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10088966-RR-98 | 10,088,966 | 23,861,822 | RR | 98 | 2131-11-16 13:20:00 | 2131-11-16 17:23:00 | EXAMINATION: Chest radiograph
INDICATION: History: ___ with s/p fall left hip pain on warfrain// eval for
iCH NCHCT eval for C spine fracture eval for left femur fracture
TECHNIQUE: Single supine chest radiograph
COMPARISON: Chest CT from the same day
FINDINGS:
Lung volumes are low, limiting evaluation. Opacity in the left lower lobe
likely represents atelectasis, though consolidation may have a similar
appearance. There is mild pulmonary edema. No large pleural effusion is
seen. There is no pericardial effusion. Left upper extremity infusion
catheter tip projects over the distal SVC. Multiple mediastinal cerclage
wires are aligned and intact. Patient is status post mitral valve
replacement. The mediastinal silhouette is enlarged, possibly due to supine
positioning and as well as AP technique, in the setting of pulmonary edema.
IMPRESSION:
Pulmonary edema. Likely left lower lobe atelectasis, though consolidation may
have a similar appearance.
Enlarged mediastinal silhouette, likely due to positioning and technique.
|
10088966-RR-99 | 10,088,966 | 23,861,822 | RR | 99 | 2131-11-16 13:21:00 | 2131-11-16 18:33:00 | INDICATION: ___ with s/p fall left hip pain on warfrain
COMPARISON: Prior exam from ___
FINDINGS:
AP view of the pelvis and AP and lateral views of the left femur provided.
The bony pelvic ring is intact.SI joints and lower lumbar spine appear normal.
Both hips align anatomically without significant degenerative disease. The
left femur is intact. No definite joint effusion at the left knee. Left knee
and hip joints articulate normally.
IMPRESSION:
No fractures or dislocation. Please per to subsequent CT torso for further
details.
|
10089076-RR-3 | 10,089,076 | 27,132,872 | RR | 3 | 2172-05-21 00:12:00 | 2172-05-21 01:07:00 | INDICATION: Struck by motor vehicle.
TECHNIQUE: Single AP view the chest
COMPARISON: None
FINDINGS:
The cardiomediastinal and hilar contours are within normal limits. The lungs
are clear without focal consolidation, pleural effusion or pneumothorax.
There is irregularity of the left scapula consistent with fracture, better
appreciated on dedicated left shoulder radiographs.
IMPRESSION:
No acute cardiopulmonary process. Left scapular fracture, better appreciated
on dedicated left shoulder radiographs.
|
10089076-RR-4 | 10,089,076 | 27,132,872 | RR | 4 | 2172-05-21 00:55:00 | 2172-05-21 08:26:00 | EXAMINATION: DX HIP AND FEMUR
INDICATION: evaluate for fracture, acute process
evaluate for fracture, acute process
evaluate for fracture, acute process
evaluate for fracture, acute process
TECHNIQUE: AP view of the pelvis and 7 views of the right hip and right
femur.
COMPARISON: None
FINDINGS:
There is an obliquely oriented fracture through the base of the femoral neck.
Additionally there is a comminuted, overlapping fracture of the midportion of
the right femur with approximately 2.3 cm of bony overlap. A 5 cm bony
fragment is seen adjacent to the fracture site. There is no evidence of right
hip or right knee dislocation. No suspicious osseous lesions are identified.
There is marked soft tissue swelling around the right femur fracture.
IMPRESSION:
1. Obliquely oriented fracture through the right femoral neck.
2. Comminuted fracture of the midshaft of the right femur with 3 cm of bony
overlap. 5 cm bony fragment is identified adjacent to the fracture site.
3. No evidence of right knee or right hip dislocation.
|
10089076-RR-5 | 10,089,076 | 27,132,872 | RR | 5 | 2172-05-21 00:58:00 | 2172-05-21 08:24:00 | EXAMINATION: GLENO-HUMERAL SHOULDER (W/ Y VIEW) LEFT
INDICATION: History: ___ with ped struck, pan scan at OSH // evaluate for
fracture, acute process evaluate for fracture, acute process
TECHNIQUE: 3 views of the left shoulder.
COMPARISON: Chest radiograph on ___
FINDINGS:
There is a fracture through the left scapula with moderate displacement.
There is no evidence of fracture through the glenoid or humeral head. The
glenohumeral joint is congruent. No suspicious lytic or sclerotic lesion is
identified. No periarticular calcification or radio-opaque foreign body is
seen.
IMPRESSION:
Moderately displaced left scapular fracture.
|
10089076-RR-6 | 10,089,076 | 27,132,872 | RR | 6 | 2172-05-21 02:34:00 | 2172-05-21 03:40:00 | EXAMINATION: DX KNEE AND TIB/FIB
INDICATION: History: ___ with right femur fracture // eval for
fracture/dislocation, operative planning eval for fracture/dislocation,
operative planning eval for
fracture/dislocation, operative planning eval
for fracture/dislocation, operative planning
TECHNIQUE: Multiple views of the right knee, right tibia and right fibula.
COMPARISON: Radiographs of the pelvis and right hip on ___
FINDINGS:
Of note partially imaged is a comminuted fracture of the right femur.No
additional fracture, dislocation, or gross degenerative change is detected. No
suspicious lytic or sclerotic lesion is identified. No joint effusion is
seen. No soft tissue calcification or radio-opaque foreign body is detected.
IMPRESSION:
Partially imaged is a comminuted fracture of the right femur, better assessed
on dedicated right hip radiographs. No additional fractures identified. No
evidence of dislocation.
|
10089076-RR-7 | 10,089,076 | 27,132,872 | RR | 7 | 2172-05-21 02:37:00 | 2172-05-21 04:41:00 | INDICATION: ___ year old woman with possible scapular fracture on xray after
pedestrian struck // eval for scapular fracture
TECHNIQUE:
Contiguous thin section helically acquired images were obtained through
theleft shoulder, from the AC joint to the inferior angle of the scapula and
reconstructed using both bone and soft tissue algorithm. Coronal and sagittal
reformats were also generated.
DOSE: DLP ___ MGY-CM
COMPARISON: Radiographs of the left shoulder dated faintly 715
FINDINGS:
Images are slightly degraded by motion. Allowing for this, there is a
comminuted fracture of the scapula, predominately involving the mid body.
Sagittal views show that the major inferior fragment is displaced posteriorly
to a small degree. There is also slight overriding of the upper and lower
major fragments. No extension into the scapular neck or glenoid is detected.
Fragments to extend to the inferolateral edge of these spinoglenoid notch, but
not into the notch itself (220, 401b:115).
The glenohumeral and AC joints remain congruent. No fracture of the proximal
humerus is detected. Incidental note is made of a normal variant os acromiale
(2:6).
No fracture identified in the visualized ribs about the left upper chest.
Limited assessment of the mediastinum shows non-specific graying of the
perivascular and retrosternal fat (03:48). Limited assessment of the
visualized portion of the left lung shows no focal consult addition effusion
or pneumothorax. Faint small focus of faint patchy density in the left lower
lobe superomedial E (3:77) is thought to represent artifact due to motion.
Limited assessment of soft tissues about the scapula shows expansion of the
periscapular muscles consistent with hemorrhage and edema.
IMPRESSION:
Comminuted fracture of the left scapula predominantly involving the mid body.
No extension into the scapular neck or glenoid.
The glenohumeral joint remains congruent. No fracture detected in the
proximal humerus.
|
10089076-RR-8 | 10,089,076 | 27,132,872 | RR | 8 | 2172-05-21 08:27:00 | 2172-05-21 12:58:00 | EXAMINATION: FEMUR (AP AND LAT) RIGHT IN O.R.
INDICATION:
___ female with orif rt femur.
TECHNIQUE:
36 intraoperative spot radiographs of the right hip were taken without a
radiologist present. Fluoro time not recorded on the requisition. Images not
labeled as to side.
COMPARISON: Radiographic of hip and femur dated ___.
FINDINGS:
Intraoperative radiographs demonstrate stepwise internal fixation of a right
femoral neck fracture using a dynamic compression screw.
In addition, there has been interval placement of an intra medullary rod and
screws across the right femoral midshaft fracture.
IMPRESSION:
Correlation with real-time findings and, when appropriate, conventional
radiographs is recommended for further assessment.
|
10089076-RR-9 | 10,089,076 | 27,132,872 | RR | 9 | 2172-05-23 14:53:00 | 2172-05-23 16:37:00 | EXAMINATION: HIP UNILAT MIN 2 VIEWS RIGHT
INDICATION: Status post ORIF of right femoral neck and shaft fractures.
TECHNIQUE: Five views pelvis, right hip and the right femur.
COMPARISON: Right hip in femur radiograph and right knee and tibia-fibula
radiograph both from ___.
FINDINGS:
Gamma nail fixation of a femoral neck fracture without evidence of hardware
failure. Note made of 10 mm distraction along the medial fracture line.
Intra medullary nail and transverse screw fixation of a mid right femoral
shaft fracture with near anatomic alignment. No evidence of hardware failure.
Lateral view demonstrates new lucency at the inferior patellar margin along
with a small joint effusion.
IMPRESSION:
1. Right femoral neck fracture fixation without hardware failure though there
is 10 mm distraction along the medial fracture line. Correlate clinically for
adequacy.
2. Right mid femoral shaft fracture fixation without hardware failure and near
anatomic alignment.
3. New lucency at the inferior patellar pole suggesting iatrogenic injury
during fixation.
|
10089085-RR-36 | 10,089,085 | 29,273,555 | RR | 36 | 2118-06-11 21:30:00 | 2118-06-11 21:50:00 | HISTORY: Lung cancer, shortness of breath.
TECHNIQUE: PA and lateral views of the chest.
COMPARISON: Chest CT ___ and chest radiograph ___.
FINDINGS:
Heart size is mildly enlarged. Right hilar opacity is compatible with known
mass and radiation treatment changes. Previously noted right upper lobe
atelectasis has improved though is still present. Small right pleural
effusion persists. Left lung is clear. There is no pulmonary edema. No
pneumothorax is demonstrated. Mild degenerative changes are noted in the
thoracic spine. The patient is status post tracheostomy.
IMPRESSION:
Right perihilar opacity compatible with known mass and radiation treatment
changes. Previously demonstrated right upper lobe atelectasis is improved but
persists. Small right pleural effusion.
|
10089085-RR-37 | 10,089,085 | 29,273,555 | RR | 37 | 2118-06-11 22:23:00 | 2118-06-12 05:00:00 | HISTORY: Squamous cell cancer mass. Question mass, operative planning.
COMPARISON: Prior outside chest CT from ___.
TECHNIQUE: Volumetric, multi detector CT of the chest was performed with
intravenous contrast. Images are presented for display in axial plane in 5 mm
and 1.25 mm collimation. A series of multiplanar reformation images are also
submitted for review.
Total exam DLP: 797 mGy-cm
FINDINGS:
CT OF THE THORAX: There is an ill-defined right perihilar mass measuring
approximately 4.1 x 3.4 cm (02:14; 601b:38) extending along the major fissure
and into the thoracic inlet, adjacent to the brachiocephalic vessels. The
mass is causing effacement and narrowing of the right main stem bronchus.
Surrounding fibrotic changes of the right lung could reflect changes secondary
to radiation therapy. There is a 2.1 x 1.8 x 2.4 cm left hilar nodular mass
(2:23; 601b:40). There is a moderate-sized right-sided pleural effusion with
associated compressive atelectasis. There is a stable 4 mm nodule in the
right upper lobe and note is made of a new patch opacity at the right lung
base. The left lung is essentially clear.
A tracheostomy tube is seen in adequate position. The airways are otherwise
patent. There is no mediastinal or axillary lymph node enlargement by CT size
criteria. The heart, pericardium and great vessels are otherwise within
normal limits.
Although this study is not designed for assessment of intra-abdominal
structures, the visualized solid organs and stomach are unremarkable.
OSSEOUS STRUCTURES: No focal osseous lesion concerning for malignancy.
IMPRESSION:
1. 4.1 cm right perihilar mass, causing effacement and narrowing of the right
mainstem bronchus and extending along the major fissure and into the thoracic
inlet, adjacent to the brachiocephalic vessels.
2. 2.4 cm left hilar nodular mass.
3. Stable 4 mm nodule in the right upper lobe and new patchy opacity at the
right lung base.
4. Improved moderate sized right sided pleural effusion.
Findings discussed with ___ by ___ via telephone on
___ 10:20 AM.
|
10089085-RR-38 | 10,089,085 | 29,273,555 | RR | 38 | 2118-06-12 16:55:00 | 2118-06-13 08:41:00 | HISTORY: Bronchoscopy.
FINDINGS: In comparison with study of ___, following bronchoscopy, there is
no evidence of pneumothorax. The extensive opacification at the right base
has decreased, consistent with some removal of mucus plug and improved
aeration of the right lower lung. However, there is now a dense triangular
streak of atelectasis in the right mid zone. Left hemidiaphragm is not
sharply seen on this study, though some of this could merely reflect the AP
position of the patient.
|
10089085-RR-39 | 10,089,085 | 29,273,555 | RR | 39 | 2118-06-13 21:19:00 | 2118-06-14 10:05:00 | HISTORY: Lung cancer, tracheostomy present, now has increased O2 needs.
CHEST:
___.
There has been a decrease in the atelectasis in the right upper lung present
on the prior chest x-ray. The right lower lobe remains expanded.
Left hemidiaphragm is not well seen, and some atelectasis in this region may
be present, though this was not present on the CT of ___.
IMPRESSION: Some reexpansion of right-sided atelectasis; otherwise unchanged.
|
10089119-RR-17 | 10,089,119 | 22,582,998 | RR | 17 | 2125-01-12 14:52:00 | 2125-01-12 17:23:00 | EXAMINATION:
Chest: Frontal and lateral views
INDICATION: History: ___ with DKA// eval pneumonia
TECHNIQUE: Chest: Frontal and Lateral
COMPARISON: None.
FINDINGS:
The lungs are clear without focal consolidation. No pleural effusion or
pneumothorax is seen. The cardiac and mediastinal silhouettes are
unremarkable.
IMPRESSION:
No acute cardiopulmonary process.
|
10089199-RR-20 | 10,089,199 | 27,816,056 | RR | 20 | 2123-10-12 17:28:00 | 2123-10-12 18:00:00 | EXAMINATION: SECOND OPINION CT TORSO
INDICATION: History: ___ with focal tenderness, severe ileitis? normal
stools, hx Crohn's disease // evaluate for any abscess, fistula,
appendicitis-given focal and severity of pain despite having normal stools (GI
Recs)
TECHNIQUE: ___ read request of an outside hospital CT of the abdomen pelvis
performed with intravenous contrast.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: DLP: 279.65 mGy-cm
COMPARISON: MR enterography dated ___.
FINDINGS:
LOWER CHEST: Visualized lung fields are within normal limits. There is no
evidence of pleural or pericardial effusion.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There is no evidence of focal lesions. There is no evidence of intrahepatic or
extrahepatic biliary dilatation. The gallbladder is within normal limits.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: There is a hypodense lesion along the superior aspect of the spleen
measuring 11 mm, decreased from prior study and compatible with a splenic cyst
(2:24). Otherwise, the spleen shows normal size and attenuation throughout.
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 a punctate hypodense lesion in the interpolar region of the right
kidney, too small to characterize (2:55), likely a tiny cyst. There is no
evidence of solid renal lesions or hydronephrosis. There is no perinephric
abnormality.
GASTROINTESTINAL: The stomach, duodenum, and jejunum are unremarkable. There
is circumferential mucosal hyperenhancement mural thickening involving an
approximately 25 cm contiguous segment of the mid and distal ileum with Vasa
recta prominence (2:123). Appearance of disease extent is similar to that
seen on prior MR enterography from ___. No definite evidence of
fistulizing disease, abscess, or obstruction. The terminal ileum is not
involved. Otherwise, the remaining ileal loops demonstrate normal caliber,
wall thickness, and enhancement throughout. The colon and rectum are within
normal limits. The appendix is normal.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is a
small amount of free fluid in the pelvis.
REPRODUCTIVE ORGANS: The uterus and bilateral adnexae are grossly within
normal limits.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease
is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. Active Crohn's disease involving an approximately 25 cm contiguous segment
of mid and distal ileum, similar in extent and appearance when compared to the
prior MR enterography from ___. No evidence of bowel
obstruction, abscess, or fistulizing disease. No new sites of inflammatory
bowel disease identified.
