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10074908-RR-58 | 10,074,908 | 29,170,411 | RR | 58 | 2165-01-13 07:11:00 | 2165-01-13 08:59:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman found down on the floor with unclear history
// Please evaluate for any intrathoracic process, rib fracture Please
evaluate for any intrathoracic process, rib fracture
IMPRESSION:
In comparison with the study ___, the endotracheal and nasogastric
tubes have been removed. There are lower lung volumes, but no evidence of
acute pneumonia, vascular congestion, or pleural effusion.
Ventriculoperitoneal shunt is unchanged.
Single frontal view shows old healed rib fractures on the left without
definite acute fracture or pneumothorax.
|
10074908-RR-59 | 10,074,908 | 29,170,411 | RR | 59 | 2165-01-13 08:09:00 | 2165-01-13 08:43:00 | EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ year old woman found down on the floor; poor historian at
baseline, evaluate for acute intracranial bleed appear
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast. Coronal and sagittal reformations as well as bone algorithm
reconstructions were provided and reviewed.
DOSE: Total DLP = 1092 mGy-cm.
CTDIvol: 100mGy
COMPARISON: Head CT ___.
FINDINGS:
There is no evidence of infarction, hemorrhage, edema, or mass. Dilatation of
the lateral and third ventricles is unchanged from multiple prior studies with
a right frontal ventriculoperitoneal shunt in unchanged position.
There is no evidence of fracture. A large calcified extra-axial mass in the
right posterior fossa table is unchanged from multiple prior studies,
consistent with a meningioma. Aside from mild mucosal thickening of the
maxillary sinuses and anterior ethmoidal air cells, the visualized portion of
the paranasal sinuses, mastoid air cells, and middle ear cavities are clear.
A tiny right anterior ethmoidal air cell osteoma is incidentally noted (4 kg:
25). The visualized portion of the orbits are unremarkable.
IMPRESSION:
1. No evidence of fracture, hemorrhage or infarction.
2. Unchanged ventricular size and configuration status post right frontal
approach ventriculoperitoneal shunt placement.
|
10075053-RR-10 | 10,075,053 | 26,259,455 | RR | 10 | 2177-06-20 11:26:00 | 2177-06-20 15:11:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old man, unrestrained passenger, +EtOH, rollover//
Interval change, asp vs. pulm contusion
TECHNIQUE: Chest PA and lateral
COMPARISON: None
FINDINGS:
Cardiomediastinal silhouette is stable, within normal limits. No evidence of
focal consolidation, pneumothorax or pleural effusion. No osseous or upper
abdominal abnormality is noted.
IMPRESSION:
No evidence of aspiration or pulmonary contusion at this time.
|
10075053-RR-11 | 10,075,053 | 26,259,455 | RR | 11 | 2177-06-20 19:40:00 | 2177-06-20 20:46:00 | EXAMINATION: WRIST(3 + VIEWS) BILATERAL
INDICATION: ___ yo male, unrestrained passenger in roll, now with increased
pain in R wrist, edema noted.// ?fracture
TECHNIQUE: Frontal, oblique, and lateral view radiographs of bilateral
wrists.
COMPARISON: None.
FINDINGS:
RIGHT WRIST:
There is a mildly displaced fracture through the ulnar styloid. Deformity of
the fourth metacarpal most likely represents a healed fracture. There are no
significant degenerative changes. Carpal bones are well aligned.
Mineralization is normal. There are no erosions. Diffuse soft tissue
swelling is seen around the wrist. There is an intravenous line along the
dorsal aspect of the wrist.
LEFT WRIST:
No acute fractures or dislocation are seen. Deformity of the fourth
metacarpal most likely represents a healed fractures. There are no
significant degenerative changes. Carpal bones are well aligned.
Mineralization is normal. There are no erosions.
IMPRESSION:
1. Mildly displaced fracture through the right ulnar styloid.
2. Healed fractures of the bilateral fourth metacarpals.
|
10075053-RR-12 | 10,075,053 | 26,259,455 | RR | 12 | 2177-06-21 11:46:00 | 2177-06-21 14:17:00 | EXAMINATION: ELBOW, AP AND LAT VIEWS RIGHT
INDICATION: ___ yo male, urestrained passenger in rollover MVC, w/ right ulnar
styloid fx// Eval for fx Eval for fx
IMPRESSION:
No comparison. Two views of the right elbow are provided. The soft tissues
are unremarkable. No evidence of luxation or cortical disruptions indicative
of fracture.
|
10075053-RR-13 | 10,075,053 | 26,259,455 | RR | 13 | 2177-06-21 11:46:00 | 2177-06-21 14:17:00 | EXAMINATION: HAND (PA,LAT AND OBLIQUE) RIGHT
INDICATION: ___ yo male, urestrained passenger in rollover MVC, w/ right ulnar
styloid fx// Eval for fx Eval for fx
IMPRESSION:
No comparison. 4 views of the right hand are provided. There is a known and
previously documented fracture of the styloid process. No abnormalities of
the soft tissues. No luxation or subluxation. The cortical structures are
intact. No evidence of fracture.
|
10075053-RR-14 | 10,075,053 | 26,259,455 | RR | 14 | 2177-06-21 11:46:00 | 2177-06-21 14:18:00 | EXAMINATION: ANKLE (AP, MORTISE AND LAT) RIGHT
INDICATION: ___ yo male, urestrained passenger in rollover MVC, w/ right ankle
pain// Eval for fx Eval for fx
IMPRESSION:
No comparison. Three views of the right ankle are provided. The soft tissues
are unremarkable. No luxation of subluxation. No cortical disruptions
indicative of fracture.
|
10075053-RR-3 | 10,075,053 | 26,259,455 | RR | 3 | 2177-06-20 02:27:00 | 2177-06-20 03:29:00 | EXAMINATION: TRAUMA #2 (AP CXR AND PELVIS PORT)
INDICATION: History: ___ unrestrained MVC trauma *** WARNING *** Multiple
patients with same last name!// History: ___ unrestrained MVC trauma
TECHNIQUE: Portable AP chest
COMPARISON: Same day CT torso
FINDINGS:
Multiple bilateral, predominantly upper lobe, parenchymal opacities are better
assessed on same day CT chest, compatible with pulmonary contusions. No
pleural effusion or pneumothorax. The cardiomediastinal silhouette is within
normal limits. A paper clip is seen overlying the mediastinum is likely
external to the patient.
IMPRESSION:
Ill-defined bilateral predominantly upper lobe pulmonary opacities are better
assessed on same day CT chest, compatible with pulmonary contusions.
|
10075053-RR-4 | 10,075,053 | 26,259,455 | RR | 4 | 2177-06-20 02:28:00 | 2177-06-20 03:26:00 | EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: History: ___ with MVC, multiple roll over*** WARNING *** Multiple
patients with same last name!// eval for fx, bleed
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast. Coronal and sagittal reformations as well as bone algorithm
reconstructions were provided and reviewed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 18.0 s, 18.3 cm; CTDIvol = 49.5 mGy (Head) DLP =
903.1 mGy-cm.
Total DLP (Head) = 903 mGy-cm.
COMPARISON: None.
FINDINGS:
There is no evidence of infarction, hemorrhage, edema, or mass. The
ventricles and sulci are normal in size and configuration.
There is no evidence of a calvarial fracture. Maxillofacial findings will be
reported separately.
IMPRESSION:
1. No acute intracranial process.
2. Maxillofacial findings will be separately reported.
|
10075053-RR-5 | 10,075,053 | 26,259,455 | RR | 5 | 2177-06-20 02:29:00 | 2177-06-20 02:55:00 | EXAMINATION: CT C-SPINE W/O CONTRAST Q311 CT SPINE
INDICATION: History: ___ with MVC, multiple roll over*** WARNING *** Multiple
patients with same last name!// eval for fx, bleed eval for fx, bleed
TECHNIQUE: Non-contrast helical multidetector CT was performed. Soft tissue
and bone algorithm images were generated. Coronal and sagittal reformations
were then constructed.
DOSE: Acquisition sequence:
1) Spiral Acquisition 6.6 s, 25.8 cm; CTDIvol = 23.2 mGy (Body) DLP = 597.6
mGy-cm.
Total DLP (Body) = 598 mGy-cm.
COMPARISON: None.
FINDINGS:
Alignment is normal. No fractures are identified. No significant degenerative
changes are demonstrated. No evidence of severe spinal canal or neural
foraminal stenosis. There is no prevertebral soft tissue swelling. The
visualized thyroid and lung apices are unremarkable.
IMPRESSION:
No evidence of traumatic cervical malalignment or acute fracture.
|
10075053-RR-6 | 10,075,053 | 26,259,455 | RR | 6 | 2177-06-20 02:29:00 | 2177-06-20 03:03:00 | EXAMINATION: CT SINUS/MANDIBLE/MAXILLOFACIAL W/O CONTRAST Q116 CT HEADSINUS
INDICATION: ___ year old man with facial trauma. s/p MVC// ? eval for fx
TECHNIQUE: Helically-acquired multidetector CT axial images were obtained
through the maxillofacial bones and mandible. Intravenous contrast was not
administered. Axial images reconstructed with soft tissue and bone algorithm
to display images with 1.25 mm slice. Coronal and sagittal reformations were
also constructed. All produced images were evaluated in production of this
report.
DOSE: Acquisition sequence:
1) Spiral Acquisition 2.9 s, 22.8 cm; CTDIvol = 25.9 mGy (Head) DLP = 590.5
mGy-cm.
Total DLP (Head) = 590 mGy-cm.
COMPARISON: None.
FINDINGS:
No fractures are identified.
There is no evidence of facial swelling.
There is trace mucosal thickening of the ethmoid air cells, left maxillary
sinus, and left sphenoid sinus. The remainder of the paranasal sinuses are
clear.
There is no evidence of abnormal fluid collections.
Bilateral mastoids air cells and middle ear cavities appear normal.
The globes, extraocular muscles, optic nerves, and retrobulbar fat appear
normal.
The visualized upper aerodigestive tract appears normal.
The mandible and temporomandibular joints appear normal.
IMPRESSION:
No fractures identified.
|
10075053-RR-7 | 10,075,053 | 26,259,455 | RR | 7 | 2177-06-20 02:30:00 | 2177-06-20 03:21:00 | EXAMINATION: CT chest, abdomen, and pelvis.
INDICATION: History: ___ with MVC, multiple roll over*** WARNING *** Multiple
patients with same last name!// eval for fx, bleed
TECHNIQUE: MDCT axial images were acquired through the chest, 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) Spiral Acquisition 9.1 s, 71.3 cm; CTDIvol = 22.7 mGy (Body) DLP =
1,618.3 mGy-cm.
Total DLP (Body) = 1,618 mGy-cm.
COMPARISON: None.
FINDINGS:
CHEST:
HEART AND VASCULATURE: The thoracic aorta is normal in caliber without
evidence of acute injury. The heart, pericardium, and great vessels are
within normal limits. No pericardial effusion is seen.
AXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar
lymphadenopathy is present. No mediastinal mass or hematoma.
PLEURAL SPACES: No pleural effusion or pneumothorax.
LUNGS/AIRWAYS: Multiple areas of patchy ground-glass opacification seen the
bilateral upper lobes, and to a lesser degree in the bilateral lower lobes,
may reflect pulmonary contusion in the setting of trauma. The airways are
patent to the level of the segmental bronchi bilaterally.
BASE OF NECK: Visualized portions of the base of the neck show no abnormality.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There is no evidence of focal lesion or laceration. 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 lesion or laceration.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
There is no evidence of focal renal lesions or hydronephrosis. There is no
perinephric abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. The colon and
rectum are within normal limits. The appendix is normal. There is no
evidence of mesenteric injury.
There is no free fluid or free air in the abdomen.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: The prostate and seminal vesicles are unremarkable.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm or retroperitoneal hematoma.
No atherosclerotic disease is noted.
BONES: 6 mm of anterolisthesis L4 on L5 with associated bilateral pars defects
is chronic appearing. There are chronic appearing bilateral transverse
process fractures of the L1 vertebra. There is no acute fracture. No focal
suspicious osseous abnormality.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. Patchy areas of ground-glass opacification in the bilateral upper lobes and
to a lesser degree bilateral lower lobes may reflect pulmonary
contusion/alveolar hemorrhage in the setting of trauma.
2. No evidence of acute fracture.
3. 6 mm of anterolisthesis of L4 on L5 with associated bilateral pars defects.
4. Otherwise, no evidence of acute injury in the abdomen or pelvis.
|
10075053-RR-8 | 10,075,053 | 26,259,455 | RR | 8 | 2177-06-20 02:43:00 | 2177-06-20 03:40:00 | EXAMINATION: KNEE (AP, LAT AND OBLIQUE) BILATERAL
INDICATION: History: ___ unrestrained MVC trauma *** WARNING *** Multiple
patients with same last name!// History: ___ unrestrained MVC trauma
TECHNIQUE: AP, lateral, oblique views of the bilateral knees are provided.
COMPARISON: None.
FINDINGS:
No fracture or dislocation is seen. There are no significant degenerative
changes. There is no knee joint effusion. There is normal osseous
mineralization. No suspicious lytic or sclerotic lesions are identified.
IMPRESSION:
Normal bilateral knee radiographs.
|
10075053-RR-9 | 10,075,053 | 26,259,455 | RR | 9 | 2177-06-20 02:44:00 | 2177-06-20 03:39:00 | EXAMINATION: TIB/FIB (AP AND LAT) LEFT
INDICATION: History: ___ unrestrained MVC trauma *** WARNING *** Multiple
patients with same last name!// History: ___ unrestrained MVC trauma
TECHNIQUE: Frontal and lateral view radiographs of the left tibia and fibula.
COMPARISON: None.
FINDINGS:
No fracture is detected in the tibia or fibula. No suspicious lytic lesion,
sclerotic lesion, or periosteal new bone formation is detected. No soft tissue
calcification or radio-opaque foreign bodies are detected. Limited assessment
of the knee and ankle joint is unremarkable.
IMPRESSION:
No fracture.
|
10075925-RR-35 | 10,075,925 | 24,184,489 | RR | 35 | 2132-12-22 06:54:00 | 2132-12-22 07:47:00 | EXAMINATION: Chest radiograph
INDICATION: History: ___ with h/o chf p/w dyspnea// ?edema or pneumonia
TECHNIQUE: Portable semi upright view of the chest
COMPARISON: Chest radiograph from ___
FINDINGS:
Lung volumes appear low with moderate pulmonary edema. Cardiac size is
enlarged and accentuated by low lung volumes. Retrocardiac opacities may
represent atelectasis, however, superimposed pneumonia cannot be excluded in
the appropriate clinical setting. No pneumothorax. Small bilateral effusions
are probable.
IMPRESSION:
Hypoinflated lungs with moderate pulmonary edema and probable small bilateral
pleural effusions. Retrocardiac opacities may represent atelectasis, however,
superimposed pneumonia cannot be excluded in the appropriate clinical setting.
|
10075925-RR-36 | 10,075,925 | 24,184,489 | RR | 36 | 2132-12-23 05:13:00 | 2132-12-23 10:14:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with respiratory failure// interval changes
IMPRESSION:
In comparison with study of ___, there again are low lung volumes with
substantial enlargement of the cardiac silhouette and moderate pulmonary
edema. Increased opacity at the right base with silhouetting of the
hemidiaphragm is consistent with pleural effusion and volume loss in the left
lower lobe. The left hemidiaphragm is better seen, suggesting some
improvement in atelectatic changes and pleural effusion.
In the appropriate clinical setting, it would be impossible to exclude
superimposed pneumonia/aspiration, given the findings described above in the
absence of a lateral view.
|
10075925-RR-38 | 10,075,925 | 21,574,077 | RR | 38 | 2133-03-25 18:41:00 | 2133-03-25 18:59:00 | EXAMINATION: Chest radiograph
INDICATION: History: ___ with cough, hypoxia// Evaluate for pneumonia
TECHNIQUE: Chest PA and lateral
COMPARISON: Summer ___ and ___.
FINDINGS:
There is severe cardiomegaly with pulmonary vascular congestion and moderate
interstitial edema and a trace right-sided effusion. There is no
pneumothorax. Superimposed consolidation would be difficult to exclude given
the presence of edema. There is no pneumothorax. There is no acute osseous
abnormality.
