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10081869-RR-19 | 10,081,869 | 24,176,922 | RR | 19 | 2188-06-10 01:47:00 | 2188-06-10 02:05:00 | EXAMINATION: CT CHEST W/O CONTRAST
INDICATION: History: ___ with spontaneous pneumothorax, prior pleurodesis.
// Evaluate for pneumothorax
TECHNIQUE: Multidetector helical scanning of the chest was performed without
intravenous contrast agent reconstructed as contiguous 5- and 1.25-mm thick
axial, 2.5-mm thick coronal and parasagittal, and 8 x 8 mm MIPs axial images.
DOSE: DLP: 218.78 mGy-cm.
COMPARISON: Chest radiograph ___, CT abdomen pelvis ___.
FINDINGS:
The thyroid is normal. Supraclavicular, axillary, mediastinal, and hilar lymph
nodes are not enlarged. Aorta and pulmonary arteries are normal size. Cardiac
configuration is normal and there is no appreciable coronary calcification.
Hypodensity of the blood pool relative to the myocardial wall is consistent
with anemia.
There is a large loculated right pneumothorax with a predominantly basal
component but also smaller apical components anteriorly and posteriorly. This
pneumothorax results in compression of aerated lung and partial collapse of
the right lower lobe. There is no left pneumothorax. There is a small
right-sided pleural effusion.
Airways are patent to subsegmental levels. There is no suspicious pulmonary
nodule or mass. Mild left basilar atelectasis is present.
An 8 mm simple cyst is seen in the right lobe of the liver. No osseous
lesions suspicious for malignancy or infection are present. There is no
fracture.
IMPRESSION:
Large loculated right pneumothorax with partial collapse of the right lower
lobe. A small right-sided pleural effusion is present.
|
10081869-RR-20 | 10,081,869 | 24,176,922 | RR | 20 | 2188-06-10 10:35:00 | 2188-06-10 13:40:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ with hx of spontaneous pneumothorax p/w dyspnea on exertion
and R lateral thoracic pain x 5 days, found to have large R pneumothorax on
CXR at OSH // eval PTX, new chest tube placement to suction, stat eval
PTX, chest tube placement, obtain at ***12pm ___
IMPRESSION:
In comparison with the study of ___ from an outside hospital, there
has been placement of a right pigtail catheter with some re-expansion of the
right lung. Nevertheless, there is still a substantial pneumothorax involving
the mid and lower zones. No evidence of residual tension component.
The left lung is clear.
|
10081869-RR-21 | 10,081,869 | 24,176,922 | RR | 21 | 2188-06-11 07:17:00 | 2188-06-11 08:54:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ with hx of spontaneous pneumothorax p/w dyspnea on exertion
and R lateral thoracic pain x 5 days, found to have large R pneumothorax on
CXR at OSH // eval PTX, chest tube placement, obtain at ***6am ___
eval PTX, chest tube placement, obtain at ***6am ___
IMPRESSION:
In comparison with the study of ___, the right pigtail catheter has
been substantially pulled back to lie in the region of the pneumothorax
involving the lower zone. There has been virtually complete re-expansion of
the right lung. The left lung remains clear.
|
10081869-RR-22 | 10,081,869 | 24,176,922 | RR | 22 | 2188-06-12 10:57:00 | 2188-06-12 12:40:00 | INDICATION: ___ with hx of spontaneous pneumothorax p/w dyspnea on exertion
and R lateral thoracic pain x 5 days, found to have large R pneumothorax on
CXR at OSH, S/P pig tail placement and Talc. Evaluate for pneumothorax.
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest radiographs from ___
FINDINGS:
Again seen is a right pneumothorax, slightly increased in size compared to ___, which may be due to expiratory phase at which current study was
taken. There is a small right pleural effusion, consistent with history of
interval talc pleurodesis. Right-sided pigtail catheter is again seen,
slightly superior in position compared to the prior exam.
IMPRESSION:
1. Persistent small right pneumothorax, may appear larger due to expiratory
phase.
2. New pleural effusion, likely due to interval top pleurodesis.
3. Apparent change and pigtail catheter. Please correlate clinically.
NOTIFICATION: The findings were discussed by Dr. ___ with Dr.
___ on the ___ ___ at 12:00 ___, 5 minutes after discovery
of the findings.
|
10081869-RR-23 | 10,081,869 | 24,176,922 | RR | 23 | 2188-06-12 16:22:00 | 2188-06-12 16:46:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with recurrent spont R ptx // s/p chest tube
clamped @1200, ptx?
IMPRESSION:
Right pigtail pleural catheter remains in place with persistent small right
apical pneumothorax and small loculated right basilar hydro pneumothorax.
Overall, there has not been a substantial change in the appearance of the
chest since the recent study performed several hr earlier.
|
10081869-RR-24 | 10,081,869 | 24,176,922 | RR | 24 | 2188-06-13 04:41:00 | 2188-06-13 09:30:00 | INDICATION: ___ year old woman with recurrent pneumothorax after 24 hrs
clamped chest tube.
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest radiographs from ___
FINDINGS:
There is similarly sized, small right pneumothorax with apical component with
increasing pleural effusion compared to the exam performed 12 hours earlier.
Right basal atelectasis is less conspicuous on this exam. There is a small
left pleural effusion. The pigtail catheter appears to be in similar
position. Heart size is within normal limits.Mediastinal and hilar contours
are unremarkable.
IMPRESSION:
Unchanged small right pneumothorax and slightly increased right pleural
effusion. Unchanged small left pleural effusion.
|
10081891-RR-17 | 10,081,891 | 27,752,151 | RR | 17 | 2128-01-19 11:38:00 | 2128-01-19 12:48:00 | INDICATION: Syncope and fall.
COMPARISON: Chest radiograph ___.
FINDINGS: Semi-erect AP and lateral images of the chest were obtained. There
are low lung volumes and resultant bibasilar atelectasis; otherwise the lungs
are clear without consolidation or pulmonary edema. Allowing for the
technique, the cardiomediastinal silhouette is within normal limits and
unchanged. There is no pneumothorax. Blunting of the bilateral costophrenic
angles greater on the left than on the right which is due to a small pleural
effusions. Mild multilevel thoracolumbar spondylosis is unchanged. There is
no free air beneath the right hemi-diaphragm.
IMPRESSION: Bilateral small pleural effusions, greater on the left than right.
No other acute intrathoracic process.
|
10081891-RR-18 | 10,081,891 | 27,752,151 | RR | 18 | 2128-01-19 11:28:00 | 2128-01-19 13:46:00 | INDICATION: Syncope and fall.
COMPARISON: CT head ___.
TECHNIQUE: MDCT axial images through the brain were obtained without the
administration of IV contrast. Coronal, sagittal and thin section bone
algorithm reconstruction images were obtained.
FINDINGS: There is no acute hemorrhage, edema, mass effect, or acute
territorial infarction. Prominent ventricles and sulci likely indicate
age-related involutional changes. The basal cisterns are patent and there is
preservation of gray-white differentiation.
No fracture. The paranasal sinuses, mastoid air cells and middle ear cavities
are clear. The globes are unremarkable.
IMPERSSION: No acute intracranial process.
|
10081891-RR-19 | 10,081,891 | 27,752,151 | RR | 19 | 2128-01-19 11:28:00 | 2128-01-19 14:11:00 | INDICATION: Syncope and fall with C-spine tenderness.
COMPARISON: CT C-spine ___.
TECHNIQUE: MDCT axial images from the skull base to the T3 level were
obtained without the administration of IV contrast. Coronal, sagittal and
thin section bone algorithm reconstructed images were obtained.
FINDINGS: There is no acute fracture or traumatic malalignment. Persistent
5mm of anterolisthesis of C3 on C4 which appears chronic given bridging
osteophytes and is unchnagedd from prior.
Patient is status post C2 through C6 bilateral laminectomies, also similar to
prior. The C2-C3 through C5-C6 facet joints are fused on the left and the
C2-C3 and C3-C4 on the right. There is severe multilevel degenerative joint
disease most prominent at the craniocervical junction that is unchanged
compared to the prior CT C-spine, as previously documented.
There is no lymphadenopathy. The imaged portion of the thyroid is normal.
There are left greater than right pleural effusions in the visualized portions
of the lung apices.
IMPRESSION:
1. No acute fracture or traumatic malalignment.
2. Unchanged severe multilevel degenerative changes.
3. Bilateral left greater than right pleural effusions.
|
10081891-RR-20 | 10,081,891 | 27,752,151 | RR | 20 | 2128-01-21 10:57:00 | 2128-01-21 13:20:00 | INDICATION: Respiratory acidosis, interval change in pulmonary edema.
COMPARISON: ___.
FINDINGS: Compared with most recent prior radiograph, the lung volumes are
lower. A moderate right pleural effusion is unchanged. Moderate left pleural
effusion layers posteriorly in somewhat different distribution, likely related
to positioning. Retrocardiac consolidation is likely compressive atelectasis.
Heart size is unchanged.
IMPRESSION: Moderate bilateral pleural effusions with retrocardiac
consolidation, likely compressive atelectasis.
Telephone notification to Dr. ___ by Dr. ___ at 11:45 a.m. on
___.
|
10081891-RR-21 | 10,081,891 | 27,752,151 | RR | 21 | 2128-01-21 19:57:00 | 2128-01-21 20:40:00 | HISTORY: Tachycardia and tachypnea, assess for DVT.
COMPARISON: None
FINDINGS: Gray scale and color Doppler sonographic evaluation was performed of
the bilateral lower extremities. Normal compressibility, flow and response to
augmentation is seen in the common femoral, superficial femoral and popliteal
veins bilaterally. The calf veins were not well assessed. Edema is seen in
subcutaneous tissues in the right greater than left lower extremities.
IMPRESSION: No lower extremity DVT with limited evaluation of the calf veins.
|
10082014-RR-71 | 10,082,014 | 22,293,901 | RR | 71 | 2185-07-01 19:52:00 | 2185-07-01 20:52:00 | INDICATION: ___ with right hip pain // fx?
COMPARISON: ___
FINDINGS:
AP pelvis and two views right hip were provided. There is an acute fracture of
the right femoral neck and a mid cervical level. Mild superior displacement
of the right femoral shaft is noted. The right femoral head maintains normal
articulation with the right acetabulum. The left hip aligns normally. No
pelvic fracture is seen. SI joints are symmetric. A calcified fibroid is again
seen within the right mid pelvis.
IMPRESSION:
Acute right femoral neck fracture, mid cervical level.
|
10082014-RR-72 | 10,082,014 | 22,293,901 | RR | 72 | 2185-07-01 19:23:00 | 2185-07-01 20:34:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ with head injury // bleed?
TECHNIQUE: Contiguous axial images images of the brain were obtained without
contrast. Coronal and sagittal as well as thin bone-algorithm reconstructed
images were obtained.
DOSE: DLP: 191 mGy-cm
CTDI: 52 mGy
COMPARISON: CT head ___
FINDINGS:
Embolization coil within a posterior communicating artery aneurysm cause
significant streak artifact limiting evaluation. There is no evidence of acute
intracranial hemorrhage, edema, mass effect or acute large territorial
infarction. Prominence of the ventricles and sulci are similar to the prior
study suggesting age-related atrophy. Periventricular white matter
hypodensities are nonspecific but may reflect chronic microvascular ischemic
disease. The basal cisterns are patent. Gray-white matter differentiation is
preserved.
There is no fracture. Minimal opacification of left apical mastoid air cells
is similar to prior studies. The middle ear cavities are clear. The paranasal
sinuses are normally pneumatized. There are atherosclerotic calcifications of
the cavernous internal carotid arteries. There is a large volume of cerumen
in the left external auditory canal.
IMPRESSION:
1. No evidence of acute intracranial abnormality
2. Large volume of cerumen in the left external auditory canal.
|
10082014-RR-73 | 10,082,014 | 22,293,901 | RR | 73 | 2185-07-01 19:23:00 | 2185-07-01 20:46:00 | EXAMINATION: Cervical spine CT
INDICATION: ___ s/p fall // fx?
TECHNIQUE: Non contrast CT axial images of the cervical spine were obtained.
Sagittal and coronal reconstructions were performed.
DOSE: DLP: 1634 mGy-cm; CTDI: 73 mGy
COMPARISON: MR cervical spine ___
FINDINGS:
There is no evidence of acute fracture or malalignment. Cervical lordosis is
mildly exaggerated. Vertebral body heights are preserved. The dens is normally
positioned between the lateral masses of C1. The prevertebral and paraspinal
soft tissues are unremarkable.
There are multilevel multifactorial degenerative changes with anterior and
posterior osteophytes. Posterior disc osteophyte complexes cause mild to
moderate central canal narrowing from C3 through C7. Uncovertebral facet joint
hypertrophy results in central canal narrowing severe at C3-C4 on the left,
C4-C5 on the right, bilaterally at C5-C6 and C6-C7.
The thyroid is grossly normal. Included lung apices are clear.
IMPRESSION:
1. No evidence of acute fracture or malalignment.
2. Degenerative changes resulting in severe neural foraminal narrowing at
multiple levels.
|
10082014-RR-74 | 10,082,014 | 22,293,901 | RR | 74 | 2185-07-01 20:14:00 | 2185-07-01 20:42:00 | EXAMINATION: CHEST (SINGLE VIEW)
INDICATION: ___ s/p fall // acute process?
COMPARISON: ___
FINDINGS:
AP portable supine view of the chest. A large retrocardiac density is
consistent with a hiatal hernia, unchanged. Lungs are clear. There is no focal
consolidation. No evidence for effusion or pneumothorax on this supine exam.
The cardiomediastinal silhouette is stable with a prominent mediastinum
unchanged from multiple prior studies dating back to ___ likely
representing ectatic vasculature. Imaged osseous structures are intact.
IMPRESSION:
No acute intrathoracic process. Large hiatal hernia.
|
10082014-RR-75 | 10,082,014 | 22,293,901 | RR | 75 | 2185-07-01 22:47:00 | 2185-07-01 23:29:00 | INDICATION: ___ with hip fx, ortho wants distal femur films // fx?
COMPARISON: None.
FINDINGS:
AP, lateral, obliques views of the right knee provided demonstrate no fracture
or dislocation. Moderate severe to severe degenerative disease are seen with
loss of joint space, marginal spurring. Bones appear demineralized. No joint
effusion.
IMPRESSION:
Degenerative changes without fracture.
|
10082014-RR-76 | 10,082,014 | 22,293,901 | RR | 76 | 2185-07-01 22:47:00 | 2185-07-01 23:27:00 | INDICATION: ___ with tenderness to palpation to thigh, shin // fx?
COMPARISON: Pelvis radiograph from earlier today.
FINDINGS:
Total of 8 images provided including views of the left femur, left knee and
left tibia fibula. No fracture or dislocation is seen. Degenerative changes of
the left knee are moderate with marginal spurring and loss of medial tibial
femoral joint space. Left ankle articulate normally. Tiny left knee joint
effusion is noted.
IMPRESSION:
No acute findings.
|
10082014-RR-78 | 10,082,014 | 22,293,901 | RR | 78 | 2185-07-02 16:37:00 | 2185-07-03 08:45:00 | EXAMINATION: HIP 1 VIEW
INDICATION: RIGHT HIP HEMIARTHROPLASTY
TECHNIQUE: A single intraoperative radiograph of the right hip was acquired.
COMPARISON: Hip radiographs from ___.
FINDINGS:
The patient is status post interval right hip hemiarthroplasty, with a
well-seated prosthesis and no evidence of a periprosthetic fracture. For
additional details, please see the operative report in the ___
medical record.
IMPRESSION:
As above.
|
10082014-RR-79 | 10,082,014 | 22,293,901 | RR | 79 | 2185-07-05 10:10:00 | 2185-07-05 13:20:00 | EXAMINATION: CHEST (PORTABLE AP)CHEST (PORTABLE AP)
INDICATION: ___ year old woman with fever and 02 requirement // eval for pna
x
COMPARISON: Chest radiographs ___ since ___ most recently ___.
IMPRESSION:
Large hiatus hernia is significantly more distended today than on ___.
There is new opacification at the right lung base which could be an acute
aspiration pneumonia. Upper lungs are clear. Heart size is hard to assess,
probably top- normal. A small right pleural effusion is new. There is no
pneumothorax.
NOTIFICATION: Dr. ___ reported the findings to Dr. ___ by
telephone on ___ at 1:19 ___, 10 minutes after discovery of the findings.
|
10082014-RR-80 | 10,082,014 | 20,221,705 | RR | 80 | 2185-08-07 21:11:00 | 2185-08-07 22:00:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ with ETT, NG tube, CVL // ETT placment?
COMPARISON: None.
FINDINGS:
AP portable supine view of the chest. Endotracheal tube is seen with its tip
located 2.8 cm above the carinal. A right IJ central venous catheter tip is
positioned in the region of the low SVC. Lung volumes are low limiting
assessment. No large consolidation or supine evidence for effusion or
pneumothorax. Mediastinal contour is difficult to assess due to rotation. Bony
structures are grossly intact. Degenerative changes are partially noted in the
lumbar spine.