2. Normal appendix.
|
10089894-RR-13 | 10,089,894 | 27,964,500 | RR | 13 | 2169-04-14 16:16:00 | 2169-04-14 21:03:00 | PELVIS AND LEFT FEMUR RADIOGRAPH PERFORMED ON ___
COMPARISON: None.
CLINICAL HISTORY: ___ female with unwitnessed fall, deformity of the
left proximal femur, assess fracture.
FINDINGS: Total of 10 views were provided including AP view of the pelvis, AP
and lateral views of the left femur. Bilateral hemiarthroplasties are noted
at the hip. Bones are demineralized. The bony pelvic ring is intact. On the
left, there is a fracture traversing the subtrochanteric segment of the left
proximal femur which involves the lateral cortex. The prosthesis is intact
through the left proximal femur. Distally, the left femur is intact. Limited
views of the left knee are unrevealing.
IMPRESSION: Periprosthesis fracture of the left proximal femur.
|
10089894-RR-14 | 10,089,894 | 27,964,500 | RR | 14 | 2169-04-14 16:18:00 | 2169-04-14 21:04:00 | CHEST RADIOGRAPH PERFORMED ON ___
COMPARISON: None.
CLINICAL HISTORY: ___ female with unwitnessed fall, left proximal
femur deformity, pre-op chest radiograph.
FINDINGS: Supine AP portable view of the chest provided. The lungs are clear
without focal consolidation, or supine signs of pneumothorax or effusion. The
heart is mildly enlarged though this could be technique related. Mediastinal
contour appears grossly unremarkable allowing for slight leftward rotation.
No bony abnormalities are seen.
IMPRESSION: No acute findings in the chest.
|
10089894-RR-15 | 10,089,894 | 27,964,500 | RR | 15 | 2169-04-14 15:58:00 | 2169-04-14 16:42:00 | HISTORY: ___ year old female with unwitnessed fall.
COMPARISON: None.
TECHNIQUE: Contiguous axial MDCT sections were obtained through the brain
without administration of IV contrast. Coronal, sagittal, and thin slice bone
algorithm reformats were reviewed.
FINDINGS: There is no evidence of hemorrhage, edema, mass effect, or large
territorial infarction. Well-developed encephalomalacia of the left frontal
lobe is consistent with a chronic MCA stroke. Prominent ventricles and sulci
are compatible with age-related volume loss. Extensive periventricular and
subcortical white matter hypodensities are consistent with chronic small
vessel ischemic disease. The basal cisterns appear patent and there is
preservation of gray-white matter differentiation.
No fracture is identified. Mucous retention cyst is present in the left
maxillary sinus. Aerosolized secretions are present in the left sphenoid and
ethmoidal air cells. The mastoid air cells and middle ear cavities are clear.
Bilateral ocular lens have been replaced.
IMPRESSION:
1. No intracranial hemorrhage or calvarial fracture.
2. Aerosolized secretions in the left sphenoid and ethmoidal air cells
suggest acute sinus disease.
|
10089894-RR-16 | 10,089,894 | 27,964,500 | RR | 16 | 2169-04-14 15:59:00 | 2169-04-14 16:47:00 | HISTORY: ___ female with unwitnessed fall.
COMPARISON: None.
TECHNIQUE: 2.5 mm helical axial MDCT sections were obtained from the skull
base through the superior endplate of T4. Axial images were interpreted in
conjunction with coronal and sagittal reformats.
FINDINGS: Vertebral body heights are maintained and there is no evidence of
fracture. There is slight rotation of C1 on C2, which is likely positional.
No acute alignment abnormality is identified. Multilevel cervical spine
degenerative changes are present, with loss of intervertebral disc space
height most pronounced at C2-3 and C5-6.
No prevertebral soft tissue abnormality. No lymphadenopathy is present by CT
size criteria. 3.1 cm hypodense nodule containing calcification is present
within the right thyroid lobe. Biapical pleuroparenchymal lung scarring is
minimal.
IMPRESSION:
1. No cervical spine fracture or prevertebral soft tissue abnormality.
2. Slight rotation of C1 on C2 is likely positional.
3. 3.1 cm minimally calcified right thyroid lobe nodule, for which thyroid
ultrasound may be obtained for further evaluation.
|
10089894-RR-19 | 10,089,894 | 27,964,500 | RR | 19 | 2169-04-17 17:06:00 | 2169-04-18 09:33:00 | HISTORY: Femur fracture, ORIF.
FINDINGS:
Images from the operating suite show placement of a fixation device. Further
information can be gathered from the operative report.
|
10089922-RR-20 | 10,089,922 | 20,015,409 | RR | 20 | 2189-05-25 01:23:00 | 2189-05-25 01:46:00 | EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: History: ___ with ruq pain // Cystic lesions?
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: None.
FINDINGS:
LIVER: The hepatic parenchyma appears within normal limits. The contour of
the liver is smooth. There is no focal liver mass. The main portal vein is
patent with hepatopetal flow. There is no ascites.
BILE DUCTS: There is no intrahepatic biliary dilation. The CHD measures 4 mm.
GALLBLADDER: There is no evidence of stones or gallbladder wall thickening.
PANCREAS: The imaged portion of the pancreas appears within normal limits,
without masses or pancreatic ductal dilation, with portions of the pancreatic
tail obscured by overlying bowel gas.
SPLEEN: Normal echogenicity, measuring 13.8 cm.
KIDNEYS: The right kidney measures approximately 12 cm. The left kidney
measures 11.6 cm. Normal cortical echogenicity and corticomedullary
differentiation is seen bilaterally. There is no evidence of masses, stones,
or hydronephrosis in the kidneys.
RETROPERITONEUM: The visualized portions of aorta and IVC are within normal
limits.
IMPRESSION:
1. Normal gallbladder.
2. Splenomegaly.
|
10090148-RR-9 | 10,090,148 | 26,354,377 | RR | 9 | 2153-08-10 18:30:00 | 2153-08-10 19:05:00 | EXAMINATION: HAND (PA AND LAT) SOFT TISSUE LEFT
INDICATION: ___ year old man with CAD, pancytopenia admitted with fall with
IPH and hand laceration now with increased pain, swelling and erythema at
laceration site c/f acute infection// Please assess for gas in subcutaneous
tissue Please assess for gas in subcutaneous tissue
TECHNIQUE: Frontal, oblique, and lateral view radiographs of the left hand
COMPARISON: Outside images dated ___
FINDINGS:
No fracture or dislocation is seen. There are no significant degenerative
changes. No bone erosion or periostitis is identified. No suspicious lytic or
sclerotic lesion is identified. There is significant swelling over the dorsum
of the hand and wrist. There is no evidence of subcutaneous gas.
IMPRESSION:
Significant swelling over the left hand and wrist within no evidence of
subcutaneous gas or radiographic evidence of osteomyelitis.
|
10090190-RR-2 | 10,090,190 | 21,564,652 | RR | 2 | 2186-01-01 08:22:00 | 2186-01-01 13:08:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with table saw to hand- preop CXR// preop
assessment Surg: ___ (hand repair) preop assessment
IMPRESSION:
Heart size and mediastinum are overall normal in size. Descending aorta is
tortuous. Lungs are clear. No pleural effusion or pneumothorax is
appreciated.
|
10090242-RR-21 | 10,090,242 | 24,992,688 | RR | 21 | 2151-09-11 07:22:00 | 2151-09-11 08:54:00 | INDICATION: History of right upper quadrant pain with a stent for
choledocholithiasis. Evaluate for cholecystitis or CBD dilation.
COMPARISONS: CT of the abdomen and pelvis from ___ and
ultrasound from ___ from outside institution.
FINDINGS: The liver is of normal echogenicity without any focal lesions or
intra- or extra-hepatic biliary dilatation. The main portal vein is patent.
The gallbladder is markedly thick walled and edematous with a large stone near
the fundus measuring 2.5 mm. There is pericholecystic fluid though no
organized fluid collections are identified. Multiple stones are impacted
within the neck where the gallbladder wall is also markedly thickened. There
is no evidence of biliary obstruction which is consistent with appropriate
functioning of the CBD stent. The visualized portion of the pancreas head and
body and tail are unremarkable. Limited view of the right kidney is
unremarkable.
IMPRESSION: Markedly edematous gallbladder with a large stone near the fundus
and smaller stones impacted in the thick walled gallbladder neck/proximal
cystic duct. A CBD stent is in place with no evidence of biliary obstruction,
consistent with appropriate functioning of the stent.
In comparison with prior studies the findings suggest that there has been
ongoing cholecystitis for some time (patient reports pain since ___
with prior obstruction of CBD due to either stone or secondary inflammation,
now improved after stenting. The gallbladder itself remains markedly
edematous although the lumen is not significantly distended. Recommend
short-term interval followup, however, to ensure that there is resolution of
the present findings in order to exclude a mass lesion in the gallbladder
neck, cystic duct or CBD.
|
10090737-RR-10 | 10,090,737 | 29,582,629 | RR | 10 | 2119-07-12 01:30:00 | 2119-07-12 09:33:00 | CLINICAL INFORMATION: Prior cervical and thoracic spine MRI showing spinal
cord signal abnormality. Football injury with hyperesthesia across shoulders
and upper arms. Further evaluation of spinal cord signal abnormality on prior
exam.
COMPARISON: MRI of the cervical spine dated ___.
TECHNIQUE: Multisequence, multiplanar imaging of the cervical spine was
performed, including diffusion imaging, axial STIR, and sagittal STIR images.
FINDINGS: Again seen are focal areas of increased signal within the spinal
cord at C3-C4 and C5-C6. No new areas of signal abnormality are seen. There
is no decreased diffusion to indicate a spinal cord infarct and there is no
spinal cord hemorrhage. An age-indeterminate anterior annular tear is again
present in the C5-C6 intervertebral disc and possible high STIR signal in the
anterior superior endplate of C6 adjacent to sclerosis which may again reflect
chronic-subacute fracture versus degenerative signal change to the endplate.
Small disc bulges are also present at the levels of the spinal cord signal
abnormality. There is no interval change from the prior exam.
IMPRESSION:
1. Focal areas of signal abnormality in the spinal cord at C3-C4 and C5-C6
levels. Findings may reflect spinal cord contusion. No spinal cord hemorrhage
or diffusion abnormality.
2. Age-indeterminate anterior annular tear in the C5-C6 intervertebral disc.
Possible high STIR signal in the anterior superior endplate of C6 adjacent to
sclerosis which may reflect chronic-subacute fracture versus degenerative
signal change to the endplate. No evidence of ligamentous injury.
|
10090737-RR-11 | 10,090,737 | 29,582,629 | RR | 11 | 2119-07-12 09:59:00 | 2119-07-12 12:50:00 | HISTORY: Paresthesias both shoulders. Trauma playing football.Upright in
collar, to assess alignment.
CERVICAL SPINE, THREE VIEWS INCLUDING SWIMMER'S VIEW.
C1 through C6 is demonstrated on the lateral view. C7 and T1 are partially
visualized on the swimmer's view. Artifact from a collar noted. The patient
is borderline skeletally immature, with residua of the apophyseal rings noted.
Vertebral body and disc heights are preserved. No spondylolisthesis is
detected. Small uncovertebral joint spurs are suggested at the C4 and C5
levels. No obvious fracture line is detected.
IMPRESSION: No spondylolisthesis is detected, in collar.
|
10090755-RR-27 | 10,090,755 | 23,765,179 | RR | 27 | 2110-10-20 17:12:00 | 2110-10-20 18:33:00 | EXAMINATION: Chest radiograph, portable AP upright.
INDICATION: Right pleural effusion. Chest tube placement.
COMPARISON: Prior radiographs from ___ and CT from ___.
FINDINGS:
A pigtail catheter projects over the right lower hemithorax. There has been a
marked decrease in a large right-sided pleural effusion there is a small to
medium size residual pleural effusion with substantial remaining atelectasis
of the right middle and probably lower lobes. However, previously the pleural
effusion filled up most of the right hemithorax. Minor left basilar
atelectasis appears very similar. There is no pneumothorax.
IMPRESSION:
Marked decrease in right-sided pleural effusion. Please note recent comments
on chest CT regarding pleural based nodular opacities at the base of the chest
which potentially represent malignant disease. These cannot be assessed with
this technique.
|
10090755-RR-28 | 10,090,755 | 23,765,179 | RR | 28 | 2110-10-21 08:38:00 | 2110-10-21 09:52:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with R pleural effusion, s/p pigtail placement//
eval interval change after draining 1800cc and clamping overnight
TECHNIQUE: Chest AP view
COMPARISON: ___
IMPRESSION:
The right pleural effusion is partially loculated. Subsegmental atelectasis
in the right lower lobe is unchanged. Right basilar pigtail catheter is also
unchanged. No pneumothorax. Cardiomediastinal silhouette stable.
|
10090755-RR-29 | 10,090,755 | 23,765,179 | RR | 29 | 2110-10-22 21:02:00 | 2110-10-22 23:03:00 | EXAMINATION: CT ABD AND PELVIS WITH CONTRAST
INDICATION: ___ yoM with ___ s/p R hepatic lobectomy ___ p/w large
pleural effusion, likely malignant with possible pleural mets.// staging CT
for ___. please do addl sections and disregard the previously placed
outpatient order. thanks.
TECHNIQUE: Single phase contrast: MDCT axial images were acquired through the
abdomen and pelvis following intravenous contrast administration. The
arterial, and 3 minutes delayed images were acquired through the abdomen
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Total DLP (Body) = 761 mGy-cm.
** Note: This radiation dose report was copied from CLIP ___ (CT CHEST
W/CONTRAST)
COMPARISON: None.
FINDINGS:
LOWER CHEST: Moderate right pleural effusion few locules of air and adjacent
subsegmental atelectasis. A percutaneous drainage catheter terminates within
the right pleural effusion. There is right basilar and left lingula
subsegmental atelectasis.
ABDOMEN:
HEPATOBILIARY: The patient is status post right hepatectomy with a hyperdense
suture line along the medial edge of the left hepatic lobe. The liver
demonstrates homogenous attenuation throughout. There is no evidence of focal
lesions. There is no evidence of intrahepatic or extrahepatic biliary
dilatation. The gallbladder is within normal limits.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
There is no evidence of focal renal lesions or hydronephrosis. There is no
perinephric abnormality.
GASTROINTESTINAL: Small hiatal hernia, abdomen the stomach is unremarkable.
Small bowel loops demonstrate normal caliber, wall thickness, and enhancement
throughout. There is a cecal diverticulum which demonstrates no wall
thickening. However there is incidental adjacent fat stranding which may be a
postsurgical change, (series 303, image 171). The appendix is normal.
PELVIS: The urinary bladder demonstrates mildly thickened wall which may
suggest mild cystitis. The distal ureters are unremarkable. There is no free
fluid in the pelvis.
REPRODUCTIVE ORGANS: The prostate and seminal vesicles are grossly
unremarkable.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is a nonocclusive 22 x 15 mm filling defect in the super
hepatic inferior vena cava, just inferior to the bifurcation of the middle and
left hepatic veins (series 303, image 91). The remaining hepatic veins remain
widely patent. There is fusiform dilatation of right renal artery that spans
two bifurcations of the renal artery and the right renal hilum measuring 2.2 x
1.5 x 1.1 cm (series 301, image 54) (series 603, image 63). There is no
abdominal aortic aneurysm. Mild atherosclerotic disease is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: There is a healing midline abdominal incision.
IMPRESSION:
1. Moderately-sized non-occlusive filling defect in the inferior vena cava
approximately at the confluence of the middle and left hepatic veins. The
middle and left hepatic veins are widely patent.
2. The patient is status post right hepatectomy with expected postsurgical
changes.
3. There are no hepatic lesions that meet OPTN 5 criteria for hepatocellular
carcinoma.
4. Moderate right pleural effusion with subcutaneous drainage catheter in
place.
5. Right renal artery aneurysm at the bifurcation in the right hilum measuring
2.2 x 1.5 x 1.1 cm.
|
10090755-RR-30 | 10,090,755 | 23,765,179 | RR | 30 | 2110-10-22 21:02:00 | 2110-10-22 22:31:00 | EXAMINATION: CT CHEST W/CONTRAST
INDICATION: ___ yoM with ___ s/p R hepatic lobectomy ___ p/w large
pleural effusion, likely malignant with possible pleural mets.// staging CT
for ___. please do addl sections and disregard the previously placed
outpatient order. thanks.
