note_id
stringlengths 13
15
| subject_id
int64 10M
20M
| hadm_id
int64 20M
30M
| note_type
stringclasses 1
value | note_seq
int64 2
851
| charttime
stringlengths 19
19
| storetime
stringlengths 19
19
| text
stringlengths 35
17.5k
|
|---|---|---|---|---|---|---|---|
10092110-RR-14 | 10,092,110 | 22,808,156 | RR | 14 | 2113-02-26 02:38:00 | 2113-02-26 03:19:00 | HISTORY: ___ male with recent fall and lumbar spine fracture.
STUDY: Supine AP chest radiograph.
COMPARISON: None.
FINDINGS: The heart size is at the upper limits of normal, likely exaggerated
by supine positioning and AP technique. The mediastinal contours are not
widened. The lungs are clear. There is no pleural effusion or pneumothorax.
No fractures are identified.
IMPRESSION: No acute thoracic injury.
|
10092110-RR-15 | 10,092,110 | 22,808,156 | RR | 15 | 2113-02-26 19:05:00 | 2113-02-26 21:16:00 | INDICATION: ___ male transfered from ___ with transverse
process fractures of L2, L3, L4 and L5 after a fall, currently has superficial
tenderness and swelling of the right flank area.
COMPARISON: None.
TECHNIQUE: MDCT axial images were obtained through the abdomen and pelvis
without the administration of IV contrast. Multiplanar reformats were
generated and reviewed.
TOTAL EXAM DLP: 620.23 mGy-cm.
FINDINGS:
CT ABDOMEN WITHOUT IV CONTRAST:
Visualized lung bases demonstrate mild dependent atelectasis. The visualized
heart and pericardium are unremarkable.
Evaluation of solid organs and intra-abdominal vasculature is limited by
non-contrast technique. Within this limitation, the liver, spleen, pancreas,
gallbladder, and bilateral adrenal glands are unremarkable. Both kidneys are
unremarkable, without evidence of liver laceration or other injury.
Intra-abdominal loops of large and small bowel are within normal limits.
Retroperitoneal and mesenteric lymph nodes do not meet CT size criteria for
pathology. Intra-abdominal vasculature shows no contour abnormalities.
There is evidence of a right sided retroperitoneal hemorrhage with slight
enlargement of the right psoas muscle with edema in the adjacent
retroperitoneal fat and a trace of adjacent hyperdense fluid along the fascia.
CT PELVIS WITHOUT IV CONTRAST:
The bladder, distal ureters, rectum and sigmoid colon are unremarkable.
Pelvic loops of large and small bowel are within normal limits.
Visualized osseous structures show fracture of the right L1, L2, L3, L4 and L5
transverse process.
IMPRESSION:
1. Right flank retroperitoneal hemorrhage extending along and slightly
expanding the right psoas muscle with a trace of blood along the
retroperitoneal fat planes.
2. Right transverse process fractures of L1-L5.
3. Unremarkable appearance of solid viscera of abdomen and pelvis, allowing
for noncontrast technique.
Findings were discussed with Dr. ___ at 8:12 p.m. approximately three
minutes after discovery of critical findings on ___ via
telephone.
|
10092201-RR-23 | 10,092,201 | 28,030,798 | RR | 23 | 2183-02-16 10:50:00 | 2183-02-16 18:44:00 | EXAMINATION: MR HEAD W AND W/O CONTRAST T9112 MR HEAD
INDICATION: History: ___ with seizure found to have parenchymal bleed c/f
venous malformation // ?avm
TECHNIQUE: Sagittal and axial T1 weighted imaging were performed. After
administration of 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: CTA head ___, CTA head and neck with contrast ___.
FINDINGS:
Study is somewhat motion degraded. The hyperdense lesion in the left parietal
lobe seen on CT of the in ___ and ___ correlates to a predominantly
hypointense intense lesion on all sequences lesion with some focal internal
hyperintensity centrally. There is blooming seen on gradient echo consistent
with chronic hemorrhage. Motion degradation limits assessment of enhancement,
but none is appreciated.
There is no evidence of edema, masses, mass effect, midline shift or
infarction. The ventricles and sulci are normal in caliber and configuration.
There is no abnormal enhancement after contrast administration.
IMPRESSION:
1. THe left parietal lesions is most likely an occult vascular malformation.
|
10092201-RR-24 | 10,092,201 | 28,030,798 | RR | 24 | 2183-02-16 07:20:00 | 2183-02-16 18:14:00 | EXAMINATION: CTA HEAD WANDW/O C AND RECONSQ1213CTHEAD
INDICATION: History: ___ with seizure found to have parenchymal bleed c/f
venous malformation // ?avm
TECHNIQUE: Contiguous MDCT axial images were obtained through the brain
without contrast material. Next, rapid axial imaging was performed through
the brain during the uneventful infusion of 70 mL of Omnipaque intravenous
contrast material. Three-dimensional angiographic volume rendered and
segmented images were then generated on a dedicated workstation. This report
is based on interpretation of all of these images.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 7.2 s, 18.0 cm; CTDIvol = 56.1 mGy (Head) DLP =
1,009.3 mGy-cm.
2) Stationary Acquisition 5.4 s, 0.5 cm; CTDIvol = 82.1 mGy (Head) DLP =
41.1 mGy-cm.
3) Spiral Acquisition 6.1 s, 19.7 cm; CTDIvol = 30.7 mGy (Head) DLP = 604.6
mGy-cm.
Total DLP (Head) = 1,655 mGy-cm.
COMPARISON: CT HEAD FROM ___.
FINDINGS:
CT HEAD WITHOUT CONTRAST:
A curvilinear hyperdense lesion is seen within the left parietal lobe
extending to the left falx. There is no definite evidence of acute
intracranial hemorrhage, or infarction. Ventricles and sulci are normal in
size and configuration. The basilar cisterns are patent and there is
otherwise good preservation gray-white matter differentiation.
No acute fracture is identified. Moderate mucosal sinus thickening is seen
involving the ethmoid air cells. The remainder the visualized paranasal
sinuses, mastoid air cells, and middle ear cavities are clear. The globes are
unremarkable.
CTA HEAD:
The left vertebral artery is dominant with a diminutive right vertebral
artery. The posterior circulation is well preserved. The left internal
carotid artery, MCA, and ACA appear to be unremarkable. The right internal
carotid artery, MCA and ACA appear to be unremarkable. Note is made of a
hypoplastic A1 segment of the right ACA. The anterior communicating artery is
visualized. There is no evidence of aneurysm, or significant stenosis.
IMPRESSION:
1. Curvilinear hyperdense lesion within the left parietal lobe, with extension
to the left parafalcine region is likely secondary to calcification, which may
be secondary to a partially thrombosed AVM, cavernous malformation, or
sequelae of prior hemorrhage. No definite acute intracranial hemorrhage or
acute large territorial infarction.
2. Unremarkable CTA of the head without evidence of stenosis or aneurysm. No
evidence of vascular malformation.
RECOMMENDATION(S): Further evaluation with MRI is recommended.
|
10092201-RR-25 | 10,092,201 | 28,030,798 | RR | 25 | 2183-02-16 08:03:00 | 2183-02-16 12:25:00 | INDICATION: History: ___ with seizure // ?pna
TECHNIQUE: Single supine AP portable view of the chest
COMPARISON: None.
FINDINGS:
No focal consolidation is seen. There is no pleural effusion or pneumothorax.
Cardiac and mediastinal silhouettes are grossly unremarkable. There is
deformity of the right mid clavicle, not well assessed on this study, but may
be chronic.
IMPRESSION:
No focal consolidation to suggest pneumonia. Deformity of the right mid
clavicle, not well assessed on this study, but may be chronic.
|
10092201-RR-26 | 10,092,201 | 28,030,798 | RR | 26 | 2183-02-18 20:06:00 | 2183-02-18 21:27:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: pre op // rule out infection Surg: ___ (angio)
TECHNIQUE: Chest single view
COMPARISON: ___ 08:25
FINDINGS:
Small area right infrahilar atelectasis. Bibasilar opacities have improved
since prior. Probably chronic right clavicle fracture, stable. Normal heart
size, pulmonary vascularity. No pneumothorax. No effusion.
IMPRESSION:
Mild right infrahilar atelectasis.
|
10092201-RR-27 | 10,092,201 | 28,030,798 | RR | 27 | 2183-02-19 11:40:00 | 2183-02-19 13:38:00 | EXAMINATION: Right internal carotid artery angiogram.
Right external carotid artery angiogram.
Left internal carotid artery angiogram.
Left external carotid artery angiogram.
Left vertebral artery angiogram.
Right common femoral artery angiogram.
INDICATION: ___ year old man with Lt partial lesion // assess for vascular
malformation
ANESTHESIA: Anesthesia: Conscious sedation with local analgesia, please see
separate sheets for medications and dosing.
TECHNIQUE:
Patient was brought into the angio suite, ID was confirmed via wrist band.The
patient was placed supine on fluoroscopy table and bilateral groins were
prepped and draped in the usual sterile manner. Time-out procedure was
performed per institutional guidelines. The location of the right mid femoral
head was located using anatomic and radiographic landmarks. 10 +10 cc of
subcutaneous lidocaine was infused into the tissue. Micropuncture kit was
used to gain access to the right femoral artery, serial dilation was
undertaken until a long 5 ___ groin sheath connected to a continuous
heparinized saline flush could be inserted. ___ catheter was
connected to the power injector and also to a continuous heparinized saline
flush. This was advanced over the 0.038 glidewire brought up the aorta used to
select the right internal carotid artery under roadmap guidance. AP, oblique
and lateral views of the anterior cerebral circulation were obtained .
Subsequently, the catheter was pulled back into the common carotid and under
roadmap guidance the external carotid artery was selected, AP and lateral
views were obtained.
Catheter was then pulled back in the aorta and used to select the left
internal carotid artery under roadmap guidance. AP, oblique and lateral views
of the anterior cerebral circulation were obtained. Subsequently, the catheter
was pulled back into the common carotid and under roadmap guidance the
external carotid artery was selected, AP and lateral views were obtained.
The catheter was then pulled back in the aorta and the left subclavian artery
was selected. AP road map imaging was undertaken. Next, the left vertebral
artery was selected. AP and lateral views were taken from this vessel for the
posterior cerebral circulation. The catheter was then pulled back in the aorta
fully removed from the body. A common femoral arteriogram was performed prior
to use of a closure device, subsequently Angio-Seal was put in. At the
conclusion of the procedure, there is no evidence of thromboembolic
complication and the patient was at his neurologic baseline.
COMPARISON: None.
PROCEDURE: Diagnostic cerebral angiogram.
FINDINGS:
Right internal carotid artery: The distal right ICA, proximal and distal MCA
branches are well-visualized. Vessel caliber smooth and tapering. No filling
of the ACA complex. Normal arterial, capillary, and venous phase . No
vascular abnormalities identified .
Right external carotid artery: Branches well-visualized, no signs of
arteriovenous shunting.
Left internal carotid artery: Distal left ICA, proximal and distal MCA and
ACA branches are well-visualized.cross-filling to the contralateral A2 via the
A-comm. Vessel caliber smooth and tapering. Normal arterial, capillary, and
venous phase . No vascular abnormalities identified .
Left external carotid artery: Branches well-visualized, no signs of
arteriovenous shunting
Left vertebral artery , left ___, basilar artery, bilateral AICA, bilateral
SCA and bilateral PCAs are well-visualized. The right ___ is not well
visualized as there was no cross-filling to the right vertebral artery. No
vascular abnormalities identified, vessel caliber smooth and tapering.
Arterial, capillary, venous phases were normal .
Right common femoral artery: Well-visualized with a good caliber size for
closure device.
I, ___, participated in the procedure. I, ___, was
present for the entirety of the procedure and supervised all critical steps.
I, ___, have reviewed the report and agree with the fellow's
findings.
IMPRESSION:
1. 5 vessels diagnostic cerebral angiogram did not demonstrate any vascular
abnormalities.
RECOMMENDATION(S):
1. Follow-up as there the treating team
|
10092227-RR-12 | 10,092,227 | 23,138,040 | RR | 12 | 2158-06-30 19:09:00 | 2158-06-30 19:32:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: History: ___ intubated transfer // confirm ETT
TECHNIQUE: SUPINE AP VIEW OF THE CHEST
COMPARISON: None. Patient is currently listed as EU critical.
FINDINGS:
Endotracheal tube tip terminates approximately 5.3 cm from the carina. An
enteric tube courses below the left hemidiaphragm with tip off the inferior
borders of the film, however, the side port appears just proximal to the
gastroesophageal junction. Opacification of the right upper lobe with
rightward tracheal deviation suggest complete collapse. Small right pleural
effusion is also noted with associated right basilar opacity, potentially
compressive atelectasis. Cardiac silhouette size appears moderately enlarged.
The mediastinal and hilar contours are difficult to completely assess, but
appear grossly unremarkable. Mild pulmonary vascular congestion is
demonstrated. No large pneumothorax is detected on this supine exam. No
acute osseous abnormalities visualized.
IMPRESSION:
1. Standard positioning of endotracheal tube.
2. Enteric tube tip is likely within the stomach, however the side port is
just proximal to the gastroesophageal junction, and slight interval
advancement by approximately 4 cm is suggested.
3. Opacification of the right upper lobe concerning for collapse given the
presence of rightward tracheal deviation. Consider contrast-enhanced chest CT
to assess for an underlying obstructive lesion.
4. Small right pleural effusion and right basilar opacity, potentially
compressive atelectasis.
5. Mild pulmonary vascular congestion.
|
10092227-RR-13 | 10,092,227 | 23,138,040 | RR | 13 | 2158-06-30 20:40:00 | 2158-06-30 21:16:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: History: ___ with subacute infarct on head CT at OSH. Unable to
obtain images. // Infarct?
TECHNIQUE: Routine unenhanced head CT was performed and viewed in brain,
intermediate and bone windows. Coronal and sagittal reformats were also
performed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 16.0 s, 16.7 cm; CTDIvol = 48.0 mGy (Head) DLP =
802.7 mGy-cm.
Total DLP (Head) = 803 mGy-cm.
COMPARISON: None.
FINDINGS:
There are late subacute to chronic infarcts in the right occipital, right
temporal lobes. There is no intra-axial or extra-axial hemorrhage, edema,
shift of normally midline structures, or evidence of acute major vascular
territorial infarction. Periventricular and subcortical white matter
hypodensities are nonspecific, but likely reflect sequelae of mild to moderate
chronic small vessel ischemic disease. There is tiny chronic lacunar infarct
in the right caudate nucleus. Prominence of the ventricles and sulci suggest
involutional changes.
There is mild mucosal thickening of bilateral maxillary sinuses and bilateral
ethmoid air cells. There is near-complete opacification of bilateral sphenoid
sinuses. Mastoid air cells and middle ear cavities are well aerated. The bony
calvarium is intact. There is soft tissue thickening overlying left parietal
bone, right ___ be posttraumatic. Mild edema about upper margin of
partially seen parotid gland is indeterminate can suboptimally evaluated,
consider parotitis. There is bilateral proptosis, without evidence of
extraocular muscle enlargement of or intraorbital mass. Bilateral superior
ophthalmic veins are enlarged, a nonspecific finding, can be seen with
increased intracranial pressure, however, there is no hydrocephalus or mass on
head CT.
A subcutaneous round mass with soft tissue attenuation measuring 2.5 x 2.3 x
2.0 cm is seen in the medial pre antral space, abutting right nares.
IMPRESSION:
1. There are late subacute to chronic infarcts in the right occipital,
temporal lobes. If there is clinical concern for acute component, MRI would
be helpful.