IMPRESSION:
Right IJ central venous catheter and endotracheal tube positioned
appropriately.
|
10082014-RR-81 | 10,082,014 | 20,221,705 | RR | 81 | 2185-08-08 07:32:00 | 2185-08-08 14:49:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with urosepsis, AMS, intubated, fluid
resuscitated. // Acute cardiopulmonary process, volume status Acute
cardiopulmonary process, volume status
COMPARISON: Solitary chest radiograph ___.
IMPRESSION:
Lung volumes have improved, although there is still mild atelectasis at the
left lung base. Pleural effusions are minimal if any, and there is no
pneumothorax. Upper lungs are clear. Heart size is normal. ET tube and
right internal jugular line are in standard placements.
|
10082014-RR-82 | 10,082,014 | 20,221,705 | RR | 82 | 2185-08-11 09:02:00 | 2185-08-11 12:02:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with resolving urosepsis, previously intubated,
with cough evaluate for any infectious process.
COMPARISON: Portable chest radiograph dated ___.
FINDINGS:
Interval removal of the ETT and right IJ. Stable bilateral lower lung volumes,
with expected slightly increased bibasilar atelectasis status-post ETT
removal. New small bilateral pleural effusions, slightly greater on the left
compared to the right, since ___. Otherwise, no focal consolidation, overt
pulmonary edema, or pneumothorax. The cardiomediastinal silhouette is overall
unchanged. The moderate hiatal hernia is also unchanged.
IMPRESSION:
1. New small bilateral pleural effusions since ___.
2. Expected post-extubation bibasilar atelectasis.
|
10082014-RR-83 | 10,082,014 | 20,221,705 | RR | 83 | 2185-08-14 08:40:00 | 2185-08-14 11:09:00 | EXAMINATION: CHEST PORT. LINE PLACEMENT
INDICATION: ___ year old woman with newR PICC // 45cm R basilic SL PICC -
___ ___ Contact name: ___ , ___: ___ R basilic SL
PICC - ___ ___
COMPARISON: Chest radiographs since ___ most recently ___.
IMPRESSION:
New right PIC line tip projects at a level 65 mm below the aortic knob and
would need to be withdrawn 2 cm to reposition it in the low SVC, if required.
Small bilateral pleural effusions which developed between ___ and
___ are unchanged. Cardiomegaly has decreased since ___.
Upper lungs are clear. Moderate left lower lobe atelectasis is presumed.
NOTIFICATION: ___ was paged, as requested at 11:05.
|
10082014-RR-84 | 10,082,014 | 20,221,705 | RR | 84 | 2185-08-15 17:58:00 | 2185-08-15 18:07:00 | EXAMINATION: CHEST (SINGLE VIEW)
INDICATION: ___ with PICC line repositioned
COMPARISON: ___.
FINDINGS:
AP portable upright view of the chest. Right arm PICC line is seen with its
tip located in the low SVC. No pneumothorax. Bilateral pleural effusions and
bibasilar atelectasis noted. No significant change from prior.
IMPRESSION:
PICC line positioned appropriately with tip in low SVC. Stable bilateral
pleural effusions and lower lobe atelectasis.
|
10082014-RR-85 | 10,082,014 | 26,270,834 | RR | 85 | 2185-08-26 11:36:00 | 2185-08-26 15:26:00 | EXAMINATION: PORTABLE CHEST RADIOGRAPH
INDICATION: ___ female intubated. Evaluate position of the
endotracheal tube. .
TECHNIQUE: Frontal supine chest radiograph
COMPARISON: None available
FINDINGS:
The endotracheal tube ends 2.6 cm above the carina. A right sided IJ line ends
in the upper to mid SVC. A right-sided PICC ends in the lower SVC.
There is no evidence of pneumothorax. No focal opacities concerning for
pneumonia identified. There is no pleural effusion or pneumothorax. A vague
opacity in the right costophrenic angle is likely artifactual due to
positioning. Cardiomediastinal and hilar contours are unremarkable.
IMPRESSION:
1. Supportive devices are in appropriate position.
2. No focal parenchymal opacity. No evidence of pneumothorax.
|
10082014-RR-86 | 10,082,014 | 26,270,834 | RR | 86 | 2185-08-26 13:35:00 | 2185-08-26 14:11:00 | EXAMINATION: PORTABLE CHEST RADIOGRAPH
INDICATION: ___ female with new esophageal tube placement.
TECHNIQUE: Frontal supine chest radiograph
COMPARISON: Chest radiograph performed 2 hr prior to this study.
FINDINGS:
New esophageal ube loops and ends within the thorax, likely within a large
hiatal hernia. Otherwise there is no significant change compared with the
previous exam. The endotracheal tube ends 2.6 cm above the carina. A right
sided IJ line ends in the upper to mid SVC. A right-sided PICC ends in the
lower SVC.
There is no evidence of pneumothorax. No focal opacities concerning for
pneumonia identified. No pleural effusion is identified. Previous right
costophrenic angle vague opacity has cleared and it was most likely due to
positioning. There is no pneumothorax. Cardiomediastinal and hilar contours
are unremarkable.
IMPRESSION:
New esophageal tube ends above the diaphragm, likely within a large hiatal
hernia. Otherwise unchanged from recent exam. No evidence of pleural
effusion or pneumothorax.
|
10082014-RR-87 | 10,082,014 | 26,270,834 | RR | 87 | 2185-08-29 16:20:00 | 2185-08-29 17:22:00 | INDICATION: Cough.
COMPARISON: Chest radiograph from ___.
TECHNIQUE: Frontal chest radiograph.
FINDINGS:
This exam is severely limited by suboptimal positioning. A right PICC
terminates at the lower SVC. Small bilateral pleural effusions are suggested,
appearing new since ___. No definite consolidation is detected.
No large pneumothorax is seen.
IMPRESSION:
Limited evaluation due to suboptimal positioning. Repeat radiographs should
be performed with improved posture. Equivocal small bilateral pleural
effusions.
|
10082014-RR-88 | 10,082,014 | 26,270,834 | RR | 88 | 2185-08-29 17:42:00 | 2185-08-29 21:27:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ woman with GI bleed, hypotension and seizure. Family
now noting facial droop, new since 2 weeks ago. Evaluate for stroke.
TECHNIQUE: Contiguous multidetector CT scan through the head was performed
without intravenous contrast. Axial images displayed as separate 5 mm soft
tissue and 2.5 mm bone algorithm image series. Multiplanar reformation was
performed to construct coronal and sagittal images.
DOSE: DLP: 951.50 mGy-cm. CTDIvol: 55.80 mGy.
COMPARISON: Head CTs from ___ and ___.
FINDINGS:
Aneurysm coils in the region of the circle of ___ limit assessment of the
inferior brain. There is no evidence of hemorrhage, edema, mass effect, or
infarction. Prominence of the ventricles and sulci is consistent with
age-related involutional changes. There is no fracture. There is minimal
mucosal thickening in the right maxillary sinus and sphenoid sinuses. There is
layering fluid in sphenoid sinus. There is soft tissue density in the left
external auditory canal. Fluid opacification of the left mastoid air cells is
unchanged from the prior study.
IMPRESSION:
No acute intracranial abnormality.
|
10082014-RR-89 | 10,082,014 | 26,270,834 | RR | 89 | 2185-08-30 11:24:00 | 2185-08-30 12:23:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old woman with new oxygen requirement, recent ICU stay
w/intubation and volume resuscitation // ?Infiltrates, edema
?Infiltrates, edema
COMPARISON: COMPARISON TO PRIOR STUDY ___ AT 16:32
FINDINGS:
Portable AP upright chest ___ 11:38 is submitted.
IMPRESSION:
Right PICC line unchanged in position. Overall cardiac and mediastinal
contours difficult to assess due to marked patient rotation. There continue be
layering bilateral effusions with bibasilar patchy airspace disease, right
greater than left ,suggestive of compressive atelectasis. Superimposed
pneumonia cannot be excluded. No evidence of pulmonary edema. Several more
focal nodular opacities in the left upper lobe are unchanged since ___ and
therefore consistent with a benign process. No pneumothorax.
|
10082090-RR-21 | 10,082,090 | 27,631,162 | RR | 21 | 2189-10-20 01:26:00 | 2189-10-20 03:03:00 | INDICATION: Evaluate for deep space infection in a patient with right ulnar
volar soft tissue defect and ulnar nerve paralysis.
TECHNIQUE: Helical axial MDCT images were obtained from the right elbow
through hand after the administration of IV contrast. Reformatted images in
coronal and sagittal axes were generated.
DOSE: Acquisition sequence:
1) Spiral Acquisition 11.5 s, 47.5 cm; CTDIvol = 10.0 mGy (Body) DLP =
476.4 mGy-cm.
Total DLP (Body) = 476 mGy-cm.
COMPARISON: None.
FINDINGS:
There is no acute fracture or dislocation. There is skin thickening and soft
tissue edema along the ulnar aspect of the distal forearm which abuts the
muscles, without fluid collection or soft tissue gas. No focal lytic or
sclerotic osseous lesion is identified. No soft tissue foreign body is
identified.
IMPRESSION:
Skin thickening and soft tissue edema along the ulnar aspect of the distal
forearm compatible with cellulitis, without fluid collection or soft tissue
gas.
|
10082090-RR-22 | 10,082,090 | 27,631,162 | RR | 22 | 2189-10-21 11:10:00 | 2189-10-21 22:06:00 | EXAMINATION: MR ___
INDICATION: ___ year old woman with rt volar wrist IV infiltration one week
ago, now with overlying cellulitis, neuropathy in hand of ulnar, median and
even partly radial distributions, CT of the arm negative for acute process
other than cellulitis, however, would like further characterization of the rt
forearm and wrist, particularly in re: soft tissue injury and ulnar nerve
injury/transection/compression please // ___ year old woman with rt volar
wrist IV infiltration one week ago, now with overlying cellulitis, neuropathy
in hand of ulnar, median and even partly
TECHNIQUE: Following administration of 7 mL of Gadavist, multiplanar multi
sequence T1 and T2 weighted images were obtained in a 1.5 tesla magnet
COMPARISON: CT forearm dated ___
FINDINGS:
Spanning approximately 8 cm from the distal forearm to the carpal tunnel,
there is enhancement and increased signal on the fluid sensitive sequences in
the flexor carpi ulnaris muscle and tendon and along the third and fourth
flexor digitorum superficialis muscles and tendons. Although the median and
ulnar nerves are normal in signal characteristics and caliber, the ulnar nerve
courses through the surrounding inflammatory change in the soft tissues in the
median nerve also abuts an area of soft tissue edema (7:19, 6:19). The
remainder of the muscles and tendons are within normal limits.
There is marked edema and enhancement of the skin and subcutaneous tissues
along the volar aspect of the forearm with relative sparing of the dorsal
side.
The bone marrow demonstrates normal signal characteristics. No concerning
osseous lesions to suggest osteomyelitis.
IMPRESSION:
Edema and enhancement of the subcutaneous tissues along the volar aspect of
the distal forearm is suggestive of cellulitis.
Enhancement several of the flexor muscles is also seen --this is non-specific,
the differential diagnosis includes intravasated fluid and myositis. Small
amounts of flexor tenosynovitis are of the ___ and ___ flexor digitorum
superficialis and flexor carpi ulnaris tendons are demonstrated on the
post-contrast images
Although the median and ulnar nerves and swells are grossly unremarkable, the
ulnar nerve is surrounded by areas of soft tissue edema which could account
for the described neuropathy. The median nerve also abuts an area of soft
tissue edema. The radial nerve lies remote from the areas of soft tissue
edema.
Consultation with a hand specialist is recommended.
RECOMMENDATION(S): Given the presence of muscle edema, tenosynovitis, and
soft tissue edema surrounding the ulnar and abutting the median nerves,
consultation with a hand specialist is recommended.
NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on
the ___ ___ at 4:40 ___, 120 minutes after discovery of the
findings.
|
10082090-RR-23 | 10,082,090 | 27,631,162 | RR | 23 | 2189-10-21 13:38:00 | 2189-10-21 16:52:00 | INDICATION: Pre MRI KUB
TECHNIQUE: Supine and upright abdominal radiographs were obtained.
COMPARISON: None.
FINDINGS:
Gas is seen the small and large bowel. There are no abnormally dilated loops
of large or small bowel. There is no free intraperitoneal air.
Surgical clips are seen in the right upper quadrant. Osseous structures are
unremarkable. There are no unexplained soft tissue calcifications or
radiopaque foreign bodies.
IMPRESSION:
No radiopaque metallic objects are seen.
|
10082090-RR-24 | 10,082,090 | 27,631,162 | RR | 24 | 2189-10-24 10:46:00 | 2189-10-24 11:27:00 | EXAMINATION: DX CHEST PORT LINE/TUBE PLCMT 1 EXAM
INDICATION: ___ year old woman with left PICC ___ ___ // Left 38cm PICC ___
___ ___ Contact name: ___: ___
IMPRESSION:
Tip of left PICC terminates in the lower superior vena cava. Heart size is
normal, and lungs and pleural surfaces are clear.
|
10082090-RR-25 | 10,082,090 | 27,631,162 | RR | 25 | 2189-10-27 16:38:00 | 2189-10-27 17:24:00 | INDICATION: ___ year old woman with crohns with n/v/d // eval for obstruction
TECHNIQUE: Supine and upright abdominal radiographs were obtained.
COMPARISON: Supine upright abdominal radiographs dated ___
FINDINGS:
Gas is seen in the small and large bowel. There are no abnormally dilated
loops of large or small bowel. A single air-fluid level seen on the upright
view. There is no free intraperitoneal air.
Cholecystectomy clips are seen in the right upper quadrant. Osseous
structures are unremarkable. There are no unexplained soft tissue
calcifications or radiopaque foreign bodies.
IMPRESSION:
No ileus or obstruction.
|
10082090-RR-33 | 10,082,090 | 21,995,625 | RR | 33 | 2189-11-08 02:10:00 | 2189-11-08 02:35:00 | EXAMINATION: PELVIS U.S., TRANSVAGINAL
INDICATION: Evaluate for acute process or infection in a patient with right
lower quadrant and suprapubic pain.
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 4.3 x 2.8 x 6.7 cm. The endometrium is
homogenous and measures 5 mm.
The ovaries are normal. There is no free fluid.
Due to acute, localized pain symptoms, spectral and color Doppler of the
ovaries was performed. There was normal arterial and venous flow demonstrated
within the ovaries.
IMPRESSION:
Normal pelvic ultrasound.
|
10082163-RR-10 | 10,082,163 | 26,875,625 | RR | 10 | 2127-03-13 13:37:00 | 2127-03-13 20:36:00 | EXAMINATION: US EXTREMITY LIMITED SOFT TISSUE RIGHT
INDICATION: ___ year old woman with hx Crohn's, multiple abscesses, most
recently in RLQ/groin s/p 6 weeks augmentin/flagyl with drain in place, had
drain pulled 2 weeks ago, now with 1 week worsening cellulitis and repeat
abscess seen on CT.// R groin abscess drainage
TECHNIQUE: Real-time grayscale an color Doppler imaging was performed of the
right groin.
COMPARISON: ___ right groin ultrasound
FINDINGS:
The patient presented for potential drain placement into a subcutaneous fluid
collection in the right groin, which is secondary to a known enterocutaneous
fistula. Preprocedure ultrasound images demonstrated a thin fluid collection
containing echogenic gas, which appears to have decreased in thickness
compared to prior CT of the abdomen/pelvis from ___. The patient
has an actively draining wound in the skin lateral to the site of the
collection. The amount of fluid was felt to be insufficient for drainage at
this time.
IMPRESSION:
Actively draining enterocutaneous fistula. Subcutaneous fluid collection in
the right groin has decreased in thickness, insufficient for drainage at this
time.
|
10082163-RR-5 | 10,082,163 | 21,587,377 | RR | 5 | 2126-11-29 16:02:00 | 2126-11-29 18:04:00 | EXAMINATION: CT-guided catheter placement within right inguinal subcutaneous
collection
INDICATION: ___ year old woman with right entercutaneous fistula ___ chron's
disease.// Drain in the collect of the right inguinal fold (omid from ___
surgery talked to ___ from ___
COMPARISON: CT scan of the abdomen and pelvis dated ___.
PROCEDURE: CT-guided drainage of right inguinal collection.
OPERATORS: Dr. ___ 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 supine position on the CT scan table. Limited
preprocedure CT scan was performed to localize the collection. Based on the
CT findings an appropriate skin entry site for the drain placement was chosen.
The site was marked. Local anesthesia was administered with 1% Lidocaine
solution.
Using intermittent CT fluoroscopic guidance, an 18-G ___ needle was
inserted into the collection. A sample of fluid was aspirated, confirming
needle position within the collection. 0.038 ___ wire was placed through
the needle and needle was removed. This was followed by placement of ___
Exodus pigtail catheter into the collection. The plastic stiffener and the
wire were removed. The pigtail was deployed. The position of the pigtail was
confirmed within the collection via CT fluoroscopy.
Approximately 20 cc of dark, opaque fluid was aspirated. The catheter was
secured by a StatLock. The catheter was attached to bag. Sterile dressing was
applied.