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) Spiral Acquisition 2.0 s, 32.2 cm; CTDIvol = 2.0 mGy (Body) DLP = 65.6
mGy-cm.
2) Spiral Acquisition 1.6 s, 21.2 cm; CTDIvol = 6.0 mGy (Body) DLP = 126.6
mGy-cm.
3) Spiral Acquisition 5.4 s, 71.2 cm; CTDIvol = 6.1 mGy (Body) DLP = 434.0
mGy-cm.
4) Spiral Acquisition 1.6 s, 21.2 cm; CTDIvol = 6.0 mGy (Body) DLP = 126.8
mGy-cm.
5) Stationary Acquisition 0.6 s, 0.5 cm; CTDIvol = 3.1 mGy (Body) DLP = 1.5
mGy-cm.
6) Stationary Acquisition 2.4 s, 0.5 cm; CTDIvol = 12.2 mGy (Body) DLP =
6.1 mGy-cm.
Total DLP (Body) = 761 mGy-cm.
COMPARISON: Multiple prior chest CTs in CT A's, most recently ___.
FINDINGS:
NECK, THORACIC INLET, AXILLAE AND CHEST WALL:
The thyroid is unremarkable. No enlarged lymph nodes in either axilla or
thoracic inlet. No abnormalities on the chest wall. No atherosclerotic
calcifications in the head and neck arteries.
HEART AND VASCULATURE:
The heart is normal size and shape. No pericardial effusion. Mild
atherosclerotic calcifications in the coronary arteries in aorta, none in the
cardiac valves. The pulmonary arteries and ascending aorta are normal in
caliber throughout. Borderline enlarged ascending aorta measuring 4.0 cm.
MEDIASTINUM AND HILA:
The esophagus is unremarkable. Multiple small mediastinal lymph nodes, none
pathologically enlarged by CT size criteria. Several hyperdense pleural
nodules are still noted in the right lung base, relatively unchanged in size
and appearance. No hilar lymphadenopathy.
PLEURA:
Small right hydropneumothorax drained by a pigtail catheter place through the
right eighth intercostal space, smaller than the prior study now showing gas
foci. No left pleural effusion or pneumothorax.
LUNGS:
The airways are patent to the subsegmental levels. No bronchial wall
thickening, bronchiectasis or mucus plugging. Partial compressive atelectasis
of the right lower lobe. Subpleural 10 mm nodule in the left upper lobe
(306:83) and 6 mm nodule in the right upper lobe (306:53), unchanged compared
to ___ however new since ___.
CHEST CAGE:
No acute fractures. No suspicious lytic or sclerotic lesions. Mild dorsal
spondylosis.
UPPER ABDOMEN:
Incidental filling defect in the inferior vena cava (306:182). Please refer
to same day abdominal CT report for subdiaphragmatic findings.
IMPRESSION:
The previously large right pleural effusion drained by a basal pigtail
catheter, is much smaller and contains small air collections incidental to
drain placement.
High attenuation pleural nodules are likely metastases, but some could be
clot. Image guided transthoracic needle aspiration should be feasible.
A nonocclusive filling defect is new or newly apparent in the supra hepatic
IVC and could be thrombus or tumor thrombus. Doppler ultrasound evaluation
could better differentiate these.
Small pulmonary nodules are new since ___ and more prominent though
small mediastinal lymphadenopathy are likely metastases.
NOTIFICATION: Pertinent critical findings were posted by Dr. ___
on ___ at 12:18 to the Department of Radiology online critical
communications system for direct communication to the referring provider.
|
10090755-RR-31 | 10,090,755 | 23,765,179 | RR | 31 | 2110-10-24 22:04:00 | 2110-10-25 00:06:00 | EXAMINATION: CT ABDOMEN WITHOUT AND WITH CONTRAST
INDICATION: ___ year old man w/PMH HBV on tenofovir c/b HCCs/p R hepatic
lobectomy ___, HTN, and BPH who presented on___ with two weeks of chest
pain/tightness and subjectivefevers with increased sputum production, found to
have R pleuraleffusion s/p R pigtail catheter placement, now with CT
findingsconcerning for pulmonary metastases and IVC thrombus/tumorthrombus.//
please perform multiphasic liver CT to evaluate for bland thrombus versus
tumor inside IVC, question of whether he needs anticoagulation
TECHNIQUE: Multiphasic Liver: Multidetector CT of the abdomen was done
without and with IV contrast. Initially, the abdomen was scanned without IV
contrast. Subsequently, a single bolus of IV contrast was injected and the
abdomen was scanned in the early arterial phase, followed by a scan of the
abdomen in the portal venous phase, followed by a scan of the abdomen in
equilibrium phase (3-min delay).
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 2.0 s, 32.2 cm; CTDIvol = 2.0 mGy (Body) DLP = 65.6
mGy-cm.
2) Spiral Acquisition 1.5 s, 19.7 cm; CTDIvol = 5.9 mGy (Body) DLP = 115.4
mGy-cm.
3) Spiral Acquisition 2.5 s, 33.4 cm; CTDIvol = 5.9 mGy (Body) DLP = 195.3
mGy-cm.
4) Spiral Acquisition 1.8 s, 23.9 cm; CTDIvol = 5.8 mGy (Body) DLP = 139.7
mGy-cm.
5) Stationary Acquisition 0.6 s, 0.5 cm; CTDIvol = 3.1 mGy (Body) DLP = 1.5
mGy-cm.
6) Stationary Acquisition 3.0 s, 0.5 cm; CTDIvol = 15.3 mGy (Body) DLP =
7.6 mGy-cm.
Total DLP (Body) = 525 mGy-cm.
COMPARISON: CT abdomen and pelvis without and with contrast ___.
FINDINGS:
LOWER CHEST: The right pleural effusion with locules of air is not
significantly changed in size. The right chest tube is been removed. There
are unchanged multiple areas of pleural thickening and nodular enhancement in
the right lung base, which is suspicious for metastatic disease.
ABDOMEN:
HEPATOBILIARY: There are postsurgical changes from right hepatectomy. There
is no evidence of a focal liver lesion. There is no intrahepatic or
extrahepatic biliary ductal dilatation.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
There is hypoenhancement of the lateral limb of the right adrenal gland on the
arterial and portal venous phases which normalizes on the delayed phase and
may be related to postsurgical changes/perfusional differences.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
A few scattered hypodense lesions in the kidney's measuring up to 4 mm are too
small to characterize but most likely represent renal cysts. There is no
perinephric abnormality.
GASTROINTESTINAL: There is a small hiatal hernia. Visualized small and large
bowel loops demonstrate normal caliber, wall thickness, and enhancement
throughout.
LYMPH NODES: There is no lymphadenopathy by size criteria.
VASCULAR: There is redemonstration of the thrombus in the suprahepatic
inferior vena cava adjacent to the confluence of the hepatic veins. There is
no evidence of thrombus enhancement. The middle and left hepatic veins are
patent.
BONES: There are no suspicious osseous lesions.
SOFT TISSUES: There are postsurgical changes in the anterior abdominal wall.
IMPRESSION:
1. Postsurgical changes from right hepatectomy. No evidence of a hepatic
lesion which meets OPTN 5 criteria for hepatocellular carcinoma.
2. Unchanged nonenhancing thrombus in the suprahepatic inferior vena cava,
which is favored to represent bland thrombus.
3. Unchanged right pleural effusion with areas of pleural thickening,
nodularity and enhancement, which is suspicious for metastatic disease.
|
10090755-RR-32 | 10,090,755 | 23,765,179 | RR | 32 | 2110-10-25 20:22:00 | 2110-10-25 21:17:00 | EXAMINATION: CR - CHEST PORTABLE AP
INDICATION: ___ year old man with HCC likely mets to lung, new fevers// ?eval
for pna
TECHNIQUE: AP radiograph of the chest.
COMPARISON: CT abdomen and pelvis ___. Chest radiograph ___.
IMPRESSION:
The right basilar chest tube has been removed. The small to moderate right
pleural effusion with locules of air and compressive atelectasis of the right
middle lobe and right lower lobe are not significantly changed compared to
prior study, allowing for differences in patient's respiratory effort. There
is no new consolidation. No pneumothorax is identified. The cardiomediastinal
silhouette is stable in appearance. There are no acute osseous abnormalities.
|
10090755-RR-33 | 10,090,755 | 21,527,537 | RR | 33 | 2110-10-30 13:05:00 | 2110-10-30 13:49:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old man with HCC. Recent hospital admission with large
pleural effusion and newly found pulmonary nodules.// Please assess for
re-accumulation of pleural effusion Please assess for re-accumulation of
pleural effusion
IMPRESSION:
Compared to chest radiographs since ___ most recently ___.
Substantial residual right pleural effusion, probably loculated, containing
small collections of gas, right posterior and lower lateral hemithorax,
extending into the major fissure. Persistent severe right basal atelectasis.
Left lung clear. Heart size normal.
|
10090755-RR-35 | 10,090,755 | 21,527,537 | RR | 35 | 2110-10-30 23:23:00 | 2110-10-31 01:04:00 | EXAMINATION: CT CHEST W/O CONTRAST
INDICATION: ___ year old man with sepsis from empyema vs. complicated
parapneumonic effusion, with h/o HCC s/p R hepatic lobectomy w/concern for
metastases into the chest// please evaluate R pleural effusion-- study
requested by ___ prior to ___ morning CT-guided chest tube placement--
please perform this study prior to 7am on ___. Thanks.
TECHNIQUE: Multi detector helical scanning of the chest was reconstructed as
5 and 1.25 mm thick axial, 2.5 mm thick coronal and parasagittal, and 8 mm MIP
axial images. Contrast agent was not administered. All images were reviewed.
DOSE: Acquisition sequence:
1) Spiral Acquisition 6.4 s, 41.4 cm; CTDIvol = 8.0 mGy (Body) DLP = 324.5
mGy-cm.
Total DLP (Body) = 325 mGy-cm.
COMPARISON: Multiple prior chest CTs, most recently ___.
FINDINGS:
NECK, THORACIC INLET, AXILLAE AND CHEST WALL:
The thyroid is unremarkable. No enlarged lymph nodes in either axilla or
thoracic inlet. No abnormalities on the chest wall. No atherosclerotic
calcifications in the head and neck arteries.
HEART AND VASCULATURE:
The heart is normal in size and shape. No pericardial effusion. No
atherosclerotic calcifications in the coronary arteries, aorta or cardiac
valves. The ascending aorta is top-normal in size. The descending aorta and
pulmonary arteries are normal in caliber throughout.
MEDIASTINUM AND HILA:
The esophagus is unremarkable. Multiple prominent mediastinal lymph nodes,
the largest in the right upper paratracheal station measuring 9 mm in short
axis diameter. No apparent hilar lymphadenopathy.
PLEURA:
Redemonstration of a complex right pleural effusion, slightly larger than in
the prior study, with visible larger hyperdense nodularities and several gas
foci. The largest hyperdense area measures up 26.6 cm (series 2, image 51).
This is new from the prior examination. Previously placed pigtail catheter
has been removed. No left pleural effusion.
LUNGS:
The airways are patent to the subsegmental levels. No bronchial wall
thickening, bronchiectasis or mucus plugging. Partial compressive atelectasis
of the middle and right lower lobes. Unchanged 6 mm nodule in the right upper
lobe (4:60) and subpleural 7 mm nodule in the left upper lobe (4:96).
CHEST CAGE:
No acute fractures. No suspicious lytic or sclerotic lesions. Mild dorsal
spondylosis.
UPPER ABDOMEN:
The limited sections of the upper abdomen show status post right hepatectomy.
No other significant abnormal findings.
IMPRESSION:
Again redemonstrated is a complex right small to moderate pleural effusion
with multiple locules of gas. The overall volume of the pleural effusion has
decreased in comparison to the prior examination, however, hyperattenuating
areas appear to be slightly larger. Given the 8 day interval between the two
CT examinations and the increase in size it is favored that these represent
areas of hemothorax and blood clot (also given reported prior negative
cytology results). PET/CT could be of value after acute symptoms have
resolved to evaluate for the degree of possible metastatic disease.
Stable small pulmonary nodules, suspicious for metastatic disease.
|
10090755-RR-36 | 10,090,755 | 21,527,537 | RR | 36 | 2110-10-31 11:07:00 | 2110-10-31 14:40:00 | EXAMINATION: CT-guided pleural drainage.
INDICATION: ___ year old man with hepatocellular carcinoma s/p recent right
hepatic lobectomy, also with pleural effusion of unclear etiology, now with
symptomatic reaccumulation of R pleural effusion;// requesting drainage, and
if possible pleural biopsy
COMPARISON: Chest CT from ___.
PROCEDURE: CT-guided drainage of pleural collection.
OPERATORS: Dr. ___, radiology trainee and Dr. ___,
attending 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 left lateral oblique position on the CT scan
table. Limited preprocedure CT 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, ___ Exodus drainage catheter
was advanced via trocar technique into the collection. The pigtail was
deployed. The position of the pigtail was confirmed within the collection via
CT.
Given large loculated gas foci only trace bloody 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.
SEDATION: Moderate sedation was provided by administering divided doses of
1.5 mg Versed and 75 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:
Loculated complex right pleural effusion with several hyperdense areas which
could represent blood clots (given aspiration of trace bloody fluid during the
procedure).
IMPRESSION:
Successful CT-guided placement of ___ pigtail catheter into the
collection. Samples was sent for microbiology evaluation.
|
10090755-RR-37 | 10,090,755 | 21,527,537 | RR | 37 | 2110-11-01 13:56:00 | 2110-11-01 15:17:00 | EXAMINATION: CHEST PORT. LINE PLACEMENT
INDICATION: ___ year old man with chest tube placement// chest tube placement
Contact name: ___: ___ chest tube placement
IMPRESSION:
Compared to chest radiographs since ___ most recently ___.
New right pleural drains, one a pigtail and the other a small bore catheter
have been inserted. There has probably been a decrease in the right pleural
effusion most of which was loculated posteriorly, but that assessment would
require conventional radiographs, especially a lateral view. I do not see a
large pneumothorax, but a small volume of pleural air remains at the base of
the right hemithorax.
Heart is mildly enlarged and pulmonary vasculature is engorged but there is no
pulmonary edema or left pleural effusion.
|
10090755-RR-38 | 10,090,755 | 21,527,537 | RR | 38 | 2110-11-03 07:15:00 | 2110-11-03 10:30:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with R loculated effusion, persistent s/p pigtail
placement x 2, dyspneic// eval for interval resolution/change, r/o ptx- pt on
airborne precautions r/o TB eval for interval resolution/change, r/o ptx-
pt on airborne precautions r/o TB
IMPRESSION:
Compared to chest radiographs since ___, most recently ___
through ___.
Despite the 2 right pleural drainage catheters placed on ___, there
has been only a slight decrease in the size of the persistent moderate pleural
effusion in the right lower hemithorax since ___. Middle and lower
lobe remain substantially atelectatic. No pneumothorax.
Left lung and left pleural space are normal. Heart size is top-normal.
|
10090755-RR-39 | 10,090,755 | 21,527,537 | RR | 39 | 2110-11-04 05:34:00 | 2110-11-04 09:41:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with HCC, R loculated pleural effusion, now s/p R
VATS washout, decortication// r/o htx, effusion, POD#1 ___ 0600a r/o
htx, effusion, POD#1 ___ 0600a
IMPRESSION:
Compared to chest radiographs ___ through ___ one.
Right pleural effusion tiny if any, has not increased since ___ one. 3
right thoracostomy tubes in place. Pneumothorax minimal if any. Aeration
still compromised in the right lower lung. Left lung is grossly clear. No
left pleural abnormality. Moderate cardiac enlargement unchanged.
|
10090755-RR-40 | 10,090,755 | 21,527,537 | RR | 40 | 2110-11-03 11:34:00 | 2110-11-03 13:36:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with HCC, R loculated pleural effusion, now s/p R
VATS washout, decortication// r/o htx, ptx r/o htx, ptx
IMPRESSION:
Compared to chest radiographs ___ through ___.