2. There is 2.5 cm well-circumscribed right pre antral mass, abutting right
nares.
3. There is left scalp, right temporal scalp edema. There is mild edema about
partially seen upper right parotid gland, indeterminate come consider
parotitis.
|
10092227-RR-14 | 10,092,227 | 23,138,040 | RR | 14 | 2158-07-01 03:59:00 | 2158-07-01 10:25:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with enteric tube being advanced. // Tube
positioning correct? Tube positioning correct?
IMPRESSION:
Compared to chest radiograph ___.
Previous right upper lobe collapse has resolved. Substantial atelectasis
persists in the right lower lobe accompanied by at least small right pleural
effusion, probably unchanged. Previous pulmonary vascular congestion has
improved. There is no pulmonary edema. Moderate cardiomegaly stable.
ET tube in standard placement. Esophageal drainage tube ends beyond the upper
stomach, probably in the mid stomach if I am seeing the most proximal
side-port just beyond the GE junction.
|
10092227-RR-15 | 10,092,227 | 23,138,040 | RR | 15 | 2158-07-01 08:07:00 | 2158-07-01 11:23:00 | EXAMINATION: Chest radiograph
INDICATION: ___ year old woman with concern for sepsis // eval for interval
change in placement of OGT
TECHNIQUE: Portable semi upright view of the chest
COMPARISON: Chest radiograph from ___
FINDINGS:
The tip of an ETT is seen approximately 5.8 cm above the carina. An enteric
tube is seen in the stomach. There is some obscuration of the right
hemidiaphragm, likely due to a combination of small to moderate right pleural
effusion and associated right basilar atelectasis, but this is significantly
improved since admission. The cardiac silhouette appears moderately enlarged,
but unchanged. The mediastinum is not widened. Left basilar linear opacities
are likely due to atelectasis. Mild pulmonary vascular congestion appears
improved since admission. There is no pulmonary edema or pneumothorax.
IMPRESSION:
1. Mild pulmonary vascular congestion and right basilar atelectasis is
improved since admission on ___.
2. The enteric tube is seen coursing into a left sided stomach.
|
10092227-RR-17 | 10,092,227 | 23,138,040 | RR | 17 | 2158-07-01 10:37:00 | 2158-07-01 14:16:00 | EXAMINATION: ___ DUP EXTEXT BIL (MAP/DVT)
INDICATION: ___ year old woman found down, c/f PE // DVT?
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the bilateral lower extremity veins.
COMPARISON: None.
FINDINGS:
There is normal compressibility, flow, and augmentation of the bilateral
common femoral, femoral, and popliteal veins. Visualization of the posterior
tibial and peroneal veins bilaterally is limited however no thrombus is
identified within the calf veins.
There is normal respiratory variation in the common femoral veins bilaterally.
No evidence of medial popliteal fossa (___) cyst.
IMPRESSION:
No evidence of deep venous thrombosis in the right or left lower extremity
veins. Note is made of limited visualization of the calf veins bilaterally.
|
10092227-RR-19 | 10,092,227 | 23,138,040 | RR | 19 | 2158-07-01 17:05:00 | 2158-07-01 19:24:00 | EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ year old woman with acute liver failure // Please evaluate
for biliary dilation or evidence of cirrhosis; please do with doppler
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: Chest radiograph with the same date.
FINDINGS:
A right pleural effusion is noted.
LIVER: The hepatic parenchyma appears within normal limits. The contour of the
liver is smooth. There is no focal liver mass. The main, right, and left
portal veins are patent with hepatopetal flow. Hepatic veins are also patent.
There is a small volume perihepatic ascites.
BILE DUCTS: There is no intrahepatic biliary dilation. The CHD measures 6 mm.
GALLBLADDER: There is a large stone at the gallbladder neck in the gallbladder
is mildly distended. No gallbladder wall thickening, mural edema, or
pericholecystic fluid.
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 6.2 cm.
KIDNEYS: Limited views of the right kidney show no hydronephrosis.
RETROPERITONEUM: The visualized portions of aorta and IVC are within normal
limits.
IMPRESSION:
1. Normal liver. The portal vein is patent.
2. Cholelithiasis without specific evidence for acute cholecystitis. No
biliary dilatation.
3. Right pleural effusion and small volume perihepatic ascites.
|
10092227-RR-20 | 10,092,227 | 23,138,040 | RR | 20 | 2158-07-01 19:46:00 | 2158-07-01 20:08:00 | EXAMINATION: DX CHEST PORT LINE/TUBE PLCMT 1 EXAM
INDICATION: ___ year old woman with acute hypoxic respiratory failure with
self extubation s/p re-intubation // please eval position of ETT
TECHNIQUE: Chest single view
COMPARISON: ___ 08:25
FINDINGS:
Endotracheal tube tip 3 cm above carina. Enteric tube tip below diaphragm,
not included on the radiograph. Increased heart size, improved since prior.
Stable pulmonary vascularity. No pulmonary edema. Stable mild to moderate
right, and possibly small left pleural effusion. Right basilar consolidation
is mildly improved. No pneumothorax.
IMPRESSION:
Improved right basilar consolidation.
|
10092227-RR-22 | 10,092,227 | 23,138,040 | RR | 22 | 2158-07-01 22:44:00 | 2158-07-02 08:21:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with attempted IJ line, but unsuccessful, now
desaturating // R/o pneumothorax, eval for consolidation R/o
pneumothorax, eval for consolidation
IMPRESSION:
In comparison with the earlier study of this date, there has been an
unsuccessful attempt at IJ line placement. No evidence of post procedure
pneumothorax. Otherwise no change in the appearance of the heart and lungs
and monitoring support devices.
|
10092227-RR-23 | 10,092,227 | 23,138,040 | RR | 23 | 2158-07-03 04:18:00 | 2158-07-03 08:07:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman in sepsis/shock presently intubated s/p
re-intubation yesterday. // eval for interval change eval for interval
change
IMPRESSION:
ET tube tip is 5.8 cm above the carinal. NG tube tip is in the stomach.
Cardiomegaly is substantial. Mediastinum is stable in appearance. There is
interval development of vascular congestion and mild interstitial edema.
Large bilateral pleural effusions are unchanged.
|
10092227-RR-24 | 10,092,227 | 23,138,040 | RR | 24 | 2158-07-04 07:12:00 | 2158-07-04 10:26:00 | EXAMINATION: Chest radiograph.
INDICATION: ___ intubated s/p shock liver // interval change
TECHNIQUE: Single AP view
COMPARISON: Chest radiograph ___.
FINDINGS:
An endotracheal tube ends the mid thoracic trachea. An enteric tube courses
below the level of the diaphragm and terminates off the inferior aspect of the
film. Severe cardiomegaly and prominence the pulmonary vasculature suggesting
fluid overload is unchanged. Opacification of the right mid lung and right
lung base is allowing for technical differences likely mildly increased from
prior examination and secondary to an increased right pleural effusion.
IMPRESSION:
Moderate right pleural effusion is increased. Mild pulmonary vascular
congestion, unchanged.
|
10092227-RR-25 | 10,092,227 | 23,138,040 | RR | 25 | 2158-07-05 08:00:00 | 2158-07-05 08:54:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with R pleural effusion, intubated // interval
change in pleural effusion interval change in pleural effusion
IMPRESSION:
Comparison to ___. Complete opacification of the right lung,
with deviation of the mediastinal structures to the right, indicating that
atelectasis is the predominant tick cause for the right lung collapse.
Minimal left pleural effusion with left retrocardiac atelectasis. Stable
monitoring and support devices.
|
10092227-RR-26 | 10,092,227 | 23,138,040 | RR | 26 | 2158-07-05 16:45:00 | 2158-07-05 18:11:00 | INDICATION: ___ year old woman with COPD and respiratory // interval change
post bronch
TECHNIQUE: AP portable chest radiograph
COMPARISON: ___
FINDINGS:
The tip of the endotracheal tube projects over the mid thoracic trachea. A
nasogastric tube extends into the stomach.
Interval decrease in the extent of the opacification of the right lung.
Persisting atelectasis and a pleural effusion persist. Unchanged left pleural
effusion. No pneumothorax is identified. The size of the cardiac silhouette
is enlarged.
IMPRESSION:
Interval decrease in the extent of the opacification throughout the right
lung. Persisting atelectasis and a pleural effusion are however present.
|
10092227-RR-27 | 10,092,227 | 23,138,040 | RR | 27 | 2158-07-06 04:00:00 | 2158-07-06 07:49:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with right lung white out on cxr previously //
interval change interval change
IMPRESSION:
Comparison to ___. Stable moderate cardiomegaly with moderate
right pleural effusion and subsequent right basal areas of atelectasis. The
severity of the retrocardiac atelectasis has increased. The monitoring and
support devices continue to be correctly positioned.
|
10092227-RR-28 | 10,092,227 | 23,138,040 | RR | 28 | 2158-07-07 04:12:00 | 2158-07-07 08:30:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with COPD, hypercarbic resp failure, now s/p
bronchoscopy ___// Eval for interval change in consolidation Eval for
interval change in consolidation
IMPRESSION:
In comparison with the study of ___, there is little overall change.
Moderate enlargement of the cardiac silhouette is stable with bilateral
pleural effusions and compressive basilar atelectasis and mild elevation of
pulmonary venous pressure.
|
10092227-RR-30 | 10,092,227 | 23,138,040 | RR | 30 | 2158-07-09 02:55:00 | 2158-07-09 08:26:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman s/p extubation who is now hypoxic.// Eval for
PNA or effusion Eval for PNA or effusion
IMPRESSION:
Comparison to ___. Increase in extent of the pre-existing right
pleural effusion with subsequent increasing atelectasis of the right lung.
Deviation of the mediastinum to the right. In the interval, the patient has
been extubated and the nasogastric tube was removed. No change in appearance
of the left lung.
|
10092227-RR-31 | 10,092,227 | 23,138,040 | RR | 31 | 2158-07-10 03:48:00 | 2158-07-10 09:59:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with respiratory failure// interval change,
MICU B rounds interval change, MICU B rounds
IMPRESSION:
Compared to chest radiographs ___ through ___.
Moderate to large right pleural effusion is smaller today than yesterday.
Right lower lobe still largely or entirely collapsed. No pneumothorax.
Moderate cardiomegaly unchanged. Left basal atelectasis mild. Left pleural
effusion is small. Pulmonary vasculature is engorged, but there is no
pulmonary edema.
|
10092227-RR-32 | 10,092,227 | 23,138,040 | RR | 32 | 2158-07-11 19:34:00 | 2158-07-11 22:36:00 | EXAMINATION: CT NECK W/O CONTRAST (EG: PAROTIDS) Q21 CT NECK
INDICATION: ___ with unclear medical history (?COPD) presenting from
out of hospital for unresponsiveness s/p intubation and off pressors// ? neck
swelling prior to presentation
TECHNIQUE: 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, 28.6 cm; CTDIvol = 15.3 mGy (Body) DLP = 438.5
mGy-cm.
Total DLP (Body) = 438 mGy-cm.
COMPARISON: Chest radiograph from earlier the same day, CT head ___
FINDINGS:
Evaluation of the aerodigestive tract demonstrates no areas of focal mass
effect. There is significant patient motion through the level of larynx.
There is a significant amount of debris in the lower trachea and extending to
the imaged portion of the proximal right main bronchus.
The salivary glands are grossly without mass or adjacent fat stranding. There
is an approximately 2.6 x 2.2 x 2.6 cm hypodense right thyroid nodule with a
small area of peripheral calcification. Approximately 2.4 cm right pre antral
soft tissue mass abutting the right nare is not significantly change since ___. There is a lower right paratracheal lymph node measuring up to
1.6 cm (2:92).
There is an 8 mm left upper lobe nodule (2:93). The imaged portion of the
right lung is collapsed, as seen earlier today. There is a small to moderate
surrounding right pleural effusion. There is a small left pleural effusion.
Enlargement of the main pulmonary artery up to 4.6 cm consistent with
pulmonary arterial hypertension. Right PICC is partially imaged. There are
no osseous lesions. There is surgical material in the subcutaneous tissues of
the midline upper back. There is chronic infarct in the right temporal lobe,
better seen on head CT. Degenerative changes spine
IMPRESSION:
1. Significant amount of debris and secretions in the lower trachea and
extending to the imaged portion of the proximal right main bronchus. The
imaged portion of the right lung is collapsed, as seen earlier today.
Bilateral pleural effusions, greater on the right.
2. Approximately 2.6 cm right thyroid nodule. Thyroid ultrasound recommended.
3. 8 mm left upper lobe pulmonary nodule.
4. Marked enlargement of main pulmonary artery, consistent with pulmonary
artery hypertension.
5. Indeterminate 2.4 cm right pre antral soft tissue mass.
RECOMMENDATION(S):
1. The ___ society pulmonary nodule recommendations are intended as
guidelines for follow-up and management of newly incidentally detected
pulmonary nodules smaller than 8 mm, in patients ___ years of age or older. Low
risk patients have minimal or absent history of smoking or other known risk
factors for primary lung neoplasm. High risk patients have a history of
smoking or other known risk factors for primary lung neoplasm.
In the case of nodule size >6 - 8 mm: For low risk patients, initial follow-up
CT at ___ months and then at ___ months if no change. For high risk
patients - initial follow-up CT at ___ months and then at ___ and 24 months
if no change.
2. Nonurgent thyroid ultrasound.
|
10092227-RR-33 | 10,092,227 | 23,138,040 | RR | 33 | 2158-07-11 11:21:00 | 2158-07-11 14:40:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ with unclear medical history of COPD originally
presented from OSH for unresponsiveness, found to be in shock, likely septic,
with transaminases in the thousands and respiratory failure, now extubated
with greatly improved mentation and improving liver and kidney function.//
hypercarbia requiring CPAP, ? pulmonary edema vs. residual PNA
TECHNIQUE: Portable AP chest
COMPARISON: Chest radiographs from ___,
___.
FINDINGS:
Compared to ___, there is near complete opacification of the
right lung, with tracheal and mediastinal shift to the right, consistent with
right lung collapse secondary to mucous plugging. Persistent left basilar
atelectasis and small left pleural effusion.
IMPRESSION:
Compared to ___, there is near complete opacification of the
right lung, with tracheal and mediastinal shift to the right, consistent with
right lung collapse secondary to mucous plugging.
NOTIFICATION: The findings were discussed with ___, M.D. by ___
___, M.D. on the telephone on ___ at 2:38 pm, 15 minutes after
discovery of the findings.
|
10092227-RR-34 | 10,092,227 | 23,138,040 | RR | 34 | 2158-07-11 18:23:00 | 2158-07-12 11:51:00 | INDICATION: ___ with unclear medical history (?COPD) presenting from
out of hospital for unresponsiveness s/p intubation+extubation with likely
COPD exacerbation// Please place RUE PICC (failed by IV RN ___ poor access);
LUE being preserved for potential dialysis planning
COMPARISON: None
TECHNIQUE: OPERATORS: Dr. ___,
performed the procedure.
ANESTHESIA: 1% lidocaine was injected in the skin and subcutaneous tissues
overlying the access site.
MEDICATIONS: 1% lidocaine
CONTRAST: 0 ml of Optiray contrast.
FLUOROSCOPY TIME AND DOSE: 0.1 min, 3 mGy
PROCEDURE:
1. Double lumen PICC placement through the right basilic vein.
PROCEDURE DETAILS: Using sterile technique and local anesthesia, the right
basilic vein was punctured under direct ultrasound guidance using a
micropuncture set. Permanent ultrasound images were obtained before and after
intravenous access, which confirmed vein patency. A peel-away sheath was then
placed over a guidewire. The guidewire was then advanced into the superior
vena cava using fluoroscopic guidance. A double lumen PIC line measuring 50 cm
in length was then placed through the peel-away sheath with its tip positioned
in the cavoatrial junction under fluoroscopic guidance. Position of the
catheter was confirmed by a fluoroscopic spot film of the chest. The peel-away
sheath and guidewire were then removed. The catheter was secured to the skin,
flushed, and a sterile dressing applied.
