic osseous lesions are identified. IMPRESSION: 1. Primary lung, less likely mediastinal neoplasm obliterating the left upper lobe bronchus with secondary left upper lobe. Loss of fat planes with the adjacent left pericardium with mediastinal invasion and encasement and narrowing of the left main pulmonary artery, which however remains patent. Encasement of the left lower lobe bronchus without occlusion is also noted. Necrotic subcarinal and AP window lymphadenopathy, likely metastatic. 2. Small to moderate simple left layering pleural effusion with adjacent subsegmental atelectasis. 3. S-shaped scoliosis of the thoracic spine with no suspicious osteolytic or blastic osseous lesions. NOTIFICATION: The findings were discussed by Dr. ___, MD with Dr. ___, MD on the telephone on ___ at 10:00am, a few minutes after discovery of the findings.
10063856-RR-20
10,063,856
28,403,663
RR
20
2178-09-18 19:25:00
2178-09-18 19:51:00
EXAMINATION: RENAL U.S. INDICATION: Further evaluation of a patient with multiple brain lesions, with bilateral renal lesions seen on metastatic workup. TECHNIQUE: Grey scale and color Doppler ultrasound images of the kidneys were obtained. COMPARISON: CT abdomen/pelvis from ___. FINDINGS: The right kidney measures 9.0 cm. The left kidney measures 8.8 cm. There is no hydronephrosis or stone bilaterally. The multiple lesions seen on CT from the day prior are not well visualized on ultrasound. A 1.5 x 1.4 x 1.2 cm isoechoic lesion is seen in the lateral interpolar region of the left kidney. Normal cortical echogenicity and corticomedullary differentiation are seen bilaterally. The bladder is moderately well distended and normal in appearance. IMPRESSION: A 1.5 x 1.4 x 1.2 cm isoechoic solid-appearing lesion is seen in the lateral interpolar region of the left kidney. Otherwise, the multiple lesions seen on CT from the day prior are not well of visualized on ultrasound. RECOMMENDATION(S): Further evaluation of multiple renal lesions with MRI is recommended.
10063856-RR-21
10,063,856
28,403,663
RR
21
2178-09-22 12:13:00
2178-09-22 15:07:00
INDICATION: ___ year old woman s/p thoracentesis on left // ? pneumothorax TECHNIQUE: Chest PA and lateral COMPARISON: ___ FINDINGS: New veil like opacity of the left hemithorax with a crescent of air surrounding the aortic arch and keeping with left upper lobe collapse. The left hilum and mediastinum are enlarged. A small left-sided pleural effusion is seen. The right lung is clear. No pneumothorax. Marked scoliosis convex to the right. IMPRESSION: Left upper lobe collapse, with large hilar mass and small pleural effusion. No pneumothorax.
10063856-RR-33
10,063,856
22,345,354
RR
33
2179-01-06 09:35:00
2179-01-06 11:09:00
EXAMINATION: CHEST (PORTABLE AP) INDICATION: ___ year old woman with metastatic lung cancer and hypotension. // Evaluate for pneumonia. TECHNIQUE: CHEST (PORTABLE AP) COMPARISON: CT chest from 1 day prior, PA and lateral views of the chest dated ___, portable view of the chest dated ___ FINDINGS: There is persistent elevation of the left hemidiaphragm with opacity of the left hemithorax and elevation of the left mainstem bronchus and a stable Luftsichel sign, consistent with continued left upper lobe collapse although the volume of the collapsed lobe and the large central mass have mass have both decreased since ___. Right basilar atelectasis is noted and there could be a small metastatic nodule. There is no radiographic evidence of pneumonia, though evaluation on recent CT is more specific. The cardiac silhouette and pulmonary vasculature are unremarkable and unchanged since the prior examinations. No definite pleural effusion or pneumothorax identified. IMPRESSION: Persistent left upper lobe collapse without evidence of pneumonia. Decreasing mass, left hilus and left upper lobe. Possible pulmonary metastasis, right lower lobe. This examination neither suggests nor excludes the diagnosis of pulmonary embolism.
10063856-RR-34
10,063,856
29,364,646
RR
34
2179-01-10 14:54:00
2179-01-10 17:06:00
EXAMINATION: CHEST (AP AND LAT) INDICATION: ___ with weakness, history of metastatic non-small-cell lung cancer. COMPARISON: PET-CT exam from ___. FINDINGS: AP upright and lateral views of the chest provided. Left upper lobe consolidation is compatible with known malignancy. Right lung is clear. No pleural effusion is seen. Heart size appears normal. Mediastinal contour difficult to assess given the adjacent opacity. A prominent dextroscoliosis of T-spine is again noted. IMPRESSION: Left upper lobe consolidation compatible with known malignancy. No significant change from recent prior chest radiograph.
10063856-RR-35
10,063,856
29,364,646
RR
35
2179-01-10 20:31:00
2179-01-10 22:07:00
EXAMINATION: MR HEAD W AND W/O CONTRAST T___ MR HEAD INDICATION: ___ year old woman with metastatic lung cancer to brain, status post radiation, now with recent "shaking" episodes. Rule out progression or worsening edema. TECHNIQUE: Sagittal and axial T1 weighted imaging were performed. After administration of 7 mL of Gadavist intravenous contrast, axial imaging was performed with gradient echo, FLAIR, diffusion, and T1 technique. Sagittal MPRAGE imaging was performed and re-formatted in axial and coronal orientations. COMPARISON: MRI brain: ___. CT head: ___. FINDINGS: Since the prior study, there has been interval appearance of multiple foci with diffusion weighted signal intensity in the right frontal lobe (502:24, 25), some of which correspond to associated FLAIR signal intensity (07:19, 20). A single focus of left frontal peripheral diffusion-weighted hyperintense signal is also new (series 502, image 72). Another tiny focus of right parietal cortical FLAIR/diffusion signal hyperintensity also demonstrates postcontrast enhancement (502:20, 7:16, 10:16), and is also new since the prior study. Otherwise, known enhancing lesions in the infratentorial brain are stable compared to the prior study, and include a lower left cerebellar hemispheric lesion (900:24), anterior inferior right cerebellar hemisphere lesion (900:28), and an 11 x 8 mm medial left cerebellar hemispheric lesion (900:41). Other supratentorial lesions previously described are also stable, including a left occipital lesion (10:14), anterior right frontal lobe lesion (10:18), and an 8 mm left temporal lobe lesion (900:54). Punctate hemorrhagic foci are stable in the left parietal and posterior right frontal and anterior right frontal lobes. No new hemorrhage is identified. There is no shift of the normally midline structures. Ventricles and sulci remain unchanged in size and configuration. The major intracranial vascular flow voids are preserved, and the major dural venous sinuses appear patent. The paranasal sinuses are clear. The orbits are unremarkable. The left mastoid air cells are clear. IMPRESSION: 1. Multiple new right frontal cortical foci in a single left frontal focus of likely reflect sites of acute/subacute infarction of embolic origin, given distribution and small size and rapid development since prior examination of ___. However, in the context of known metastatic disease, underlying malignancy cannot be completely excluded. 2. A similar tiny focus in the right parietal cortex exhibits mild enhancement. Likely etiology is again acute/subacute infarction, but malignancy cannot be excluded. 3. Numerous other supra and infratentorial metastatic lesions are stable since the recent prior study, as described above. RECOMMENDATION(S): 1. Continued follow-up imaging is recommended for findings described in IMPRESSION #'s 1 and 2. NOTIFICATION: The findings and changes from initially provided wet read were discussed by Dr. ___ with Dr. ___ on the ___ ___ at 12:08 ___, 10 minutes after discovery of the findings.
10063856-RR-36
10,063,856
29,364,646
RR
36
2179-01-12 15:30:00
2179-01-12 17:28:00
INDICATION: ___ year old female with stage IV lung cancer receiving palliative chemotherapy. // Assess response to therapy TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired through the abdomen and pelvis following intravenous contrast administration with split bolus technique. Delayed images through the abdomen were additionally performed. IV Contrast: 130 mL Omnipaque. Oral contrast was administered. Coronal and sagittal reformations were performed and reviewed on PACS. DOSE: Total DLP (Body) = 524 mGy-cm. COMPARISON: Multiple prior CT abdomen and pelvis examinations dated most recently ___. FINDINGS: Chest: For complete intrathoracic findings, please refer to CT chest performed on the same date, ___, clip number ___. Abdomen: The liver appears homogeneous in attenuation without a focal lesion identified. There is no intrahepatic biliary duct dilation. The portal veins are patent. The gallbladder is without radiopaque cholelithiasis. The pancreas is homogeneous in attenuation without pancreatic duct dilation. A focal hypodensity within the distal pancreatic body is unchanged, possibly interdigitation of fat or alternatively small IPMN. The spleen is small in size though unchanged relative to prior study. Adrenal glands bilaterally are unremarkable. Multiple bilateral renal lesions are present which relative to examination dated ___ are decreased in size. Although somewhat difficult to measure margins, a previously 1.3 x 1.8 cm left renal cortical hypodensity currently measures 1.0 x 0.7 cm (05:59). There is no perinephric stranding or hydronephrosis. A nonobstructing 5 mm stone is noted within the right collecting system, present previously and unchanged. The stomach, duodenum, and loops of small bowel are grossly unremarkable. No evidence of small-bowel obstruction. Patient is status post colectomy with a right lower quadrant ileostomy. There is no abdominal free fluid or air. The abdominal aorta demonstrates moderate atherosclerotic calcifications without aneurysmal dilatation. There are no pathologically enlarged retroperitoneal or mesenteric nodes present. Pelvis: The bladder is moderately well distended, grossly unremarkable. There is no inguinal or pelvic sidewall adenopathy. A previously present 1.4 cm left iliac chain node currently measures 0.5 cm in largest dimension (05:10 4). There is no pelvic free fluid. Osseous structures: Sclerotic lesions involving the bilateral iliac bones, the right sacrum, and L4 vertebral body posteriorly are consistent with metastatic disease as previously demonstrated on bone scan performed ___. Lesions appear new relative to CT study performed ___. Anterior compression deformity of the L1 vertebral body is unchanged. New relative to prior examination is a compression fracture involving the T10 vertebral body. IMPRESSION: 1. Interval decrease in size of left iliac chain node and multiple bilateral renal hypodensities to suggest treatment response. 2. Status post total colectomy with right lower quadrant ileostomy. No evidence of obstruction. 3. Multiple sclerotic osseous lesions involve the iliac bones bilaterally, sacrum, L4 vertebral body and several thoracic vertebral bodies, new relative to prior study consistent with osseous metastatic disease. 4. New compression fracture involving T10 vertebral body, likely pathologic. 5. Distal pancreatic body small hypodensity is unchanged in appearance, possibly interdigitation of fat or alternatively a small IPMN for which attention on follow up is advised. 6. For complete intrathoracic findings, please refer to CT chest performed on the same date, ___, clip number ___.
10063856-RR-37
10,063,856
29,364,646
RR
37
2179-01-12 15:56:00
2179-01-12 17:03:00
EXAMINATION: Chest CT INDICATION: Stage IV lung cancer, palliative chemotherapy, assessing response TECHNIQUE: MDCT of the chest was obtained from thoracic inlet to upper abdomen. Axial images were reviewed in conjunction with coronal and sagittal reformats COMPARISON: ___ and ___ FINDINGS: Aorta and pulmonary arteries are overall unremarkable. Left upper lobe continues to be collapsed due to obstructed left upper lobe bronchus, series 5, image 29. Overall the volume of the collapsed lobe is currently smaller than on the previous studies, approaching 5.7 x 2.7 cm as compared to 5.7 x 4 cm that might represent potential interval decrease of the tumor mass. There is no pleural effusion accumulation. No mediastinal lymph nodes currently seen with resolution of lymphadenopathy demonstrated on ___. Heart size is normal. No pericardial effusion is seen. Image portion of the upper abdomen will be reviewed separately in corresponding report will be issued Besides left upper lobe bronchus the rest of the airways are patent to the subsegmental level bilaterally. No new pulmonary nodules masses or consolidations demonstrated. Lytic and sclerotic lesions previously mentioned are overall unchanged. More of mild compression of the lower thoracic spine is demonstrated, series 9, image 34 compared to previous images that might represent either compression fracture due to osteoporosis or metastatic disease with no evidence of retropulsion. IMPRESSION: Interval improvement in the bulk of the disease within the left upper lobe. Judging by overall decrease in size of the atelectatic lobe. Slight interval progression of mild compression fractures of the spine. Overall unchanged metastatic bone disease. No new pulmonary nodules masses or consolidations demonstrated.