The procedure was tolerated well, and there were no immediate post-procedural
complications.
DOSE: Acquisition sequence:
1) Spiral Acquisition 7.7 s, 23.6 cm; CTDIvol = 16.3 mGy (Body) DLP = 364.3
mGy-cm.
2) Stationary Acquisition 6.1 s, 1.4 cm; CTDIvol = 64.0 mGy (Body) DLP =
92.1 mGy-cm.
Total DLP (Body) = 466 mGy-cm.
SEDATION: Moderate sedation was provided by administering divided doses of
100 mcg fentanyl throughout the total intra-service time of 20 minutes during
which patient's hemodynamic parameters were continuously monitored by an
independent trained radiology nurse.
FINDINGS:
1. Fistula tract communicating between the cecal pole/terminal ileum, right
iliacus muscle, right inguinal subcutaneous tissues and right lower quadrant
skin surface.
2. 3.2 x 10.1 cm gas and fluid containing collection within the subcutaneous
tissues of the right inguinal region, which was targeted for catheter
placement.
IMPRESSION:
Successful CT-guided placement of an ___ pigtail catheter into the
collection. Samples were sent for microbiology evaluation. No immediate
postprocedure complications.
|
10082163-RR-9 | 10,082,163 | 26,875,625 | RR | 9 | 2127-03-13 11:40:00 | 2127-03-13 12:13:00 | EXAMINATION: US EXTREMITY LIMITED SOFT TISSUE RIGHT
INDICATION: ___ year old woman with Crohn's multiple abscesses, recent drain
in R groin abscess, now with recurrent collection seen on CT.// please assess
R groin abscess collection for interval change in size per ___ recs
TECHNIQUE: Grayscale ultrasound images were obtained of the superficial
tissues of the right groin.
COMPARISON: CT dated ___.
FINDINGS:
Transverse and sagittal images were obtained of the superficial tissues of the
right groin. There is an irregularly marginated, complex fluid collection
spanning approximately 10.0 cm transverse, 1.7 cm AP and 4.5 cm craniocaudal.
There is echogenic gas layering non dependently within this collection. The
collection appears thinner compared to the prior CT, at which time it measured
2.7 cm AP.
IMPRESSION:
Collection of fluid and air in the right groin, which appears decreased in
thickness compared to the prior CT.
|
10082640-RR-19 | 10,082,640 | 22,930,426 | RR | 19 | 2179-09-03 08:38:00 | 2179-09-03 09:15:00 | EXAMINATION: ABDOMEN US (COMPLETE STUDY)
INDICATION: ___ year old woman with beta thalassemia, extensive extramedullary
hematopoiesis, evaluate spleen ___ and liver morphology // ___ year old
woman with beta thalassemia, extensive extramedullary hematopoiesis, evaluate
spleen ___ and liver morphology
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: Reference CT abdomen dated ___ and abdominal
ultrasound dated ___
FINDINGS:
LIVER: The hepatic parenchyma appears within normal limits. The contour of the
liver is smooth. There is no focal liver mass. The main portal vein is patent
with hepatopetal flow. There is no ascites. There is a right pleural
effusion.
BILE DUCTS: There is no intrahepatic biliary dilation. The CBD measures 5 mm.
GALLBLADDER: Cholelithiasis without gallbladder wall thickening.
PANCREAS: 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 25 cm. Anterior to the spleen there is
a 2.5 cm round lesion with similar echogenicity to the spleen and which
appeared similar in attenuation to the spleen on the CT likely or collecting
an accessory spleen.
KIDNEYS: The right kidney measures 12.9 cm. The left kidney measures 12.5 cm.
Normal cortical echogenicity and corticomedullary differentiation is seen
bilaterally. A shadowing echogenic stone is seen in the lower pole of the
right kidney. A 2.3 cm simple anechoic cyst was seen in the left kidney.
IMPRESSION:
1. Massive splenomegaly with the spleen measuring 25 cm.
2. Normal appearance of the liver.
3. Right pleural effusion.
4. Right nonobstructing nephrolithiasis
|
10082662-RR-63 | 10,082,662 | 22,060,359 | RR | 63 | 2146-07-25 13:15:00 | 2146-07-25 15:48:00 | EXAMINATION: CT abdomen and pelvis with contrast
INDICATION: ___ year old woman with history of metastatic melanoma involving
liver, spleen, lungs. Also biopsy-documented pulmonary aspergillosis.// Assess
status of metastases.
TECHNIQUE: Oncology 2 phase: Multidetector CT of the abdomen and pelvis was
done as part of CT torso with IV contrast. A single bolus of IV contrast was
injected and the abdomen and pelvis were scanned in the portal venous phase,
followed by scan of the abdomen in equilibrium (3-min delay) phase.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Total DLP (Body) = 1,099 mGy-cm.
COMPARISON: Multiple CT abdomen pelvis, most recently dated ___.
FINDINGS:
LOWER CHEST: Please refer to separate report of CT chest performed on the same
day for description of the thoracic findings.
ABDOMEN:
HEPATOBILIARY: The margin of the liver is distorted and in places nodular,
likely representing scarring from treatment. There is slightly heterogeneous
attenuation throughout. A 1.9 cm simple cyst in segment 7 is stable at least
from ___ (5:13). Multiple additional areas of hypoattenuation
in the liver are stable since prior exam and continue to be less conspicuous
compared to exams from ___. There is no new focal lesion.
Non-specific subtle focal thickening of the anterior gallbladder wall is
persistent (2:61).
PANCREAS: The pancreas has normal attenuation throughout or pancreatic ductal
dilatation. 1.0 cm hypoattenuating lesion in the pancreatic head adjacent to
the SMV (02:59), is stable when comparing measurements to the prior coronal
images, likely side branch IPMN. There is no peripancreatic stranding.
SPLEEN: The spleen shows normal size and attenuation throughout. There are
multiple hypodensities in the spleen, unchanged. No new lesion is seen.
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 hiatal hernia is small. Otherwise, the stomach is
unremarkable. There is an air distended duodenal diverticulum. Otherwise, the
remaining small bowel loops demonstrate normal caliber, wall thickness, and
enhancement throughout. The colon and rectum are within normal limits. The
appendix is not visualized.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal
limits.
LYMPH NODES: Scattered celiac and retroperitoneal lymph nodes are overall
stable in size and distribution since ___. Multiple mesenteric lymph
node aggregates (likely mild mesenteric panniculitis) are also stable. A left
inguinal lymph node is stable (2:95).
VASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic
disease is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture. T9
vertebral body compression fracture is stable (602:41). There are Schmorl's
nodes at L5 and L3.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. Stable hepatic and splenic lesions. No new lesions.
2. Stable retroperitoneal and mesenteric lymphadenopathy. No new or enlarging
lymphadenopathy in the abdomen or the pelvis.
3. Stable 1.0 cm cystic lesion in the pancreatic head, likely a side branch
IPMN. Attention on follow is recommended.
4. Persistent, nonspecific mild thickening along the anterior wall of the
gallbladder.
|
10082662-RR-64 | 10,082,662 | 22,060,359 | RR | 64 | 2146-07-25 14:07:00 | 2146-07-25 15:19:00 | EXAMINATION: CT CHEST W/CONTRAST
INDICATION: ___ woman with a history of metastatic melanoma
involving the liver and spleen. Pulmonary aspergillosis.
TECHNIQUE: Multi-detector helical scanning of the chest, coordinated with
intravenous infusion of nonionic, iodinated contrast agent, following oral
administration of contrast agent for selected abdominal studies, and/or
followed by scanning of the neck, was reconstructed as contiguous 5 mm and 1.0
or 1.25 mm thick axial, 2.5 or 5 mm thick coronal and parasagittal, and 8 mm
MIP axial images. Concurrent scanning of the abdomen and pelvis and/or neck
will be reported separately. All images of the chest were reviewed.
DOSE: Acquisition sequence:
1) Stationary Acquisition 5.0 s, 0.5 cm; CTDIvol = 24.1 mGy (Body) DLP =
12.0 mGy-cm.
2) Spiral Acquisition 5.7 s, 62.9 cm; CTDIvol = 11.9 mGy (Body) DLP = 749.3
mGy-cm.
3) Spiral Acquisition 2.7 s, 30.0 cm; CTDIvol = 11.3 mGy (Body) DLP = 337.4
mGy-cm.
Total DLP (Body) = 1,099 mGy-cm.
** Note: This radiation dose report was copied from CLIP ___ (CT ABD AND
PELVIS WITH CONTRAST)
COMPARISON: Compared to chest CT scanning since ___, most recently ___
___, ___, and ___.
FINDINGS:
CHEST PERIMETER: 14 mm well-circumscribed low-attenuation lesion in the lower
pole of the right thyroid is been present since at least ___.
Supraclavicular and axillary lymph nodes are not enlarged. Specifically
excluding the breasts which require mammography for evaluation, there is no
soft tissue abnormality in the imaged elsewhere in the imaged chest wall
suspicious for malignancy.
CARDIO-MEDIASTINUM:Small hiatus hernia is unchanged. Above that level lower
esophagus is mildly patulous. Atherosclerotic calcification is mild in head
and neck vessels, more pronounced in left anterior descending circumflex and
right coronary arteries, as before. Aortic valve is not calcified. Aorta is
normal size. Pericardium is physiologic.
Nearly occlusive thrombosis is new in the right descending pulmonary artery
extending into lower lobe segmental branches 4:105-133.
THORACIC LYMPH NODES:
Mild central adenopathy is improved:
7 by 11 mm, prevascular mediastinum, 4:65, previously 12 x 19 mm.
9 x 20 mm right posterior paraesophageal mediastinum, 4:84, previously 15 x 24
mm.
16 x 19 mm, right hilus, 4:85, previously 22 x 29 mm.
LUNGS, AIRWAYS, PLEURAE: 4 mm right upper lobe nodule, 4:85, was 5 mm in
___. Otherwise there is no nodulation to suggest either metastasis or
bronchiolar infection or inflammation. Triangular opacity projecting over the
right middle lobe is probably fissural, not a lung lesion of concern. Septal
thickening in the lower lungs, less pronounced today, is probably mild
pulmonary edema.
CHEST CAGE: Moderate compression of a blastic lower thoracic vertebral body,
stable since at least ___ is the only finding of note in chest cage.
IMPRESSION:
New substantial right lower lobe pulmonary emboli. No infarction.
Borderline heart failure, improved.
Improving central adenopathy. No evidence of active intrathoracic malignancy
or infection.
Single, indeterminate 4 mm pulmonary nodule.
Mild pathologic compression fracture lower thoracic spine unchanged since at
least ___.
NOTIFICATION: The findings were discussed with ___, M.D. by ___,
M.D. on the telephone on ___ at 2:54 pm, 1 minutes after discovery of
the findings.
|
10082662-RR-65 | 10,082,662 | 22,060,359 | RR | 65 | 2146-07-25 19:20:00 | 2146-07-25 19:48:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ with new PE// eval for bleed/metastatic lesions prior to
anticoagulation
TECHNIQUE: Contiguous axial images from skullbase to vertex were obtained
without intravenous contrast. Coronal and sagittal reformations and bone
algorithms reconstructions were also performed.
DOSE: Total DLP (Head) = 803 mGy-cm.
COMPARISON: MRI brain ___.
FINDINGS:
There is no evidence of infarction, hemorrhage, edema, or large mass. There
is prominence of the ventricles and sulci suggestive of age-related cerebral
volume loss. Hyperdense appearance of the blood pool due to recent IV
contrast administration.
No osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and
middle ear cavities are clear. The orbits are unremarkable.
IMPRESSION:
No acute intracranial process. No evidence of intracranial hemorrhage. No
evidence of metastatic lesions, however note that MRI is a more sensitive
modality for evaluation of masses.
|
10082662-RR-66 | 10,082,662 | 22,060,359 | RR | 66 | 2146-07-25 20:45:00 | 2146-07-25 21:25:00 | EXAMINATION: UNILAT LOWER EXT VEINS RIGHT
INDICATION: ___ with PE, RLE swelling// eval for dvt
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the bilateral lower extremity veins.
COMPARISON: None.
FINDINGS:
There is normal compressibility, flow, and augmentation of the right common
femoral, femoral, and popliteal veins. Normal color flow and compressibility
are demonstrated in the right posterior tibial and peroneal veins.
The left distal femoral vein demonstrates lack of compressibility and
intraluminal echogenic material extending to the left popliteal vein, left
posterior tibial vein and one of the left peroneal veins consistent with
occlusive thrombus.
There is normal respiratory variation in the common femoral veins bilaterally.
No evidence of medial popliteal fossa (___) cyst.
IMPRESSION:
Deep venous thrombosis in the leftlower extremity veins.
|
10082662-RR-88 | 10,082,662 | 28,631,269 | RR | 88 | 2148-07-22 10:15:00 | 2148-07-22 14:38:00 | EXAMINATION: CT ABD AND PELVIS WITH CONTRAST
INDICATION: ___ with history of metastatic melanoma involving liver, spleen,
lungs. Also biopsy-documented pulmonary. aspergillosis. Needs pre and post
hydration. // interval change.
TECHNIQUE: Oncology 2 phase: Multidetector CT of the abdomen was done with IV
contrast. A single bolus of IV contrast was injected and the abdomen and
pelvis was scanned in the portal venous phase, followed by scan of the abdomen
in equilibrium (3-min delay) phase.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 0.5 s, 0.2 cm; CTDIvol = 9.0 mGy (Body) DLP = 1.8
mGy-cm.
2) Stationary Acquisition 0.8 s, 0.2 cm; CTDIvol = 13.5 mGy (Body) DLP =
2.7 mGy-cm.
3) Spiral Acquisition 9.5 s, 61.9 cm; CTDIvol = 10.8 mGy (Body) DLP = 662.4
mGy-cm.
4) Spiral Acquisition 4.5 s, 28.9 cm; CTDIvol = 11.5 mGy (Body) DLP = 324.9
mGy-cm.
Total DLP (Body) = 992 mGy-cm.
COMPARISON: Chest CT ___. CT abdomen and pelvis ___.
FINDINGS:
LOWER CHEST: Please refer to separate report of CT chest performed on the same
day for description of the thoracic findings.
ABDOMEN:
HEPATOBILIARY: The liver appears dysmorphic, with atrophy of the left hepatic
lobe and focal areas of capsular retraction, likely reflecting post treatment
changes. Multiple hypoattenuating hepatic lesions are identified, some new,
while others unchanged. A 1.6 cm lesion within the left hepatic lobe,
adjacent to the main portal vein, appears increased in size from 0.3 cm
previously (05:50). Multiple other subcentimeter hepatic hypodensities are
also not evident on the most recent prior study (for example, 05:38, 50, 64).
A 2.3 cm cyst within the right hepatic lobe (05:42) and a subcentimeter
hypodensity within the left hepatic lobe (05:51) appear unchanged. Mild
intrahepatic biliary dilatation within the right and left hepatic lobes. A
juxta papillary duodenal diverticulum appears to exert mild mass effect on the
distal common bile duct (09:23), possibly resulting in mild upstream
dilatation of the common bile duct, measuring up to approximately 1.3 cm. 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: Multifocal areas of capsular retraction of the spleen appear
unchanged. Multiple, subcentimeter splenic hypodensities, some peripherally
calcified, appear grossly unchanged. No definite new splenic lesions are
identified.
ADRENALS: Bilateral adrenal nodules measuring up to 0.8 cm appear new from the
prior study.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
There is no evidence of solid 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.
PELVIS: The bladder is unremarkable. There is no free fluid in the pelvis.
REPRODUCTIVE ORGANS: The uterus is unremarkable for age. No adnexal masses.
LYMPH NODES: Prominent aortocaval and left para-aortic nodes are not
pathologically enlarged by CT size criteria (for example 8:29). There is no
mesenteric lymphadenopathy. There is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic
disease is noted.
BONES: A chronic compression deformity of the T9 vertebral body appears
unchanged. A compression deformity of the T12 vertebral body is new from the
prior study from ___, with a vertically oriented fracture line through
the posterior aspect of the vertebral body and approximately 5 mm of
retropulsion of the bony fragment, with resultant moderate vertebral canal
narrowing (10:37, 05:52). A prominent Schmorl's node is seen within the
superior endplate of the L4 vertebral body. There is a nondisplaced,
vertically oriented fracture through the superior left acetabulum (5:96,
10:52). Levoconvex curvature of the thoracolumbar spine.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. Interval growth of a now 1.6 cm hypodense lesion within the right hepatic
lobe, previously 0.3 cm, with new, scattered subcentimeter hepatic
hypodensities, concerning for worsening metastatic disease.
2. New, bilateral adrenal nodules, measuring up to 0.8 cm, also concerning for
new sites of metastasis.
3. No substantial change in multiple splenic hypodensities, reflecting treated
metastases.
4. New, nondisplaced left superior acetabular fracture.
5. New, interval compression deformity of the T12 vertebral body, with
retropulsion of the posterior aspect of the vertebral body and resultant
moderate vertebral canal narrowing.