The patient tolerated the procedure well. There were no immediate
complications.
FINDINGS:
1. The accessed vein was patent and compressible.
2. Basilicvein approach double lumen right PICC with tip in the cavoatrial
junction.
IMPRESSION:
Successful placement of a right 50 cm basilic approach double lumen PowerPICC
with tip in the cavoatrial junction. The line is ready to use.
|
10092227-RR-35 | 10,092,227 | 23,138,040 | RR | 35 | 2158-07-12 10:30:00 | 2158-07-12 12:18:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with right lung collapse on prior CXR//
interval change interval change
IMPRESSION:
In Comparison with study of ___, there again is virtual complete
opacification of the right hemithorax with displacement of the mediastinal
structures to the right. Again this is consistent with significant right lung
collapse.
The left lung remains essentially clear. Interval placement of a central
catheter from the right that extends to about the level of the cavoatrial
junction or upper right atrium.
|
10092227-RR-36 | 10,092,227 | 23,138,040 | RR | 36 | 2158-07-12 12:52:00 | 2158-07-12 13:24:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with sudden hypoxia, afib with RVR// interval
change, new consolidation/collapse interval change, new
consolidation/collapse
IMPRESSION:
In comparison with the earlier study of this date, there is little change.
Again there is almost complete opacification of the right hemithorax
consistent with right lung collapse. Left lung remains clear.
|
10092227-RR-37 | 10,092,227 | 23,138,040 | RR | 37 | 2158-07-12 22:10:00 | 2158-07-12 23:02:00 | EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ year old woman with AMS, somnolence, s/p fall today// r/o
bleed
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 6.4 s, 17.0 cm; CTDIvol = 47.1 mGy (Head) DLP =
802.7 mGy-cm.
Total DLP (Head) = 803 mGy-cm.
COMPARISON: Head CT ___
FINDINGS:
There are chronic infarct involving right occipital lobe, right temporal lobe,
stable since prior. There are moderate chronic small vessel ischemic changes.
There is generalized brain parenchymal atrophy, similar. There is no evidence
of acute infarction,hemorrhage,edema, or mass.
There is no evidence of fracture. The visualized portion of the paranasal
sinuses, mastoid air cells, and middle ear cavities are clear. Stable
bilateral proptosis. No orbital mass. Stable right medial pre antral mass.
IMPRESSION:
There are no acute changes.
There are chronic right hemispheric infarcts.
Remainder as above
|
10092227-RR-38 | 10,092,227 | 23,138,040 | RR | 38 | 2158-07-14 19:08:00 | 2158-07-14 19:27:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old woman with COPD, R lung collapse// interval
progression of R lung collapse
TECHNIQUE: Chest two views
COMPARISON: ___
FINDINGS:
Complete opacification of the right chest, very low change since prior. Small
aerated component of the right lung apex seen on prior is not aerated today.
Tiny left pleural effusion, probably similar. Left lung is clear. Stable
pulmonary vascularity. No edema. Heart size is difficult to assess. No
pneumothorax. Right PICC line tip near cavoatrial junction or in the upper
right atrium, stable.
IMPRESSION:
Very similar exam.
|
10092227-RR-39 | 10,092,227 | 23,138,040 | RR | 39 | 2158-07-15 20:56:00 | 2158-07-16 11:21:00 | EXAMINATION: MRI AND MRA BRAIN AND MRA NECK PT11 MR ___
INDICATION: ___ year old woman with subacute infarcts seen on CT head//
characterize vessels, infarcts
TECHNIQUE: Three dimensional time of flight MR arteriography was performed
through the brain with maximum intensity projection reconstructions.
Time-of-flight MRA of the neck without contrast performed. Dynamic MRA of the
neck was performed during administration of 17 mL of Multihance intravenous
contrast.
Brain imaging was performed with sagittal T1 and axial FLAIR, T2, gradient
echo and diffusion technique.
Three dimensional maximum intensity projection and segmented images were
generated. This report is based on interpretation of all of these images. The
examination was performed using a 1.5T MRI.
COMPARISON: ___ noncontrast head CT
FINDINGS:
MRI BRAIN:
There is no abnormal signal on diffusion-weighted images to suggest acute
infarction. Right temporo-occipital encephalomalacia and FLAIR hyperintense
signal is consistent with a chronic infarct. Additional confluent
periventricular and scattered subcortical and deep white matter foci of FLAIR
hyperintense signal are nonspecific but likely sequelae of chronic
microangiopathy in this age group. There is no mass or mass effect. The
ventricles and sulci are age-appropriate. Principal intracranial vascular
flow voids are preserved. There is no evidence of acute infarct or
hemorrhage.
There is an 18 x 23 mm lobulated T1 hypointense, heterogeneously T2
hyperintense mass in the subcutaneous tissues at the junction of the nose and
upper lip, extending to the skin surface anteriorly and the mucosa the right
nasal cavity medially. Posteriorly, the mass is inseparable from the levator
labii superioris alaeque nasi muscle (9:6, 06:15).
MRA BRAIN:
The images are moderately degraded by motion. The circle of ___ and its
major tributaries are grossly patent however due to extensive motion artifact
evaluation is very limited.
MRA NECK:
The 2D time-of-flight images are degraded by motion artifact. The
postcontrast dynamic sequences are difficult to interpret due to low signal in
the arteries, likely from suboptimal contrast timing and motion artifact,
essentially nondiagnostic.
IMPRESSION:
1. Chronic right temporo-occipital infarct and chronic small vessel ischemic
changes. No evidence of acute or subacute vascular territorial infarction.
2. 18 x 23 mm indeterminate mass at the junction of the nose and right upper
lip as described above, unchanged from the recent CT scan of ___.
3. Moderately motion degraded brain MRI shows grossly patent circle of
___.
4. Nondiagnostic contrast enhanced neck MRA, but appears grossly patent on
moderately motion degraded time-of-flight MRA of the neck.
|
10092227-RR-40 | 10,092,227 | 23,138,040 | RR | 40 | 2158-07-16 16:50:00 | 2158-07-16 18:08:00 | EXAMINATION: CT CHEST W/O CONTRAST
INDICATION: ___ year old woman with right lung collapse, ___ from ATN// assess
for cause of right lung collapse
TECHNIQUE: MD CT axial imaging of the thoracic inlet through the adrenal
glands without intravenous contrast. Sagittal and coronal reformatted images
are provided.
DOSE: Acquisition sequence:
1) Spiral Acquisition 8.6 s, 33.1 cm; CTDIvol = 13.1 mGy (Body) DLP = 413.6
mGy-cm.
2) Spiral Acquisition 3.3 s, 12.5 cm; CTDIvol = 12.8 mGy (Body) DLP = 139.6
mGy-cm.
Total DLP (Body) = 564 mGy-cm.
COMPARISON: Chest radiograph ___. CT neck soft tissues ___.
FINDINGS:
FINDINGS:
NECK, THORACIC INLET, AXILLAE, CHEST WALL: A partially calcified 2.4 cm right
thyroid lobe nodule is again seen.
A right PICC is noted with its tip in the upper right atrium.
There is no axillary lymphadenopathy.
A surgical defect is seen within the soft tissues superficial to the upper-mid
thoracic spine, with surgical clips.
UPPER ABDOMEN: Grossly unremarkable on this noncontrast enhanced study.
MEDIASTINUM: Shifted to the right secondary to right lung collapse.
Multiple nonenlarged right paratracheal lymph nodes are seen.
HILA: No bulky lymphadenopathy.
HEART and PERICARDIUM: No pericardial effusion is identified.
Moderate coronary artery, aortic arch, and descending thoracic aortic calcific
atherosclerosis is seen. Mitral valve calcifications are also noted.
PLEURA: Moderate right pleural effusion. A trace left effusion is noted.
LUNG:
1. PARENCHYMA: Near complete consolidation of the right lung with small
scattered air bronchograms. Presence of an underlying mass cannot be assessed
given the degree of consolidation. Suggestion of 2 cm low-attenuation nodule
in the right lower lobe series 3, image 37. Rounded areas of none
consolidated right lung parenchyma in the right upper lobe, right lower ___,
___ represent aerated normal of lung parenchyma in the absence of clinical
symptoms of pneumonia, in which case cavitating pneumonia could have similar
appearance. There is a 11 mm SI x 7 mm TV nodule within the periphery of the
left upper lobe. Mild atelectasis left lateral costophrenic angle.
2. AIRWAYS: Extensive intraluminal debris and secretions within the lower
right mainstem bronchus with resultant near complete opacification of the
right upper, middle, and lower lobar bronchi. Mild distal air bronchograms
are seen throughout the right lung. There was a left clear.
3. VESSELS: Severe enlargement of the main, right, and left pulmonary
arteries, measuring 4.6 cm, 3.3 cm, and 3.0 cm, respectively. Findings are
consistent with pulmonary hypertension.
CHEST CAGE: No displaced rib or sternal fracture.
Mild degenerative changes are seen within the visualized thoracic spine.
IMPRESSION:
1. Complete collapse of the right lung with rightward mediastinal shift
secondary to volume loss. Extensive intraluminal airway secretions with near
complete distal airway opacification on the right. Suggestion of 2 cm
low-attenuation nodule in the right lower lobe. 2 rounded areas of aerated
lung parenchyma in the right upper lung, or, if there is clinical symptoms of
pneumonia, cavitated pneumonia could have similar appearance. Right hilar or
perihilar Masse cannot be excluded on a noncontrast scan.
2. Probable pulmonary hypertension.
3. Moderate right pleural effusion.
4. Unchanged 11 mm left upper lobe nodule.
5. Nonspecific old surgical skin defect overlying the upper-mid thoracic
spine.
RECOMMENDATION(S): Follow-up of left upper lobe pulmonary nodule should be
based on ___ criteria as reported on prior CT neck soft tissues ___.
|
10092227-RR-41 | 10,092,227 | 23,138,040 | RR | 41 | 2158-07-21 11:21:00 | 2158-07-21 13:26:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old woman with right lung collapse.// Is right lung
collapse improved?
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest radiographs from ___.
FINDINGS:
Compared to ___, there is re-expansion of the right lung with
some residual right pleural effusion and adjacent volume loss at the right
base. The left lung and left PICC line position are unchanged.
IMPRESSION:
Compared to ___, re-expansion of the right lung with some
residual right pleural effusion and adjacent volume loss at the right base.
|
10092227-RR-42 | 10,092,227 | 23,138,040 | RR | 42 | 2158-07-23 09:24:00 | 2158-07-23 10:13:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old woman with right lung collapse.// Please evaluate for
interval change in right lung collapse. Please evaluate for interval
change in right lung collapse.
IMPRESSION:
In comparison with the study of ___, there is little overall change.
Again there is extensive opacification at the right base consistent with
pleural fluid and substantial volume loss in the right lower lobe.
The cardiomediastinal silhouette is unchanged and there again is tortuosity of
the descending aorta. There may be mild elevation of pulmonary venous
pressure.
The tip of the central catheter again extends into the right atrium.
|
10092572-RR-19 | 10,092,572 | 29,709,457 | RR | 19 | 2139-05-24 09:08:00 | 2139-05-24 13:52:00 | INDICATION: ___ with intubation for SAH. Evaluate for ETT placement.
TECHNIQUE: Portable AP chest radiograph.
COMPARISON: None available.
FINDINGS:
The endotracheal tube terminates approximately 4 cm above the carina. The
enteric tube extends into the stomach and out of view with side port of on the
left. The lungs are clear. The pulmonary vasculature is unremarkable. There
is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is
unremarkable. No fracture. There is moderate to severe degenerative disease
of the right AC joint, right glenohumeral joint, and thoracolumbar spine.
IMPRESSION:
1. ETT terminates approximately 4 cm above the carina. The enteric tube
extends into the stomach and out of view with side port on the left.
2. No acute cardiopulmonary process.
|
10092572-RR-20 | 10,092,572 | 29,709,457 | RR | 20 | 2139-05-24 09:24:00 | 2139-05-24 10:27:00 | EXAMINATION: CT ANGIOGRAPHY OF THE HEAD AND NECK
INDICATION: History: ___ with SAH @ OSH. Mental status change. Intubated.
Cr 1.0 today// Aneurysm?
TECHNIQUE: CT of the head was acquired. Following contrast administration and
departmental protocol CT angiography of the head and neck was obtained. 3D
and curved reformatted images were obtained on the independent workstation.
DOSE:
Total DLP (Body) = 450 mGy-cm.
Total DLP (Head) = 1,507 mGy-cm.
COMPARISON: Outside CT of ___.
FINDINGS:
CT head shows subarachnoid hemorrhage along the right temporal convexity,
within the right ambient cistern, underlying the left temporal lobe and at
bilateral frontal convexities, similar to prior. No new foci of hemorrhage. No
midline shift. No large vascular territory infarction. Ventricles are
prominent, size and configuration similar to prior.
CT angiography of the neck shows approximately 70-80% stenosis at the origin
of the left internal carotid artery with calcification. There is
approximately 50% stenosis at the origin of the right internal carotid artery.
There is calcification near the origin of right vertebral artery without
stenosis. The left vertebral artery is patent without stenosis or occlusion.
CT angiography of the head shows mild irregularity in tortuosity of the right
supraclinoid internal carotid artery without discrete aneurysm. Mild
atherosclerotic disease noted in bilateral V4 segments of the vertebral
arteries and the basilar artery. No definite evidence of other vascular
abnormalities of the circle ___ and its principal intracranial branches
such as occlusion, dissection, and aneurysm information.
Large right frontal scalp hematoma noted. Significant amount of aerosolized
secretions are noted in the posterior nasopharynx and pharynx. Partial
visualization of the ET tube and enteric tube. No evidence of fracture.
Paranasal sinuses are clear. Mastoid air cells and middle ear cavities are
clear. Right lens replacement.
IMPRESSION:
1. Subarachnoid hemorrhage and prominent ventricular size unchanged from the
previous outside CT. Some of the ventricular prominence could be related to
atrophy as well as medial temporal atrophy.
2. Approximately 70- 80% stenosis at the origin of the left internal carotid
artery and 50% stenosis at the origin of right internal carotid artery.
3. Mild atherosclerotic disease in the intracranial circulation without
stenosis or occlusion or aneurysm greater than 3 mm in size.
|
10092572-RR-21 | 10,092,572 | 29,709,457 | RR | 21 | 2139-05-24 16:13:00 | 2139-05-24 17:55:00 | EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ year old woman with SAH after fall on Plavix/ASA// repeat Ct
to assess for interval change, complete at 1600 ___
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 9.0 s, 15.3 cm; CTDIvol = 48.8 mGy (Head) DLP =
746.1 mGy-cm.
Total DLP (Head) = 759 mGy-cm.
COMPARISON: CT head the neck ___ at 11:46AM.
FINDINGS:
Again demonstrated is a right perimesencephalic subarachnoid hemorrhage as
well as a right temporal subarachnoid hemorrhage, that appears unchanged from
prior CT/CTA performed 5 hours prior. There is a small amount of
intraventricular hemorrhage in the bilateral occipital horns. Ventricles are
prominent with underlying chronic microvascular ischemic changes in the
surrounding white matter, that is unchanged from prior exam. Bilateral
punctate areas of possible hemorrhagic contusion in the frontal lobes are
unchanged. Small left tentorial subdural hemorrhage is also re-demonstrated
on this exam (image 14, series 3). Soft tissue swelling at the site of the
right frontal scalp hematoma is again noted.