10063856-RR-38
10,063,856
29,364,646
RR
38
2179-01-14 18:32:00
2179-01-15 09:20:00
EXAMINATION: MRI CERVICAL, THORACIC, AND LUMBAR PT22 MR SPINE INDICATION: ___ year old woman with metastatic lung cancer with osseous metastatic disease with new T10 compression fracture // dedication evaluation of spine disease per Spine service. TECHNIQUE: Sagittal imaging was performed with T2, T1, and STIR technique. Axial T2 imaging was performed. Axial GRE images of the cervical spine were performed. After the uneventful administration of 6 mL of contrast agent, additional axial and sagittal T1 images were obtained. COMPARISON: None. FINDINGS: There is S-shaped scoliosis of the thoracolumbar spine with levoscoliosis of the lumbar spine and dextroscoliosis of the thoracic spine. CERVICAL: There is 3 mm retrolisthesis of C4 on C5 and C5 on C6. The alignment of the cervical spine is otherwise maintained. The vertebral body heights are maintained. The marrow signal is unremarkable without focal marrow lesions seen. The visualized cervical spinal cord appears unremarkable without any focal cord expansion, signal abnormality or abnormal enhancement. Patient is status post left hemithyroidectomy. The visualized prevertebral, paravertebral, paraspinal soft tissues appear unremarkable. At C2-C3, no neural foramina or spinal canal stenosis is seen. At C3-C4, mild bilateral uncovertebral and facet arthropathy causing mild bilateral neural foraminal narrowing. The spinal canal is patent. At C4-C5, bilateral uncovertebral and facet arthropathy causes moderate right neural foraminal narrowing. The left neural foramen is patent. The spinal canal is patent. At C5-C6, bilateral uncovertebral and facet arthropathy causes mild bilateral neural foraminal narrowing. The spinal canal is patent. At C6-C7, bilateral neural foramina and spinal canal are patent. THORACIC: The alignment of the thoracic spine is maintained. There is acute compression deformity of T10 vertebral body along the superior endplate with loss of height by approximately 40% and minimal retropulsion of the fractured fragments into the spinal canal by approximately 3 mm. There is associated marrow edema. No abnormal marrow signal or enhancement on postcontrast images is seen to suggest pathologic fracture. There are prominent Schmorl's nodes along the superior endplate of T1 vertebral body. The remaining thoracic vertebral bodies are maintained in height. The visualized thoracic spinal cord appears unremarkable without focal cord expansion, signal abnormality or abnormal enhancement on postcontrast images. Atelectasis in bilateral lung bases. The visualized mediastinal, paravertebral, paraspinal soft tissues and lung parenchyma otherwise appears unremarkable. There is loss of disc height and signal at multiple levels in keeping with disc degeneration. The neural foramen and spinal canal are patent at all levels in the thoracic spine. LUMBAR: The alignment of the lumbar spine is maintained. The vertebral body heights are maintained at all levels. There is a focal T2 bright lesion is seen in the right ilium adjacent into the sacroiliac joint on image 12:37 which demonstrates hyperintense signal on T1 postcontrast images. However the lesion is incompletely evaluated in the absence of precontrast T1 weighted images through the lesion. The marrow signal is otherwise unremarkable without focal marrow lesion. The conus is unremarkable and terminates at L1-L2. The visualized prevertebral, paravertebral, paraspinal and retroperitoneal soft tissues appear unremarkable. The visualized upper sacroiliac joints appear unremarkable. There are Tarlov cysts at the level of the S1-S2 vertebrae. At T12-L1, no significant neural foramina or spinal canal stenosis is seen. At L1-L2, no neural foramina or spinal canal stenosis. L2-L3, diffuse disc bulge with facet arthropathy without significant neural foramina or spinal canal stenosis. At L3-L4, diffuse disc bulge with bilateral facet arthropathy without significant neural foramina or spinal canal stenosis. At L4-L5, there is Bilate bilateral ral facet arthropathy without significant neural foramina or spinal canal stenosis. At L5-S1, there is mild disc bulge without significant neural foramina or spinal canal stenosis. IMPRESSION: 1. Acute benign-appearing compression deformity of T10 vertebrae with retropulsion into the spinal canal by approximately 3 mm without significant spinal canal stenosis. 2. Mild degenerative changes involving the cervical, thoracic and lumbar spine as described above with moderately right neural foramen narrowing at C4-C5. No significant neural foramina or spinal canal narrowing at any other level. 3. Incompletely evaluated lesion in the right ilium adjacent to the sacroiliac joints as described above. Abdominal CT of ___ demonstrates some sclerosis and lucency in the region which could be secondary to a remote fracture.
10063856-RR-39
10,063,856
29,364,646
RR
39
2179-01-16 14:57:00
2179-01-17 09:43:00
EXAMINATION: MR HEAD W AND W/O CONTRAST INDICATION: ___ year old female with metastatic lung cancer to brain and recent MRI showing possible infarcts now with new nocturnal headaches. Evaluate for progression of metastatic disease vs. new infarcts TECHNIQUE: Sagittal and axial T1 weighted imaging were performed. After administration of 6 mL of Gadavist intravenous contrast, axial imaging was performed with gradient echo, FLAIR, diffusion, and T1 technique. Sagittal MPRAGE imaging was performed and re-formatted in axial and coronal orientations. COMPARISON: Multiple prior MRIs, most recent from ___. FINDINGS: There are multiple foci of restricted diffusion throughout the supra and infra tentorium, some of which have resolved in comparison to the prior MRI, particularly one in the right occipital lobe, and 3 of which are new in comparison to the prior MRI, two in the cerebellum, series 602, image 24 and one in the right parietal lobe, series 602, image 6. There is mild FLAIR hyperintense signal in the lesion that no longer demonstrates restricted diffusion in the right occipital lobe with no associated contrast enhancement. Some of the areas of restricted diffusion demonstrate peripheral contrast enhancement and other areas of punctate contrast enhancement do not demonstrate restricted diffusion, series 900, image 39. Multiple stable foci of susceptibility are seen throughout the supra and infratentorial, consistent with micro hemorrhages, at the sites of prior metastatic lesions, as seen on the original MRI from ___. There is no evidence of mass effect or midline shift. The major vascular flow voids are preserved. Fluid is seen in the left mastoid air cells. The orbits are normal. Minimal mucosal thickening of the ethmoid sinuses is seen. IMPRESSION: 1. Multiple stable lesions in the supra and infra tentorium, as described above, which demonstrate contrast enhancement and are stable since ___ and decreased in size since ___, consistent with metastatic lesions. Some of these lesions demonstrate restricted diffusion. 2. Interval resolution of few foci of restricted diffusion, seen on the prior MRI, with no interval development of contrast enhancement which may represent a evolution of acute infarctions versus metastatic lesions. Attention to these areas on subsequent short term MRI is recommended. 3. Multiple stable areas of restricted diffusion, since the prior MRI, which do not demonstrate contrast enhancement and are favored to represent metastatic lesions, although evolving infarcts are also within the differential. Short-term follow-up is recommended for further evaluation. 4. Three new areas of restricted diffusion with no associated contrast enhancement, as described above which again is favored to represent new areas of intracranial metastatic disease however, acute infarcts is also within the differential. Short-term interval follow-up MRI is recommended. 5. No significant mass effect or midline shift. RECOMMENDATION(S): Short-term follow-up MRI and ___ weeks is recommended.
10063991-RR-9
10,063,991
25,007,733
RR
9
2148-01-28 22:02:00
2148-01-29 09:21:00
EXAMINATION: MRI ORBITS AND BRAIN WANDW/O CONTRAST T714 MR ___ INDICATION: ___ year old man with bilateral CNIII/VI palsies and evidence of left sided color desaturation. Has areflexia, ophthalmoplegia, ataxia which is consistent with MF-GBS, however the red desaturation on the left is concerning for alternate process causing optic neuritis or other. Requesting thin slices through the orbits, cavernous sinus, and brain stem with Fiesta/MPRage. Evaluate for optic neuritis, venous sinus thrombosis, brain stem pathology. TECHNIQUE: Brain: Sagittal and axial T1 weighted imaging were performed. After administration of 5 cc Gadavist intravenous contrast, axial imaging was performed with gradient echo, FLAIR, diffusion, and T1 technique. Sagittal MPRAGE imaging was performed and re-formatted in axial and coronal orientations. Orbit: Images acquired at 3 mm slice thickness. Precontrast sequences included axial and coronal T1, coronal STIR. Postcontrast sequences included axial and coronal T1 with fat saturation. COMPARISON: None. FINDINGS: MRI BRAIN: There is no evidence of of acute infarction, intracranial mass, edema, blood products, demyelinating lesions, or other parenchymal signal abnormalities. Specifically, no evidence for signal abnormalities in the brainstem. Ventricles, sulci, and basal cisterns are normal in size. Cerebellar tonsils are normally positioned. There is no abnormal enhancement of the cranial nerves. There is a developmental venous anomaly in the right frontal lobe, coursing from the frontal horn of the right lateral ventricle inferolaterally along the anterior insula and into the sylvian fissure (21:106-110). No evidence for associated cavernous malformation. Major arterial flow voids are preserved allowing for hypoplasia of the non dominant intracranial right vertebral artery. Dural venous sinuses are patent on postcontrast MP RAGE images. Small T2 hyperintense mucous retention cysts are seen in the right maxillary sinus and left sphenoid sinus. T2 isointense aerated secretions in the left maxillary sinus are seen. MRI ORBITS: The globes appear unremarkable. The optic nerves and complex are normal, without edema or abnormal enhancement. The extraocular muscles are uniform in size and normal in signal. No evidence for intraorbital mass or inflammatory changes. Cavernous sinuses appear unremarkable and symmetric. IMPRESSION: 1. No imaging evidence for optic neuritis or other orbital abnormalities. 2. No evidence abnormal enhancement along the cranial nerves. Unremarkable appearance of the cavernous sinuses. 3. No evidence for dural venous sinus thrombosis. 4. No evidence for intracranial mass or acute intracranial abnormalities. Specifically, no signal abnormalities in the brainstem. 5. Right frontal developmental venous anomaly.
10064049-RR-10
10,064,049
26,336,999
RR
10
2162-08-19 16:56:00
2162-08-19 17:56:00
INDICATION: ___ year old man with picc // r dl power picc 50cm iv ___ ___ Contact name: ping, ___: ___ TECHNIQUE: Single view at ___ 4:56 ___ COMPARISON: ___ FINDINGS: A right-sided PICC line has been inserted and is seen within the right jugular vein. There is been partial but significant improvement of the right basilar pleural parenchymal process. Scarring or linear atelectasis is noted in the left lung as well as a calcified granuloma. The heart is enlarged.. The osseous structures are normal for age. IMPRESSION: Right PICC line is in the right jugular vein and extends to the superior aspect of the film. Partial improvement in the right-sided pleural and parenchymal disease Cardiomegaly
10064049-RR-11
10,064,049
26,336,999
RR
11
2162-08-20 09:50:00
2162-08-20 18:58:00
INDICATION: ___ year old man with myelodysplastic syndrome, needs central access for chemo // Please reposition PICC. COMPARISON: Chest radiograph ___ TECHNIQUE: OPERATORS: Dr. ___ radiology fellow) and Dr. ___ radiology attending) performed the procedure. The attending, Dr. ___ was present and supervising throughout the procedure. ANESTHESIA: None MEDICATIONS: None CONTRAST: None ml of Optiray contrast. FLUOROSCOPY TIME AND DOSE: 1 min 27 second, 151 cGy-cm2 PROCEDURE: 1. Repositioning of right PICC. PROCEDURE DETAILS: Using sterile technique, the existing right arm PICC line was flushed with a 3 cc syringe of saline. The catheter tip flipped into the low SVC while being observed under fluoroscopy. Position of the catheter was confirmed by a fluoroscopic spot film of the chest. The patient tolerated the procedure well. There were no immediate complications. FINDINGS: 1. Existing right arm approach PICC with tip in the right internal jugular vein repositioned with the tip in the low SVC. IMPRESSION: Repositioning of right arm approach single lumen PICC with the tip in the low SVC. The line is ready to use.
10064049-RR-12
10,064,049
26,336,999
RR
12
2162-08-22 08:34:00
2162-08-22 10:49:00
EXAMINATION: Portable chest radiograph INDICATION: ___ year old man with pAfib and new SOB. O2 desat 87% on RA // please eval for worsening edema COMPARISON: CXR ___ FINDINGS: Since the prior chest x-ray on ___, there has been interval development of a new small to moderate right-sided pleural effusion. Bibasilar parenchymal opacities, right greater than left, which has slightly increased compared to the prior CXR. No pneumothorax. Left lower lobe calcified granuloma is unchanged since ___. The heart is enlarged. Right PICC line has been adjusted since the prior radiograph, but is now coiled along its course and terminates in the mid-SVC. IMPRESSION: 1. New small/moderate right pleural effusion. Bibasilar parenchymal opacities with cardiomegaly suggests underlying pulmonary edema, but cannot exclude right lung base pneumonia. 3. Right PICC is coiled, but terminates in mid-SVC. NOTIFICATION: Findings were telephoned to Dr. ___ by Dr. ___ on ___ at 10:39AM, approximately 15 minutes after discovery.
10064049-RR-13
10,064,049
26,336,999
RR
13
2162-08-22 14:57:00
2162-08-22 16:51:00
EXAMINATION: CT CHEST W/O CONTRAST INDICATION: Worsening respiratory status and increased oxygen requirements. Evaluate for evolving pulmonary process. TECHNIQUE: Multidetector helical scanning of the chest was performed without intravenous contrast agent reconstructed as contiguous 5- and 1.25-mm thick axial, 2.5-mm thick coronal and parasagittal, and 8 x 8 mm MIPs axial images. DOSE: 1092.10 mGy.cm COMPARISON: CTA chest ___ and chest radiograph ___. FINDINGS: There is mild pulmonary edema, improved from ___. This is manifest as peribronchial cuffing and ground-glass opacities. Interlobular septal thickening has improved. A nonhemorrhagic, moderate right pleural effusion is unchanged from prior while a left pleural effusion has decreased, now trace. A consolidation at the right lung base with air bronchograms is slightly more extensive than prior and consistent with compressive atelectasis. The increasing consolidation obscures the previously mentioned pulmonary nodules. Mediastinal lymphadenopathy is unchanged and ranges up to 10 mm in the subcarinal station. A coarse calcification is seen in the right thyroid lobe. A right PICC terminates in the low SVC. The heart is mildly enlarged and there is no pericardial effusion. Hypoattenuation of the blood pool is compatible with anemia. The main pulmonary artery is minimally dilated, measuring 3.1 cm, unchanged. The aorta is normal caliber. The esophagus is patulous but otherwise unremarkable. Calcifications are seen within a mildly enlarged spleen indicating prior granulomatous disease. There are no lytic or blastic osseous lesions within the chest. IMPRESSION: 1. Improving pulmonary edema, now mild, with an unchanged moderate right and smaller, now trace, left pleural effusions. 2. Increasing compressive atelectasis at the right lung base.