IMPRESSION:
Severe cardiomegaly with vascular congestion and moderate interstitial edema
and a trace right-sided effusion. Superimposed infection would be difficult
to exclude in the appropriate clinical context.
|
10075925-RR-39 | 10,075,925 | 21,574,077 | RR | 39 | 2133-03-26 12:26:00 | 2133-03-26 16:21:00 | INDICATION: ___ year old woman with acute on chronic CHF.// eval improvement
after diuresis, any opacity suggestive of infection
COMPARISON: Radiographs from ___
IMPRESSION:
Cardiac silhouette is enlarged. There is again seen diffuse interstitial
opacities bilaterally. There is worsening of opacities at the right base.
Again, findings can be seen with pulmonary edema; however, given the diuresis,
infection should also be considered.
|
10075925-RR-40 | 10,075,925 | 21,574,077 | RR | 40 | 2133-03-27 03:37:00 | 2133-03-27 09:13:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with acute on chronic CHF.// eval lung
parenchyma and effusions eval lung parenchyma and effusions
IMPRESSION:
Compared to chest radiographs since ___ most recently ___ and one ___.
Mild to moderate pulmonary edema has improved since ___, particularly at
the base of the right lung. Small pleural effusions, moderate cardiomegaly
and dilatation of the pulmonary arteries have improved as well. No
pneumothorax.
Indentation of the trachea from the left at the thoracic inlet is
long-standing, usually due to an enlarged thyroid. Clinical evaluation
recommended.
|
10075925-RR-68 | 10,075,925 | 25,211,602 | RR | 68 | 2133-11-14 06:51:00 | 2133-11-14 07:50:00 | EXAMINATION: CR - HUMERUS (AP ) RIGHT
INDICATION: ___ with R arm pain// ? fx
TECHNIQUE: AP view of the right humerus.
COMPARISON: None
FINDINGS:
There is an oblique fracture through the midshaft of the right humerus with
lateral displacement and apparent apex dorsal angulation of the distal
fracture fragment. Evaluation of alignment is limited on this single
projection. There is prominent surrounding soft tissue swelling. Limited
view of the elbow joint is unremarkable. There is no definite displaced rib
fracture in the right chest cage on limited assessment.
IMPRESSION:
Oblique fracture through the midshaft of the right humerus with displacement
and probable angulation as described.
|
10075925-RR-69 | 10,075,925 | 25,211,602 | RR | 69 | 2133-11-14 06:41:00 | 2133-11-14 07:04:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ with chest pain, dyspnea// ? pneumo ? rib fx
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest radiograph ___. Chest CT ___
FINDINGS:
There is a large right mid-lung field opacity which appears larger and more
confluent in comparison to the radiograph dated ___ but is
compatible with the right upper lobe and hilar soft tissue mass seen on the
chest CT dated ___. No displaced rib fractures are seen. Lung
volumes are low. There is likely a large pericardial effusion as well as
bilateral pleural effusions and mild pulmonary edema.
IMPRESSION:
1. Large right mid-lung field opacity, larger more confluent in comparison to
___. While this opacity is compatible with the right upper lobe
soft tissue mass seen in the chest CT ___, it is difficult to
exclude superimposed infectious or even posttraumatic process given the
history of fall. No displaced rib fractures are seen.
2. Large pericardial effusion and bilateral pleural effusions.
|
10075925-RR-70 | 10,075,925 | 25,211,602 | RR | 70 | 2133-11-14 10:09:00 | 2133-11-14 12:17:00 | INDICATION: ___ year old woman with humeral shaft fx// post-splint
TECHNIQUE: Two views of the right humerus
COMPARISON: Earlier today, ___ at 06:44
FINDINGS:
Overlying cast/splint obscures fine bony detail. Given this, fracture of the
midshaft of the humerus is again seen, with interval decrease in angulation
since the prior study.
|
10076144-RR-66 | 10,076,144 | 24,347,474 | RR | 66 | 2203-07-02 12:38:00 | 2203-07-02 14:00:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ with cough and DOE// cough and DOE
TECHNIQUE: Chest PA and lateral
COMPARISON: CT chest ___, chest radiograph ___
FINDINGS:
Heart size is normal. The mediastinal and hilar contours are normal. The
pulmonary vasculature is normal. Lungs are clear. No pleural effusion or
pneumothorax is seen. There are no acute osseous abnormalities.
IMPRESSION:
No acute cardiopulmonary process.
|
10076144-RR-67 | 10,076,144 | 24,347,474 | RR | 67 | 2203-07-04 17:05:00 | 2203-07-04 18:16:00 | INDICATION: ___ year old man presenting with COPD exacerbation now with
increased SOB// ? pulmonary edema vs pneumonia
TECHNIQUE: AP portable chest radiograph
COMPARISON: ___
IMPRESSION:
New consolidation in the right lower lobe may reflect atelectasis and/or
pneumonia. Another fairly rounded opacity in the right midlung may reflect
the costochondral junction of the right fourth rib however an underlying
consolidation cannot entirely be excluded. There is no pleural effusion or
pneumothorax. The size of the cardiac silhouette is within normal limits.
|
10076144-RR-68 | 10,076,144 | 24,347,474 | RR | 68 | 2203-07-06 20:30:00 | 2203-07-06 21:02:00 | EXAMINATION: ABDOMEN US (COMPLETE STUDY)
INDICATION: ___ year old man with ascites on exam// eval for ascites and
hepatic echotexture
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: CT scan of the abdomen 520 16. CT scan of the abdomen ___.
FINDINGS:
LIVER: Patient is status post left hepatectomy. The contour of the liver is
smooth. There is no focal liver mass. The main portal vein is patent with
hepatopetal flow. There is no ascites.
BILE DUCTS: There is no intrahepatic biliary dilation. The CHD measures 3 mm.
GALLBLADDER: There is no evidence of stones. The gallbladder is not distended
however there is no gross evidence of gallbladder wall thickening. There is
no pericholecystic fluid. The ultrasonographer reports a negative sonographic
___ sign.
PANCREAS: The imaged portion of the pancreas appears within normal limits,
without masses or pancreatic ductal dilation, with portions of the pancreatic
tail obscured by overlying bowel gas.
SPLEEN: Normal echogenicity, measuring 7.8 cm.
KIDNEYS: The right kidney measures 8.4 cm. The left kidney measures 10.8 cm.
Normal cortical echogenicity and corticomedullary differentiation is seen
bilaterally. There is a 1.2 x 0.6 x 0.8 cm right her upper pole renal cyst.
RETROPERITONEUM: The visualized portions of aorta and IVC are within normal
limits.
IMPRESSION:
The patient 8 recently in the gallbladder is not distended however there is no
gross evidence of gallbladder wall thickening. There is no ascites.
|
10076263-RR-27 | 10,076,263 | 26,818,240 | RR | 27 | 2193-02-14 13:32:00 | 2193-02-14 13:56:00 | INDICATION: Pancreatitis. Rule out pleural effusion.
COMPARISON: Chest radiographs, ___ and ___.
FINDINGS: Upright PA and lateral radiographs of the chest. The lungs are
normally expanded and clear. The cardiomediastinal silhouette and hilar
contours are normal. There is no pleural effusion or pneumothorax.
IMPRESSION: Unremarkable radiographs of the chest.
|
10076263-RR-28 | 10,076,263 | 26,818,240 | RR | 28 | 2193-02-17 18:23:00 | 2193-02-17 19:47:00 | HISTORY: ___ female with abdominal pain and history of alcoholic
pancreatitis. Evaluate for cause of abdominal pain.
TECHNIQUE: Multi detector CT images were obtained from the lung bases to the
proximal femurs following the administration of 130 cc of Omnipaque
intravenous contrast material. Multiplanar reformatted images in coronal and
sagittal planes are provided.
DLP: 648.01 mGy-cm
COMPARISON: CT of the abdomen pelvis dated ___.
FINDINGS:
CT ABDOMEN: There has been interval collapse of left lower lobe with tubular
branching hypodensities, and surrounding pleural fluid, compatible with
inspissated secretions. In sum, this picture suggestive of mucus plugging
versus obstructive lesions which is less likely given the relative normal
appearance 3 days prior. Additionally, there is lingular scarring or
atelectasis. There are no concerning mass lesions or nodules in the lower
lungs. The visualized portion of the heart and pericardium are normal. There
is no pericardial effusion.
The liver is normal in size and homogeneous in enhancement. There is hepatic
steatosis. The portal and hepatic veins are patent and there is no intra or
extrahepatic biliary ductal dilatation. There is trace perihepatic free fluid
noted. The gallbladder is decompressed and does not contain radiopaque
gallstones. The spleen is normal in size and homogeneous in enhancement.
The pancreas is normal in size and homogeneous in enhancement. There is a
mild amount of peripancreatic stranding, without evidence of focal fluid
collections or other sequela of acute pancreatitis. There is no pancreatic
ductal dilatation.
The adrenal glands are normal in size and shape. The kidneys are normal in
size and display symmetric nephrograms and contrast excretion. The ureters
are normal in caliber along their course to the bladder. There are no mass
lesions in the kidneys. There is no perinephric abnormality is seen.
There is a small hiatal hernia. The stomach is quite distended relative to
the rest of the GI tract, which may suggest gastroparesis. The small bowel
contains contrast and does not show abnormal thickening or dilation. The
large bowel contains stool and does not show obstructive mass lesions or wall
thickening.
There are no pathologically enlarged retroperitoneal or mesenteric lymph nodes
by CT size criteria.
There is no abnormal dilatation of the abdominal aorta. The aorta and its
major branches are patent.
CT PELVIS: The bladder is under distended and demonstrates generalized wall
thickening. There is trace pelvic free fluid. An IUD is seen in place in the
uterine cavity. There is follicular activity in the bilateral ovaries, with a
1.8 cm left ovarian cyst or follicle. There are no hernias seen. There is no
pelvic sidewall or inguinal lymphadenopathy by CT size criteria.
OSSEOUS STRUCTURES: No significant abnormality in the visualized osseous
structures.
IMPRESSION:
1. Interval collapse of left lower lobe with tubular branching hypodensities,
and surrounding the pleural fluid compatible with inspissated secretions. In
sum, this picture suggestive of mucus plugging versus obstructive lesions
which is less likely given the relative normal appearance 3 days prior.
2. Mild amount of peripancreatic stranding, without evidence of focal fluid
collections or other sequela of acute pancreatitis.
3. The stomach is quite distended relative to the rest of the GI tract, which
may suggest gastroparesis. Recommend gastric emptying study for additional
evaluation.
4. Trace perihepatic and pelvic free fluid.
|
10076263-RR-29 | 10,076,263 | 26,818,240 | RR | 29 | 2193-02-19 15:26:00 | 2193-02-19 15:59:00 | PA AND LATERAL VIEWS OF THE CHEST
REASON FOR EXAM: Evaluate collapse of the left lower lobe.
Comparison is made with prior study, ___.
Cardiomediastinal contours are normal. Bibasilar opacities are a combination
of pleural effusions and atelectasis, larger on the left side. The collapse
of the left lower lobe is grossly unchanged. There is no pneumothorax. There
are low lung volumes. Residual contrast is seen in the colon.
|
10076616-RR-6 | 10,076,616 | 21,934,451 | RR | 6 | 2118-01-24 11:04:00 | 2118-01-24 11:59:00 | PORTABLE CHEST ___
COMPARISON: ___ radiograph.
FINDINGS: Widening of the upper mediastinum is shown to be due to increased
mediastinal fat (mediastinal lipomatosis) and tortuous vessels on recent neck
CT ___. Heart size is normal. Hazy opacity in left
cardiophrenic angle region probably represents an enlarged cardiac fat pad in
the setting of mediastinal lipomatosis. Adjacent linear opacity at the left
lung base favors atelectasis. Consider a standard PA and lateral chest x-ray
to exclude the possibility of a small left pleural effusion when the patient's
condition permits. Right lung and pleural surfaces are clear.
|
10076616-RR-8 | 10,076,616 | 21,934,451 | RR | 8 | 2118-01-28 10:54:00 | 2118-01-31 09:57:00 | Patient Name: ___ Date of Study: ___
MRN: ___
Date of Birth: ___ Requesting Physician: ___, MD
___: 63 Cardiology Staff: ___, MD
Gender: Male Radiology Staff: ___, MD
Technologist: ___, RT
Status: Inpatient
Complications: None.
Indication: NsVT, To look for LVOT scar , r/ out ARVC
CMR MEASUREMENTS:
Measurement Result Normal Range
* Mildly abnormal | ** Moderately abnormal | *** Severely abnormal
CMR TECHNICAL INFORMATION:
CMR FINDINGS:
ADDITIONAL INFORMATION/FINDINGS:
None.
NON-CARDIAC FINDINGS:
No Incidental findings.
IMPRESSION:
The patient was extremly uncooperative and uncomftable. He was unable to
tolerate the MRI scanner. We could not get any usable images and had to abort
the study.
No Non-cardiac Incidental findings.
Interpreted by Drs.: ___, Murilo ___,
and ___.
|
10076617-RR-57 | 10,076,617 | 26,439,893 | RR | 57 | 2164-09-28 11:15:00 | 2164-09-28 11:41:00 | INDICATION: ___ with left facial droop since yesterday at 330 ___ // eval
for ICH, CHF, pneumonia
TECHNIQUE: PA and lateral views the chest.
COMPARISON: ___.
FINDINGS:
There is a linear opacity at the left lung base potentially atelectasis versus
scarring. The lungs are otherwise clear without focal consolidation,
effusion, or edema. The cardiomediastinal silhouette is stable. No acute
osseous abnormalities.
IMPRESSION:
No acute cardiopulmonary process.
|
10076617-RR-58 | 10,076,617 | 26,439,893 | RR | 58 | 2164-09-28 14:48:00 | 2164-09-28 15:44:00 | EXAMINATION: CTA HEAD AND CTA NECK PQ147 CT HEADNECK
INDICATION: ___ with left facial droop and left arm weakness
TECHNIQUE: Contiguous MDCT axial images were obtained through the brain
without contrast material. Subsequently, helically acquired rapid axial
imaging was performed from the aortic arch through the brain during the
infusion of 70 mL of Omnipaque intravenous contrast material.
Three-dimensional angiographic volume rendered, curved reformatted and
segmented images were generated on a dedicated workstation. This report is
based on interpretation of all of these images.
DOSE: Total DLP (Head) = 2,126 mGy-cm.
COMPARISON: None.
FINDINGS:
CT HEAD WITHOUT CONTRAST:
There is no acute hemorrhage identified. No evidence of mass effect or edema.
Prominent ventricles and sulci likely reflect age related global atrophy.
There is no shift of normally midline structures. Basal cisterns are patent.
Gray-white matter differentiation is preserved. No evidence to suggest acute
large territorial infarction.
Visualized paranasal sinuses, mastoid air cells, and middle ear cavities are
clear.
CTA HEAD and Neck:
A common origin of the right brachiocephalic artery and left common carotid
artery is noted. Moderate atherosclerotic calcifications involve the carotid
siphons bilaterally. A right fetal type PCA is incidentally noted. Minimal
atherosclerotic calcifications involve the V4 segment of the right vertebral
artery. The left vertebral artery is smaller in caliber relative to the
contralateral side, the right vertebral artery dominant. Bilateral internal
carotid arteries are patent without significant narrowing or stenosis.
Bilateral carotid bulb calcifications are symmetric. Bilateral middle cerebral
arteries are patent, symmetric in caliber an arborization. Anterior and
posterior cerebral arteries are patent. No flow-limiting stenosis or aneurysm
is identified within the intra cerebral arteries.
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. No acute intracranial abnormality.
2. No flow limiting stenosis within the vessels of the head and neck.
|
10076617-RR-59 | 10,076,617 | 26,439,893 | RR | 59 | 2164-09-28 23:41:00 | 2164-09-29 17:49:00 | EXAMINATION: MR HEAD W/O CONTRAST
INDICATION: ___ year old woman with new L facial droop // ?stroke
TECHNIQUE: MR BRAIN WITHOUT IV CONTRAST
COMPARISON: None
FINDINGS:
No acute infarct, suspicious focus of intracranial hemorrhage, mass effect,
shift of normally midline structures or hydrocephalus.
There are a few small scattered T2 FLAIR hyperintense foci in the cerebral
white matter in the frontal and parietal lobes and a few in the pons,
nonspecific in appearance.
The lateral and the third ventricles are moderately dilated. Cavum septum
pellucidum et vergae noted. Prominent cerebral sulci and extra-axial CSF
spaces noted, related to diffuse parenchymal volume loss.
The major intracranial arterial flow voids are noted. The cavernous carotid
segments are tortuous in course. Venous sinuses are unremarkable.
Sella, pineal gland, craniocervical junction regions are unremarkable.
Mild to moderate ethmoidal mucosal thickening.