There is no evidence of fracture. The visualized portion of the paranasal
sinuses, mastoid air cells, and middle ear cavities are clear. There is
re-demonstration of right lens replacement as seen on prior CT.
IMPRESSION:
1. Re-demonstration of the right perimesencephalic subarachnoid hemorrhage and
right temporal subarachnoid hemorrhage with small intraventricular hemorrhage
in the bilateral occipital horns.
2. Bilateral punctate areas of hemorrhagic contusion in the frontal lobes that
are unchanged from prior exam.
3. Right frontal scalp hematoma with soft tissue swelling, unchanged from
prior exam. No evidence of fractures.
|
10092572-RR-22 | 10,092,572 | 29,709,457 | RR | 22 | 2139-05-24 13:01:00 | 2139-05-24 16:36:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with fall, tbi, tSAH// intubated, eval ETT and
OGT intubated, eval ETT and OGT
IMPRESSION:
Compared to chest radiographs since ___ most recently ___.
Lungs are fully expanded and clear. Cardiomediastinal and hilar silhouettes
and pleural surfaces are normal. Right skin fold should not be mistaken for
pneumothorax. ET tube in standard placement. Nasogastric tube ends in the
mid stomach.
Although no acute fracture or other chest wall lesion is seen, conventional
chest radiographs are not sufficient for detection or characterization of most
such abnormalities. If the demonstration of trauma to the chest wall is
clinically warranted, the location of any referrable focal findings should
be clearly marked and imaged with either bone detail radiographs or Chest CT
scanning.
|
10092572-RR-23 | 10,092,572 | 29,709,457 | RR | 23 | 2139-05-25 03:12:00 | 2139-05-25 09:59:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with SAH, intubated// Eval for interval change,
position of lines/tubes Eval for interval change, position of lines/tubes
IMPRESSION:
Compared to chest radiographs since ___, most recently ___.
Lungs are clear. Heart size normal. Mediastinal and hilar contours are
unremarkable. No appreciable pleural effusion.
Repeat examination should be performed with care to reduce any skin folds and
ovoid confusion with possible pneumothorax.
ET tube and transesophageal drainage tube in standard placements.
|
10092572-RR-26 | 10,092,572 | 29,709,457 | RR | 26 | 2139-05-25 15:38:00 | 2139-05-25 16:36:00 | INDICATION: ___ year old woman with traumatic SAH s/p fall and noted bruising
to R. hip.// ? injury or fx.
COMPARISON: Radiographs from ___
IMPRESSION:
No acute fractures or dislocations are seen. There is generalized
demineralization. There are mild to moderate degenerative changes of both
hips, worse on the right side.Degenerative changes of the lower lumbar spine
are seen. Numerous surgical clips are seen within the pelvis.
|
10092572-RR-27 | 10,092,572 | 29,709,457 | RR | 27 | 2139-05-27 21:59:00 | 2139-05-27 22:52:00 | INDICATION: ___ year old woman with productive cough// eval for interval
change
TECHNIQUE: AP portable chest radiograph
COMPARISON: ___
FINDINGS:
The endotracheal tube and gastric tube have been removed. Opacities at the
left lung base likely reflect atelectasis and a small pleural effusion.
Superimposed soft tissue densities are also noted over the left mid and lower
lung zone. No pneumothorax is identified. The right lung is grossly clear.
The size and appearance of the cardiac silhouette is unchanged.
IMPRESSION:
Small left pleural effusion with overlying atelectasis. The endotracheal tube
and gastric tube have been removed.
|
10092572-RR-28 | 10,092,572 | 29,709,457 | RR | 28 | 2139-05-29 10:31:00 | 2139-05-29 11:53:00 | EXAMINATION: WRIST(3 + VIEWS) RIGHT
INDICATION: ___ year old woman with fall now with swollen right hand// R/O
Fracture. Please do portable if possible
TECHNIQUE: Three views right wrist
COMPARISON: None available
FINDINGS:
No fracture or dislocation seen. Bones appear mildly demineralized. There
severe degenerative changes at the thumb carpometacarpal joint. No radiopaque
foreign body or soft tissue calcification seen.
IMPRESSION:
No acute bony injury seen.
|
10093120-RR-20 | 10,093,120 | 28,669,551 | RR | 20 | 2119-11-21 10:33:00 | 2119-11-21 11:40:00 | EXAMINATION: Ultrasound-guided paracentesis
INDICATION: ___ year old woman with abdominal discomfort/bloating, CT with
evidence of (new findings) ovarian mass, ascites, partial SBO. Concern for
malignant ascites, seeking diagnostic and therapeutic paracentesis.//
Determine etiology of new ascites, assess for therapeutic benefit of fluid
removal
TECHNIQUE: Ultrasound guided diagnostic and therapeutic paracentesis
COMPARISON: None.
FINDINGS:
Limited grayscale ultrasound imaging of the abdomen demonstrated a large
amount of ascites. A suitable target in the deepest pocket in the right lower
quadrant was selected for paracentesis.
PROCEDURE: The procedure, risks, benefits and alternatives were discussed
with the patient and written informed consent was obtained.
A preprocedure time-out was performed discussing the planned procedure,
confirming the patient's identity with 3 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 5 ___ catheter was advanced into the largest fluid pocket in the right
lower quadrant and 2 L of clear, straw-colored fluid were removed. Fluid
samples were submitted to the laboratory for chemistry, cell count,
differential, culture, and cytology.
The patient tolerated the procedure well without immediate complication.
Estimated blood loss was minimal.
Dr. ___ personally supervised the trainee during the key components of
the procedure and reviewed and agrees with the trainee's findings.
IMPRESSION:
1. Technically successful ultrasound guided diagnostic and therapeutic
paracentesis.
2. 2 L of fluid were removed.
|
10093120-RR-21 | 10,093,120 | 28,669,551 | RR | 21 | 2119-11-21 11:42:00 | 2119-11-21 15:54:00 | EXAMINATION: CT CHEST W/CONTRAST
INDICATION: ___ year old woman with new findings of pelvic masses, peritoneal
carcinomatosis concerning for metastatic ovarian cancer.// Staging exam in
setting of suspected metastatic ovarian cancer (awaiting cytology)
TECHNIQUE: Multi detector helical scanning of the chest was coordinated with
intravenous infusion of nonionic iodinated contrast agent and reconstructed as
5 and 1.25 mm thick axial, 5 mm thick coronal and parasagittal, and 8 mm MIP
axial images. All images were reviewed.
DOSE: Acquisition sequence:
1) Spiral Acquisition 3.9 s, 31.0 cm; CTDIvol = 7.1 mGy (Body) DLP = 221.0
mGy-cm.
Total DLP (Body) = 221 mGy-cm.
COMPARISON: No prior relevant studies available for example.
FINDINGS:
NECK, THORACIC INLET, AXILLAE, CHEST WALL: Thyroid is a with punctate
calcification in the left lobe. There is no supraclavicular and no axillary
lymphadenopathy.
CHEST CAGE: No evidence of osteo destructive lesions at the level of ribs,
sternum or vertebral bodies.
UPPER ABDOMEN: Small quantity of ascites in the upper abdomen largely
unchanged in comparison to yesterday's CT abdomen and pelvis.
MEDIASTINUM: Right and left anterior supradiaphragmatic lymph nodes measure up
to 0.8 cm (4:150, 151). Posterior mediastinum is unremarkable.
HILA: There is no hilar lymphadenopathy.
HEART and PERICARDIUM: Heart is normal in size. Moderate calcifications of
the mitral valve. Moderate to severe calcifications of aortic valve leaflets.
Extensive calcifications of all coronaries. Scattered calcifications along
the normal caliber thoracic aorta. Main pulmonary artery is normal in
diameter.
PLEURA: There is no pleural effusion.
LUNG: Both hemidiaphragms mildly elevated with bibasilar scattered
subsegmental atelectasis. Tracheobronchial tree is patent to the subsegmental
level. No pulmonary nodules identified.
IMPRESSION:
Anterior supradiaphragmatic lymph nodes are subcentimeter, concerning for
possible metastatic involvement, for further follow-up.
|
10093120-RR-22 | 10,093,120 | 28,669,551 | RR | 22 | 2119-11-26 19:48:00 | 2119-11-26 20:47:00 | INDICATION: ___ year old woman with Ovarian Mass// Pulmonary Edema?
TECHNIQUE: AP portable chest radiograph
COMPARISON: CT chest dated ___
FINDINGS:
A feeding tube projects over the stomach. The right hemidiaphragm is elevated
and there is a probable small right pleural effusion and atelectasis. No
pneumothorax. The size of the cardiac silhouette is within normal limits.
IMPRESSION:
No evidence of pulmonary edema. Small right pleural effusion and atelectasis.
|
10093120-RR-24 | 10,093,120 | 28,669,551 | RR | 24 | 2119-11-27 21:47:00 | 2119-11-27 22:43:00 | EXAMINATION: BILAT LOWER EXT VEINS
INDICATION: ___ year old woman with metastatic ovarian cancer, now s/p
TAH/BSO, appendectomy, omenectomy, admitted to FICU for mild hypotension
post-op requiring neo and now with respiratory distress// ? DVT
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the bilateral lower extremity veins.
COMPARISON: None.
FINDINGS:
There is normal compressibility, flow, and augmentation of the bilateral
common femoral, femoral, and popliteal veins. Normal color flow is
demonstrated in the posterior tibial and peroneal veins.
There is normal respiratory variation in the common femoral veins bilaterally.
No evidence of medial popliteal fossa (___) cyst.
Bilateral lower extremity subcutaneous edema is noted.
IMPRESSION:
No evidence of deep venous thrombosis in the right or left lower extremity
veins.
|
10093120-RR-25 | 10,093,120 | 28,669,551 | RR | 25 | 2119-11-28 04:50:00 | 2119-11-28 09:00:00 | EXAMINATION: CHEST (PORTABLE AP) IN O.R.
INDICATION: ___ year old woman with metastatic ovarian cancer likely from
metastatic ovarian cancer, s/p TAH/BSO, appendectomy, omenectomy, admitted to
FICU for mild hypotension post-op requiring neo as well as increased O2
requirement// ?Pneumonia, pulm edema-- cause for increased O2 requirement
?Pneumonia, pulm edema-- cause for increased O2 requirement
IMPRESSION:
Compared to earlier postoperative chest radiograph ___.
Lungs are substantially lower in volume. New opacification at the left lung
base medially, probable pneumonia, could be an explanation for new hypoxia.
No pulmonary edema. No lung abnormality elsewhere. Pleural effusion small if
any. No pneumothorax. Heart size normal. Nasogastric drainage tube ends in
upper portion of a nondistended stomach. Epidural infusion catheter in place.
|
10093120-RR-26 | 10,093,120 | 28,669,551 | RR | 26 | 2119-11-28 10:09:00 | 2119-11-28 10:56:00 | EXAMINATION: CHEST RADIOGRAPH
INDICATION: ___ year old woman with Right PICC// Right PICC 42 cm, ___ ___
Contact name: ___: ___
TECHNIQUE: Chest AP
COMPARISON: Chest radiograph ___ at 05:13
FINDINGS:
Enteric tube terminates underneath the left hemidiaphragm in the expected
location of the stomach. Epidural infusion catheter remains in place. There
has been interval placement of a right PICC terminating near the cavoatrial
junction.
Opacity at the left lung base is unchanged, likely atelectasis. It is
difficult to exclude a small pleural effusion due to low lung volumes and only
an AP view. No pneumothorax. Heart size is normal.
IMPRESSION:
1. Interval placement of a right-sided PICC terminating close to the
cavoatrial junction. A pneumothorax.
2. Unchanged opacity at the left lung base, likely atelectasis.
NOTIFICATION: The findings were discussed with ___, IV nurse by ___,
M.D. on the telephone on ___ at 10:35 am, 2 minutes after discovery of
the findings.
|
10093120-RR-38 | 10,093,120 | 21,033,575 | RR | 38 | 2121-08-08 15:38:00 | 2121-08-08 18:46:00 | EXAMINATION: CT ABD AND PELVIS WITH CONTRAST
INDICATION: NO_PO contrast; History: ___ with locally advanced ovarian
endometrial CA, recent SBO, now p/w recurrent N/V/abd pain unable to keep down
PONO_PO contrast // Evidence of SBO? Or diverticulitis?
TECHNIQUE: Single phase contrast: MDCT axial images were acquired through the
abdomen and pelvis following intravenous contrast administration.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Stationary Acquisition 1.0 s, 0.5 cm; CTDIvol = 4.8 mGy (Body) DLP = 2.4
mGy-cm.
2) Spiral Acquisition 6.3 s, 49.6 cm; CTDIvol = 8.3 mGy (Body) DLP = 410.3
mGy-cm.
Total DLP (Body) = 413 mGy-cm.
COMPARISON: CT abdomen pelvis ___
FINDINGS:
LOWER CHEST: Interval increase in small to moderate left nonhemorrhagic
pleural effusion with convex morphology suggestive of loculation. Interval
decrease in small right nonhemorrhagic pleural effusion. The heart is normal
in size. Tips of 2 venous catheters are seen within the right atrium. No
pericardial effusion.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. A
few subcentimeter hypodensities throughout the liver are too small to
characterize but unchanged since at least ___. There is no evidence
of intrahepatic or extrahepatic biliary dilatation. The gallbladder is
distended without wall thickening, similar to prior.
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. An ovoid hypoattenuating lesion near the splenic
hilum (2:60) is unchanged compared to prior toe but markedly decreased in size
since ___. Perisplenic fluid which indents the capsule appears
unchanged.
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.
1.4 cm simple cyst in the interpolar region of the right kidney (2:30) is
unchanged. There is no evidence of solid renal lesions or hydronephrosis.
There is no perinephric abnormality.
GASTROINTESTINAL: Small bowel loops are diffusely dilated up to 3.4 cm with
transition point in the mid pelvis (601:27). Some short segments of small
bowel loops demonstrate wall thickening (2:51) but otherwise enhance normally
throughout. The colon is largely distended with air, but is decompressed from
the sigmoid colon to the rectum.
Interval increase in small to moderate volume ascites. Peripheral
thickening/rim enhancement may suggest infection or malignancy. Omental
nodularity or fluid is seen in the left upper quadrant (2:60).
PELVIS: Loops of small bowel are likely tethered to the bladder (602:36).
Interval increase in moderate volume pelvic free fluid.
REPRODUCTIVE ORGANS: Status post total abdominal hysterectomy and bilateral
salpingo-oophorectomy.
LYMPH NODES: Few prominent subcentimeter nodes about the mesenteric root are
not pathologically enlarged by CT size criteria but are increased in
conspicuity, and are likely reactive. There is no retroperitoneal or
mesenteric lymphadenopathy. There is no pelvic or inguinal lymphadenopathy.
VASCULAR: The IVC is largely decompressed. There is partially occlusive
thrombus extending from the right common iliac vein to the right femoral vein,
likely present on prior but not well seen. There is no abdominal aortic
aneurysm. Moderate atherosclerotic disease is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
Grade 2 anterolisthesis of L4-5 due to chronic bilateral pars defects is
unchanged. There is severe bilateral hip osteoarthritis.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. Small-bowel obstruction with likely transition point in the lower pelvis.
No definite mass or specific etiology identified.
2. Interval increase in small to moderate volume ascites. Peripheral
thickening/rim enhancement of the ascites, slightly increased in conspicuity,
may be related to the patient's malignancy although infectious peritonitis
cannot be excluded.