10064049-RR-14
10,064,049
26,336,999
RR
14
2162-08-22 12:14:00
2162-08-22 16:42:00
INDICATION: ___ year old man with MDS, needs chemo through PICC // PICC line power-flushed by ___ ___ to coiling with IV team placement, now coiled again, ___ spoke with ___. COMPARISON: ___ TECHNIQUE: OPERATORS: Dr. ___ radiology fellow) and Dr. ___ radiology attending) performed the procedure. The attending, Dr. ___ was present and supervising throughout the procedure. ANESTHESIA: 1% lidocaine was injected in the skin and subcutaneous tissues overlying the access site. MEDICATIONS: None CONTRAST: 0 ml of Optiray contrast. FLUOROSCOPY TIME AND DOSE: 3 min 44 seconds, 321 cGy-cm2 PROCEDURE: 1. Repositioning of right PICC. PROCEDURE DETAILS: Using sterile technique and local anesthesia, the existing PICC line was aspirated and flushed and a Nitinol guidewire was introduced into the superior vena cava (SVC). A peel-away sheath was then placed over a guidewire. The guidewire was then advanced into the superior vena cava. A double lumen PIC line measuring 32 cm in length was then placed through the peel-away sheath with its tip positioned in the distal SVC under fluoroscopic guidance. Position of the catheter was confirmed by a fluoroscopic spot film of the chest. The peel-away sheath and guidewire were then removed. The catheter was secured to the skin, flushed, and a sterile dressing applied. The patient tolerated the procedure well. There were no immediate complications. FINDINGS: 1. Existing right arm approach PICC with tip in the right atrium replaced with a new double lumen PIC line with tip in the low SVC. IMPRESSION: Successful placement of a 32 cm right arm approach double lumen PICC with tip in the low SVC. The line is ready to use.
10064049-RR-15
10,064,049
26,336,999
RR
15
2162-08-23 18:26:00
2162-08-24 16:33:00
HISTORY: AFib, right pleural effusion, sounds wet on exam. Evaluate for PICC line and worsening edema. CHEST, SINGLE AP PORTABLE VIEW. Compared to ___ at 8:45 a.m., the PICC line position has changed, with the right subclavian PICC line now coursing cephalad to overlie the lower neck/thoracic inlet. As before, there is cardiomegaly, CHF and interstitial edema. Again seen is a small-to-moderate right effusion with underlying right base collapse and/or consolidation. Increased retrocardiac opacity and patchy opacity at the left base is slightly worse. The degree of interstitial edema is similar or very slightly worse. Note is made of a scout film obtained in the interval between these two films on ___ at 15:07 p.m., which showed a more conventional position of the PICC line with tip over mid SVC. However, this has degraded and needs to be re-positioned based on the current film. Findings called to Dr. ___ covering for Dr. ___ at the time of discovery at 9:58 a.m. on ___ and discussed shortly thereafter ___, phone).
10064049-RR-16
10,064,049
26,336,999
RR
16
2162-08-25 08:21:00
2162-08-25 11:44:00
EXAMINATION: RENAL U.S. INDICATION: ___ year old man with ___, obtaining U/S per renal recommendation. // ___ year old man with ___, obtaining U/S per renal recommendation. TECHNIQUE: Grey scale and color Doppler ultrasound images of the kidneys were obtained. COMPARISON: None. FINDINGS: The right kidney measures 14.5 cm. The left kidney measures 13.5 cm. There is no hydronephrosis, stones, or masses bilaterally. There is slightly increased cortical echogenicity bilaterally. There is normal corticomedullary differentiation bilaterally. The bladder is moderately well seen and normal in appearance. Prostate gland measures 3.8 x 3.5 x 4.6 cm. Prostate volume 31.6 cm3 IMPRESSION: 1. Slightly increased cortical echogenicity bilaterally suggestive of medical renal disease. 2. No evidence of hydronephrosis.
10064049-RR-24
10,064,049
25,054,827
RR
24
2163-04-16 10:49:00
2163-04-16 11:57:00
INDICATION: ___ with presyncope, cough // evaluate for acute process TECHNIQUE: PA and lateral views of the chest. COMPARISON: ___. FINDINGS: Right-sided central venous catheter is again seen with tip at the RA/SVC junction. The lungs are clear without focal consolidation, effusion, or pneumothorax. The left lung base calcified granulomas are again noted. There is no overt pulmonary edema. The cardiac silhouette is enlarged but stable. No acute osseous abnormalities. IMPRESSION: No acute cardiopulmonary process.
10064049-RR-25
10,064,049
25,054,827
RR
25
2163-04-18 14:40:00
2163-04-18 15:06:00
INDICATION: Question pneumonia or pulmonary edema. TECHNIQUE: Frontal lateral chest radiographs COMPARISON: ___ FINDINGS: A dual lumen hemodialysis catheter tip terminates at the cavoatrial junction. The heart is enlarged. The pulmonary vasculature is normal. There is no focal consolidation, pneumothorax, or effusion. There is a calcified left lower lobe granuloma. IMPRESSION: No acute cardiopulmonary abnormality.
10064049-RR-26
10,064,049
25,054,827
RR
26
2163-04-19 15:16:00
2163-04-19 18:23:00
INDICATION: ___ year old man with MDS ___ allo SCT c/b pure red cell aplasia and acute gvhd now with cough // eval for infiltrate, infection TECHNIQUE: MDCT images were obtained from the thoracic inlet to the upper abdomen. IV Omnipaque contrast was administered. Axial images were interpreted in conjunction with sagittal and coronal reformats. DLP: 276 mGy-cm COMPARISON: ___. FINDINGS: The thyroid is normal. Mediastinal lymph nodes are visible but not individually pathologically enlarged. Axillary, supraclavicular, and hilar lymph nodes are not pathologically enlarged. The great vessels are normal caliber. No large central pulmonary embolism is identified. The heart size is normal. No pericardial effusion. The airways are patent to subsegmental levels. No pleural effusion, focal consolidation, or pneumothorax. Two calcified granulomas in the left lower lobe are similar to prior. Minimal biapical scarring is similar to prior. Multiple calcifications in the spleen are unchanged and consistent with prior granulomatous disease. The esophagus and imaged upper abdominal organs are otherwise unremarkable. OSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for malignancy. IMPRESSION: No focal consolidation, pleural effusion, or other evidence of pulmonary infection.
10064049-RR-27
10,064,049
25,054,827
RR
27
2163-04-26 17:26:00
2163-04-26 18:21:00
EXAMINATION: CT SINUS/MANDIBLE/MAXILLOFACIAL W/O CONTRAST INDICATION: ___ male with history myelodysplastic syndrome status post bone marrow transplant, complicated by GVHD now all with persistent cough. Evaluate for sinusitis. TECHNIQUE: Helical axial images were acquired through the paranasal sinuses. Bone and soft tissue reconstructed images were generated. Coronal reformatted images were also obtained DOSE: DLP: 522.6 mGy-cm; CTDI: 35.9 mGy COMPARISON: ___ CT sinus study. FINDINGS: There is minimal bilateral maxillary sinus mucosal thickening. The paranasal sinuses are otherwise normally aerated, with no other areas of mucosal thickening or air-fluid levels identified. The ostiomeatal units are patent. The cribriform plates are intact. There is no nasal septal defect. The anterior clinoid processes are not pneumatized. The lamina papyracea is intact. No bony sclerosis or destruction. The nasal septum is minimally deviated to the left with a tiny bony spur. The sphenoid sinus septum is midline. IMPRESSION: 1. Minimal bilateral maxillary sinus mucosal thickening 2. Otherwise unremrakable CT sinus examination.
10064049-RR-28
10,064,049
25,054,827
RR
28
2163-04-28 21:36:00
2163-04-28 22:29:00
EXAMINATION: CT ABD AND PELVIS WITH CONTRAST INDICATION: A ___ man with MDS now day ___ after stem cell transplant, with recent development of GVHD of the skin, now with abdominal cramping and diarrhea despite being NPO, evaluate for wall thickening, colitis. TECHNIQUE: Contiguous axial multidetector CT images through the abdomen and pelvis with intravenous contrast. Multiplanar reformations were generated and reviewed. DLP: 572.80 mGy-cm. COMPARISON: CT abdomen and pelvis ___. FINDINGS: LUNG BASES: There is a 6 mm calcified granuloma in the left lower lobe periphery, unchanged from prior studies. Otherwise, the imaged lung bases are clear. There is no pleural or pericardial effusion. The tip of a central venous catheter is seen terminating in right atrium. CT ABDOMEN: A 5 mm hypodensity in the left hepatic lobe is unchanged, too small to characterize but statistically likely a simple hepatic cyst or biliary hematoma. Otherwise, the liver enhances homogeneously without evidence of focal lesion. There is no intrahepatic biliary ductal dilation. The portal vein is patent. There is mild periportal edema, possibly sequelae of volume resuscitation or generalized edematous state. The gallbladder is distended, consistent with NPO status. There is no evidence of gallbladder wall thickening or surrounding inflammation. The pancreas enhances homogeneously. There is no peripancreatic stranding or ductal dilation. There is no splenomegaly. Multiple scattered coarse splenic calcifications are unchanged, likely sequelae of prior granulomatous disease. The adrenal glands are normal. Multiple bilateral subcentimeter renal cortical hypodensities are too small to characterize. Otherwise, the kidneys enhance normally and symmetrically. There is no hydronephrosis. There is a small hiatus hernia. The stomach and duodenum are otherwise unremarkable. Multiple loops of fluid-filled, distended but non-dilated small bowel are identified throughout the abdomen. There is no evidence of mucosal hyperenhancement to suggest graft versus host disease. There is no wall thickening. Similarly, the colon is non-dilated, with multiple segments appearing fluid-filled, most notably the descending and rectosigmoid colon. There is no evidence of wall thickening. The appendix is not directly visualized, however, there are no secondary signs of appendicitis. These findings are nonspecific, however most suggestive of enteritis. There is mild calcification of the abdominal aorta. There is no aneurysm or dilation. Proximal tributaries are patent. More inferiorly in the lower abdomen, there are portions of mesentery which demonstrates mild edema, nonspecific, possibly related to a generalized edematous state or possibly reactive in the setting of enteritis (for example, see series 4, image 60). There is no mesenteric or retroperitoneal lymphadenopathy by CT size criteria. There is no free intraperitoneal air or fluid. CT PELVIS: There is a small amount of layering simple free pelvic fluid in the rectovesical pouch. The imaged pelvic organs including the bladder and terminal ureters are unremarkable. Prostatic calcifications are seen. There is no pelvic sidewall or inguinal lymphadenopathy. MUSCULOSKELETAL: There is diffuse mild edema involving the subcutaneous soft tissues, compatible with a generalized edematous state. There is a small periumbilical hernia containing only fat. There is mild degenerative change of the imaged thoracolumbar spine, with small anterior osteophytes. Alignment is normal. No concerning focal lytic or sclerotic osseous lesions are seen. IMPRESSION: 1. Fluid filled non-dilated loops of large and small bowel with mild mesenteric stranding inferiorly, nonspecific but suggestive of enteritis. No definite evidence of graft versus host disease. 2. Sequelae of generalized edematous state, including mild subcutaneous edema, trace free simple pelvic fluid, and diffuse periportal edema. 3. Distended gallbladder relates to NPO status. 4. Hiatus hernia.
10064049-RR-29
10,064,049
25,054,827
RR
29
2163-05-05 13:01:00
2163-05-05 14:26:00
INDICATION: ___ year old man with MDS ___ allogenic transplant ___ admitted with anemia --> pure red cell aplasion, receiving plasmaphoresis // non-tunneled plasmaphoresis line placement COMPARISON: Comparison is made to CT chest performed ___. TECHNIQUE: OPERATORS: Dr. ___ radiology fellow) and Dr. ___ radiology attending) performed the procedure. Dr. ___ radiologist, personally supervised the trainee during the key components of the procedure and reviewed and agreed with the trainee's findings. ANESTHESIA: Moderate sedation was provided by administrating divided doses of 50 mcg of fentanyl and 2 mg of midazolam throughout the total intra-service time of 18 min during which the patient's hemodynamic parameters were continuously monitored by an independent trained radiology nurse. 1% lidocaine was injected in the skin and subcutaneous tissues overlying the access site. MEDICATIONS: Fentanyl, Versed, lidocaine. CONTRAST: 0 ml of Optiray contrast. FLUOROSCOPY TIME AND DOSE: 3 min 51 seconds, 191 cGy-cm2 PROCEDURE: PROCEDURE DETAILS: Following the explanation of the risks, benefits and alternatives to the procedure, written informed consent was obtained from the patient. The patient was then brought to the angiography suite and placed supine on the exam table. A pre-procedure time-out was performed per ___ protocol. The neck was prepped and draped in the usual sterile fashion. Under continuous ultrasound guidance, the patent right internal jugular vein was compressible and accessed using a micropuncture needle. Permanent ultrasound images were obtained before and after intravenous access, which confirmed vein patency. Subsequently a Nitinol wire was passed into the right atrium using fluoroscopic guidance. The needle was exchanged for a micropuncture sheath. The Nitinol wire was removed and a short ___ wire was advanced into the IVC. After sequential dilation of the soft tissue tract using 13 ___ and 14 ___ dilators, a triple lumen 14 ___ pheresis catheter was advanced over the wire into the superior vena cava with the tip in the distal SVC. All 3 access ports were aspirated, flushed and capped. The catheter was secured to the skin with a 0 silk suture and sterile dressings were applied. Final spot fluoroscopic image demonstrating good alignment of the catheter and no kinking. The patient tolerated the procedure well without immediate complications. FINDINGS: Patent right internal jugular vein. Final fluoroscopic image showing triple lumen temporary pheresis catheter with catheter tip terminating in the distal superior vena cava. IMPRESSION: Successful placement of a right internal jugular approach triple lumen temporary pheresis catheter. The line is ready to use.
10064049-RR-30
10,064,049
25,054,827
RR
30
2163-05-15 10:54:00
2163-05-15 16:49:00
EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN) INDICATION: ___ male with elevated LFTs. Please do dopplers also. TECHNIQUE: Gray scale, color and spectral Doppler evaluation of the abdomen was performed. COMPARISON: CT abdomen and pelvis from ___. FINDINGS: Liver: The hepatic parenchyma is within normal limits. 8 mm cyst is seen in the left liver lobe likely corresponds to the hypodensity previously seen on prior CT. Nosuspicious liver lesions are identified. There is trace ascites. Bile ducts: There is no intrahepatic biliary ductal dilation. The common hepatic duct measures mm. Gallbladder: 3 mm gallbladder polyp is incidentally noted. There are no stones or abnormal wall thickening. Pancreas: Imaged portion of the pancreas appears within normal limits, with portions of the pancreatic tail obscured by overlying bowel gas. Spleen: Spleen measures 11.5 cm. Punctate hyperechoic foci are seen, likely corresponding to the granulomas previously seen on prior CT. Doppler evaluation: Main portal vein is patent, with flow in the appropriate direction Main portal vein velocity is 40 cm/sec. Right and left portal veins are patent, with antegrade flow Main hepatic artery is patent, with appropriate waveform. Irregular heart rate is incidentally noted. Right, middle and left hepatic veins are patent, with appropriate waveforms. IMPRESSION: 1. Patent hepatic vasculature. 2. Irregular heart rate is incidentally noted.
