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10095542-RR-15
10,095,542
25,562,395
RR
15
2134-05-25 20:16:00
2134-05-25 22:10:00
EXAM: Right wrist, three views. CLINICAL INFORMATION: ___ female with history of post-reduction. ___ at 17:28. FINDINGS: AP, oblique, and lateral views of the right wrist were obtained. Overlying cast/splint partially obscures the view. Given this, comminuted, intra-articular fracture of the distal radius is seen with lateral displacement of fracture fragments by approximately 5 or so mm. The alignment of the distal radius and ulna with the carpal bones is significantly improved and now near anatomic. Possible widening of the scapholunate interval is difficult to assess on this study.
10095542-RR-17
10,095,542
25,562,395
RR
17
2134-05-26 09:24:00
2134-05-26 10:53:00
STUDY: Right wrist, three views, ___. CLINICAL HISTORY: Patient with right wrist fracture and placement of external fixation hardware. FINDINGS: Comparison is made to prior study from ___. There has been fixation of the distal radius fracture via cutaneous pins. There is improved anatomic alignment. There has been subsequent placement of external fixation pins within the second metacarpal shaft and the distal radius. There are severe degenerative changes of the first CMC and triscaphe joints. The total intraservice fluoroscopic time was 79.4 seconds. Please refer to the operative note for additional details.
10095681-RR-81
10,095,681
23,257,434
RR
81
2149-06-21 01:15:00
2149-06-21 05:49:00
EXAMINATION: DX SHOULDER AND HUMERUS INDICATION: History: ___ with left arm fracture after fall// eval for fracture eval for fracture eval for fracture eval for fracture TECHNIQUE: Three views of left shoulder and two views of left elbow COMPARISON: None FINDINGS: There is no fracture or dislocation involving the glenohumeral, AC, or elbow joint. Osteophytes are noted at the AC joint. No suspicious lytic or sclerotic lesions are identified. No periarticular calcification is identified. 7 mm soft tissue structure overlying the mid upper arm may be a skin lesion. IMPRESSION: No fracture is identified.
10095681-RR-82
10,095,681
23,257,434
RR
82
2149-06-21 09:07:00
2149-06-21 14:21:00
EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD INDICATION: ___ year old woman with right frontal traumatic subarachnoid hemorrhage, on coumadin. Please evaluate for hemorrhage. 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 4.0 s, 16.0 cm; CTDIvol = 46.7 mGy (Head) DLP = 747.5 mGy-cm. Total DLP (Head) = 747 mGy-cm. COMPARISON: Head CT from ___. FINDINGS: Again noted is a hazy area of high attenuation along the sulcus adjacent to the right middle frontal gyrus (series 2; image 16), appears less conspicuous when compared to the prior exam, suggestive of evolution of the subarachnoid hemorrhage. There is no evidence of significant edema or mass effect. A hypodensity in the right cerebellar hemisphere which could represent a chronic infarct is again noted, also unchanged the prior study. There is prominence of the ventricles and sulci suggestive of involutional changes. Atherosclerotic calcifications are noted in the internal carotid arteries bilaterally at the level of the cavernous sinus. There is no evidence of fracture. Again noted is mild left frontal subcutaneous tissue swelling, less conspicuous than in the prior exam. The visualized portion of the paranasal sinuses again demonstrate mild mucosal thickening in the ethmoid sinus and a small amount of fluid in the left sphenoid sinus. The mastoid air cells and middle ear cavities are clear. The patient is status post bilateral cataract surgery. Otherwise, the visualized portion of the orbits are unremarkable. IMPRESSION: 1. Evolution of right frontal subarachnoid hemorrhage. No evidence of new bleeding. 2. Right cerebellar hemisphere chronic infarct, unchanged from prior study.
10095681-RR-88
10,095,681
27,503,137
RR
88
2149-07-21 12:57:00
2149-07-21 13:56:00
EXAMINATION: UNILAT LOWER EXT VEINS LEFT INDICATION: ___ woman with left leg pain and swelling. Please evaluate for DVT. TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed on the left lower extremity veins. COMPARISON: None. FINDINGS: There is normal compressibility, flow, and augmentation of the left 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. IMPRESSION: No evidence of leftdeep venous thrombosis in the left lower extremity veins.
10095681-RR-92
10,095,681
25,225,196
RR
92
2150-03-16 15:38:00
2150-03-16 16:31:00
INDICATION: ___ year old woman with abdominal pain, constipation// Please evaluate for evidence of SBO TECHNIQUE: Portable abdominal radiograph COMPARISON: No prior radiographs available for comparisons. Multiple CT abdomen/pelvis exams, most recent dated ___. FINDINGS: Mild stool burden, most prominent in the transverse and left colon. There are no abnormally dilated loops of large or small bowel. There is no free intraperitoneal air. Degenerative changes of the spine and costochondral calcifications seen. There are no unexplained soft tissue calcifications or radiopaque foreign bodies. Right femoral arthroplasty seen. IMPRESSION: Mild stool burden without signs of obstruction.
10095681-RR-94
10,095,681
25,225,196
RR
94
2150-03-17 16:52:00
2150-03-17 18:28:00
EXAMINATION: CT ABDOMEN AND PELVIS WITHOUT CONTRAST INDICATION: ___ year old woman with with CHF, afib on warfarin, hypothyroidism, dementia who presents with nausea, decreased PO intake and a supratherapeutic INR found to have UTI and epigastric abdominal pain.// Please evaluate for pancreatitis or other abdominal pathology TECHNIQUE: MDCT axial images were acquired through the abdomen and pelvis without intravenous contrast. Oral contrast was administered. Coronal and sagittal reformations were performed and reviewed on PACS. DOSE: Total DLP: 488 mGy cm. COMPARISON: CTA of the abdomen and pelvis from ___. FINDINGS: LOWER CHEST: Global cardiomegaly with marked enlargement of the right atrium. Small pericardial effusion. Small bilateral pleural effusions with associated bibasilar atelectasis. ABDOMEN: HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There is no evidence of focal lesion within the limits of the unenhanced exam. There is no evidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder is not visualized. PANCREAS: Pancreas is unremarkable within the limits of the unenhanced exam technique. There is no peripancreatic stranding to suggest pancreatitis. SPLEEN: Unremarkable. ADRENALS: Unremarkable. URINARY: A few small cortical defect in the right kidney likely represents scarring. Both kidneys are otherwise unremarkable. GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate normal caliber, wall thickness, and enhancement throughout. Oral contrast has passed to the level of the distal ileum with no evidence of obstruction. The large bowel is grossly unremarkable. The rectal wall appears circumferentially prominent, but is otherwise not well evaluated due to metal artifact from hip arthroplasty hardware. The appendix is normal. PELVIS: Evaluation of the bladder is limited by metal artifact. No gross abnormality is seen. There is no free fluid in the pelvis. REPRODUCTIVE ORGANS: Prior hysterectomy. Adnexae appear within normal limits. LYMPH NODES: No enlarged lymph nodes are demonstrated. VASCULAR: There is no abdominal aortic aneurysm. There is extensive atherosclerotic calcification in the abdominal aorta. BONES: There is a new comminuted fracture of the L2 vertebral body involving primarily the superior endplate, with mild distraction of fragments and no wedge deformity. There is extension into the posterior cortex and left pedicle with no significant displacement. There is a healed oblique fracture through L5 vertebral body and there are advanced multilevel lumbar degenerative changes. There is a right hip arthroplasty and a healed fracture deformity through the proximal right femur. SOFT TISSUES: There is a high-density collection along the medial aspect of the left psoas muscle extending from the L2 level to at least the L5 level and measuring up to 2.2 x 3.7 cm in cross-sectional diameter. This is consistent with acute hematoma. Bilateral fat containing inguinal hernias and small fat containing periumbilical hernia. Stranding in the left groin is likely related to prior vascular access. IMPRESSION: 1. Acute comminuted fracture through the L2 vertebral body with extension into the left pedicle. No retropulsion of fracture fragments. 2. New left psoas intramuscular hematoma. 3. No evidence of acute pancreatitis. 4. Cardiomegaly. Small pericardial effusion. 5. Small bilateral pleural effusions. NOTIFICATION: The impression above was entered by Dr. ___ on ___ at 18:26 into the Department of Radiology critical communications system for direct communication to the referring provider.
10095681-RR-95
10,095,681
25,225,196
RR
95
2150-03-19 00:02:00
2150-03-19 10:05:00
EXAMINATION: MR ___ SPINE W/O CONTRAST ___ MR SPINE INDICATION: ___ year old woman with acute L2 fracture. TECHNIQUE: Sagittal imaging was performed with T2, T1, and STIR technique, followed by axial T2 imaging. COMPARISON: CT abdomen and pelvis ___. FINDINGS: There are 5 non-rib-bearing lumbar type vertebral bodies. There is 3 mm of L4-5 retrolisthesis, as well as 3 mm of L2-3 (grade 1) anterolisthesis. Otherwise, lumbar spine alignment is within normal limits. There is a transversely oriented linear low signal line through the primarily anterior, superior aspect of the L2 vertebral body which extends posteriorly to involve the left L2 pedicle (for example see series 4, images 14 and 10), compatible with fracture. There is diffuse surrounding L2 marrow edema. Although the fracture line extends posteriorly to involve the left pedicle and does appear to encroach on the posterior third of the vertebral body, there is no involvement of the posterior cortex, nor buckling or retropulsion of the posterior aspect of the vertebral body/posterior cortex. There is no appreciable anterior height loss. Surrounding T1 hypointense, T2/STIR hyperintense material extending into the paraspinal soft tissues is compatible with edema. There is masslike, heterogeneously T2 hypo- and hyperintense material expanding the ___ the left psoas, which is also edematous (100: 34 and 31), compatible with left psoas intramuscular hematoma and edema. Probable intraosseous hemangiomas in T12 and L1. Otherwise, marrow signal is unremarkable. The distal spinal cord and conus medullaris is unremarkable and terminates at L1. The cauda equina nerve roots are within normal limits. Signal height loss of lumbar spine intervertebral discs is consistent with degenerative change, worst at L4-5 and L5-S1. Trace high T2/STIR signal in the L4-5 and L5-S1 intervertebral discs likely relates to degenerative changes. Specifically: T12-L1: Unremarkable. L1-2: No spinal canal or neural foraminal narrowing. L2-3: There is mild ligamentum flavum thickening, however no spinal canal or significant neural foraminal narrowing. L3-4: There is a mild posterior disc bulge, ligamentum flavum thickening, and small facet osteophytes causes mild spinal canal narrowing; the subarticular zones are narrowed however there is no impingement of the descending bilateral L4 nerve roots. No significant neural foraminal narrowing. L4-5: There is severe right-sided disc height loss posteriorly with prominent endplate osteophytes, along with ligamentum flavum thickening and facet osteophytes which cause mild spinal canal narrowing and narrowing of the right subarticular zone; there does not appear to be definite impingement of the descending right L5 nerve root which appears medially displaced (100:52). There is moderate right neural foraminal narrowing (5:6). No left neural foraminal narrowing. L5-S1: Mild posterior disc bulge, ligamentum flavum thickening and facet osteophytes without significant spinal canal narrowing, however causing severe right and moderate left neural foraminal narrowing, likely with impingement on the exiting right L5 nerve root by osteophytes in the neural foramen (100:60). There is diffuse prevertebral and paraspinal muscular atrophy and fatty infiltration. Slight edema in the posterior soft tissues at L1-2. IMPRESSION: 1. Acute transverse fracture through the superior L1 vertebral body extending into the left L1 pedicle with surrounding marrow edema. No buckling/discontinuity of the posterior cortex or bony retropulsion into the spinal canal. Ligamentum flavum and posterior longitudinal ligament appear continuous. The anterior longitudinal ligament also appears mostly continuous. 2. No spinal cord signal abnormality. 3. Left psoas intramuscular hematoma and edema. 4. Reactive soft tissue edema surrounding the L2 fracture. 5. Moderate multilevel lumbar spondylosis, notably causing severe right L5-S1 neural foraminal stenosis likely with impingement on the exiting right L5 nerve root. Further details, as above.
10095682-RR-7
10,095,682
23,420,795
RR
7
2122-03-29 22:00:00
2122-03-30 00:12:00
EXAMINATION: CT L-SPINE W/O CONTRAST INDICATION: ___ with history of melanoma. s/p eye surgery and MR contraindicated now with pain radiating down left leg. Assess for tumor. TECHNIQUE: Axial, helical, MDCT images were acquired through the lumbar spine without the administration of intravenous contrast. Coronal, sagittal, and bone algorithm thin section reformatted images were generated. DOSE: CTDIvol: 1025.59 mGy DLP: 32.21 mGy-cm COMPARISON: None available. FINDINGS: There is no evidence of acute fracture. Vertebral body alignment and height are preserved. Multilevel degenerative changes are noted throughout the lumbar spine. T12-L1: Mild retrolisthesis of T12 on L1 causing mild canal narrowing at this level. Mild uncovertebral hypertrophy right greater than left causing mild neural foraminal narrowing. Moderate degenerative changes are noted. No compression fracture. L1-L2: Moderate degenerative changes with anterior osteophyte. No compression fracture. Small posterior disc osteophyte complex causing mild canal narrowing at this level. Mild to moderate neural foraminal narrowing due to uncovertebral hypertrophy. L2-L3: Moderate degenerative changes with anterior osteophyte. Small posterior disk osteophyte complex without spinal canal narrowing. Minimal neural foraminal narrowing. L3-L4: Mild to moderate spinal canal narrowing from posterior disc osteophyte complex and hypertrophy of the ligamentum flavum. Moderate degenerative changes with anterior osteophytes and disc space narrowing. Minimal retrolisthesis of L3 on L4 noted. No compression fracture. Moderate neural foraminal narrowing, right greater than left, from uncovertebral hypertrophy. Mild hypertrophy of the ligamentum flavum. L4-L5: Moderate degenerative changes with anterior osteophytes and disc space narrowing. Mild spinal canal narrowing at this level. No compression fracture. Mild bilateral uncovertebral hypertrophy,right greater than left, with mild neural foraminal narrowing. L5-S1: Moderate degenerative changes with and bilateral uncovertebral hypertrophy, right greater than left, causing mild to moderate neural foraminal narrowing. Minimal spinal canal narrowing at this level. No compression fracture. Schmorl's nodes are identified. The prevertebral and paraspinal soft tissues are unremarkable. Limited assessment of the pelvis demonstrates a distended bladder. IMPRESSION: 1. Mild retrolisthesis of T12 on L1 causing mild canal narrowing. 2. Mild to moderate spinal canal narrowing at L3-L4 from posterior osteophyte complex and hypertrophy of the ligamentum flavum. 3. No evidence of acute compression fracture. 4. Moderate multilevel degenerative changes with multilevel mild to moderate uncovertebral hypertrophy and mild canal narrowing as described above. 5. Moderately distended bladder.