3. Thickening of few small loops of small bowel. Unclear if this is related
to infection or patient's underlying malignancy. Ischemia cannot be excluded.
4. Partially occlusive thrombus extending from the right common iliac vein to
the visualize right femoral vein, increased in conspicuity compared to prior.
5. Interval increase in small to moderate nonhemorrhagic left pleural effusion
which is likely loculated.
6. Interval decrease in small nonhemorrhagic right pleural effusion.
|
10093362-RR-14 | 10,093,362 | 25,322,183 | RR | 14 | 2169-12-30 18:46:00 | 2169-12-31 16:06:00 | EXAMINATION: MR HEAD W AND W/O CONTRAST
INDICATION: ___ year old woman with acute onset vertigo, at rest. has had
previous symptoms. // ? demylinating lesion vs stroke
TECHNIQUE: A MRI of the brain was performed with and without contrast.
COMPARISON: No prior examinations of the head are available here
FINDINGS:
There is mildly increased T2/FLAIR signal hyperintensity in the
periventricular white matter as well as additional nonenhancing tiny
nonspecific focus of T2/FLAIR hyperintensity in the subcortical white matter
in the left temporal lobe -subinsular location(series 300b, image 74).
There is no acute infarction, intracranial hemorrhage, extracerebral fluid
collection, midline shift or mass effect. No diffusion abnormalities are
detected. The cerebral volume is appropriate for the patient's stated age.
The major vascular flow voids are maintained. There is a slightly prominent
venous tributary noted in the right cerebellum which is likely developmental.
There is no evidence of abnormal enhancement.
The orbits are unremarkable.
There is minimal mucosal thickening within the paranasal sinuses.
The mastoid air cells are clear.
IMPRESSION:
Mildly increased T2/FLAIR signal hyperintensity in the periventricular white
matter with an additional nonenhancing tiny focus of T2/FLAIR signal
hyperintensity in the subcortical white matter of the left temporal
lobe-subinsular location.
These findings are nonspecific and could be seen with demyelinating disease,
inflammation, etc amongst other and entities.
Clinical correlation and follow up is recommended to assess for interval
change.
No priors.
No acute infarct or mass effect or enhancing lesions.
Other details as above
|
10093425-RR-15 | 10,093,425 | 26,667,861 | RR | 15 | 2162-08-22 18:01:00 | 2162-08-22 18:32:00 | INDICATION: ___ with abnormal EKG // r/o acute process
TECHNIQUE: PA and lateral views the chest.
COMPARISON: ___.
FINDINGS:
Lower lung volumes are seen, but the lungs remain clear. The
cardiomediastinal silhouette is within normal limits. No acute osseous
abnormalities.
IMPRESSION:
No acute cardiopulmonary process.
|
10093425-RR-16 | 10,093,425 | 26,667,861 | RR | 16 | 2162-08-26 08:29:00 | 2162-08-26 11:02:00 | EXAMINATION: ___
Department of Radiology
Study: Carotid Series Complete
Reason: ___ year old male with CAD.
Findings:
Duplex evaluation was performed of bilateral carotid arteries. On the right
there is mild heterogenous plaque in the ICA. On the left there is mild
heterogenous plaque seen in the ICA.
On the right systolic/end diastolic velocities of the ICA proximal, mid and
distal respectively are 70/26, 99/31, and 77/35 cm/sec. CCA peak systolic
velocity is 83 cm/sec. ECA peak systolic velocity is 124 cm/sec. The ICA/CCA
ratio is 1.2 . These findings are consistent with less than 40% stenosis.
On the left systolic/end diastolic velocities of the ICA proximal, mid and
distal respectively 79/25, 57/24, and 54/26 cm/sec. CCA peak systolic velocity
107 cm/sec. ECA peak systolic velocity is 99 cm/sec. The ICA/CCA ratio is 0.70
. These findings are consistent with less than 40% stenosis.
Right antegrade vertebral artery flow.
Left antegrade vertebral artery flow.
Impression:
Right ICA less than 40% stenosis.
Left ICA less than 40% stenosis.
|
10093425-RR-17 | 10,093,425 | 26,667,861 | RR | 17 | 2162-08-26 17:01:00 | 2162-08-26 23:27:00 | EXAMINATION: CHEST PORT. LINE PLACEMENT
INDICATION: ___ year old man s/p CABG // FAST TRACK EARLY EXTUBATION CARDIAC
SURGERY Contact name: ___, Phone: 1
COMPARISON: ___.
IMPRESSION:
As compared to the previous radiograph, the patient has undergone cardiac
surgery. The alignment of the sternal wires is normal. The tip of the
intra-aortic balloon pump projects approximately 2 cm be low the upper most
part of the aortic arch. All other monitoring and support devices are in
correct position. No larger pleural effusions. No pneumothorax. No
cardiomegaly. No pulmonary edema.
|
10093425-RR-18 | 10,093,425 | 26,667,861 | RR | 18 | 2162-08-28 08:00:00 | 2162-08-28 08:59:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man s/p CABG // rval for pneumo
IMPRESSION:
As compared to ___ radiograph, various support and monitoring
devices have been removed with residual right internal jugular catheter in
place and no visible pneumothorax. Cardiomediastinal contours are stable.
Lungs are remarkable for bibasilar patchy atelectasis, improved on the left
and slightly worse on the right.
|
10093425-RR-19 | 10,093,425 | 26,667,861 | RR | 19 | 2162-08-29 12:55:00 | 2162-08-29 13:23:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man s/p CABG with hypotension // eval for
mediastinal widening eval for mediastinal widening
IMPRESSION:
In comparison with study of ___, there are improved lung volumes.
Streaks of atelectasis are seen at the left base, with the right base
essentially clear. No vascular congestion or acute focal pneumonia.
Right IJ catheter again extends to the lower portion of the SVC.
|
10093425-RR-20 | 10,093,425 | 26,667,861 | RR | 20 | 2162-08-31 13:15:00 | 2162-08-31 16:46:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old man s/p CABG // eval for pleural effusions
TECHNIQUE: PA and lateral chest radiograph
COMPARISON: Chest radiograph ___
FINDINGS:
There has been interval removal of the right internal jugular catheter. Lung
volumes are low but unchanged compared to the prior study. There is improved
aeration of the left base. There is a small right pleural effusion with
associated compressive atelectasis. A rectangular opacity at the right lower
lung is likely also due to atelectasis. Continued attention on followup
recommended.
|
10093609-RR-34 | 10,093,609 | 29,765,478 | RR | 34 | 2164-03-05 15:18:00 | 2164-03-05 15:27:00 | EXAMINATION:
Chest: Frontal and lateral views
INDICATION: History: ___ with fever and sob// pna
TECHNIQUE: Chest: Frontal and Lateral
COMPARISON: ___
FINDINGS:
There is a small left pleural effusion with overlying atelectasis. Underlying
left base consolidation is not excluded. Minimal linear atelectasis is seen
at the right costophrenic angle. The cardiac silhouette is mildly enlarged.
Mediastinal contours are grossly unremarkable.
IMPRESSION:
Small left pleural effusion with overlying atelectasis; underlying left base
consolidation is not excluded.
Cardiomegaly.
|
10093609-RR-35 | 10,093,609 | 29,765,478 | RR | 35 | 2164-03-05 17:05:00 | 2164-03-05 18:20:00 | EXAMINATION: CTA chest
INDICATION: History: ___ with elev dimer and chest pain, eval pe// History:
___ with elev dimer and chest pain, eval pe
TECHNIQUE: Axial multidetector CT images were obtained through the thorax
after the uneventful administration of intravenous contrast.
Reformatted coronal, sagittal, thin slice axial images, and oblique maximal
intensity projection images were submitted to PACS and reviewed.
DOSE: Acquisition sequence:
1) Stationary Acquisition 2.0 s, 0.5 cm; CTDIvol = 7.5 mGy (Body) DLP = 3.8
mGy-cm.
2) Spiral Acquisition 3.7 s, 28.6 cm; CTDIvol = 14.3 mGy (Body) DLP = 410.2
mGy-cm.
Total DLP (Body) = 414 mGy-cm.
COMPARISON: None
FINDINGS:
The aorta is normal in course and caliber.
The pulmonary arteries are well opacified to the subsegmental level, with no
evidence of filling defect within the main, right, left, lobar, segmental or
subsegmental pulmonary arteries. The main pulmonary artery is top normal in
caliber, measuring up to 3 cm.
While there is no lymphadenopathy by CT size criteria, there are scattered
supraclavicular and mediastinal lymph nodes, the largest measuring up to 5 mm.
There is no axillary or hilar lymphadenopathy. Patient is status post right
thyroidectomy. There is no abnormal soft tissue density in the surgical bed.
The remaining thyroid gland is homogeneous in attenuation without focal
nodularity.
There is a moderate pericardial effusion. There is evidence of straightening
of the intraventricular septum and mild asymmetric diminished size of the
right atrium with minimal reflux of contrast into the IVC, suggestive of right
heart strain. There are left greater than right bilateral small pleural
effusions.
There is mild bibasilar atelectasis. No suspicious pulmonary nodules that
require follow-up seen. Subtle perihilar ground-glass opacity could relate to
respiratory motion or mild pulmonary edema. The airways are patent to the
subsegmental level.
Limited images of the upper abdomen demonstrate subcentimeter accessory
spleens. Partially imaged spleen appears top normal in size.
No lytic or blastic osseous lesion suspicious for malignancy is identified.
There is a large anterior osteophyte at the mid thoracic spine.
IMPRESSION:
-Moderate pericardial effusion with straightening of the interventricular
septum raising concern for underlying right heart strain which could be
further assessed for on echocardiogram. Tamponade physiology is difficult to
evaluate on current modality. Further evaluation with echocardiogram and or
consultation with interventional cardiology is recommended for
pericardiocentesis.
-Small bilateral pleural effusions, left greater than right. Subtle perihilar
ground-glass opacities could relate to respiratory motion versus mild
pulmonary edema.
-No evidence of pulmonary embolism.
NOTIFICATION: The findings were discussed with ___, M.D. by ___,
M.D. on the telephone on ___ at 6:13 pm, 2 minutes after discovery of the
findings.
|
10093609-RR-36 | 10,093,609 | 29,765,478 | RR | 36 | 2164-03-07 09:09:00 | 2164-03-07 09:59:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with pericardial, pleural effusion// ? PNA,
worsening effusion ? PNA, worsening effusion
IMPRESSION:
Compared to chest radiographs since ___ most recently ___.
Moderate left pleural effusion and moderately severe left lower lobe
atelectasis have worsened since ___. Pneumonia left lower lobe would be
difficult to exclude under the circumstances. No change in diameter of the
top-normal cardiac silhouette or distension of mediastinal veins to suggest
either cardiac tamponade or substantial increase in pericardial effusion.
Right lung and left upper lung are clear. No appreciable right pleural
effusion. No pulmonary vascular abnormality.
|
10093718-RR-28 | 10,093,718 | 21,604,509 | RR | 28 | 2193-10-06 21:54:00 | 2193-10-06 22:15:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ with post-intubation// ett
COMPARISON: Prior exam is dated ___
FINDINGS:
AP portable supine view of the chest. An endotracheal tube is seen with its
tip located 3.8 cm above the carina. An NG tube courses into the left upper
abdomen, tip outside of field of view. Lung volumes are low. No large
consolidation, effusion or pneumothorax seen. Cardiomediastinal silhouette
appears grossly unremarkable allowing for supine portable technique. No acute
osseous abnormality seen.
IMPRESSION:
As above.
|
10093718-RR-29 | 10,093,718 | 21,604,509 | RR | 29 | 2193-10-07 02:39:00 | 2193-10-07 03:26:00 | EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ year old man with new AMS and clonus.
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast. Coronal and sagittal reformations as well as bone algorithm
reconstructions were provided and reviewed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 18.0 s, 18.0 cm; CTDIvol = 50.2 mGy (Head) DLP =
903.1 mGy-cm.
Total DLP (Head) = 903 mGy-cm.
COMPARISON: ___ noncontrast head CT
FINDINGS:
There is no evidence of acute large territory infarct,hemorrhage,edema,or mass
effect. The ventricles and sulci are normal in size and configuration.
There is apparent mild diffuse cutaneous thickening and subcutaneous fat
stranding. No evidence of acute fracture. Surgical hardware for prior
anterior maxillary wall, orbital floor, and lateral orbital wall fractures is
seen. There is extensive mucosal thickening, somewhat polypoid, in the
bilateral maxillary sinuses, ethmoid air cells, and frontoethmoidal recess.
Fluid and aerosolized secretions are seen within the posterior nasopharynx and
oropharynx, not unexpected in the setting of intubation and nasoenteric
catheter placement.
IMPRESSION:
1. No evidence of an acute intracranial abnormality on noncontrast head CT.
2. Apparent mild diffuse cutaneous thickening and subcutaneous fat stranding
of uncertain etiology.
3. Paranasal sinus disease.
|
10093718-RR-30 | 10,093,718 | 21,604,509 | RR | 30 | 2193-10-08 05:29:00 | 2193-10-08 07:13:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with extensive psychiatric history and drug abuse
who presented with SI and tox screen positive for cocaine who became
progressively altered in the ED and developed sustained clonus and ocular
clonus, was intubated in the ED for airway protection and is admitted w/
concern for serotonin syndrome// ?PNA
IMPRESSION:
In comparison with the study ___, the monitoring and support devices
are unchanged. Cardiomediastinal silhouette is stable and there is no
evidence of acute focal pneumonia or appreciable vascular congestion.
|
10093718-RR-31 | 10,093,718 | 21,604,509 | RR | 31 | 2193-10-09 04:14:00 | 2193-10-09 09:38:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with serotonin syndrome// Eval for interval
change Eval for interval change
IMPRESSION:
Heart size and mediastinum are stable. ET tube tip is 5 cm above the carina.
NG tube passes below the diaphragm terminating in the stomach. Heart size and
mediastinum are stable. Large bilateral pleural effusions are present.
|
10093718-RR-32 | 10,093,718 | 21,604,509 | RR | 32 | 2193-10-11 03:54:00 | 2193-10-11 10:42:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with intubation, fever// Tube placement,
pneumonia
IMPRESSION:
In comparison with the study ___, the monitoring and support devices
appear stable, as does the cardiomediastinal silhouette. Continued bilateral
layering pleural effusions with compressive atelectasis at the bases and
elevation of pulmonary venous pressure.
Given the extensive changes described above, would be extremely difficult to
exclude superimposed pneumonia in the appropriate clinical setting, especially
in the absence of a lateral view.
|
10093718-RR-33 | 10,093,718 | 21,604,509 | RR | 33 | 2193-10-11 11:48:00 | 2193-10-11 15:02:00 | INDICATION: ___ year old man with vomiting and diarrhea worsening O2
requirment// Evidence of ileus or obstruction
TECHNIQUE: Portable supine abdominal radiograph was obtained.
COMPARISON: None.
FINDINGS:
An enteric tube terminates at the stomach. There are no abnormally dilated
loops of large or small bowel. There is a paucity of gas in the small bowel.
Gas is seen throughout the large bowel.
There is no free intraperitoneal air.
Osseous structures are notable for mild dextroscoliosis of the spine.
There are no unexplained soft tissue calcifications or radiopaque foreign
bodies.
IMPRESSION:
No radiographic evidence of obstruction or ileus.
|
10093718-RR-34 | 10,093,718 | 21,604,509 | RR | 34 | 2193-10-11 10:57:00 | 2193-10-11 14:06:00 | EXAMINATION: UNILAT UP EXT VEINS US
INDICATION: ___ year old man with serotonin syndrome now with LUE swelling//
?DVT
TECHNIQUE: Grey scale and Doppler evaluation was performed on the left upper
extremity veins.