6. Please refer to the separate report of the chest CT performed on the same
day for intrathoracic characterization.
NOTIFICATION: The findings were discussed with ___, M.D. by ___
___, M.D. on the telephone on ___ at 2:27 pm, 5 minutes after discovery
of the findings.
|
10082662-RR-89 | 10,082,662 | 28,631,269 | RR | 89 | 2148-07-22 10:17:00 | 2148-07-22 16:59:00 | EXAMINATION: CT CHEST W/CONTRAST
INDICATION: ___ with history of metastatic melanoma involving liver, spleen,
lungs. Also biopsy-documented pulmonary. aspergillosis. Needs pre and post
hydration. // interval change.
TECHNIQUE: Multi detector helical scanning of the chest was coordinated with
intravenous infusion of nonionic iodinated contrast agent and reconstructed as
5 and 1.25 mm thick axial, 2.5 mm thick coronal and parasagittal, and 8 mm MIP
axial images. All images were reviewed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 0.5 s, 0.2 cm; CTDIvol = 9.0 mGy (Body) DLP = 1.8
mGy-cm.
2) Stationary Acquisition 0.8 s, 0.2 cm; CTDIvol = 13.5 mGy (Body) DLP =
2.7 mGy-cm.
3) Spiral Acquisition 9.5 s, 61.9 cm; CTDIvol = 10.8 mGy (Body) DLP = 662.4
mGy-cm.
4) Spiral Acquisition 4.5 s, 28.9 cm; CTDIvol = 11.5 mGy (Body) DLP = 324.9
mGy-cm.
Total DLP (Body) = 992 mGy-cm.
** Note: This radiation dose report was copied from CLIP ___ (CT ABD AND
PELVIS WITH CONTRAST)
COMPARISON: Chest CTs from ___ to most recent ___.
FINDINGS:
NECK, THORACIC INLET, AXILLAE AND CHEST WALL:
Thyroid is unremarkable. Small axillary and thoracic inlet lymph nodes are
stable. There are no chest wall abnormalities. Mild dorsal spondylosis at
the proximal bilateral subclavian arteries.
MEDIASTINUM AND HILA:
Esophagus is unremarkable. Stable small mediastinal lymph nodes. No enlarged
hilar lymph nodes.
HEART, PERICARDIUM AND VASCULATURE:
Left ventricle is mildly dilated with a linear hypodensity in the appy
completing probably related to prior myocardial infarction. No pericardial
effusion. Moderate atherosclerotic calcifications in the coronary arteries,
especially the LAD. Moderate mitral annulus calcification. Aorta and
pulmonary artery normal in caliber throughout.
LUNGS, AIRWAYS, AND PLEURA:
Multiple bilateral nodules, some are new, some are increased in size, examples
as follows:
New nodules:
-Two nearby right upper lobe 2 mm (06:51, 52)
-Right upper lobe 3 mm (6:67)
-Left lower lobe 3 mm (6:126)
-Right lower lobe 6 mm (6:129)
Left upper lobe 3 mm perifissural (06:43) and right upper lobe 5 mm (6:89)
triangular-shaped nodules most likely correspond to lymphoid aggregates.
Enlarged nodules:
-Two right upper lobe 5 mm, was 3 mm (06:56)
-Left lower lobe 3 mm, was 1 mm before (6:89)
Diffuse bilateral interlobular septal thickening with scattered associated
ground-glass opacities reflecting interstitial pulmonary edema is moderately
worsened. Airways are patent to the subsegmental level. No bronchial wall
thickening, bronchiectasis or mucus plugging.
CHEST CAGE:
T12 vertebral body fracture and fragment retropulsion into the spinal canal.
Stable T9 compression fracture and diffuse increased density. Stable mild
dorsal spondylosis.
UPPER ABDOMEN:
Please see separately submitted Abdomen and Pelvis CT report for
subdiaphragmatic findings.
IMPRESSION:
Multiple bilateral lung nodules ranging from 2-6 mm, some are new, some are
enlarged and others are stable, concerning for metastatic disease.
New T12 vertebral body fracture with fragment retropulsion into the spinal
canal. Stable T9 compression fracture with increased density suspicious for
metastatic disease.
Moderately worsened pulmonary edema.
RECOMMENDATION(S): Thoracolumbar spine MRI is recommended to assess degree of
spinal cord compression.
NOTIFICATION: The findings were discussed with ___, M.D. by ___
___, M.D. on the telephone on ___ at 4:56 pm, 5 minutes after
discovery of the findings.
|
10082662-RR-90 | 10,082,662 | 28,631,269 | RR | 90 | 2148-07-22 11:39:00 | 2148-07-22 16:01:00 | EXAMINATION: BILAT HIPS (AP, LAT, AND PELVIS) 5 OR MORE VIEWS
INDICATION: ___ year old woman with metastatic melanoma. New severe L hip pain
in setting of traumatic fall. // eval for fracture
TECHNIQUE: Frontal view radiograph of the pelvis with additional frontal and
frog-leg lateral views of bilateral hips.
COMPARISON: Correlation was made to CT of the abdomen and pelvis from the
same day
FINDINGS:
Right hip: There is no fracture or dislocation. Mild degenerative change of
the right hip with subchondral sclerosis and osteophytosis. There is no
suspicious lytic or sclerotic lesion. There is no soft tissue calcification
or radio-opaque foreign body.
Left hip: There is no fracture or dislocation within the resolution limits of
plain film radiography. Mild degenerative change of the left hip with
subchondral sclerosis and mild osteophytosis. There is no suspicious lytic or
sclerotic lesion. There is no soft tissue calcification or radio-opaque
foreign body.
Contrast seen projecting over the bladder and in the small bowel from recent
CT of the abdomen and pelvis. Mild bilateral sacroiliac degenerative changes
with spurring.
IMPRESSION:
1. No plain film radiographic evidence of acute fracture. However, there is a
vertically oriented minimally displaced fracture of the superior acetabulum
that is seen on the CT of the pelvis from ___.
2. Mild degenerative joint disease in the bilateral hips and sacroiliac
joints.
NOTIFICATION: The findings were discussed with ___, M.D. by ___
___, M.D. on the telephone on ___ at 4:00 pm.
|
10082701-RR-19 | 10,082,701 | 20,717,652 | RR | 19 | 2110-03-21 00:31:00 | 2110-03-21 06:05:00 | EXAMINATION: Chest radiograph
INDICATION: History: ___ with left arm and rib pain after fall currently in
cast// eval for left sided rib fractures and scapula fractureeval for left arm
fracture
TECHNIQUE: Frontal chest radiograph
COMPARISON: CT upper extremity from ___
FINDINGS:
The lungs are well expanded and clear. The heart size is within normal
limits. The hilar and mediastinal contours are unremarkable. There is no
pleural effusion or pneumothorax. 2 rings from the arm sling projects over
the left lower lung zone. No displaced rib fractures or scapular fractures
are noted. Breast implants are seen.
IMPRESSION:
-No acute intrathoracic abnormalities.
-No displaced rib or scapular fractures.
|
10082701-RR-21 | 10,082,701 | 20,717,652 | RR | 21 | 2110-03-21 00:29:00 | 2110-03-21 05:58:00 | EXAMINATION:
Humerus and elbow
INDICATION: ___ woman with left humeral fracture.
TECHNIQUE: Single view of the left humerus and single view of the left elbow.
COMPARISON: None.
FINDINGS:
Evaluation of the distal humerus in the elbow are limited due to overlying
cast material. There is oblique fracture, exiting along the lateral surface
of the distal humeral diaphysis with approximately 6 mm distraction of the
fracture fragment. There is no significant distraction in anterior upper
posterior direction.
The elbow joint is overall congruent. The limited view of the wrist joint
appears unremarkable.
IMPRESSION:
Limited evaluation of the humerus and the elbow due to overlying cast material
and patient's inability to mobilize the arm for positioning. Within these
limits, oblique fracture of the distal humerus with 6 mm displacement of the
fracture fragment.
|
10082701-RR-22 | 10,082,701 | 20,717,652 | RR | 22 | 2110-03-21 04:17:00 | 2110-03-21 06:02:00 | EXAMINATION: CT left upper extremity without contrast
INDICATION: ___ year old woman with left supratrochlear fracture possible
shoulder dislocation and humeral head fracture// Eval for humeral head
fracture, shoulder dislocation and supratrochlear fracture
TECHNIQUE: ___ MD CT imaging was performed through the left humerus without
intravenous contrast. Coronal and sagittal reformats targeted towards both
the shoulder and the elbow were produced and reviewed.
DOSE: Acquisition sequence:
1) Spiral Acquisition 6.2 s, 30.4 cm; CTDIvol = 24.8 mGy (Body) DLP = 754.2
mGy-cm.
2) Spiral Acquisition 5.3 s, 26.1 cm; CTDIvol = 24.7 mGy (Body) DLP = 644.1
mGy-cm.
3) Spiral Acquisition 4.5 s, 22.1 cm; CTDIvol = 24.4 mGy (Body) DLP = 539.9
mGy-cm.
Total DLP (Body) = 1,938 mGy-cm.
COMPARISON: Left humerus radiographs ___ and ___
FINDINGS:
There are fractures of both the proximal and distal humerus.
There is unusual anterior impaction fracture along the humeral head (02:25,
400:31) with a fracture fragment measuring 2 x 0.7 cm. This is minimally
displaced but given this location, may represent reverse ___ if the
patient has history of a posterior dislocation. There is a small glenohumeral
joint effusion. No reverse bony Bankart is appreciated, evaluation of the
labrum is limited on CT.
Separate from the proximal humerus injury there is a distal humeral
intercondylar fracture with extension to the articular surface of the
radiocapitellar articulation. This is a T-shaped fracture with both a
supracondylar and intercondylar component (81: 64). There is distraction of
the fracture fragments by approximately 9 mm. There is a possible radial head
fracture although seen only on 1 set of images (6:64). There is a moderate
joint effusion. No dislocation seen.
There is diffuse soft tissue edema primarily about the elbow but also in the
axilla. A left-sided breast prosthesis is noted. Scattered axillary lymph
nodes do not meet the CT size criteria for pathologic enlargement. Tiny
pleural-based nodules in the left upper lobe measure less than 6 mm.
IMPRESSION:
1. Unusual impaction fracture along the anterior margin of the left humeral
head, this appearance can be seen with posterior dislocations and a reverse
___ lesion. Correlate with clinical history.
2. T-shaped supracondylar and intercondylar distal humerus fracture with
extension to the articular surface of the radiocapitellar joint. The patient
has subsequently undergone open reduction internal fixation of this fracture.
3. Possible radial head fracture.
4. Moderate elbow effusion.
5. Tiny left upper lobe pulmonary nodules are pleural-based and likely reflect
either scarring or intraparenchymal lymph nodes. These measure greater than 6
mm:
For incidentally detected multiple solid pulmonary nodules smaller than 6mm,
no CT follow-up is recommended in a low-risk patient, and an optional CT
follow-up in 12 months is recommended in a high-risk patient.
See the ___ ___ Society Guidelines for the Management of Pulmonary
Nodules Incidentally Detected on CT" for comments and reference:
___
NOTIFICATION: Findings in addition to the wet read regarding the humeral head
fracture were discussed with Dr. ___ ___ by Dr. ___
___ by telephone at 13:30 on ___, within in 30 minutes of
discovery.
|
10082701-RR-23 | 10,082,701 | 20,717,652 | RR | 23 | 2110-03-22 09:17:00 | 2110-03-22 13:54:00 | INDICATION: Distal humerus fracture. ORIF.
COMPARISON: CT scan from ___
IMPRESSION:
Fluoroscopic images demonstrates placement of fracture plates medially and
laterally within the distal humerus fixating a complex fracture of the distal
humerus. Please refer to the operative note for additional details. The
total intraservice fluoroscopic time was 82.2 seconds.
|
10082986-RR-32 | 10,082,986 | 26,111,347 | RR | 32 | 2189-06-22 09:17:00 | 2189-06-22 12:10:00 | AP CHEST, 9:21 A.M., ___.
HISTORY: New left PICC line.
IMPRESSION: AP chest compared to most recent prior chest radiograph ___:
Tip of the new left PICC line ends at level 4 cm below the carina at the
superior cavoatrial junction. Lungs clear. Heart size normal. No pleural
abnormality. ___ paged at ___ as requested.
|
10083375-RR-14 | 10,083,375 | 20,979,796 | RR | 14 | 2199-05-02 08:58:00 | 2199-05-02 11:17:00 | EXAMINATION: RENAL U.S.
INDICATION: ___ year old man with PCKD presenting with new, painless hematuria
// eval for new mass/etiology of bleed
TECHNIQUE: Grey scale and color Doppler ultrasound images of the kidneys were
obtained.
COMPARISON: ___
FINDINGS:
Renal parenchyma is replaced by bilateral innumerable cysts of varying shape
and size, some of which contain complex or hemorrhagic fluid. There is no
obvious hydronephrosis, stones, or masses bilaterally, although evaluation is
limited sonographically due to the underlying cystic disease.
The bladder is normal in appearance.
IMPRESSION:
1. Innumerable bilateral renal cysts in keeping with known polycystic kidney
disease, grossly stable from the previous examination.
2. No obvious mass to explain patient's hematuria, although evaluation with
ultrasound is limited and MRI could be performed as a more definitive
examination.
|
10083375-RR-15 | 10,083,375 | 20,979,796 | RR | 15 | 2199-05-02 12:13:00 | 2199-05-02 13:43:00 | EXAMINATION: CT ABD AND PELVIS W/O CONTRAST
INDICATION: ___ year old man with PCKD w/ multiple hemorrhagic cysts on recent
imaging presenting with hematuria, anemia, c/f retroperitoneal bleed. Please
evaluate for retroperitoneal bleed.
TECHNIQUE: MDCT axial images were acquired through abdomen and pelvis without
the administration of IV contrast. Coronal and sagittal reformations were
performed.
DOSE: DLP: 363 mGy-cm.
COMPARISON: MRI from ___
FINDINGS:
CHEST:
Visualized lung fields are within normal limits. There is no evidence of
pleural or pericardial effusion.
ABDOMEN:
The liver demonstrates innumerable cystic lesions compatible with clinical
history of polycystic liver disease. There is no concerning focal liver mass.
There is no intrahepatic biliary ductal dilatation. There is no evidence of
portal hypertension suggest varices, splenomegaly, or ascites. The spleen is
homogeneous, and normal in size. The gallbladder is normal without evidence of
stones, or wall thickening. There is no evidence of extrahepatic biliary
ductal dilatation.
The kidneys bilaterally are enlarged and also demonstrate innumerable cystic
lesions. Some of these lesions are of intermediate density suggesting 1 in the
midpole measuring up to 1 cm, series 2, image 48 which may be consistent with
hemorrhagic or proteinaceous cysts. There is no definite evidence of
hydronephrosis. The adrenal glands bilaterally are normal.
The stomach, duodenum, and small bowel are normal without evidence of wall
thickening or obstruction. There is no retroperitoneal or mesenteric
lymphadenopathy. There is no intra-abdominal free fluid, or free air.
Colon demonstrates moderate fecal loading, which is otherwise unremarkable.
No focal pancreatic lesions concerning for malignancy are identified.
Specifically, the previously characterize side branch IPMNs on the prior MRI
are not seen on this exam.
PELVIS:
The urinary bladder and distal ureters are unremarkable. There is no evidence
of pelvic or inguinal lymphadenopathy. There is no free fluid in the pelvis.
BONES AND SOFT TISSUES:
There is no evidence of worrisome lesions.
IMPRESSION:
1. No evidence of a retroperitoneal bleed.
2. Re demonstrated are innumerable kidney and hepatic simple/hemorrhagic
cysts, compatible with patient's polycystic kidney disease. No signs of
portal hypertension suggestive of varices, splenomegaly, or ascites.
|
10084077-RR-26 | 10,084,077 | 28,745,424 | RR | 26 | 2162-12-05 19:23:00 | 2162-12-06 13:24:00 | INDICATION: ___ woman with splenic bleed post-colonoscopy, positive
CTA and hemodynamic instability.
OPERATORS: Dr. ___ (fellow) and Dr. ___ (attending)
performed the procedure.
MEDICATION: Moderate sedation was achieved by providing divided doses of 1 mg
of Versed and 200 mcg of fentanyl during the procedure time of 1 hour and 30
minutes.
PROCEDURES PERFORMED:
1. Splenic arteriogram in multiple projections.
2. Proximal splenic artery coil embolization beyond the dorsal and pancreatic
magna branches.
PROCEDURE DETAILS: Written informed consent was obtained after explaining the
risks, benefits and potential complications of the procedure. The patient was
brought to the angiography suite and placed supine on the imaging table. A
preprocedural timeout was performed as per ___ protocol.
After providing generous local anesthesia in the right groin, the right common
femoral artery was punctured using a 19-gauge needle and ___ wire
advanced into the thoracic aorta. The needle was exchanged for a 5 ___
sheath and a C2 ___ Cobra Glide catheter advanced over the wire. The
later was then used to cannulate the celiac trunk. With the help of a
Glidewire, purchase was gained into the splenic artery and the Glide catheter
then advanced in the proximal splenic artery. DSA runs in multiple
projections demonstrated normal anatomy of the splenic artery and its branches
with two dorsal pancreatic branches identified at its distal portion.