10064049-RR-31
10,064,049
25,054,827
RR
31
2163-05-18 14:48:00
2163-05-18 15:15:00
INDICATION: ___ male with myelodysplastic syndrome. Completion of pheresis therapy. COMPARISON: Temporary pheresis line placement from ___. TECHNIQUE: OPERATORS: Dr. ___ radiology fellow) and Dr. ___ ___ radiology attending) performed the procedure. The attending, Dr. ___ was present and supervising throughout the procedure. Dr. ___, ___ radiologist, personally supervised the trainee during the key components of the procedure and reviewed and agreed with the trainee's findings. ANESTHESIA: None. MEDICATIONS: None. CONTRAST: None. FLUOROSCOPY TIME AND DOSE: None. PROCEDURE: 1. Temporary triple-lumen pheresis line removal. PROCEDURE DETAILS: The procedure was performed at the patient's bedside. A pre-procedure time-out was performed per ___ protocol. The right upper chest was prepped and draped in the usual sterile fashion. Skin sutures were cut. Using gentle manual traction, the temporary triple-lumen pheresis catheter was removed. Hemostasis was achieved by holding pressure at neck venotomy site for 10 minutes. Sterile dressing was applied over the tunnel exit site. The patient tolerated the procedure well and there were no immediate post-procedure complications. FINDINGS: 1. Uncomplicated removal of right internal jugular approach temporary triple-lumen pheresis catheter. IMPRESSION: Uncomplicated removal of a right internal jugular approach temporary triple-lumen pheresis catheter.
10064049-RR-5
10,064,049
26,336,999
RR
5
2162-08-12 00:07:00
2162-08-12 01:54:00
INDICATION: History of dyspnea, chest pain. Please evaluate for PE. COMPARISONS: None. TECHNIQUE: ___ MDCT images were obtained through the chest after the administration of IV contrast. Multiplanar reformatted images in coronal and sagittal axes were generated and reviewed. FINDINGS: The thyroid is normal. There is no axillary or supraclavicular lymphadenopathy. Note, however, is made of enlarged hilar and mediastinal nodes measuring up to 1.1 cm. The heart size is normal. The pericardium is intact without evidence of an effusion. CTA: The aorta is unremarkable without evidence of a dissection. The main pulmonary artery is normal in size. The main, lobar, segmental and subsegmental pulmonary arteries are well opacified without evidence of filling defect concerning for a pulmonary embolus. The airways are patent to the subsegmental levels. There is a moderate right and small left pleural effusion. There is a 4-mm nodule in the right lower lobe (series 3, image 158). There is a 0.6 cm x 0.7 cm nodule, pleural-based, in the right lower lobe (series 3, image 132). The lungs demonstrate diffuse septal thickening with peribronchiolar thickening concerning for moderate pulmonary edema bilaterally. There is a large left lower lobe granuloma, which measures approximately 0.8 cm x 0.7 cm (series 3, image 172). Additional granulomas are seen throughout the left lung base. There is a focal area of consolidation in the anterior segment of the left upper lobe (series 3, image 93) as well as consolidation in the lingula (series 3, image 125) concerning for pneumonia. There is no evidence of a pneumothorax. This study is not tailored for the evaluation of the subdiaphragmatic structures; however, multiple calcifications within the spleen are likely secondary to prior granulomatous infection. Hypodense lesion in segment II of the liver measures approximately 0.8 cm and is likely secondary to a simple hepatic cyst. OSSEOUS STRUCTURES: No lytic or blastic lesions concerning for malignancy are identified. IMPRESSION: 1. No evidence of a pulmonary embolus. 2. Consolidations in the left upper lobe, lingula and right middle lobe are likely secondary to multifocal pneumonia. Enlarged lymph nodes measuring up to 1.1 cm in the right hilum and mediastinum are likely reactive. 3. Moderate pulmonary edema. 4. Moderate right and small left pleural effusion. 5. Lung nodules are seen bilaterally measuring up to 0.6 cm. A six-month chest CT is recommended for further evaluation to evaluate for stability.
10064049-RR-6
10,064,049
26,336,999
RR
6
2162-08-12 12:57:00
2162-08-12 15:34:00
EXAMINATION: CT ABD AND PELVIS WITH CONTRAST INDICATION: ___ man with acute leukemia and history of alcohol abuse complaining of abdominal pain and distension. Please evaluate for intra-abdominal process, lymphadenopathy, splenomegaly, etc. TECHNIQUE: MDCT acquired axial images of the abdomen and pelvis were obtained after administration of 150 mL Omnipaque intravenous contrast. Enteric contrast was also given. Coronal and sagittal reformats prepared and reviewed. DOSE: DLP: ___ MGy-cm. COMPARISON: CT angiogram of the chest from earlier today, ___ at 00:26. FINDINGS: CHEST: There is consolidation of the right lower lobe with small to moderate bilateral pleural effusions and left lower lobe compressive atelectasis. The appearance is unchanged from the CT of the chest performed on the same date, ___ at 00:26 ABDOMEN: The liver enhances homogeneously. The contour is smooth. There is a sub cm hypodensity in the left lobe of the liver, too small to characterize but statistically likely a simple cyst (series 4, image 12). The gallbladder and biliary tree are normal. The pancreas is normal, without focal lesion or duct dilation. The spleen is top-normal in size, 12.4 cm cranio-caudally, without multiple coarse calcifications consistent with exposure to granulomatous disease. . The adrenal glands are normal. The kidneys enhance normally and excrete contrast briskly. There are no solid renal lesions or hydronephrosis. The stomach and duodenum are normal. The small bowel and large bowel are normal in caliber, without wall thickening or mass. There is no intra- or retroperitoneal lymphadenopathy. There is no ascites, fluid collection, or pneumoperitoneum. The abdominal aorta is normal caliber, with patent main branches. Portal vein and IVC are patent. PELVIS: The urinary bladder is without wall thickening or mass. The rectum is unremarkable. There is no pelvic mass. There is no free fluid. There is a single isolated minimally enlarged 12 mm lymph node adjacent to the right ureter, at the level of the common iliac bifurcation (4:53). Prostate and seminal vesicles are unremarkable. BONES AND SOFT TISSUES: There is no acute fracture. There are no destructive osseous lesions concerning for malignancy or infection. There are no soft tissue masses. IMPRESSION: 1. No evidence of lymphoproliferative disorder in the abdomen or pelvis. 2. Nonspecific isolated minimally enlarged periureteral lymph node. 3. Right lower lobe consolidation consistent with pneumonia. Bilateral pleural effusions. The appearance of the lower chest is unchanged from earlier today. 4. No splenomegaly. Multiple coarse calcifications consistent with exposure to granulomatous disease such as histoplasmosis. 5. Liver morphology is not consistent with advanced cirrhosis. There is no evidence of chronic portal venous hypertension. There is no ascites. 6. There is no bowel obstruction or ileus.
10064049-RR-7
10,064,049
26,336,999
RR
7
2162-08-12 16:41:00
2162-08-12 18:57:00
EXAMINATION: CHEST (PORTABLE AP) INDICATION: ___ year old man with acute leukemia, now in A fib with RVR // please eval for worsening edema and consolidation COMPARISON: ___ IMPRESSION: As compared to the previous radiograph, the severity of pulmonary edema has decreased. New are small bilateral pleural effusions, likely caused by lymphatic drainage of the edema. Subsequent development of atelectatic lung areas at the left and right lung bases. Unchanged size of the cardiac silhouette.
10064049-RR-73
10,064,049
22,275,203
RR
73
2164-04-08 17:15:00
2164-04-08 17:56:00
EXAMINATION: Chest: Frontal and lateral views INDICATION: History: ___ with tachycardia // eval for CHF/pneumonia TECHNIQUE: Chest: Frontal and Lateral COMPARISON: ___ CT and ___ chest radiograph FINDINGS: 1.6 cm right lower lobe pulmonary nodule was better assessed on recent prior CT. Calcified left lower lobe pulmonary nodule is also re- demonstrated. No new focal consolidation is seen. There is no pleural effusion or pneumothorax. The cardiac and mediastinal silhouettes are grossly stable. IMPRESSION: Right lower lobe pulmonary nodule was better assessed on prior CT. No new focal consolidation seen.
10064049-RR-8
10,064,049
26,336,999
RR
8
2162-08-14 09:21:00
2162-08-14 11:03:00
EXAMINATION: CHEST (PORTABLE AP) INDICATION: ___ year old man with multifocal pna and pleural effusions. Worsening lung exam // please eval for worsening effusion/ pna COMPARISON: ___ IMPRESSION: No relevant change. The known right pleural effusion with moderate basal atelectasis. The left minimal pleural effusion is also unchanged. Unchanged mild pulmonary edema and moderate cardiomegaly. No new parenchymal opacities.
10064049-RR-9
10,064,049
26,336,999
RR
9
2162-08-16 08:30:00
2162-08-16 13:31:00
EXAMINATION: CHEST (PORTABLE AP) INDICATION: ___ year old man with AFib with RVR and pneumonia, possible fluid overload // ___ year old man with AFib with RVR and pneumonia, possible fluid overload COMPARISON: Chest radiograph from ___. FINDINGS: AP portable upright view of the chest. The heart size is normal. The hilar mediastinal contours remain within normal limits. This is small left and moderate right pleural effusion, both unchanged since ___. Linear bibasilar opacities reflect adjacent compressive atelectasis. There is no pneumothorax. The central pulmonary vessels are not engorged. Mild pulmonary edema seen on the ___ study appears improved IMPRESSION: Improved mild pulmonary edema. Unchanged moderate right and small left pleural effusions.
10064390-RR-10
10,064,390
23,328,727
RR
10
2137-11-17 12:10:00
2137-11-17 14:22:00
INDICATION: ___ year old man with PMH of RA, now SAH s/p fall, complaining of R hand pain // ?fx COMPARISON: None IMPRESSION: No acute fractures or dislocations are seen. There are moderate degenerative changes of the first CMC and triscaphe joints. There are severe degenerative changes of several DIP and PIP joints with joint space narrowing and spurring. A peripheral IV catheter is identified. There is normal osseous mineralization.
10064390-RR-11
10,064,390
23,328,727
RR
11
2137-11-17 13:03:00
2137-11-17 14:19:00
EXAMINATION: CHEST (PORTABLE AP) INDICATION: ___ year old man with infiltrate on previous x-ray // assess s/p bronch assess s/p bronch IMPRESSION: Compared to prior chest radiographs ___ and ___. Previous moderate pulmonary edema has improved. Given the lung volumes are greater, there is more consolidation at the left lung base, presumably atelectasis. The severity of right basal consolidation is stable. This is either atelectasis or pneumonia. Small pleural effusions are presumed. Heart size normal. ET tube in standard placement.
10064390-RR-12
10,064,390
23,328,727
RR
12
2137-11-17 16:19:00
2137-11-17 16:51:00
EXAMINATION: DX CHEST PORT LINE/TUBE PLCMT 1 EXAM INDICATION: ___ year old man with new ogt // ogt placement ogt placement IMPRESSION: Compared to prior chest radiographs ___ through ___ at 13:23. Lower lung volumes exaggerate new mild pulmonary edema. Bibasilar consolidation has worsened as well. Mild pulmonary edema in the left lung has worsened, though less severe now than at 06:00 this morning. Heart size top-normal. No pneumothorax. ET tube in standard placement. Transesophageal drainage tube ends in the upper nondistended stomach.
10064390-RR-13
10,064,390
23,328,727
RR
13
2137-11-17 18:21:00
2137-11-17 19:40:00
EXAMINATION: UNILAT UP EXT VEINS US RIGHT INDICATION: ___ year old man with swollen, red right hand. Rule out DVT. // Rule out DVT. TECHNIQUE: Grey scale and Doppler evaluation was performed on the right upper extremity veins. COMPARISON: None. FINDINGS: The bilateral subclavian veins are patent. The right internal jugular vein could not be evaluated due to the presence of a cervical spine collar. The axillary veins are patent, show normal color flow and compressibility. The right brachial, basilic, and cephalic veins are patent, compressible and show normal color flow and augmentation. IMPRESSION: No evidence of deep vein thrombosis in the right upper extremity.
10064390-RR-14
10,064,390
23,328,727
RR
14
2137-11-19 04:24:00
2137-11-19 14:33:00
INDICATION: ___ year old man with pneumonia // ?worsening pneumonia COMPARISON: The comparison is made with prior studies including ___. IMPRESSION: There is slight improved aeration bilaterally. Endotracheal tube tip is 5 cm above the carina. The nasogastric tube tip is in the stomach. There are no new areas of consolidation. There is no pneumothorax.
10064390-RR-15
10,064,390
23,328,727
RR
15
2137-11-20 05:01:00
2137-11-20 13:38:00
INDICATION: ___ year old man with SAH // eval lungs COMPARISON: The comparison is made with prior studies including ___ IMPRESSION: The endotracheal tube and nasogastric tubes are unchanged. There is linear atelectasis in the right mid lung zone. There is a persistent area patchy density in the left perihilar region there is a small left effusion. There is small area of patchy density in the right base. These findings are largely unchanged..
10064390-RR-16
10,064,390
23,328,727
RR
16
2137-11-21 14:04:00
2137-11-21 16:08:00
EXAMINATION: CERVICAL SINGLE VIEW IN OR INDICATION: ___ man for anterior C5-C6 fusion. Intraoperative films. TECHNIQUE: Intraoperative films of the cervical spine were obtained COMPARISON: MRI of the cervical spine from ___. FINDINGS: 5 intraoperative plain films were obtained without a radiologist present. These depict anterior fusion at C5-C6 with anterior plate, screws, and interbody spacer. For further information, please refer to operative report in OMR. IMPRESSION: As above.