Sphenoid sinus septations insert on the carotid grooves.
The imaged orbits are unremarkable.
Bone marrow signal is slightly hypointense.
IMPRESSION:
No acute infarct or mass effect.
A few small scattered cerebral white matter changes, can relate to small
vessel ischemic changes, etc.
Mild to moderate diffuse parenchymal volume loss
|
10076617-RR-65 | 10,076,617 | 21,474,221 | RR | 65 | 2165-09-25 12:06:00 | 2165-09-25 12:49:00 | EXAMINATION:
Chest: Frontal and lateral views
INDICATION: History: ___ with fever, cough x1 week // R/O pneumonia
TECHNIQUE: Chest: Frontal and Lateral
COMPARISON: ___
FINDINGS:
Mild left mid to lower lung linear atelectasis/scarring is seen. No large
pleural effusion is seen. There is no pneumothorax. Moderate pulmonary edema
is re- demonstrated. No definite focal consolidation is seen. The cardiac and
mediastinal silhouettes are stable. Evidence of DISH is seen along the
thoracic spine.
IMPRESSION:
Re- demonstrated moderate pulmonary edema without definite focal
consolidation. Atypical infection is not excluded in the appropriate clinical
setting.
|
10076617-RR-66 | 10,076,617 | 21,474,221 | RR | 66 | 2165-09-26 11:14:00 | 2165-09-26 19:54:00 | EXAMINATION: KNEE (2 VIEWS) BILATERAL
INDICATION: ___ year old woman with bilateral knee pain, warmth, tenderness to
medial joint line // eval for bony abnormalities, arthritis, effusion
TECHNIQUE: Right knee two views. Left knee two views. Lateral views
obtained as cross-table lateral views. Not known whether AP views are
obtained standing. No oblique or patellar view available.
COMPARISON: Bilateral knee radiographs dated ___
FINDINGS:
RIGHT KNEE: There is diffuse osteopenia. There are moderate to moderately
severe degenerative changes , with narrowing the medial femorotibial
compartment and small tricompartmental osteophytes. Prominent patellar
enthesophytes noted superiorly and inferiorly. No obvious fracture or
dislocation is identified. Punctate calcific density along the posterior
tibia likely represents a small loose body. No bone erosion. No
chondrocalcinosis. Tiny dystrophic calcification noted in the distal thigh
laterally. No gross effusion or fat-fluid level detected.
LEFT KNEE: There is diffuse osteopenia. There is moderate to moderately
severe degenerative changes, with medial compartment medial femorotibial
compartment narrowing and tricompartmental osteophytes. Patellar spurring
also noted. No gross effusion. No lipohemarthrosis. No bone erosion or
chondrocalcinosis. Scattered vascular calcifications noted.
IMPRESSION:
Diffuse osteopenia.
Moderate to moderately severe osteoarthritis in both knees.
No obvious fracture or dislocation identified on these views.
No gross effusion detected in either knee. A small joint effusion might not
be apparent on the cross-table lateral views.
No bone erosion, periostitis, or chondrocalcinosis detected in either knee.
|
10076617-RR-68 | 10,076,617 | 25,575,063 | RR | 68 | 2167-09-05 10:56:00 | 2167-09-05 11:30:00 | EXAMINATION: UNILAT LOWER EXT VEINS RIGHT
INDICATION: History: ___ with dimer 950 swelling r leg// dvt
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the right lower extremity veins.
COMPARISON: None.
FINDINGS:
There is normal compressibility, flow, and augmentation of the right common
femoral, femoral, and popliteal veins. Normal color flow and compressibility
are demonstrated in the posterior tibial and peroneal veins.
There is normal respiratory variation in the common femoral veins bilaterally.
No evidence of medial popliteal fossa (___) cyst. There is mild
subcutaneous edema in the right calf.
IMPRESSION:
No evidence of deep venous thrombosis in the right lower extremity veins.
|
10076617-RR-69 | 10,076,617 | 25,575,063 | RR | 69 | 2167-09-05 11:01:00 | 2167-09-05 11:40:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ with dyspnea// pna? chf?
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest radiograph dated ___.
FINDINGS:
Lung volumes are low accentuating the pulmonary vasculature. There is no
focal consolidation or large pleural effusion. Streaky opacity in the left
lung base likely reflects scarring and is unchanged from prior. There is no
pneumothorax. Heart size is enlarged, but unchanged.
IMPRESSION:
Low lung volumes without focal consolidation or definite pulmonary edema.
|
10076617-RR-70 | 10,076,617 | 25,575,063 | RR | 70 | 2167-09-05 14:05:00 | 2167-09-05 16:36:00 | EXAMINATION: CTA CHEST WITH CONTRAST
INDICATION: ___ with dyspnea, leg swelling, dizziness// eval for PE
TECHNIQUE: Axial multidetector CT images were obtained through the thorax
after the uneventful administration of intravenous contrast. Reformatted
coronal, sagittal, thin slice axial images, and oblique maximal intensity
projection images were submitted to PACS and reviewed.
DOSE: Acquisition sequence:
1) Stationary Acquisition 0.5 s, 0.5 cm; CTDIvol = 3.0 mGy (Body) DLP = 1.5
mGy-cm.
2) Stationary Acquisition 0.5 s, 0.5 cm; CTDIvol = 3.0 mGy (Body) DLP = 1.5
mGy-cm.
3) Stationary Acquisition 3.0 s, 0.5 cm; CTDIvol = 18.2 mGy (Body) DLP =
9.1 mGy-cm.
4) Spiral Acquisition 3.7 s, 29.1 cm; CTDIvol = 17.0 mGy (Body) DLP = 494.8
mGy-cm.
Total DLP (Body) = 507 mGy-cm.
COMPARISON: CTA chest dated ___ and same day chest radiograph
dated ___.
FINDINGS:
HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the
subsegmental level without filling defect to indicate a pulmonary embolus. The
thoracic aorta is normal in caliber without evidence of dissection or
intramural hematoma. The heart, pericardium, and great vessels are within
normal limits. No pericardial effusion is seen.
AXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar
lymphadenopathy is present. Prominent mediastinal lymph nodes are not
enlarged by CT size criteria and are likely reactive. There is no mediastinal
mass.
PLEURAL SPACES: No pleural effusion or pneumothorax.
LUNGS/AIRWAYS: Evaluation of the lung parenchyma is somewhat limited secondary
to patient respiratory motion. There is diffuse small vessel airway disease
with patchy airspace opacities. Differential considerations include
multifocal pneumonia as well as aspiration pneumonitis. A 1.6 x 2.2 cm
nodular airspace opacity is stable in comparison to ___ (03:36).
Scattered pulmonary nodules are noted. For example, there is a new 1.2 cm
pulmonary nodule in the right middle lobe (02:55). There is a 7 mm solid
pulmonary nodule at the right lung base, similar to prior. An 8 mm nodular
opacity at the left lung base may represent a nodule or transient atelectasis
(2:65).
BASE OF NECK: Visualized portions of the base of the neck show no abnormality.
8 mm hypodensity in the right thyroid lobe is nonspecific and incompletely
evaluated on the current exam.
ABDOMEN: Included portion of the upper abdomen demonstrates hepatic steatosis
but is otherwise unremarkable.
BONES: There is no suspicious osseous abnormality or acute fracture. There
are multilevel degenerative changes.
IMPRESSION:
1. No evidence of pulmonary embolism or aortic abnormality.
2. Small vessel airway disease and multifocal patchy airspace opacities.
Differential considerations include multifocal pneumonia as well as aspiration
pneumonitis. Follow-up CT chest in ___ weeks after resolution of symptoms is
recommended.
3. Multiple pulmonary nodules as described above.
RECOMMENDATION(S): For incidentally detected multiple solid pulmonary nodules
bigger than 8mm, a CT follow-up in 3 to 6 months is recommended in a low-risk
patient, with an optional CT follow-up in 18 to 24 months. In a high-risk
patient, both a CT follow-up in 3 to 6 months and in 18 to 24 months is
recommended.
See the ___ ___ Society Guidelines for the Management of Pulmonary
Nodules Incidentally Detected on CT" for comments and reference:
___
|
10076617-RR-71 | 10,076,617 | 20,598,574 | RR | 71 | 2167-11-07 12:02:00 | 2167-11-07 12:36:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: History: ___ with hyperglycemia, fall 1 week ago, weakness// eval
pna, displaced rib fx
TECHNIQUE: Chest AP and lateral.
COMPARISON: Multiple prior chest radiographs, most recently ___.
FINDINGS:
Lung volumes are slightly low. Linear atelectasis left lung base laterally
stable. There is pulmonary vascular congestion. No focal consolidation.
Cardiomegaly is stable. No pleural effusion or pneumothorax.
IMPRESSION:
Pulmonary vascular congestion without focal consolidation.
|
10076617-RR-72 | 10,076,617 | 20,598,574 | RR | 72 | 2167-11-10 11:12:00 | 2167-11-10 13:18:00 | EXAMINATION: HAND (PA,LAT AND OBLIQUE) BILATERAL
INDICATION: ___ year old woman with ?synovitis/inflammatory arthritis- kindly
perform entire hands// ?inflammatory arthritis
TECHNIQUE: Three views of the right and left hands each.
COMPARISON: ___ and prior.
FINDINGS:
Right hand: No acute osseous abnormality seen. There multifocal degenerative
changes, most pronounced and severe at the basal joints of the thumb as well
as the distal interphalangeal joints. There is a questionable periarticular
erosion at the radial aspect of the long finger DIP, as well as at the
proximal triquetrum. There is diffuse mild soft tissue edema.
Left hand: No acute osseous abnormality seen. Multifocal degenerative
changes, most pronounced and moderately severe at the basal joints of the
thumb. Questionable chronic erosion at the ulnar size process tip. Mild
diffuse soft tissue edema.
IMPRESSION:
Mild diffuse soft tissue edema about the bilateral hands and questionable
chronic erosions at the right hand long finger DIP and proximal triquetrum and
left ulnar styloid process tip. Recommend clinical correlation for
inflammatory arthropathy.
|
10076617-RR-76 | 10,076,617 | 20,598,574 | RR | 76 | 2167-11-17 19:04:00 | 2167-11-17 21:32:00 | EXAMINATION: MR WRIST ___ CONTRAST RIGHT
INDICATION: ___ year old woman with ?inflammatory arthritis// ?synovitis
TECHNIQUE: Multiplanar imaging of the right wrist was obtained without
contrast using a synovitis particle.
COMPARISON: Hand radiographs on ___ MRI hand on ___
FINDINGS:
Exam prematurely due to patient discomfort and no contrast was administered,
limiting evaluation for synovitis. In addition, images are degraded by
motion.
Triangular fibrocartilage: There is macerated appearance of the peripheral and
paracentral TFCC consistent with degenerative tearing.
Scapholunate ligament: Within normal limits.
Lunotriquetral ligament: Within normal limits.
Flexor tendons: Normal.
Extensor tendons: Edema surrounding the extensor digitorum tendons, consistent
with mild peritendinitis. There is tendinosis of the extensor carpi ulnaris
with intrasubstance tearing. Trace fluid within the second and third and
sixth extensor tendon sheaths. Trace edema about the flexor compartment
tendon sheaths in the carpal tunnel.
Carpal tunnel: There is no abnormal bowing. The median nerve has normal
signal and size.
___ canal: Within normal limits.
Bone marrow: There are degenerative changes at the radioulnar joint and
radiocarpal joints. There are degenerative changes in the carpal bones with
joint space narrowing cystic changes, most prominent at the triscaphe joint.
Diffuse cortical irregularity involving the radiocarpal joint and carpal
bones, likely reflecting chronic erosive changes.
Joint effusion: Small amount of lobulated fluid within the ulnocarpal
consistent with chronic synovitis. Additional 0.4 cm ganglion cyst arising
from the volar aspect of the radiocarpal joint, series 16 image 18 trace fluid
in the radioulnar recess. There is a small amount of lobulated fluid in the
pisiform recess. There is nonspecific mild periarticular soft tissue edema
most pronounced about the ulnar carpal joint as well as the dorsal intercarpal
extrinsic ligament overlying the mid carpal row.
Muscles: Muscles about the wrist within normal limits without edema or
atrophy.
IMPRESSION:
1. Evaluation for synovitis is limited due to motion degradation and lack of
IV contrast.
2. Chronic changes related to a combination of likely inflammatory arthritis
and osteoarthritis in the carpal bones and at the wrist joints.
3. Small loculated joint effusion in the ulnocarpal joint, fluid in the distal
radioulnar joint and nonspecific mild soft tissue edema in the dorsal
intercarpal ligament and at the ulnar aspect of the wrist likely relates to
chronic synovitis with mild acute inflammatory component not excluded. This
could be further evaluated with Doppler ultrasound if MRI contrast is not
feasible.
4. Mild tendinosis of the extensor carpi ulnaris with intrasubstance tearing.
5. Mild peritendinitis of the extensor digitorum tendons at the hand, and
trace fluid in the ECU, second and third extensor compartment and trace edema
about the flexor tendon sheaths in the carpal tunnel, nonspecific but may
relate to mild tenosynovitis. This could be further evaluated with Doppler
ultrasound if MRI contrast is not feasible.
6. Degenerative tearing of the TFCC.
|
10076617-RR-77 | 10,076,617 | 20,598,574 | RR | 77 | 2167-11-17 19:04:00 | 2167-11-17 21:27:00 | EXAMINATION: MR HAND W/O CONTRAST RIGHT
INDICATION: ___ year old woman with ?inflammatory arthritis// ?synovitis
TECHNIQUE: Multiplanar imaging of the right hand was obtained without
contrast using a synovitis particle.
COMPARISON: Hand radiographs on ___, MRI right hand on ___
FINDINGS:
Exam was terminated prematurely due to patient discomfort and no contrast was
administered, limiting evaluation for synovitis. There are trace joint
effusions at the third metacarpophalangeal joint and fifth proximal
interphalangeal joint, with mild surrounding soft tissue edema, particularly
at the fifth PIP. The there is loculated joint fluid within the ulnar carpal
joint space with associated mild soft tissue edema..
Cystic change in the metacarpal heads and in the visualized distal carpal
bones and carpometacarpal joints is not significantly changed compared with
MRI hand on ___. Diffuse cortical irregularity in involving the
metacarpophalangeal joints and the carpal bones is similar to prior and
possibly related to mild chronic erosive changes. There degenerative changes
in the visualized carpal bones, most pronounced at the triscaphe joint.
There is mild edema surrounding extensor digitorum tendons on the dorsum of
the hand, similar to prior and may represent mild peritendinitis. Trace fluid
within the second and third extensor tendon sheaths and ECU at the wrist.
There is trace fluid surrounding the fourth and fifth flexor digitorum tendons
on the palmar aspect of the hands, however less fluid than is typically is the
seen in tenosynovitis. Trace edema about the flexor tendons in the carpal
tunnel and proximal hand. The remainder of the flexor tendons on the plantar
aspect of the hand are unremarkable. Additionally mild soft tissue edema
about the dorsal intercarpal ligament. No soft tissue fluid collection.
IMPRESSION:
1. Evaluation for synovitis is limited by lack of IV contrast
2. Chronic cortical changes likely related osteoarthritis with possible
superimposed chronic erosive changes.
3. Small joint effusions at the third metacarpophalangeal joint and fifth
proximal interphalangeal joints, with mild associated soft tissue no
particular at the fifth PIP may represent mild synovitis. Recommend clinical
correlation. If clinically warranted, further evaluation with Doppler
ultrasound can be performed if contrast-enhanced MRI is not feasible.
4. Mild peritendinitis around the extensor digitorum tendons, similar to prior
MRI. Trace fluid in multiple extensor compartment tendon sheaths, trace edema
about the flexor tendons in the carpal tunnel, as well as loculated fluid in
the ulnar carpal joint space and associated soft tissue edema is nonspecific
but mild acute on chronic inflammation is not excluded. Note that overall the
soft tissue edema has decreased from prior study of ___ however.
5. Trace nonspecific fluid surrounding the fourth and fifth digit flexor
tendons.
6. Please see MRI wrist of same day for additional Findings.
|
10076617-RR-80 | 10,076,617 | 20,459,993 | RR | 80 | 2168-01-26 09:20:00 | 2168-01-26 11:38:00 | EXAMINATION: FOOT AP,LAT AND OBL BILATERAL
INDICATION: History: ___ with Rt foot cellulitis (erythema and pain) but
bilateral blisters s/p I+D by podiatry. they near bone.// ?osteo
TECHNIQUE: Three view radiographs of the bilateral feet
COMPARISON: None
FINDINGS:
Right: Bandage material is noted around the fifth digit, obscuring some
detail. Edema is noted in the fifth digit. No acute fractures are seen. Mild
degenerative changes involving the MTP joints, and mild to moderate
degenerative change throughout the midfoot. Large calcaneal spur. There is a
mild talar beak which may be related to prior trauma. Mineralization is
normal. Os peroneum is noted. No definite destructive lesion is seen.