Separation of the spleen from the abdominal wall was noted related to a large
subcapsular hematoma. Of note, there was no evidence of active extravasation.
In agreement with the referring physicians, it was decided to perform a
proximal splenic artery embolization, distal to the dorsal pancreatic artery.
Accordingly, the C2 Glide catheter was advanced beyond these vessels, using a
Glidewire for support. Subsequently, coiling was performed by introducing a 6
mm x 14 cm and 3 mm x 2 cm coil.
A subsequent run from a proximal position of the splenic artery demonstrated
significant reduction in splenic perfusion with residual perfusion mainly in
the upper and most lower pole.
At this stage, wires, catheters and sheaths were withdrawn and hemostasis
achieved by applying manual pressure for 20 minutes.
The patient withstood the procedure well and there was no immediate
complication.
IMPRESSION: Successful proximal splenic artery coil embolization in the
setting of large splenic hematoma and hemodynamic instability.
|
10084077-RR-27 | 10,084,077 | 28,745,424 | RR | 27 | 2162-12-06 20:59:00 | 2162-12-07 09:06:00 | HISTORY: Possible pneumonia or pleural effusion.
FINDINGS: In comparison with the study of ___, the patient has taken a
much poorer inspiration, which most likely accounts for the increased
prominence of the transverse diameter of the heart. There are atelectatic
changes at the bases, especially on the left with blunting of the costophrenic
angle, though this appears to reflect pleural thickening rather than effusion
on the lateral view.
No evidence of acute focal pneumonia or vascular congestion.
Of incidental note is residual contrast material in the colon, related to a
recent CT scan.
|
10084077-RR-28 | 10,084,077 | 28,745,424 | RR | 28 | 2162-12-07 02:20:00 | 2162-12-07 03:41:00 | HISTORY: Splenic hematoma after colonoscopy status post prior embolization of
proximal splenic artery now with continued falling hematocrit, evaluate for
active extravasation.
TECHNIQUE: Single phase helical CT acquisition through the abdomen and
pelvis. Coronal and sagittal reformats provided by technologist. Uneventful
administration of 130 cc Omnipaque IV contrast.
DLP: 1,120 mGy-cm.
COMPARISON: CT abdomen pelvis ___.
FINDINGS:
Lung bases demonstrate bibasilar atelectasis, and heart size within normal
limits. Normal appearance of the gastroesophageal junction.
Liver demonstrates increasing perihepatic fluid with a 3.3 cm left lobe low
density lesion which is nonspecific on a single-phase contrast-enhanced
examination, but has a somewhat linear appearance on coronal reformations
(series 601, image ___, suggesting laceration (though ? mechanism of
injury). However there is also bulging of the capsule of the liver from this
region (series 601, image 23) which might indicate a lesion such as
hemangioma. Additional subcentimeter hepatic hypodensities are noted which
likely represent simple cysts in the right hepatic lobe.
Vicarious excretion of contrast is noted in the gallbladder. The common bile
duct is within normal limits for size. Normal appearance of the pancreas,
adrenals, kidneys, ureters and bladder.
There is been interval increase in size of perisplenic hematoma which
previously measured 12 x 3.6 x 11 cm, now measures approximately 13 x 6 x 14
cm with the increasing fluid in the abdomen (perihepatic) and extra capsular
left upper quadrant, paracolic gutters and pelvis at the consistent with
expansion of the splenic hematoma. Endovascular coils are noted in the
splenic artery with collateral flow to the spleen through the short gastric
arteries. Presistently enhancing splenule noted inferior to the spleen.
Normal caliber of the aorta. Hepatic arterial supply is conventional.
Osseous structures demonstrate mild degenerative changes without acute or
suspicious abnormality.
IMPRESSION:
1. Increasing size of the perisplenic hematoma and marked interval increase
in the left upper quadrant, pericolic gutter and pelvic hemoperitoneum
consistent with continued bleeding likely from the perisplenic hematoma. No
active extravasation or overt source of bleeding is seen. The patient is
status post coiling of the splenic artery with collateral flow through the
short gastric arteries.
2. Possible 3.3 cm left lobe hepatic laceration, though not definitively
characterized on single-phase contrast-enhanced examination. Increased
perihepatic high density fluid is consistent with blood; however, given the
large amount of high-density fluid through the peritoneum, this is likely to
be tracking into the perihepatic space from the spleen as well.
|
10084077-RR-29 | 10,084,077 | 28,745,424 | RR | 29 | 2162-12-07 07:46:00 | 2162-12-07 17:47:00 | INDICATION: ___ woman with splenic bleed post-colonoscopy and
proximal splenic artery embolization two days ago, now presenting with further
hematocrit drop, enlarging hematoma, and questionable laceration involving the
left lobe on the liver.
OPERATORS: Dr. ___ (fellow) and Dr. ___
(attending) performed the procedure.
PROCEDURES PERFORMED:
1. Selective common and left hepatic angiography.
2. Gelfoam embolization of left particle artery.
3. Selective conventional and rotational angiography of splenic artery with
further coil embolization.
MEDICATIONS: Moderate sedation was achieved providing divided doses of Versed
and fentanyl.
PROCEDURE DETAILS: Written informed consent was obtained after explaining the
procedure, benefits, alternatives, and risks. The patient was brought to the
angiography suite and placed supine on the imaging table. Right groin was
prepped and draped in the usual sterile fashion. A pre-procedural timeout was
performed as per ___ protocol.
Under fluoroscopic and palpatory guidance, access was obtained into the right
common femoral artery with a 19-gauge single wall needle. A 0.035 ___
wire was placed through the needle and advanced into the thoracic aorta. The
needle was then exchanged for 5 ___ vascular sheath, the sidearm of which
was connected to a continuous heparinized saline flush. Then, using the
combination of Glidewire and a C2 5 ___ glide catheter, access was gained
into the common hepatic artery. A DSA run was performed in multiple
projections. Subsequently, the C2 glide catheter was advanced into the left
hepatic artery and further and an additional run performed. While there was
questionable evidence of liver laceration on the previous CT exams, no
definite focus of extravasation could be identified. However, given some
haziness and irregularity along the distal segment II/III arteries, decision
was made to prophylactically Gelfoam the left hepatic artery. This was
performed with the C2 glide catheter tip positioned in the proximal left
hepatic trunk.
Subsequently, the C2 catheter was exchanged and access obtained into the
proximal splenic artery. Multiple runs in various projections were performed,
demonstrating significant residual perfusion of the spleen via collaterals
demonstrating occlusion of the distal splenic artery by previous coil
embolization. Good perfusion of the spleen was seen via collateral flow.
There was no evidence of active extravasation. Given the huge drop in
hematocrit and questionable residual patency of one splenic artery branch,
decision was made to place additional coils on top of the previous coil
embolization site. This was performed over a Renegade ___ microwire using
a Trupush coil pusher. In total three 0.018, 6 cm x 7 mm Cook coils were
deployed. Branches going from the hepatic artery towards the pancreas were
spared.
Eventually, a subtracted rotational angiogram was performed to identify
potential foci of extravasation, missed on classic DSA runs. However, as dyna
CT would not show extravasation, decision was made to hold off more aggressive
embolization or targeting of collaterals.
Accordingly, wires and catheters were withdrawn and hemostasis in the right
groin achieved by using an Angio-Seal closure device.
The patient withstood the procedure well and there was no immediate
complication.
IMPRESSION:
1. Questionable liver laceration on previous CTs with no angiographic
evidence of active extravasation, yet prophylactic Gelfoam embolization of the
left hepatic artery.
2. No evidence of active extravasation involving the spleen with residual
perfusion of the organ via collaterals. Given questionable residual supply by
one splenic artery branch, previous splenic artery embolization was reinforced
by additional coil embolization.
|
10084262-RR-20 | 10,084,262 | 26,913,631 | RR | 20 | 2179-05-29 09:41:00 | 2179-05-29 11:25:00 | EXAMINATION: CHEST PORTABLE PICC LINE PLACEMENT
INDICATION: ___ year old man with new line// new right PICC 47 cm ___
___ Contact name: ___: ___
TECHNIQUE: Chest PA and lateral
COMPARISON: None
FINDINGS:
The cardiomediastinal silhouette and pulmonary vasculature are unremarkable.
There is no definite focal consolidation, pleural effusion, or pneumothorax.
A right-sided PICC terminates at the cavoatrial junction.
IMPRESSION:
Right-sided PICC terminates at the cavoatrial junction.
|
10084454-RR-10 | 10,084,454 | 28,036,597 | RR | 10 | 2147-06-11 02:25:00 | 2147-06-11 03:56:00 | INDICATION: ___ female with hypoxia.
TECHNIQUE: Single frontal radiograph of the chest was obtained.
COMPARISON: None.
FINDINGS:
There is mild cardiomegaly and a large hernia containing stomach causing
streak-like atelectatic change at the right lower lobe. Incidental note is
made of an azygos lobe at the right side. No pleural effusion and no
pneumothorax.
IMPRESSION: No acute cardiothoracic process. Large hiatal hernia containing
at least stomach.
|
10084454-RR-11 | 10,084,454 | 28,036,597 | RR | 11 | 2147-06-11 02:45:00 | 2147-06-11 04:08:00 | INDICATION: ___ with hypoxia after fall (hip fracture).
TECHNIQUE: CT angiography of the chest was obtained with arterial phase
imaging. Axial, coronal, sagittal and oblique reformats were acquired.
COMPARISON: None.
FINDINGS:
CTA OF THE CHEST:
There is no pneumomediastinum, mediastinal hemorrhage, pericardial or large
pleural effusion. There is no pulmonary embolism. There are
moderate-to-severe atherosclerotic calcifications of the thoracic aorta and
the coronary arteries. Moderate-to-severe centrilobular emphysema is seen most
pronounced in the upper lobes. There is a right azygos lobe (incidental
finding).
There is a large Bochdalek hernia containing fat, stomach (upside down
stomach), and colon (with diverticula) without evidence of bowel obstruction
or gastric strangulation. This large hernia causes streak-like atelectasis of
the right lower lobe. The partially visualized abdomen demonstrates a left
liver lobe cystic lesion, likely a simple cyst or hemangioma.
BONES: There is moderate to severe osteopenia. There are no suspicious lytic
or sclerotic bony lesions.
IMPRESSION:
1. Large hiatal hernia containing fat, stomach (upside down stomach), and
colon (with diverticula) - no obstruction or acute findings.
2. No pulmonary embolism.
3. Severe atherosclerotic disease of the thoracic aorta and coronary arteries.
4. Severe centrilobular emphysema.
5. Left liver lobe cystic lesion, likely cyst or hemangioma.
6. Moderate to severe osteoporosis.
|
10084454-RR-12 | 10,084,454 | 28,036,597 | RR | 12 | 2147-06-11 04:15:00 | 2147-06-11 05:10:00 | INDICATION: ___ after fall.
FINDINGS: There is a fracture of the right femoral neck fracture with varus
angulation. No fracture of the pelvic bones, femur, proximal tibia of fibula.
There are mild degenerative changes of the right knee joint with joint space
narrowing. Atherosclerotic calcification are seen at the superifical femoral
and popliteal arteries.
IMPRESSION: Right femoral neck fracture with varus angulation.
|
10084454-RR-13 | 10,084,454 | 28,036,597 | RR | 13 | 2147-06-11 16:44:00 | 2147-06-12 10:56:00 | HISTORY: Right hemiarthroplasty, question fracture.
Single AP portable view of the right hip obtained in the OR.
The patient is status post right hip hemiarthroplasty, in overall anatomic
alignment on this single AP view. No periarticular fracture is identified.
|
10084454-RR-14 | 10,084,454 | 28,036,597 | RR | 14 | 2147-06-11 22:11:00 | 2147-06-12 10:43:00 | INDICATION: ___ female with COPD, now with increased oxygen
requirement.
COMPARISON: Comparison is made with chest radiographs from ___
earlier the same day.
FINDINGS: Two frontal images of the chest demonstrate well-expanded lungs,
which are generally clear with some slight atelectatic changes at the lung
bases. There is no pneumothorax or pleural effusion. Cardiomediastinal
silhouette is unchanged. Again seen is a large hiatal hernia containing
stomach elevating the lower lobe of the right lung.
IMPRESSION: No acute pulmonary process seen. Unchanged chest radiograph.
|
10085111-RR-12 | 10,085,111 | 24,078,130 | RR | 12 | 2126-03-04 01:19:00 | 2126-03-04 02:47:00 | HISTORY: ___ male with periumbilical and suprapubic pain radiating to
groin.
COMPARISON: None.
TECHNIQUE: MDCT images were obtained from the lung bases to the pubic
symphysis after administration of 150 cc of IV Omnipaque contrast. Axial
images were interpreted in conjunction with coronal and sagittal reformats.
FINDINGS:
The visualized heart is normal. Lung bases are clear. No pericardial or
pleural effusion.
ABDOMEN:
The liver is normal without focal or diffuse abnormality. The gallbladder,
intra- and extra-hepatic bile ducts, pancreas, and bilateral adrenal glands
are normal. The spleen is top normal size, 13.0 cm. The kidneys enhance
symmetrically and excrete contrast promptly. The ureters are normal in course
and caliber.
The stomach is normal. The small and large bowel enhance homogeneously and
have a normal course and calibur.
The appendix is dilated to 9 mm, is fluid filled, and has periappendiceal
stranding. No extraluminal gas or periappendiceal collection.
No retroperitoneal or mesenteric lymphadenopathy. The portal and
intra-abdominal systemic vasculature are normal. The left renal vein is
retroaortic. No abdominal wall hernia, pneumoperitoneum, or free abdominal
fluid.
PELVIS: The bladder and terminal ureters are normal. The prostate gland is
unremarkable. 2.2 cm hypodense structure in the right inguinal canal (2: 97)
extending into the right pelvis is compatible with the right testis. A
bilobed hypodense structure anterior to the left external iliac vessels (2:83)
extending into the left inguinal canal is compatible with undescended
testicles. No pelvic side-wall or inguinal lymphadenopathy. No free pelvic
fluid or inguinal hernia.
OSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for
malignancy.
IMPRESSION:
1. Acute uncomplicated appendicitis.
2. Bilateral undescended testicles.
|
10085725-RR-7 | 10,085,725 | 26,264,561 | RR | 7 | 2172-06-12 17:21:00 | 2172-06-12 18:01:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with malignant pleural effusion s/p pleurex
placement // eval for PTX, positioning of pleurex
TECHNIQUE: Chest single view
COMPARISON: ___
FINDINGS:
Moderate left pleural effusion, improved since prior. New left chest tube.
Left basilar consolidation, mildly improved. Possible tiny left apical
pneumothorax. Emphysematous changes in the upper lungs. Right Port-A-Cath.
Right lung is clear. No right pleural effusion. No pulmonary edema.
IMPRESSION:
Possible tiny left apical pneumothorax.
Mildly decreased left pleural effusion.
Improved left basilar consolidation, likely atelectasis.
|
10085725-RR-8 | 10,085,725 | 26,264,561 | RR | 8 | 2172-06-13 08:42:00 | 2172-06-13 10:14:00 | INDICATION: ___ yo F metastatic lung carcinoma presenting to the ED with
worsening dyspnea with CT from ___ consistent with worsening left
sided pleural effusions s/p pleurex placement by IP on ___ and serosanguinous
drainage. increased drainage, pt feeling dyspnic this AM // eval for PTX,
worsening effusion
TECHNIQUE: Portable upright chest radiograph.
COMPARISON: ___
FINDINGS:
Right chest wall port catheter terminates in the upper SVC. Left pleural
effusion is minimally smaller as a pleural catheter projects over the lower
lung. The right lung is clear. Probable tiny left apical pneumothorax.
IMPRESSION:
Minimally improved left pleural effusion.
|
10086022-RR-92 | 10,086,022 | 24,567,350 | RR | 92 | 2159-11-12 16:04:00 | 2159-11-12 16:37:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: History: ___ with hypotension// pna?
TECHNIQUE: Portable semi-upright AP view of the chest
COMPARISON: Chest radiograph ___
FINDINGS:
Evaluation is limited by patient positioning with obscuration of the lung
apices, right greater left due to the patient's overlying chin. Left-sided
pacer device with leads in the right atrium and right ventricle appears
unchanged. Status post median sternotomy and aortic valve replacement. Lung
volumes appear slightly low with continued moderate cardiac enlargement.
Mediastinal and hilar contours are grossly unchanged. Crowding of
bronchovascular structures is present with probable mild pulmonary vascular
congestion. Streaky opacities in the retrocardiac region could reflect
atelectasis, without definite focal consolidation. No large pneumothorax and
no pleural effusion. No acute osseous abnormality.