10064390-RR-18
10,064,390
23,328,727
RR
18
2137-11-21 20:34:00
2137-11-22 08:57:00
EXAMINATION: CHEST (PORTABLE AP) INDICATION: ___ year old man with cervical cord contusion s/p decompression, now with temp // ?pneumonia ?pneumonia IMPRESSION: Compared to prior chest radiographs ___ through ___. Slight increase in heterogeneous opacification in the left mid and lower lung zone to be due to worsening atelectasis or pneumonia. Smaller region of abnormality at the right lung base has been invariably abnormal over the past several days. Moderate to severe cardiomegaly worsened between ___ and ___, subsequently stable, although mild edema and previous vascular congestion have improved. ET tube in standard placement. Nasogastric tube ends in the upper nondistended stomach.
10064390-RR-2
10,064,390
23,328,727
RR
2
2137-11-16 12:12:00
2137-11-16 14:19:00
INDICATION: Trauma. Subarachnoid hemorrhage. TECHNIQUE: Single portable frontal supine view of the chest. COMPARISON: None. FINDINGS: Allowing for the AP supine technique and patient position, cardiomediastinal silhouette is within normal limits. Lung volumes are low. Basilar opacities likely represent atelectasis. Lungs are otherwise clear. No large pleural effusion. No pneumothorax. An endotracheal tube projects approximately 4 cm above the carina. Enteric tube tip and side hole projects over the stomach. IMPRESSION: 1. Low lung volumes and bibasilar atelectasis. 2. Standard positioning of endotracheal and enteric tubes.
10064390-RR-21
10,064,390
23,328,727
RR
21
2137-11-23 13:14:00
2137-11-23 14:03:00
INDICATION: ___ year old male s/p fall backwards and striking his head walking his dog, subarachnoid hemorrhage in the basal cisterns predominant on the right and osteophyte C5-C6. // Assess for Dobhoff placement Contact name: ___: ___ TECHNIQUE: Portable FINDINGS: As compared to ___ insertion of the Dobhoff tube with the tip in the body of the stomach. The bibasilar opacities have not substantially changed. Mild pulmonary vascular congestion persists. Likely small left-sided effusion. Moderate cardiomegaly. IMPRESSION: Dobhoff tube in the body of the stomach.
10064390-RR-4
10,064,390
23,328,727
RR
4
2137-11-16 12:52:00
2137-11-16 14:00:00
INDICATION: ___ with trauma, known head bleed near brain stem, question fractures in torso TECHNIQUE: Noncontrast MDCT axial images were acquired through the chest, abdomen and pelvis. Oral contrast was not administered. Coronal and sagittal reformations were performed and reviewed on PACS. DOSE: Acquisition sequence: 1) CT Localizer Radiograph 2) CT Localizer Radiograph 3) Spiral Acquisition 8.8 s, 69.4 cm; CTDIvol = 19.3 mGy (Body) DLP = 1,340.4 mGy-cm. Total DLP (Body) = 1,340 mGy-cm. COMPARISON: None. FINDINGS: CHEST: An endotracheal tube is appropriately positioned. There is a small amount of secretions in the trachea just distal to the tip of the endotracheal tube. The airways are otherwise patent to subsegmental level. Lungs are notable for dependent bibasilar opacities with air bronchograms likely representing atelectasis. Bilateral calcified pleural plaques are suggestive of prior asbestos exposure. There is no pleural effusion or pneumothorax. Heart size is normal. There is no pericardial effusion. Aortic valve calcifications are noted. Thoracic aorta and main pulmonary artery are normal in caliber. There is no axillary, mediastinal, or hilar lymphadenopathy. Thyroid is homogeneous. ABDOMEN: Evaluation of intra abdominal organs is limited by lack intravenous 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 within normal limits. PANCREAS: The pancreas has normal attenuation throughout, without evidence of focal lesions or pancreatic ductal dilatation. There is no peripancreatic stranding. SPLEEN: The spleen shows normal size and attenuation throughout, without evidence of focal lesions. ADRENALS: The right and left adrenal glands are normal in size and shape. URINARY: The kidneys are of normal and symmetric size with normal nephrogram. There is no evidence of focal renal lesions or hydronephrosis. An 8 mm hypodensity in the left kidney is consistent with a simple cyst. Excreted contrast in the collecting system from a prior contrast-enhanced CT study is noted. There is no perinephric abnormality. GASTROINTESTINAL: The stomach is unremarkable. Enteric tube terminates in the proximal stomach. Small bowel loops demonstrate normal caliber, wall thickness, and enhancement throughout. The colon is notable for diverticulosis without adjacent inflammatory changes to suggest diverticulitis. The appendix is normal. PELVIS: A Foley catheter is in the bladder.The urinary bladder and distal ureters are otherwise unremarkable. There is no free fluid in the pelvis. REPRODUCTIVE ORGANS: Prostate is mildly enlarged. LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There is no pelvic or inguinal lymphadenopathy. VASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic disease is noted. BONES: There is no evidence of worrisome osseous lesions or acute fracture. Degenerative changes are most severe in the lumbar spine, particularly at the L5-S1 level were there is complete loss of disc height with anterior and posterior osteophyte formation resulting in mild-to-moderate spinal canal narrowing and bilateral neural foraminal narrowing. SOFT TISSUES: The abdominal and pelvic wall is within normal limits. IMPRESSION: 1. No fracture. 2. Standard positioning of endotracheal and enteric tubes. A small amount of secretion is present distal to the tip of the endotracheal tube. 3. Bibasilar atelectasis. 4. Bilateral calcified pleural plaques compatible with prior asbestos exposure.
10064390-RR-5
10,064,390
23,328,727
RR
5
2137-11-16 13:11:00
2137-11-16 14:37:00
EXAMINATION: CTA HEAD WANDW/O C AND RECONS Q1213 CT HEAD INDICATION: History: ___ with trauma, known head bleed near brain stem, ? fractures in torso*** WARNING *** Multiple patients with same last name! // ? status of head bleed, ? fractures in torso TECHNIQUE: Contiguous MDCT axial images were obtained through the brain without contrast material. Next, rapid axial imaging was performed through the brain during the uneventful infusion of 70 mL of Omnipaque intravenous contrast material. Three-dimensional angiographic volume rendered and segmented images were then generated on a dedicated workstation. This report is based on interpretation of all of these images. DOSE: Acquisition sequence: 1) CT Localizer Radiograph 2) CT Localizer Radiograph 3) Sequenced Acquisition 7.2 s, 18.0 cm; CTDIvol = 56.1 mGy (Head) DLP = 1,009.3 mGy-cm. 4) Stationary Acquisition 9.0 s, 0.5 cm; CTDIvol = 136.8 mGy (Head) DLP = 68.4 mGy-cm. 5) Spiral Acquisition 7.1 s, 22.9 cm; CTDIvol = 30.7 mGy (Head) DLP = 703.0 mGy-cm. Total DLP (Head) = 1,781 mGy-cm. COMPARISON: Comparison is made with CT head from OSH from earlier the same day, ___. FINDINGS: CT HEAD WITHOUT CONTRAST: Blood products are seen in the basal cisterns predominantly on the right, consistent with subarachnoid hemorrhage and unchanged from prior exam. Faint hyperdensity is seen extending from the basal cisterns toward the occipital area, consistent with redistribution of subarachnoid blood (3:15). In the right parietal area, there is an additional focus of hyperdensity consistent with a subarachnoid blood redistribution (3:22), new from prior exam. There is no evidence of new hemorrhage, acute territorial infarction, edema, or mass effect. The ventricles and sulci are normal in size and configuration. Mucosal thickening is seen in the ethmoid air cells, frontal sinuses, sphenoid sinuses, and bilateral maxillary sinuses. The visualized portions of the mastoid air cells and middle ear cavities are clear. The patient is intubated with fluid filled nasopharynx. The visualized portion of the orbits are unremarkable. There is a left occipital skull subgaleal hematoma measuring 6 mm in greatest thickness. There is no underlying skull fracture. CTA HEAD: The right A1 and A2 segments are dominant. Otherwise, the vessels of the circle of ___ and their principal intracranial branches appear normal with no evidence of stenosis,occlusion or aneurysm. The dural venous sinuses are patent. There is no spot sign. IMPRESSION: 1. Subarachnoid hemorrhage in the basal cisterns predominant on the right, with some redistribution from prior exam. No new focus of hemorrhage or infarction. 2. Unremarkable CTA of the head without aneurysm or evidence of active extravasation.
10064390-RR-6
10,064,390
23,328,727
RR
6
2137-11-16 23:48:00
2137-11-17 11:13:00
EXAMINATION: MR CERVICAL SPINE W/O CONTRAST ___ MR ___ SPINE INDICATION: ___ year old man with status post fall on ice, with subarachnoid hemorrhage, now only moving bilateral upper extremities response not stimuli, with no lower extremity movement identified. Evaluate for cervical spinal cord injury. TECHNIQUE: Sagittal imaging was performed with T2, T1, and STIR technique. Axial T2 and gradient echo imaging were next performed. Sagittal diffusion weighted imaging was then performed. COMPARISON: ___ outside noncontrast cervical spine CT. FINDINGS: Study is mildly degraded by motion, especially on diffusion-weighted cervical spine imaging. There is 2 mm retrolisthesis of C3 on C4 and 4 mm anterolisthesis of C7 on T1. The vertebral body heights are maintained at all levels. There are ___ type 3 changes at C5-C6 and ___ Type 1 changes at C6-C7, without evidence of epidural collection. There is focal high-grade spinal stenosis at C5-C6 with T2 / STIR signal hyperintensity within the spinal cord as seen on image 3:8 and 06:20. Within limits of study, no definite abnormal focus of slow diffusion is seen within the spinal cord to suggest cord infarct. Within the limits of this noncontrast study there is no evidence of infection or neoplasm. There is no prevertebral soft tissue swelling.. The visualized portion of the posterior fossa, cervicomedullary junction are preserved. Endotracheal and enteric tubes are partially visualized. At C2-C3, there is loss of disc height and signal with a central disc osteophyte complex indenting the ventral thecal sac. No neural foraminal stenosis is seen. At C3-C4, there is loss of disc height and signal with central disc osteophyte complex indenting the ventral spinal cord causing more mild spinal canal stenosis. Also seen is bilateral uncovertebral and facet arthropathy resulting in moderate bilateral neural foramen narrowing. At C4-C5, there is loss of disc height and signal with broad-based disc bulge indenting the ventral aspect of cord causing mild spinal canal stenosis. Bilateral uncovertebral and facet arthropathy results in severe bilateral neural foramen narrowing. At C5-C6, there is loss of disc height and signal with broad-based disc osteophyte complex causing severe spinal canal stenosis and focal myelomalacia at this level. Bilateral uncovertebral and facet arthropathy also results in severe bilateral neural foramen narrowing. At C6-C7, there is loss of disc height and signal with broad-based disc bulge indenting the ventral thecal sac causing mild spinal canal stenosis. Bilateral uncovertebral and facet arthropathy results in severe bilateral neural foramen narrowing. At C7-T1, there is loss of disc signal in keeping with disc desiccation. The disc height is maintained. No neural foramen stenosis. No spinal canal stenosis. IMPRESSION: 1. Study is mildly degraded by motion. 2. Severe C5-C6 spinal canal stenosis with focal cervical spinal cord signal abnormality. While findings may represent myelomalacia, acute cord injury is not excluded on the basis of this examination. 3. Within limits of study, no definite acute cord infarct identified. 4. Multilevel multifactorial degenerative disease of the cervical spine, worst at C5-C6, where there is severe spinal canal and bilateral neural foramen stenosis. 5. Severe neural foramen stenosis at C4-C5 and C6-C7 as described.
10064390-RR-7
10,064,390
23,328,727
RR
7
2137-11-17 06:22:00
2137-11-17 10:52:00
EXAMINATION: CHEST (PORTABLE AP) INDICATION: ___ year old man with SAH now w fevers // eval for PNA eval for PNA IMPRESSION: Only chest radiographs from ___ available. Large calcified pleural plaques obscure much of the left lower lung, but there appears to be at least mild, new, bilateral perihilar pulmonary edema. Left basal atelectasis has improved since the chest CT on ___. Moderate right basal atelectasis has not. Pleural effusion small if any. Mild cardiomegaly stable. ET tube in standard placement. Nasogastric tube passes into the stomach, but the tip is at review.
10064390-RR-8
10,064,390
23,328,727
RR
8
2137-11-18 03:33:00
2137-11-18 13:35:00
INDICATION: ___ year old man with ett // please eval ett COMPARISON: The comparison is made with prior studies including ___. IMPRESSION: Endotracheal tube tip is 5 cm above the carina. Nasogastric tube tip is correlate in the body of the stomach. There is no pneumothorax. There is patchy density in both lung bases more pronounced on the left. There is mild CHF.
10064390-RR-9
10,064,390
23,328,727
RR
9
2137-11-17 09:29:00
2137-11-17 12:04:00
EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD INDICATION: ___ year old man with SAH. Portable head CT without contrast to evaluate status of SAH. // Portable head CT without contrast to evaluate status of SAH. TECHNIQUE: Contiguous axial images of the brain were obtained without contrast. DOSE: DLP: 1273.10 mGy cm CTDI vol: 70.73 mGy COMPARISON: Comparison is made with CTA head from ___ and CT head from OSH from ___. FINDINGS: The blood products are seen again seen in the basal cisterns, predominantly on the right and similar in appearance to prior exams. Blood products have redistributed in the interval and are now seen in a few sulci, the fourth ventricle, and the occipital horns of the bilateral lateral ventricles. No no new focus of hemorrhage is seen. There is no evidence of acute territorial infarction, edema, or mass effect. The ventricles and sulci are stable in size and configuration. There is no evidence of fracture. Mucosal thickening is seen in the right frontal sinus is, ethmoid air cells, left maxillary sinus, and sphenoid sinuses. Otherwise, the visualized paranasal sinuses, mastoid air cells, and middle ear cavities are clear. The visualized portion of the orbits are unremarkable. Left parietal occipital 5 mm thick subgaleal hematoma is unchanged from prior examination. IMPRESSION: Subarachnoid hemorrhage in the basal cisterns, predominantly on the right and similar in appearance to prior exam. Interval redistribution of blood products to the sulci and ventricular system. No new acute findings.