Left: No acute fractures or dislocation are seen. Moderate degenerative
changes throughout the midfoot, with mild talar beaking that may reflect prior
trauma. Large calcaneal spur. Hammertoe deformity in the second through
fifth digits is noted. Mild enthesophyte formation at the insertion of the
Achilles. Mineralization is normal. No definite destructive lesions. Os
peroneum is noted.
IMPRESSION:
1. No definite destructive lesion. If there is continued clinical concern,
MRI would be more sensitive for the detection of osteomyelitis.
2. Swelling of the right fifth digit without evidence of acute bony
abnormality.
3. Degenerative changes as described above.
|
10076617-RR-81 | 10,076,617 | 20,459,993 | RR | 81 | 2168-01-27 09:42:00 | 2168-01-27 13:54:00 | EXAMINATION: ABI rest only.
INDICATION: ___ year old woman with diabetic foot wound// arterial flow
TECHNIQUE: Non-invasive evaluation of the arterial system in the
lower extremities was performed with Doppler signal recording, pulse volume
recordings and segmental limb pressure measurements.
COMPARISON: None.
FINDINGS:
On the right side, triphasic Doppler waveforms are seen in the right femoral,
superficial femoral, popliteal, and posterior tibial arteries. A monophasic
waveform is identified in the dorsalis pedis artery.
The right ABI was 1.21.
On the left side, triphasic Doppler waveforms are seen at the left femoral,
superficial femoral, popliteal, and posterior tibial arteries. A monophasic
waveform is identified in the dorsalis pedis artery.
The left ABI was 1.09.
Pulse volume recordings showed symmetric amplitudes bilaterally, at all
levels.
IMPRESSION:
No evidence of arterial insufficiency to the lower extremities bilaterally.
|
10076617-RR-82 | 10,076,617 | 20,459,993 | RR | 82 | 2168-01-28 18:38:00 | 2168-01-28 21:28:00 | EXAMINATION: MR FOOT ___ CONTRAST RIGHT
INDICATION: ___ year old woman with DM, pHTN, Sweet's syndrome, inflammatory
arthritis p/w R ___ toe abscess and c/f osteo// Please evaluate for
osteomyelitis
TECHNIQUE: Multiplanar images of the right foot were performed without and
with the administration of intravenous contrast using a infection MR foot
protocol.
COMPARISON: Radiographs from ___
FINDINGS:
There is preserved T1 marrow signal seen throughout the bones of the mid and
forefoot and no significant marrow edema to suggest MRI signs for acute
osteomyelitis. There are degenerative changes of the PIP joint of the second
through fifth toes. There is some soft tissue swelling and mild subcutaneous
edema of the forefoot along the dorsal aspect. There are no rim enhancing
fluid collections to suggest an abscess. There are no bony erosions.
The Lisfranc interval is preserved. The flexor and extensor tendons are
grossly intact without tenosynovitis or significant tendinosis. There is mild
nonspecific muscle edema in the plantar muscle soft tissues.
IMPRESSION:
1. No MRI signs for acute osteomyelitis or soft tissue abscess. There is
dorsal forefoot and fifth toe soft tissue swelling.
2. Degenerative changes of PIP joints of the second through fifth toes.
|
10076617-RR-83 | 10,076,617 | 20,459,993 | RR | 83 | 2168-01-29 08:13:00 | 2168-01-29 12:53:00 | EXAMINATION: US MSK HAND/FINGER LEFT
INDICATION: ___ year old woman with Sweet's syndrome and seroneg inflammatory
arthritis// Please eval for arthritis per rheumatology
TECHNIQUE: Grayscale and Doppler ultrasound images were obtained of the
superficial tissues of the left hand
COMPARISON: Bilateral hand radiographs ___
FINDINGS:
No wrist or MCP joint effusion is identified. Trace tenosynovitis of flexor
tendons are noted. No focal fluid collection is identified. No significant
synovitis is demonstrated in the wrist or MCP joints.
IMPRESSION:
No joint effusion is identified.
|
10076617-RR-84 | 10,076,617 | 20,459,993 | RR | 84 | 2168-01-29 08:13:00 | 2168-01-29 12:59:00 | EXAMINATION: US MSK HAND/FINGER RIGHT
INDICATION: ___ with hx Sweet's syndrome and seroneg arthritis now with
suspected flare.// Please eval for arthritis per rheumatology
TECHNIQUE: Grayscale and Doppler ultrasound images were obtained of the
superficial tissues of the right wrist.
COMPARISON: Right hand MR ___
FINDINGS:
Soft tissues with mild vascularity surrounding the extensor tendons of the
hand are suggestive of tenosynovitis. No fluid collection is identified. No
joint effusion is identified in the wrist, MCP, and IP joints of the fingers.
Soft tissue thickening with vascularity at the dorsal aspect of the MCP and
PIP joints of small finger is consistent with synovitis.
IMPRESSION:
No joint effusion is identified. Soft tissues surrounding the extensor
tendons and small finger MCP and PIP joints are suggestive of
tenosynovitis/synovitis.
|
10077370-RR-11 | 10,077,370 | 21,019,625 | RR | 11 | 2112-11-16 10:23:00 | 2112-11-28 14:38:00 | EXAMINATION: VIDEO SWALLOW
INDICATION: ___ year old woman with sudden onset dysphagia to solids and
liquids, unable to take adequate PO. C/o sensation that food is stuck in her
throat. Barium swallow suggesting oropharyngeal dysphagia. ENT evaluated and
recommended video swallow for further diagnostic workup.// Etiology for
oropharyngeal dysphagia (strength vs. coordination vs. other), Techniques to
improve swallow
TECHNIQUE: Oropharyngeal swallowing videofluoroscopy was performed in
conjunction with the speech and swallow division. Multiple consistencies of
barium were administered.
DOSE: Fluoro time: 05:29 min.
COMPARISON: Esophagram from ___.
FINDINGS:
Barium passes freely through the oropharynx and esophagus without evidence of
obstruction. There was aspiration with thin and nectar consistency liquids.
Residue was noted in the left piriform sinus. Limited evaluation esophagus
was notable for esophageal dysmotility and uncoordinated spasms on some
swallow attempts.
IMPRESSION:
1. Aspiration with thin and nectar consistency liquids.
2. Limited evaluation of the esophagus was notable for esophageal dysmotility
and uncoordinated spasms on some swallow attempts.
3. Please refer to the speech and swallow division note in OMR for full
details, assessment, and recommendations.
|
10077370-RR-12 | 10,077,370 | 21,019,625 | RR | 12 | 2112-11-15 17:33:00 | 2112-11-15 19:28:00 | INDICATION: ___ year old woman with bronch w/ biopsies// r/o ptx
TECHNIQUE: AP portable chest radiograph
COMPARISON: No prior radiographs available. Comparison is made to the CT
scan of the torso dated ___
FINDINGS:
The patient is rotated. No focal consolidation, pleural effusion or
pneumothorax is identified. The size of the cardiac silhouette is mildly
enlarged. The hila are prominent bilaterally, consistent with the patient's
known hilar lymphadenopathy.
IMPRESSION:
No pneumothorax identified.
|
10077370-RR-4 | 10,077,370 | 21,019,625 | RR | 4 | 2112-11-12 14:18:00 | 2112-11-12 15:50:00 | EXAMINATION: Esophagram
INDICATION: ___ year old woman with sudden onset dysphagia to solids and
liquids. EGD preliminarily shows no abnormalities.// ?functional dysphagia
TECHNIQUE: Barium esophagram.
DOSE: Acc air kerma: 12 mGy; Accum DAP: 245 uGym2; Fluoro time: 3 minutes 23
seconds
COMPARISON: Reference CT neck
FINDINGS:
On the lateral view, patient was noted to have mild penetration of thin
liquids. There was residue noted within the piriform sinuses as well as upon
swallowing of a 13 mm barium tablet. The barium tab was noted to have holdup
in the left piriform sinus for around 2 minutes prior to passing into the
esophagus.
The esophagus was not dilated. There was no stricture within the esophagus.
There was no esophageal mass. The esophageal mucosa appear normal.
The primary peristaltic wave was normal, with contrast passing readily into
the stomach. The lower esophageal sphincter opened and closed normally.
There was no gastroesophageal reflux. There was a small hiatal hernia.
No overt abnormality in the stomach or duodenum on limited evaluation.
IMPRESSION:
1. Mild penetration of thin liquids. Residue in the piriform sinuses with
holdup of barium tablet in the left piriform sinus for around 2 minutes.
Recommend dedicated formal video oropharyngeal swallow study with the speech
pathology team for more detailed evaluation of the oropharynx.
2. Normal esophageal motility.
3. Small hiatal hernia.
RECOMMENDATION(S): Video oropharyngeal study with the speech and swallow
pathology team.
NOTIFICATION: The findings were discussed with ___, M.D. by
___, M.D. on the telephone on ___ at 3:40 pm, 5 minutes after
discovery of the findings.
|
10077370-RR-5 | 10,077,370 | 21,019,625 | RR | 5 | 2112-11-13 01:00:00 | 2112-11-13 11:03:00 | EXAMINATION: MRI AND MRA BRAIN AND MRA NECK PT11 MR ___
INDICATION: ___ year old woman with sudden onset oropharyngeal dysphagia,
right facial, left mandibular, and left torso numbness. EGD found no masses.
Barium swallow showed oropharyngeal dysphagia. Question of brain stem lesion,
dissection.
TECHNIQUE: Three dimensional time of flight MR arteriography was performed
through the brain with maximum intensity projection reconstructions.
Dynamic MRA of the neck was performed during administration of 14 mL of
Multihance intravenous contrast. Three dimensional maximum intensity
projection and segmented images were generated.
Brain imaging was performed with sagittal T1 and axial T1, FLAIR, T2, gradient
echo and diffusion technique. Following intravenous MultiHance administration,
axial T1 weighted and sagittal MP RAGE with multiplanar reformations images of
the brain were obtained.
This report is based on interpretation of all of these images.
COMPARISON: ___ neck CT with contrast is available for correlation.
FINDINGS:
MRI BRAIN:
Images are limited by motion artifact. There is no acute infarction, edema,
evidence for blood products, or other signal abnormalities in the brain
parenchyma. There is no evidence for an enhancing mass or other abnormal
contrast enhancement. There is linear artifact through the brainstem on
postcontrast MP RAGE images without a correlate on postcontrast axial T1
weighted images. There is also pulsation artifact through the pons on FLAIR
and T2 weighted images. Ventricles, sulci, and basal cisterns are normal in
size. Dural venous sinuses are patent on postcontrast MP RAGE images.
There is a small mucous retention cyst in the lower portion of the right
maxillary sinus.
MRA NECK:
Timing of the dynamic MRA relative to the contrast bolus is suboptimal.
Proximal common carotid arteries, as well as a V1 and proximal V2 segments of
the vertebral arteries, are not adequately assessed. Distal common carotid
arteries and cervical internal carotid arteries appear widely patent without
evidence for stenosis by NASCET criteria. Remaining courses of bilateral
vertebral arteries also appear patent without evidence for flow-limiting
stenosis.
MRA BRAIN:
Images are mildly limited by artifacts. Branches of the M1 segment of the
left middle cerebral artery are more affected by artifacts than the right due
to a tilt of the patient's head. There is otherwise no evidence for
flow-limiting stenosis or aneurysm.
OTHER:
Approximately 1.7 cm left thyroid nodule is better seen on the preceding neck
CT.
IMPRESSION:
1. Images are limited by motion, pulsation, and other artifacts.
2. No evidence for an acute infarction, intracranial mass, or other
intracranial abnormalities.
3. Inadequate assessment of the proximal common carotid and vertebral
arteries. No evidence for internal carotid stenosis by NASCET criteria.
4. No evidence for flow-limiting intracranial arterial stenosis.
5. Approximately 1.7 cm left thyroid nodule is better seen on the ___ neck CT.
RECOMMENDATION(S): The ___ College of Radiology guidelines suggest
thyroid ultrasound, if not previously performed elsewhere.
|
10077370-RR-7 | 10,077,370 | 21,019,625 | RR | 7 | 2112-11-14 08:32:00 | 2112-11-14 16:01:00 | EXAMINATION: CT NECK WITHOUT CONTRAST SECOND OPINION
INDICATION: SECOND OPINION ___ year old woman with sudden onset dysphagia to
solids and liquids and multifocal numbness. EGD negative for masses and
gastritis. ENT eval negative for upper airway etiology.CT soft tissue neck
with contrast done on ___ at ___ (MRN ___// ?oropharyngeal mass,
vascular dissection
TECHNIQUE: Axial images of the head were obtained without contrast with
sagittal and coronal reformats. This is an outside study for second opinion.
The examination was performed at the ___.
DOSE: DLP: 316mGy-cm
COMPARISON: None
FINDINGS:
There is no evidence of oropharyngeal retropharyngeal mass. The airway is
patent. A torus palatini is identified which was also further evaluated on a
subsequent are sinus CT. There is no evidence of lymphadenopathy. The
prevertebral soft tissue thickness is maintained. An approximately 1.6 cm
somewhat enhancing lesion is identified in the left lobe of thyroid. No bony
abnormalities are identified. Normal vascular enhancement is seen. The
salivary glands are symmetric and normal in appearance.
IMPRESSION:
No oro pharyngeal or retropharyngeal mass identified. There is no narrowing
of the airways. 1.6 cm enhancing thyroid nodule with surrounding hypodensity.
Further evaluation is recommended with ultrasound
RECOMMENDATION(S): Thyroid nodule. Ultrasound follow up recommended.
___ College of Radiology guidelines recommend further evaluation for
incidental thyroid nodules of 1.0 cm or larger in patients under age ___ or 1.5
cm in patients age ___ or older, or with suspicious findings.
Suspicious findings include: Abnormal lymph nodes (those displaying
enlargement, calcification, cystic components and/or increased enhancement) or
invasion of local tissues by the thyroid nodule.
___, et al, "Managing Incidental Thyroid Nodules Detected on Imaging: White
Paper of the ACR Incidental Findings Committee". J ___ ___
12:143-150.
|
10077370-RR-8 | 10,077,370 | 21,019,625 | RR | 8 | 2112-11-14 08:39:00 | 2112-11-14 11:10:00 | EXAMINATION: SECOND OPINION CT TORSO
INDICATION: ___ year old woman with sudden onset dysphagia to solids and
liquids and multifocal numbness. EGD negative for masses and gastritis. ENT
eval negative for upper airway etiology.CT chest with contrast done on ___
at ___ (MRN ___// quality of pulmonary nodule, bilateral hilar
lymphadenopathy, ?distal esophageal thickening
TECHNIQUE: This is a review of a chest CT that was obtained at an outside
hospital. CT chest axial images and multiplanar reformats obtained before and
after intravenous contrast administration were submitted for second opinion.
DOSE: Total DLP: 159 mGy-cm
COMPARISON: None.
FINDINGS:
NECK, THORACIC INLET, AXILLAE, CHEST WALL: The imaged portion of thyroid gland
is mildly heterogeneous with possible hypodensity within the left thyroid
gland. Scattered supraclavicular lymph nodes are mildly enlarged with a
collection of nodes at the thoracic inlet measuring up to 19 x 16 mm (02:11).
There is no axillary lymphadenopathy. Aside from the breast parenchyma, which
is suboptimally evaluated on the current modality, the chest wall is
unremarkable.
UPPER ABDOMEN: The imaged portion of the upper abdomen demonstrate multiple
subcentimeter hypodensities throughout the liver, likely representing cysts or
biliary hamartomas. Hypodensity that is partially imaged in the midpole of
the right kidney is incompletely evaluated on this exam. There is a small
hiatal hernia. Residual high-density material within the esophagus is likely
ingested oral contrast. Otherwise, the imaged upper abdomen is unremarkable.
MEDIASTINUM: There are numerous pathologically enlarged lymph nodes in the
mediastinum, measuring up to 10 mm. The largest lymph nodes are located in
the aortopulmonic window and the subcarinal station (02:17, 18). Multiple
enlarged lymph nodes are seen adjacent to the esophagus, the largest measuring
up to 10 mm (02:27).