10095982-RR-11
10,095,982
25,909,015
RR
11
2130-01-11 16:47:00
2130-01-11 18:32:00
HISTORY: Right upper quadrant pain and elevated WBC. COMPARISON: None. FINDINGS: The lungs are well expanded and clear. Cardiomediastinal silhouette is unremarkable. There is no pneumothorax or pleural effusion. Visualized osseous structures are unremarkable. IMPRESSION: No acute cardiopulmonary process.
10095982-RR-12
10,095,982
25,909,015
RR
12
2130-01-12 11:01:00
2130-01-13 07:56:00
HISTORY: Status post laparoscopic subtotal cholecystectomy on the ___ with persistent postoperative collection status post previous percutaneous drain placement, removed at the end of ___. Patient now presenting with progressive right upper quadrant pain and CT demonstrating a recurrent/persistent collection. COMPARISON: CT from ___. FINDINGS: Limited grayscale imaging of the right upper quadrant demonstrated a heterogeneous fluid collection in the gallbladder fossa. Within this fluid collection to shadowing calculi could be seen correlating with the small calculi seen on CT within the residual collection. This fluid collection was targeted for percutaneous drainage. PROCEDURE: After explaining the risks, benefits, and alternatives to the procedure, signed informed consent was obtained. A time-out procedure was performed according to hospital protocol. A mark was made on the skin at the desired entry site. The skin was then prepped and draped in the usual sterile fashion. The soft tissues were anesthetized using 10 mL 1% lidocaine. Under real-time ultrasound guidance, an 8 ___ drainage catheter was advanced into the collection using trochar technique. Once the tip of the catheter was confirmed within the collection, the inner sharp stylet was removed. A small sample of fluid was aspirated to confirm the location of the catheter within the collection. After this was performed, the catheter was advanced over the metal stiffener into the collection, the stiffener was withdrawn, and the pigtail was formed. The catheter was then attached to a three-way stopcock and a drainage bag. Aspiration of the collection was then performed yielding 100 mL purulent material. A sample was sent to microbiology for analysis. The catheter was then fixed to the skin using a Stat Lock device and a dry sterile dressing was applied. The patient tolerated the procedure well and there were no immediate complications. Medications: Moderate sedation was provided for the procedure using 2 mg IV Versed and 100 mcg IV fentanyl. Total sedation time was 12 min. IMPRESSION: Ultrasound-guided 8 ___ drainage catheter placement into recurrent abscess collection in the gallbladder fossa yielding 100 mL of purulent material without immediate complication. Of note, two gallstones, are noted within this residual collection and will be removed at some point.
10095982-RR-13
10,095,982
25,886,557
RR
13
2130-09-18 16:40:00
2130-09-18 18:05:00
HISTORY: ___ male with right upper quadrant pain for two days, with weight loss. History of cholecystectomy, complicated by recurrent right upper quadrant abscesses. Evaluation for stones, abscesses, or other pathology contributing to right upper quadrant pain. COMPARISON: Comparison is made to outside CT of the chest from ___ and CT of the abdomen and pelvis from ___. TECHNIQUE: Axial MDCT images were obtained through the abdomen and pelvis after the administration of oral and intravenous contrast. Reformatted coronal and sagittal images were also reviewed. DLP: 735.1 mGy-cm. FINDINGS: CT ABDOMEN: A moderate-to-large right pleural effusion is new since the prior CT of the chest (2:1) and is nonhemorrhagic. There is a 1.9 x 4.4 x 4.9 cm subdiaphragmatic fluid collection along the posterior right hepatic lobe (2:13, 601B:49), new since the prior studies, with surrounding fat stranding and relative ___ of the rim, compatible with abscess formation. Additionally, there is a 2.8-cm fluid collection along the lateral right hepatic lobe in the area of prior gallbladder fossa fluid collection, as seen on the prior CT from ___ and previously drained via ultrasound-guided drain placement on ___. This collection is slightly smaller when compared to the prior chest CT from outside hospital on ___. Two 8mm associated hyperdensities compatible with retained gallstones are again noted (2:34, 2:31). An 11-mm hypodensity in the left hepatic lobe (2:8) is unchanged, likely a hepatic cyst. The portal vein is patent, and there is no intra- or extra-hepatic biliary ductal dilatation. The gallbladder is surgically absent. The spleen is enlarged, measuring 14 cm in greatest axial dimension and greatest craniocaudal dimension (601B:41). The bilateral adrenal glands are unremarkable. An exophytic cyst is noted along the lower pole of the right kidney (2:39); otherwise, the kidneys present symmetric nephrograms and excretion of contrast. Fat stranding along Gerota's fascia and extending down the lateral conal fascia on the right is noted. There is no intraperitoneal free air or free fluid. The pancreas is relatively atrophic but unchanged compared to prior studies. Note is made of subcentimeter left renal cysts as well. The stomach, duodenum, and small bowel are normal in course and caliber with no evidence of wall thickening or obstruction. Enteric contrast material is seen to the level of the sigmoid colon. Moderate fecal load is noted. CT PELVIS: The rectum and sigmoid colon are filled with a large amount of fecal material. The bladder and terminal ureters are unremarkable. The prostate gland is enlarged, similar in appearance compared to prior studies. There is no pelvic free fluid. No pelvic side wall or inguinal lymphadenopathy is noted. OSSEOUS STRUCTURES: No lytic or blastic lesion suspicious for malignancy is identified. IMPRESSION: 1. New subdiaphragmatic fluid collection with rim enhancement adjacent to the posterior right hepatic lobe measures up to 4.9 cm, compatible with abscess. 2. New moderate right pleural effusion. 3. Small residual fluid collection along the anterolateral right hepatic lobe appears smaller compared to prior studies; however, superinfection cannot be excluded. Two associated 8 mm hyperdensities persist and are compatible with retained stones. 4. Hepatic and renal cysts. 5. Splenomegaly. 6. Enlarged prostate.
10095982-RR-15
10,095,982
25,886,557
RR
15
2130-09-18 21:04:00
2130-09-18 22:50:00
HISTORY: ___ man with subdiaphragmatic abscess. Evaluation for retained stones. COMPARISON: Comparison is made to CT of the abdomen and pelvis obtained earlier today, as well as outside CT of the chest from ___ and CT of the abdomen and pelvis from ___. FINDINGS: Limited grayscale and color Doppler ultrasound of the area of concern along the posterior upper right hepatic lobe under the diaphragm demonstrates a moderate right pleural effusion, as well as a hypoechoic fluid collection under the diaphragm, measuring approximately 3.0 x 2.0 x 2.6 cm, compatible with the previously seen findings on recent CT. There is no evidence of calcified gallstones within the area of this new collection. The chronic fluid collection along the anterolateral margin of the right hepatic lobe is similar in appearance to the prior studies, with two adjacent subcentimeter echogenic shadowing stones, as seen previously. IMPRESSION: 1. No evidence of retained gallstones in the area of the new subdiaphragmatic fluid collection along the posterior right hepatic lobe. 2. The previously drained fluid collection along the anterolateral right hepatic lobe is again seen, with two adjacent subcentimeter shadowing gallstones, unchanged.
10095982-RR-16
10,095,982
25,886,557
RR
16
2130-09-20 13:52:00
2130-09-20 15:48:00
EXAMINATION: CT-guided drainage INDICATION: Right posterior hepatic abscess seen on CT scan. Please aspirate/place drain. Send fluid for gram stain, culture, and bilirubin. COMPARISON: Compared with previous CT abdomen pelvis from ___ and previous abdominal ultrasound from ___. PROCEDURE: CT-guided drainage OPERATORS: Dr. ___, abdominal radiology attending, who was present and supervising throughout the total procedure time and Dr. ___, abdominal radiology fellow. TECHNIQUE: The risks, benefits, and alternatives of the procedure were explained to the patient. After a detailed discussion, informed written consent was obtained from the patient. A pre-procedure timeout using three patient identifiers was performed as per ___ protocol. The patient was placed in a right lateral decubitus position on the CT scan table. Limited preprocedure CTscan of the intended drainage area was performed. Based on the CT findings an appropriate position for the drain placement was chosen. The site was marked. The site was prepped and draped in the usual sterile fashion. 8 cc of 1% lidocaine were administered to the subcutaneous and deep tissues for local anesthetic effect. Under CT guidance, an 18 gauge, 15 cm ___ needle was introduced into the collection posterior to the liver via a posterior approach and during placement a total of 90 cc of clear yellow fluid were withdrawn from the right pleural space in order to obtain better access to the right upper quadrant collection posterior to the liver. Subsequently, a ___ wire was introduced through the ___ needle and exchange was made for a 6 ___ ___ pigtail catheter. A total of 20 cc of green purulent fluid were withdrawn from the catheter, and a sample was sent for culture, gram stain and bilirubin as requested. The pigtail catheter was fixed in place with a 0 silk suture and attached to a JP suction bulb. The procedure was well tolerated and there were no immediate post-procedural complications. DOSE: DLP: 242 mGy-cm. SEDATION: Moderate sedation was provided by administering divided doses of 2 mg Versed and 100 mcg fentanyl throughout the total intra-service time of 22 minutes during which patient's hemodynamic parameters were continuously monitored by an independent trained radiology nurse. FINDINGS: A pre-procedure CT of the upper abdomen, which is limited due to the lack of contrast, demonstrates a moderate-sized right pleural effusion. Again noted is a well-defined collection posterior to the right lobe of the liver which measures 3.7 x 5.3 cm (3:13). In addition, just deep to the abdominal wall muscles and to the right of the liver there is a small collection measuring 3.2 x 1.1 cm. There are a few prominent porta hepatic lymph nodes, which are likely reactive. There has been prior cholecystectomy. There is mild to moderate atherosclerosis of the visualized abdominal aorta. IMPRESSION: Technically successful CT-guided drainage of collection posterior to the right lobe of the liver with 20 cc of purulent fluid withdrawn, a sample of which was sent for analysis. An additional 90 cc of clear yellow right pleural fluid were withdrawn for better access for drainage of right posterior upper abdominal collection. Findings were discussed with Dr. ___, from the surgery consultation team at 3:20 ___, 15 min after completion of the procedure.
10095982-RR-17
10,095,982
25,886,557
RR
17
2130-09-20 21:38:00
2130-09-21 08:12:00
EXAMINATION: CHEST (PA AND LAT) INDICATION: ___ year old man with liver abscess and pleural effusions s/p ___ drainage of each // please evaluate for pneumothorax COMPARISON: ___. IMPRESSION: There is now complete clearing of pre-existing interstitial parenchymal opacities. Moderate cardiomegaly persists. Status post thoracocentesis of a right pleural effusion. Last filling is a small amount of right effusion, on the lateral than on the frontal image. A part of this effusion could be subpulmonary. There is no evidence of pneumothorax. No left effusion. .
10095982-RR-21
10,095,982
23,069,054
RR
21
2131-09-24 14:55:00
2131-09-24 15:42:00
EXAMINATION: CHEST RADIOGRAPHS INDICATION: Dyspnea and chest pain. History of empyema. TECHNIQUE: Chest, PA and lateral. COMPARISON: ___. FINDINGS: The cardiac, mediastinal and hilar contours appear within normal limits. A pigtail catheter projects over the posterior base of the right side chest. , its exact location uncertain. There is a small pleural effusion, partly loculated. This includes pleural thickening along the lateral side of the chest are. Although these findings are new of air in not necessarily acute and in the setting on chronicity of patchy new opacities in the right middle lobe and lingula is uncertain. Interstitium is mildly prominent throughout each lung which suggests are mild vascular congestion, however. IMPRESSION: 1. Mild interstitial process most suggestive of vascular congestion. 2. Small loculated pleural effusion on the right with patchy densities which may be due to coinciding atelectasis. Although no recent prior radiographs are available, some of this appearance may be subacute or more chronic, although recent or ongoing infectious process is not excluded. 3. Pigtail catheter posterior along the posterior base of the chest; its exact location with respect to the diaphragm is not well delineated by the radiographs but it is compatible with pleural placement.