10064678-RR-26
10,064,678
21,638,060
RR
26
2183-05-28 16:38:00
2183-05-28 16:57:00
CHEST RADIOGRAPH PERFORMED ON ___ ___ and CT abdomen and pelvis from ___. CLINICAL HISTORY: Recent cholecystectomy with shortness of breath, abdominal pain, mild hypoxia, question pneumonia. FINDINGS: PA and lateral views of the chest were provided. There are low lung volumes with increasing right basal atelectasis. Calcified granuloma projects over the right lung base. Cardiomediastinal silhouette appears normal. Additional calcified granuloma in the right mid lung noted. No pneumothorax. Bony structures are intact. IMPRESSION: Right basal atelectasis.
10064678-RR-27
10,064,678
21,638,060
RR
27
2183-05-28 16:11:00
2183-05-28 16:53:00
INDICATION: Patient is status post recent cholecystectomy with elevated lipase and lactate and abdominal pain. Evaluate for ductal stone. COMPARISON: CT abdomen from ___. TECHNIQUE: Grayscale and color Doppler images of the abdomen were obtained. FINDINGS: The liver is coarse in echotexture, with a nodular contour in keeping with known history of chronic liver disease. There is no focal lesion or intrahepatic biliary duct dilatation. The patient is status post cholecystectomy. The common bile duct is not dilated, normal measuring 5 mm. The portal vein is patent with hepatopetal flow. The spleen is mildly enlarged measuring 12.9 cm. There is significant amount of ascites, which appears slightly increased compared with prior abdomen CT allowing for difference in techniques. IMPRESSION: 1. No evidence of biliary ductal dilation. No evidence of choledocholithiasis. 2. Coarse liver echotexture with nodular contour is compatible with underlying chronic liver disease. 3. Moderate amount of ascites is slightly increased in size compared with prior CT abdomen allowing for difference in techniques.
10064678-RR-28
10,064,678
21,638,060
RR
28
2183-05-29 13:42:00
2183-05-29 15:22:00
INDICATION: History of cholecystectomy one month ago with recent removal of JP drain, now admitted with bacterial peritonitis, here to evaluate for intra-abdominal abscess or underlying cause of peritonitis. COMPARISON: CT of the abdomen and pelvis without contrast dated ___. Right upper quadrant sonogram dated ___. TECHNIQUE: MDCT-acquired axial images were obtained from the lung bases to the pubic symphysis following the uneventful administration of 150 cc Omnipaque intravenous contrast and enteric contrast. Coronal and sagittal reformatted images were generated and reviewed. DLP: 1040 mGy-cm. FINDINGS: LUNG BASES: Although this study is not tailored for the evaluation of supradiaphragmatic contents, the imaged lung bases demonstrate consolidation of the right lung base with intervening air bronchograms, most compatible with right lower lobe atelectasis. There are multiple calcified granulomas in the lung bases compatible with prior granulomatous infection. No pleural effusion is present. There is mild atelectasis at the left lung base. Limited imaging of the heart shows no pericardial effusion. A small hiatal hernia is incidentally noted. There are prominent pre-pericardial lymph nodes, measuring 10 mm in short axis (2A:6, 7). ABDOMEN: The liver enhances homogeneously without perfusion defects or focal liver lesions. Scattered calcified granulomas are noted in the right lobe (2A:8, 23), compatible with prior granulomatous infection. The portal, splenic and superior mesenteric veins are well opacified with intravenous contrast. The portal and splenic veins are of increased caliber suggesting portal hypertension. The spleen is enlarged, measuring 14 cm on coronal imaging. Paraesophageal varices and upper abdominal venous collaterals are also compatible with pulmonary hypertension. Multiple prominent perigastric and portacaval lymph nodes measuring 10 mm in short axis (2A:20) may be reactive or nonspecific in the setting of underlying liver disease. The patient is status post cholecystectomy. There is a small focal fluid collection in the gallbladder fossa containing several foci of air, which measures approximately 28 x 22 mm in the gallbladder fossa (2A:23), similar to the prior CT. The pancreas, bilateral adrenal glands and kidneys are within normal limits. The stomach, duodenum and intra-abdominal loops of small and large bowel are normal in caliber without evidence of obstruction. There is moderate-volume simple ascites. There is no significant peritoneal enhancement. A normal appendix is visualized in the right lower quadrant. There is no walled-off or complex fluid collection within the abdomen. There are prominent retroperitoneal lymph nodes, measuring up to 13 mm in short axis in the left paraaortic station (2A:27). No pathologically enlarged mesenteric lymph nodes are seen. There is no free air or evidence of bowel ischemia. There is moderate aortoiliac calcified atherosclerosis without aneurysmal dilatation. PELVIS: The urinary bladder, uterus, adnexa, rectum and sigmoid colon are within normal limits. There is pelvic ascites contiguous with abdominal ascites. No pathologically enlarged pelvic lymph nodes are seen, measuring up to 7 mm in short axis in the external iliac station bilaterally. OSSEOUS STRUCTURES: There are no osseous destructive lesions concerning for malignancy. IMPRESSION: 1. Increased moderate ascites from the prior CT at ___ without significant peritoneal enhancement. No walled off or complex collection in the abdomen or pelvis to suggest abscess. 2. Evidence of portal hypertension including splenomegaly, varices and upper abdominal venous collaterals. 3. Status post cholecystectomy with stable collection of fluid and air in the gallbladder fossa compared to ___. 4. Multiple prominent lymph nodes in the pre-pericardial, perigastric, portocaval, retroperitoneal and external iliac stations are a nonspecific finding but may be reactive. 5. Generalized anasarca.
10064678-RR-29
10,064,678
21,638,060
RR
29
2183-06-06 14:40:00
2183-06-06 16:14:00
PROCEDURE: Diagnostic and therapeutic paracentesis. OPERATORS: Dr. ___ (attending radiologist), Dr. ___ (resident), Dr. ___ (resident). INDICATION: ___ female with history of HCV cirrhosis and MSSA spontaneous bacterial peritonitis and ascites. Unsuccessful therapeutic paracentesis on ___. COMPARISON: CT abdomen and pelvis ___. PROCEDURE: Initial four-quadrant ultrasound demonstrates large amount of intra-abdominal free fluid consistent with ascites. Following discussion of the risks, benefits and alternatives to the procedure, written informed consent was obtained. The left lower quadrant was selected given the largest pocket of free fluid. Preprocedure timeout was performed using three patient identifiers. The skin was prepped and draped in the usual sterile fashion. Approximately 10 cc of buffered 1% lidocaine was infiltrated in the skin and subcutaneous tissue for local anesthesia. A 5 ___ ___ catheter was passed into the peritoneum. The catheter was then attached to a syringe and 20 mL of clear, dark yellow serous fluid was drained and sent to the laboratory. Subsequently, a catheter was then attached to wall suction and 3 liters of clear, dark yellow serous fluid was drained. The cathether was then removed and pressure was applied at insertion site for 5 minutes and hemostasis was achieved. Post procedure the patient had mild periumbilical tenderness. An ultrasound demonstrated normal peristalsing bowel without intra-abdominal free air. Within approximately 5 minutes, patient reported that symptoms had resolved. There were no additional complications. The patient was transferred back to the floor. Dr. ___, the attending radiologist, was available throughout and present for critical portions of the procedure. IMPRESSION: Technically successful diagnostic and therapeutic paracentesis with 3 liters of light dark yellow serous fluid removed.
10064678-RR-30
10,064,678
21,638,060
RR
30
2183-06-06 18:46:00
2183-06-07 09:29:00
HISTORY: Cirrhosis. Pretransplant workup. COMPARISON: ___. FINDINGS: Frontal and lateral radiographs of the chest demonstrate a new moderate right pleural effusion with adjacent atelectasis. There is no left pleural effusion. Mild cardiomegaly is noted. There is a focus of opacity in the left upper lobe which is new since the prior study and may represent pneumonia in the appropriate clinical setting. Calcified granuloma in the right middle lung which is stable since at least ___. The hilar and mediastinal contours are normal. No pneumothorax is seen. IMPRESSION: New moderate right pleural effusion with new opacity in the left upper lobe which may represent pneumonia in the appropriate clinical setting.
10064678-RR-31
10,064,678
21,638,060
RR
31
2183-06-11 14:11:00
2183-06-11 15:09:00
HISTORY: Cirrhosis and spontaneous bacterial peritonitis and ascites. COMPARISON: Prior ultrasounds including ___ FINDINGS: ULTRASOUND-GUIDED PARACENTESIS: After an explanation of the risks, benefits and alternatives, written informed consent was obtained. A limited ultrasound of all four quadrants revealed a moderate amount of ascites, much of which was a loculated. A spot was marked in the left upper quadrant for paracentesis. A preprocedure timeout was performed to verify the correct patient using three identifiers and examination to be performed. The spot was prepped and draped in the standard sterile fashion. 1% lidocaine was used to anesthetize the soft tissues. A 5 ___ ___ catheter was inserted through the peritoneum and clear yellow ascites was removed. Samples were sent to microbiology and hematology as well as chemistry for analysis. 0.75 L of fluid were drained and despite provocative maneuvers, additional fluid could not be obtained. The patient tolerated the procedure well and there were no immediate complications. The attending radiologist, Dr. ___ was present and supervised the procedure. IMPRESSION: Successful therapeutic and diagnostic ultrasound-guided paracentesis yielding 0.75 liters of ascites.
10064678-RR-33
10,064,678
21,638,060
RR
33
2183-06-15 08:47:00
2183-06-15 10:02:00
HISTORY: Spontaneous bacterial peritonitis. COMPARISON : Paracentesis ultrasound ___. CT abdomen /pelvis ___. PROCEDURE: Diagnostic and therapeutic paracentesis. FINDINGS: Initial four quadrant ultrasound demonstrates large amount of intra-abdominal free fluid consistent with ascites. Following discussion of the risks, benefits, and alternatives to the procedure, written informed consent was obtained. The left lower quadrant was selected given the largest pocket of free fluid. Preprocedure timeout was performed using three patient identified. The skin was prepped and draped in usual sterile fashion. Approximately 10 mL of 1% lidocaine was infiltrated into the skin and subcutaneous tissues for local anesthesia. A 5 ___ ___ catheter was passed into the peritoneum. The catheter was then attached to wall suction and 755 mL of clear pink serosanguineous fluid was drained. Ultrasound was used to assess the abdomen and a loculated fluid collection was identified which was not drained today. There were no immediate complications and the patient tolerated the procedure well. The patient was transferred back to the floor. Dr. ___ attending radiologist, was present throughout the procedure. IMPRESSION: Technically successful diagnostic and therapeutic paracentesis with 755 mL of clear pink serosanguineous fluid removed.
10064678-RR-34
10,064,678
21,638,060
RR
34
2183-06-14 08:13:00
2183-06-14 09:25:00
CHEST RADIOGRAPH INDICATION: Shortness of breath and crackles, questionable pneumonia. COMPARISON: ___. FINDINGS: As compared to the previous radiograph, there is unchanged evidence of a relatively extensive right pleural effusion with subsequent areas of atelectasis. A minimal left pleural effusion is also present. Mild cardiomegaly with mild pulmonary edema. Known calcified right upper lobe granulomas are constant. No evidence of new parenchymal changes. No pneumothorax.
