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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.
|
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