10095982-RR-23
10,095,982
23,069,054
RR
23
2131-09-24 16:55:00
2131-09-24 17:56:00
EXAMINATION: CT TORSO WITH CONTRAST INDICATION: ___ with abdominal pain, has RUQ drain in place, complicated h/o multiple intra-abdominal infections and empyema requiring chest tube. TECHNIQUE: MDCT images were obtained from the thoracic inlet to the pelvis. IV Omnipaque contrast was administered. Axial images were interpreted in conjunction with sagittal and coronal reformats. Oral contrast was not administered DLP: 1290 mGy-cm COMPARISON: Comparison is made to abdominal CT from ___ and ___. FINDINGS: CHEST: The thyroid is normal. There are multiple enlarged lymph nodes. Axillary lymph nodes measure up to 11 mm on the left (series 2, image 21). Additionally, enlarged nodes are present at the supraclavicular station measuring up to 17 mm (2, 4), in the mediastinum with the largest right paratracheal lymph node measuring 20 mm (series 2, image 28), and subcarinal station measuring 25 mm (series 2, image 35). Additionally, a right epicardial lymph node on the right is also enlarged measuring 11 mm (series 2, image 49), however this appears stable compared to ___. The heart is not enlarged. There is no pericardial effusion. Coronary artery calcifications are moderate. The thoracic aorta is normal in caliber with calcifications. Aortic annular calcifications are mild. Centrilobular emphysema is moderate. There is a small right and left nonhemorrhagic pleural effusions. There is fluid tracking into the right fissure with chronic opacity adjacent to the fissure, most compatible with rounded atelectasis. No large loculated fluid collection is identified. The airway is grossly patent to the subsegmental level bilaterally. ___ opacities in the right lower greater than left lower lobes, may reflect infection (series 4, image 193). ABDOMEN: A right upper quadrant drainage catheter is present near the posterior right aspect of the liver (series 2, image 60), in region of prior abscess. There is a low-density subcapsular posterior right perihepatic collection measuring 2.8 x 6.5 cm (AP x transverse). The drainage catheter is positioned just superior to this collection. A sub cm hypodensity in the left dome of the liver is too small to characterize (series 2, image 56). The liver otherwise enhances homogeneously and is without focal lesions. Mild to moderate biliary duct dilation is minimally improved from ___. The gallbladder is surgically absent. There is fatty atrophy of the pancreas. The spleen is mildly enlarged measuring 14.0 cm. The adrenal glands are unremarkable. Views of the kidneys demonstrate subcentimeter hypodensities which are too small to characterize. A 14 mm exophytic right lower pole hypodensity measures 25 Hounsfield units in is unchanged from ___, and likely represents a hyperdense cyst. There is no hydronephrosis. The ureters are normal in caliber along their course to the bladder. The distal esophagus is normal without a hiatal hernia. Views of the small and large bowel are unremarkable without focal wall thickening. The abdominal aorta is heavily calcified without aneurysmal dilation. There is no intra-abdominal free fluid or free air. There are no abdominal wall hernias. PELVIS: The bladder is decompressed, but unremarkable in appearance. The prostate is mildly enlarged measuring 4.5 x 6.5 cm. There is no pelvic free fluid. OSSEOUS STRUCTURES/SOFT TISSUES: No focal lytic or sclerotic lesion concerning for malignancy. An old healed sternal fracture is present. Abdominal wall thickening on the right and surgical clips are unchanged. IMPRESSION: 1. Bilateral lower lobe ___ opacities right greater than left, concerning for pneumonia. 2. Supraclavicular, mediastinal, and axillary lymphadenopathy, could be reactive however, given the extent, the possibility of a neoplastic process such as lymphoma should be considered. 3. Small bilateral pleural effusions. No large loculated fluid collection in the chest. 4. Pigtail catheter in the right upper quadrant at site of prior hepatic abscess. 5. Low density subcapsular right perihepatic fluid collection measuring 2.8 x 6.5 cm, is doubtful to represent an abscess, and may represent evolution of prior subcapsular hematoma, although findings are not specific. 6. Mild splenomegaly, unchanged. NOTIFICATION: Updated findings impression number to discussed with Dr. ___ by Dr. ___ the telephone on ___ at 18:00, 5 min after they were made
10095982-RR-24
10,095,982
23,069,054
RR
24
2131-09-25 11:30:00
2131-09-25 12:10:00
EXAMINATION: BILAT LOWER EXT VEINS INDICATION: ___ year old man with pain and new edema ___. Assess for deep venous thrombosis. 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, superficial femoral, and popliteal veins. Normal color flow and compressibility are demonstrated in the posterior tibial and peroneal veins. A patent duplicated left popliteal vein is noted. 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 within bilateral lower extremities.
10095982-RR-25
10,095,982
23,069,054
RR
25
2131-09-25 14:28:00
2131-09-25 15:29:00
EXAMINATION: CHEST (PORTABLE AP) INDICATION: ___ year old man with persistent (above-baseline) O2 requirement and cough. // Pls eval for interval change of lung findings seen on admission (PNA vs atelectasis?). Pls eval for interval change of lung findings seen on admiss COMPARISON: Comparison to plain radiographs dated ___ at 15:00 and ___ at 21:39 and selected images of the chest CT dated ___ FINDINGS: Portable AP upright chest film ___ at 14:32 is submitted. IMPRESSION: Overall cardiac and mediastinal contours are stably enlarged. There is a small right basilar and lateral pleural effusion. The overall interstitium is somewhat prominent, particularly in the right mid and lower lung, but this does not appear to be significantly changed since ___. Given that the left lung appears grossly clear, this more likely represents an infectious process rather than edema. Clinical correlation, however, is advised. No pneumothorax.
10095982-RR-26
10,095,982
23,069,054
RR
26
2131-09-28 09:21:00
2131-09-28 10:47:00
EXAMINATION: CHEST (PA AND LAT) INDICATION: ___ year old man with recent empyema s/p drainage, now w/ persistent 2L O2 requirement // Pls veal any interval change or etiology of new O2 requirement TECHNIQUE: PA and lateral radiographs of the chest. COMPARISON: ___. FINDINGS: Moderate right pleural effusion is decreased with right basilar pigtail catheter in place. A small left pleural effusion is unchanged. Mild pulmonary edema superimposed on chronic interstitial changes attributable to emphysema is unchanged. Mild cardiomegaly is unchanged. Extensive spinal degenerative changes are stable. IMPRESSION: Decreased moderate right pleural effusion with chest tube in place. Stable small left pleural effusion. Stable mild pulmonary edema superimposed on emphysema.
10095982-RR-27
10,095,982
23,069,054
RR
27
2131-10-01 09:22:00
2131-10-01 14:36:00
EXAMINATION: CHEST (PA AND LAT) INDICATION: ___ year old man with CHF with new cough and reduced O2 saturation with crackles on exam. Please evaluate for pulmonary edema. // Please evaluate for pulmonary edema TECHNIQUE: CHEST (PA AND LAT) COMPARISON: ___ IMPRESSION: Heart size and mediastinum are stable. Diffuse interstitial changes are present but substantially improved since the prior study. At least partially loculated right pleural effusion is noted. No pneumothorax is seen. Underlying interstitial lung disease is a possibility based on the current appearance of the EXAMINATION. Underlying emphysema is better appreciated on the recent CT chest.
10095982-RR-6
10,095,982
22,345,836
RR
6
2129-10-11 19:42:00
2129-10-11 21:14:00
INDICATION: ___ man with an impacted gallstone in the common bile duct and reported CBD diameter of 20 mm. COMPARISON: CT of the abdomen from an outside facility performed on the same day. FINDINGS: There are no focal liver lesions. The gallbladder is distended but thin-walled, with multiple small mobile gallstones. There is intrahepatic bile duct dilation. The common bile duct measures 13 mm, unchanged from the CT. The stone seen impacted in the ampulla could not be seen on this study. There is no ascites. The visualized IVC and abdominal aorta are normal. IMPRESSION: 1. Cholelithiasis without evidence of cholecystitis. 2. Intrahepatic bile duct dilation. 3. The CBD measures 13 mm, unchanged from the outside hospital CT.
10095982-RR-9
10,095,982
21,599,347
RR
9
2129-10-29 08:50:00
2129-10-29 11:45:00
CT-GUIDED DRAINAGE INDICATION: s/p lap chole ___ now with subhepatic fluid collection PHYSICIANS: Dr ___, Dr ___ Dr. ___ attending radiologist, was present throughout the critical portions of the procedure. PROCEDURE: The procedure, risks, benefits and alternatives were discussed with the patient and written informed consent was obtained. A preprocedure timeout was performed discussing the planned procedure, confirming the patient's identity with three identifiers, and reviewing a checklist per ___ protocol. Under CT 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. An 8fr drain was advanced into the collection located in the GB fossa and 60cc pus was removed. The drain was secured to the skin with a Stat-Lock device. The patient tolerated the procedure well without immediate complication. Estimated blood loss was minimal. IMPRESSION: CT-guided therapeutic drainage of GB fossa abscess with removal of 60cc pus. 8fr drain in place. No complications.
10096046-RR-37
10,096,046
25,557,189
RR
37
2131-07-30 19:09:00
2131-07-31 01:10:00
CHEST RADIOGRAPH PERFORMED ON ___ COMPARISON: Prior chest CT from ___. CLINICAL HISTORY: Cough and weakness, assess pneumonia. FINDINGS: PA and lateral views of the chest are provided. There is no focal consolidation, large effusion, or pneumothorax. Cardiomediastinal silhouette appears normal. Atherosclerotic calcifications at the aortic knob noted. Bony structures are intact. There is blunting at the right CP angle laterally which could indicate mild pleural thickening or possibly a tiny effusion.
10096109-RR-9
10,096,109
21,449,873
RR
9
2148-12-06 14:32:00
2148-12-07 03:07:00
INDICATION: History of Crohn's disease and ileostomy, presenting with concern for bowel obstruction. COMPARISON: MR enterography from ___. TECHNIQUE: Contiguous MDCT images were obtained through the abdomen and pelvis with IV contrast only. Coronal and sagittal reformatted images were obtained. FINDINGS: Limited view of lung bases is clear. There is no pleural effusion. ABDOMEN: Liver enhances homogeneously without focal lesions. There is no intra- or extra-hepatic biliary dilatation. Gallbladder contains a stone, but does not show wall thickening or pericholecystic fluid. The spleen is absent, but again splenosis is noted. Pancreas and adrenal glands are within normal limits. Kidneys enhance and excrete symmetrically without focal lesions or hydronephrosis. Stomach is unremarkable. Demonstrated is diffuse distention of small bowel loops without overt dilatation extending to the ostomy without clear transition point and no collapsed distal segment, making obstruction unlikely. The degree of bowel distention, maximally measuring 3.1 cm has increased compared to the prior examination. Mild narrowing at the ostomy site is noted and could reflect normal post-surgical anatomy. Colon is surgically absent. There is no mesenteric or retroperitoneal lymphadenopathy. The abdominal aorta is of normal caliber. There is no intra-abdominal free fluid or air. PELVIS: The bladder is unremarkable. There are no abnormal adnexal masses. There is no free pelvic fluid or adenopathy. Bones do not show significant degenerative changes, suspicious lytic or sclerotic lesions, or acute fractures. IMPRESSION: Diffuse distention of small bowel loops, increased compared to the prior examination, extending to the ostomy without clear transition point could reflect ileus.
10096391-RR-30
10,096,391
26,251,990
RR
30
2145-12-07 15:01:00
2145-12-07 18:28:00
EXAMINATION: Ultrasound-guided percutaneous cholecystostomy tube placement INDICATION: ___ year old woman with cystic duct obstruction // Please place perc chole tube COMPARISON: HIDA scan ___, abdominal ultrasound ___ PROCEDURE: Ultrasound-guided percutaneous cholecystostomy. OPERATORS: Dr. ___ trainee and Dr. ___ radiologist. Dr. ___ supervised the trainee during the key components of the procedure and reviewed and agrees with the trainee's findings. TECHNIQUE: The risks, benefits, and alternatives of the procedure were explained to the patient. After a detailed discussion, informed written consent was obtained. A pre-procedure timeout using three patient identifiers was performed per ___ protocol. The patient was placed in a supine position on the ultrasound table. Limited preprocedure imaging was performed to localize the gallbladder. An appropriate skin entry site was chosen and the site marked. Local anesthesia was administered with 1% Lidocaine solution. Using continuous sonographic guidance, an ___ Exodus drainage catheter was advanced via trocar technique into the gallbladder. A sample of fluid was aspirated, confirming catheter position within the collection. The stiffener was removed. The pigtail was deployed. The position of the pigtail was confirmed within the collection via ultrasound. Ultrasound images were stored on PACS. Approximately 15 cc of layering clear and light brown fluid was drained with a sample sent for microbiology evaluation. The catheter was secured by a StatLock. The catheter was attached to bag. Sterile dressing was applied. The procedure was tolerated well, and there were no immediate post-procedural complications. SEDATION: Moderate sedation was provided by administering divided doses of 0.5 mg Versed and 25 mcg fentanyl throughout the total intra-service time of 20 minutes during which patient's hemodynamic parameters were continuously monitored by an independent trained radiology nurse. FINDINGS: Gallbladder was identified with multiple stones, and amenable to drain placement. Post-procedure imaging showed no evidence of complication. IMPRESSION: Successful ultrasound-guided placement of ___ pigtail catheter into the gallbladder. Samples was sent for microbiology evaluation.