10065057-RR-16
10,065,057
21,928,958
RR
16
2119-04-27 09:57:00
2119-04-27 15:34:00
EXAMINATION: MRI CERVICAL, THORACIC, AND LUMBAR PT22 MR SPINE INDICATION: History: ___ with ___ s/p fall, multiple compression fractures of uncertain chronicity. exam indeterminate.IV contrast to be given at radiologist discretion as clinically needed// evaluate for traumatic injuries evaluate for traumatic injury TECHNIQUE: Sagittal imaging was performed with T2, T1, and STIR technique. Axial T2 imaging was performed. Axial GRE images of the cervical spine were performed. After the uneventful administration of Gadavist contrast agent, additional axial and sagittal T1 images were obtained. COMPARISON: CT C-spine ___ FINDINGS: Study is degraded by motion. Study is limited by patient positioning. CERVICAL, THORACIC AND LUMBAR SPINE: There is approximately 2 mm C3 and C4 retrolisthesis. There is marked dextroscoliosis of the thoracic spine. There is levoscoliosis of the lumbar spine. The L5 vertebral body demonstrates transitional anatomy with partial sacralization. There is 30% anterior vertebral body height loss at the C7 vertebral body which appears chronic and is unchanged since at least ___. There is approximately 30% chronic height loss anteriorly of the T7 vertebral body. There is approximately 25% of chronic anterior height loss of the T8 vertebral body. There is substantial effacement of the central inferior endplate of the L3 vertebral body without anterior height loss. There is expansion and herniation of the intervertebral disc which demonstrates heterogeneous internal STIR signal abnormality (series 9, image 18). Additionally, there is a focal fluid collection inferior to the L3 vertebral body and contacting the L3/4 intervertebral disc superiorly measuring 2.2 x 0.8 cm (series 9, image 18), which demonstrates mild anterior enhancement. There is edema anteriorly. No definite peripherally enhancing collection is identified. There is abnormal T2 signal prolongation through the inferior endplate of the L5 vertebral body which contacts the cortex (series 8, image 16) with additional abnormal signal extending superiorly along the slightly rightward aspect of the L5 vertebral body (series 9, image 12), consistent with a acute to subacute fracture. C5 vertebral body probable hemangioma is noted. There is a 6 mm hemangioma within the T8 vertebral body (series 10 image 15). Numerous chronic Schmorl's nodes are demonstrated throughout the cervical, thoracic, and lumbar spine. The visualized portion of the spinal cord is grossly preserved in signal. There is loss of intervertebral disc height and signal throughout the spine. Nonspecific facet fluid is noted at multiple levels throughout lumbar spine. At C2-3 there is disc bulge, central disc protrusion, ligamentum flavum thickening, facet joint hypertrophy, mild to moderate vertebral canal and mild bilateral neural foraminal narrowing. At C3-4 there is disc bulge, uncovertebral hypertrophy, facet hypertrophy, ligamentum flavum thickening, deformation of the ventral thecal sac and spinal cord without definite associated cord signal abnormality, with moderate to severe vertebral canal, mild left and moderate right neural foraminal narrowing. At C4-5 there is disc bulge, uncovertebral hypertrophy, central disc protrusion, ligamentum flavum thickening, facet joint hypertrophy, vertebral canal and mild bilateral neural foraminal narrowing. At C5-6 there is disc bulge, central disc protrusion, uncovertebral hypertrophy, ligamentum flavum thickening, facet joint hypertrophy, deformation of the ventral thecal sac and spinal cord without definite associated cord signal abnormality, with mild vertebral canal and mild bilateral neural foraminal narrowing. At C6-7 there is disc bulge, facet joint hypertrophy, addendum flavum thickening, deformation of the ventral thecal sac and spinal cord without definite associated cord signal abnormality, with mild vertebral canal and moderate left neural foraminal narrowing. At C7-T1 there is central disc protrusion,, uncovertebral hypertrophy, facet joint hypertrophy, with mild vertebral canal and no neural foraminal narrowing. At T6-7 there is a disc bulge with deformation of the ventral thecal sac and spinal cord without definite associated cord signal abnormality, with mild vertebral canal neural foraminal narrowing. At T7-8 there is a disc bulge with deformation of the ventral thecal sac and spinal cord without definite associated cord signal abnormality, with mild vertebral canal neural foraminal narrowing. Otherwise, throughout thoracic spine there are multiple disc bulges with up to mild vertebral canal and no neural foraminal narrowing. There are multilevel degenerative changes throughout the lumbar spine, which are mild in severity and include posterior disc bulge at T12/L1, L1/L2, L2/L3 and L3/L4. Spinal canal narrowing is minimal. There is moderate neural foraminal narrowing at L4/L5 on the left, and mild narrowing at T12/L1 on the right. OTHER: There is abnormal STIR signal also demonstrated within the central sacrum, which corresponds with a linear area abnormal T2 signal extending along the slightly rightward midline sacrum (series 14, image 38). The fracture extends from the spinal canal at S1 inferiorly, without significant involvement of the bilateral sacral foramina. These findings are incompletely evaluated on this spinal sequence MR. ___ bilateral right and left pleural effusions, with overlying atelectasis most prominent the left lower lobe are noted. Nonspecific patulous esophagus with some fluid is noted. Numerous gallstones are demonstrated within the gallbladder without definite evidence of gallbladder wall thickening. There is asymmetric atrophy of the lumbar paraspinal muscles more prominent on the right. The known right parotid cystic mass is better characterized on the same day brain MR. ___: 1. Study is degraded by motion and limited by patient positioning. 2. Abnormal fluid signal with effacement of the central inferior endplate of the L3 vertebral body as described, with no definite peripherally enhancing collection. While findings are suggestive of acute Schmorl's node, differential considerations of phlegmonous change or early discitis osteomyelitis is not excluded on the basis ex of this amination. Recommend follow-up imaging to resolution. 3. Acute to subacute L5 vertebral body fracture, as described. 4. Central and vertically oriented fracture through the sacrum, which is incompletely evaluated. A dedicated sacral MR can be considered if further characterization is warranted. 5. Anterior height loss of the C7 vertebral body is unchanged since ___. 6. Probable chronic T7 and T8 anterior compression deformities, as described. 7. Multilevel cervical spondylosis as described, most pronounced at C3-4, where there is moderate to severe vertebral canal, mild left and moderate right neural foraminal narrowing. 8. Additional multilevel thoracic and lumbar spine spondylosis as described without definite evidence of moderate or severe vertebral canal narrowing. 9. Within limits of study, no definite evidence of spinal cord lesion. Multilevel spinal cord probable remodeling as described. 10. ___ bilateral pleural effusions as described. If clinically indicated, consider correlation with dedicated chest imaging. 11. Cholelithiasis. 12. Known right parotid cystic mass better characterized on same day brain MR. 13. Please see concurrently obtained brain MRI for description of cranial structures.
10065057-RR-17
10,065,057
21,928,958
RR
17
2119-04-25 12:35:00
2119-04-25 13:58:00
EXAMINATION: CHEST (PORTABLE AP) INDICATION: ___ year old woman s/p trauma with Cspine and L spine fx requires MRI, but with pacemaker// evaluate pacemaker for MRI evaluate pacemaker for MRI IMPRESSION: Comparison to ___. No relevant change is noted. Single lead pacemaker in left pectoral position. Moderate scoliosis. Borderline size of the cardiac silhouette. No pneumonia, no pulmonary edema.
10065057-RR-18
10,065,057
21,928,958
RR
18
2119-04-27 09:57:00
2119-04-27 13:26:00
EXAMINATION: MR HEAD W/O CONTRAST ___ MR HEAD INDICATION: ___ cognitive delay s/p unwitnessed fall at group home, small SAH, L sup inf pubic rami Fx, C7/L2/L4 compression Fx's of unclear age, multiple L-sided rib Fx's (some new, some old)// Assess injuries TECHNIQUE: Sagittal T1 weighted imaging was performed. Axial imaging was performed with gradient echo, FLAIR, diffusion, and T2 technique were then obtained. COMPARISON CT head ___ under MRN ___ CT ___ FINDINGS: Study is mildly degraded by motion. Question small approximately 1 mm in maximal diameter collection overlying left parietal lobe with increase susceptibility, FLAIR hyperintensity, and T2 isointense to CSF without definite corresponding T1 hyperintensity versus artifact (see 8:2; 3, 04:18; 9, 10, 11:14). Additional punctate foci of blood products versus mineralization without definite corresponding restricted diffusion, T1 hyperintensity, or T2 hypointensity is seen within the left precentral gyrus (see 11:19). No definite MRI abnormality is noted to correspond to previously noted right perimesencephalic cistern hyperintensity. There is prominence of the ventricles and sulci suggestive of involutional changes. Periventricular and subcortical T2 and FLAIR hyperintensities are noted which may represent small vessel ischemic changes. There is no definite evidence of acute infarct, intracranial mass, mass effect, or midline shift. The visualized portion of the major intracranial vascular flow voids are preserved. There is a T1 hypointense and cystic structure with T2 prolongation within the right parotid gland measuring approximately 2.5 x 2.7 cm (series 10 image 2). Allowing for difference in technique, finding is suggested the increased in size compared to ___ prior exam. There is a left parietal subgaleal hematoma measuring up to 5 mm from the calvarium (series 9, image 14). There is a small mucous retention cyst within the left sphenoid sinus. Bilateral ethmoid air cell and maxillary sinus mucosal thickening is present. Minimal bilateral nonspecific mastoid fluid is seen. IMPRESSION: 1. Study is mildly degraded by motion. 2. Question approximately 1 mm left parietal subdural hemorrhage versus artifact, as described. 3. Punctate left precentral gyrus foci of chronic blood products versus mineralization. 4. Previously demonstrated hyperdensity within the right perimesencephalic cistern not definitely seen on current study. Question interval redistribution of blood products. 5. 5 mm left parietal subgaleal hematoma. 6. Interval progression in size of previously noted parotid mass, now measuring up to 2.5 cm, compared to ___ prior exam. 7. Global volume loss and probable microangiopathic changes as described. 8. Paranasal sinus disease and minimal bilateral nonspecific mastoid fluid, as described.
10065584-RR-21
10,065,584
20,108,164
RR
21
2150-07-14 02:05:00
2150-07-14 03:03:00
EXAMINATION: CTA HEAD AND CTA NECK Q16 CT NECK INDICATION: History: ___ with PCA infarct on MRI// ?occlusion, dissection, flow through infarct TECHNIQUE: Contiguous MDCT axial images were obtained through the brain without contrast material. Subsequently, helically acquired rapid axial imaging was performed from the aortic arch through the brain during the infusion of 70 mL of Omnipaque350 intravenous contrast material. Three-dimensional angiographic volume rendered, curved reformatted and segmented images were generated on a dedicated workstation. This report is based on interpretation of all of these images. DOSE: Acquisition sequence: 1) Sequenced Acquisition 18.0 s, 18.0 cm; CTDIvol = 50.2 mGy (Head) DLP = 903.1 mGy-cm. 2) Stationary Acquisition 5.5 s, 0.5 cm; CTDIvol = 119.8 mGy (Head) DLP = 59.9 mGy-cm. 3) Spiral Acquisition 5.7 s, 44.7 cm; CTDIvol = 31.1 mGy (Head) DLP = 1,391.1 mGy-cm. Total DLP (Head) = 2,354 mGy-cm. COMPARISON: MR dated ___. FINDINGS: CT HEAD WITHOUT CONTRAST: Hypodensity in the right occipital lobe corresponds to late acute/subacute infarct seen on MRI. There is no evidence of no evidence of new infarct, hemorrhage, edema, or mass. The ventricles and sulci are normal in size and configuration. There is mild mucosal thickening of the bilateral ethmoid air cells. The remaining paranasal sinuses, mastoid air cells, and middle ear cavities are clear. The visualized portion of the orbits are unremarkable. CTA HEAD: The vessels of the circle of ___ and their principal intracranial branches appear normal without stenosis, occlusion, or aneurysm formation. Incidental note is made of a fetal origin of the right PCA. A filling defect in the P2 segment of the right PCA is seen, with slightly decreased flow distally. The dural venous sinuses are patent. CTA NECK: There is calcified and noncalcified atherosclerotic plaque resulting in complete occlusion of the right internal carotid artery just superior to the bifurcation (3:169), with reconstitution within the cavernous sinus (3:277), as seen on MRA. No soft tissue mass is seen to indicate an acute thrombus. The vertebral arteries and their major branches appear normal with no evidence of stenosis or occlusion. OTHER: The visualized portion of the lungs are clear. The visualized portion of the thyroid gland is within normal limits. There is no lymphadenopathy by CT size criteria. IMPRESSION: 1. Right occipital lobe hypodensity is consistent with known late acute/subacute infarct, as seen on MRI. 2. Complete occlusion of the right internal carotid artery just superior to the bifurcation, with reconstitution within the cavernous sinus, likely due to chronic occlusion secondary to atherosclerotic disease. 3. A nonocclusive filling defect is seen in the P2 segment of the right PCA with slightly slow distal flow.
10065656-RR-20
10,065,656
27,129,771
RR
20
2119-11-11 00:38:00
2119-11-11 08:48:00
PORTABLE CHEST, ___ No prior studies for comparison. FINDINGS: Lung volumes are low. Allowing for this factor, heart size and pulmonary vascularity are normal. With the exception of crowding of bronchovascular structures at the lung bases, lungs as well as pleural surfaces are grossly clear. If clinical suspicion for acute pulmonary process persists, repeat radiograph with improved inspiratory level may be helpful for more full assessment of the lung bases.
10065656-RR-23
10,065,656
27,129,771
RR
23
2119-11-11 19:25:00
2119-11-12 10:53:00
INDICATION: Worsening headaches, possible seizure activity, to evaluate for structural lesion. COMPARISON: CT head done on ___ at ___, report not available for perusal. TECHNIQUE: MR of the head without and with IV contrast, per seizure protocol. FINDINGS: There is no focus of slow diffusion to suggest an acute infarct. There is no focus of negative susceptibility to suggest blood products or mineralization. On the FLAIR sequence, no obvious focal lesions are noted. There is no focus of abnormal enhancement noted in the brain parenchyma or the meninges. The MP-RAGE sequences are limited due to some degree of motion. Within this limitation, no large area of structural abnormality is noted. The hippocampi are grossly unremarkable in size. Internal architecture of the hippocampi is relatively well maintained. Major intracranial arterial flow voids are noted, with a dominant left vertebral artery and diminutive right vertebral artery. Minimal mucosal thickening is noted on to the right ethmoid air cells. IMPRESSION: 1. No obvious focal lesions in the brain parenchyma as described above. 3D sequences are limited due to motion. Within this limitation, no large area of structural abnormality is noted. Correlate with EEG and semiology and if necessary, a followup study can be considered when the patient is cooperative.
10065767-RR-29
10,065,767
25,730,443
RR
29
2122-01-06 13:47:00
2122-01-06 14:26:00
HISTORY: Weakness and hypotension. TECHNIQUE: Upright AP view of the chest. COMPARISON: Chest CTA ___ and chest radiograph ___. FINDINGS: Left-sided pacemaker/AICD device is noted with leads terminating in the right atrium and right ventricle. Low lung volumes are present. There is mild enlargement of the cardiac silhouette which is unchanged. Mediastinal and hilar contours are stable. Bibasilar interstitial opacities are re- demonstrated, compatible with chronic interstitial lung disease. No large pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities. IMPRESSION: Low lung volumes with bibasilar interstitial opacities compatible with chronic interstitial lung disease.
10065767-RR-30
10,065,767
20,620,437
RR
30
2122-01-16 16:20:00
2122-01-16 21:05:00
CHEST RADIOGRAPH PERFORMED ON ___ COMPARISON: Comparison made with a prior study from ___. CLINICAL HISTORY: ___ man with tachycardia and hypoxia, assess for pneumonia or cause of shortness of breath. FINDINGS: AP upright portable chest radiograph obtained. An AICD device is unchanged with lead tips extending to the right atrium and right ventricular regions. The heart remains mildly enlarged. While the lung volumes are low, the lungs appear grossly clear without large consolidation, effusion, or pneumothorax. Bony structures are intact. IMPRESSION: Limited, negative.
10065767-RR-31
10,065,767
20,620,437
RR
31
2122-01-16 18:03:00
2122-01-16 21:13:00
CHEST RADIOGRAPH PERFORMED ON ___. Comparison with prior exam from earlier today. CLINICAL HISTORY: Right IJ central venous catheter placement, assess line position. FINDINGS: Portable AP upright chest radiograph obtained. There has been interval placement of a right IJ central venous catheter with its tip residing in the mid SVC. No pneumothorax is seen. Otherwise, no change.