Right pigtail and small bore right pleural drainage catheters were inserted on
or after ___. Both have now been replaced by two thoracostomy tubes
terminating at the level of the carina and a third drainage tube inserted at
the level of the diaphragm which I cannot localize on the single frontal view.
Residual right pleural effusion is much smaller. No pneumothorax is evident.
There is still substantial atelectasis in right middle and lower lobes.
Pulmonary vascular engorgement is improved. Heart size is normal. There may
be a new small left pleural effusion.
|
10090755-RR-42 | 10,090,755 | 21,527,537 | RR | 42 | 2110-11-05 14:03:00 | 2110-11-05 15:06:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with recent VAT, decortication, CT in place to
waterseal, now on anticoagulation// r/o complication from procedure
TECHNIQUE: Chest AP view
COMPARISON: ___
IMPRESSION:
Multiple right-sided chest tubes are again noted. These unchanged in
position. Parenchymal opacity in the right lower lobe is stable.
Cardiomediastinal silhouette is unchanged. No pneumothorax. There is
subsegmental atelectasis in the left lung base
|
10090755-RR-43 | 10,090,755 | 21,527,537 | RR | 43 | 2110-11-06 08:20:00 | 2110-11-06 10:56:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with recent VAT/decortication now with CT to
water seal// r/o complication from procedure
TECHNIQUE: Chest AP view
COMPARISON: ___
IMPRESSION:
Right-sided chest tubes are unchanged. Small right pleural effusion is
stable. The right basilar pneumothorax is also unchanged. Parenchymal
opacity in the right lower lobe is stable. There is subsegmental atelectasis
in the lingula. Cardiomediastinal silhouette is stable. Lungs continue to be
low volume. No new consolidations
|
10090755-RR-44 | 10,090,755 | 21,527,537 | RR | 44 | 2110-11-05 18:30:00 | 2110-11-05 20:34:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ w/ h/o hep B on tenofovir c/b HCC s/p recent R hepatic
lobectomy (___) with cholecystectomy and partial excision and repair of
right hemidiaphragm, with recent readmission for R sided exudative pleural
effusion of unclear etiology, also found to have a supra-hepatic IVC thrombus
prompting initiation oflovenox, readmitted ___ with sepsis and empyema,
requiring operative management, now stable s/p VAT/ decortication with need
for intermittent pRBC transfusions and boluses.// s/p CT chest pulled
TECHNIQUE: AP portable chest radiograph
COMPARISON: ___ from earlier in the day
FINDINGS:
1 of the 3 chest tubes has been removed. A right basal pneumothorax is
suspected. Opacities in the right mid to lower lung are re-demonstrated.
There may be a small increase in right pleural fluid. Atelectasis is present
at the left lung base. The size of the cardiac silhouette is enlarged but
unchanged.
IMPRESSION:
A small right basal pneumothorax is suspected. 2 right-sided chest tubes
remain present.
|
10090755-RR-45 | 10,090,755 | 21,527,537 | RR | 45 | 2110-11-07 07:29:00 | 2110-11-07 15:31:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with metastatic hcc, empyema s/p decortication//
chest tube, interval change on R in PTX or fluid accumulation
TECHNIQUE: Frontal view the chest
COMPARISON: ___ at 09:30
FINDINGS:
Parenchymal opacities at the right lung base is stable. Previous right
basilar pneumothorax has resolved. There is now a small right effusion. The
right-sided chest tube remains in place.
Moderate cardiomegaly stable.
IMPRESSION:
Right basilar pneumothorax has resolved. Right basilar parenchymal opacities
stable. New small right effusion.
|
10090755-RR-46 | 10,090,755 | 21,527,537 | RR | 46 | 2110-11-07 14:02:00 | 2110-11-07 14:49:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ hx HBV and HCC s/p right hepatic lobectomy and diaphragmatic
resection c/b suprahepatic IVC thrombus and persistent right pleural effusion,
possible empyema; s/p R VATS Decortication// post pull CXR
TECHNIQUE: Frontal view of the chest
COMPARISON: ___ at 08:37
FINDINGS:
Probable opacities at the right lung base are stable. Small right effusion is
stable the right chest tube has been pulled. No pneumothorax is seen. Mild
fluid in the right major fissure again noted..
Mild cardiomegaly again noted. Tortuous aorta.
IMPRESSION:
The right chest tube has been pulled. No pneumothorax. Parenchymal opacities
in the right lung base and small right effusion are stable.
|
10090755-RR-47 | 10,090,755 | 21,527,537 | RR | 47 | 2110-11-08 07:31:00 | 2110-11-08 08:38:00 | INDICATION: ___ hx HBV and HCC s/p right hepatic lobectomy and diaphragmatic
resection c/b suprahepatic IVC thrombus and persistent right pleural effusion,
possible empyema; s/p R VATS Decortication// follow up
TECHNIQUE: Portable AP view of the chest
IMPRESSION:
Mild interval increasing opacities in the right lung suggestive of continued
effusion compared to the radiograph from 17 hours prior.
|
10090755-RR-48 | 10,090,755 | 21,527,537 | RR | 48 | 2110-11-08 18:08:00 | 2110-11-08 19:37:00 | EXAMINATION: CT CHEST W/CONTRAST
INDICATION: ___ year old man with hepatocellular carcinoma s/p resection with
evidence of metastatic disease to chest (malignant effusion, LAD) and several
days of hemoptysis concerning for PNA vs. tumor involvement// Please evaluate
for PNA, effusion, malignancy, bleeding
TECHNIQUE: Multidetector helical scanning of the chest was coordinated with
intravenous infusion of nonionic iodinated contrast agent and reconstructed as
contiguous 5 mm and 1.25 mm thick axial, 2.5 mm thick coronal and
parasagittal, and 8 mm MIP axial images.
DOSE: Acquisition sequence:
1) Spiral Acquisition 2.2 s, 34.7 cm; CTDIvol = 7.5 mGy (Body) DLP = 258.3
mGy-cm.
Total DLP (Body) = 258 mGy-cm.
COMPARISON: Prior Chest CT ___
FINDINGS:
NECK, THORACIC INLET, AXILLAE: The visualized thyroid is normal.
Supraclavicular and axillary lymph nodes are not enlarged.
MEDIASTINUM: Mediastinal lymph nodes are not enlarged.
HILA: Hilar lymph nodes are not enlarged.
HEART: The heart is not enlarged and there is mild coronary arterial
calcification. There is no pericardial effusion.
VESSELS: Aortic caliber is normal. The main, right, and left pulmonary
arteries are normal caliber. Small filling defect in the right upper lobe is
consistent with the subsegmental pulmonary embolism (302:58, 3 603:10 and
602:53).
PULMONARY PARENCHYMA: A 6 mm nodule in the right upper lobe (302:34) and a 9
mm nodule in the left upper lobe (302:77) are unchanged. Etiology for these
is indeterminate. Linear and branching are mild follow G0 are more often seen
with the benign inflammatory than malignant processes although malignancy is
possible. There is right lower lobe compressive atelectasis. There is no
emphysema.
AIRWAYS: The airways are patent to the subsegmental level bilaterally.
PLEURA: There is a loculated mixed density right pleural effusion measuring
9.1 x 7.6 cm, containing some high-density material suggestive of blood
products, and foci of air. There is also a small right pneumothorax with
layering high density material. A small left simple pleural effusion is new
from prior.
CHEST WALL AND BONES: There is no worrisome lytic or sclerotic lesion.
Multilevel degenerative changes are unchanged 4.0 x 1.7 cm intramuscular
lipoma overlying the right posterior chest wall. Locules of air in the soft
tissue overlying the right lower chest wall is consistent with recent catheter
placement.
UPPER ABDOMEN: This study is not tailored for evaluation of the abdomen.
Allowing for this, the partially visualized upper abdomen is notable for right
hepatectomy.
IMPRESSION:
1. Slight increase in size of moderate right loculated pleural effusion
containing high-density material suggestive of blood products, and foci of
air.
2. Additional small hydropneumothorax along the right upper lobe is new from
prior CT. Status post chest tube removal.
3. Small simple left pleural effusion.
4. Unchanged 6 mm right upper lobe nodule and 9 mm left upper lobe nodule,
indeterminate.
5. New visualization of small sub segmental pulmonary embolism of the right
upper lobe.
NOTIFICATION: The findings were discussed with ___, M.D. by
___, M.D. on the telephone on ___ at 10:12 pm.
|
10090768-RR-10 | 10,090,768 | 28,397,943 | RR | 10 | 2148-11-08 11:05:00 | 2148-11-08 11:51:00 | INDICATION: ___ year old woman with RA and sigmoid diverticulitis // PO and
IV contrast. Rule out abscess.
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired
through the abdomen and pelvis following intravenous contrast administration
with split bolus technique. IV Contrast: 130 mL Omnipaque.
Coronal and sagittal reformations were performed and reviewed on PACS.
Oral contrast was administered.
DOSE: This study involved 4 CT acquisition phases with dose indices as
follows:
1) CT Localizer Radiograph
2) CT Localizer Radiograph
3) Stationary Acquisition 3.5 s, 0.5 cm; CTDIvol = 16.9 mGy (Body) DLP =
8.4 mGy-cm.
4) Spiral Acquisition 4.5 s, 49.4 cm; CTDIvol = 9.8 mGy (Body) DLP = 484.7
mGy-cm.
Total DLP (Body) = 493 mGy-cm.
COMPARISON: CT abdomen pelvis ___.
FINDINGS:
LOWER CHEST: Atelectasis is present at the lung bases bilaterally. There is
no pleural or pericardial effusion. The heart is normal in size.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There is no evidence of focal lesions. There is no evidence of intrahepatic
or extrahepatic biliary dilatation. The gallbladder is within normal limits.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
There is no evidence of focal renal lesions or hydronephrosis. There is no
perinephric abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. Multiple
diverticular are again noted within the descending and sigmoid colon. Minimal
stranding of the distal sigmoid colon in the deep pelvis is present,
consistent with sigmoid diverticulitis. There is no new fluid collection
concerning for abscess. The previously noted trace free fluid in the pelvis
is resolved. 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 reproductive organs are unremarkable.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease
is noted.
BONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or
acute fracture. Calcification in the L5 disc is incidentally noted.
IMPRESSION:
1. Improvement in sigmoid diverticulitis without evidence of fluid
collection.
2. Resolution of previously seen trace pelvic free fluid.
|
10090768-RR-9 | 10,090,768 | 28,397,943 | RR | 9 | 2148-11-06 10:07:00 | 2148-11-06 11:18:00 | EXAMINATION: CT abdomen and pelvis with intravenous contrast.
INDICATION: NO_PO contrast; History: ___ with LLQ pain and TTP x2 daysNO_PO
contrast // ?diverticulitis
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired
through the abdomen and pelvis following intravenous contrast administration
with split bolus technique. IV Contrast: 130 mL Omnipaque.
Coronal and sagittal reformations were performed and reviewed on PACS.
Oral contrast was not administered.
DOSE: Total DLP (Body) = 355 mGy-cm.
COMPARISON: None.
FINDINGS:
LOWER CHEST: Visualized lung fields are within normal limits. There is no
evidence of pleural or pericardial effusion.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There is no evidence of focal lesions. There is no evidence of intrahepatic
or extrahepatic biliary dilatation. The gallbladder is within normal limits.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
There is no evidence of focal renal lesions or hydronephrosis. There is no
perinephric abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. There is
diverticulosis involving the entire colon, most severely affecting the sigmoid
colon. There is evidence of diverticulitis involving the distal sigmoid colon
with multiple peripheral pockets of air in the deep pelvis as well as trace
free fluid in the pelvis. There is no walled off fluid collection identified
in the pelvis.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: Uterus and adnexal regions appear grossly within normal
limits.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease
is noted.
BONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or
acute fracture. The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. Diverticulitis of the sigmoid colon with multiple pockets of peripheral
air in the deep pelvis, which may represent large diverticula or small foci
perforations. Trace free fluid in the pelvis is identified. No walled off
fluid collection is identified within the pelvis.
2. Moderate perisigmoid fat stranding.
RECOMMENDATION(S): These findings were discussed with Dr. ___
telephone at 11:12 on ___ by Dr. ___
|
10090787-RR-15 | 10,090,787 | 20,628,099 | RR | 15 | 2172-01-17 20:13:00 | 2172-01-17 23:57:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old man with chest pain // ?pulmonary edema or
consolidation
TECHNIQUE: Chest two views
COMPARISON: ___ 10:45
FINDINGS:
Sternotomy. Mildly tortuous thoracic aorta. Aortic calcification. Normal
heart size, pulmonary vascularity Suggestion of tiny pleural effusion or
thickening posterior costophrenic angle.
IMPRESSION:
Tiny pleural effusion or thickening
|
10090787-RR-17 | 10,090,787 | 27,982,098 | RR | 17 | 2174-03-27 16:31:00 | 2174-03-27 16:57:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ with tachycardia, chest pain// eval for PNA
COMPARISON: None
FINDINGS:
PA and lateral views of the chest provided. Midline sternotomy wires are
again noted as well as mediastinal clips. Lung volumes are low. Subtle lower
lung opacities left greater than right likely represent atelectasis though
difficult to exclude a component of pneumonia in the correct clinical setting.
No signs of edema. No large effusion or pneumothorax. Mediastinal contour is
prominent likely reflecting on fold partially calcified thoracic aorta. The
heart appears normal in size. Bony structures are intact.
IMPRESSION:
Lower lung opacities likely atelectasis though difficult to exclude a
developing pneumonia especially at the left lung base.
|
10091225-RR-59 | 10,091,225 | 28,005,563 | RR | 59 | 2163-11-20 04:07:00 | 2163-11-20 05:44:00 | INDICATION: History of a hernia with multiple repairs, now with increasing
pain and nausea for the past four hours.
COMPARISON: CT abdomen and pelvis from ___. CT pelvis from
___.
TECHNIQUE: MDCT axial images were acquired through the abdomen and pelvis
following the administration of intravenous Omnipaque contrast material.
Multiplanar reformats were performed.
TOTAL DLP: 589 mGy-cm.
ABDOMEN CT: There is subsegmental bilateral lower lobe dependent atelectasis.
The liver enhances homogeneously. No suspicious hepatic lesions are
identified. There is no intra- or extra-hepatic biliary ductal dilatation.
The portal vein is patent. The gallbladder is unremarkable. The spleen is
normal. The pancreas is normal. The adrenal glands are normal. Cortical
thinning along the posterior aspect of the right kidney is similar in
appearance compared to the prior CT from ___, likely the sequelae
of prior infection or infarction. A 7-mm hypodensity within the left lower
renal pole is too small to characterize, statistically a simple cyst, not
significantly changed dating back to ___. The kidneys exctrete intravenous
contrast material symmetrically. The stomach is unremarkable.
There is a small bowel to small bowel anastomosis in the right lower abdominal
quadrant (2:63). Just upstream from this anastomosis, there is dilatation and
fecalization of loops of small bowel, measuring up to at least 4.7 cm in
caliber. Stool is seen throughout the colon. There is a small quantity of
simple free fluid in the mesentery between the dilated loops of bowel (2:62).
There is no pneumatosis or pneumoperitoneum. The abdominal aorta is normal in
caliber. There are no pathologically enlarged abdominal lymph nodes.
PELVIS CT: A large ventral abdominal wall hernia contains a moderate quantity
of fluid, not significantly changed in appearance. The bladder is
unremarkable. Multiple calcified and noncalcified fibroids are seen
throughout the enlarged uterus, similar to the prior study from ___. There is a small quantity of simple free fluid in the dependent aspect
of the pelvis. There are no pathologically enlarged pelvic lymph nodes.
BONE WINDOW: No suspicious lytic or blastic lesions are identified.
IMPRESSION:
1. Dilated loops of distal small bowel leading up to an anastomosis in the
lower right abdominal quadrant. Stool is seen throughout the colon. The
constellation of these findings are suggestive of either a partial or early
complete small bowel obstruction. No convincing evidence of bowel ischemia.
2. Small volume ascites, nonspecific in nature.
3. Fluid containing large ventral hernia, not significantly changed.
4. Enlarged fibroid uterus, as before.
Pertinent findings were discussed with Dr. ___ by Dr. ___ at 5:02 a.m.
via telephone on the day of the study, three minutes after discovery.
|
10091225-RR-60 | 10,091,225 | 28,005,563 | RR | 60 | 2163-11-20 17:07:00 | 2163-11-21 09:08:00 | PORTABLE CHEST, ___
COMPARISON: Radiograph of ___.