10096391-RR-31
10,096,391
26,251,990
RR
31
2145-12-08 12:06:00
2145-12-08 15:12:00
EXAMINATION: CHEST (PORTABLE AP) INDICATION: ___ year old woman with epigastric pain s/p perc chole, now with hypoxia // Cause for new hypoxia TECHNIQUE: Single frontal view of the chest COMPARISON: ___ FINDINGS: Moderate cardiomegaly is stable. Mild to moderate pulmonary edema is new. Right lower lobe opacities are likely atelectasis. There is pleural small right effusion. There is no evident pneumothorax. Catheter projects in the right upper quadrant of the abdomen IMPRESSION: Mild to moderate pulmonary edema
10096391-RR-35
10,096,391
27,466,615
RR
35
2147-05-13 00:48:00
2147-05-13 01:11:00
EXAMINATION: Chest radiographs. INDICATION: History: ___ with cough, recent fall// eval for PNA, rib fracture TECHNIQUE: Chest AP and lateral COMPARISON: Chest radiographs dated ___. FINDINGS: Patient has emphysema. Vascular congestion suggests mild fluid overload. There is no lobar consolidation, pneumothorax or pleural effusion. Extensive calcifications are noted at the aortic arch. The cardiomediastinal silhouette is otherwise within normal limits. No acute, displaced rib fracture is visualized. IMPRESSION: Emphysema. Mild fluid overload. No pneumonia. 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.
10096391-RR-36
10,096,391
27,466,615
RR
36
2147-05-13 03:06:00
2147-05-13 03:30:00
EXAMINATION: CT C-SPINE W/O CONTRAST Q311 CT SPINE INDICATION: History: ___ with fall, cervical spine tenderness. Evaluate for fracture. TECHNIQUE: Non-contrast helical multidetector CT of the cervical spine was performed. Soft tissue and bone algorithm images were generated. Coronal and sagittal reformations were then constructed. DOSE: Acquisition sequence: 1) Spiral Acquisition 4.8 s, 19.0 cm; CTDIvol = 32.0 mGy (Body) DLP = 609.7 mGy-cm. Total DLP (Body) = 610 mGy-cm. COMPARISON: None. FINDINGS: There is no evidence for acute fracture. There is mild retrolisthesis of C4 on C5 with disc space narrowing. There is no evidence for prevertebral edema, disc space widening, or distraction of the posterior elements. Moderate central disc protrusion at C3-C4 moderately narrows the spinal canal and indents the ventral spinal cord. Small to moderate central disc protrusion and endplate osteophytes at C4-C5 cause mild to moderate spinal canal narrowing and may slightly remodel the ventral spinal cord, not well assessed. Small central disc protrusion and endplate osteophytes at C5-C6 mildly indent the ventral thecal sac with mild spinal canal narrowing. There is multilevel neural foraminal narrowing by uncovertebral and facet osteophytes. There is pleural/parenchymal scarring at the included lung apices, partially visualized, with calcifications on the left. There also paraseptal bullae at the lung apices. Concurrent CT torso is reported separately. The thyroid gland is grossly unremarkable allowing for streak artifact from the shoulder girdles. Paranasal sinus disease is partially visualized, better assessed on the concurrent head CT. IMPRESSION: 1. No evidence for a fracture. 2. Mild retrolisthesis of C4 on C5 is almost certainly degenerative, though there are no prior exams to confirm chronicity. 3. Multilevel degenerative disease. 4. Paraseptal emphysema and partially visualized pleural/parenchymal scarring at the included lung apices. Concurrent CT torso is reported separately.
10096391-RR-37
10,096,391
27,466,615
RR
37
2147-05-13 03:06:00
2147-05-13 03:28:00
EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD INDICATION: History: ___ with syncope, fall, head strike on coumadin// eval for ICH TECHNIQUE: Contiguous axial images of the brain were obtained without contrast. Coronal and sagittal reformations as well as bone algorithm reconstructions were provided and reviewed. DOSE: Acquisition sequence: 1) Sequenced Acquisition 16.0 s, 16.7 cm; CTDIvol = 48.1 mGy (Head) DLP = 802.7 mGy-cm. Total DLP (Head) = 803 mGy-cm. COMPARISON: None. FINDINGS: There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles and sulci are age appropriate in size and configuration. There is preservation of gray-white matter differentiation. The basal cisterns remain patent. There is no evidence of fracture. There is near complete opacification of the left maxillary sinus and bilateral sphenoid sinuses. There is chronic sphenoid sinus osteitis, indicating underlying chronic inflammation component. The remainder of the paranasal sinuses, mastoid air cells, and middle ear cavities are clear. Calcifications are seen within the bilateral cavernous carotid arteries. The visualized portion of the orbits are unremarkable. IMPRESSION: 1. No acute intracranial process. 2. There is acute paranasal sinusitis with fluid, and chronic sphenoid sinusitis.
10096391-RR-38
10,096,391
27,466,615
RR
38
2147-05-13 03:07:00
2147-05-13 03:49:00
EXAMINATION: CT CHEST/ABD/PELVIS W/ CONTRAST INDICATION: History: ___ with afib on warfarin (supratherapeutic) presenting with R chest/flank pain after fall// eval for bleed TECHNIQUE: MDCT acquired axial images of the chest, abdomen, and pelvis were obtained after administration of 130 mL Omnipaque intravenous contrast. Enteric contrast was not given. Coronal and sagittal reformats were prepared and reviewed. DOSE: Acquisition sequence: 1) Spiral Acquisition 8.1 s, 64.1 cm; CTDIvol = 18.0 mGy (Body) DLP = 1,155.7 mGy-cm. Total DLP (Body) = 1,156 mGy-cm. COMPARISON: CT abdomen dated ___, ___ chest dated ___. FINDINGS: CHEST: There are severe coronary artery calcifications. There is no mediastinal hematoma. There is no pericardial effusion. There are multiple borderline enlarged mediastinal lymph nodes, for instance pretracheal measuring 1 cm, precarinal measuring 0.9 cm subcarinal measuring 1 cm and hilar measuring 1.3 cm on the right. There is moderate to severe centrilobular emphysema, regions of optical scarring, patchy ground-glass opacities and mild peripheral fibrosis, more so at the periphery of the lower lobes. There is a miniscule right anterolateral pneumothorax (2:78). There is no pleural effusion. ABDOMEN: The liver, spleen, pancreas, adrenal glands and kidneys are unremarkable except for stable bilateral hypodense renal lesions that are too small to characterize. Post cholecystectomy. There is no evidence of renal or collecting system injury. Extensive atherosclerotic calcifications are seen within the aorta and its major branches. Small hiatal hernia. No lymphadenopathy, bowel obstruction, free air, or free fluid. No hematoma in the abdomen or pelvis. PELVIS: There is no pelvic free fluid. The uterus and adnexa are unremarkable on CT for age. BONES: Displaced rib fractures are noted involving the posterior right tenth and eleventh ribs. No displaced pelvic fractures. IMPRESSION: 1. Displaced posterior right tenth and eleventh rib fractures with diminutive right pneumothorax. 2. Diffuse centrilobular emphysema, fibrosis, and multiple areas of scarring. New borderline and enlarged mediastinal and hilar lymph nodes, compared to prior examination. In the setting of centrilobular emphysema and lung fibrosis, tissue sampling could be considered. 3. Severe aortic and coronary artery calcifications. NOTIFICATION: Updated findings were conveyed by Dr. ___ to Dr. ___ at 08:32 on ___.
10096391-RR-40
10,096,391
27,466,615
RR
40
2147-05-13 20:18:00
2147-05-13 22:44:00
EXAMINATION: CHEST (PA AND LAT) INDICATION: ___ year old woman with small pneumothorax seen on CT ___// please evaluate for progression- please obtain at 8 ___ EST ___ TECHNIQUE: Chest two views COMPARISON: ___ FINDINGS: Shallow inspiration. Pulmonary physeal a. vascular congestion has improved. Stable heart size. Small pleural effusions, probably similar. Mild basilar opacities, likely atelectasis, more prominent. No pneumothorax. Biapical subpleural scarring. IMPRESSION: Improved vascular congestion. Small pleural effusions. Mild basilar opacities, likely atelectasis.
10096391-RR-41
10,096,391
27,466,615
RR
41
2147-05-14 11:52:00
2147-05-14 12:17:00
EXAMINATION: CHEST (PA AND LAT) INDICATION: ___ with URI symptoms and UTI, feeling lethargic, fell in bathroom on right side, with rib fractures x 2 and miniscule ptx seen on Chest CT// please assess for changes/ reaccumulation of PTX please assess for changes/ reaccumulation of PTX IMPRESSION: COMPARISON TO ___. NO RELEVANT CHANGE IS NOTED. THE LATERAL RADIOGRAPH SHOWS MINIMAL BILATERAL DORSAL PLEURAL EFFUSIONS. NO PULMONARY EDEMA. MILD CARDIOMEGALY. NO PNEUMONIA. THE CURRENT IMAGE SHOWS NO EVIDENCE OF PNEUMOTHORAX.
10096420-RR-13
10,096,420
25,396,519
RR
13
2204-07-16 20:01:00
2204-07-17 08:38:00
HISTORY: MI with the increased O2 requirement. FINDINGS: In comparison with the study of ___, there is little overall change. Cardiac silhouette remains within normal limits. Mild indistinctness of pulmonary vessels could reflect some elevated pulmonary venous pressure. No acute focal pneumonia or pleural effusion.
10096420-RR-14
10,096,420
26,321,485
RR
14
2204-08-14 10:55:00
2204-08-14 13:49:00
INDICATION: Left-sided ureteral stone and elevated creatinine. Evaluate for hydronephrosis. TECHNIQUE: Renal ultrasound. COMPARISON: CT abdomen and pelvis ___. FINDINGS: The right kidney measures 11.4 cm. The left kidney measures 12.0 cm. There is mild caliectasis in the left kidney, but no hydronephrosis, stone or mass in either kidney. Right side ureteral jet is seen. No left ureteral jet is visualized. There may be a prominent vessel in the porstate (image 23). IMPRESSION: Mild left caliectasis. No ureteral jet on the left visualized.
10096420-RR-15
10,096,420
26,321,485
RR
15
2204-08-15 08:42:00
2204-08-15 16:46:00
STUDY: SUPINE VIEW OF THE ABDOMEN PLAIN RADIOGRAPH. COMPARISON EXAM: CT abdomen and pelvis ___. INDICATION: ___, nephrolithiasis. FINDINGS: No definite kidney stone is identified. Again noted is evidence of ileocecal and distal sigmoid anastomoses. There are calcifications seen on the left side of the mid lumbar spine, compatible with those present in a presumed nerve sheath tumor seen previously at CT. There is diffuse gaseous distention of the colon. Minimal small bowel gas is seen. There is no free air. IMPRESSION: No nephrolithiasis seen. Left paraspinal calcifications likely located within a known left paraspinal mass that may represent a nerve sheath tumor.
10096969-RR-11
10,096,969
25,079,335
RR
11
2190-02-03 12:03:00
2190-02-03 14:11:00
INDICATION: Known left thalamic stroke. Interval evaluation. TECHNIQUE: Multidetector CT scan of the head was obtained without the administration of contrast. Coronal and sagittal reformations were prepared. COMPARISON: CT scan of the same date obtained approximately five hours prior at ___. FINDINGS: Overall the extent of left thalamic intraparenchymal hemorrhage appears similar measuring up to 4.1 x 1.8 cm (2:19) and extending to the ventricles. Hemorrhage is seen within the left lateral ventricle predominantly within the frontal horn as well as within the frontal horn of the right lateral ventricle and third ventricle. Slight asymmetric enlargement of the left lateral ventricle appears overall similar to the prior examination. There is minimal, 2 mm rightward shift of normally midline structures. Edema surrounding the area of hemorrhage is slightly increased from the prior examination with edema extending to the left centrum semiovale. No concerning osseous lesion is seen. There are vascular calcifications. The visualized paranasal sinuses and mastoid air cells are grossly clear. IMPRESSION: Interval evolution of known left thalamic hemorrhage with slightly increased surrounding parenchymal edema. Similar appearance of hemorrhagic extension into the ventricle system with mild, approximately 2 mm rightward shift of normally midline structures. Slight asymmetric enlargement of the left lateral ventricle appears similar to the prior examination.
10096969-RR-12
10,096,969
25,079,335
RR
12
2190-02-03 15:16:00
2190-02-03 16:48:00
REASON FOR EXAMINATION: Sudden onset of chest pain in a patient with left thalamic stroke. AP radiograph of the chest was reviewed with no prior studies available for comparison. Heart size and mediastinum are unremarkable. Lungs are essentially clear. No pleural effusion or pneumothorax demonstrated.
10096969-RR-13
10,096,969
25,079,335
RR
13
2190-02-03 18:28:00
2190-02-03 20:54:00
CLINICAL HISTORY: ___ man with left thalamic hemorrhagic stroke. Evaluate for progression of hemorrhage. COMPARISON: NECT of 12:15 p.m. and ___) of 7:31 a.m., ___. TECHNIQUE: Non-contrast MDCT axial images were acquired through the head. FINDINGS: Over the ensuing roughly six hours, the left thalamic hemorrhage, measuring approximately 1.9 x 4.6 cm, and previously 1.8 x 4.1 cm, is essentially unchanged, allowing for differences in plane of scanning. Vasogenic edema surrounding the hemorrhage is unchanged from the prior study. Minimal, 2-mm rightward shift of normally midline structures is also unchanged. The degree of intraventricular extension is also unchanged from the prior study. Hemorrhage is seen within the left lateral ventricular frontal, occipital and temporal and right lateral ventricular frontal horns. Hemorrhage is also seen within third and fourth ventricles. The basilar cisterns are patent. No new hemorrhage is identified. The visualized paranasal sinuses and mastoid air cells are clear. No osseous abnormality is identified. Calcification of the cavernous portion of the internal carotid arteries is redemonstrated. IMPRESSION: Overall, no significant change from the study of roughly six hours earlier, with: 1. Unchanged left thalamic hemorrhage with stable surrounding edema and minimal rightward shift of normally-midline structures. 2. Transependymal "dissection" of hemorrhage into the ventricular system, as before, with no evidence of hydrocephalus at this time.