10065767-RR-32
10,065,767
20,620,437
RR
32
2122-01-17 03:43:00
2122-01-17 10:25:00
INDICATION: ___ male with a history of interstitial lung disease who presents for evaluation of pneumonia. COMPARISON: Chest radiographs from ___, ___ and ___. CT from ___. TECHNIQUE: Single AP portable chest radiograph. FINDINGS: There are no new focal opacities. The extent of peribronchial ground glass infiltration seen on the CT from ___ is not expected to be seen on the radiograph. There is a small stable left pleural effusion. There is no pneumothorax. The right-sided IJL ends in the mid SVC. The left sided pacemaker and AICD leads end in the right atrium and right ventricle respectively. Mildly cardiomegaly is stable. The hilar and mediastinal contours are otherwise normal. IMPRESSION: No acute interval changes to suggest pneumonia.
10065767-RR-33
10,065,767
20,620,437
RR
33
2122-01-21 09:40:00
2122-01-21 10:15:00
PA AND LATERAL VIEWS OF THE CHEST REASON FOR EXAM: Fever, cough, ILD. Comparison is made with prior study ___ chest x-ray and CT ___. Mild-to-moderate cardiomegaly is unchanged. Pacemaker leads are in standard position. Right IJ catheter tip is in the lower SVC. Interstitial opacities in the mid and lower lungs, larger on the right side, consistent with patient's known interstitial lung disease is unchanged. There are no new lung lesions, pneumothorax or pleural effusion. There are mild-to-moderate degenerative changes in the thoracic spine.
10065767-RR-34
10,065,767
20,620,437
RR
34
2122-01-23 17:57:00
2122-01-24 09:04:00
EXAM: CT TORSO WITH CONTRAST CLINICAL INDICATION: History of ischemic cardiomyopathy, interstitial lung disease, vasculitis, Sjo___ syndrome, admitted for shortness of breath and transient hypotension, now with persistent diarrhea, question mycobacterial pneumonia or colitis. COMPARISON: ___ CT chest, CT abdomen and pelvis ___. TECHNIQUE: Helical CTA single phase acquisition through the chest, abdomen and pelvis following uneventful administration of 130 mL of Omnipaque IV contrast. Coronal and sagittal reformats provided by technologist. DLP: 972 mGy-cm. FINDINGS: No lower cervical adenopathy. Normal appearance of the visualized thyroid gland. No mediastinal adenopathy by CT size criteria. There is mild left ventricular enlargement. Multiple coronary stents are noted as well as cardiac pacer wires. Central airways and pulmonary arteries are patent. Ascending aorta is borderline enlarged measuring 3.9 cm, pulmonary trunk is also borderline enlarged measuring 3.3 cm on today's exam. Lungs demonstrate bilateral lower lobe bronchiectasis with areas of heterogeneous density and ground-glass opacity involving primarily the lower lobes consistent with history of interstitial lung disease. No evidence of focal consolidation or pneumothorax. No focal liver lesions or evidence of intrahepatic biliary dilatation. Normal appearance of the gallbladder and common bile duct, pancreas, spleen, adrenals and right kidney. Left kidney demonstrates stable subcentimeter hypodensities which are too small to characterize but likely represent simple cysts. Small and large bowel are unobstructed. There is no evidence of focal wall thickening or diffuse colitis. Undigested pills are noted within the cecum. Aorta and major branches are normal in caliber without evidence of aneurysm or dissection. No acute or suspicious osseous abnormality. Degenerative changes of the lower lumbar spine and sacroiliac joints are noted. IMPRESSION: 1. No acute abnormality to explain diarrhea. No evidence of acute infection. 2. Fibrotic interstitial lung disease involving primarily the lower lobe, unchanged from comparison. 3. Cardiomegaly and borderline enlargement of both the ascending aorta and pulmonary trunk.
10065997-RR-46
10,065,997
25,252,424
RR
46
2205-11-28 18:55:00
2205-11-28 20:02:00
EXAMINATION: FOOT AP,LAT AND OBL RIGHT INDICATION: ___ year old woman with blister on R second toe with purulence// please eval for osteo TECHNIQUE: Non-weightbearing frontal, oblique, and lateral view radiographs of COMPARISON: None. FINDINGS: No acute fractures or dislocation are seen. There are no erosions. A small plantar calcaneal spur is noted. IMPRESSION: No radiographic evidence of osteomyelitis.
10065997-RR-47
10,065,997
25,252,424
RR
47
2205-11-28 18:55:00
2205-11-28 20:14:00
EXAMINATION: CHEST (PA AND LAT) INDICATION: ___ with necrotic foot, CXR for preop// please eval pna TECHNIQUE: Chest PA and lateral COMPARISON: Chest radiographs from ___. FINDINGS: The cardiomediastinal and hilar contours are normal. Lungs are clear. There is no evidence of pulmonary edema, pleural effusion, or pneumothorax. No acute osseous abnormalities. IMPRESSION: No acute cardiopulmonary process.
10065997-RR-48
10,065,997
25,252,424
RR
48
2205-11-29 09:37:00
2205-11-29 11:11:00
EXAMINATION: FOOT AP,LAT AND OBL RIGHT INDICATION: ___ year old woman s/p right second toe debridement and arthroplasty// eval post op IMPRESSION: In comparison with study of ___, there has been resection of bone about the PIP joint of the second digit. Further information can be gathered from the operative report.
10066039-RR-10
10,066,039
24,763,357
RR
10
2189-10-19 01:23:00
2189-10-19 05:01:00
EXAMINATION: CT C-SPINE W/O CONTRAST INDICATION: History: ___ with unwitnessed fall, not beared weight, // evaluate for acute injury TECHNIQUE: Contiguous axial images obtained through the cervical spine without intravenous contrast. Coronal and sagittal reformats were reviewed. DOSE: Acquisition sequence: 1) CT Localizer Radiograph 2) CT Localizer Radiograph 3) Spiral Acquisition 5.3 s, 20.6 cm; CTDIvol = 37.0 mGy (Body) DLP = 761.1 mGy-cm. Total DLP (Body) = 761 mGy-cm. COMPARISON: None available. FINDINGS: Alignment is normal. No fractures are identified.There is no significant canal narrowing.There is no prevertebral edema. There are mild changes of degenerative disk disease without spinal canal or neural foraminal encroachment. There is diffuse osteopenia suggesting osteoporosis. The thyroid and included lung apices are unremarkable. IMPRESSION: No evidence of fracture or malalignment. Mild degenerative disc disease without canal or foraminal encroachment
10066039-RR-11
10,066,039
24,763,357
RR
11
2189-10-19 01:37:00
2189-10-19 10:39:00
EXAMINATION: DX PELVIS AND HIP UNILATERAL INDICATION: History: ___ with unwitnessed fall, not beared weight, // evaluate for acute injury TECHNIQUE: Frontal view of the pelvis, frontal view of the right hip, and a cross-table lateral view of the right hip COMPARISON: None available FINDINGS: Evaluation is limited by overlying soft tissues. No fracture or dislocation is seen. There is significant femoroacetabular joint space narrowing bilaterally, right greater than left. Evaluation of the sacrum is somewhat limited by overlying bowel gas. No radiopaque foreign body seen. IMPRESSION: Limited evaluation for fracture. If there is suspicion for fracture, cross-sectional imaging should be performed. NOTIFICATION: Findings conveyed to the ___ QA nurse.
10066039-RR-12
10,066,039
24,763,357
RR
12
2189-10-19 01:37:00
2189-10-19 10:43:00
EXAMINATION: KNEE (AP, LAT AND OBLIQUE) RIGHT INDICATION: History: ___ with unwitnessed fall, not beared weight TECHNIQUE: Frontal, oblique, and lateral views COMPARISON: None available FINDINGS: No fracture or dislocation is detected. There is narrowing in the medial compartment. Chondrocalcinosis is most prominent in the lateral compartment. No suspicious lytic or sclerotic lesion is identified. No joint effusion is seen. Vascular calcifications are seen. No radio-opaque foreign body is detected. The bones are demineralized. IMPRESSION: No fracture.
10066039-RR-13
10,066,039
24,763,357
RR
13
2189-10-19 02:53:00
2189-10-19 10:59:00
EXAMINATION: SHOULDER 1 VIEW RIGHT INDICATION: ___ year old woman with ?shoulder dislocation // please get axillary view for ?dislocation TECHNIQUE: Axillary view COMPARISON: Outside shoulder radiographs ___ FINDINGS: The axillary view is technically limited. There is anterior glenohumeral dislocation. IMPRESSION: Anterior glenohumeral dislocation. Fractures are better evaluated on subsequent CT shoulder.
10066039-RR-15
10,066,039
24,763,357
RR
15
2189-10-19 08:54:00
2189-10-19 10:09:00
EXAMINATION: CT right upper extremity INDICATION: ___ year old woman with shoulder dislocation s/p reduction, too unstable for manipulation in X-ray // evaluate for reduction of shoulder dislocation COMPARISON: None available FINDINGS: There is a fracture through the base of the coracoid process which is displaced anteriorly by approximately 1.6 cm. There is also transverse fracture through the acromion with mild distraction and minimal anterior displacement of the distal fragment segment (02:13). There is a large effusion involving at least the subacromial and the subcoracoid bursa. The humeral head appears to be mildly anteriorly subluxed at the glenohumeral joint. There are multiple punctate and linear calcifications around the humeral head anteroinferiorly which most likely represents chondrocalcinosis but small avulsion fracture fragments from the glenoid are possible. Degenerative changes are noted at the glenohumeral joint, with subchondral sclerosis, subchondral cystic change, and significant joint space narrowing. There are small osteophytes at the acromioclavicular joint. Minimal basilar atelectasis in the visualized portions of the right lung. There is diffuse osteopenia of the cervical vertebral bodies with large osteophytes. There is a 1.1 cm left thyroid hypodense nodule (03:18) IMPRESSION: 1. Minimally displaced right acromion fracture. 2. Fracture through the base of the coracoid process with 1.6 cm of anterior distraction of the bony fragment segment. 3. Mild anterior subluxation of the humeral head at the glenohumeral joint without frank dislocation. 4. Large subacromial and subcoracoid joint effusion.
10066039-RR-17
10,066,039
24,763,357
RR
17
2189-10-20 00:21:00
2189-10-20 01:01:00
EXAMINATION: ED CODE STROKE ONLY CT INDICATION: History: ___ with new delirum, left eye droop // Eval for ICH TECHNIQUE: Contiguous axial images from skullbase to vertex were obtained without intravenous contrast. Multiple acquisitions were required due to significant patient agitation. In addition because of this, CTA could not be performed. Coronal and sagittal reformations and bone algorithms reconstructions were performed. DOSE: Total DLP 5131.86 mGy-cm COMPARISON: CT head ___ FINDINGS: There is no evidence of acute territorial infarction, hemorrhage, edema, or large mass effect. Asymmetric hypodensity of the left pons is noted, which may be secondary to artifact at the skullbase. Prominence of the ventricles and sulci is is within the range of normal for age. Carotid siphon calcifications are seen bilaterally. No fracture seen. The left sphenoid sinus is completely opacified with wall sclerosis indicating chronicity. The paranasal sinuses, mastoid air cells, and middle ear cavities are otherwise clear. The orbits are unremarkable. IMPRESSION: 1. No definitive acute intracranial abnormality on noncontrast head CT. There is no intracranial hemorrhage. 2. Nonspecific asymmetric hypodensity of the left pons is slightly more prominent on the current exam, which may be secondary to artifact. If there no contraindications, MRI would be more sensitive for acute infarcts.
10066039-RR-19
10,066,039
24,763,357
RR
19
2189-10-20 13:40:00
2189-10-20 16:23:00
INDICATION: ___ year old woman with h/o HTN here s/p fall and humeral fracture with an episode of O2 sat to high 70's, recovered after nebs // evidence of infiltrate or consolidation? COMPARISON: No prior FINDINGS: The lung volumes are low. Mild pulmonary vascular congestion with widening of right upper mediastinal vessels, no overt pulmonary edema. Small left pleural effusion. Moderate cardiomegaly. No pneumothorax. IMPRESSION: Mild pulmonary vascular congestion and small left effusion.
10066039-RR-9
10,066,039
24,763,357
RR
9
2189-10-19 01:23:00
2189-10-19 04:56:00
EXAMINATION: CT HEAD W/O CONTRAST INDICATION: History: ___ with unwitnessed fall, not beared weight, // evaluate for acute injury 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) CT Localizer Radiograph 2) CT Localizer Radiograph 3) Sequenced Acquisition 16.0 s, 17.1 cm; CTDIvol = 46.8 mGy (Head) DLP = 802.7 mGy-cm. Total DLP (Head) = 803 mGy-cm. COMPARISON: None available. FINDINGS: There is no evidence of infarction, hemorrhage, edema, or large mass. Prominence of the ventricles and sulci is well within the range of normal for age. Carotid siphon calcifications are seen bilaterally. No fracture seen. The left sphenoid sinus is completely opacified with wall sclerosis indicating chronicity. The paranasal sinuses, mastoid air cells, and middle ear cavities are otherwise clear. The orbits are unremarkable. IMPRESSION: No evidence of fracture, hemorrhage or infarction. Chronic opacification of the left sphenoid sinus.
10066149-RR-10
10,066,149
20,842,875
RR
10
2137-12-31 04:23:00
2137-12-31 08:02:00
EXAMINATION: TRAUMA #3 (PORT CHEST ONLY) INDICATION: ___ year old man with trauma ___ MVC// traumatic injury TECHNIQUE: Single frontal view of the chest COMPARISON: CT torso performed on same day on ___ FINDINGS: Cardiac size is normal. The lungs are clear. No pleural effusion. A tiny right pneumothorax seen on CT chest is not visualized on radiograph. No displaced rib fractures. IMPRESSION: Tiny right pneumothorax seen on CT chest is not visualized on radiograph.