IMPRESSION:
Limited evaluation of the lung apices due to patient positioning and overlying
structures. Streaky retrocardiac opacity could reflect atelectasis, but
infection is not completely excluded. Mild pulmonary vascular congestion.
|
10086022-RR-93 | 10,086,022 | 24,567,350 | RR | 93 | 2159-11-12 18:15:00 | 2159-11-12 20:29:00 | EXAMINATION: CT CHEST/ABD/PELVIS W/O CONTRAST
INDICATION: History: ___ with coccygeal ulcer with surrounding erythema.//
pna? extension of coccygeal ulcer.
TECHNIQUE: Contiguous axial images were obtained through the chest, abdomen
and pelvis without intravenous contrast. Coronal and sagittal reformats were
performed.
DOSE: Acquisition sequence:
1) Spiral Acquisition 16.4 s, 63.1 cm; CTDIvol = 9.3 mGy (Body) DLP = 570.2
mGy-cm.
Total DLP (Body) = 587 mGy-cm.
COMPARISON: Prior CT T-spine ___, CT lumbar spine ___, CT
abdomen and pelvis ___
FINDINGS:
CHEST:
HEART AND VASCULATURE: The ascending thoracic aorta is dilated up to 4.5 cm.
There is moderate atherosclerotic calcification of the aortic arch. The
descending thoracic aorta is normal caliber. No evidence of aortic intramural
hematoma. The main pulmonary artery appears dilated measuring up to 4.1 cm.
There is increased central vascular prominence bilaterally. Trace pericardial
effusion. There is a replaced aortic valve, and severe calcification of the
mitral annulus. Status post CABG. Moderate cardiomegaly. A dual lead left
chest wall pacemaker is present.
AXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy is
present. No mediastinal mass or hematoma. There are bilateral hilar
calcified lymph nodes consistent with prior granulomatous disease. Esophagus
is patulous proximally with intraluminal debris.
PLEURAL SPACES: No pleural effusion or pneumothorax.
LUNGS/AIRWAYS: There is mild pulmonary edema with mild upper lobe ground-glass
opacification and smooth septal thickening. There is an area of more focal
opacification at the right lower lobe which appears somewhat rounded (series
4, image 201), which could reflect infection. There is bibasilar streaky
atelectasis. A calcified granuloma is demonstrated at the left lung base.
The airway walls are diffusely thickened with mucoid impaction noted.
BASE OF NECK: Visualized portions of the base of the neck show a distended
right internal jugular vein, but otherwise without acute abnormality.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There are multiple hepatic hypodensities measuring up to 1.4 cm. Some
represent simple cysts or biliary hamartomas, others are not characterized due
to size. There is a calcified granuloma within the right hepatic lobe. No
substantial intrahepatic biliary dilatation. There is no perihepatic free
fluid. The gallbladder contains gallstones without wall thickening or
surrounding inflammation.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesion or laceration within the limitation of an unenhanced
scan.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size. There is no evidence
of focal renal lesions or hydronephrosis. There is no perinephric
abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel appears within
normal limits. There is no bowel obstruction. There is moderate background
diverticulosis without secondary signs of diverticulitis.
There is no free fluid or free air in the abdomen.
PELVIS:
There is a small focus of air demonstrated within the urinary bladder. The
distal ureters are not well visualized. No free fluid in the pelvis.
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.
Extensive atherosclerotic disease is noted.
SOFT TISSUES AND BONES: Overlying the distal sacrum and coccyx, there is a
focal subcutaneous SOFT tissue defect with substantial ADJACENT stranding and
thickening (series 9, image 106). The defect extends to within 0.9 cm of the
coccyx. No definitive cortical destruction to suggest osteomyelitis. No focal
fluid collection is demonstrated. No subcutaneous emphysema. The defect
appears to extend inferiorly along the gluteal cleft, and may communicate with
the anorectal region (series 9, image 121).
There are severe degenerative changes diffusely. There is posterior
fixation hardware which spans L4-S1, with posterior laminectomies at this
level. There is moderate grade 2 anterolisthesis by 1.2 cm of L3 over L4.
There is a compression deformity of the T7 vertebral body (series 6, image
34), with approximately 40% loss of height centrally along the inferior
endplate, increased from the prior exam. Median sternotomy changes are
evident. No acute, displaced fractures.
There is diffuse mild to moderate anasarca.
IMPRESSION:
1. Large soft tissue defect overlying the distal sacrum and coccyx, which
extends down the gluteal cleft and may involve the anorectal region. The
defect extends to within 0.9 cm of the coccyx, but no definite underlying bony
destruction is demonstrated to suggest osteomyelitis. No focal fluid
collections. No subcutaneous emphysema.
2. Opacity in the right lower lobe could represent aspiration versus
pneumonia.
3. Diffuse airway wall thickening indicative of chronic bronchitis with
scattered areas of mucous plugging.
4. Mild pulmonary edema.
5. Cardiomegaly with a dilated ascending aorta to 4.5 cm.
6. Dilatation of the main pulmonary artery can be seen with pulmonary arterial
hypertension.
7. Compression deformity of the T7 vertebral body with approximately 40% of
central height loss appears worse from the prior study.
8. Small focus of air within the urinary bladder. Recommend correlation with
prior instrumentation. If none recently, recommend correlation with
urinalysis as infection is not excluded.
9. Diffuse degenerative changes throughout the visualized spine as above.
10. Diverticulosis without diverticulitis.
11. Cholelithiasis.
RECOMMENDATION(S): If there is high concern for osteomyelitis, MRI of the
pelvis would be more sensitive.
|
10086390-RR-38 | 10,086,390 | 23,265,953 | RR | 38 | 2184-12-23 22:17:00 | 2184-12-23 23:23:00 | INDICATION: ___ woman with question of pneumonia.
COMPARISON: Chest radiograph ___.
FINDINGS: The cardiomediastinal contours are normal. There is a moderate left
and a small right pleural effusion, which are new since the prior study. Hazy
opacification in the right lung base, is concerning for pneumonia. There is
volume loss and consolidation in the left lung base, which likely represents
additional site of infection. Bilateral apical pleural parenchymal scarring
is noted.
IMPRESSION: Bilateral pleural effusions, with associated basal
consolidations, suggestive of pneumonia.
|
10086390-RR-39 | 10,086,390 | 29,791,446 | RR | 39 | 2185-03-22 20:14:00 | 2185-03-22 22:12:00 | INDICATION: ___ female with fever to 103, evaluate for pneumonia.
COMPARISON: PA and lateral chest radiograph ___.
PA AND LATERAL CHEST RADIOGRAPH: The cardiac, mediastinal contours are
normal. There is a moderate left pleural effusion which is similar to the
prior examination of ___. There is opacification in the
retrocardiac area which may represent layering pleural effusion with adjacent
compressive atelectasis; however, infectious process such as pneumonia appears
more likely. Biapical parenchymal scarring is noted. There is near total
resolution of the right-sided pleural effusion.
IMPRESSION: Left lower lobe pleural effusion with consolidation. Repeat
imaging post treatment to document resolution and rule out underlying mass.
|
10086390-RR-40 | 10,086,390 | 29,791,446 | RR | 40 | 2185-03-23 15:15:00 | 2185-03-23 17:29:00 | INDICATION: High grade fever, altered mental status, feculent vaginal
discharge for six months in patient with history of CLL. A prior chest
radiograph suspicious for left lung base pneumonia.
COMPARISON: Chest radiograph from ___ and CT torso from ___.
TECHNIQUE: MDCT-acquired axial images from the lung bases through the pubic
symphysis were displayed with 5 mm slice thickness. Images obtained after
administration of oral contrast and 100 cc Omnipaque IV contrast material.
Coronal and sagittal reformats provided and reviewed.
DLP: 329.43 mGy-cm.
FINDINGS:
The imaged lower chest is remarkable for dense consolidation of the left lower
lobe with numerous air bronchograms. There is a small pleural effusion. The
imaged portion of the right lung appears clear. There are extensive coronary
arterial calcifications. Great vessels are otherwise unremarkable.
ABDOMEN: The liver enhances homogeneously and there are no focal lesions.
The gallbladder is not present. The tortuous and prominent common bile duct
with low insertion into the duodenal papilla is stable in appearance from the
prior study. The contrast opacified stomach, duodenum and proximal small
bowel are unremarkable. The pancreas and adrenal glands are grossly
unremarkable. Once again noted is marked splenomegaly with largest
craniocaudal dimension of 18 cm, slightly decreased from the prior study. The
kidneys enhance normally and excrete contrast symmetrically.
There is a stable-appearing a conglomerate of lymph nodes in the periportal
region extending to the spleen and extending inferiorly to the level of the
inferior mesenteric artery. There is no evidence of vascular invasion. There
is no free fluid or air within the upper abdomen. The aorta is normal in
course and caliber, with patent main branches.
PELVIS: Contrast fills the small bowel and has progressed through the
ileocecal valve to the level of the mid transverse colon. Extensive
rectosigmoid diverticulosis is noted. The rectal and sigmoid wall is
diffusely thickened. This is accompanied by pre-sacral soft tissue swelling
and fat stranding (2:67). There is more exaggerated focal thickening of the
sigmoid, which may represent overlapping colonic wall or a mass (301b:35).
There is no discrete fluid collection or pneumatosis.
A pessary within the vaginal vault is surrounded by gas. There is a fistula
tract from the vagina extending to the sigmoid colon (2:73, 300b:37). A tiny
focus of air within the bladder is also seen (2:68). The bladder wall is
normal. The uterus and adnexae are unremarkable.
The osseous structures contain no focal lesions. There are degenerative
changes of the imaged spine.
IMPRESSION:
1. Left lower lobe pneumonia.
2. Fistula tract between sigmoid colon and vagina, new from ___.
3. Rectosigmoid wall thickening with a focus of more extensive thickening
which could represent a mass. Direct visualization with sigmoidoscopy is
recommended.
4. Small focus of air within bladder raises concern for colovesicular fistula
as well. Correlate with urinalysis.
5. No pneumoperitoneum or discrete fluid collection. However, extensive
presacral fat stranding is suggestive of ongoing inflammatory process.
6. Stable confluent abdominal lymphadenopathy and splenomegaly, consistent
with history of CLL.
|
10087092-RR-20 | 10,087,092 | 21,411,023 | RR | 20 | 2196-05-08 16:44:00 | 2196-05-08 16:59:00 | EXAMINATION: SPLEEN ULTRASOUND
INDICATION: ___ year old woman with newly diagnosed CML.// Evaluate spleen for
baseline measurements for splenomegaly; track response to treatment.
TECHNIQUE: Grey scale and color Doppler ultrasound images of the left upper
quadrant of the abdomen were obtained.
COMPARISON: None.
FINDINGS:
SPLEEN: The spleen is enlarged. There is normal echogenicity. No focal
lesions are identified.
Spleen length: 19.1 cm
IMPRESSION:
Splenomegaly, measuring 19.1 cm.
|
10087981-RR-4 | 10,087,981 | 26,111,029 | RR | 4 | 2159-04-10 11:47:00 | 2159-04-10 13:51:00 | STUDY: Left hip, ___.
CLINICAL HISTORY: ___ woman with left hip pain.
FINDINGS: Comparison is made to the CT scan from ___.
Contrast material is seen throughout the colon. There are severe degenerative
changes of the lower lumbar spine with numerous compression deformities,
better assessed on the recent CT scan. Since the prior study, compression
deformity of L4 was severe. Bilateral hip joint spaces demonstrate mild
degenerative changes with some minimal joint space narrowing and spurring
superolaterally. There are also proliferative changes of pubic symphysis. No
focal lytic or blastic lesions are identified. There is some calcification
adjacent to the left greater trochanter which may represent calcific
tendinitis.
|
10087981-RR-6 | 10,087,981 | 20,474,591 | RR | 6 | 2160-06-16 00:29:00 | 2160-06-16 06:26:00 | INDICATION: ___ woman with hip fracture, preop chest x-ray.
TECHNIQUE: Portable supine view of the chest.
COMPARISON: Outside chest radiograph performed on ___.
FINDINGS:
The lungs are hyperinflated. No focal consolidation is identified. The
cardiomediastinal silhouette and hilar contours are normal. Calcifications of
the costochondral cartilage is present. There is no pleural effusion or
pneumothorax.
IMPRESSION:
No acute cardiopulmonary process.
|
10087981-RR-7 | 10,087,981 | 20,474,591 | RR | 7 | 2160-06-16 05:17:00 | 2160-06-16 05:54:00 | EXAMINATION: GLENO-HUMERAL SHOULDER (W/ Y VIEW) RIGHT
INDICATION: ___ woman with right shoulder and right hip fracture
status post reduction.
TECHNIQUE: Right shoulder, two views.
COMPARISON: Outside right shoulder radiograph performed on ___
FINDINGS:
Again seen is a comminuted, slightly impacted fracture through the surgical
neck of the right humerus with inferior subluxation of the humeral head with
respect to the glenoid. There is a laterally displaced greater tuberosity
fracture fragment, unchanged. Included right lung parenchyma is clear.
IMPRESSION:
Re- demonstration of a comminuted, slightly impacted fracture through the
surgical neck of the right humerus.
|
10087981-RR-8 | 10,087,981 | 20,474,591 | RR | 8 | 2160-06-17 08:12:00 | 2160-06-17 08:55:00 | EXAMINATION: HIP UNILAT MIN 2 VIEWS IN O.R. RIGHT
INDICATION: ORIF RT HIP
IMPRESSION:
Fluoroscopic images show placement of a fixation device about fracture of the
right proximal femur. Further information can be gathered from the operative
report.
|
10088198-RR-22 | 10,088,198 | 24,942,180 | RR | 22 | 2146-04-07 22:01:00 | 2146-04-07 22:52:00 | HISTORY: ___ female with left upper extremity, ataxia, weakness.
Evaluate for stroke.
TECHNIQUE: Non contrast CT head was obtained followed by CTA of the head and
neck with multiplanar maximum intensity projections. 3D angiographic images at
a separate station were acquired.
COMPARISON: No prior.
FINDINGS:
Non contrast CT head: There is no evidence of acute territorial infarct or
hemorrhage. There is no midline shift, mass effect, or hydrocephalus. There
is mild prominence of the extra-axial CSF spaces and ventricles.
The visualized soft tissues are unremarkable.
There is mild mucosal thickening of the ethmoid air cells.
There is atherosclerotic calcification of the bilateral V4 segments of the
vertebral arteries and bilateral cavernous segments of the internal carotid
arteries.
CTA head and neck: There is atherosclerotic calcified and noncalcified plaque
of the aortic arch. There is a 3 vessel arch. There is calcified and
noncalcified plaque at the origin of the brachiocephalic vessels. The origin
of the left subclavian artery, left common carotid artery, and right
brachiocephalic trunk are patent. There is a punctate calcification at the
origins of the vertebral arteries, with mild narrowing of the right vertebral
artery origin. The vertebral arteries are otherwise patent throughout the
neck.
The right common carotid artery appears patent with calcified and noncalcified
plaque in the distal common carotid artery near the bulb. There is also mild
atherosclerotic disease at the origin of the right internal carotid artery but
otherwise appears patent without evidence of stenosis by NASCET criteria.
The left common carotid artery exhibits mild atherosclerotic disease without
narrowing. However, there is narrowing of the left internal carotid artery at
the origin due to calcified plaque resulting in 40% narrowing by NASCET
criteria.
The intracranial internal carotid arteries demonstrate atherosclerotic
calcification without significant narrowing of the cavernous segments. Tiny
outpouching is noted in the communicating segment of the right internal
carotid artery likely at the infundibulum. Otherwise, the anterior and middle
cerebral arteries appear patent with normal branching pattern.
The intracranial vertebral arteries are patent. The basilar artery appears
patent. The right posterior cerebral artery is patent with normal branching
pattern. The left posterior cerebral artery has a fetal origin with a
hypoplastic P1 segment.
There is no evidence of stenosis or other vascular malformation in the
anterior or posterior circulation.
There is mild biapical scarring.
Mild degenerative change of the cervical spine with facet joint arthropathy is
noted.
IMPRESSION:
1. No acute territorial infarct or hemorrhage.
2. 40% focal narrowing of the proximal left internal carotid artery due to
atherosclerotic disease.
3. Mild narrowing of the origin of the right vertebral artery.
4. Atherosclerotic disease of the cavernous segments of the internal carotid
arteries, otherwise unremarkable CTA of the head.
|
10088198-RR-23 | 10,088,198 | 24,942,180 | RR | 23 | 2146-04-08 09:48:00 | 2146-04-08 10:14:00 | INDICATION: ___ woman with left brachial plexus injury and normal
chest exam. Radiation to the neck in the 1950s. Question a chest lesion.
COMPARISONS: Chest radiograph from ___.
TECHNIQUE: PA and lateral chest radiographs were provided. There is no focal
consolidation, pleural effusion or pneumothorax. The aorta is tortuous. The
heart size is within normal limits. There is pleural thickening at the right
base. The bones are intact.
IMPRESSION: No acute cardiopulmonary process.
|
10088198-RR-24 | 10,088,198 | 24,942,180 | RR | 24 | 2146-04-08 12:05:00 | 2146-04-09 11:55:00 | HISTORY: Upper extremity weakness.
COMPARISON: CT from ___.
TECHNIQUE: Multiplanar MR images are acquired through the head without
intravenous contrast.