FINDINGS: Radiographs centered at the thoracoabdominal junction was obtained
to assess a nasogastric tube, which terminates in the distal stomach. Within
the chest, cardiomediastinal contours are within normal limits for technique.
Imaged portions of the lungs are clear except for minimal atelectasis at the
lung bases. No pleural effusion is evident, but right costophrenic sulcus has
been excluded from the study.
|
10091225-RR-61 | 10,091,225 | 28,005,563 | RR | 61 | 2163-11-22 11:02:00 | 2163-11-22 14:20:00 | HISTORY: ___ female with recurrent ventral hernia and possible small
bowel stricture. Evaluate for ileus or obstruction.
COMPARISON: CT of the abdomen and pelvis dated ___.
FINDINGS:
Supine and upright radiographs of the abdomen demonstrate multiple distended
loops of small bowel with some gas seen in the colon, consistent with early or
partial small bowel obstruction. There is no pneumatosis or free air. The
visualized osseous structures are unremarkable. Multiple calcified uterine
fibroids project over the pelvis.
IMPRESSION:
Multiple distended loops of small bowel with some gas seen in the colon,
consistent with early or partial small bowel obstruction.
COMMENTS: These findings were discussed with Dr. ___ by Dr.
___ telephone at 14:18 on ___, 5 min after the findings were
discovered.
|
10091327-RR-25 | 10,091,327 | 21,172,588 | RR | 25 | 2148-01-10 01:13:00 | 2148-01-10 04:07:00 | HISTORY: Fever and polyarthritis.
COMPARISON: ___.
FINDINGS: Frontal AP and lateral views of the chest were obtained. Low lung
volumes results in bronchovascular crowding. There is no focal consolidation,
pleural effusion or pneumothorax. The heart size is normal. Mediastinal
silhouette and hilar contours are normal. There is gaseous distention of
large bowel.
IMPRESSION: No pneumonia, edema or effusion.
|
10091327-RR-26 | 10,091,327 | 21,172,588 | RR | 26 | 2148-01-10 01:13:00 | 2148-01-10 05:06:00 | INDICATION: Polyarticular arthritis.
COMPARISON: ___.
FINDINGS: Frontal, oblique and lateral views of the left wrist were obtained.
The appearance of the wrist is unchanged since ___. Widening of the
scapholunate interval is again seen compatible with scapholunate dissociation
with advanced collapse (SLAC wrist). Secondary osteoarthritis at the
radiocarpal joint with joint space narrowing and subchondral sclerosis is
similar. There is no acute fracture or dislocation. No erosion is seen. No
significant soft tissue swelling.
IMPRESSION: No acute abnormality. SLAC (scapholunate dissociation with
advanced collapse) wrist with secondary osteoarthritis, similar in appearance
to ___.
|
10091327-RR-27 | 10,091,327 | 21,172,588 | RR | 27 | 2148-01-10 01:14:00 | 2148-01-10 04:59:00 | INDICATION: Polyarticular arthritis.
___.
RIGHT KNEE: Frontal, oblique, and lateral views of the right knee were
obtained. The patient is status post hinged total knee arthroplasty. There
is no evidence of hardware loosening or complication. Anterior tibial plateau
suture anchors are also unchanged. There is no fracture or dislocation.
Heterotopic ossification about the knee joint has minimally increased. A
large ossific fragment adjacent to the medial femoral condyle may represent
injury of the medial collateral ligament. Possible right knee joint effusion.
LEFT KNEE: Frontal, oblique and lateral views of the left knee were obtained.
The patient is status post left hinged total knee arthroplasty. There is no
evidence of hardware loosening or complication. There is no fracture or
dislocation. Heterotopic ossification at the knee joint has increased at the
medial border and decreased at the lateral border. The horizontal lucency in
the distal femoral metadiaphysis is less apparent. No joint effusion.
IMPRESSION: No fracture or dislocation. No evidence of hardware loosening or
complication.
|
10091327-RR-28 | 10,091,327 | 21,172,588 | RR | 28 | 2148-01-10 01:14:00 | 2148-01-10 04:13:00 | HISTORY: Polyarticular arthritis.
COMPARISON: No relevant comparisons available.
LEFT ANKLE: Frontal, mortise and lateral views of the left ankle were
obtained. There is no fracture or dislocation. The ankle mortise is
congruent. No soft tissue swelling. There is no cortical erosion or
periosteal reaction to suggest osteomyelitis. No erosions. A tiny inferior
calcaneal enthesophyte is seen.
RIGHT ANKLE: Frontal, oblique and lateral views of the right ankle were
obtained. There is no fracture or dislocation. The ankle mortise is
congruent. No soft tissue swelling. There is no cortical erosion or
periosteal reaction to suggest osteomyelitis. No erosions.
IMPRESSION: No fracture or dislocation. No radiographic evidence of
osteomyelitis.
|
10091327-RR-29 | 10,091,327 | 21,172,588 | RR | 29 | 2148-01-10 02:34:00 | 2148-01-10 03:41:00 | INDICATION: Bilateral lower extremity swelling and pain, recent plane travel.
COMPARISON: ___.
FINDINGS: Grayscale and color Doppler sonograms with spectral analysis of the
bilateral common femoral, superficial femoral, popliteal and posterior tibial
veins were performed. The peroneal veins were not visualized bilaterally.
There is normal compressibility, flow and augmentation. Normal phasicity is
seen in the common femoral veins bilaterally.
IMPRESSION: No bilateral lower extremity deep venous thrombosis. Peroneal
veins not visualized bilaterally.
|
10091327-RR-30 | 10,091,327 | 21,172,588 | RR | 30 | 2148-01-11 01:32:00 | 2148-01-11 08:57:00 | STUDY: Bilateral knees ___.
CLINICAL HISTORY: Patient is status post bilateral total knee replacement
with liner removal for septic joint. Antibiotic spacer placement.
Comparison is made to images of bilateral knees from ___.
RIGHT KNEE: There is a longstemmed total knee prosthesis. There has been
placement of an antibiotic spacer and beads in the anterior aspect of the knee
joint. The hardware components appear preserved.
LEFT KNEE: There is also a left total knee prosthesis. There has been
placement of antibiotic spacer and beads. The hardware appears intact. There
is prominent anterior soft tissue swelling.
|
10091327-RR-31 | 10,091,327 | 21,172,588 | RR | 31 | 2148-01-11 01:46:00 | 2148-01-11 09:46:00 | STUDY: AP chest, ___.
CLINICAL HISTORY: ___ man with knee infection, status post surgery.
FINDINGS: Comparison is made to previous study from ___.
There is an endotracheal tube whose distal tip is 2.4 cm above the carina.
This could be pulled back 1-2 cm for more optimal placement. There are low
lung volumes. There are no signs of pulmonary edema, pneumothoraces, or focal
consolidation.
|
10091327-RR-32 | 10,091,327 | 21,172,588 | RR | 32 | 2148-01-11 07:59:00 | 2148-01-11 10:20:00 | STUDY: AP chest, ___.
CLINICAL HISTORY: ___ man with knee surgery. Line placement.
FINDINGS: Comparison is made to previous study from ___.
The endotracheal tube tip has been pulled back slightly and the tip is now 5
cm above the carina, appropriately sited. There is a new right IJ central
line distal lead tip at the distal SVC, appropriately sited. There are no
focal consolidation or pleural effusions. There are low lung volumes causing
mild atelectasis at the lung bases.
|
10091327-RR-33 | 10,091,327 | 21,172,588 | RR | 33 | 2148-01-12 11:21:00 | 2148-01-12 12:48:00 | STUDY: AP chest ___.
CLINICAL HISTORY: ___ man with sepsis, bacteremia and bilateral
septic joint. Recent intubation.
FINDINGS: Study is compared to the prior from ___.
There has been removal of the endotracheal tube since the previous study.
There is a right IJ central line with the distal lead tip at the distal SVC.
There are no pneumothoraces. There are slightly low lung volumes without
focal consolidation, pleural effusions, or signs for acute pulmonary edema.
|
10091327-RR-34 | 10,091,327 | 21,172,588 | RR | 34 | 2148-01-15 12:00:00 | 2148-01-15 16:28:00 | HISTORY: Group B strep bacteremia, septic bilateral knees, septic right
wrist. Evaluate for discitis or epidural abscess.
TECHNIQUE: Multiplanar multisequence MRI of the cervical, thoracic, and
lumbar spine was obtained before and after the administration of 9 mL of
Gadavist as per department protocol.
COMPARISON: No prior.
FINDINGS:
Cervical spine: There is mild retrolisthesis of C4 on C5 and C5 on C6 and
also anterolisthesis of T1 on T2. The bone marrow signal is abnormal with
diffuse low T1 signal.
There is abnormal STIR signal in the prevertebral soft tissues with mild
enhancement from C3 through T2 with extension to the right second rib (6:28).
There is abnormal STIR signal at C5 and C6 vertebral bodies and increased
T2/STIR signal within the disc. There is a focus of enhancement in the
superior endplate of C6 vertebral body. Additional abnormal STIR/T2 signal in
the vertebral bodies C7, T1 and T2 is also seen. There is extension of
abnormal soft tissue into the anterior epidural space at C5-C6 level with
enhancement measuring approximately 7 mm x 20 mm and causing severe narrowing
of the thecal sac and likely causing cord compression without abnormal signal
within the cord (6:19). These findings are suspicious for developing discitis
osteomyelitis with epidural phlegmon/epidural abscess. There is also abnormal
STIR signal in the interspinous soft tissues from C3-C4 through C6-C7.
There is also abnormal T1 signal of the posterior inferior aspect of the C7
vertebral body in keeping with fatty deposit.
There are multilevel degenerative changes of the cervical spine with
multilevel central disc bulges deforming the anterior thecal sac and
contacting the cord at C3-C4 and C4-C5 without evidence of abnormal signal
within the cord. There are uncovertebral and facet joint osteophytes
resulting in moderate bilateral C3-C4 and C4-C5 neural foraminal narrowing.
Thoracic spine: There is diffuse T1 and T2 hypointensity throughout the bone
marrow with scattered fatty deposits. The vertebral body heights are grossly
preserved. There is no evidence of significant spinal canal or neural
foraminal narrowing.
The paraspinal soft tissues are unremarkable.
Lumbar spine: There is retrolisthesis of L4 on L5 and anterolisthesis of L5 on
S1. There is abnormal T2 hyperintensity at the L4-L5 and L5-S1 disc spaces
with irregularity of the endplates and mild abnormal STIR signal of the bone
marrow at L4 and L5 vertebral bodies with heterogeneous enhancement. There is
extension of abnormal soft tissue material in the anterior aspect of the
epidural space from L3-L4 through L5-S1 with rim enhancing pattern consistent
with epidural abscess (___) with severe narrowing of the thecal sac with
a residual AP diameter of 4 mm. There is enhancement of a nerve root in the
thecal sac. These findings are suspicious for developing discitis
osteomyelitis with epidural abscess. There is abnormal T2 signal of the
posterior paraspinal soft tissues of the lumbar spine.
There is an additional focus of abnormal enhancement at L3-L2 anterior
epidural space which in part is related to disk bulging with prominent venous
plexus, but it is difficult to exclude an additional area of abscess (16:20).
The conus medullaris terminates at T12-L1.
At L2-L3, there is a left foraminal disc protrusion with mild inferior
extrusion effacing the left subarticular zone and impinging the traversing L3
nerve root. There is deformity of the thecal sac. There is ligamentum flavum
thickening and facet joint arthropathy resulting in moderate to severe left
and mild right neural foraminal narrowing.
At L3-L4, there is a diffuse disc bulge, ligamentum flavum thickening, and
facet joint arthropathy resulting in mild narrowing of the bilateral
subarticular zones and moderate to severe bilateral neural foraminal
narrowing.
At L4-L5, there is a diffuse disc bulge, facet joint arthropathy, and
ligamentum flavum thickening resulting in severe bilateral neural foraminal
narrowing.
At L5-S1, there is a diffuse disc bulge and facet joint arthropathy resulting
in moderate to severe bilateral neural foraminal narrowing, worse on the left.
Large hemangiomas are noted in the L3 vertebral body and right sacral ala.
There are a few T2 hyperintensities in the kidneys likely representing simple
cysts.
IMPRESSION:
1. Findings suggestive of discitis osteomyelitis at C5-C6 with epidural
phlegmon/abscess causing severe narrowing of the thecal sac and likely causing
cord compression without abnormal signal within the cord.
2. Findings suggestive of discitis osteomyelitis at L4-L5 and possibly L5-S1
with epidural abscess extending from L4 through S1 with severe narrowing of
the thecal sac with a residual AP diameter of 4 mm.
3. Abnormal enhancement of the prevertebral soft tissues in the cervical spine
with extension into the right second rib as described. Abnormal signal of the
C7, T1 and T2 vertebral bodies probably reactive. Abnormal cervical
interspinous soft tissue enhancement.
4. Abnormal STIR signal in the posterior lumbar paraspinal soft tissues
without evidence of fluid collections.
5. Focus of abnormal enhancement at L3-L2 anterior epidural space, which in
part could be related to disc bulging with prominent venous plexus, but it is
difficult to exclude an additional area of abscess.
6. Enhancement of a nerve root within the thecal sac that could be reactive,
however, clinical correlation is advised to exclude early arachnoiditis or
developing meningitis.
7. Diffuse abnormal bone marrow signal that could be seen in marrow
reconversion processes either related to chronic anemia or marrow infiltrative
disorders.
These findings were discussed with Dr. ___ at 5:40 pm on ___,
via phone call by Dr. ___, 30 minutes after the discovery of the findings.
|
10091327-RR-35 | 10,091,327 | 21,172,588 | RR | 35 | 2148-01-16 11:55:00 | 2148-01-16 16:45:00 | STUDY: MRI of the cervical spine.
CLINICAL INDICATION: ___ man with cervical spine abscess, prior
examination concerned with motion artifact, evaluate for cervical spine
abscess.
COMPARISON: Prior MRI of the cervical spine dated ___.
TECHNIQUE: Pre-contrast sagittal T1, T2, and sagittal IDEAL sequences were
obtained throughout the cervical spine, axial T2 and gradient echo sequences
were obtained, the T1-weighted images were repeated after the administration
of gadolinium contrast in axial and sagittal projections.
FINDINGS: In comparison with the prior examination, no significant changes
are identified, again abnormal enhancement is re-demonstrated in the epidural
space at C5/C6 level, consistent with an epidural abscess formation, measuring
approximately 7.4 x 22.4 mm in sagittal dimension and approximately 23 x 6.5
mm in transverse dimension, causing significant spinal canal stenosis and
likely cord compression with no evidence of abnormal signal within the cord
(image #9, series #4). The pattern of enhancement throughout the disc is less
conspicuous, however there is heterogeneous enhancement at the C6 vertebral
body on the left (image #9, series #9), there is persistent edema throughout
the bone marrow from C5 through T1 (image #8, series #4). Fat deposit appears
unchanged in the T7 vertebral body (image #9, series 400). Unchanged edema in
the interspinous processes from C4/C5 through C7/T1 (image #9, series #4).
IMPRESSION: Persistent and grossly unchanged abnormal enhancement at C5/C6
level, with epidural abscess formation, causing severe narrowing of the thecal
sac and producing cord compression without abnormal signal within the cord.
The pattern of enhancement throughout the intervertebral disc space appears
less conspicuous in comparison with the prior study, however, there is
persistent abnormal enhancement in the vertebral body at C6 on the left
suggesting osteomyelitis and diffuse edema from C5 through T1 level.
|
10091327-RR-36 | 10,091,327 | 21,172,588 | RR | 36 | 2148-01-17 21:54:00 | 2148-01-18 18:17:00 | CERVICAL SPINE
Status post fusion.
A single intraoperative view is provided.
|
10091327-RR-37 | 10,091,327 | 21,172,588 | RR | 37 | 2148-01-21 12:24:00 | 2148-01-21 17:41:00 | TYPE OF EXAMINATION: Chest AP portable single view.