10096969-RR-14
10,096,969
25,079,335
RR
14
2190-02-04 21:27:00
2190-02-05 09:37:00
STUDY: MRI of the head. CLINICAL INDICATION: History of large left thalamic hemorrhage, evaluate for characterization of hemorrhage, underlying lesions, microbleeds. COMPARISON: Prior head CT dated ___. TECHNIQUE: Sagittal T1, axial T2, axial FLAIR, axial magnetic susceptibility, and axial diffusion-weighted sequences were obtained. FINDINGS: The left thalamic hemorrhage is redemonstrated, measuring approximately 30.4 x 38.0 mm in transverse dimension with no significant midline shifting, there is mild effacement of the left ventricular atrium, unchanged since the prior head CT. There is also persistent small amount of intraventricular hemorrhage layering in the left occipital ventricular horn. Grossly, there is no evidence of large vessels to suggest large arteriovenous malformation; however, other underlying conditions cannot be completely ruled out. The T2 and FLAIR sequences demonstrate multiple scattered foci of high signal intensity in the subcortical white matter, which are nonspecific and may reflect chronic microvascular ischemic disease. The gradient echo sequence demonstrates the area of hemorrhage centered at the left pulvinar region, there is mild edema extending at the left cerebral peduncle with no significant mass effect. The perimesencephalic cisterns are patent. Normal flow void signal is noted at the major vascular structures. The orbits, the paranasal sinuses, and the mastoid air cells are grossly unremarkable. IMPRESSION: Left thalamic hemorrhage, centered at the left pulvinar as described in detail above, relatively stable since the most recent head CT dated ___. A small amount of intraventricular hemorrhage is identified on the left occipital ventricular horn. Scattered foci of high signal intensity are visualized in the subcortical and periventricular white matter, which are nonspecific and may suggest chronic microvascular ischemic disease.
10097383-RR-10
10,097,383
22,623,208
RR
10
2139-12-21 13:46:00
2139-12-21 15:31:00
EXAMINATION: CTA ABD WANDW/O C AND RECONS INDICATION: ___ year old man with recurrent pancreatitis here with acute epigastric and RUQ pain// PANCREAS PROTOCOLeval for acute inflammation, other complications of chronic pancreatitis TECHNIQUE: Abdomen and pelvis CTA: Non-contrast and multiphasic post-contrast images were acquired through the abdomen. Oral contrast was not administered. MIP reconstructions were performed on independent workstation and reviewed on PACS. DOSE: Acquisition sequence: 1) Spiral Acquisition 3.7 s, 29.3 cm; CTDIvol = 18.0 mGy (Body) DLP = 527.2 mGy-cm. Total DLP (Body) = 527 mGy-cm. COMPARISON: ___ CT abdomen/pelvis FINDINGS: LOWER CHEST: Minimal bibasilar atelectasis. The partially imaged lung bases are otherwise unremarkable. ABDOMEN: HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There is a transient hepatic attenuation difference or focal fat deposition adjacent to the groove of the falciform ligament in segment IV. No focal lesions identified. The portal veins are patent. No evidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder is within normal limits. PANCREAS: There is mild main pancreatic ductal dilation measuring up to 4 mm in diameter, similar to the prior examination. No focal lesions. No peripancreatic fat stranding in contradistinction to the prior examination dated ___. No peripancreatic fluid collections. The adjacent splenic artery and splenic vein are unremarkable. 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. No evidence of concerning renal lesions or hydronephrosis. GASTROINTESTINAL: Imaged large and small bowel loops are unremarkable. LYMPH NODES: Nonspecific prominence of multiple retroperitoneal and mesenteric lymph nodes measuring up to 1 cm. VASCULAR: No abdominal aortic aneurysm. no significant atherosclerotic disease. Incidental bilateral accessory renal arteries. BONES/SOFT TISSUES: There is no aggressive osseous lesion or acute fracture. Small, fat containing umbilical hernia. IMPRESSION: 1. No evidence of acute pancreatitis. 2. Mild unchanged main pancreatic ductal dilation measuring up to 4 mm in diameter without an obstructing process identified. 3. Nonspecific prominence of multiple retroperitoneal and mesenteric lymph nodes measuring up to 1 cm.
10097383-RR-7
10,097,383
25,378,217
RR
7
2139-04-01 21:17:00
2139-04-01 21:52:00
EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN) INDICATION: ___ epigastric RUQ pain, r/o gallbladder pathology, stones. Evaluate for gallbladder pathology, stones. TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were obtained. COMPARISON: Liver ultrasound ___. FINDINGS: LIVER: The hepatic parenchyma appears within normal limits. The contour of the liver is smooth. There is no focal liver mass. The main portal vein is patent with hepatopetal flow. There is trace ascites. BILE DUCTS: There is no intrahepatic biliary dilation. CHD: 4 mm GALLBLADDER: There is no evidence of stones or gallbladder wall thickening. PANCREAS: The imaged portion of the pancreas appears within normal limits, without masses. The imaged main pancreatic duct measures 5 mm. Portion of the pancreatic tail are obscured by overlying bowel gas. SPLEEN: Normal echogenicity Spleen length: 13.4 cm KIDNEYS: Limited views of the kidneys show no hydronephrosis. RETROPERITONEUM: The visualized portions of aorta and IVC are within normal limits. IMPRESSION: 1. No evidence of cholelithiasis or acute cholecystitis. 2. Mild dilatation of the main pancreatic duct. 3. Mild splenomegaly. Trace ascites.
10097383-RR-8
10,097,383
25,378,217
RR
8
2139-04-01 23:11:00
2139-04-02 00:05:00
EXAMINATION: Chest radiograph INDICATION: ___ pancreatitis r/o effusions vs. other pathology// ___ pancreatitis r/o effusions vs. other pathology TECHNIQUE: Chest PA and lateral COMPARISON: No relevant comparison identified. FINDINGS: Lungs are clear. Pleural spaces are normal. Cardiomediastinal silhouette is within normal limits. IMPRESSION: No focal consolidation. No pleural effusions.
10097383-RR-9
10,097,383
22,623,208
RR
9
2139-12-20 20:22:00
2139-12-20 22:10:00
EXAMINATION: ABDOMEN US (COMPLETE STUDY) INDICATION: ___ year old man with recurrent idiopathic pancreatitis presenting with 3 days of severe RUQ and epigastric abdominal pain associated with nausea/vomiting// evaluate for pancreatic, pancreatic pseudocyst, cholecystitis TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were obtained. COMPARISON: ___ FINDINGS: LIVER: The hepatic parenchyma appears within normal limits. The contour of the liver is smooth. There is no focal liver mass. The main portal vein is patent with hepatopetal flow. There is no ascites. BILE DUCTS: There is no intrahepatic biliary dilation. CHD: 2 mm GALLBLADDER: There is no evidence of stones or gallbladder wall thickening. PANCREAS: There is equivocal peripancreatic edema. Pancreas is not fully assessed due to overlying bowel gas. SPLEEN: Normal echogenicity. Spleen length: 13 cm, borderline in size. KIDNEYS: Normal cortical echogenicity and corticomedullary differentiation is seen bilaterally. There is no evidence of masses, stones, or hydronephrosis in the kidneys. Right kidney: 11.0 cm Left kidney: 11.2 cm RETROPERITONEUM: The visualized portions of aorta and IVC are within normal limits. IMPRESSION: Equivocal peripancreatic edema. Normal gallbladder. No biliary dilatation.
10097612-RR-17
10,097,612
29,104,091
RR
17
2156-10-19 11:19:00
2156-10-19 13:25:00
CHEST RADIOGRAPHS HISTORY: Shortness of breath and chest pain. COMPARISONS: CT from ___. TECHNIQUE: Chest, PA and lateral. FINDINGS: The heart is moderately enlarged. There is mild prominence of pulmonary vascularity and interstitium without frank pulmonary edema. Patchy opacity in the lingula is linear and suggests atelectasis. Small bilateral pleural effusions are suspected. The lungs are hyperinflated. There is a mild lower thoracic wedge compression deformity that appears chronic and correlates with the prior CT findings. Mild degenerative changes involve the right shoulder. IMPRESSION: Moderate cardiomegaly and findings suggesting mild vascular congestion.
10097612-RR-24
10,097,612
26,618,472
RR
24
2159-05-22 13:48:00
2159-05-22 14:13:00
EXAMINATION: CHEST (PORTABLE AP) INDICATION: History: ___ with SOB // evidence of effusion TECHNIQUE: Single frontal view of the chest COMPARISON: ___ FINDINGS: The cardiac silhouette remains markedly enlarged. Mediastinal contours are stable there is likely a tortuous aorta. The right costophrenic angle is not completely included in the image. Given this, no pleural effusion is seen. There is no focal consolidation or evidence of pneumothorax. IMPRESSION: Right costophrenic angle not completely included on the image; given this, no pleural effusion seen. Persistent enlargement of the cardiac silhouette without overt pulmonary edema.
10097612-RR-28
10,097,612
21,981,172
RR
28
2159-11-11 23:18:00
2159-11-12 07:37:00
EXAMINATION: CHEST (PA AND LAT) INDICATION: History: ___ with progressive ___ edema // evaluate for CHF exacerbation TECHNIQUE: AP upright and lateral chest radiographs COMPARISON: ___ FINDINGS: Since the prior study, the cardiac silhouette is enlarged, there is more central vascular congestion, and there is mild interstitial edema. No large pleural effusion. No pneumothorax. IMPRESSION: Moderate cardiomegaly increased from ___, with increased mild interstitial edema. No large pleural effusion.
10097612-RR-29
10,097,612
21,981,172
RR
29
2159-11-15 18:08:00
2159-11-15 23:14:00
EXAMINATION: DX CHEST PORTABLE PICC LINE PLACEMENT INDICATION: ___ year old man with cardiogenic shock s/p PA cath placement // line placement TECHNIQUE: Portable chest COMPARISON: ___ FINDINGS: There is severe cardiomegaly, slightly increased compared to prior. There is a new Swan-Ganz catheter with tip in the right main pulmonary artery. Lung volumes are slightly low and there is volume loss/ early infiltrate at the bases. There is no pneumothorax
10097612-RR-30
10,097,612
21,981,172
RR
30
2159-11-18 10:57:00
2159-11-18 12:31:00
EXAMINATION: SHOULDER (AP, NEUTRAL AND AXILLARY) TRAUMA RIGHT INDICATION: ___ year old man with cardiogenic shock, hx fall and fx of R shoulder, seen at OSH // fracture type TECHNIQUE: Three views right shoulder. COMPARISON: None available FINDINGS: There is deformity of the right proximal humerus with a surgical neck of humerus fracture. This is age indeterminate as the margins appear somewhat ill-defined and there is likely some callus formation. The fracture line appears to extend through the greater tuberosity. There is mild impaction of the fracture. Inferior subluxation of the humeral head relative to the glenoid. A linear lucency through the glenoid is likely related to degenerative change as there is moderate degenerative change at the glenohumeral joint although a fracture cannot be excluded.
10098553-RR-36
10,098,553
24,711,357
RR
36
2156-03-09 14:19:00
2156-03-09 15:51:00
HISTORY: ___ female with nausea, vomiting, and bloody emesis. STUDY: PA and lateral chest radiograph. COMPARISON: ___. FINDINGS: The cardiomediastinal and hilar contours are normal. The lungs are clear. There is no pleural effusion or pneumothorax. There is no evidence of pneumomediastinum or subdiaphragmatic free air. IMPRESSION: No acute cardiopulmonary process. No evidence of pneumomediastinum or free air beneath the diaphragms.
10098672-RR-13
10,098,672
21,259,834
RR
13
2141-04-13 14:23:00
2141-04-13 18:13:00
INDICATION: ___ man with short gut syndrome, fever at 102, abdominal tenderness on exam, please perform without IV contrast. COMPARISON: CT abdomen and pelvis without contrast from ___. TECHNIQUE: MDCT axial imaging was obtained from the lung bases through the pubic symphysis without the administration of intravenous contrast material. Coronal and sagittal reformats were completed. FINDINGS: CT ABDOMEN WITHOUT CONTRAST: There is minimal atelectasis at the lung bases. There is no pleural effusion or focal consolidation. The visualized heart and pericardium are unremarkable. Evaluation of intra-abdominal solid organs and vasculature is limited without the administration of intravenous contrast material. Within these limitations, the liver is unremarkable. There are no focal lesions, intra- or extra-hepatic biliary dilatation. The patient is status post cholecystectomy and surgical clips are seen. The pancreas and adrenal glands are unremarkable. The spleen has enlarged since the prior study, now measuring 17.4 cm compared to 14.4 cm from the prior study. Again seen is a cyst arising from the upper pole of the right kidney. The kidneys are otherwise unremarkable. There is no hydronephrosis or stones. The stomach and small bowel are unremarkable. Contrast passes through the small bowel without evidence of obstruction. There are clips seen in the left upper quadrant, likely from prior colectomy. The patient is status post proctocolectomy with an ostomy in the right lower quadrant. The previously seen solid mass in the left kidney is unchanged since the prior study. We would recommend further characterization with ultrasound. There is no free fluid, free air or lymphadenopathy in the abdomen. CT PELVIS: Ostomy is seen in the right lower quadrant fluid collection anterior to the aortic bifurcation, unchanged, image 2:55. There is no free fluid, free air, or lymphadenopathy within the pelvis. OSSEOUS STRUCTURES: There are no suspicious lytic or sclerotic lesions. IMPRESSION: 1. No evidence of obstruction or acute intra-abdominal process. 2. Increased splenomegaly since the prior study from ___. 3. Solid mass in the interpolar region of the left kidney, unchanged from the prior study. If further investigation has not been completed with ultrasound, would recommend.