FINDINGS: There are numerous punctate foci of abnormally slow diffusion,
which are predominantly peripheral in location. The largest cluster these
foci as noted in the right parietal lobe cub with additional foci also noted
in the right frontal operculum. Equivocal foci of slow diffusion are noted in
the paramedian aspect of the left occipital lobe (series 702, image 12) as
well as in the right cerebellar hemisphere. Susceptibility artifact is noted
in a gyriform pattern overlying the right parietal lobe. There is no other
evidence of intracranial hemorrhage.
Ventricles and sulci are enlarged, reflecting mild parenchymal volume loss.
FLAIR hyperintense signal is noted in the right cerebellar hemisphere, pons
and in scattered bilateral cerebral foci, consistent with chronic
microvascular disease.
IMPRESSION: Multiple punctate peripheral areas of abnormally slow diffusion,
consistent with multiple embolic infarcts. A small amount of susceptibility
artifact overlying the right parietal lobe suggests associated blood products.
|
10088198-RR-26 | 10,088,198 | 24,942,180 | RR | 26 | 2146-04-11 14:59:00 | 2146-04-11 15:57:00 | HISTORY: Mitral valve mass, question near-anatomic abscess. Evaluate for
pancreatic or colon adenocarcinoma or other for primary malignancy.
TECHNIQUE: Helical CT acquisition through the chest, abdomen and pelvis.
Coronal and sagittal reformats provided by technologist. Uneventful
administration of 130 cc Omnipaque IV contrast and 900 cc PO contrast.
COMPARISON: No direct comparison available.
FINDINGS:
No lower cervical adenopathy. The patient appears to be status post
thyroidectomy.
No CT mediastinal adenopathy by CT size criteria. Heart size is within normal
limits. Atherosclerotic coronary artery calcifications are noted. The known
mitral valve mass is not well seen due to calcification and motion artifact.
There is reflux of contrast into the midesophagus and a small hiatal hernia.
Shotty non-enlarged left para-aortic lymph nodes at the level of the GE
junction may be reactive.
Central airways and pulmonary arteries are patent.
Lungs demonstrate normal background parenchymal pattern. No suspicious lung
nodule or mass.
The liver demonstrates normal enhancement. In segment 7 there is a 11 mm
cyst. No other liver lesions identified. Normal appearance of the
gallbladder, spleen, adrenals, kidneys, visualized ureters and bladder. Mild
fatty atrophy of the pancreatic parenchyma is noted.
Small and large bowel are unobstructed. There is colonic diverticulosis. No
evidence of diverticulitis or focal bowel wall thickening is seen.
There no intra-abdominal or retroperitoneal adenopathy by size criteria.
Atherosclerotic calcifications are present. Aorta is normal in caliber.
Mesenteric vessels are patent.
Osseous structures demonstrates degenerative change including marked kyphosis
of the thoracic spine and moderate scoliosis of the lumbar spine. Severe
degenerative change at the of the bilateral sacroiliac joints is present. At
the left S2 level there is a 3.2 x 4.1 cm cystic structure arising from the
nerve root foramen and expanding the bone without evidence of invasion most
consistent with a Tarlov cyst.
IMPRESSION:
1. No evidence of primary intrathoraic or abdominal malignancy.
2. 1.1 cm simple hepatic cyst.
3. Large Tarlov cyst expanding the left S2 foramen.
|
10088198-RR-46 | 10,088,198 | 25,635,144 | RR | 46 | 2146-12-28 01:53:00 | 2146-12-28 03:51:00 | INDICATION: Epigastric pain. Evaluate for free air.
___.
FRONTAL UPRIGHT PORTABLE CHEST: Lung volumes are lower than on the prior
study. There is no focal consolidation, pleural effusion or pneumothorax.
Cardiac and mediastinal silhouettes are stable with mild-moderate
cardiomegaly. The patient is status post median sternotomy. No free
intra-abdominal air is seen.
IMPRESSION: No free air.
|
10088198-RR-47 | 10,088,198 | 25,635,144 | RR | 47 | 2146-12-28 04:55:00 | 2146-12-28 05:39:00 | INDICATION: Transaminitis and epigastric pain.
COMPARISON: CT ___.
FINDINGS: The liver shows no textural abnormality. A 1.4 x 1.1 cm cyst in the
right hepatic lobe is similar to CT ___. No concerning focal liver
lesion is identified. Doppler assessment of the main portal vein shows patency
and normal hepatopetal flow. There is no intra- or extra-hepatic bile duct
dilation. The common duct is not dilated, measuring 5 mm. Tiny gallstones or
sludge are seen within the gallbladder without gallbladder distention or wall
edema. Sonographic ___ sign is negative. The visualized portions of the
pancreatic head, body and tail are unremarkable. The pancreatic duct is
normal, measuring 2 mm. Visualized portions of the IVC are normal. There is
no ascites in the upper abdomen.
IMPRESSION: Tiny gallstones or sludge without evidence of acute
cholecystitis.
|
10088198-RR-48 | 10,088,198 | 25,635,144 | RR | 48 | 2146-12-28 19:41:00 | 2146-12-29 09:34:00 | HISTORY: Epigastric abdominal pain with elevated LFTs. Concern for passed
stone.
TECHNIQUE: T1 and T2 weighted multiplanar images of the abdomen were acquired
within a 1.5 Tesla magnet, including 3D dynamic sequence performed prior to,
during, and following the administration of 15 cc of Prohance intravenous
contrast. 1 cc of Gadavist mixed with 50 cc of water were administered for
oral contrast.
COMPARISON: CT and ultrasound examinations from ___ and ___.
MRI OF THE ABDOMEN WITH AND WITHOUT IV CONTRAST:
Included views of the lung bases demonstrate mild right lower lobe
atelectasis. There is no pericardial or pleural effusion. The heart size is
normal.
Multiple hepatic cysts and/or biliary hamartomas are denoted by high uniform
signal intensity on T2 weighted sequences without appreciable internal
contrast enhancement, the largest arising from segment VI measuring 10 x 10 mm
(series 4 image 29). No concerning intrahepatic mass is detected.
There is no intrahepatic or extrahepatic bile duct dilation. Trace sludge
and/or tiny stones lie within an otherwise normal gallbladder (series 1,002
image 107). No ductal stones are present.
The pancreas demonstrates moderate fatty deposition (series 5 image 25, 24),
but remains normal in bulk. Within the pancreatic neck and body are 5 and 3
mm cystic lesions demonstrating high internal signal intensity on T2 weighted
sequences (series 4 image 19, 16), which, in combination with a normal-caliber
main pancreatic duct, are most compatible with side branch IPMN.
The spleen, adrenal glands, kidneys, stomach, and intra-abdominal loops of
small and large bowel are normal. There is no mesenteric or retroperitoneal
lymphadenopathy, and no ascites.
A replaced right hepatic artery arises from the SMA (series 1,001 image 80).
The portal and hepatic veins are patent. The abdominal aorta, celiac trunk,
SMA, and renal arteries are patent. Atherosclerotic plaques extend throughout
the infrarenal abdominal aorta (series 1,001 image 84, 91, 118), without flow
limiting stenosis or dissection.
There are no bony lesions concerning for malignancy or infection. Mild
dextroscoliosis is centered about the thoracolumbar junction (series 3 image
17). Multiple sacral Tarlov's cysts are present (series 3 image 12).
IMPRESSION:
1. Trace cholelithiasis. No intrahepatic or extrahepatic bile duct dilation.
No ductal stones.
2. 5 and 3 mm cystic lesions within the pancreatic neck and body,
respectively, likely represent side branch IPMN. At this age, no further
dedicated follow up is recommended per departmental guidelines.
3. Mild right lower lobe atelectasis.
4. Benign hepatic cysts or biliary hamartomas.
|
10088198-RR-55 | 10,088,198 | 26,124,727 | RR | 55 | 2150-01-15 19:43:00 | 2150-01-15 21:23:00 | EXAMINATION: CTA HEAD AND CTA NECK
INDICATION: History of prior infarct with dizziness since this morning and
unsteady gait. Evaluate for posterior circulation infarct.
TECHNIQUE: Contiguous MDCT axial images were obtained through the brain
without contrast material. Subsequently, helically acquired rapid axial
imaging was performed from the aortic arch through the brain during the
infusion of 70 mL of Omnipaque intravenous contrast material.
Three-dimensional angiographic volume rendered, curved reformatted and
segmented images were generated on a dedicated workstation. This report is
based on interpretation of all of these images.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 5.0 s, 20.0 cm; CTDIvol = 46.7 mGy (Head) DLP =
934.2 mGy-cm.
2) Spiral Acquisition 4.5 s, 35.4 cm; CTDIvol = 11.4 mGy (Body) DLP = 401.7
mGy-cm.
3) Stationary Acquisition 3.5 s, 0.5 cm; CTDIvol = 17.8 mGy (Body) DLP =
8.9 mGy-cm.
Total DLP (Body) = 411 mGy-cm.
Total DLP (Head) = 934 mGy-cm.
COMPARISON: MR head ___ and ___. Subsequent MR head ___. CTA head and neck ___ and ___.
FINDINGS:
CT HEAD WITHOUT CONTRAST:
There is unchanged right parietal encephalomalacia compatible with chronic
infarct. There is additional tiny lacunar infarct of the right thalamus
(02:22). Similar-appearing area is seen in the left midbrain (02:18). There
is no evidence of acute infarction, hemorrhage, edema, or mass. Moderate
prominence of the ventricles and sulci suggestive of involutional change.
There is trace mucosal wall thickening in the floors of the maxillary sinuses.
The visualized portion of the paranasal sinuses, mastoid air cells, and middle
ear cavities are otherwise clear. The visualized portion of the orbits are
unremarkable.
CTA HEAD:
There is a right dominant vertebrobasilar system. There is normal variant
fetal type origin of the left posterior cerebral artery. There are mild
atherosclerotic calcifications of the bilateral intracranial internal carotid
arteries without significant narrowing. The vessels of the circle of ___
and their principal intracranial branches otherwise appear patent without
significant stenosis, occlusion, or aneurysm formation. Right posterior
communicating artery infundibulum is incidentally noted. The dural venous
sinuses are patent.
CTA NECK:
There are moderate atherosclerotic calcifications of a 3 vessel aortic arch.
Atherosclerotic calcifications are noted along the great vessel origins
without significant narrowing. There is mild narrowing at the origin of the
right vertebral artery. There is moderate narrowing at the origin of the left
vertebral artery. There is mild narrowing at the origin of the left common
carotid artery, with scattered areas of atherosclerotic calcification along
the bilateral common carotid arteries. There is moderate calcified
atherosclerotic plaque at the left carotid bifurcation. This produces 50%
narrowing of the left internal carotid artery. There is moderate focal
calcified and noncalcified atherosclerotic plaque of the distal right common
carotid artery producing mild narrowing. There is no right internal carotid
artery stenosis by NASCET criteria. The carotid and vertebral arteries and
their major branches otherwise appear patent with no evidence of dissection or
occlusion.
OTHER:
A 1 mm nodule of the right upper lobe is unchanged since ___ (03:12). A
2 mm nodule of the left upper lobe is also unchanged since ___ (03:26).
No new nodule is seen in the visualized lung apices. There are postsurgical
changes from thyroidectomy and right-sided neck dissection. There is no
lymphadenopathy by CT size criteria. Mottled appearance of the lower cervical
vertebrae is again noted, unchanged.
IMPRESSION:
1. No acute intracranial abnormality.
2. Chronic right parietal infarct and chronic lacunar infarcts of the right
thalamus and left midbrain.
3. Multifocal cervical arterial atherosclerotic disease, with mild narrowing
at the origin of the right vertebral artery, moderate narrowing at the origin
of the left vertebral artery, mild narrowing at the origin of the left common
carotid artery, mild narrowing of the distal right common carotid artery, and
50% stenosis of the left internal carotid artery by NASCET criteria.
4. Otherwise patent cervical arterial vasculature without occlusion or
dissection.
5. Patent intracranial arterial vasculature without significant stenosis,
occlusion, or aneurysm formation.
6. 1 and 2 mm pulmonary nodules, unchanged since ___. No further
surveillance is required.
7. Postsurgical changes from total thyroidectomy and right-sided neck
dissection.
|
10088198-RR-56 | 10,088,198 | 26,124,727 | RR | 56 | 2150-01-16 00:40:00 | 2150-01-16 10:05:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with dizziness// rule out infection
TECHNIQUE: Portable AP chest radiograph
COMPARISON: Multiple chest radiographs, most recently dated ___
FINDINGS:
Median sternotomy wires are aligned intact.
The lungs are persistently hyperinflated. Mild cardiomegaly is unchanged.
There is subtle opacity in the right upper lung, not significantly changed
since ___. There is chronic prominence of the pulmonary vasculature,
unchanged from prior exam. There is no pleural effusion or pneumothorax. The
cardiomediastinal silhouette is grossly unchanged from prior exam.
IMPRESSION:
Chronic pulmonary congestion and subtle opacity in the right upper lung,
unchanged since ___.
|
10088198-RR-57 | 10,088,198 | 26,124,727 | RR | 57 | 2150-01-16 06:18:00 | 2150-01-16 11:13:00 | EXAMINATION: MR HEAD W/O CONTRAST
INDICATION: Dizziness and right-sided weakness. Evaluate for infarct.
TECHNIQUE: Sagittal T1 weighted imaging was performed. Axial imaging was
performed with gradient echo, FLAIR, diffusion, and T2 technique were then
obtained.
COMPARISON MR head ___ and ___. CTA head neck ___, ___.
FINDINGS:
There is unchanged focus of right parietal encephalomalacia compatible with
chronic infarct. Hemosiderin staining is seen in this area. Tiny bilateral
chronic cerebellar infarcts are unchanged. There are also tiny chronic
lacunar infarcts versus prominent perivascular spaces of the left midbrain.
There is no evidence of hemorrhage, edema, masses, mass effect, midline shift
or acute infarction. There is moderate prominence of the ventricles and sulci
suggestive of involutional change. Small scattered areas of white matter
T2/FLAIR hyperintensity in a configuration most suggestive of chronic small
vessel ischemic disease. There is no abnormal focus of slowed diffusion. The
principal intracranial vascular flow voids are preserved.
There is minimal mucosal thickening in the bilateral ethmoid sinuses. The
remainder of the visualized paranasal sinuses are otherwise clear. There are
changes from bilateral lens replacement surgery. The orbits are otherwise
grossly unremarkable. The mastoid air cells are clear.
IMPRESSION:
1. No acute intracranial abnormality including acute hemorrhage, acute
infarct, or suggestion of mass.
2. Unchanged chronic right parietal infarct with superficial siderosis.
Additional tiny chronic lacunar infarcts of the left midbrain and bilateral
cerebellar hemispheres.
3. Moderate global atrophy and areas of white matter signal abnormality in a
configuration most suggestive of chronic small vessel ischemic disease.
|
10088799-RR-58 | 10,088,799 | 28,732,089 | RR | 58 | 2166-09-23 22:10:00 | 2166-09-23 22:39:00 | INDICATION: Evaluation of patient with shortness of breath.
COMPARISON: Chest radiograph from ___ and CT chest from ___.
FINDINGS: There are bibasilar atelectatic changes. However, more focal
opacity in the right middle lobe may be representative of a developing right
middle lobe pneumonia. Previously visualized right apical spiculated nodule
is again identified and continued to follow up as per CT is recommended.
Multiple other pulmonary nodules previously visualized on CT are better
visualized on prior CT from ___. Cardiomediastinal silhouette is
normal. No acute fractures identified.
|
10088937-RR-16 | 10,088,937 | 20,696,600 | RR | 16 | 2168-07-07 15:23:00 | 2168-07-07 16:30:00 | REASON FOR EXAMINATION: Shortness of breath and bradycardia.
PA and lateral upright chest radiographs were reviewed with no prior studies
available for comparison.
Heart size is normal. Mediastinum is normal. Lungs are clear. There is no
pleural effusion or pneumothorax.
IMPRESSION:
No evidence of acute cardiopulmonary process.
|
10088966-RR-100 | 10,088,966 | 23,861,822 | RR | 100 | 2131-11-16 16:20:00 | 2131-11-16 18:05:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ with s/p fall left hip pain on // eval for ICH NCHCT
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast. Coronal reformations as well as bone algorithm reconstructions were
provided and reviewed.
DOSE: Total DLP (Head) = 803 mGy-cm.
COMPARISON: CT head from ___
FINDINGS:
There is no evidence of acute infarction,hemorrhage,edema, or mass. T no
intra-axial or extra-axial hemorrhage, edema, shift of normally midline
structures, or evidence of a cute major vascular territorial infarction.
Ventricular and sulcal prominence are unchanged reflecting involution/atrophy.
Similar pattern of periventricular and subcortical white matter hypodensities
are again noted and likely reflect chronic microvascular ischemic disease.
There is no acute acute fracture. The imaged paranasal sinuses,mastoid air
cells, and middle ear cavities are clear. The visualized portion of the
orbits are otherwise unremarkable.