INDICATION: ___ male patient with new PICC line. Contact name:
___ ___.
FINDINGS: AP single view of the chest has been obtained with patient in
semi-upright position. Left-sided PICC line is identified seen to terminate
in the right mediastinal structures at the level of the carina. This is
compatible with the mid portion of the SVC. No pneumothorax or any other
placement-related complication is identified. Telephone contact was
established as requested.
|
10091327-RR-38 | 10,091,327 | 21,172,588 | RR | 38 | 2148-01-23 12:02:00 | 2148-01-23 14:57:00 | HISTORY: Patient with bacteremia who now presents with abdominal distention
and diarrhea. Evaluate for stool loading, ileus or obstruction.
COMPARISON: None.
FINDINGS: Nonobstructive bowel gas pattern is noted. No free air is
identified. Fecal material is noted within the rectum.
IMPRESSION:
Nonobstructive bowel gas pattern.
|
10091327-RR-52 | 10,091,327 | 26,480,651 | RR | 52 | 2148-06-26 12:05:00 | 2148-06-27 02:34:00 | MR EXAMINATION OF THE RIGHT CALF WITHOUT INTRAVENOUS CONTRAST
HISTORY: Right calf pain. Evaluation for muscle tear and / or underlying
neoplasm.
COMPARISON: Radiographs of the right lower extremity performed ___.
FINDINGS:
There is marked intramuscular edema within the medial head of the
gastrocnemius (4:17, 7:23). In addition, there is a small amount of fluid
extending along the fascial plane along the inferomedial aspect of the medial
head of the gastrocnemius (4:20, 7:35).
In addition, there is prominent heterogeneous muscular edema within the distal
right flexor hallucis longus (7:59). There is minimal muscular edema within
the left gastrocnemius.
Evaluation of the knees is markedly suboptimal secondary to metallic
susceptibility artifact from the patient's bilateral hinged total knee
arthroplasties. There is no abnormal marrow signal visualized portions of the
lower extremities.
There is minimal subcutaneous edema extending along the anteromedial aspect of
the left lower extremity. There is minimal subcutaneous fluid extending along
the lateral aspect of the left lower extremity as well (7:16). There is
normal marrow signal within the left lower extremity as well.
IMPRESSION:
1. Marked muscle edema of the medial head of the right gastrocnemius with
minimal fluid extending along the inferomedial fascial plane along the surface
of this muscle representing a myositis of indeterminate etiology. This
finding may be infectious in nature in this patient with gram negative
bacteremia.
2. Prominent heterogeneous muscular edema within the distal right flexor
hallucis longus, again may be infectious in etiology. Recommend clinical
correlation.
3. No MR evidence of an underlying neoplasm and / or osteomyelitis.
Findings were discussed with Dr. ___ his clinical team at 5:15 p.m. on
___.
The patient will undergo subsequent ultrasound-guided right knee aspiration
and fluid aspiration from the right calf.
|
10091327-RR-53 | 10,091,327 | 26,480,651 | RR | 53 | 2148-06-26 17:01:00 | 2148-06-27 10:28:00 | HISTORY: To assess for sinusitis.
FINDINGS: The paranasal sinuses are quite well pneumatized with no evidence
of acute air-fluid level or chronic opacification along the sinus wall.
|
10091327-RR-54 | 10,091,327 | 26,480,651 | RR | 54 | 2148-06-28 15:01:00 | 2148-06-28 16:17:00 | INDICATION: History of multiple myeloma and gram-negative rods on Gram stain,
question of infection.
COMPARISON: CT Torso ___.
TECHNIQUE: MDCT images were obtained through the abdomen and pelvis without
IV contrast. Oral contrast was administered. Coronal and sagittal
reformations were performed.
FINDINGS: The imaged lung bases are clear. Visualized heart and pericardium
are unremarkable.
Lack of IV contrast limits evaluation of the intra-abdominal organs. The
liver, adrenal glands, pancreas, gallbladder, left kidney, stomach, and
abdominal loops of small and large bowel are unremarkable. There is moderate
fecal loading. A 1.6 cm hypodense lesion in the interpolar region of the
right kidney has increased in size, but still likely represents a cyst. There
is no definite retroperitoneal or mesenteric lymphadenopathy. The aorta is
normal in caliber.
PELVIS: The rectum, sigmoid colon and bladder are normal. The prostate and
seminal vesicles are normal. There is no pelvic or inguinal lymphadenopathy.
BONES: There is significant endplate irregularity a the L5/S1 disc
interspace. Milder changes are noted at L4/5 and L2/3. A few scattered
lucent lesions, for example in T12, may relate to known multiple myeloma.
IMPRESSION:
1. No evidence of intra-abdominal infection. Limited due to lack of IV
contrast. No abscess is identified.
2. Significant endplate irregularity at the L5/S1 disc interspace. Correlate
for evidence of infection in this location. MRI of the lumbar spine would be
helpful for further evaluation.
Findings discussed with Dr. ___ on ___ @ 5:08 pm.
|
10091327-RR-55 | 10,091,327 | 26,480,651 | RR | 55 | 2148-06-26 19:11:00 | 2148-06-26 20:20:00 | ULTRASOUND-GUIDED KNEE AND CALF ASPIRATION
INDICATION: ___ year old man with chronic R TKA infection and new calf mass.
PHYSICIANS: Dr ___, Dr ___
Dr. ___ attending radiologist, was present throughout the critical
portions of the procedure.
PROCEDURE:
The procedure, risks, benefits and alternatives were discussed with the
patient and written informed consent was obtained.
A preprocedure timeout was performed discussing the planned procedure,
confirming the patient's identity with three identifiers, and reviewing a
checklist per ___ protocol.
Under ultrasound guidance, an entrance site was selected and the skin was
prepped and draped in the usual sterile fashion. 1% lidocaine was instilled
for local anesthesia.
A 20ga spinal needle was advanced into the right knee joint with US guidance
and 25cc turbid joint fluid was aspirated. This was send for culture and
requested labs.
Using a new set of sterile needles, the procedure was repeated at the right
calf and a few drops serosanguinous fluid was aspirated. This was send for
culture.
The patient tolerated the procedure well without immediate complication.
Estimated blood loss was minimal.
All needles were removed and hemostasis achieved. The patient left the
department in good condition.
FINDINGS: There is fluid within the right knee joint. A small amount of
subcutaneous fluid tracks along the right calf.
IMPRESSION:
Ultrasound-guided right knee and right calf aspiration with sample sent for
analysis. No complications.
|
10091327-RR-57 | 10,091,327 | 26,480,651 | RR | 57 | 2148-06-29 16:06:00 | 2148-06-29 20:04:00 | HISTORY: History of multiple myeloma and recurrent native and prosthetic
joint infections with new septic arthritis of the knee and bacteremia now with
evidence of bony changes in the spine on CT abdomen. Question osteomyelitis
at L5-S1.
TECHNIQUE: Multiplanar MR images were acquired of the lumbar spine before and
after the uneventful intravenous administration of 8 mL of Gadavist.
COMPARISON: CT abdomen and pelvis from ___ and MRI L-spine from ___.
FINDINGS:
Lumbar vertebral body height and alignment are unchanged. Again seen in the
L3 vertebral body is a T1 hyperintense lesion consistent with focal fatty
deposition.
At T12-L1 and L1-L2 level there is no significant disc disease, spinal canal
narrowing or neural foraminal stenosis. No abnormal disc or vertebral body
signal abnormality is seen.
At L2-L3 level there is abnormal signal in the intervertebral disc with T2
hyperintensity and enhancement of the disc post-contrast. The enhancement
extends into the L2 vertebral body as well, consistent with
discitis/osteomyelitis. In the anterior epidural space on the left there is an
inhomogeneous collection which enhances inhomogeneously and runs down to the
L2-3 disc space; although, does not arise from the disc space. This collection
is consistent with an epidural abscess spanning the L2 vertebral body.
At L3-4 level, there is mild posterior disc bulge but no neural foraminal
stenosis.
At L4-L5, there is near complete loss of disc height with posterior
osteophytes and bulging disc causing foraminal narrowing bilaterally. There
is mild anterolisthesis of L5 on S1, unchanged from prior. There is near
complete loss of disc height at L5-S1. There are facet osteophytes causing
bilateral foraminal narrowing.
IMPRESSION:
Discitis and osteomyelitis at the L2-3 level with adjacent epidural abscess.
NOTIFICATION: Telephone notification to Dr. ___ by Dr. ___ at 17:45
on ___, 20 minutes after discovery findings.
|
10091327-RR-58 | 10,091,327 | 26,480,651 | RR | 58 | 2148-06-28 21:58:00 | 2148-06-29 08:51:00 | PORTABLE CHEST X-RAY DATED ___
COMPARISON: ___ radiograph.
FINDINGS: Cardiomediastinal contours are within normal limits and without
change. Lungs and pleural surfaces are clear. Sclerotic focus on the left
sixth anterior rib is without change and has been previously attributed to a
bone island on CT torso of ___. Mild elevation of right
hemidiaphragm is again demonstrated.
|
10091327-RR-59 | 10,091,327 | 26,480,651 | RR | 59 | 2148-06-29 14:01:00 | 2148-06-29 15:17:00 | LEFT KNEE ASPIRATION
History: Bilateral knee replacements (___) complicated by MRSA infections,
assess for joint infection in left knee.
Procedure:
The patient was informed of possible benefits and risks and informed written
consent obtained. The patient was placed supine and an appropriate skin entry
site markedin the superomedial left knee after visualization of a pocket of
joint fluid with ultrasound. The area was prepped and draped in the usual
sterile fashion. Local anesthesia in the form of 1% lidocaine was inserted
into the skin and subcutaneous soft tissues. A 20 gauge spinal needle was
inserted into the knee joint. Aspiration was attempted which yielded 10 cc of
turbid fluid which was sent for microbiology. The needle was removed, the
skin entry site cleaned and a dressing was applied.
IMPRESSION:
Left knee joint aspiration yielding 10 cc of turbid fluid which was sent for
microbiology. Dr. ___ attending was present for the whole procedure.
|
10091327-RR-60 | 10,091,327 | 26,480,651 | RR | 60 | 2148-06-30 11:28:00 | 2148-06-30 13:37:00 | CERVICAL AND THORACIC SPINE MRI WITH AND WITHOUT CONTRAST, ___
INDICATION: ___ man with multiple myeloma, multiple prosthetic joint
infections, now with back pain and lumbar epidural abscess at L2. Evaluate
for osteomyelitis.
COMPARISON: Cervical spine MRI from ___, and cervical and
thoracic spine MRI from ___.
TECHNIQUE: Sagittal T1-weighted, T2-weighted, and STIR images of the cervical
and thoracic spine were obtained, with axial T2-weighted and gradient echo
images of the cervical spine, and axial T2-weighted images of the thoracic
spine. Following intravenous gadolinium administration, sagittal and axial
T1-weighted images of the cervical and thoracic spine were obtained.
FINDINGS: Previously noted edema in the C5-6 disc and endplates has resolved.
No new evidence of discitis or osteomyelitis is seen. Hemangiomas in the
vertebral bodies of C6 and C7 are unchanged. Vertebral body heights are
preserved. There is minimal anterolisthesis of C3 on C4 and minimal
retrolisthesis of C6 on C7, unchanged. There is no evidence for epidural
phlegmon or abscess. There is no evidence for a paravertebral collection.
Evaluation of spinal cord signal on sagittal T2-weighted and STIR images is
limited by artifacts. No focal cord signal abnormalities are seen on axial
T2-weighted images. The imaged portion of the posterior fossa is
unremarkable. Multilevel degenerative disease with moderate spinal canal
stenosis and multilevel neural foraminal narrowing is again noted, not
significantly changed.
THORACIC SPINE MRI: Previously noted edema in the T1-2 disc and endplates has
resolved. No new area of discitis or osteomyelitis is seen. Minimal anterior
wedging of the T1 vertebral body and minimal anterolisthesis of T1 on T2 are
unchanged. Minimal anterior wedging of the T5 vertebral body is also
unchanged. Alignment is normal. There is no evidence for an epidural
collection or paravertebral collection in the thoracic spine. Spinal cord
signal is within normal limits. No thoracic spinal canal narrowing is seen.
IMPRESSION:
1. Compared to ___, there is resolution of edema in the C5-6 and T1-2
discs and endplates. No new focus of discitis/osteomyelitis is seen. No
epidural collection.
2. Unchanged multilevel degenerative disease in the cervical spine.
|
10091327-RR-61 | 10,091,327 | 26,480,651 | RR | 61 | 2148-06-30 21:25:00 | 2148-07-01 08:19:00 | HISTORY: Infected total knee arthroplasty. Assess for loosening.
TECHNIQUE: Five radiographs of the knees.
COMPARISON: Radiographs of the right knee performed ___ as well as
radiographs of the knees performed ___.
FINDINGS:
RIGHT KNEE:
There has been revision of a prior right total knee arthroplasty. The new
arthroplasty hardware is intact without evidence of hardware loosening. There
are antibiotic spacers in place within the joint space and suprapatellar
recess of the right knee as well.
There is a moderate knee effusion. There is prominent heterotopic
ossification again present. Surgical anchors are again present anterior to
the proximal aspect of the tibial component. There is a wound vac on the
anterior aspect of the knee.
LEFT KNEE:
The patient is status post left total knee arthroplasty. The surgical
hardwarew appears intact. Antibiotic spacers are in place within the
suprapatellar recess as well as the joint space. There has been interval
removal of antibiotic impregnated beads since ___.
Foci of postoperative soft tissue gas are present within the suprapatellar
region as well. There appears to be a moderate knee effusion. Prominent
heterotopic ossification is again present. There is a wound vac on the
anterior aspect of the left knee.
IMPRESSION:
1. No evidence of loosening of the patient's bilateral total knee
arthroplasties.
2. Antibiotic impregnated spacer devices are present within the knees.
3. Bilateral knee effusions, post operative changes.
4. Bilateral prominent heterotopic ossification.
|
10091327-RR-62 | 10,091,327 | 26,480,651 | RR | 62 | 2148-07-02 12:05:00 | 2148-07-03 08:29:00 | INDICATION: ___ man with multiple myeloma, bilateral septic
arthritis, status post OR washout with new cough and crackles in right lower
lobe on exam. Rule out pneumonia.
COMPARISON: Prior chest radiograph from ___ and CT torso from ___.
TECHNIQUE: Portable AP chest radiograph.
FINDINGS: The cardiomediastinal and hilar contours are within normal limits.
Lungs are clear. There are no focal consolidations or pleural effusions.
Mild elevation of the right hemidiaphragm is redemonstrated. A sclerotic focus
on the left sixth anterior rib is again seen and is unchanged, previously
described as a bone island on CT torso of ___.
IMPRESSION: No radiographic evidence of an acute cardiopulmonary process.
|
10091327-RR-63 | 10,091,327 | 26,480,651 | RR | 63 | 2148-07-13 19:34:00 | 2148-07-13 20:22:00 | HISTORY: ___ male status post bilateral total knee arthroplasty.
TECHNIQUE: AP and lateral radiographs of bilateral knees.
COMPARISON: ___.
FINDINGS:
Right knee: The patient is status post right knee total arthroplasty.
Multiple drains project over the knee joint. There are no hardware
complications. There has been interval removal of antibiotic spacer from the
joint space. Extensive heterotopic ossification is present along the medial
compartment. A joint effusion is still seen. Surgical anchor is again noted
projecting anterior to the proximal aspect of the tibial component.
Left knee: The total knee arthroplasty is intact without evidence of hardware
complication. Surgical anchors project anterior to the tibial component as
well as multiple drains. A joint effusion is again noted. Heterotopic
ossification is also again noted. Foci of soft tissue gas is present within
the suprapatellar region.
IMPRESSION:
1. No evidence of hardware complication of bilateral knee arthroplasties.
2. Stable bilateral joint effusions.
3. Stable bilateral heterotopic ossification.
|
10091327-RR-64 | 10,091,327 | 26,480,651 | RR | 64 | 2148-07-14 11:38:00 | 2148-07-14 13:40:00 | TYPE OF EXAMINATION: Chest AP portable single view.
INDICATION: ___ male patient with new PICC line from right side.
Contact: Sal, page ___.
FINDINGS: AP single view of the chest has been obtained with patient in
upright position. A right-sided PICC line is identified, seen to terminate
overlying the right-sided mediastinal structures at the level of the carina.