10098672-RR-14
10,098,672
21,259,834
RR
14
2141-04-13 16:17:00
2141-04-13 17:46:00
INDICATION: ___ man with fever to 102, chills, question infectious source or pneumonia. COMPARISONS: Portable chest radiograph from ___. FINDINGS: There is no focal consolidation, pleural effusion, or pneumothorax. Since the prior study, the heart size has enlarged. Mediastinal silhouette is unremarkable. There are no acute skeletal abnormalities. IMPRESSION: Increased cardiomegaly since the prior study of ___. Otherwise, no acute intrathoracic process.
10098672-RR-15
10,098,672
21,259,834
RR
15
2141-04-16 13:42:00
2141-04-16 19:00:00
INDICATION: High-grade fungemia and back spasms. Evaluation for fluid collection, discitis or osteomyelitis. TECHNIQUE: MR of the thoracic and lumbar spine. COMPARISON: CT abdomen and pelvis ___ and ___. FINDINGS: THORACIC SPINE: At T7-8 is a left paracentral disc protrusion not causing significant spinal canal stenosis or neural foraminal narrowing. At T8-9, there are ___ type I changes in the vertebral body endplates without abnormal signal in the intervertebral disc. There is normal alignment and marrow signal of the thoracic spine. There is no cord signal abnormality. No epidural mass or fluid collection is seen. There is no abnormal signal in the intervertebral discs. LUMBAR SPINE: Lumbar lordosis is preserved. Vertebral body heights and alignment are maintained. There is no expansile or destructive osseous lesion. No focal disc herniation is seen. No spinal canal or neural foraminal stenosis is identified. The conus and cauda equina appear normal. No epidural mass or collection is seen. There is no signal abnormality in the intervertebral discs. The fluid collection in the mid abdomen corresponds to finding seen on multiple prior CT-Abdomen/Pelvis. The right renal cyst is also visualized. IMPRESSION: No evidence of epidural abscess or discitis/osteomyelitis. MRI with contrast would be more sensitive for these entities. The case was discussed by Dr. ___ with Dr. ___ by phone at 4:19 p.m. on ___.
10098672-RR-16
10,098,672
21,259,834
RR
16
2141-04-17 14:31:00
2141-04-17 14:56:00
HISTORY: ___ male with need for TPN, status post PICC placement. COMPARISON: ___. FINDINGS: There has been interval placement of a right upper extremity PICC, the tip of which is in the mid-to-lower SVC. Lung expansion is improved compared with ___, the lungs are clear. There is no pleural effusion or pneumothorax. The cardiac silhouette is top normal in size, the mediastinal contours are normal. Surgical clips are seen in the right upper quadrant and in the left upper quadrant. IMPRESSION: 1. Interval PICC placement, tip is in the mid-to-lower SVC. 2. No acute chest abnormality.
10098672-RR-39
10,098,672
21,229,395
RR
39
2142-05-16 00:56:00
2142-05-16 02:37:00
HISTORY: Bilateral lower quadrant abdominal pain after surgery for prostate cancer (per the ___ medical record surgery was ___. Evaluate for intra-abdominal abscess or worsening Crohn's disease. TECHNIQUE: MDCT-axial images were acquired from the dome of the liver to the pubic symphysis without the administration of IV contrast given renal insufficiency. Oral contrast was administered. Coronal and sagittal reformations were provided and reviewed. DLP: 842.42 mGy/cm. COMPARISON: CT abdomen pelvis ___. FINDINGS: Abdomen: The imaged lung bases show mild bronchiectasis at the left lung base. There is no pleural effusion or pneumothorax. The heart is normal in size and there is no pericardial effusion. Evaluation of the intra-abdominal contents is limited by lack of intravenous contrast. Within this limitation the pancreas and adrenal glands are unremarkable. The spleen is enlarged, measuring 14.9 cm in the craniocaudal dimension, decreased from 17 cm. The gallbladder is surgically absent. Hypodensities within the liver likely reflect focal fat (2:19, 26). A 4.8 cm simple cyst within the right kidney is unchanged. There is no definte solid-appearing lesion within the left kidney seen on this study. Otherwise, there is no hydronephrosis or nephrolithiasis. There is no retroperitoneal or mesenteric lymphadenopathy. Dense calcifications are seen at the origin of the superior mesenteric artery and left renal artery. The stomach is normal. Contrast has progressed to the ileostomy. There is no bowel wall thickening or evidence for obstruction. The patient is status post a total proctocolectomy. There is no extraluminal contrast, free fluid or free air. Pelvis: A 2.9 x 2.7 cm fluid collection anterior to the aortic bifurcation is unchanged from ___. There are extensive postsurgical changes within the pelvis, including stranding, clips and air (2:80). There is no discrete fluid collection. A Foley catheter and air are seen within the bladder. There is no pelvic lymphadenopathy. Bones: There are no concerning sclerotic foci. IMPRESSION: 1. Postsurgical changes in the pelvis from recent prostatectomy. The absence of contrast limits the evaluation for abscess, however, there is no new discrete fluid collection. 2. Decrease in size of splenomegaly.
10098672-RR-40
10,098,672
21,229,395
RR
40
2142-05-19 13:05:00
2142-05-19 14:02:00
HISTORY: Foley in place after radical prostatectomy with lower pelvic pain, assess for urine leak. COMPARISON: CT abdomen pelvis ___. FINDINGS: Scout radiographs demonstrate multiple surgical clips in the pelvis and Foley catheter in situ. The bladder was slowly filled with water soluble contrast. Oblique and lateral views reveal extravasation of contrast from the posterior base of the bladder. A track of contrast approximately 1 cm in width connects the base of the bladder to a 5.8 x 1.7 cm collection in the presacral space. IMPRESSION: Urine leak from the posterior base of the bladder communicates with a 5.8 x 1.7 cm collection via a 1 cm track. Findings were discussed with Dr. ___ by Dr. ___ by phone at 13:55 on ___, 2 minutes after discovery. Findings were subsequently discussed with Dr. ___ by phone at ___.
10098993-RR-124
10,098,993
21,687,208
RR
124
2166-02-16 08:17:00
2166-02-16 10:45:00
CHEST, TWO VIEWS: ___ HISTORY: ___ female with chest pain. History of congestive failure. Question pulmonary edema. FINDINGS: PA and lateral views of the chest are compared to previous exam from ___. Compared with prior, there has been no significant interval change. The lungs remain clear. There is no pleural effusion. There is no pulmonary vascular engorgement. Cardiac silhouette is enlarged, but stable in configuration. Biventricular pacing device again seen with multiple leads in stable positions. Atherosclerotic calcifications seen throughout the aorta. Median sternotomy wires and mediastinal clips again noted. IMPRESSION: No acute cardiopulmonary process.
10099104-RR-30
10,099,104
28,798,348
RR
30
2180-11-15 22:39:00
2180-11-15 22:54:00
EXAMINATION: CHEST (AP upright AND LAT) INDICATION: ___ with fever// r/o infiltrate COMPARISON: Prior exam is dated ___ FINDINGS: AP upright and lateral views of the chest provided. Overlying EKG leads are present. Slightly increased interstitial opacity at the lung bases may reflect areas of fibrosis. No large effusion or pneumothorax. No signs of pneumonia or edema. Cardiomediastinal silhouette is normal. Bony structures are intact IMPRESSION: No signs of pneumonia.
10099480-RR-43
10,099,480
26,044,496
RR
43
2175-07-03 17:28:00
2175-07-03 17:49:00
EXAMINATION: CHEST (PA AND LAT) INDICATION: History: ___ with recent admission for influenza, now with weakness/malaise*** WARNING *** Multiple patients with same last name! // Eval PNA. TECHNIQUE: Chest PA and lateral COMPARISON: Chest radiograph ___ FINDINGS: Left-sided pacer with leads in the right atrium and right ventricle appears unchanged. There is persistent moderate cardiomegaly. Mediastinal contour is unchanged. There is increased perihilar haziness and mild vascular indistinctness compatible with mild pulmonary edema, slightly worse in the interval. Patchy atelectasis is seen in the lung bases. Small bilateral pleural effusions are noted, minimally increased in size. No pneumothorax. Right shoulder arthroplasty is incompletely imaged. IMPRESSION: Mild pulmonary edema, slightly worse in the interval, with small bilateral pleural effusions. Patchy bibasilar opacities may reflect atelectasis, but infection is difficult to exclude in the correct clinical setting and follow up radiographs after diuresis are recommended for further evaluation.
10099480-RR-44
10,099,480
26,044,496
RR
44
2175-07-04 19:59:00
2175-07-04 21:53:00
EXAMINATION: Chest radiograph, portable AP upright view. INDICATION: Coronary artery disease. Swan-Ganz catheter placement. COMPARISON: Prior studies available from ___. FINDINGS: Swan-Ganz catheter has been placed via a right internal jugular venous approach. The catheter projects tip projects 2.5 cm lateral to the right mediastinal border, probably in the basilar trunk of the right lower lobe pulmonary artery. Dual lead pacemaker/ICD device appears unchanged. Trace pleural effusions are likely. There is no pneumothorax. Moderate to severe pulmonary edema has substantially worsened since the prior day. IMPRESSION: Swan-Ganz catheter likely terminating in the basilar right lower lobe pulmonary artery.
10099480-RR-46
10,099,480
26,044,496
RR
46
2175-07-06 03:05:00
2175-07-06 07:54:00
EXAMINATION: CHEST (PORTABLE AP) INDICATION: ___ year old man with PA catheter, eval line position // line position IMPRESSION: In comparison with the study of ___, the right IJ Swan-Ganz catheter is been pulled back so that it lies at the mediastinal border of the right pulmonary artery. Cardiac silhouette is less prominent and there has been substantial decrease in the degree of pulmonary vascular congestion. The right costophrenic angle is now sharply seen.
10099480-RR-47
10,099,480
26,044,496
RR
47
2175-07-06 08:24:00
2175-07-06 09:36:00
EXAMINATION: CHEST (PORTABLE AP) INDICATION: ___ year old man with HFrEF, swan in place, pulled back 1cm // Assess PA line positioning IMPRESSION: In comparison with the earlier study of this date, there is little change in the appearance of the Swan-Ganz catheter tip which again appears in the right pulmonary artery at the mediastinal border. The lungs are essentially clear and there is no vascular congestion.
10099592-RR-145
10,099,592
26,871,521
RR
145
2137-07-31 12:13:00
2137-07-31 13:41:00
CT SCAN OF THE ABDOMEN AND PELVIS PERFORMED ON ___ COMPARISON: None. CLINICAL HISTORY: ___ woman with abdominal pain, nausea, vomiting, hematuria, question kidney stone. TECHNIQUE: Multidetector CT was used to obtain contiguous axial images through the abdomen and pelvis without oral or IV contrast material. IV contrast was held due to patient's elevated creatinine. Coronal and sagittal reformations were provided. COMPARISON: CT chest from ___. FINDINGS: LUNG BASES: There is a small nodule in the right middle lobe on series 2 image 1 measuring approximately 5 mm stable from ___ CT. An area of subsegmental atelectasis is seen in the inferior lingula. ABDOMEN: Non-contrast evaluation does limit evaluation of solid organs. Multiple hepatic and splenic calcified granulomas are noted. Multiple calcified stones are seen layering within the gallbladder lumen. There is no evidence of choledocholithiasis. Adrenal glands are normal bilaterally. The pancreas and kidneys appear normal. No hydronephrosis. Tiny calcific densities in the renal hilum bilaterally likely reflect vascular calcification. Abdominal aorta is normal in course and caliber with faint minimal atherosclerotic calcification. No retroperitoneal lymphadenopathy. The stomach is decompressed. Duodenum appears normal. PELVIS: Loops of small bowel demonstrate no signs of ileus or obstruction. No appendix is visualized. The colon is notable for diverticulosis but no signs of diverticulitis. No free pelvic fluid. Uterus appears surgically absent. No adnexal masses. Urinary bladder is minimally distended. No free pelvic fluid. BONES: Unremarkable. IMPRESSION: 1. Gallstones without definite signs of cholecystitis. 2. No hydronephrosis or kidney stone. 3. 5-mm nodule in the right middle lobe stable from ___ requiring no further workup. 4. Diverticulosis without diverticulitis.
10099592-RR-158
10,099,592
21,483,421
RR
158
2138-02-05 10:35:00
2138-02-05 13:47:00
Study: Carotid Series Complete Reason: ___ year old woman s/p fall. Findings: Duplex evaluation was performed of bilateral carotid arteries. On the right there is a tiny heterogeneous plaque in the ICA. On the left there is no plaque in the ICA. On the right systolic/end diastolic velocities of the ICA proximal, mid and distal respectively are 37/12, 92/25, 77/24, cm/sec. CCA peak systolic velocity is 108 cm/sec. ECA peak systolic velocity is 149 cm/sec. The ICA/CCA ratio is .85. These findings are consistent with no stenosis. On the left systolic/end diastolic velocities of the ICA proximal, mid and distal respectively are 63/15, 90/19, 58/16, cm/sec. CCA peak systolic velocity is 74 cm/sec. ECA peak systolic velocity is 83 cm/sec. The ICA/CCA ratio is 1.2. These findings are consistent with no stenosis. There is antegrade right vertebral artery flow. There is antegrade left vertebral artery flow. Impression: Right ICA with no stenosis. Left ICA with no stenosis.