IMPRESSION:
No acute intracranial abnormalities.
|
10088966-RR-101 | 10,088,966 | 23,861,822 | RR | 101 | 2131-11-16 16:21:00 | 2131-11-16 18:11:00 | EXAMINATION: CT C-SPINE W/O CONTRAST
INDICATION: ___ with s/p fall, neck pain.
TECHNIQUE: Non-contrast helical multidetector CT was performed. Soft tissue
and bone algorithm images were generated. Coronal and sagittal reformations
were then constructed.
DOSE: Total DLP (Body) = 878 mGy-cm.
COMPARISON: CT cervical spine from ___.
FINDINGS:
Multilevel degenerative changes within the cervical spine appear unchanged
from recent prior exam performed less than 1 month ago. No acute fracture or
change in alignment. No prevertebral soft tissue swelling. Stable mild
anterolisthesis again noted involving C2-C3, C3 on C4 and C7 on T1, and C2 on
C3. Degenerative disc disease is most pronounced at C4-5, C5-6, C6-7 levels.
Facet and uncovertebral joint hypertrophic changes more notable on the left
than right. No critical stenosis is seen. Partially visualized left
subclavian central venous catheter noted. Thyroid is unremarkable. Chronic
left first rib fractures near the costovertebral junction is unchanged. There
is no prevertebral soft tissue swelling.
IMPRESSION:
No acute fracture or traumatic malalignment. Additional nonemergent findings
as described above.
|
10088966-RR-102 | 10,088,966 | 23,861,822 | RR | 102 | 2131-11-16 16:21:00 | 2131-11-16 18:37:00 | EXAMINATION: CT torso with contrast
INDICATION: History: ___ with mechanical fall and scattere ecchymosese over
chest and abdomen. Evaluate for fractures or hemorrhage.
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:
Total DLP (Body) = 979 mGy-cm.
COMPARISON: CT abdomen pelvis from ___ and CT chest from ___
FINDINGS:
CHEST:
HEART AND VASCULATURE: The ascending aorta appears ectatic measuring up to 3.6
cm 3.6 cm in diameter. Mild atherosclerotic calcification is noted. The
heart is enlarged with right chamber enlargement. Mitral valve replacement
noted. No pericardial effusion.
Left upper extremity catheter tip terminates in the distal SVC. There is
dense coronary calcification. Patient is status post mitral valve
replacement. The right and left atria are mildly enlarged. The main
pulmonary and right pulmonary artery are mildly enlarged, measuring up to 3.0
cm. Patient status post CABG.
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: There is emphysema and mild fibrosis with scattered calcified
granulomas. No concerning pulmonary nodule is seen. There is evidence of
small airway disease with nodular opacities in the periphery of the lungs,
most notable in the right upper and left upper lobes. The airways are patent
to the level of the segmental bronchi bilaterally. However, there is mild
bronchiectasis, especially in the bilateral lower lobes.
BASE OF NECK: Visualized portions of the base of the neck show no abnormality.
Bones: Patient is status post median sternotomy with multiple intact cerclage
wires around the fractured sternum. There is no significant bridging callus
formation in the manubrium as well as the remaining sternum. Chronic
deformity of the left first rib at the costovertebral junction is unchanged
from prior exam.
There is bilateral gynecomastia.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates mottled enhancement, consistent with
congested liver secondary to right-sided heart disease. Focal
hyperenhancement at the edge of segment VI (2:114) likely corresponds with
previously demonstrated hemangioma on ___. 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 laceration. Subcentimeter hypodensity in the superior aspect of
the spleen is too small to characterize by CT (3:92). There is a 1.5 cm
accessory spleen.
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. Previously
demonstrated mass at the ileocecal valve is not seen. There is no evidence
obstruction. Diverticulosis of the sigmoid colon is noted, without evidence
of wall thickening and fat stranding. 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 is heterogeneous and enlarged.
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.
Extensive atherosclerotic disease with noncalcified atheroma in the abdominal
aorta is noted. There is new ulcerated plaque in the infrarenal aorta at the
level of the origin of the ___ (3:114).
BONES: There is no acute fracture. No focal suspicious osseous abnormality.
There are diffuse bilateral facet arthropathy at the lumbar spine.
Compression fracture of L1 and L2 with minimal retropulsion is unchanged from
prior exam dated ___. Cortical deformity at the costovertebral
junction of the right eleventh rib demonstrate some callus formation, likely
reflective of chronic changes.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. No acute sequelae of trauma.
2. Subacute and chronic fractures, detailed above.
3. Atheromatous disease of the abdominal aorta with new ulcerated plaque in
the abdominal aorta at the level of the ___.
4. Cardiomegaly with right chamber enlargement and evidence of hepatic
congestion.
|
10088966-RR-103 | 10,088,966 | 23,861,822 | RR | 103 | 2131-11-18 12:04:00 | 2131-11-18 12:25:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old man with orthostatic hypotension, increased
dyspnea.// evaluate for worsening pulmonary edema, consolidation evaluate
for worsening pulmonary edema, consolidation
IMPRESSION:
In comparison with study of ___, the cardiac silhouette remains at the
upper limits of normal or mildly enlarged in this patient with intact midline
sternal wires. The pulmonary vascular congestion has substantially improved.
There may be small joint effusions on both sides.
No evidence of acute focal pneumonia. Port-A-Cath is unchanged.
|
10088966-RR-104 | 10,088,966 | 27,318,566 | RR | 104 | 2131-11-29 12:26:00 | 2131-11-29 13:13:00 | EXAMINATION: CHEST (AP AND LAT)
INDICATION: History: ___ with shortness of breath//infiltrate?
TECHNIQUE: Upright AP and lateral views of the chest
COMPARISON: Chest radiograph ___
FINDINGS:
Left-sided Port-A-Cath tip terminates in the lower SVC. Patient is status
post median sternotomy, CABG, and mitral valve replacement. Moderate cardiac
enlargement is unchanged. The mediastinal and hilar contours are similar.
There is mild pulmonary vascular congestion, similar to the previous exam. No
focal consolidation, pneumothorax, or pleural effusion is identified. Patchy
opacities in the lung bases may reflect areas of atelectasis. No acute
osseous abnormalities seen.
IMPRESSION:
Mild pulmonary vascular congestion and moderate cardiomegaly, not changed in
the interval. Patchy atelectasis in the lung bases.
|
10088966-RR-105 | 10,088,966 | 27,318,566 | RR | 105 | 2131-11-29 16:00:00 | 2131-11-29 16:41:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ male with lethargy and altered mental status on
Coumadin. Please evaluate for 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 = 49.3 mGy (Head) DLP =
903.1 mGy-cm.
2) Sequenced Acquisition 3.0 s, 6.1 cm; CTDIvol = 49.3 mGy (Head) DLP =
301.0 mGy-cm.
Total DLP (Head) = 1,204 mGy-cm.
COMPARISON: CT head from ___ and ___.
FINDINGS:
There is no evidence of acute large territorial infarction,hemorrhage,edema,
or mass. There is prominence of the ventricles and sulci suggestive of
involutional changes. Periventricular, subcortical and deep white matter
hypodensities are nonspecific but likely sequela of chronic small vessel
ischemic changes. Mild atherosclerotic calcifications are demonstrated within
the cavernous carotid arteries.
There is no evidence of fracture. Minimal mucosal thickening is seen within
the ethmoid air cells bilaterally. The visualized portion of the remaining
paranasal sinuses, mastoid air cells, and middle ear cavities are clear.
Patient is status post bilateral lens replacement.
IMPRESSION:
No acute intracranial abnormality.
|
10088966-RR-106 | 10,088,966 | 27,318,566 | RR | 106 | 2131-12-02 12:22:00 | 2131-12-02 13:21:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with fluid overload and AMS, rule out PNA.// AMS
with unclear etiology, rule out PNA AMS with unclear etiology, rule out
PNA
IMPRESSION:
In comparison with study of ___, the patient has taken a slightly better
inspiration. Continued enlargement of the cardiac silhouette, though the
vascular congestion has essentially cleared and there is no evidence of
pleural effusion or acute focal pneumonia. Port-A-Cath tip is unchanged in
position.
|
10088966-RR-107 | 10,088,966 | 27,318,566 | RR | 107 | 2131-12-08 14:50:00 | 2131-12-08 16:03:00 | EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ year old man with PMHx afib on subtherapeutic Coumadin
presenting with the right shoulder weakness, evaluate for stroke.
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Total DLP = appended 36.67 mGy-cm.
COMPARISON: Prior head CT dated ___.
FINDINGS:
There is no evidence of infarction, hemorrhage, edema, or mass. There is
prominence of the ventricles and sulci suggestive of involutional changes.
Nonspecific periventricular and deep subcortical white matter hypodensities
most likely represent moderate chronic small vessel ischemic disease.
There is no evidence of fracture. The visualized portion of the paranasal
sinuses, mastoid air cells, and middle ear cavities are clear. The visualized
portion of the orbits are unremarkable.
IMPRESSION:
1. No evidence of acute intracranial process.
2. Involutional changes and nonspecific white matter hypodensities likely
representing the sequelae of moderate chronic small vessel ischemic disease.
|
10088966-RR-108 | 10,088,966 | 27,318,566 | RR | 108 | 2131-12-09 02:28:00 | 2131-12-09 11:26:00 | EXAMINATION: MRI AND MRA BRAIN AND MRA NECK PT11 MR HEAD NECK.
INDICATION: ___ year old man with new R sided weakness (R shoulder flexion,
finger extension, and hip flexion)// Any evidence of stroke.
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 15 mL of
Multihance intravenous contrast. Please note that secondary to technical
limitation, a post-contrast MRA could not be performed. 2D time-of-flight
of the neck was performed.
Brain imaging was performed with sagittal T1 and axial FLAIR, T2, gradient
echo and diffusion technique.
Three dimensional maximum intensity projection and segmented images were
generated. This report is based on interpretation of all of these images. The
examination was performed using a 1.5T MRI.
COMPARISON: CT head from ___ and MRI head from ___.
FINDINGS:
MRI BRAIN:
A focus of slow diffusion with associated FLAIR signal abnormality measuring
approximately 1 cm x 1.1 cm is seen within the left precentral gyrus. A 2 mm
focus of high signal is seen within the right frontal lobe, series 6, image 22
on the diffusion-weighted images, without a definite correlate on the ADC
maps. A 2 mm focus of high signal is seen within the right occipital lobe
with associated FLAIR signal abnormality, series 6, image 15. Ventricles and
sulci are age appropriate. Periventricular deep subcortical FLAIR white
matter hyperintensities are likely sequelae of chronic microangiopathy.
Multiple bilateral cortical and subcortical foci of hypointense signal is
seen, which may be secondary to amyloid angiopathy versus hypertensive
encephalopathy. Low signal within the pons and right middle cerebellar
peduncle, on the susceptibility weighted images may be secondary to chronic
microhemorrhage with an underlying capillary telangiectasia, which appears
unchanged since the prior exam.
Mild mucosal sinus thickening is seen involving the ethmoid air cells. The
remainder the visualized paranasal sinuses, mastoid air cells, and middle ear
cavities are clear. The globes demonstrate bilateral lens replacement
surgery. The principal vascular flow voids appear to be well preserved.
MRA BRAIN:
The left internal carotid artery is unremarkable. There is loss of flow
related enhancement along the cavernous segment of the left internal carotid
artery, which may be secondary to atherosclerotic disease. The left middle
cerebral artery is normal. There is normal arborization of the left MCA
vessels. The right internal carotid artery is normal. The right middle
cerebral artery is normal. There is normal arborization of the right MCA
vessels. The A1 segment of the left anterior cerebral artery is hypoplastic.
The right anterior cerebral artery is normal. The distal right ACA vessels
are normal. The vertebral arteries are normal. The basilar artery is normal.
The posterior cerebral arteries are normal.
MRA NECK:
Please note that it is due to technical errors, postcontrast MRA of the neck
could not be performed. Evaluation of the neck vessels is based upon the 2D
time-of-flight images.
The vertebral arteries and bilateral internal carotid arteries appear to be
unremarkable, without evidence of significant stenosis by NASCET criteria.
IMPRESSION:
1. 1.1 cm focus of slow diffusion with associated FLAIR signal abnormality
within the left precentral gyrus is concerning for an acute to subacute
infarct.
2. Subtle 0.2 cm focus of high signal within the right frontal lobe, series 6,
image 22 without definite correlate on the ADC maps, may be artifactual versus
a focal small subacute infarct. Likely 0.2 cm focus of subacute infarction is
seen within the right occipital lobe, series 6, image 15.
3. Unremarkable MRA of the head, specifically with normal arborization of the
distal left MCA vessels. Moderate intracranial atherosclerotic disease.
4. Limited MRA of the neck without contrast. However, based on the 2D
time-of-flight images, the bilateral internal carotid arteries appear to be
unremarkable without evidence of significant stenosis by NASCET criteria.
5. Diffuse foci of low signal on the susceptibility weighted sequences within
the cortical and subcortical regions may be secondary to hypertensive
encephalopathy versus amyloid angiopathy.
6. Severe chronic microangiopathy.
NOTIFICATION: The findings were discussed with Dr. ___, M.D. by
___, M.D. on the telephone on ___ at 11 am, 15 minutes after
discovery of the findings.
|
10088966-RR-86 | 10,088,966 | 24,370,348 | RR | 86 | 2131-05-30 18:48:00 | 2131-05-30 19:36:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ with syncope/head strike on coumadin // acute process
TECHNIQUE: Contiguous axial images from skullbase to vertex were obtained
without intravenous contrast. Coronal and sagittal reformats were also
performed.
DOSE: Total DLP (Head) = 803 mGy-cm.
COMPARISON: MRI head from ___ and head CT from ___.
FINDINGS:
There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or
acute major vascular territorial infarct. Gray-white matter differentiation is
preserved. Ventricles and sulci are prominent compatible with global volume
loss. Basilar cisterns are patent.
Included paranasal sinuses and mastoids are essentially clear besides
scattered mucosal thickening in the ethmoid air cells. There is mild swelling
overlying the left temporal region without underlying fracture.
IMPRESSION:
No acute intracranial process.
|
10088966-RR-87 | 10,088,966 | 24,370,348 | RR | 87 | 2131-05-30 19:08:00 | 2131-05-30 19:55:00 | EXAMINATION: CT C-SPINE W/O CONTRAST
INDICATION: ___ with syncope/head strike on coumadin // acute process
acute process
TECHNIQUE: Non-contrast helical multidetector CT was performed through the
cervical spine. Soft tissue and bone algorithm images were generated. Coronal
and sagittal reformations were then constructed.
DOSE: Total DLP (Body) = 1,045 mGy-cm.
COMPARISON: MRI from ___. Chest CT from ___.
FINDINGS:
There is no traumatic malalignment. There is unchanged mild anterolisthesis at
C2 on C3, C3 on C4, C7 on T1 and T2 on T3. Mild retrolisthesis of C5 on C6 is
also unchanged. No acute cervical spine fractures are identified.
Significant neural foraminal narrowing at C3-4 on the left and bilateral C5-6
is better evaluated on prior MRI from ___. Moderate spinal cord
stenosis at multiple levels is also better evaluated on prior MRI. However,
there is no significant interval change, allowing for differences in
technique. There is no prevertebral soft tissue swelling.
There is an acute appearing fracture of the left first rib at the
costovertebral junction (02:57).
Subpleural reticular markings, left greater than right were seen on prior exam
and suggestive of a chronic interstitial process. Superimposed mosaic
attenuation could be due to air trapping in the setting of small airways
disease. There is a stable right apical pulmonary nodule (2:76) since ___.
The imaged thyroid is unremarkable. Patient status post sternotomy.
IMPRESSION:
1. No acute fracture or traumatic malalignment in the cervical spine.
2. Acute appearing left first rib fracture at the costovertebral junction.
3. Moderate degenerative changes of the cervical spine, better evaluated on
prior MRI from ___. No significant interval change.
NOTIFICATION: The updated finding of left rib fracture were discussed with
___, M.D. by ___, M.D. on the telephone on ___ at 9:23
___, 1 minute after discovery of the findings.
|
10088966-RR-88 | 10,088,966 | 24,370,348 | RR | 88 | 2131-05-30 21:39:00 | 2131-05-30 22:33:00 | EXAMINATION:
Chest: Frontal and lateral views
INDICATION: ___ with recent fall. left first rib fracture on CT C spine,
otherwise non-tender // ?rib fracture
TECHNIQUE: Chest: Frontal and Lateral
COMPARISON: CT C-spine from ___, CT chest from ___.
FINDINGS:
The lungs are clear without focal consolidation. No pleural effusion or
pneumothorax is seen. The cardiac and mediastinal silhouettes are stably
enlarged. Median sternotomy wires are aligned and intact. Left-sided
Port-A-Cath terminates in mid SVC. There is mild retrocardiac atelectasis.
Anterior wedging deformity of L1 is stable since ___. Minimally displaced
left first rib fracture is better appreciated on the prior CT from ___.
IMPRESSION:
1. No acute cardiopulmonary process.
2. Left first rib fracture better appreciated on prior CT. No other displaced
rib fractures.
|
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