HILA: There is bilateral, symmetric confluent hilar lymphadenopathy. The
right hilar lymph node measures up to 31 x 21 mm (02:21, 24) and the left
hilar node measures up to 23 x 11 mm (02:18, 20, 24). The lymphadenopathy
does not narrow the pulmonary vasculature or the bronchi.
HEART and PERICARDIUM: The heart is mildly enlarged in size. There is no
significant valvular or coronary calcifications. There is no pericardial
effusion.
PLEURA: There is no pleural effusion or pneumothorax. There is mild pleural
thickening in the posteromedial right lower lobe pleura with associated mild
ground-glass opacity (6:170), measuring up to 10 mm.
LUNG:
1. PARENCHYMA: There is mild biapical scarring. There are multiple
millimetric subpleural nodules in the left and right upper, right lower lobe
and lingula (6:170, 167, 68, 63, 61, 60, 27, 22), some in peribronchial
distribution. In the right paraspinal subpleural lesion, there is mildly
spiculated soft tissue thickening adjacent to the pulmonary vessel (6:146),
measuring 15 x 6 mm, which extends downward to the diaphragm. Inferior to the
right lower lobe prior median soft tissue and ground-glass opacities, there is
a 12 x 8 mm slightly spiculated solid pulmonary nodule (6:189). The second
largest solid pulmonary nodule measures up to 5 mm in the left upper lobe
(6:61). The linear opacity in the right middle lobe likely represents
atelectasis (6:170).
2. AIRWAYS: The airways are patent to the subsegmental levels. There is no
significant peribronchial thickening or irregularity.
3. VESSELS: Coarse calcification is seen in the descending aorta. Otherwise,
there is no significant aortic arch calcifications. There is common origin of
the innominate and left common carotid artery. The main and right pulmonary
arteries are normal in caliber. The ascending and descending aorta are not
aneurysmal.
CHEST CAGE: There are no worrisome osseous lesions for infection or
malignancy.
IMPRESSION:
-Confluent mediastinal and symmetric bilateral hilar lymphadenopathy with
peribronchial nodules, suspicious for sarcoidosis.
-Slightly spiculated solid pulmonary nodule in the right lower lobe measuring
up to 12 mm. This is likely be part of the spectrum of sarcoidosis and less
likely lymphoma or small cell lung cancer. However, transbronchial biopsy and
tissue diagnosis would be helpful for definitive clinical management.
-Multiple enlarged lymph nodes adjacent to the esophagus, which is mildly
enlarged.
RECOMMENDATION(S): Slightly spiculated solid pulmonary nodule in the right
lower lobe measuring up to 12 mm. This is likely be part of the spectrum of
sarcoidosis and less likely lymphoma or small cell lung cancer. However,
transbronchial biopsy and tissue diagnosis would be helpful for definitive
clinical management.
NOTIFICATION: The findings were discussed with ___. by
___, M.D. on the telephone on ___ at 10:18 am, 10 minutes after
discovery of the findings.
|
10077370-RR-9 | 10,077,370 | 21,019,625 | RR | 9 | 2112-11-14 13:19:00 | 2112-11-14 14:27:00 | EXAMINATION: CT SINUS/MANDIBLE/MAXILLOFACIAL W/O CONTRAST
INDICATION: ___ year old woman with sudden onset oropharyngeal dysphagia to
solids and liquids and multifocal paresthesias. EGD unrevealing. MRI/MRA brain
inadequate for interpretation. No evidence of upper airway obstruction/masses
per ENT.// ?Bony mets to the mandible
TECHNIQUE: Helically-acquired multidetector CT axial images were obtained
through the maxillofacial bones and mandible. Intravenous contrast was not
administered. Axial images reconstructed with soft tissue and bone algorithm
to display images with 1.25 mm slice. Coronal and sagittal reformations were
also constructed. All produced images were evaluated in production of this
report.
DOSE: Acquisition sequence:
1) Spiral Acquisition 2.5 s, 19.5 cm; CTDIvol = 26.5 mGy (Head) DLP = 514.6
mGy-cm.
Total DLP (Head) = 515 mGy-cm.
COMPARISON: None.
FINDINGS:
Dental almalgam streak artifact limits study.
No fractures are identified.
There is no evidence of facial swelling.
There is a small mucosal retention cyst in the right maxillary sinus.
Visualized paranasal sinuses are otherwise clear and well aerated.
There is no evidence of abnormal fluid collections.
Bilateral mastoids appear normal.
The globes, extraocular muscles, optic nerves, and retrobulbar fat appear
normal.
The visualized upper aerodigestive tract appears normal.
Incidental note is made of a midline bony protrusion of the palatine bone into
the oral cavity, consistent with a torus ___ (2:72, 604:84)).
The mandible and temporomandibular joints appear normal.
IMPRESSION:
1. No evidence of focal mandibular lesion.
2. Incidental note of a torus ___.
3. Small right maxillary mucosal retention cyst.
|
10077534-RR-38 | 10,077,534 | 29,345,364 | RR | 38 | 2133-06-01 13:53:00 | 2133-06-01 15:37:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: History: ___ with cough // ? infectious process ?
infectious process
IMPRESSION:
COMPARED TO THE ONLY PRIOR CHEST RADIOGRAPHS AVAILABLE, ___.
MILD TO MODERATE CARDIOMEGALY INCREASED SLIGHTLY. SMALL BILATERAL PLEURAL
EFFUSIONS. LUNGS CLEAR.
THORACIC AORTA IS CALCIFIED BUT NOT FOCALLY ANEURYSMAL.
|
10077534-RR-39 | 10,077,534 | 29,345,364 | RR | 39 | 2133-06-01 15:46:00 | 2133-06-01 16:09:00 | EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: History: ___ with left sided weakness since last night // ?
acute process
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast. Coronal and sagittal reformations as well as bone algorithm
reconstructions were provided and reviewed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 16.0 s, 17.3 cm; CTDIvol = 46.5 mGy (Head) DLP =
802.7 mGy-cm.
Total DLP (Head) = 803 mGy-cm.
COMPARISON: MRI from outside institution ___, head CT from outside
institution ___
FINDINGS:
There is no evidence of acute territorial infarction, hemorrhage, edema, or
mass. There is prominence of the ventricles and sulci suggestive of
involutional changes. Chronic lacune is noted within the right basal ganglia.
Periventricular, subcortical and deep white matter hypodensities are
nonspecific, but likely reflect the sequela of chronic microvascular
infarction. Atherosclerotic calcifications are noted involving the distal
right and both cavernous carotid arteries.
There is no evidence of fracture. Partial opacification of the left mastoid
air cells suggests ongoing inflammation. The visualized portion of the
paranasal sinuses, right mastoid air cells, and middle ear cavities are clear.
The visualized portion of the orbits are unremarkable apart from left lens
replacement surgery.
IMPRESSION:
No acute intracranial hemorrhage or mass effect. Please note that MRI is more
sensitive for the detection of acute infarction.
|
10077769-RR-4 | 10,077,769 | 21,673,397 | RR | 4 | 2150-02-21 01:26:00 | 2150-02-21 11:05:00 | EXAMINATION: MR ___ AND W/O CONTRAST ___ MR SPINE
INDICATION: History of IV drug use with traumatic back pain with right leg
numbness and tingling with outside hospital MR concerning for epidural abscess
or hematoma.
TECHNIQUE: Sagittal imaging was performed with T2, T1, and STIR technique,
followed by axial T2 imaging. This was followed by sagittal and axial T1
images obtained after the uneventful intravenous administration of 8 mL of
Gadavist contrast agent.
COMPARISON: Outside hospital lumbar spine MR ___.
FINDINGS:
There are 5 non rib-bearing lumbar type vertebral bodies. Alignment is
normal. Vertebral body heights are preserved.
There is endplate and intervertebral disc edema and enhancement at the L5-S1
level with subtle cortical destruction (03:11) posterior to this level, there
is a heterogeneously enhancing 5.1 x 1.3 cm anterior epidural collection
(08:12). This fluid collection extends inferiorly and to the left extending
into the left S1-S2 neural foramen and extends outward into the adjacent
retroperitoneum with incompletely imaged adjacent prevertebral soft tissue
edema and enhancement, with a suggestion of a 3.0 x 0.8 cm presacral enhancing
fluid collection. There is resultant near complete destruction of the
intervertebral disc space.
There is loss of T2 signal and mild intervertebral disc height loss at L4-L5.
At this level, there is a mild posterior disc bulge without significant spinal
canal or neural foraminal narrowing.
From the image levels of T10-T11 through L3-L4, there is no significant spinal
canal or neural foraminal narrowing.
The visualized terminal spinal cord appears normal in caliber and
configuration. The conus medullaris terminates at the L1 level.
IMPRESSION:
1. L5-S1 discitis osteomyelitis.
2. 5.1 x 1.3 cm anterior epidural abscess spanning the L5 and S1 vertebral
bodies, extending through the left S1-S2 neural foramen with partially imaged
presacral abscess/phlegmon measuring at least 3.0 x 0.8 cm.
3. Mild spondylosis at the L4-L5 level.
4. No evidence of fracture.
NOTIFICATION: The findings were discussed with ___, M.D. by
___, M.D. on the telephone on ___ at 11:10 AM, 10 minutes after
discovery of the findings.
|
10077769-RR-5 | 10,077,769 | 21,673,397 | RR | 5 | 2150-02-23 12:43:00 | 2150-02-24 11:19:00 | EXAMINATION: CT-GUIDED BIOPSY
INDICATION: ___ year old man with traumatic back pain now found to have
epidural abscess/phlegmon and possibly infectious discitis on MRI imaging.
Need tissue for antibiotic therapy guidance. // Please perform biopsy of
epidural abscess (vs phlegmon) at L5/S1
COMPARISON: MRI FROM ___
PROCEDURE: CT-guided spine biopsy.
OPERATORS: Dr. ___, radiology fellow and Dr. ___
radiologist. Dr. ___ supervised the trainee during the key
components of the procedure and reviewed and agrees with the trainee's
findings.
TECHNIQUE: The risks, benefits, and alternatives of the procedure were
explained to the patient. After a detailed discussion, informed written
consent was obtained. A pre-procedure timeout using three patient identifiers
was performed per ___ protocol.
The patient was placed in a prone position on the CT scan table. Limited
preprocedure CTscan of the intended biopsy area was performed. Based on the
CT findings an appropriate position for the biopsy was chosen. The site was
marked.
The site was prepped and draped in the usual sterile fashion. 1% lidocaine
were administered to the subcutaneous and deep tissues for local anesthetic
effect. Under CT guidance, an 11 gauge trocar was introduced into the S1
vertebrae using an OnControl bone drill. A 13 gauge biopsy needle was used
with the bone drill to obtain a single core biopsy specimen of the S1 superior
endplate and L5/S1 disc. The trocar needles were removed and a sterile
dressing was placed. The sample was sent for microbiology.
A small subcutaneous hematoma developed over the biopsy site. Manual pressure
was applied and the bleeding stopped. The procedure was tolerated well and
there were no immediate post-procedural complications.
DOSE: Acquisition sequence:
1) Spiral Acquisition 7.4 s, 22.6 cm; CTDIvol = 7.2 mGy (Body) DLP = 152.8
mGy-cm.
2) Stationary Acquisition 5.8 s, 1.4 cm; CTDIvol = 60.2 mGy (Body) DLP =
86.7 mGy-cm.
Total DLP (Body) = 250 mGy-cm.
SEDATION: Moderate sedation was provided by administering divided doses of 3
mg Versed and 150 mcg fentanyl throughout the total intra-service time of 25
minutes during which patient's hemodynamic parameters were continuously
monitored by an independent trained radiology nurse.
FINDINGS:
Pre biopsy CT scan demonstrated erosions of the inferior endplate of L5 and
superior endplate of S1 with perispinal soft tissue inflammatory changes, in
keeping with spondylodiscitis.
IMPRESSION:
Technically successful biopsy the superior endplate of S1 and L5/S1 disc.
|
10078309-RR-16 | 10,078,309 | 27,617,852 | RR | 16 | 2174-04-13 08:48:00 | 2174-04-13 12:14:00 | EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ year old man with epigastric and RUQ pain with likely
pancreatitis evaluate for biliary dilation or stones.
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: None available.
FINDINGS:
LIVER: The hepatic parenchyma appears within normal limits. The contour of the
liver is smooth. There is no focal liver mass. The main portal vein is patent
with hepatopetal flow. There is no ascites.
BILE DUCTS: There is no intrahepatic biliary dilation. The CBD measures 2 mm.
GALLBLADDER: There is no evidence of stones or gallbladder wall thickening.
PANCREAS: Imaged portion of the pancreas appears within normal limits, without
masses or pancreatic ductal dilation.
SPLEEN: Normal echogenicity, measuring 8.2 cm.
KIDNEYS: The right kidney measures 9.2 cm. The left kidney measures 9.6 cm.
Normal cortical echogenicity and corticomedullary differentiation is seen
bilaterally. There is no evidence of masses, stones, or hydronephrosis in the
kidneys.
RETROPERITONEUM: Visualized portions of aorta and IVC are within normal
limits.
IMPRESSION:
Normal abdominal ultrasound. Specifically, normal gallbladder and biliary
tree.
|
10078480-RR-21 | 10,078,480 | 25,516,910 | RR | 21 | 2171-11-03 18:17:00 | 2171-11-03 18:39:00 | INDICATION: ___ with confusion // infiltrate?
TECHNIQUE: Single portable view of the chest.
COMPARISON: ___.
FINDINGS:
Given differences in positioning and technique, there has been no significant
interval change. Bibasilar opacities are most likely due to superimposed soft
tissue structures and overlying material. Superiorly the lungs are clear. The
cardiomediastinal silhouette is stable. Leftward deviation of the trachea at
the thoracic inlet is suggestive of underlying right-sided thyroid
enlargement. Calcification suggesting intra-articular bodies project over the
glenohumeral joints.
IMPRESSION:
No acute cardiopulmonary process. Leftward deviation of the trachea at the
thoracic inlet as on prior suggestive right thyroid enlargement which can be
further assessed by dedicated thyroid ultrasound.
|
10078480-RR-23 | 10,078,480 | 25,516,910 | RR | 23 | 2171-11-04 15:32:00 | 2171-11-04 15:47:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ with worsening depression // eval for interval change from
MRI; ischemia;atrophy
TECHNIQUE: Contiguous axial MDCT images were obtained through the brain
without the administration of IV contrast. Reformatted coronal, sagittal and
thin section bone algorithm-reconstructed images were then generated.
DOSE: CTDIvol: 53.31 mGy
DLP: 891.93 mGy-cm
COMPARISON: Comparison is made to MRI head dated ___.
FINDINGS:
There is no evidence of acute intracranial hemorrhage, edema, mass effect, or
large territorial infarction. Prominent ventricles and sulci suggest
age-related involutional changes or atrophy. The basal cisterns appear patent
and there is preservation of gray-white matter differentiation.
There is significant degenerative changes of the left temporomandibular joint.
Mild mucosal thickening is seen within the left maxillary sinus which is also
notable for an 8 mm linear high-density structure within it, likely a foreign
body. Aerosolized secretions are noted within the left sphenoid sinus. The
remainder of the paranasal sinuses, mastoid air cells, and middle ear cavities
are clear.
IMPRESSION:
1. No acute intracranial hemorrhage or evidence of large territorial
infarction.
2. Moderate, global cerebral atrophy. Findings are similar as compared to the
patient's prior MRI dated ___.
3. 8 mm linear radiopaque foreign body identified within the left maxillary
sinus.
NOTIFICATION: Addition to WET was discussed by Dr. ___ on ___ by Dr. ___
|
10078805-RR-22 | 10,078,805 | 25,487,374 | RR | 22 | 2173-02-24 21:04:00 | 2173-02-24 21:58:00 | CLINICAL INFORMATION: ___ male with increased lower extremity pain
and swelling, question DVT.
COMPARISON: None.
TECHNIQUE AND FINDINGS: There is normal compressibility, color Doppler flow,
and response to augmentation within the left common femoral, superficial
femoral, and popliteal veins. There is normal flow in the peroneal and
posterior tibial veins of the calf.
IMPRESSION: No DVT of the left lower extremity.
|
10078805-RR-23 | 10,078,805 | 25,487,374 | RR | 23 | 2173-02-25 09:10:00 | 2173-02-25 11:57:00 | PA AND LATERAL CHEST, ___ 9:15 A.M.
HISTORY: Lower extremity edema and bilateral crackles.
IMPRESSION: PA and lateral chest reviewed in the absence of prior chest
radiographs:
Lung volumes are low, but clear. Heart size normal. No pleural abnormality.