10099652-RR-17
10,099,652
28,009,527
RR
17
2184-11-04 16:59:00
2184-11-04 21:34:00
EXAMINATION: CHEST RADIOGRAPHS INDICATION: Increasing dyspnea on exertion. COMPARISON: ___. TECHNIQUE: Chest, PA and lateral. FINDINGS: The heart appears mildly enlarged. The aorta is calcified along the arch. There is patchy left basilar opacity involving the lingula and left lower lobe, probably compatible with atelectasis. There is no pleural effusion or pneumothorax. IMPRESSION: Opacities at the left lung base, probably compatible with atelectasis. Infectious process is not excluded, however.
10099652-RR-18
10,099,652
28,009,527
RR
18
2184-11-04 20:50:00
2184-11-04 21:32:00
EXAMINATION: CHEST CT INDICATION: Dyspnea on exertion and positive D-diameter. Question pulmonary embolism. TECHNIQUE: Multi detector CT images of the chest were obtained with intravenous contrast in the pulmonary arterial phase. Sagittal, coronal, and bilateral oblique projection reformations are also performed. DOSE: 767.7 mGy-cm. COMPARISON: None. FINDINGS: No filling defects are identified among the pulmonary arterial branches. The right pulmonary artery is mildly enlarged, measuring up to 3.0 cm in diameter although left and main are normal in caliber. The heart is borderline in size. There are no pleural or pericardial effusions. A right lower paratracheal lymph node measures up to 13 x 15 mm in axial ___ (sees 2:37) which is enlarged although probably reactive. A few other subcentimeter nodes are also present in the mediastinum, mildly prominent and probably also reactive. The lungs demonstrate a mild mosaic attenuation pattern. Patchy opacities at the lung bases as well as in the right middle lobe suggests minor atelectasis. There is also patchy peripheral opacity in the right upper lobe which is not specific. Along the minor fissure there is a very small nodule which measures 3-4 mm (2:50). Limited views of the upper abdomen are unremarkable. There are no suspicious bone lesions. There is a prior healed left clavicle fracture. Mild to moderate degenerative changes are incompletely characterized along the right shoulder. There is mild chronic-appearing anterior wedging of the T11 vertebral body. Throughout the mid through lower thoracic spine, there are small to moderate anterior osteophytes. The bones are probably demineralized. IMPRESSION: 1. No evidence of pulmonary embolism. 2. Mild mosaic attenuation pattern, most often due to air trapping associated with small airways disease, versus slight vascular congestion. 3. Patchy peripheral opacities in the right upper lobe, possibly atelectasis; pneumonia hard to exclude but seems less likely. Although less common, organizing and eosinophilic forms of pneumonitis can also present as peripheral opacities; focal edema could also be considered. 4. Small perifissural nodule measuring 3-4 mm and mildly enlarged lymph node, probably reactive. However, follow-up surveillance of the findings is suggested in six months with chest CT. 5. Mild dilatation of the right pulmonary artery.
10099652-RR-19
10,099,652
28,009,527
RR
19
2184-11-10 09:39:00
2184-11-10 10:40:00
EXAMINATION: CHEST (PA AND LAT) INDICATION: ___ year old woman s/p PPM implant // PTX, leads COMPARISON: ___ IMPRESSION: As compared to the previous radiograph, the patient has received a left pectoral pacemaker. The course of the pacemaker leads is unremarkable, 1 lead projects over the right atrium and 1 over the right ventricle. There is no pneumothorax. No pleural effusions. No pulmonary edema. The known left basal atelectasis is completely unchanged.
10099869-RR-35
10,099,869
21,026,790
RR
35
2185-01-06 03:09:00
2185-01-06 04:35:00
EXAMINATION: UNILAT LOWER EXT VEINS RIGHT INDICATION: ___ man with history of DVT with new pulmonary embolus on CTA from OSH. Evaluate for new deep venous thrombosis and size. TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed on the right lower extremity veins. COMPARISON: Right lower extremity deep vein ultrasound dated ___. FINDINGS: There is normal compressibility and flow of the right common femoral, femoral, and popliteal veins. The right calf veins were not evaluated secondary to bandaging, skin graft, and possible open wounds. 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 common femoral, femoral, and popliteal veins. Calf veins not imaged secondary to bandaging and skin graft.
10099869-RR-37
10,099,869
21,026,790
RR
37
2185-01-06 21:19:00
2185-01-07 09:54:00
INDICATION: Evaluate for abscess in a patient with recurrent DVT, recent motor vehicle accident with skin flap infection. TECHNIQUE: Helical axial MDCT images were obtained through the right lower extremity from the distal femur through the foot after the administration of IV contrast. Reformatted images in coronal and sagittal axes were generated. DOSE: Total DLP (Body) = 1,264 mGy-cm. COMPARISON: None. FINDINGS: There is a comminuted fracture of the right tibia and fibula, now post ORIF. The cortical plates create significant beam hardening artifact largely obscuring the surrounding soft tissues, particularly anteriorly. Within these limits, no rim enhancing fluid collection to suggest abscess is identified. There is soft tissue density anteriorly compatible with the skin flap. Extensive edema is noted in the subcutaneous soft tissues. Vessels appear grossly patent. There is a small knee joint effusion, with tiny locules of air likely related to recent surgery. IMPRESSION: 1. Examination limited by streak artifact from extensive orthopedic hardware. Within these limitations, no focal fluid collection is detected. 2. Post ORIF of comminuted right tibial and fibular fractures. 3. Small knee joint effusion, with tiny locules of air likely related to recent surgery.
10099869-RR-38
10,099,869
21,026,790
RR
38
2185-01-08 10:12:00
2185-01-08 13:58:00
EXAMINATION: TIB/FIB (AP AND LAT) RIGHT INDICATION: ___ year old man // repeat s/p repeat s/p IMPRESSION: In comparison with the study of ___, an external device is in place. Again there are medial and lateral fracture plates and graft material in the proximal tibia without evidence of hardware-related complication. Fracture of the proximal fibular shaft is again seen with apparently less angulation. The surgical skin staples have been removed.
10099869-RR-39
10,099,869
21,026,790
RR
39
2185-01-12 14:47:00
2185-01-12 16:15:00
INDICATION: ___ year old man with new L PICC // L DL Power PICC 48cm ___ ___ Contact name: ___: ___ TECHNIQUE: Chest PA and lateral COMPARISON: ___ FINDINGS: Left-sided PICC line in situ with that tip in the distal SVC. No left-sided pneumothorax. Right-sided pneumothorax demonstrates interval decrease in size currently measuring 2 mm. No airspace consolidation. No pulmonary edema. No pleural effusions. Normal heart size. Mild unfolding of the aorta. IMPRESSION: Satisfactory position of the left-sided PICC line. Interval decrease in size of the right-sided pneumothorax. No left-sided pneumothorax.
10099869-RR-40
10,099,869
21,026,790
RR
40
2185-01-14 13:01:00
2185-01-14 14:14:00
EXAMINATION: Chest single view INDICATION: ___ year old man with traumatic pneumothorax, PE, increased pleuritic chest discomfort // interval change in pneumothorax? TECHNIQUE: Portable AP COMPARISON: ___. FINDINGS: The heart is normal. The descending aorta is slightly tortuous. The lungs are clear of active process and well expanded. There is no pleural effusion or pneumothorax. Left PICC line with its tip in mid to distal SVC. IMPRESSION: Clear lungs.
10100035-RR-10
10,100,035
20,559,195
RR
10
2110-04-28 14:25:00
2110-04-28 16:26:00
EXAMINATION: CT-guided drainage. INDICATION: ___ y/o M POD6 ex lap, ___ procedure- now p/w perisplenic fluid collection // please aspirate and/or place a drain COMPARISON: CT abdomen and pelvis with contrast ___. PROCEDURE: CT-guided drainage of a left perisplenic fluid. Placement of an 8 ___ drainage catheter. OPERATORS: Dr. ___ radiology fellow, and Dr. ___ ___ resident) and Dr. ___ radiologist, who personally supervised the trainee during the key components of the procedure and reviewed and agrees with the trainee's findings. TECHNIQUE: The risks, benefits, and alternatives of the procedure were explained to the patient. After a detailed discussion, informed written consent was obtained. A pre-procedure timeout using three patient identifiers was performed per ___ protocol. The patient was placed in a supine position on the CT scan table. Limited preprocedure CT scan was performed to localize the fluid. Based on the CT findings an appropriate skin entry site for the drain placement was chosen. The site was marked. Local anesthesia was administered with 1% Lidocaine solution. Using intermittent CT fluoroscopic guidance, an 18-G ___ needle was inserted into the perisplenic fluid. The ___ wire could not be advanced due septations. A glidewire was used a could not be advanced cranially. The needle was directed cranially and the ___ wire was coiled in the cranial aspect of the fluid. The needle was removed. This was followed by placement of ___ Exodus pigtail catheter into the fluid. The metal stiffener and the wire were removed. The pigtail was deployed. The position of the pigtail was confirmed within the collection via CT fluoroscopy. Approximately 80 cc of serous fluid was aspirated with a sample sent for microbiology evaluation. The catheter was secured by a StatLock. The catheter was attached to bag. Sterile dressing was applied. The procedure was tolerated well, and there were no immediate post-procedural complications. DOSE: Total DLP (Body) = 327 mGy-cm. SEDATION: Moderate sedation was provided by administering divided doses of 1.5 mg Versed and 75 mcg fentanyl throughout the total intra-service time of 50 minutes during which patient's hemodynamic parameters were continuously monitored by an independent trained radiology nurse. FINDINGS: 1. Peritoneal fluid more prominent adjacent to the spleen. 2. Appropriately positioned perisplenic catheter. 3. Bibasilar atelectasis and moderate pleural effusions. IMPRESSION: Placement of an 8 ___ drainage catheter in the perisplenic fluid yielding 80 cc of serous fluid.
10100035-RR-11
10,100,035
20,559,195
RR
11
2110-05-01 12:14:00
2110-05-01 15:03:00
EXAMINATION: CT ABD AND PELVIS WITH CONTRAST INDICATION: ___ year old man s/p repair of perforated colon now with decreased uop, increasing distension // Please evaluate for interval change with PO and IV contrast TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired through the abdomen and pelvis following intravenous contrast administration with split bolus technique. IV Contrast: 130 mL Omnipaque. Oral contrast was administered. Coronal and sagittal reformations were performed and reviewed on PACS. DOSE: Total DLP (Body) = 981 mGy-cm. COMPARISON: CT of the abdomen and pelvis dated ___ and ___. FINDINGS: LOWER CHEST: There bilateral moderate size nonhemorrhagic pleural effusions with adjacent compressive atelectasis, unchanged from prior. The visualized portion the heart and pericardium are normal. There is a small pericardial effusion. ABDOMEN: HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There is no evidence of focal lesions. There is no evidence of intrahepatic or extrahepatic biliary dilatation. Layering sludge is seen within the gallbladder, which is mildly distended. There is no evidence of 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. Unchanged subcentimeter hypodensities in the right kidney are too small to fully characterize, but likely represent cysts. Bilateral parapelvic cysts are also unchanged. There is no evidence of hydronephrosis. There is no perinephric abnormality. GASTROINTESTINAL: There is a small hiatal hernia. The stomach is under distended, but grossly normal. No evidence of small bowel obstruction. Patient is status post sigmoidectomy, colostomy, and creation of ___ pouch. There is no evidence of extraluminal contrast or intra-abdominal free air to suggest the presence of a perforation. Patient is status post placement of a pigtail drainage catheter within a peripherally rim enhancing perisplenic fluid collection, which appears slightly decreased in size, now measuring approximately 13.2 x 2.6 cm (601b:47), previously 13.5 x 5.1 cm. The pigtail formation of the catheter appears somewhat buckled. There has been increase in simple mesenteric free fluid within the left upper quadrant (2:48). A collection of fluid in the pelvis with thin, incomplete peripheral enhancement (2:77) has decreased in size over the interval. Multiple additional smaller foci of fluid with thin peripheral enhancement are also present, but have also decreased in size. PELVIS: There is air within the urinary bladder, compatible with recent Foley catheter use. REPRODUCTIVE ORGANS: Coarse calcifications are seen within the prostate gland. LYMPH NODES: Multiple enlarged retroperitoneal and mesenteric lymph nodes are again seen, grossly unchanged the prior CT. There is no pelvic or inguinal lymphadenopathy. VASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic disease is noted. BONES: A lucent lesion within the right iliac bone is unchanged. No acute fracture. SOFT TISSUES: There is a fat containing left inguinal hernia. Note is made of diffuse anasarca. IMPRESSION: 1. Status post placement of pigtail drainage catheter within a peripherally rim enhancing perisplenic fluid collection, which has decreased in size. The pigtail formation of the catheter appears somewhat buckled. Recommend correlation with catheter output and its ability to be flushed. 2. Interval increase in simple free mesenteric fluid. 3. Interval decrease in size of the collection of fluid in the pelvis with thin, incomplete peripheral enhancement. 4. No evidence of extraluminal contrast or intra-abdominal free air to suggest the presence of a perforated viscus. 5. Moderate bilateral pleural effusions with adjacent atelectasis appears similar to prior. RECOMMENDATION(S): Status post placement of pigtail drainage catheter within a peripherally rim enhancing perisplenic fluid collection, which has decreased in size. The pigtail formation of the catheter appears somewhat buckled. Recommend correlation with catheter output and its ability to be flushed. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the ___ ___ at 2:52 ___, 10 minutes after discovery of the findings.