COMPARISON: None.
FINDINGS:
There is normal flow with respiratory variation in the subclavian veins
bilaterally.
The left internal jugular and axillary veins are patent, show normal color
flow and compressibility. Nonocclusive thrombus is seen within the left
brachial veins and within the left basilic veins. These veins demonstrate
slow flow however nonocclusive thrombus is seen within the lumen of these
veins and the do not entirely compress. No thrombus is visualized in the left
cephalic vein.
IMPRESSION:
Deep vein thrombosis which is nonocclusive is visualized in the two left
brachial veins and also within the left basilic vein.
NOTIFICATION: Findings of left arm nonocclusive DVT were discovered at 13:45
on ___ and were conveyed by telephone by ___ to Dr. ___
___ at 14:04 on the same day.
|
10093718-RR-35 | 10,093,718 | 21,604,509 | RR | 35 | 2193-10-11 11:48:00 | 2193-10-11 13:56:00 | EXAMINATION: CHEST PORT. LINE PLACEMENT
INDICATION: ___ year old man with new R IJ// Placement of R IJ position and
complications Contact name: ___: ___
COMPARISON: Prior chest radiographs ___ through ___
FINDINGS:
Portable upright AP view of the chest provided.
There has been interval placement of a right internal jugular line which
terminates at the mid SVC. ET tube terminates 7.2 cm above the level of
carina. An NG tube has its side port in the stomach but terminates beyond the
field of view of the image. Bilateral pleural effusions are not significantly
changed in size. There is stable bibasilar atelectasis. No pneumothorax.
Cardiomediastinal silhouette is stable.
IMPRESSION:
Right IJ line terminates at the mid SVC. No evidence of pneumothorax.
|
10093718-RR-36 | 10,093,718 | 21,604,509 | RR | 36 | 2193-10-13 00:55:00 | 2193-10-13 02:51:00 | EXAMINATION: MR HEAD W AND W/O CONTRAST T9112 MR HEAD.
INDICATION: ___ year old man with clonus and AMS. Evidence of hemorrhage or
CNS.
TECHNIQUE: Sagittal and axial T1 weighted imaging were performed. After
administration of 8 mL of Gadavist intravenous contrast, axial imaging was
performed with gradient echo, FLAIR, diffusion, and T1 technique. Sagittal
MPRAGE imaging was performed and re-formatted in axial and coronal
orientations.
COMPARISON: CT head ___.
FINDINGS:
There is no evidence of territorial infarction or hemorrhage. There is no
mass or abnormal enhancement. The ventricles are normal in size without mass
effect or midline shift. The major visualized arterial vascular flow voids
are preserved the dural venous sinuses appear patent on the postcontrast
images.
There is moderate paranasal sinus disease with mucosal thickening of bilateral
frontal, ethmoid, maxillary, and sphenoid sinuses. There is a right maxillary
sinus mucosal retention cyst. There is fluid within the nasopharynx, probably
related to intubation and enteric tube placement. There is moderate
nonspecific fluid opacification of the bilateral mastoid air cells, left
greater than right. The orbits appear unremarkable.
IMPRESSION:
1. No evidence of infarction, hemorrhage, enhancing mass or abnormal
enhancement.
2. Moderate paranasal sinus disease as above, with nonspecific fluid
opacification of the bilateral mastoid air cells.
|
10093718-RR-37 | 10,093,718 | 21,604,509 | RR | 37 | 2193-10-12 04:30:00 | 2193-10-12 11:46:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man pw serotonin syndrome now intubated/sedated// ___
yoM pw serotonin syndrome now intubated/sedated w/fevers. Interval change and
ET placement? ___ yoM pw serotonin syndrome now intubated/sedated w/fevers.
Interval change and ET placement?
IMPRESSION:
Right internal jugular line tip is at the level of mid SVC. NG tube passes
below the diaphragm terminating in the stomach. Heart size and mediastinum
are stable but there is interval increase in bilateral pleural effusions and
progression of pulmonary edema currently moderate to severe. No pneumothorax.
|
10093718-RR-39 | 10,093,718 | 21,604,509 | RR | 39 | 2193-10-13 15:07:00 | 2193-10-13 16:57:00 | EXAMINATION: Chest radiographs
INDICATION: ___ year old man with dobhoff placement under protocol.
TECHNIQUE: Frontal views
COMPARISON: Chest radiographs between ___ and ___
FINDINGS:
Initial images reveal 2 enteric catheters coursing below the diaphragm. Final
image reveals an enteric catheter courses below the diaphragm with its side
port projecting over the proximal gastric body. A right IJ central venous
catheter tip projects over the lower SVC. An endotracheal tube tip projects
3.2 cm superior to the carina.
Low lung volumes resulting crowding of the bronchovascular structures and
accentuation of heart size. Probable mild bibasilar atelectasis. Compared to
1 day prior, pulmonary edema has improved, now mild. No new focal
consolidation. Pleural effusions are trace if any. No pneumothorax. Mild
cardiomegaly is unchanged.
IMPRESSION:
1. An enteric catheter side port projects over the proximal gastric body in
the final radiograph.
2. Improved pulmonary edema, now mild.
|
10093718-RR-40 | 10,093,718 | 21,604,509 | RR | 40 | 2193-10-15 11:53:00 | 2193-10-15 15:41:00 | EXAMINATION: Chest radiograph
INDICATION: ___ year old man with new R PICC.
TECHNIQUE: Frontal view
COMPARISON: Chest radiographs between ___ and ___
FINDINGS:
A new right-sided PICC tip projects over the proximal right atrium, probably
but 4.5 cm inferior to the expected location of the superior cavoatrial
junction. A right IJ central venous catheter is unchanged in position with
its tip projecting over the lower SVC. No pneumothorax or pleural effusion.
Bilateral perihilar opacities are minimally changed compared to 1 day prior.
No new focal consolidation. Heart size is moderately enlarged. The
mediastinal silhouette is otherwise unremarkable.
IMPRESSION:
A new right-sided PICC tip projects over the proximal right atrium, probably
about 4.5 cm inferior to the expected location of the superior cavoatrial
junction.
NOTIFICATION: The findings were discussed with ___, R.N. by ___
___, M.D. on the telephone on ___ at 15:40, approximately 60 minutes
after discovery of the findings.
|
10094132-RR-20 | 10,094,132 | 27,883,799 | RR | 20 | 2192-09-01 03:33:00 | 2192-09-01 05:31:00 | INDICATION: Right lower quadrant pain.
COMPARISON: MR available from ___ and ultrasound from ___.
TECHNIQUE: Transabdominal and transvaginal ultrasonography of the pelvis were
performed, the latter to better assess the uterus and adnexa.
LMP: ___.
FINDINGS: The uterus is enlarged, measuring 12.3 x 7.7 x 10.8 cm, dominated
by a left lateral fibroid measuring up to 8.8 x 5.4 x 9.8 cm. No free fluid
is detected. The right ovary is normal. The left ovary was equivocally seen,
possibly lying superiorly to the left fibroid as seen on the ___ pelvic MR
examination. The right ovary appears normal but vascular waveforms could not
be reliably obtained due to positioning difficulty.
IMPRESSION:
1. Markedly enlarged bulky fibroid uterus.
2. Normal right ovary.
3. Left ovary equivocally seen.
|
10094132-RR-21 | 10,094,132 | 27,883,799 | RR | 21 | 2192-09-01 05:44:00 | 2192-09-01 07:26:00 | INDICATION: Right lower quadrant pain.
COMPARISON: Ultrasound available from ___. Pelvic MRI available
from ___.
TECHNIQUE: MDCT-acquired 5-mm axial images of the abdomen and pelvis were
obtained following the uneventful administration of 130 cc of Omnipaque
intravenous contrast. Coronal and sagittal reformations were performed at
5-mm slice thickness.
DLP: 856 mGy-cm
CT OF THE ABDOMEN WITH IV CONTRAST:
Included views of the lung bases demonstrate dependent atelectasis. Calcified
granulomas are seen at the right base (2:1).
Cholelithiasis is present (2:25). There is a mild hepatic perfusion anomaly
within segment ___ (2:16). The pancreas, spleen, adrenal glands, stomach, and
intra-abdominal loops of small and large bowel are normal. A
well-circumscribed subcentimeter hypodensity at the lower pole of the left
kidney is statistically likely a cyst, but too small for further
characterization (2:50). There is no mesenteric or retroperitoneal
lymphadenopathy, and no free air or free fluid.
A 6.7 (CC) x 1.0 (AP) x 12.3 (transverse) cm complex fluid collection overlies
the rectus muscles (2:73) at the anterior midline. No neighboring fat
stranding is present. There is mild rim enhancement around this collection,
which appears unchanged in size since the ___ examination,
likely represents a chronic seroma or hematoma.
CT OF THE PELVIS WITH IV CONTRAST:
A large fibroid uterus is similar in appearance to the MR pelvic examination
from ___. Two dominant fibroids arise from the left aspect of
the mid uterus (2:70, 10.1 x 6.5 cm) and lower segment (2:83, 9.6 x 8.4 cm).
The ovaries are normal in size (601B:26, 21). The bladder is collapsed and
displaced anteriorly and inferiorly by the lower fibroid (___). The
rectum is normal.
Intrapelvic loops of small and large bowel are within normal limits. The
appendix is normal (601B:30).
There is no intrapelvic lymphadenopathy or free fluid.
OSSEOUS STRUCTURES: There is no acute fracture. There are no bony lesions
concerning for malignancy or infection.
IMPRESSION:
1. 1-cm-thick loculated complex fluid collection overlying the rectus
muscles, demonstrating mild rim enhancement, unchanged in size since ___, likely representing chronic seroma or hematoma.
2. Normal appendix.
3. Large fibroid uterus is similar in appearance to the ___ MR
examination. The ovaries appear grossly normal.
|
10094132-RR-22 | 10,094,132 | 27,883,799 | RR | 22 | 2192-09-02 08:46:00 | 2192-09-02 10:11:00 | HISTORY: ___ female with abdominal pain. Assess for cholecystitis.
COMPARISON: CT abdomen and pelvis from ___.
RIGHT UPPER QUADRANT ULTRASOUND: The liver is homogeneous in echogenicity
without suspicious focal lesion. The main portal vein is patent with
hepatopetal flow. There is a large 1.2 cm stone within the gallbladder neck.
However, the gallbladder is nondistended and demonstrates no wall thickening
or pericholecystic fluid. The patient was nontender on examination. No
intra- or extra-hepatic biliary ductal dilatation is identified. The common
bile duct measures 4 mm. Limited views of both kidneys demonstrate no
hydronephrosis. The pancreatic head, neck and body appear normal. Evaluation
of the tail is limited by overlying bowel gas.
IMPRESSION: Cholelithiasis without evidence of acute cholecystitis
|
10094476-RR-39 | 10,094,476 | 21,993,712 | RR | 39 | 2120-04-25 15:12:00 | 2120-04-25 15:49:00 | EXAMINATION: KNEE (AP, LAT AND OBLIQUE) RIGHT
INDICATION: ___ with with severe right leg pain// ?fracture ?DVT
TECHNIQUE: AP and lateral views of the right knee.
COMPARISON: Radiograph ___
FINDINGS:
The patient is status post total right knee arthroplasty. There is no
evidence of hardware migration or periprosthetic fracture. Appearance of the
knee joint appears stable from ___.
There is mild osteopenia about the knee joint. No worrisome lytic or
sclerotic lesions. No significant soft tissue swelling.
IMPRESSION:
No evidence of hardware complication, fracture or dislocation.
|
10094476-RR-40 | 10,094,476 | 21,993,712 | RR | 40 | 2120-04-25 15:14:00 | 2120-04-25 15:41:00 | EXAMINATION: HIP (UNILAT 2 VIEW) W/PELVIS (1 VIEW) RIGHT
INDICATION: ?fracture ?DVT
TECHNIQUE: Three views of the pelvis and right hip
COMPARISON: CT pelvis ___, radiograph ___ and
multiple priors
FINDINGS:
The patient is status post ORIF of a left femoral neck fracture, without
evidence of screw migration or loosening in comparison to ___.
The positioning of a partially imaged intramedullary femoral stem appears in
unchanged position to ___. No evidence of adjacent fracture or
loosening.
There is moderate joint space narrowing and bony spurring at the hip joints,
bilaterally.
There is disc space narrowing and osteophytosis in the visualized lumbar
spine.
No acute fracture or dislocation. Chronic deformities of the right superior
and inferior pubic rami are again noted. No worrisome lytic or sclerotic
lesion.
IMPRESSION:
Stable appearance of bilateral femoral hardware. No evidence of fracture or
dislocation. Moderate degenerative change at the hip joints, bilaterally.
|
10094476-RR-41 | 10,094,476 | 21,993,712 | RR | 41 | 2120-04-25 15:28:00 | 2120-04-25 15:50:00 | EXAMINATION: UNILAT LOWER EXT VEINS RIGHT
INDICATION: ___ with with severe right leg pain// ?fracture ?DVT
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the right lower extremity veins.
COMPARISON: Ultrasound ___
FINDINGS:
There is normal compressibility, flow, and augmentation of the right common
femoral, femoral, and popliteal veins. Normal color flow and compressibility
are demonstrated in the posterior tibial and peroneal veins.
There is normal respiratory variation in the common femoral veins bilaterally.
No evidence of medial popliteal fossa (___) cyst.
IMPRESSION:
No evidence of deep venous thrombosis in the right lower extremity veins.
|
10094582-RR-4 | 10,094,582 | 29,660,954 | RR | 4 | 2126-11-24 14:46:00 | 2126-11-24 18:40:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ with seizure, s/p fall with head injury
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Total DLP (Head) = 803 mGy-cm.
COMPARISON: None.
FINDINGS:
Streak artifact limits evaluation. There is no evidence of large territorial
infarction, hemorrhage, edema, or mass effect. The ventricles and sulci are
normal in size and configuration.
There is no evidence of fracture. The visualized portion of the paranasal
sinuses, mastoid air cells, and middle ear cavities are clear. The visualized
portion of the orbits are unremarkable.
IMPRESSION:
No acute intracranial abnormality.
|
10094582-RR-5 | 10,094,582 | 29,660,954 | RR | 5 | 2126-11-24 14:47:00 | 2126-11-24 18:45:00 | EXAMINATION: CT C-SPINE W/O CONTRAST
INDICATION: ___ with seizure, s/p fall with head injury // eval for trauma
TECHNIQUE: Non-contrast helical multidetector CT was performed. Soft tissue
and bone algorithm images were generated. Coronal and sagittal reformations
were then constructed.
DOSE: Total DLP (Body) = 888 mGy-cm.
COMPARISON: None.
FINDINGS:
Alignment is normal. No fractures are identified. There is no evidence of
spinal canal or neural foraminal stenosis. There is no prevertebral soft
tissue swelling. There is no evidence of infection or neoplasm.
The imaged thyroid and lung apices are normal.
IMPRESSION:
No acute fracture.
|
10094582-RR-6 | 10,094,582 | 29,660,954 | RR | 6 | 2126-11-24 15:14:00 | 2126-11-24 16:05:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: History: ___ with seizure. r/o infection // ?pneumonia
TECHNIQUE: Single frontal view of the chest
COMPARISON: None
FINDINGS:
No focal consolidation is seen. There is no pleural effusion or pneumothorax.
The cardiac silhouette is top-normal to mildly enlarged. Mediastinal contours
unremarkable. No pulmonary edema is seen.