This represents the mid portion of the SVC. No new abnormalities are
identified in comparison with the next preceding similar study ___.
Sal was paged at 1:30 p.m.
|
10091385-RR-17 | 10,091,385 | 28,374,166 | RR | 17 | 2142-07-24 14:27:00 | 2142-07-24 16:25:00 |
INDICATION: A 6.2 x 4 cm segment V/VI liver lesion.
PROCEDURE:
The procedure, risks, benefits and alternatives were discussed with the
patient and written informed consent was obtained. A preprocedure timeout was
performed discussing the planned procedure, confirming the patient's identity
with three identifiers, and reviewing a checklist per ___ protocol.
Under ultrasound guidance, an entrance site was selected to target known
segment V/VI lesion and the skin was prepped and draped in the usual sterile
fashion. 10 mL of 1% lidocaine was instilled for local anesthesia.
An 18-gauge biopsy needle was advanced into the lesion under ultrasound
guidance via a right subcostal approach and two core biopsies were obtained.
Samples were sent to pathology in formalin.
Moderate sedation was provided by administering divided doses of Versed and
fentanyl throughout the total intra-service time of 20 minutes during which
the patient's hemodynamic parameters were continuously monitored by
independent trained radiology nursing personnel.
The patient tolerated the procedure well with no immediate complication. Dr.
___ attending radiologist, was present throughout the entire procedure.
Post-procedure instructions were written in the ___ medical record.
IMPRESSION:
Ultrasound-guided targeted liver biopsy of segment V/VI lesion. Pathology
pending.
|
10091385-RR-18 | 10,091,385 | 28,374,166 | RR | 18 | 2142-07-25 10:02:00 | 2142-07-25 12:14:00 | CT OF THE CHEST
HISTORY: Liver mass. Question pulmonary metastases.
COMPARISONS: CT of the abdomen and pelvis is available from two days earlier.
No prior dedicated chest CT imaging is available.
TECHNIQUE: Multidetector CT images of the chest were obtained without
intravenous contrast. Sagittal and coronal reformations were also performed.
FINDINGS:
The heart is normal in size. There are no pleural or pericardial effusions.
No enlarged lymph nodes are demonstrated.
Aside from slight subpleural scarring at each lung apex, the lungs appear
clear. There are no suspicious findings.
A small calcification is present in the left lobe of the liver. The region
where a liver mass was identified in the lower part of the right lobe is not
imaged on this examination.
BONE WINDOWS: There are no suspicious lytic or blastic bone lesions.
IMPRESSION: No findings concerning for metastatic disease.
|
10091385-RR-24 | 10,091,385 | 21,340,038 | RR | 24 | 2142-08-08 17:30:00 | 2142-08-08 17:42:00 | HISTORY: Cough, fever.
TECHNIQUE: PA and lateral views of the chest.
COMPARISON: ___ chest CT.
FINDINGS:
Cardiac, mediastinal and hilar contours are normal. Pulmonary vasculature is
normal. Apart from subsegmental atelectasis in the left lower lobe, the lungs
are clear. No focal consolidation, pleural effusion or pneumothorax is
present. There are no acute osseous abnormalities.
IMPRESSION:
No acute cardiopulmonary process.
|
10091385-RR-25 | 10,091,385 | 21,340,038 | RR | 25 | 2142-08-08 17:08:00 | 2142-08-08 18:50:00 | INDICATION: Right upper quadrant pain after liver mass biopsy. Evaluate for
abscess.
COMPARISONS: CT of the abdomen and pelvis from ___. Ultrasound
liver biopsy from ___. Retroperitoneal biopsy from ___.
TECHNIQUE: Contiguous axial MDCT images were obtained through the abdomen and
pelvis after the administration of IV and oral contrast. Sagittal and coronal
reformatted images were obtained and reviewed.
FINDINGS:
LUNG BASES: The bases of the lungs are clear without consolidation or edema.
There is minimal bibasilar atelectasis. There is no pleural effusion or
pneumothorax. The base of the heart is normal in size. There is no
pericardial effusion.
ABDOMEN: The liver is normal in shape and contour. Again, in the right
inferior liver, there is an ill-defined heterogeneous mass, which is slightly
increased in size to the prior CT, measuring approximately 6.8 x 4 cm (2, 40).
It previously measured 5.5 x 3.3 cm. Inferior to the mass, there is a new,
mildly complex 2.6 x 2.2 cm cystic lesion with Hounsfield units of 32. There
are additional smaller adjacent cystic lesions, the largest which measures 0.9
x 0.7 cm, (2, 38). Also anterior to the mass, there are small similar sub-cm
hypodense cystic areas (2, 36). Given the history of fevers, these likely
represent abscesses. No new hepatic masses are identified. Again, a branch
of the right portal vein is thrombosed, unchanged from the prior exam. The
remainder of the portal vessels are patent. There is no evidence of new
thrombosis. There is no intra- or extra-hepatic biliary duct dilation.
The gallbladder, spleen, and pancreas are normal. The bilateral adrenal
glands are normal. The kidneys are normal without focal masses,
hydronephrosis or pyelonephritis. The kidneys enhance and excrete contrast
symmetrically.
The stomach and small bowel are normal in course and caliber. There is no
evidence of obstruction. There is no free air. There is very trace
perihepatic ascites. There is no periportal, retroperitoneal, or mesenteric
lymphadenopathy.
PELVIS: There is a moderate-to-large fecal load. The large bowel is
otherwise normal without focal inflammatory changes. Adjacent to the cecum,
there are several coarse calcifications (2, 65), unchanged from the prior
exam, and likely appendicoliths.
Multiple ill-defined soft tissue peritoneal implants and nodules are slightly
enlarged since the prior exam. These are mostly in the left lower quadrant
and along the left paracolic gutter. For example, a confluence of peritoneal
implants in the left lower quadrant measures 6.6 x 3.5 cm (2, 63). It
previously measured 6.1 x 2.7 cm. Also, anterior to the bladder, along the
medial edge of these peritoneal implants, there is a 2.3 x 1.6 cm fluid
collection with rim enhancement that is new from the prior exam. This is
concerning for an abscess. Again, there is minimal fat stranding along the
left paracolic gutter unchanged from the prior exam.
There is no free fluid in the cul-de-sac. The uterus is normal. There are no
adnexal masses. There is no pelvic or inguinal lymphadenopathy.
OSSEOUS STRUCTURES: There are no concerning lytic or sclerotic osseous
lesions. No fracture is identified. There are no significant degenerative
changes.
IMPRESSION:
1. New lobulated hypodensities in the region of the ill-defined mass in the
right lobe of the liver, the largest of which measures 2.6 cm. These are most
concerning for abscesses.
2. The hepatic mass itself seems slightly bigger.
3. Unchanged right portal vein branch thrombus.
4. Slight interval enlargement of the peritoneal soft tissue nodules. In the
anterior midline of the pelvis, along the left lower quadrant peritoneal
implants, there is a new 2.6 cm rim enhancing low density fluid collection,
which is also concerning for an abscess.
|
10091385-RR-26 | 10,091,385 | 21,340,038 | RR | 26 | 2142-08-09 12:41:00 | 2142-08-09 14:21:00 | HISTORY: ___ female with right hepatic lobe mass status post biopsy,
now presenting with fever and fluid collection in the right lobe immediately
adjacent to the mass concerning for abscess. Patient presents for
percutaneous drainage of this fluid collection.
COMPARISON: CT from ___.
FINDINGS:
Limited grayscale ultrasound images of the inferior right hepatic lobe were
obtained demonstrating a heterogeneous collection immediately inferior to the
previously biopsied mass measuring approximately 3 x 2.6 cm. This was
targeted for percutaneous drainage. No other significant sonographic
abnormalities were identified.
PROCEDURE:
After explaining the risks, benefits, and alternatives to the procedure,
signed informed consent was obtained. A time-out procedure was performed
according to hospital protocol. A mark was made on the skin at the desired
entry site. The skin was then prepped and draped in the usual sterile
fashion. The soft tissues were anesthetized using 10 mL 1% lidocaine. Under
real-time ultrasound guidance, an ___ drainage catheter was
advanced into the collection using trochar technique. Once the tip of the
catheter was confirmed within the collection, the inner sharp stylet was
removed. A small sample of fluid was aspirated to confirm the location of the
catheter within the collection. After this was performed, the catheter was
advanced over the metal stiffener into the collection, the stiffener was
withdrawn, and the pigtail was formed. Aspiration of the collection was then
performed yielding 15 mL bloody material. A sample was sent to microbiology
for analysis. The catheter was then attached to a suction bulb, fixed to the
skin using a Stat Lock device, and a dry sterile dressing was applied. The
patient tolerated the procedure well and there were no immediate
complications.
Medications: Moderate sedation was provided by administering divided doses of
fentanyl and Versed throughout the total intraservice time of 25 min by an
independent trained radiology nurse during which the ___ hemodynamic
parameters were continuously monitored. A total of 2 mg IV Versed and 125 mcg
IV fentanyl was administered.
IMPRESSION:
Ultrasound-guided percutaneous drainage of right hepatic fluid collection was
performed without immediate complication. The aspirate produced bloody
material most suggestive of a hematoma possibly related to the recent biopsy.
|
10091385-RR-27 | 10,091,385 | 21,340,038 | RR | 27 | 2142-08-13 13:31:00 | 2142-08-13 15:12:00 | HISTORY: Inflammatory liver mass status post biopsy, complicated by abscess
status post drain placement. Evaluate for change in size.
COMPARISON: CT abdomen and pelvis ___.
TECHNIQUE: Gray-scale and color Doppler ultrasound images were obtained of
the abdomen.
FINDINGS: A right-sided percutaneous drain is in place contained within the
previously identified right lobe mass which is similar in appearance to a
prior examination, which is heterogeneous measuring roughly 7.6 x 5.2 cm,
similar to prior study. At the location of the drain, there is no residual
cystic component. There is a linear focus of mildly complex fluid which is
extracapsular corresponding to trace perihepatic ascites on prior CT.
Otherwise, no new hepatic lesions identified. There is no intra- or
extra-hepatic biliary duct dilatation. The portal vein is patent with
hepatopetal flow. The gallbladder is thin-walled, collapsed and unremarkable
without stones.
IMPRESSION: Right percutaneous drainage catheter remains in place in the
right hepatic lobe lesion and there has been resolution of the associated
cystic focus. There is a small amount of minimally complex perihepatic fluid,
corresponding to a trace perihepatic fluid on the prior CT examination.
|
10091535-RR-15 | 10,091,535 | 27,661,378 | RR | 15 | 2171-08-07 11:53:00 | 2171-08-07 15:24:00 | EXAMINATION: KNEE (AP, LAT AND OBLIQUE) RIGHT
INDICATION: ___ year old man with s/p MVC with facial lacerations, reports
right knee pain // please evaluate for right patella fracture please
evaluate for right patella fracture
TECHNIQUE: Right knee, three views
COMPARISON: None.
FINDINGS:
There is a small suprapatellar effusion. There is no fracture seen. There are
no degenerative changes or suspicious lesions seen.
IMPRESSION:
No patellar fracture
NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___
on the telephone on ___ at 2:56 ___, a few minutes after discovery of the
findings.
|
10091535-RR-16 | 10,091,535 | 27,661,378 | RR | 16 | 2171-08-07 11:53:00 | 2171-08-07 15:21:00 | EXAMINATION: HUMERUS (AP AND LAT) RIGHT
INDICATION: ___ year old man with MVC, facial lacerations, now reports right
arm pain // please evaulate for fracture right humerus
TECHNIQUE: Humerus, two views
COMPARISON: None
FINDINGS:
No fracture or focal lytic or sclerotic lesion is detected involving the right
humerus. No soft tissue calcification or radiopaque foreign body is detected.
Assessment of the shoulder and elbow joints is limited on this examination,
but grossly unremarkable. If there is specific concern for a fracture
dislocation about either joint, then dedicated radiographs of the joint would
be recommended.
IMPRESSION:
There is no fracture of the right humerus.
NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___
on the telephone on ___ at 3:21 ___, a few minutes after discovery of the
findings.
|
10091535-RR-27 | 10,091,535 | 23,107,691 | RR | 27 | 2175-02-02 02:21:00 | 2175-02-02 03:38:00 | EXAMINATION: CT NECK W/CONTRAST (EG:PAROTIDS) Q22 CT NECK
INDICATION: History: ___ with upper back pain and swelling s/p MVC and
cervical spine surgery one week ago. Concern for infection.
TECHNIQUE: Imaging was performed after administration of 145 cc Omnipaque
intravenous contrast material (which was also utilized for the concurrent
chest CT). MDCT acquired helical axial images were obtained from the thoracic
inlet through the skull base. Coronal and sagittal multiplanar reformats were
then produced and reviewed.
DOSE: Acquisition sequence:
1) Spiral Acquisition 3.7 s, 29.5 cm; CTDIvol = 7.4 mGy (Body) DLP = 216.8
mGy-cm.
Total DLP (Body) = 217 mGy-cm.
COMPARISON: Cervical and thoracic spine MRI and cervical spine CT from ___
FINDINGS:
This exam is obtained with soft tissue neck technique, which is not optimized
for evaluation of the osseous structures. There is ACDF at C6-7 without
evidence for hardware related complications. Alignment is normal. Vertebral
body heights are preserved. There is a small amount of prevertebral fluid
from C6-C7 through T1-T2 without evidence for rim enhancement, compatible with
postsurgical change, which extends anteriorly to the right sternocleidomastoid
muscle with mild associated nonenhancing edema of the right
sternocleidomastoid, also compatible with postsurgical change. Small foci of
gas in the right anterior neck are consistent with the recent surgery. There
is fluid without evidence for rim enhancement in the midline posterior
paravertebral tissues between the paravertebral muscles, extent from C5-6
inferiorly at least to T3 and beyond the inferior margin of the field of view,
measuring 7.0 x 2.4 x 10.4 cm, also compatible with postsurgical change.
Evaluation of the aerodigestive tract demonstrates no evidence for an
exophytic mucosal mass. Adenoids and tonsils appear unremarkable for age.
The visualized portions of the salivary glands are unremarkable; anterior
portions of the parotid glands are not fully imaged. The thyroid is grossly
unremarkable. Major cervical arteries and veins appear patent.
Included upper lungs are clear.
This exam is not technically optimized for evaluation of the included brain
parenchyma, but no concerning abnormalities seen on limited assessment. There
is mild mucosal thickening and a partially visualized mucous retention cyst in
the included lower portion of the right maxillary sinus, and mild mucosal
thickening in the included lower portion of the left maxillary sinus. Mastoid
air cells appear well aerated.
IMPRESSION:
1. Status post ACDF at C6-C7. While this exam is not technically optimized
for evaluation of the osseous structures, there is no evidence for hardware
related complications or fracture.
2. Small amount of prevertebral fluid without rim enhancement from C6-C7
through T1-T2, extending anteriorly to the right sternocleidomastoid with mild
sternocleidomastoid edema, compatible with postsurgical change.
3. Partially visualized fluid without rim enhancement in the posterior
paravertebral muscles extending from C5-C6 inferiorly at least to T3 and
beyond the inferior margin of the field of view, also compatible with
postsurgical change.
4. The spinal canal is not well assessed, particularly at the level of the
hardware, but could be better assessed by MRI if clinically warranted.
|
10091535-RR-28 | 10,091,535 | 23,107,691 | RR | 28 | 2175-02-02 02:22:00 | 2175-02-02 03:50:00 | EXAMINATION: CT CHEST W/CONTRAST
INDICATION: History: ___ with upper back pain and swelling s/p MVC and cspine
surgery one week ago// concern for infection
TECHNIQUE: MD CT axial images of the chest were obtained after administration
of intravenous contrast. Multiplanar reformats, including coronal, sagittal,
axial maximum intensity projection images were obtained and reviewed on PACs.
DOSE: Acquisition sequence:
1) Spiral Acquisition 2.5 s, 39.2 cm; CTDIvol = 11.3 mGy (Body) DLP = 443.7
mGy-cm.
Total DLP (Body) = 444 mGy-cm.