Extensive degenerative change in the thoracic spine is consistent with loss of
height, kyphosis, osteophyte formation and disc space narrowing.
|
10079290-RR-7 | 10,079,290 | 25,728,335 | RR | 7 | 2143-04-01 14:10:00 | 2143-04-01 17:30:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ year old man with R thalamic stroke per report on OSH imaging
// Stroke?
TECHNIQUE: Contiguous axial images CT images were obtained through the brain
without administration of IV contrast. Reformatted coronal and sagittal and
thin section bone algorithm-reconstructed images were acquired.
DOSE: DLP: 1003.42 mGy-cm
CTDI: 55.20 mGy
COMPARISON: None.
FINDINGS:
There is no evidence of hemorrhage, edema, mass effect, or infarction. The
ventricles and sulci are normal in size and configuration. The basal cisterns
appear patent and there is preservation of gray-white matter differentiation.
A prominent perivascular spaces seen in the area of left internal capsule. A
subtle hypodensity is seen in the area of the right thalamus, which is of
unclear etiology, possibly representing a prominent perivascular space.
No fracture is identified. The visualized paranasal sinuses, mastoid air
cells, and middle ear cavities are clear. The globes are unremarkable.
IMPRESSION:
Subtle hypodensity in the area of the right thalamus, which is of unclear
etiology, possibly representing a prominent perivascular space. Further
evaluation can be performed with MRI if clinically indicated.
|
10079505-RR-19 | 10,079,505 | 21,829,299 | RR | 19 | 2170-08-20 14:21:00 | 2170-08-20 17:44:00 | EXAMINATION: SHOULDER 1 VIEW RIGHT
INDICATION: ___ year old woman with h/o recurrent falls, dementia who
presented s/p fall and R hip fracture // Shoulder fracture/displacement
Shoulder fracture/displacement
TECHNIQUE: Frontal view of the right shoulder.
COMPARISON: Chest radiograph dated ___, and ___.
FINDINGS:
There is a ___ lesion present in the humeral head, and a probable
Bankart lesion of the glenoid, suggesting prior shoulder dislocation. Numerous
right-sided healed rib fractures are again seen, resulting in marked a
deformity of the right chest wall. No radiopaque foreign body or subcutaneous
gas.
IMPRESSION:
1. ___ lesion within the humeral head and probable Bankart lesion of
the glenoid suggests prior shoulder dislocation.
2. Numerous healed right-sided rib fractures.
|
10079505-RR-20 | 10,079,505 | 21,829,299 | RR | 20 | 2170-08-20 20:49:00 | 2170-08-21 08:08:00 | INDICATION: ___ year old woman with falls, evidence of R shoulder fracture,
need axillary views to eval for dislocation // evidence of shoulder
dislocation
COMPARISON: Compared to radiographs from earlier today.
IMPRESSION:
There are no signs for glenohumeral joint dislocation on this single axillary
view. There is overall demineralization. No displaced fractures are seen.
|
10079505-RR-21 | 10,079,505 | 21,829,299 | RR | 21 | 2170-08-20 20:49:00 | 2170-08-21 08:33:00 | EXAMINATION: CHEST (SINGLE VIEW)
INDICATION: ___ year old woman with h/o recurrent falls, now with R hip
fracture and delirium // presence of PNA
COMPARISON: ___.
IMPRESSION:
Unchanged appearance of the right rib fractures. Moderate cardiomegaly
persists. Mild pulmonary edema is unchanged. No new focal parenchymal
opacities, in particular no pneumonia. No pleural effusions.
|
10079632-RR-18 | 10,079,632 | 26,559,290 | RR | 18 | 2119-09-19 01:04:00 | 2119-09-19 02:04:00 | EXAMINATION: PELVIS U.S., TRANSVAGINAL
INDICATION: ___ presenting with vaginal bleeding after elective medical
abortion on ___ without complications. Reports heavy bleeding and
passing large clots. Assess for retained products of conception.
LMP: ___
TECHNIQUE: Grayscale ultrasound images of the pelvis were obtained with
transabdominal approach followed by transvaginal approach for further
delineation of uterine and ovarian anatomy.
COMPARISON: None
FINDINGS:
The uterus is anteverted and measures 8.2 x 5.3 x 6.2 cm. There is
heterogeneous tissue within the endometrial cavity measuring approximately 4.3
x 2.9 x 2.4 cm with internal vascularity, compatible with retained products of
conception.
The right ovary is mildly enlarged, secondary to the presence of a 4.2 x 2.4 x
3.6 cm simple cyst. The compressed right ovarian parenchyma demonstrates
normal color flow and spectral waveforms.
The left ovary is normal in size and contains a cystic corpus luteum. The
left ovary also demonstrates normal color flow and spectral waveforms.
Trace amount of pelvic fluid is noted.
IMPRESSION:
1. Heterogeneous tissue in the endometrial canal with internal vascularity,
compatible with retained products of conception.
2. 4.2 cm simple cyst in the right ovary.
|
10079632-RR-19 | 10,079,632 | 26,559,290 | RR | 19 | 2119-09-19 09:41:00 | 2119-09-19 17:31:00 | EXAMINATION: US INTRA-OP ___ MINS
INDICATION: ___ year old woman with rPOCs, endometritis, bleeding, going for D
C// intra-op guidance for D C
TECHNIQUE: Intraoperative ultrasound guidance was provided to Dr. ___
during a dilatation and curettage.
COMPARISON: Ultrasound ___
FINDINGS:
Initial images demonstrate heterogeneous echogenic tissue in the mid-lower
uterine segment without definite internal vascularity identified.
Subsequent imaging obtained during the procedure demonstrates increased fluid
and echogenic debris within the endometrial cavity compatible with blood
products and fluid from the procedure.
Final imaging demonstrates a homogeneous endometrium measuring up to 9 mm
without internal vascularity. No evidence of retained products of conception.
Small echogenic foci within the lower uterine segment and mid uterus
endometrial cavity are compatible with air introduced during the procedure.
IMPRESSION:
1. Intraoperative ultrasound guidance during dilatation and curettage. No
evidence of retained products of conception following the procedure.
|
10080421-RR-12 | 10,080,421 | 27,045,826 | RR | 12 | 2183-05-24 07:20:00 | 2183-05-24 08:45:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with L hip fracture // Preoperative evaluation
Surg: ___ (hip fracture repair) Preoperative evaluation
IMPRESSION:
In comparison with the study of ___, the patient has taken a better
inspiration. Cardiac silhouette is within upper limits of normal in size and
there is tortuosity of the descending thoracic aorta. No evidence of acute
pneumonia, vascular congestion, or pleural effusion.
|
10080421-RR-13 | 10,080,421 | 27,045,826 | RR | 13 | 2183-05-24 11:18:00 | 2183-05-24 13:26:00 | EXAMINATION: HIP UNILAT MIN 2 VIEWS LEFT IN O.R.
INDICATION: LEFT HIP FX ORIF
IMPRESSION:
Images from the operating suite show placement of a fixation device about
previously described intertrochanteric fracture. Further information can be
gathered from the operative report.
|
10080421-RR-14 | 10,080,421 | 27,045,826 | RR | 14 | 2183-05-25 08:15:00 | 2183-05-25 09:15:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with respiratory distress. // respiratory
distress - stat cxr respiratory distress - stat cxr
IMPRESSION:
In comparison with the study of ___, there is little interval change.
Cardiac silhouette is within upper limits of normal and there is no vascular
congestion, pleural effusion, or acute focal pneumonia.
|
10080443-RR-20 | 10,080,443 | 24,427,299 | RR | 20 | 2126-04-18 04:37:00 | 2126-04-18 06:57:00 | INDICATION: ___ female with history of renal stones post-lithotripsy
in ___, new right abdominal pain and nausea, gastric banding in ___.
COMPARISON: CT from ___, renal ultrasound from ___, and upper GI
___.
TECHNIQUE: Helical MDCT images were acquired from the lung bases through the
greater trochanters without intravenous or oral contrast, per the CT urogram
protocol in prone position. 5-mm axial, coronal, and sagittal multiplanar
reformats were generated. Intravenous contrast was not administered due to
the patient's elevated creatinine of 1.6.
FINDINGS: 2- and 1-mm nodules in the lateral and posterior basal segments of
the right lower lobe are unchanged since ___. There is mild bibasilar
atelectasis. No pleural effusions. Heart is normal in size, with physiologic
pericardial fluid. Note is made of a small sliding hiatal hernia.
ABDOMEN: There has been antegrade propagation of the 12-mm right renal stone
into the proximal ureter. This causes obstruction, with marked ureteral wall
thickening and moderate upstream hydronephrosis. There is significant
periureteral fat stranding and perirenal edema, but no frank fluid
collections.
There is a 2-mm non-obstructing stone in the left lower renal pole. Left
gonadal venous collaterals persist, suggesting remote thrombosis. The
adrenals are normal.
There is moderate fatty infiltration of the liver. Calcified stone is noted
in a nondistended gallbladder without wall edema, fat stranding, or
pericholecystic fluid. The pancreas is unremarkable. There is no intra- or
extra-hepatic biliary ductal dilation. The spleen is normal in size.
A laparoscopic band is noted surrounding the gastric cardia, without
extraluminal fluid or air to suggest leak or obstruction. The band port
courses through the left upper quadrant, with port in the subcutaneous fat.
The stomach and small bowel are normal.
PELVIS: The cecum is posteriorly folded. Appendix, colon, and rectum are
normal. The bladder and distal ureters and unremarkable. Uterus and ovaries
are normal, other than calcification in the left adnexa.
Prominent retrocaval lymph nodes measure up to 6 mm. There is no free
intraperitoneal air.
IMPRESSION:
1. 12-mm obstructing right proximal ureteral stone, with moderate
hydronephrosis.
2. Cholelithiasis.
3. Fatty liver.
4. Laparoscopic gastric band, without complications.
5. Normal appendix.
|
10080443-RR-21 | 10,080,443 | 24,427,299 | RR | 21 | 2126-04-18 16:04:00 | 2126-04-18 17:44:00 | INDICATION: ___ female with right stent placement and retrograde
urethrogram.
COMPARISONS: None.
FINDINGS: Fluoroscopic assistance was provided to the surgeon without the
radiologist present. Six fluoroscopic spot views demonstrate a right
retrograde urogram and placement of a ureteral stent coiled in the right renal
pelvis. For further details, please refer to the operative note.
|
10080443-RR-35 | 10,080,443 | 28,790,420 | RR | 35 | 2130-05-26 00:39:00 | 2130-05-26 02:12:00 | INDICATION: Evaluate for kidney stone or abscess in a patient with fever,
dysuria, hematuria, and history of infected kidney stone, now with persistent
fever and chills.
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: Acquisition sequence:
1) Spiral Acquisition 4.9 s, 53.5 cm; CTDIvol = 16.8 mGy (Body) DLP = 897.4
mGy-cm.
Total DLP (Body) = 897 mGy-cm.
COMPARISON: CT abdomen/pelvis from ___.
FINDINGS:
LOWER CHEST: The visualized lung bases are clear, without pleural or
pericardial effusion.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. A
hypodensity in the lateral right lobe (02:28) is compatible with a cyst or
biliary hamartoma. There is no evidence of intrahepatic or extrahepatic
biliary dilatation. The gallbladder contains stones within the fundus,
without wall thickening or surrounding inflammatory changes.
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 is homogeneous and normal in size.
ADRENALS: The adrenal glands are normal in caliber and configuration
bilaterally.
URINARY: The kidneys are symmetric and normal in size. In the left renal
pelvis is a 5 x 6 x 10 mm stone. There is no hydronephrosis to suggest
obstruction. In the right lower pole is a punctate hyperdensity which could
represent a nonobstructing stone. There is no evidence of focal renal lesions
within the limitations of an unenhanced scan. There is no perinephric
abnormality.
GASTROINTESTINAL: The patient is status post laparoscopic gastric banding.
The band appears to be normal in position. Small bowel loops are normal in
caliber, without wall thickening or evidence of obstruction. 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. No atherosclerotic disease
is noted. A left gonadal vein varix is again noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. 5 x 6 x 10 mm nonobstructing stone in the left renal pelvis. Punctate
nonobstructing stone in the lower pole of the right kidney. No fluid
collection to suggest abscess.
2. Cholelithiasis.
|
10080640-RR-7 | 10,080,640 | 21,161,576 | RR | 7 | 2169-06-29 12:46:00 | 2169-06-29 15:51:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ with blurry vision s/p fall 3 days ago, hx of chronic
subdural hematoma. According to the ___ medical record, the patient, who
is visiting from ___, has headaches since ___, and history of a left
tentorial subdural hematoma in ___, with multiple prior MRIs demonstrating
"stable subdural hematoma versus meningeal lesion" .
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast. Coronal and sagittal as well as thin bone-algorithm reconstructed
images were obtained.
DOSE: DLP: 1003 mGy-cm
CTDI: 109 mGy
COMPARISON: None.
FINDINGS:
There is an extra-axial hyperdensity along the lateral left tentorium
cerebelli measuring approximately 5 mm in thickness, image 601b:69, which
extends to the medial margin of the left transverse sinus. There is no acute
parenchymal hemorrhage, edema, or loss of gray/ white matter differentiation.
The ventricles and sulci are normal in size for patient's age. Subcortical,
deep, and periventricular white matter hypodensities are nonspecific, but
likely reflect sequelae of chronic small vessel ischemic disease. Dural
calcifications are incidentally noted along the left inferolateral cerebellar
margins.
No fracture seen. The partially visualized paranasal sinuses, mastoid air
cells, and middle ear cavities are clear.
IMPRESSION:
Acute subdural hematoma layering along the left tentorium cerebelli measuring
approximately 3 mm in depth.
COMMENTS ON ATTENDING REVIEW:
Given the patient's history, the small hyperdensity along the lateral left
tentorium may reflect chronic dural thickening or a meningeal lesion, though
acute hemorrhage is not excluded.
RECOMMENDATION(S): If prior studies cannot be obtained for comparison, then
follow up head CT in several days to 1 week would be helpful to assess for any
evolving recent blood products. Please refer to the concurrent MRI report for
further detail.
NOTIFICATION: Preliminary results of suspected acute subdural hematoma were
discussed with Dr. ___ by Dr. ___ telephone at 3:30pm on ___,
immediately following discovery.
|
10080640-RR-8 | 10,080,640 | 21,161,576 | RR | 8 | 2169-06-30 01:08:00 | 2169-06-30 13:21:00 | EXAMINATION: MR HEAD W AND W/O CONTRAST
INDICATION: ___ year old woman with left tentorial subdural hematoma versus
meningeal lesion, please evaluate.According to the ___ medical record, the
patient, who is visiting from ___, has headaches since ___, and history
of a left tentorial subdural hematoma in ___, with multiple prior MRIs
demonstrating stable subdural hematoma versus meningeal lesion.
TECHNIQUE: Sagittal T1 weighted, and axial T1 weighted, T2 weighted, FLAIR,
gradient echo, and diffusion-weighted images of the brain were obtained.
Following intravenous gadolinium administration, axial T1 weighted images of
the brain and sagittal MPRAGE images of the brain with multiplanar
reformations were obtained.
COMPARISON: Noncontrast head CT ___. Prior outside MRIs are not
available.
FINDINGS:
Postcontrast MP RAGE images demonstrate linear contrast enhancement along the
lateral left tentorium, measuring up to 5 mm in thickness on image 101:82.
There is corresponding isointensity to the brain parenchyma on sagittal and
axial precontrast T1 weighted images, and faint low signal on T2 weighted
images. On gradient echo images, evaluation of this area is not possible due
to susceptibility artifact from the air in the adjacent mastoid. On the
preceding CT, there is hyperdensity in this location. This abnormality is
contiguous with the left transverse sinus, which is patent. Other major dural
venous sinuses are patent as well.
In the brain parenchyma, there is no acute infarction, edema, mass effect,
evidence for blood products or pathologic contrast enhancement. Discrete and
confluent foci of high T2 signal in the subcortical, deep, and periventricular
white matter of the cerebral hemispheres are nonspecific, but likely sequela
of chronic small vessel ischemic disease in a patient of this age. Ventricles
and sulci are normal in size for age. Major arterial flow voids are grossly
preserved.
IMPRESSION:
Linear enhancement along the lateral aspect of the left tentorium, contiguous
with the patent left transverse sinus, with corresponding hyperdensity on the
preceding CT. The enhancement is compatible with either chronic dural
thickening secondary to prior hematoma or with a meningioma. The hyperdensity
may be seen in a meningioma, but acute blood products cannot be excluded
without comparison to prior CTs.