IMPRESSION:
Top-normal to mildly enlarged cardiac silhouette without pulmonary edema. No
definite focal consolidation.
|
10094629-RR-74 | 10,094,629 | 28,659,097 | RR | 74 | 2196-12-06 16:30:00 | 2196-12-06 17:56:00 | INDICATION: Facial swelling status post fall.
COMPARISON: CT from ___
TECHNIQUE: ___-acquired 1.25-mm axial images of the facial bones were
obtained without the use of IV contrast. Coronal and sagittal reformations
were performed at 1-mm slice thickness.
FINDINGS: There is a minimally displaced fracture of the right orbital floor
(2:64, 400B:63). Fractures of the frontal, posterior, and medial walls of the
right maxillary sinus are present (2:65), with associated mixture of air and
blood products within the sinus cavity.
The lamina papyracea appear intact. Nondisplaced comminuted fracture of the
zygoma (2:45) extends along the lateral orbital wall (2:53), with a subjacent
small hematoma causing mild mass effect against the lateral rectus muscle.
Mild stranding is seen along the superior aspect of the intraconal fat (3:42).
Hyperdense products are seen within the right globe (3:53), concerning for
globe rupture and or vitreous hemorrhage. No acutely embedded bony fragments
or foreign bodies are seen. Mild right proptosis is present. A previously seen
surgical prosthesis (3:44) appears rotated laterally in comparison to the
prior CT from ___. A hyperdense focus anterior to the right globe
(3:47) is unchanged in position and may be postsurgical or a chronic foreign
body.
The right orbital wall fracture extends down to the lateralmost aspect of the
maxilla (2:80), but does not extend into the body or hard palate. The
mandible is intact.
The pterygoid plates are intact.
The mastoid air cells and middle ear cavities are clear. There is no evidence
of temporal bone fracture.
The nasal bones and septum are intact.
Extensive soft tissue swelling and subgaleal hematomas are seen along the
preseptal regions.
Included views of the upper cervical spine are within normal limits, with no
evidence of fracture.
IMPRESSION:
1. Acute right orbital floor fracture, with right globe proptosis, and likely
anterior globe disruption with vitreous hemorrhage. A surgical implant has
been rotated laterally.
2. Rightzygoma and lateral orbital wall fracture with subjacent hematoma
resulting in mass effect of the right lateral rectus muscle. Mild stranding
at the superior intraconal fat may represent early extension of hemorrhage.
3. Minimally displaced fractures of the anterior, posterior and medial right
maxillary sinus walls with blood and air products within the cavity.
4. Extension of fracture to right lateral aspect of the upper maxilla,
without extension into the body or hard palate.
5. Intact mandible.
6. No temporal bone fracture. Intact pterygoid plates.
|
10094629-RR-75 | 10,094,629 | 28,659,097 | RR | 75 | 2196-12-06 17:06:00 | 2196-12-06 18:18:00 | INDICATION: Fall.
COMPARISON: Facial bone CT available from ___.
TECHNIQUE: MDCT-acquired 5-mm axial images of the head were obtained without
the use of IV contrast. 2.5-mm bone reconstructions and additional 2-mm
coronal and sagittal reformations were obtained.
FINDINGS:
Multiple facial bone fractures and a disrupted right globe with vitreous
hemorrhage are described in detail on the facial bone CT examination performed
earlier today.
There is no evidence for acute intracranial hemorrhage, edema, mass, mass
effect, or large vascular territorial infarction. Basal ganglia
calcifications are present (2:14). There is mild prominence of the ventricles
and sulci, compatible with diffuse cortical atrophy. There is no shift of the
normally midline structures. The gray-white matter differentiation remains
preserved.
Severe atherosclerotic calcifications are present within the cavernous
portions of the internal carotid arteries (3:18). Hyperostosis frontal
interna is present.
Blood products within the right maxillary sinus and extensive soft tissue
swelling and subgaleal hematoma overlying the right calvarium and right
preseptal regions are again seen.
IMPRESSION:
1. Multiple right facial bone fractures and acute right orbit findings;
please refer to the facial bone report from earlier today for details.
2. No acute intracranial process.
|
10094629-RR-79 | 10,094,629 | 20,062,606 | RR | 79 | 2199-05-14 14:32:00 | 2199-05-14 15:21:00 | HISTORY: History of left ischemic stroke presents with altered mental status
gait instability. Assess for subdural hematoma or acute change.
COMPARISON: Non contrast head CT ___.
TECHNIQUE: Axial helical MDCT images were obtained without IV contrast.
Reformatted coronal, sagittal and thin section bone algorithm reconstructed
images were acquired.
DLP: 891.93 mGy-cm
FINDINGS:
There is no evidence of hemorrhage, edema, mass effect, shift of midline
structures, or acute infarction. Mild prominence of the ventricles and sulci
are consistent with age related cortical volume loss. Periventricular,
subcortical, and deep white matter hypodensities are likely sequela of chronic
small-vessel ischemic disease. The basal cisterns are patent and there is
preservation of gray-white matter differentiation. Basal gangliar
calcifications are again noted.
Severe atherosclerotic calcifications are present in the cavernous portions of
the internal carotid arteries. A well corticated linear line is seen
traversing the anterior wall of the right maxillary sinus may be from healed
fracture (3:1). No additional fracture identified. No extra-axial fluid
collection. Bisualized paranasal sinuses, mastoid air cells and middle ear
cavities are clear. Hyperostosis frontalis interna is present. Under
pneumatization of the frontal sinuses again noted. The replaced lens of the
right globe appears minimally displaced. Right glaucoma drainage implant is
noted.
IMPRESSION:
1. Chronic changes as described above. No evidence of subdural hematoma or
acute infarction.
2. Minimally displaced replaced right lens, unchanged since ___.
Clinical correlation is recommended.
|
10094629-RR-80 | 10,094,629 | 20,062,606 | RR | 80 | 2199-05-14 17:54:00 | 2199-05-14 18:39:00 | CHEST RADIOGRAPH
HISTORY: Delirium.
COMPARISONS: ___.
TECHNIQUE: Chest, portable AP upright.
FINDINGS: The cardiac, mediastinal and hilar contours appear unchanged
including mild cardiomegaly and calcification along the aortic arch. The
central pulmonary vascularity shows upper zone redistribution with distinct
but prominent vessels, similar to prior findings, suggesting pulmonary venous
hypertension without congestive heart failure. A small hyperdense nodule
projecting over the right mid lung is unchanged and suggests a granuloma.
There is similar mild relative elevation of the right hemidiaphragm. There is
no pleural effusion or pneumothorax. The patient is status post right
shoulder hemiarthroplasty. Flattening and sclerosis have progressed along the
left humeral head with corresponding effacement of the glenoid appears worse;
findings could be seen with a history of avascular necrosis in the appropriate
setting.
IMPRESSION: No evidence of acute cardiopulmonary disease. Increased
flattening of the left humeral head, although likely a chronic process,
possibly avascular necrosis.
|
10094902-RR-17 | 10,094,902 | 22,639,837 | RR | 17 | 2136-06-14 03:38:00 | 2136-06-14 05:57:00 | EXAMINATION: Abdomen and pelvic CT.
INDICATION: ___ year old woman with Right sided upper and lower quadrant pain.
No CMT. CVA tenderness present // eval for abscess or other abnormality
TECHNIQUE: MDCT axial images were acquired through the abdomen and pelvis
following intravenous contrast administration with split bolus technique.
Coronal and sagittal reformations were performed and reviewed on PACS.
Oral contrast was administered.
DOSE: DLP: 270 mGy-cm (abdomen and pelvis).
IV Contrast: 100 mL Omnipaque
COMPARISON: Pelvic ultrasound from ___.
FINDINGS:
LOWER CHEST: There is minimal bibasilar atelectasis. There is no pleural
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,
without stones or gallbladder wall thickening.
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 stones, focal renal lesions, or hydronephrosis. There
are no urothelial lesions in the kidneys or ureters. There is no perinephric
abnormality.
GASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness
and enhancement throughout. Colon and rectum are within normal limits.
Appendix contains air, has normal caliber without evidence of fat stranding.
There is no evidence of mesenteric lymphadenopathy.
RETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. There is no calcium burden in
the abdominal aorta and great abdominal arteries.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
evidence of pelvic or inguinal lymphadenopathy. There is no free fluid in the
pelvis.
REPRODUCTIVE ORGANS: There is redemonstration of a right ovarian cyst,
measuring up to 2.5 cm, as seen on prior pelvic ultrasound. Tubular
hypodensities seen in the pelvis bilaterally may suggest dilated fallopian
tubes (series 2, image 63). An IUD appears in adequate position within the
endometrium.
BONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions.
Abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. Bilateral tubular hypodensities in the pelvis may suggest dilated fallopian
tubes which may indicate salpingitis. Clinical correlation advised.
2. Non visualized appendix however no evidence of acute appendicitis.
NOTIFICATION: Preliminary findings were discussed by Dr. ___ with
Dr. ___ on the telephone on ___ at 5:55 AM, 10 minutes after discovery
of the findings. Final findings discussed with Dr. ___ by NSR in person
on ___ at 09:30.
|
10094902-RR-18 | 10,094,902 | 22,639,837 | RR | 18 | 2136-06-15 13:57:00 | 2136-06-15 17:23:00 | EXAMINATION: PELVIS, NON-OBSTETRIC
INDICATION: ___ year old woman with RLQ pain, ? PID, ___ // evaluate for ___
TECHNIQUE: Grayscale ultrasound images of the pelvis were obtained with
transabdominal approach followed by transvaginal approach for further
delineation of uterine and ovarian anatomy.
COMPARISON: CT abdomen pelvis ___, pelvic ultrasound ___.
FINDINGS:
The uterus is anteverted and measures 7.9 x 3.6 x 4.6 cm. The endometrium is
homogenous and measures 3 mm, best visualized on transvaginal approach.
Right ovarian cyst measuring 2.6 x 2.2 x 2.2 cm.
Smaller cystic structure posterior to the cyst on the right, which may
represent dilated tube/mild hydrosalpinx vs para-ovarian cyst. No internal
echoes or other complicating features. No evidence of torsion.
The left ovary are normal. There is no free fluid.
IMPRESSION:
1. Right ovarian cyst measuring 2.6 x 2.2 x 2.2 cm.
2. Smaller cystic structure posterior to the cyst on the right, which may
represent dilated tube/mild hydrosalpinx vs para-ovarian cyst. No internal
echoes or other complicating features. No evidence of torsion.
|
10094902-RR-19 | 10,094,902 | 22,639,837 | RR | 19 | 2136-06-17 15:28:00 | 2136-06-17 17:47:00 | EXAMINATION: ABDOMEN US (COMPLETE STUDY)
INDICATION: ___ year old woman with persistent RUQ pain following abx
treatment for PID, evaluate for perihepatic inflammation, nephrolithiasis,
please evaluate liver and kidney.
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: Recent CT of the abdomen and pelvis dated ___.
FINDINGS:
LIVER: The hepatic parenchyma appears within normal limits. The contour of the
liver is smooth. An 8 x 8 x 8 mm echogenic focus in the left lobe of the
liver is incompletely characterized and corresponds to a hypodensity seen on
recent CT of the abdomen and pelvis and most likely represents a hemangioma.
The main portal vein is patent with hepatopetal flow. There is no ascites.
BILE DUCTS: There is no intrahepatic biliary dilation. The CBD measures 2 mm.
GALLBLADDER: There is no evidence of stones or gallbladder wall thickening.
PANCREAS: Imaged portion of the pancreas appears within normal limits, without
masses or pancreatic ductal dilation, with portions of the pancreatic tail
obscured by overlying bowel gas.
SPLEEN: Normal echogenicity, measuring 11.0 cm.
KIDNEYS: The right kidney measures 10.1 cm. Mild fullness of the right renal
collecting system may represent early hydronephrosis however no definite cause
for obstruction noted, the distal ureter is nondilated. The left kidney
measures 9.2 cm and contains a 9 mm simple cyst in the lower pole. Normal
cortical echogenicity and corticomedullary differentiation is seen
bilaterally. There is no evidence of masses or stones in the kidneys.
Bilateral ureteral jets are demonstrated the bladder.
RETROPERITONEUM: Visualized portions of aorta and IVC are within normal
limits.
IMPRESSION:
1. Mild fullness of the right renal collecting system may reflect presence of
underlying reflux as bilateral ureteric jets are well demonstrated and no
definite cause for obstruction is noted. There is no nephrolithiasis.
2. 8 mm echogenic hepatic lesion in the left lobe is incompletely
characterized but likely represents a hemangioma.
3. No evidence of cholelithiasis or cholecystitis.
|
10094971-RR-31 | 10,094,971 | 20,468,650 | RR | 31 | 2122-04-11 11:41:00 | 2122-04-11 11:53:00 | HISTORY: Confusion for 2 days.
TECHNIQUE: PA and lateral views of the chest.
COMPARISON: ___.
FINDINGS:
Heart size remains mildly enlarged. The aorta is tortuous and diffusely
calcified. Calcified pleural plaques are noted bilaterally and obscures the
assessment of the underlying lung parenchyma. Mild interstitial abnormality
within the lung bases is similar. No new focal consolidation, pleural effusion
or pneumothorax is clearly noted. Rounded calcified structure projecting over
the medial aspect of the right lung apex is likely vascular in etiology and
unchanged. No pneumothorax is identified, and there are no acute osseous
abnormalities.
IMPRESSION:
Bilateral calcified pleural plaques limit assessment of the underlying lung
parenchyma, but no new focal consolidation is seen. Chronic mild interstitial
abnormality could reflect asbestosis and is unchanged.
|
10094971-RR-32 | 10,094,971 | 20,468,650 | RR | 32 | 2122-04-11 13:12:00 | 2122-04-11 16:09:00 | INDICATION: History of known brain mets from ___, please evaluate.
COMPARISONS: CT head from ___ and MR head from ___.
TECHNIQUE: ___ MDCT images were obtained through the brain without the
administration of IV contrast. Multiplanar reformatted images in coronal and
sagittal axes were generated and reviewed.
FINDINGS: There is no evidence of new masses or mass effect. There is no
intracranial hemorrhage. No acute intracranial infarction is identified.
Again seen is interval improvement in the vasogenic edema seen within the left
frontal region at the site of the known metastatic focus. The previously
noted left frontal periventricular lesion is not identified on this exam.
Mildly prominent ventricles and sulci are likely related to age-related
involutional changes. The basilar cisterns are patent and there is otherwise
preservation of gray-white matter differentiation.
No fracture is identified. There is near-complete opacification of the left
maxillary sinus. Mucosal sinus thickening is also seen in the ethmoid air
cells as well as likely a small mucous retention cyst in the right maxillary
sinus. The middle ear cavities and mastoid air cells are clear bilaterally.
IMPRESSION:
1. No evidence of an acute intracranial hemorrhage. No new metastatic lesions
identified, although MRI with contrast is a more sensitive exam. Improving
vasogenic edema within the left frontal lobe.
2. Sinus disease as detailed above.
|
10094971-RR-33 | 10,094,971 | 20,468,650 | RR | 33 | 2122-04-11 23:07:00 | 2122-04-12 13:58:00 | HISTORY: Renal cell carcinoma with mets to the brain, presenting with large
sacral ulcer, cannot tolerate MR. ___ evaluate for osteomyelitis.
COMPARISON: CT torso ___.
TECHNIQUE: Axial helical MDCT images were obtained of the pelvis after the
administration of IV contrast. Multiplanar reformatted images were generated
in the coronal and sagittal planes.
DLP: 801.57 mGy-cm.
FINDINGS: There is a large soft tissue defect measuring about 3.6 x 1.9 cm
overlying the sacrum with mild surrounding stranding. There is no aggressive
periosteal reaction or cortical destruction worrisome for osteomyelitis.