COMPARISON: MRI from ___
FINDINGS:
NECK, THORACIC INLET, AXILLAE, CHEST WALL: The imaged thyroid gland is
unremarkable. Subtle prevertebral edema and subcutaneous fluid measuring 2.8
x 1.3 cm (2:7) in the thoracic inlet likely represents postsurgical changes
and residual prevertebral edema from prior injury. Cervical fixation at C6-7
is better seen on the CT neck from the same day. Overlying the spinous
processes of the lower cervical spine, extending to the level of T5 vertebral
body is a intermuscular fluid collection measuring at least 9.1 x 2.1 x 13.8
cm. The most superior portion of the fluid collection has been excluded from
the field of view. There is no definite rim enhancement associated this fluid
collection.
UPPER ABDOMEN: The imaged portion of the upper abdomen shows a accessory
spleen measuring 1.8 cm. Otherwise, there is no acute abnormality.
MEDIASTINUM: There is no mediastinal lymphadenopathy by CT size criteria. The
main pulmonary artery measures 2.8 cm. The ascending and descending aorta are
not enlarged.
HILA: There is no hilar lymphadenopathy by CT size criteria.
HEART and PERICARDIUM: The heart size is within normal limits. There is no
pericardial effusion.
PLEURA: There is trace pleural effusions bilaterally.
LUNG:
1. PARENCHYMA: Ground-glass opacities and linear opacities in the lower lobes
presumably represent atelectasis. There is no concerning pulmonary nodule the
require further follow-up.
2. AIRWAYS: The airways are patent to the subsegmental levels. There is mild
peribronchial wall thickening of the lower lobes.
3. VESSELS: There is no mediastinal lymphadenopathy by CT size criteria. The
main pulmonary artery measures 2.8 cm. The ascending and descending aorta are
not enlarged.
CHEST CAGE: Pre-existing mild compression fractures T7 through T10 are overall
unchanged when compared to MRI from ___. Superior anterior corner
fracture of T10 is better seen on today's exam.
IMPRESSION:
1. Low density fluid collection in the posterior interfascial layers measuring
at least 9.1 x 2.1 x 13.8 cm extending from the cervical spine at C5 to T5
thoracic level. No rim enhancement. Please clinically correlate.
2. Likely postsurgical changes at the base of neck from anterior fixation at
C6-7 with residual prevertebral edema.
3. Mild compression fractures from C7 through T1, overall unchanged when
compared to MRI from ___.
|
10091873-RR-101 | 10,091,873 | 20,326,539 | RR | 101 | 2194-11-07 12:23:00 | 2194-11-07 12:54:00 | INDICATION: ___ w/recent G-tube placement, p/w N/V please perform KUB to eval
for appropriate placement
TECHNIQUE: AP views of the abdomen
COMPARISON: Abdominal radiographs on ___. CT from ___.
FINDINGS:
A gastrostomy tube overlies the left upper quadrant in the region of the
stomach. Of note, the tip of the gastrostomy tube points up toward the
gastric fundus. The bowel gas pattern is unremarkable.
There is no free intraperitoneal air.
Osseous structures are unremarkable. As before, multiple calcifications are
seen within the left kidney, better appreciated from recent CT in ___. A surgical clip is seen in the left lower quadrant.
IMPRESSION:
Gastrostomy tube projects over the region of the stomach. Of note, the tip of
the gastrostomy tube is directed toward the gastric fundus.
|
10091873-RR-102 | 10,091,873 | 20,326,539 | RR | 102 | 2194-11-08 11:42:00 | 2194-11-08 15:48:00 | EXAMINATION: US NECK, SOFT TISSUE
INDICATION: ___ year old man with h/p head and neck cancer now with severe
right sided neck pain // please evaluate for right neck abscess or fluid
collection. please do with Doppler to evaluate for thrombus ie IJ clot.
TECHNIQUE: Grayscale ultrasound images were obtained of the superficial
tissues of the right submandibular region.
COMPARISON: Neck MR ___, CT Neck ___.
FINDINGS:
Transverse and sagittal images were obtained of the superficial tissues of the
right submandibular region.
There is mild right submandibular ductal dilation with mild heterogeneity of
the gland.
IMPRESSION:
Mild right submandibular ductal dilation with mild heterogeneity of the gland
similar in appearance to CT from ___ and unlikely to be of acute
clinical significance.
|
10091873-RR-103 | 10,091,873 | 25,427,289 | RR | 103 | 2194-12-10 11:51:00 | 2194-12-10 12:50:00 | EXAMINATION:
Chest: Frontal and lateral views
INDICATION: History: ___ with throat pain// evaluate for pneumonia, masses
TECHNIQUE: Chest: Frontal and Lateral
COMPARISON: ___
FINDINGS:
No focal consolidation is seen. There is no pleural effusion or pneumothorax.
The cardiac and mediastinal silhouettes are stable and unremarkable.
Pigtailed catheter is partially imaged projecting over the left upper
quadrant.
IMPRESSION:
No acute cardiopulmonary process.
|
10091873-RR-105 | 10,091,873 | 25,427,289 | RR | 105 | 2194-12-10 22:20:00 | 2194-12-11 09:21:00 | EXAMINATION: MRI SOFT TISSUE NECK, W/O AND W/CONTRAST T925 MR NECK
INDICATION: History of HPV associated right tonsil squamous cell cancer post
chemo radiation therapy, through weeks post biopsy of a right tonsillar lesion
presenting with sore throat with production of blood tinged yellow phlegm and
erythema of the anterior neck. Evaluate for abscess. Recent biopsy
demonstrated necrotic, inflammatory tissue with bacterial overgrowth with
areas of granulation tissue, with only focal atypia, overall consistent with
treatment effect.
TECHNIQUE: Sagittal and axial T1 weighted imaging was performed along with
axial fat-suppressed T2 weighted imaging. After administration of 6 mL of
Gadavist intravenous contrast, axial and coronal T1 weighted imaging were
performed with fat suppression.
COMPARISON: CT neck ___ and ___. PET-CT ___. MR soft tissue neck ___.
FINDINGS:
Examination is limited by motion and susceptibility artifact from dental
hardware.
In the location of the treated right oropharyngeal mass, roughly at the
tonsillar junction, there is a persistent ill-defined area of heterogeneous
enhancement with central hypoenhancement measuring roughly 19 x 19 mm,
decreased since ___ with this area measured approximately 24 x 23
mm (6:6). This corresponds to the area of increased uptake seen on the PET
examination of ___ there is associated decreased mass
effect upon the airway. No organizing fluid collection is seen. Minimal
edema is noted in the retropharyngeal space (05:10), though this appears
unchanged to the ___ examination, and may be a result of
posttreatment change.
There is diffuse mild superficial soft tissue edema throughout the soft
tissues of the anterior neck, leading to the visualized upper chest, without
underlying fluid collection.
There is no evidence of new mucosal mass or abnormal lymph nodes. The neck
vessels appear patent. The salivary glands and thyroid appear unremarkable.
There is a tiny mucous retention cyst in the left maxillary sinus.
There is T1 hypointensity of the C6-C7 endplates, corresponding to type 1
___ endplate degenerative change as seen on the prior cervical spine MR.
___:
1. Slight interval decrease in size of a 19 x 19 mm ill-defined
heterogeneously enhancing right tonsillar mass, which may represent
posttreatment change, though residual tumor is not excluded.
***ALTHOUGH IT IS GETTING SMALLER, IT WOULD BE SURPRISING IF THERE WERE NO NO
RESIDUAL TUMOR. MORE LIEKLY THE DECREASE REFLECTS RESPONSE TO THERAPY BUT THE
LESION WE SEE IS TUMOR.***
1. Diffuse edema throughout the anterior superficial soft tissues of the neck,
leading to the upper chest and may represent post radiation effect, though
cellulitis remains a possibility. This does not appear to contiguously extend
into the deep spaces of the neck.
2. Minimal edema in the retropharyngeal space appears unchanged to the ___ examination, and may be a result of posttreatment effect.
3. No organizing/drainable fluid collection.
|
10091873-RR-91 | 10,091,873 | 25,541,989 | RR | 91 | 2194-07-09 08:34:00 | 2194-07-09 10:39:00 | INDICATION: ___ year old man with head and neck cancer with intractable nausea
and vomiting // eval etiology of intractable N/V
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired
through the abdomen and pelvis following intravenous contrast administration
with split bolus technique.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence: 1) Sequenced Acquisition 0.5 s, 0.2 cm; CTDIvol =
7.3 mGy (Body) DLP = 1.5 mGy-cm. 2) Stationary Acquisition 18.1 s, 0.2 cm;
CTDIvol = 309.3 mGy (Body) DLP = 61.9 mGy-cm. 3) Spiral Acquisition 8.4 s,
54.4 cm; CTDIvol = 7.7 mGy (Body) DLP = 414.0 mGy-cm. Total DLP (Body) = 477
mGy-cm.
COMPARISON: PET-CT ___, CTU and renal ultrasound ___, CT
abdomen ___ and ___
FINDINGS:
LOWER CHEST: Visualized lung fields are within normal limits. There is no
evidence of pleural or pericardial effusion.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There
is no evidence of suspicious lesions. 7 mm ovoid hypodensity in the right
lobe is similar to multiple priors and was not FDG avid on recent PET-CT.
There is no evidence of intrahepatic or extrahepatic biliary dilatation. The
gallbladder is within normal limits.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The right kidney is of normal size. The left kidney measures up to
14.8 cm, similar to prior. Both kidneys demonstrate normal nephrogram. Mid
left ureteral stone measures up to 6 mm in the axial plane, which is similar
to ___, but it has increased in size in the CC dimension, now
measuring up to 12 mm. There is moderate to severe left hydronephrosis,
mildly worse compared to ___. There are multiple other renal stones
bilaterally, better evaluated on ___ due to the presence of IV
contrast on this exam. There is no right hydronephrosis or right hydroureter.
There is no evidence of focal renal lesions. There is no perinephric
abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. The colon and
rectum are within normal limits. The appendix is normal.
PELVIS: Curvilinear calcifications in the dependent portion of the urinary
bladder (4:76) may represent small stones. There is no free fluid in the
pelvis.
REPRODUCTIVE ORGANS: Coarse calcifications in the prostate are similar to
multiple priors. Right vasectomy clip is again seen.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease
is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
Focus of sclerosis in the lateral right eighth rib (04:20) was not FDG avid on
recent PET-CT and is not significantly changed since ___.
Moderate degenerative changes in the spine are similar to ___.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. Since ___, a mid left ureteral stone has enlarged in the CC
dimension and there is mildly worsened left hydronephrosis, now moderate to
severe.
2. Curvilinear calcifications in the dependent portion of the urinary bladder
may represent small stones.
RECOMMENDATION(S): Impression point 1 was communicated to Dr. ___
by Dr. ___ telephone at 9:59 AM on ___.
|
10091873-RR-92 | 10,091,873 | 25,541,989 | RR | 92 | 2194-07-08 19:09:00 | 2194-07-08 21:14:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ year old man with known right tonsillar and posterior tongue
mass, now with intractable nausea and vomiting. Evaluate for acute
intracranial hemorrhage or intracranial mass.
TECHNIQUE: Contiguous axial images from skullbase to vertex were obtained
without intravenous contrast.
DOSE: Acquisition sequence:
1) Stationary Acquisition 4.0 s, 15.1 cm; CTDIvol = 45.3 mGy (Head) DLP =
684.4 mGy-cm.
Total DLP (Head) = 684 mGy-cm.
COMPARISON: ___ contrast neck CT.
___ FDG PET-CT.
FINDINGS:
There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles
and sulci are normal in size and configuration.
No osseous abnormalities seen. A sphenoid sinus mucous retention cyst is
noted. The remaining paranasal sinuses, mastoid air cells, and middle ear
cavities are clear. The orbits are unremarkable.
IMPRESSION:
1. No acute intracranial abnormality, with no definite evidence of
intracranial mass.
2. Please note MRI of the brain is more sensitive for the detection of acute
infarct or intracranial masses.
3. Paranasal sinus disease as described.
|
10092020-RR-10 | 10,092,020 | 22,096,323 | RR | 10 | 2135-06-15 20:12:00 | 2135-06-15 21:10:00 | EXAMINATION: MR HEAD W AND W/O CONTRAST T___ MR HEAD.
INDICATION: ___ year old man with episode of impaired awareness. seizure due
tpo Lesion? vs stroke // ? lesion or Stroke.
TECHNIQUE: Sagittal and axial T1 weighted imaging were performed. After
administration of 10 mL of Gadavist intravenous contrast, axial imaging was
performed with gradient echo, FLAIR, diffusion, and T1 technique. Sagittal
MPRAGE imaging was performed and re-formatted in axial and coronal
orientations.
COMPARISON: MRI head dated ___.
FINDINGS:
There is no evidence of hemorrhage, edema, masses, mass effect, midline shift
or infarction. The ventricles and sulci are normal in caliber and
configuration. There are multifocal foci of T2 FLAIR hyperintensities in
periventricular and subcortical white matter; nonspecific in in appearance and
could be related to chronic microangiopathy. There is no abnormal
intracranial enhancement. Preserved major intracranial vascular flow voids
with no sinus venous thrombosis.
Both orbits and globes are normal. Mild mucosal thickening involving ethmoid
air cells with small mucous retention cyst on the left maxillary sinus.
Otherwise unremarkable paranasal sinuses and mastoid air cells
IMPRESSION:
1. There is no evidence of acute intracranial process or hemorrhage.
2. There is no evidence of abnormal enhancement after contrast administration.
|
10092020-RR-7 | 10,092,020 | 22,096,323 | RR | 7 | 2135-06-15 04:42:00 | 2135-06-15 05:29:00 | EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD.
INDICATION: History: ___ with c/f seizure on a/c // eval 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 16.0 s, 16.7 cm; CTDIvol = 48.1 mGy (Head) DLP =
802.7 mGy-cm.
2) Sequenced Acquisition 6.0 s, 6.2 cm; CTDIvol = 48.7 mGy (Head) DLP =
301.0 mGy-cm.
Total DLP (Head) = 1,104 mGy-cm.
COMPARISON: Prior MRI of the head dated ___.
FINDINGS:
There is no evidence of acute territorial infarction,intracranial
hemorrhage,edema,or mass. There is prominence of the ventricles and sulci
suggestive of involutional changes. Subtle periventricular and subcortical
white matter hypodensities are nonspecific, but likely reflect sequelae of
chronic small vessel ischemic disease.
The visualized portion of the paranasal sinuses, mastoid air cells, and middle
ear cavities are clear. The visualized portion of the orbits are normal. The
soft tissues appear normal, no fractures are identified.
IMPRESSION:
1. There is no evidence of acute intracranial process or hemorrhage.
|
10092020-RR-8 | 10,092,020 | 22,096,323 | RR | 8 | 2135-06-15 04:56:00 | 2135-06-15 10:39:00 | EXAMINATION: HUMERUS (AP AND LAT) RIGHT
INDICATION: History: ___ with ? fracture.
TECHNIQUE: AP and lateral view radiographs of the right humerus.
COMPARISON: None.
FINDINGS:
There is no acute fracture or dislocation. The partially visualized shoulder
and elbow demonstrate no significant degenerative changes. No suspicious
sclerotic or lytic lesion is identified.
IMPRESSION:
No evidence of fracture in the right humerus.
|
10092020-RR-9 | 10,092,020 | 22,096,323 | RR | 9 | 2135-06-15 07:45:00 | 2135-06-15 09:11:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: History: ___ with hypoxia // ? pna
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest radiograph dated ___
FINDINGS:
Cardiomediastinal silhouette is within normal limits. There is no acute focal
consolidation. No pneumothorax or pleural effusion. No pulmonary edema.
IMPRESSION:
No evidence of pneumonia.
|
10092110-RR-13 | 10,092,110 | 22,808,156 | RR | 13 | 2113-02-26 02:17:00 | 2113-02-26 02:57:00 | HISTORY: ___ male with a fall and loss of consciousness with known L2
through L5 fractures.
STUDY: CT of the cervical spine without contrast; images were acquired in the
soft tissue and bone algorithms. Coronal and sagittal reformatted images were
also generated.
COMPARISON: None.
FINDINGS: There is no fracture or malalignment. The prevertebral soft
tissues are of normal thickness. The facet joints are appropriately aligned.
The occipitoatlantic and atlantoaxial articulations are symmetric, and the
dens is intact. The visualized portion of the lung apices appear
unremarkable.
IMPRESSION: No fracture or malalignment with normal prevertebral soft
tissues.
|
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