RECOMMENDATION(S):
If it is not possible to obtain prior CTs and MRIs for comparison, then follow
up head CT in several days to one week would be helpful to assess for any
evolving recent blood products.
|
10080679-RR-12 | 10,080,679 | 20,345,216 | RR | 12 | 2155-02-28 04:06:00 | 2155-02-28 05:16:00 | INDICATION: Right lower quadrant pain with possible appendicitis seen on
bedside ultrasound. Please evaluate for evidence of appendicitis.
COMPARISON: None.
FINDINGS: Sonographic evaluation of the right lower abdominal quadrant in the
region of the patient's pain demonstrates a noncompressible blind-ending
tubular structure arising from the expected location of the cecum, likely the
appendix. This structure measures up to 1.3 cm in caliber and contains
heterogeneous debris. There is no significant surrounding hyperemia. No
periappendiceal fluid collection is identified.
IMPRESSION: Findings consistent with acute appendicitis. No drainable fluid
collection.
|
10080928-RR-66 | 10,080,928 | 25,710,110 | RR | 66 | 2202-09-08 00:02:00 | 2202-09-08 06:05:00 | INDICATION: Shortness of breath and chest pain, abdominal pain, evaluate for
pulmonary embolism and large abdominal aneurysm.
COMPARISON: CT chest on ___ and CT abdomen and pelvis on
___.
TECHNIQUE: MDCT images were obtained through the chest, abdomen and pelvis
following the administration of IV contrast.
FINDINGS:
CHEST: There is no axillary, mediastinal, or hilar lymphadenopathy. The
aorta is normal in caliber. There are no filling defects in the pulmonary
artery to the subsegmental level. The airways are patent to the subsegmental
level. The esophagus appears normal. There is no pleural effusion or
pneumothorax. The heart and pericardium are unremarkable. There are coronary
artery calcifications. There is streaky atelectasis at the lung bases. No
focal consolidation is seen. There is a 5 mm nodule seen in the right middle
lobe, similar to study on ___. A subpleural nodule is seen
measuring 4 mm (2, 50), similar to ___.
ABDOMEN: A calcified granuloma is seen in the liver, similar to prior study.
There is perfusion anomaly in the posterior right lobe. There is significant
intrahepatic biliary duct dilatation, mainly involving the left lobe. There
is significant dilation of the common bile duct measuring up to 1.5 cm in
diameter. The gallbladder is significantly distended with cholelithiasis.
There is no evidence of bowel wall thickening or pericholecystic fluid. The
pancreas is unremarkable. The spleen is normal. There is a 1.3 cm cyst in
the upper pole of the left kidney. Otherwise, the kidneys are unremarkable.
There is no hydronephrosis. There is no mesenteric or retroperitoneal
lymphadenopathy. The pancreatic duct is dilated.
The stomach appears normal. There are dilated loops of small and large bowel,
indicating possible ileus. There is no evidence of obstruction.
PELVIS: The bladder and terminal ureters are unremarkable. Prostate and
seminal vesicles are normal. The rectum is unremarkable. There is no free
fluid in the pelvis. There is no pelvic or inguinal lymphadenopathy.
CTA: The intra-abdominal vasculature is patent. There are scattered aortic
calcifications. There are no aneurysms identified. No evidence of
dissection.
The celiac artery and its major branches are patent. SMA and its major
branches are patent. Some calcifications of the splenic artery. The ___ is
patent.
IMPRESSION:
1. Distended gallbladder with cholelithiasis and a significantly dilated
common bile duct and pancreatic duct. There is no definite pericholecystic
fluid or gallbladder wall thickening. Moderate intrahepatic biliary duct
dilatation.
2. No evidence of pulmonary embolism.
3. Stable pulmonary nodules.
4. Right lower lobe consolidation may represent aspiration.
|
10080928-RR-67 | 10,080,928 | 25,710,110 | RR | 67 | 2202-09-08 00:13:00 | 2202-09-08 06:37:00 | INDICATION: History of knee surgery last week, question effusion or fracture.
COMPARISON: Knee radiographs on ___.
FINDINGS: Again seen is total knee replacement and the hardware appears in
appropriate position without evidence of complication. There is no fracture
identified. There is a moderate-sized joint effusion, decreased from the
prior study. Skin staples are again seen anteriorly.
IMPRESSION: No evidence of hardware complication.
|
10080928-RR-68 | 10,080,928 | 25,710,110 | RR | 68 | 2202-09-08 01:19:00 | 2202-09-08 02:35:00 | INDICATION: Hypotension and LFT abnormality, question of acute cholecystitis.
COMPARISON: CTA torso on ___.
Abdominal ultrasound on ___.
FINDINGS: The liver is of normal echogenicity, and there are no focal liver
lesions. The gallbladder is very distended and filled with likely sludge and
stones. There is no definite pericholecystic fluid or wall thickening. The
common bile duct is very dilated and measures 1.1 cm in diameter.
IMPRESSION: Very distended gallbladder filled with sludge and stones and a
very dilated common bile duct. This may represent acute cholecystitis.
|
10080928-RR-69 | 10,080,928 | 25,710,110 | RR | 69 | 2202-09-08 01:43:00 | 2202-09-08 06:39:00 | INDICATION: Right IJ line placement, question pneumothorax.
COMPARISON: Chest radiograph on ___ at 22:53.
FINDINGS: There is mild right basilar atelectasis. Right internal jugular
central venous catheter ends at or just below the cavoatrial junction. There
is no focal consolidation. There is no pleural effusion or pneumothorax.
There is a slight increase in density in the right paratracheal area which may
represent mild bleeding from line placement. The heart size is normal.
IMPRESSION:
1. Right IJ ends either at or just below the superior cavoatrial junction.
Slight increase in density in the right paratracheal mediastinum may represent
mild bleeding from line placement. Attention on follow up.
2. Right basilar atelectasis. No focal consolidation.
|
10080928-RR-70 | 10,080,928 | 25,710,110 | RR | 70 | 2202-09-11 15:38:00 | 2202-09-11 18:46:00 | INDICATION: ___ male with abdominal pain, dilated gallbladder and
common bile duct, ERCP failed secondary to prior post-surgical anatomy.
Patient also had fevers recently.
PHYSICIANS: ___, M.D., fellow, performed the procedure. ___
___, M.D., attending, was present and supervising the procedure.
MEDICATIONS: General anesthesia was administered by the anesthesiologist.In
addition the patient received 10 mL of 0.5% bupivacaine along the access path.
PROCEDURES:
1. Percutaneous transhepatic biliary drainage via right lobe access.
2. Crossing of distal CBD stenosis
3. Brush and forcep biopsies of the distal CBD.
PROCEDURE DETAILS: Informed consent was obtained from the patient. He was
positioned supine. Following anesthesia timeout, anesthesia was induced. The
area was then prepped and draped in sterile fashion. We then had procedural
timeout. Fluoroscopy was used intermittently.
With ultrasound guidance multiple passes were made with a 21-gauge Cook needle
into the lower right hepatic lobe in a mid axillary line below the rib cage.
Care was taken to avoid the dilated gallbladder .A prominent right posterior
duct was opacified . With a second puncture, a duct in the lower right lobe
was targeted and accessed first with the needle. Injection of contrast
confirmed position and an 035 nitinol wire was then passed centrally. Aver the
wire the AccuStick sheath was placed. Through the sheath an 0.035 wire was
then positioned into the common bile duct and over this wire, a 6 ___ x 35
cm sheath was placed. Contrast injection was done intermittently to confirm
position within the biliary tree. See below regarding findings. With minimal
manipulation, we managed to advance the wire through the ampulla into the
duodenum. We then advanced the sheath into the bowel and placed a safety wire
into the bowel and then replaced the sheath over the second working wire.
Over this wire, we performed a limited over-the-wire cholangiogram to define
the narrowing of the distal common bile duct. Several passes were made with
the a biopsy brush system at the distal common bile duct stricture as well as
with the forceps radial jaw device. Samples were sent to cytology and
pathology, respectively.
We then placed an internal-external 8 ___ biliary drain which was attached
to the skin with a zero silk suture and adhesive device and covered with an
appropriate dressing. This was connected to leg bag for gravity drainage.
The patient was extubated in the room and transferred to the PACU in good
condition.
There were no immediate complications.
FINDINGS:
Mild intrahepatic bile duct dilatation. As seen on prior imaging the common
bile duct was quite dilated as was gallbladder. Interestingly, the contrast
injected into the common bile duct rapidly flowed into the gallbladder
suggesting a widely patent cystic duct, however, no flow was seen through the
ampulla into the duodenum. The resistance of this was so low that it was
difficult to see if there was truly obstruction at the ampulla or not as all
the contrast injected instead flowed into the gallbladder. However, given the
overall clinical picture, there is suspicion for ampullary stenosis versus
sphincter of Oddi dysfunction.
CONCLUSION:
Uncomplicated right lobe percutaneous transhepatic biliary drain as above with
biopsies and ___ internal-external drain placement.
As above the findings suggest ampullary stricture versus sphincter of Oddi
dysfunction; pathology will be pending.
Of note, the cystic duct appeared patent.
Plan for gravity bag drainage for the immediate future and can consider
capping trial on ___ hours.
|
10080928-RR-71 | 10,080,928 | 25,710,110 | RR | 71 | 2202-09-15 15:44:00 | 2202-09-15 19:31:00 | INDICATION: ___ man with cholangitis and PTBD with leakage from
around the PTBD when capped. Please perform cholangiogram with possible tube
change.
COMPARISON: PTBD placement ___.
PHYSICIANS: Dr. ___ (resident) and Dr. ___ (attending)
performed the procedure. Dr. ___ was present for and supervised the entire
procedure.
MEDICATIONS: A total of 150 mcg fentanyl and 2 mg Versed were administered
over a total in-service time of 55 minutes, during which time the patient's
hemodynamic parameters were continuously monitored.
FLUOROSCOPY TIME: 7.3 minutes.
PROCEDURES:
1. Cholangiogram.
2. Brushings and forceps biopsy.
3. Balloon dilation at the ampulla up to 10 mm.
4. Exchange of the 8 ___ drain for a 10 ___ internal-external biliary
drain.
PROCEDURE DETAILS: After discussing the risks, benefits and alternatives to
the procedure, written informed consent was obtained. The patient was brought
to the angiography suite and placed supine on the imaging table. The right
upper quadrant at the existing catheter site was prepped and draped in the
usual sterile fashion. A preprocedure timeout was performed using three
unique patient identifiers per ___ protocol. Fluoroscopy was used
intermittently.
Contrast was injected into the existing 8 ___ biliary drain for the
cholangiogram, demonstrating occlusion of the distal 8 ___ catheter with
opacification of the bile ducts only. Multiple projections during the
cholangiogram showed a shelf-like ampulla. The existing 8 ___ catheter was
cut at the hub and ___ wire was advanced via the catheter into the
bowel. The existing catheter was exchanged for a 6 ___ sheath. An Amplatz
wire was advanced through the sheath as a safety wire. The sheath was removed
and advanced over the ___ wire only. Due to the shelf-like ampulla,
brushings and forceps were performed. The sheath was removed and advanced
over the Amplatz wire. Balloon dilation was performed using 8 mm and 10 mm
balloons, which showed a minimal waist, which resolved with balloon dilation.
The balloon and 6 ___ sheath were removed. A new 10 ___
internal-external biliary drain was advanced over the Amplatz wire. The wire
was removed, and the pigtail formed. The biliary drain was attached to the
skin with 0 silk suture. A sterile dressing was applied and the drain was
connected to a bag for gravity drainage.
The patient tolerated the procedure well without immediate post-procedure
complications.
KEY FINDINGS:
1. Existing 8 ___ distal internal-external biliary drain is clogged.
2. Persistent patulous common bile duct. On some images, the ampulla appeared
more shelf-like, so additional brush and forcep biopsies were obtained.
Dilatation of the ampulla demonstrated a minimal waist when dilated upto a 10
mm balloon. Shelf-like ampulla on some projections.
3. ___ PTBD placed.
IMPRESSION: Exchange of existing malfunctioning ___ PTBD for a larger ___
PRBD, with additional sampling and dilatation of the ampulla as described.
The findings and procedure were discussed with Dr. ___
(surgery intern) upon procedure completion at 5:45 p.m., ___.
|
10080928-RR-77 | 10,080,928 | 22,443,768 | RR | 77 | 2203-01-16 10:46:00 | 2203-01-16 12:06:00 | CHEST RADIOGRAPHS
HISTORY: Abdominal and chest pain. Recent percutaneous cholecystostomy.
COMPARISONS: ___ and ___.
TECHNIQUE: Chest radiographs.
FINDINGS:
A pigtail catheter projects over the right upper quadrant. A metallic stent
also projects over the midline, recently deployed. It is vertical in
orientation and situated near the midline. The metallic stent is somewhat
distal to where a new pigtail stent was placed. It is somewhat distal to the
remaining revised internal-external pigtail biliary drain. Correlation with
procedure related findings is recommended.
The cardiac, mediastinal and hilar contours appear unchanged. There is a
patchy focal opacity in the left upper lung, which is non-specific.
Atelectasis, aspiration or pneumonia could be considered although atelectasis
may be implied by coinciding volume loss. Small pleural effusions are
difficult to exclude. There is no pneumothorax.
IMPRESSION: Patchy nonspecific opacities in the left upper lung with a mild
overall volume loss in the left hemithorax. Correlation with procedure
findings is suggested regarding the location of the biliary stents.
|
10080928-RR-79 | 10,080,928 | 22,443,768 | RR | 79 | 2203-01-17 14:52:00 | 2203-01-17 17:39:00 | HISTORY: ___ man with history of gastric surgery, PTBD performed
showing mid distal CBD stricture. Patient underwent metallic stent placement
___ and presents for followup cholangiogram, possible drain
removal.
COMPARISON: Biliary catheter check ___
MEDICATION: The patient received 25 mcg of fentanyl
RADIATION: Total radiation dose was 182 mGy, 11 min 3 seconds fluoroscopy
time.
PHYSICIANS: Dr. ___ (radiology fellow), Dr. ___
___ (radiology resident),Dr. ___ (radiology attending)and Dr. ___
___ (radiology attending), who was present troughout and supervised the
proceudre .
PROCEDURE:
Following discussion of the risks, benefits and alternatives to the procedure
informed written patient consent was obtained. The patient was brought to the
angiographic suite and placed supine on the table. A preprocedure time out
was performed using 3 patient identifiers. The skin of the anterior abdominal
wall was prepped and draped in the usual sterile fashion.
The indwelling ___ anchor drain had been pulled back and in fact was not
within the tract at all. Approximately 5 cc of 1% lidocaine was infiltrated
into the skin and subcutaneous tissues for local anesthesia along with topical
lidocaine gel. Using a 4 ___ dilator, a small injection of contrast
opacified the tract and using a combination of a glidewire and the 4 ___
catheter we were able to re-access the biliary tree via the existing tract.
Injection of contrast at this time demonstrated a dilated common bile duct
with no flow of contrast through the Luminex stent. The glidewire was
exchanged for ___ wire was positioned in the duodenum. The 4 ___
dilator was exchanged for a 7 ___ bright tip sheath positioned above the
level of the stent. A ___ balloon was used to sweep the stent, pushing
presumed debris distally into the bowel. The following this maneuver,
injection of contrast via the sheath showed flow of contrast into the duodenum
however there was an apparent persistent narrowing in the middle ___ of the
stent. Therefore a 10 mm balloon was selected and inflated in the narrowed
portion of the stent ( no waist was identified ). Repeat injection of
contrast after this showed improved flow through the stent into the duodenum.
A 10 ___ de-strung biliary drain was positioned through the stent. The
wire was removed. The drain was capped and secured to the skin with a Stat
Lock device and a 0 silk suture. There were no immediate postprocedure
complications.
IMPRESSION:
1. Complete displacement of the anchor drain with succesful reaccessing of
the tract.
2. Holdup of contrast in the mid portion of the CBD stent.
3. Balloon dilatation and ___ balloon sweep of the area of narrowing
within the CBD stent
4. Placement of a new capped ___ de-strung biliary drain through the stent.
|
10080961-RR-37 | 10,080,961 | 26,875,005 | RR | 37 | 2140-03-27 08:56:00 | 2140-03-27 10:24:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old woman ESRD s/p LURT 2 months ago, nonproductive cough
x 2 weeks, ?infiltrate on ___ CXR // eval for pneumonia
COMPARISON: ___.