There is no fracture or dislocation. There are no focal blastic or lytic
lesions in the visualized osseous structures worrisome for malignancy. There
are mild degenerative changes of bilateral hips. Severe degenerative changes
of the lower lumbar spine are incompletely imaged with severe joint space loss
at L4/L5 with prominent anterior and posterior osteophytosis and vacuum disc
phenomenon.
The visualized portions of the small and large bowel are grossly unremarkable
without evidence of obstruction. There is a small amount of peritoneal free
fluid tracking inferiorly. Dense vascular calcifications are noted.
The bladder is thick walled and collapsed, containing a Foley catheter. Trace
air within the bladder is likely due to Foley instrumentation. Central
calcifications are seen within the prostate. The rectum is unremarkable in
appearance. Again appreciated is a fat-containing right inguinal hernia with
loculated fluid, unchanged in appearance from prior study. There are no
pathologically enlarged pelvic wall or inguinal lymph nodes by CT size
criteria. Prominent bilateral inguinal lymph nodes are unchanged from prior
study.
IMPRESSION:
1. Sacral soft tissue without definite CT evidence of osteomyelitis.
2. Although the bladder is collapsed, the wall appears thickened with
intraluminal air and mild surrounding stranding, worrisome for possible
cystitis. Recommend correlation with exam and labs.
|
10094971-RR-34 | 10,094,971 | 20,468,650 | RR | 34 | 2122-04-12 18:47:00 | 2122-04-12 19:39:00 | HISTORY: Altered mental status with right upper extremity swelling. Evaluate
for a deep venous thrombosis.
TECHNIQUE: Duplex Doppler examination was performed on the right upper
extremity.
COMPARISON: None.
FINDINGS: There is normal compression and augmentation of the right
subclavian, axillary, basilic and brachial veins. There is normal flow and
compressibility seen within the right cephalic vein. Normal respiratory
phasicity is seen within the subclavian veins bilaterally. The right internal
jugular vein is patent with normal respiratory phasicity.
IMPRESSION: No deep vein thrombosis of the right upper extremity.
|
10094971-RR-35 | 10,094,971 | 20,468,650 | RR | 35 | 2122-04-13 14:35:00 | 2122-04-13 19:47:00 | INDICATION: Restage known metastatic renal cell carcinoma with brain
metastases.
COMPARISONS: CT of the pelvis from ___. CT of the torso from ___.
TECHNIQUE: Contiguous axial MDCT images were obtained through the torso after
the administration of IV contrast with repeat images through the abdomen after
three minutes per the oncology protocol. Sagittal and coronal reformatted
images were obtained and reviewed.
FINDINGS:
CHEST: The imaged portions of the thyroid gland are normal. There is no
enlarged axillary, mediastinal, or hilar lymphadenopathy. The heart is mildly
enlarged, and stable from prior exam. There is no pericardial effusion.
Atherosclerotic calcifications are noted along the coronary arteries and the
aortic valve. The thoracic aorta is normal in course and caliber.
Moderate-to-severe atherosclerotic disease is noted along its course. The
main pulmonary artery trunk is normal in diameter. This exam is not tailored
to evaluate for pulmonary embolisms. No large clot is identified.
The airways are patent to the subsegmental level. There is dependent
bibasilar atelectasis and a linear consolidation along the right minor fissure
(400B, 17), which most likely represents atelectasis. A dominant left
lingular nodule has slightly increased in size. It now measures 25 x 18 mm
(2, 39). In the prior exam, it measured 16 x 12 mm. There is a new 8-mm
nodule at the right base (2, 44). Additionally, there is a new 5-mm nodule in
the right middle lobe (2, 39).
There is no pneumothorax. There are small bilateral pleural effusions, larger
on the right than the left. There are calcifications along the pleural
surfaces, likely from prior asbestos exposure. This is unchanged from the
prior exam.
ABDOMEN: A hypodensity in the left lobe of the liver which measures 6 mm (2,
46), is too small to fully characterize, though remains unchanged and likely
represents a cyst. There are no new hepatic lesions. There is no intra- or
extra-hepatic biliary duct dilation. The portal vein is patent. The
gallbladder is not distended and normal in appearance. A small gallstone is
identified. The spleen is normal in size. There are no focal splenic
lesions. The pancreas is normal. There is no duct dilation. The right
adrenal gland is normal. Again in the left adrenal gland, there is a 12-mm
nodule (2, 58), which allowing for differences in measurement is not
significantly changed. In the right kidney, there is a large heterogeneous
partially necrotic mass which measures 65 x 50 mm (2, 70). This is increased
in size from the prior exam, at which time it measured 53 x 46 mm.
Additionally, there is new tumor thrombus within the right renal vein (2, 63).
It extends to the junction of the renal vein and IVC, although does not appear
to enter into the IVC. There is significant perinephric stranding and fluid
tracking down the right paracolic gutter, which is likely inflammatory, and
related to the known renal cell carcinoma. In the left kidney, there are
multiple hypodense lesions, which are not significantly changed. The largest
is in the midpole with several septations. This measures 26 x 27 mm. There is
trace left perinephric stranding, which is mostly stable from the prior exam.
In the right retroperitoneum, there is a 10-mm lymph node (2, 67), which is
stable from the prior exam. Other small retroperitoneal lymph nodes are
present, though none meet criteria for pathologic enlargement. There is no
mesenteric lymphadenopathy. The abdominal vasculature is normal in course and
caliber. There is moderate-to-severe atherosclerotic disease.
The stomach and small bowel are unremarkable. There is no evidence of
obstruction. There is no free air or free fluid.
PELVIS: There is a moderate-to-large fecal load within the rectum. Mild
perirectal and presacral edema are noted. The remainder of the large bowel is
normal in course and caliber. There is no evidence of large bowel
obstruction. There are no focal inflammatory changes. The bladder is
collapsed, which limits its evaluation. Thickening of the bladder wall may be
due to underdistention. There is slight perivesicular stranding. A small
amount of air within the bladder may relate to prior instrumentation.
Calcifications are noted within the prostate. There is no pelvic or inguinal
lymphadenopathy. A fluid-containing right inguinal hernia is present and
mostly stable from prior exam.
Again, there is anasarca within the soft tissues. Adjacent to the sacrum,
there is a sacral decubitus ulcer. There is no discrete fluid collection.
OSSEOUS STRUCTURES: There are no concerning lytic or sclerotic osseous
lesions. No fracture is identified. In the sacrum, near the area of soft
tissue stranding, there is no definite evidence of osteomyelitis or osseous
destruction. Again old healed rib fractures are noted, and unchanged.
In the anterior chest wall, there is a stable 16-mm hypodense lesion (2, 24).
No other soft tissue nodules are identified. This may represent a metastasis
or a small sebaceous cyst.
IMPRESSION:
1. Enlarging right renal mass with new right renal vein tumor thrombus.
2. Enlarging and new pulmonary nodules, most consistent with metastases.
3. New small bilateral pleural effusions.
4. Stable hypodense chest wall lesion, which could be a metastasis.
5. Stable indeterminate left adrenal nodule and hypodense left renal lesions.
6. Stable 10-mm right retroperitoneal lymph node.
7. Sacral decubitus ulcer. No discrete fluid collection.
8. Bladder wall thickening with some air likely due to underdistention and
recent instrumentation. The differential includes cystitis.
9. Cholelithiasis without evidence of cholecystitis.
Results were discussed with Dr. ___ at 7 p.m. on
___ via telephone by Dr. ___.
|
10094971-RR-36 | 10,094,971 | 20,468,650 | RR | 36 | 2122-04-16 15:02:00 | 2122-04-16 18:19:00 | INDICATION: Renal cell carcinoma to the brain, altered mental status,
evaluate for progression of metastases.
COMPARISON: MRI of the head on ___ and ___ and
___.
TECHNIQUE: MRI of the brain with and without contrast.
FINDINGS: The study is moderately limited by motion artifacts.
The left frontal parafalcine enhancing lesion is unchanged, measuring 4 mm
(900b, 87). Adjacent T2 hyperintensity is stable in extent. The previously
seen left frontal periventricular lesion is no longer visible on the current
or most recent prior studies. There are no new enhancing lesions identified.
There are no abnormal areas of restricted diffusion to suggest infarction.
Again seen are multiple small foci of high signal on FLAIR and T2 images in
the supratentorial white matter which are unchanged, likely the sequela of
chronic small vessel ischemic disease. There is a stable punctate focus of low
signal on gradient echo images in the left frontal centrum semiovale,
indicating chronic blood products, likely from prior radiation therapy. Again
seen is mild global cerebral atrophy. Major vascular flow voids are
preserved. Large mucus retention cyst in the left maxillary sinus is
unchanged.
IMPRESSION: Moderately motion-limited study without evidence of acute
abnormalities or disease progression.
|
10095139-RR-36 | 10,095,139 | 25,266,690 | RR | 36 | 2157-10-11 06:45:00 | 2157-10-11 07:19:00 | INDICATION: ___ female with recent ERCP and partial small bowel
obstruction from outside institution CT, with NG tube placed for
decompression. Evaluate for location of the NG tube.
COMPARISON: CT abdomen from outside institution from ___.
TECHNIQUE: Frontal AP and lateral chest radiograph.
FINDINGS: The lungs are well expanded. Bibasilar streaky opacities likely
represent subsegmental atelectases. Cardiomediastinal and hilar contours are
unremarkable. There is no pleural effusion or pneumothorax. An NG tube ends
in the distal stomach.
IMPRESSION: No evidence of acute cardiopulmonary process. NG tube in
appropriate position.
|
10095139-RR-37 | 10,095,139 | 25,266,690 | RR | 37 | 2157-10-14 08:31:00 | 2157-10-14 11:48:00 | HISTORY: Partial small-bowel obstruction, question ileus.
ABDOMEN, TWO VIEWS INCLUDING LEFT DECUBITUS FILM WITH THE RIGHT SIDE UP.
On the current exam, the bowel gas pattern is nonspecific. Air is seen in few
scattered loops of non-dilated small bowel. Air and stool are seen scattered
throughout non-distended loops of colon, including within the rectum. No free
air is seen on the decubitus film. Lung bases are not well evaluated on these
views.Multiple injection granulomas are again noted.
Wet reading was provided to Dr. ___ at approximately 11:40 a.m. on
___ by Dr. ___ by phone.
|
10095139-RR-38 | 10,095,139 | 25,266,690 | RR | 38 | 2157-10-15 09:00:00 | 2157-10-15 09:44:00 | INDICATION: Left lower extremity swelling. Evaluation for DVT.
TECHNIQUE: Gray-scale and pulse wave Doppler of left lower extremity.
COMPARISON: None.
FINDINGS: There is normal respiratory phasicity in the common femoral veins
bilaterally. There is normal compressibility, flow, and augmentation of the
left common femoral, superficial femoral, and popliteal veins. Normal flow
and compressibility is demonstrated in the left posterior tibial and deep
peroneal veins.
IMPRESSION: No evidence of deep vein thrombosis.
|
10095323-RR-3 | 10,095,323 | 24,908,097 | RR | 3 | 2162-03-21 16:14:00 | 2162-03-21 16:35:00 | EXAMINATION: CTA HEAD AND CTA NECK Q16 CT NECK
INDICATION: Suspected stroke with acute neurological deficit. // Please
exclude ICH, signs of early ischemic stroke, large vessel occlusion, or other
vascular abnormality.
TECHNIQUE: Contiguous MDCT axial images were obtained through the brain
without contrast material. Subsequently, helically acquired rapid axial
imaging was performed from the aortic arch through the brain during the
infusion of intravenous contrast material. Three-dimensional angiographic
volume rendered, curved reformatted and segmented images were generated on a
dedicated workstation. This report is based on interpretation of all of these
images.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 20.0 s, 20.0 cm; CTDIvol = 50.2 mGy (Head) DLP =
1,003.4 mGy-cm.
2) Stationary Acquisition 5.0 s, 0.5 cm; CTDIvol = 54.5 mGy (Head) DLP =
27.2 mGy-cm.
3) Spiral Acquisition 5.5 s, 43.4 cm; CTDIvol = 32.1 mGy (Head) DLP =
1,389.2 mGy-cm.
Total DLP (Head) = 2,420 mGy-cm.
COMPARISON: None.
FINDINGS:
CT HEAD WITHOUT CONTRAST:
There is no evidence of infarction,hemorrhage,edema,ormass. The ventricles
and sulci are normal in size and configuration.
With the exception of a mucous retention cyst in the left maxillary sinus, the
visualized portion of the paranasal sinuses, mastoid air cells,and middle ear
cavities are clear. The visualized portion of the orbits are normal.
CTA HEAD:
The vessels of the circle of ___ and their principal intracranial branches
appear normal without stenosis, occlusion, or aneurysm. The dural venous
sinuses are patent.
CTA NECK:
Bilateral carotid and vertebral artery origins are patent.
There is no evidence of internal carotid stenosis by NASCET criteria.
The carotidandvertebral arteries and their major branches appear normal with
no evidence of stenosis or occlusion.
OTHER:
The visualized portion of the lungs are clear. The visualized portion of the
thyroid gland is within normal limits. There is no lymphadenopathy by CT size
criteria.
IMPRESSION:
1. Normal head CT.
2. Patent circle of ___ without evidence of stenosis,occlusion,or aneurysm.
3. Patent bilateral cervical carotid and vertebral arteries without evidence
of stenosis, occlusion, or dissection.
|
10095542-RR-12 | 10,095,542 | 25,562,395 | RR | 12 | 2134-05-25 17:00:00 | 2134-05-25 17:59:00 | INDICATION: ___ with fall.
TECHNIQUE: Axial images of the head were obtained. Coronal and sagittal
reformats were acquired.
COMPARISON: There are no comparison studies available.
FINDINGS: There is no acute intracranial hemorrhage, edema, mass effect, or
acute territorial infarction. The gray-white matter differentiation is well
preserved. The ventricles and sulci are mildly prominent consistent with age
related parenchymal loss. The paranasal sinuses and mastoids are clear. No
acute fracture is seen.
IMPRESSION:
No acute intracranial process.
|
10095542-RR-13 | 10,095,542 | 25,562,395 | RR | 13 | 2134-05-25 17:20:00 | 2134-05-25 19:04:00 | INDICATION: ___ with hypoxia.
TECHNIQUE:
Single frontal radiograph of the chest was obtained.
COMPARISON: No comparison studies available.
FINDINGS:
There is mild hyperinflation and prominence of the interstitial markings,
which can be seen in COPD. The cardiomediastinal silhouette and hila are
normal. There is no pleural effusion and no pneumothorax. There is no focal
lung consolidation.
IMPRESSION:
Slight prominence of the interstitial markings and hyperinflation, possibly
due to COPD. No focal lung consolidation.
|
10095542-RR-14 | 10,095,542 | 25,562,395 | RR | 14 | 2134-05-25 17:25:00 | 2134-05-25 18:54:00 | EXAM: Right wrist, AP, oblique, and lateral views, including the forearm and
right elbow AP and oblique views.
CLINICAL INFORMATION: ___ female with history of fall with right
wrist fracture.
COMPARISON: None.
FINDINGS: No true lateral view of the right wrist was obtained, the views are
obliqued. Given this, there is a comminuted, impacted intra-articular
fracture of the distal radius. The carpal bones are displaced laterally in
relation to the radius and ulna, dislocated on the AP view. No true lateral
view was obtained for best assessment. There are osteoarthritic changes at
the first carpometacarpal joint with joint space narrowing, flattening of the
trapezium and sclerosis. No elbow fracture is seen.
|
Subsets and Splits
No community queries yet
The top public SQL queries from the community will appear here once available.