IMPRESSION:
As compared to the previous radiograph, the appearance of the cardiac
silhouette and of the right lung is unchanged. On the left, there is minimal
elevation of the hemidiaphragm and a small platelike atelectasis at the left
lung bases. No evidence of pneumonia.
|
10081375-RR-6 | 10,081,375 | 26,017,796 | RR | 6 | 2179-07-05 14:47:00 | 2179-07-05 15:24:00 | EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ with ?portal vein thrombus on CT// thrombus, cirrhosis,
ascites
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: None.
FINDINGS:
LIVER: The liver is coarsened and nodular in echotexture. The contour of the
liver is nodular, consistent with cirrhosis. There is no focal liver mass. The
main portal vein is patent with hepatopetal flow. There is small amount of
ascites. There is also a right pleural effusion.
BILE DUCTS: There is no intrahepatic biliary dilation. The CHD measures 4.5
mm.
GALLBLADDER: There is no evidence of stones or gallbladder wall thickening.
PANCREAS: The pancreas is not well visualized, largely obscured by overlying
bowel gas.
SPLEEN: Normal echogenicity, measuring 20.2 cm.
KIDNEYS: Limited views of the bilateral kidneys show no hydronephrosis.
RETROPERITONEUM: The visualized portions of aorta and IVC are within normal
limits.
IMPRESSION:
1. Cirrhotic liver with splenomegaly and small amount of ascites.
2. The main portal vein is patent with normal hepatopetal flow. Region of
eccentric partial thrombus seen within the proximal main portal vein and
portion of the SMV was better seen by same-day CT scan.
3. Right pleural effusion.
|
10081375-RR-7 | 10,081,375 | 26,017,796 | RR | 7 | 2179-07-05 15:21:00 | 2179-07-05 15:59:00 | INDICATION: ___ with cough, fever// pna
TECHNIQUE: Chest: Frontal and Lateral
COMPARISON: Chest radiograph performed 6 hours earlier on the same day ___. correlation also made to CT abdomen from earlier the same day, ___.
FINDINGS:
Relatively linear right basilar opacity is are noted in addition to a small
right pleural effusion. When reviewed in conjunction with prior CT, there is
likely component of rounded atelectasis. No definite superimposed acute
cardiopulmonary process. The cardiac and mediastinal silhouettes are
unremarkable.
IMPRESSION:
Small right pleural effusion. Superimposed opacity at the right lung base was
better characterized by same-day CT abdomen as being related to rounded
atelectasis and likely scarring.
|
10081375-RR-8 | 10,081,375 | 26,017,796 | RR | 8 | 2179-07-06 08:10:00 | 2179-07-06 10:24:00 | EXAMINATION: Second opinion of CT abdomen and pelvis
INDICATION: ___ year old man with cirrhosis presenting with GI bleed with read
noting possible portal venous thrombus. Evaluate for portal venous thrombus.
TECHNIQUE: Not available as this study was performed at an outside
institution.
DOSE: Not available as this study was performed at an outside institution.
COMPARISON: None.
FINDINGS:
LOWER CHEST: There is a small right pleural effusion and right basilar
atelectasis.
ABDOMEN:
HEPATOBILIARY: The liver is shrunken with nodular borders compatible with a
cirrhotic morphology. There is no evidence of focal lesions. There is no
evidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder
is within normal limits. There is a nonocclusive filling defect in the main
portal vein (series 2:32) with adjacent eccentric linear calcification (series
4:65). There is also a nonocclusive filling defect in the superior mesenteric
vein near the portal splenic confluence (series 2: 41) with adjacent eccentric
linear calcification (series 2:37). There is moderate volume ascites. There
are esophageal, perigastric, and parasplenic varices
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen is enlarged measuring 18.3 cm in craniocaudal length.
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. There is wall thickening of
the fourth portion of the duodenum. There is wall thickening of the ascending
colon. There is sigmoid diverticulosis without evidence of diverticulitis.
There is no evidence of obstruction.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: The prostate is not enlarged.
LYMPH NODES: There is no mesenteric retroperitoneal, pelvic, or inguinal
lymphadenopathy.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
There are moderate degenerative changes of the lumbar spine.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. Limited by a poor contrast bolus and poor opacification of the portal
venous system. Within these limitations, there is nonocclusive thrombosis in
the main portal vein and also the superior mesenteric vein. In addition,
there are eccentric linear calcifications adjacent to these areas of
nonocclusive thrombosis which may suggest a chronic component. Correlation
with any available prior imaging is recommended.
2. There is wall thickening of the ascending colon which is nonspecific and
could be secondary to inflammation or portal colopathy.
3. Wall thickening of the fourth portion of the duodenum which could be
secondary to inflammation.
4. Cirrhotic morphology liver with moderate volume ascites, varices, and
splenomegaly.
|
10081525-RR-16 | 10,081,525 | 28,566,281 | RR | 16 | 2148-01-27 23:42:00 | 2148-01-28 01:44:00 | INDICATION: Stat transfer from fall with multiple rib fractures and other
processes.
COMPARISONS: None.
TECHNIQUE: Portable supine chest radiograph.
FINDINGS: The lungs are low in volume, but clear. Cardiomediastinal contours
are unremarkable with normal heart size. Displaced fracture of the one of the
left lower ribs is noted without definite pneumothorax or pleural effusion on
this supine film. Note, the right costophrenic angle is excluded, but the
patient was ___ transferred to the operating room, so repeat images
were not obtained.
|
10081525-RR-17 | 10,081,525 | 28,566,281 | RR | 17 | 2148-01-28 03:20:00 | 2148-01-28 16:08:00 | HISTORY: NG tube placement. Status post trauma.
TECHNIQUE: Portable AP chest.
COMPARISON: Chest radiograph and CT torso ___.
FINDINGS:
The NG tube terminates in the fundus of the stomach. Surgical staples project
over the midline abdomen. Lung volumes are low and the bibasilar atelectasis
is mild. The heart may be mildly enlarged however this is exaggerated by the
low lung volumes. The mediastinum is normal. There is no pneumothorax or
large pleural effusion.
IMPRESSION:
1. The NG tube terminates in the fundus of the stomach.
2. Lung volumes are low and bibasilar atelectasis is mild.
|
10081525-RR-18 | 10,081,525 | 28,566,281 | RR | 18 | 2148-01-31 05:23:00 | 2148-01-31 13:13:00 | HISTORY: Status post fall, status post ex lap, splenectomy now with cough,
sputum production, desats. Evaluate for pneumonia.
TECHNIQUE: Portable AP chest.
COMPARISON: Chest radiograph ___.
FINDINGS:
Lung volumes are low but improved since the next most recent radiograph.
Bibasilar atelectasis is worse on the left but unchanged on the right. There
is likely a new small left pleural effusion. The cardiomediastinal silhouette
and hilar contours are normal. There is no pneumothorax. An NG tube
terminates in the stomach.
IMPRESSION:
1. Bibasilar atelectasis is worse on the left and unchanged on the right. A
new small left pleural effusion is likely present.
2. There are no focal airspace opacities to suggest pneumonia.
The above results were communicated via telephone by Dr. ___ to Dr. ___
at 09:25 a.m. on ___.
|
10081525-RR-19 | 10,081,525 | 28,566,281 | RR | 19 | 2148-01-31 20:06:00 | 2148-02-01 00:16:00 | INDICATION: Fall down five stairs with shattered spleen, splenectomy on
___, now with tachycardia and desaturations. Evaluate for pulmonary
embolism.
COMPARISON: CT torso from ___ dated ___.
TECHNIQUE: Helical MDCT images were acquired through the chest following the
uneventful administration of 100 cc of intravenous Omnipaque. 2.5 and 1.25 mm
axial, 5 mm coronal and sagittal multiplanar reformats were created. 15 mm
maximum intensity projection bilateral oblique images were reformatted.
FINDINGS: Again seen are acute non-displaced fractures of the left third
through ninth lateral ribs. Mildly displaced fractures of the left fourth
through ninth posterior ribs, with one-half to one shaft width posterior
displacement of the medial fragments. Interval increase in moderate-to-large
hemorrhagic pleural effusion, with tiny non-dependent locules of air (2:16),
indicating pleural laceration.
There is mild, apical-predominant centrilobular and paraseptal emphysema with
new smooth septal thickening, suggesting a component of pulmonary edema. Mild
diffuse peribronchial wall thickening persists. Several areas of mucoid
impaction have developed, leading to complete left lower lobe collapse, as
well as near-complete collapse of the posterior and lateral basal segments of
the right lower lobe. Numerous ground-glass centrilobular opacities have
developed in a ___ distribution, concentrated in the right lower
lobe and lingula, and to a lesser extent in the upper lobes.
Evaluation of the pulmonary arterial system is suboptimal due to contrast
bolus timing. However, there is no main, branch, lobar, or proximal segmental
pulmonary embolus. Thoracic aorta is normal in caliber, with scattered
calcifications, but no flow-limiting stenosis. Heart is normal in size, with
physiologic pericardial fluid and no right heart strain.
Interval development of multiple prominent intrathoracic nodes measuring up to
9 mm in short axis in the superior right paratracheal, 13 mm in the right
hilar, 9 mm in the left hilar, 3.6 x 1.9 cm in the subcarinal, 14 mm in the
right pulmonic, and 10 mm in the left pulmonic stations, likely reactive.
Thyroid gland is normal.
Note is made of a large interaortico-bronchial esophageal diverticulum along
the left anterolateral wall, between the aortic arch and left mainstem
bronchus (601B:30).
Examination is not tailored for subdiaphragmatic evaluation, but reveals
interval splenectomy with trace hemorrhage and fat stranding in the surgical
bed.
IMPRESSION:
1. Left third-ninth lateral and fourth-ninth posterior rib fractures, with
segmental morphology. Increasing moderate-to-large hemorrhagic left pleural
effusion.
2. Chronic obstructive airways disease. New mucoid impaction with left lower
lobe and segmental right lower lobe collapse, as well as multifocal
aspiration.
3. No pulmonary embolism.
|
10081525-RR-20 | 10,081,525 | 28,566,281 | RR | 20 | 2148-02-04 11:31:00 | 2148-02-04 13:23:00 | PA AND LATERAL CHEST X-RAY
INDICATION: Patient with suspected pneumonia, antibiotics, rule out
consolidation.
COMPARISON: Multiple chest x-rays from ___ to ___.
FINDINGS:
There is no new lung consolidation. Snal left hemothorax secondary to rib
fractures have decreased with adjacent compressive atelectasis. Mediastinal
contours are normal. There is no pneumothorax. NG tube has been removed.
CONCLUSION:
There is no new lung consolidation.
|
10081573-RR-11 | 10,081,573 | 25,935,442 | RR | 11 | 2130-01-10 00:55:00 | 2130-01-10 03:19:00 | INDICATION: Status post motor vehicle collision with right rib fractures and
acetabular fractures. Evaluate for further injuries.
COMPARISONS: None.
TECHNIQUE: MDCT axial imaging was obtained from the thoracic inlet to the
pubic symphysis following the administration of intravenous contrast material.
Coronal and sagittal reformats were completed.
FINDINGS: The thyroid gland is unremarkable. There are no enlarged
supraclavicular, axillary, mediastinal or hilar lymph nodes. The aorta is of
normal caliber without evidence of acute aortic pathology. The heart and
pericardium are unremarkable and there is no pericardial effusion. Bibasilar
atelectasis is present. There is no pleural effusion or pneumothorax. The
esophagus is fluid filled. The airways are patent to subsegmental levels.
CT ABDOMEN WITH CONTRAST: The liver enhances homogenously without any focal
lesions or intra- or extra-hepatic biliary dilatation. The portal vein is
patent. The gallbladder, pancreas, spleen and adrenal glands are
unremarkable. The kidneys enhance and excrete contrast symmetrically without
any hydronephrosis. Tiny hypodensity in the lower pole of the right kidney is
too small to characterize, most likely a cyst. The stomach, small and
intra-abdominal large bowel is otherwise unremarkable. There is no free
fluid, free air or lymphadenopathy within the abdomen. The aorta and its
major branches are patent. There is no evidence of aortic aneurysm. There is
hazy mesentery and small lymph nodes as well as a collar of stranding in the
retroperitoneal fat around the aorta (2:72).
CT PELVIS: The bladder is collapsed with a Foley catheter within. The rectum
and sigmoid colon are unremarkable. The uterus is not visualized. There is
no free fluid, free air or lymphadenopathy within the pelvis.
OSSEOUS STRUCTURES: There are displaced fractures involving the right second
through fourth ribs. Anterior cervical spinal fusion hardware is incompletely
imaged. There is a comminuted fracture of the base of the left ilium as well
as a comminuted fracture of the posterior column of the left acetabulum with
associated posterior and superior subluxation of the left femoral head.
IMPRESSION:
1. No evidence of acute intrathoracic or intra-abdominal injury.
2. Displaced right second through fourth rib fractures.
3. Comminuted left acetabular fracture involving the base of the ileum and
the posterior column with associated posterior and superior subluxation of the
left femoral head.
4. Collar of hazy mesentery / retroperitoneal fat and small lymph nodes
surrounding the infrarenal abdominal aorta. Correlate with inflammatory
markers on a nonurgent basis, as vasculitis could have a similar appearance.
|
10081573-RR-12 | 10,081,573 | 25,935,442 | RR | 12 | 2130-01-10 10:18:00 | 2130-01-10 13:24:00 | LEFT FOOT
HISTORY: Left acetabular and rib fractures.
IMPRESSION: Three views of the left foot show no fracture or dislocation. A
hallux valgus deformity with degenerative changes of the first
metatarsophalangeal joint could be due in part to remote trauma and a healed
fracture with fusion of the distal metatarsal and sesamoid. Degenerative
cysts are noted at both the base of the first phalanx and in the head of the
metatarsal.
|
10081573-RR-13 | 10,081,573 | 25,935,442 | RR | 13 | 2130-01-11 08:32:00 | 2130-01-11 10:31:00 | STUDY: Pelvis, inlet and outlet views, ___.
CLINICAL HISTORY: Patient with left acetabular fracture. ORIF.
FINDINGS: Comparison is made to the CT scan from ___.
There are several acetabular plates and hardware seen within the left
acetabulum. There is improved alignment of the femoroacetabular joint.
Please refer to the operative note for additional details.
|
10081573-RR-8 | 10,081,573 | 25,935,442 | RR | 8 | 2130-01-10 00:39:00 | 2130-01-10 02:07:00 | INDICATION: ___ female with MVC from outside hospital with known rib
fractures and left acetabular fracture. Evaluate for intracranial hemorrhage
or skull fracture.
COMPARISON: None.
TECHNIQUE: MDCT axial imaging was obtained through the brain without the
administration of intravenous contrast material. Coronal and sagittal
reformats were completed.
DLP: 1025.72 mGy-cm.
CTDIvol: 61.62 mGy.
FINDINGS: There is no acute hemorrhage, edema, mass effect, or acute large
territorial infarction. The ventricles and sulci are normal in size and
configuration. There is slightly prominent bilateral frontal extra-axial
spaces. There is mild mucosal thickening of the ethmoidal air cells and of
the right maxillary sinus. The remainder of the paranasal sinuses, mastoid
air cells and middle ear cavities are clear. There is no acute fracture.
IMPRESSION: No acute intracranial process.
|
10081573-RR-9 | 10,081,573 | 25,935,442 | RR | 9 | 2130-01-10 00:39:00 | 2130-01-10 02:11:00 | INDICATION: ___ female status post MVC with rib and acetabular
fracture. Evaluate for fracture or malalignment.
COMPARISON: None.
TECHNIQUE: MDCT axial imaging was obtained through the cervical spine without
the administration of intravenous contrast material. Coronal and sagittal
reformats were completed.
DLP: 692.84 mGy-cm.
CTDIvol: 32.46 mGy.
FINDINGS: There is no acute fracture, traumatic malalignment, or prevertebral
soft tissue swelling. The patient is status post anterior fusion of C4
through C7 with intervertebral disc spacers at C4-C5, C5-C6 and C6-C7. There
is no evidence of hardware loosening. There is a small broad-based disc bulge
at C2-C3 without central canal stenosis. There is mild central canal stenosis
at C4-C5, C5-C6, and C6-C7 from posterior osteophytes. The lung apices are
clear. The thyroid gland is unremarkable. The remainder of the soft tissues
are unremarkable. The visualized paranasal sinuses and mastoid air cells are
clear.
IMPRESSION:
1. No evidence of fracture or traumatic malalignment.
2. Status post anterior fusion of C4 through C7.
|
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