10100035-RR-12
10,100,035
20,559,195
RR
12
2110-05-02 14:38:00
2110-05-02 15:46:00
INDICATION: ___ year old man with fluid collection in pelvis // please drain pelvic fluid collection COMPARISON: CT from ___ PROCEDURE: Ultrasound-guided drainage of left lower quadrant collection. OPERATORS: Dr. ___ trainee and Dr. ___ radiologist. Dr. ___ supervised the trainee during the key components of the procedure and reviewed and agree with the trainee's findings. TECHNIQUE: The risks, benefits, and alternatives of the procedure were explained to the patient. After a detailed discussion, informed written consent was obtained. A pre-procedure timeout using three patient identifiers was performed per ___ protocol. The patient was placed in a supine position on the US scan table. Limited preprocedure ultrasound was performed to localize the collection. Based on the ultrasound findings an appropriate skin entry site for the drain placement was chosen. The site was marked. Local anesthesia was administered with 1% Lidocaine solution. Using continuous sonographic guidance, ___ Exodus drainage catheter was advanced via trocar technique into the collection. A sample of fluid was aspirated, confirming catheter position within the collection. The pigtail was deployed. The position of the pigtail was confirmed within the collection via ultrasound. Approximately 60 cc of serosanguineous fluid was drained with a sample sent for microbiology evaluation. The catheter was secured by a StatLock. The catheter was attached to suction bulb. Sterile dressing was applied. The procedure was tolerated well, and there were no immediate post-procedural complications. SEDATION: Moderate sedation was provided by administering divided doses of 2 mg Versed and 100 mcg fentanyl throughout the total intra-service time of 15 minutes during which patient's hemodynamic parameters were continuously monitored by an independent trained radiology nurse. FINDINGS: A complex fluid collection in the left lower quadrant. IMPRESSION: Successful US-guided placement of ___ pigtail catheter into the collection. Samples was sent for microbiology evaluation.
10100035-RR-13
10,100,035
20,559,195
RR
13
2110-05-04 09:59:00
2110-05-04 11:29:00
EXAMINATION: CHEST (PORTABLE AP) INDICATION: ___ year old man with increased resp effort // Please evaluate for interval change TECHNIQUE: Portable chest COMPARISON: ___ FINDINGS: Compared to the prior study there is no significant interval change. IMPRESSION: No change.
10100035-RR-15
10,100,035
20,559,195
RR
15
2110-05-07 08:08:00
2110-05-07 10:18:00
INDICATION: ___ year old man with fever to ___ s/p ___ procedure c/b peritoneal fluid collection // ?PNA may take as first routine scan at 0800 FINDINGS: Opacification at the lung bases is largely moderate atelectasis on the right, combination of moderate left pleural effusion and moderate atelectasis on the left. Upper lungs clear. Heart size normal. No pneumothorax. No pneumoperitoneum. Left of diaphragmatic pleural drain in similar position, of of known peritoneal collection. IMPRESSION: Moderate left effusion with moderate bibasal opacities have not been placed changed, given the adjacent sub phrenic intra-abdominal collection, there is concern for infected left pleural effusion.
10100035-RR-16
10,100,035
20,559,195
RR
16
2110-05-07 13:21:00
2110-05-07 15:44:00
EXAMINATION: CT scan of the abdomen and pelvis INDICATION: ___ with perforated colorectal cancer c/b multiple collections s/p drainage now with fevers // **PO contrast please**please evaluate for intra-abdominal collection or pneumonia. TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired through the abdomen and pelvis following intravenous contrast administration with split bolus technique. IV Contrast: 130 mL Omnipaque. Oral contrast was administered. Coronal and sagittal reformations were performed and reviewed on PACS. DOSE: Acquisition sequence: 1) CT Localizer Radiograph 2) CT Localizer Radiograph 3) Stationary Acquisition 5.0 s, 0.5 cm; CTDIvol = 24.1 mGy (Body) DLP = 12.0 mGy-cm. 4) Spiral Acquisition 6.8 s, 74.9 cm; CTDIvol = 15.9 mGy (Body) DLP = 1,192.5 mGy-cm. Total DLP (Body) = 1,204 mGy-cm. COMPARISON: CT from ___ FINDINGS: LOWER CHEST: There are moderate bilateral pleural effusions. Please refer to separate report of CT chest performed on the same day for more detailed description of the thoracic findings. 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. There is a moderate amount of free intra-abdominal fluid with associated omental stranding, not significantly changed when compared to previous. Given the underlying malignancy, focal omental disease is difficult to exclude. Recommend re-evaluation with CT once the acute episode resolves. A small pocket of this appears slightly more well organized in the right lower quadrant, with associated adjacent enhancement of the peritoneum, compatible with peritonitis. A 10.2 x 3.7 ___ splenic collection is seen in the left upper quadrant, minimally decreased in size when compared to the prior. A pigtail catheter is seen within this collection. A smaller 1.5 x 1.7 cm collection is seen within the mesentery. This has decreased in size from prior where it measured 2.2 x 2.6 cm. It is not drainable at this time. The patient's previously seen collection above the bladder as demonstrated significant decrease in size, now measuring only 1 cm in craniocaudal dimension, previously it measured up to 4.3 cm. A pigtail catheter is seen in appropriate position with respect to this collection. This collection is in close contact with the rectosigmoid sutures. A small thread of a collection is seen inferior to the liver along the right peritoneum/cirrhosis fascia. It measures 4 mm in thickness and extends over approximately 4.5 cm. It is almost completely collapsed. It has shown minimal improvement when compared to previous. PANCREAS: The pancreas has normal attenuation throughout, without evidence of focal lesions or pancreatic ductal dilatation. There is no peripancreatic stranding. SPLEEN: The spleen shows normal size and attenuation throughout, without evidence of focal lesions. ADRENALS: The right and left adrenal glands are normal in size and shape. URINARY: The kidneys are of normal and symmetric size with normal nephrogram. There is no evidence of focal renal lesions or hydronephrosis. There is no perinephric abnormality. GASTROINTESTINAL: Patient is status post ___ procedure with a left lower quadrant end colostomy, and sutured off rectosigmoid stump. The rectosigmoid suture line is in close approximation to the pelvic collection lying above the bladder as detailed above. There is minimal wall thickening of a few jejunal loops, likely reactive to the underlying ascites. Remainder of the visualized small and large bowel loops are unremarkable. PELVIS: The urinary bladder and distal ureters are unremarkable. There is a Foley catheter is seen with tip in the bladder, with moderate amount of gas within the bladder. There is no free fluid in the pelvis. LYMPH NODES: Increased number of subcentimeter retroperitoneal lymph nodes, likely reactive. VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease is noted. BONES: There is no evidence of worrisome osseous lesions or acute fracture. SOFT TISSUES: There is diffuse subcutaneous edema seen, otherwise the soft tissue structures of the abdomen and pelvis are unremarkable. IMPRESSION: 1. Improvement in the organized collection lying above the bladder as detailed above. It measures 1 cm in craniocaudal dimension, previously 4.3 cm. It is in close contact with the rectal stump. 2. Minimal improvement in the left upper quadrant collection. 3. Moderate amount of free intra abdominal fluid with peritoneal enhancement compatible with peritonitis. It is difficult to exclude omental disease in a patient with moderate amount of ascites, and correlation with dedicated CT scan is recommended once the acute episode resolves to exclude any omental pathology. 4. No new collections.
10100035-RR-17
10,100,035
20,559,195
RR
17
2110-05-07 13:51:00
2110-05-07 15:37:00
EXAMINATION: Chest CT INDICATION: Colorectal cancer, drainage, fevers, assessment of the patient for the recent of fever. TECHNIQUE: MDCT of the chest was obtained from thoracic inlet to upper abdomen. Axial images were reviewed in conjunction with coronal and sagittal reformats COMPARISON: Chest radiograph from ___ and CT abdomen from ___ FINDINGS: Aorta and pulmonary arteries are normally enhanced. Large diverticulum of the esophagus (potentially 3 is demonstrated in the upper esophagus, series 2, image 5, 9. Multiple small mediastinal lymph nodes are present, none of them pathologically enlarged. Main pulmonary artery is 3.2 cm in diameter. Heart size is not enlarged. There is small amount of pericardial fluid. Bilateral pleural effusions are large, similar to previous CT abdomen. Associated bibasal consolidations are mall likely to represent atelectasis than infectious process such as pneumonia although it cannot be entirely excluded. Airways are patent to the subsegmental level bilaterally with bibasal compression of the airways by atelectasis and fluid. There are no lytic or sclerotic lesions worrisome for infection or neoplasm. IMPRESSION: No definitive evidence off infectious process within the chest. Bibasal atelectasis and large bilateral pleural effusions. Multiple lymph nodes, none of them specifically pathologically enlarged. Multiple esophageal diverticula.
10100035-RR-18
10,100,035
20,559,195
RR
18
2110-05-08 11:12:00
2110-05-08 16:35:00
EXAMINATION: CT interventional procedure. INDICATION: ___ year old man with undrained persiplenic collection s/p ___ drainage of multiple abdominal drains s/p ___ procedure. Drainage vs. upsizing of parasplenic collection COMPARISON: CT abdomen/ pelvis ___. PROCEDURE: CT-guided aspiration of 3 abdominal collections. OPERATORS: Dr. ___ resident, Dr. ___ fellow, and Dr. ___ radiologist. Dr. ___ supervised the trainee during the key components of the procedure and reviewed and agrees with the trainee's findings. TECHNIQUE: The risks, benefits, and alternatives of the procedure were explained to the patient. After a detailed discussion, informed written consent was obtained. A pre-procedure timeout using three patient identifiers was performed per ___ protocol. The patient was placed in a supine position on the CT scan table. Limited preprocedure CT scan was performed to localize the collections. Additionally, targeted perisplenic ultrasound demonstrated a heterogeneously echogenic collection, likely containing multiple thick septations. Based on the CT findings an appropriate skin entry site for the aspiration was chosen. The 3 sites were marked. Site 1- Right lower quadrant: Local anesthesia was administered with 1% Lidocaine solution. Using intermittent CT fluoroscopic guidance, an 18-G ___ needle was inserted into the collection. A sample of fluid was aspirated, confirming needle position within the collection. Approximately 10 cc of serous fluid was aspirated with the sample sent for microbiology evaluation. Given the serous nature of the fluid the needle was removed and pressure was applied. Our attention was then turned to site 2. Site 2- Mesenteric fluid: Local anesthesia was administered with 1% Lidocaine solution. Using intermittent CT fluoroscopic guidance, an 18-G ___ needle was inserted into the collection. A sample of fluid was aspirated, confirming needle position within the collection. Approximately 10 cc of serous fluid was aspirated with the sample sent for microbiology evaluation. Given the serous nature of the fluid the needle was removed and pressure was applied. Our attention was then turned to site 3. Site 3- Perisplenic collection: Local anesthesia was administered with 1% Lidocaine solution. Using intermittent CT fluoroscopic guidance, an 18-G ___ needle was inserted into the collection just adjacent to the previously placed drain with tip pointing superiorly. No fluid was aspirated with suction. Subsequently, a 0.038 ___ wire was advanced into the catheter which persistently coiled within along the inferior aspect of the collection suggestive of septations. A small sample of serous fluid was aspirated, confirming needle position within the collection. Approximately 2 cc of serous fluid was aspirated with sample sent for microbiology evaluation. Sterile dressing was applied to all 3 sites. The previously placed perisplenic catheter was secured by a StatLock and sterile dressing was applied. The procedure was tolerated well, and there were no immediate post-procedural complications. DOSE: Acquisition sequence: 1) CT Localizer Radiograph 2) CT Localizer Radiograph 3) Spiral Acquisition 13.4 s, 41.1 cm; CTDIvol = 17.2 mGy (Body) DLP = 682.8 mGy-cm. 4) Stationary Acquisition 9.8 s, 1.4 cm; CTDIvol = 100.1 mGy (Body) DLP = 144.2 mGy-cm. Total DLP (Body) = 841 mGy-cm. SEDATION: Sedation was provided by administering divided doses of 2 mg Versed throughout the total intra-service time of 40 minutes during which patient's hemodynamic parameters were continuously monitored by an independent trained radiology nurse. FINDINGS: CT: 1. Partially organized collection in right lower quadrant adjacent to the ascending colon. 2. Moderate amount of free intraperitoneal fluid. 3. Persistent perisplenic collection with drainage catheter coiled within inferior aspect. Targeted perisplenic ultrasound: Heterogeneously echogenic perisplenic collection with likely thick internal septations. IMPRESSION: 1. Aspiration of right lower quadrant, mesenteric, and perisplenic fluid with return of serous fluid. Samples was sent for microbiology evaluation. No new drain placement. 2. Collections in the right lower quadrant and perisplenic collection are septated.
10100035-RR-8
10,100,035
20,559,195
RR
8
2110-04-23 10:08:00
2110-04-23 12:05:00
EXAMINATION: CHEST (PORTABLE AP) INDICATION: ___ year old man s/p ___ procedure, with tachycardia and increased oxygen requirement // Pneumonia vs. effusion vs. atelectasis vs. other intrathoracic process Pneumonia vs. effusion vs. atelectasis vs. other intrathoracic process COMPARISON: No prior chest radiographs available. IMPRESSION: Opacification at the lung bases is largely moderate atelectasis on the right, combination of moderate left pleural effusion and moderate atelectasis on the left. Upper lungs clear. Heart size normal. No pneumothorax. No pneumoperitoneum.
10100035-RR-9
10,100,035
20,559,195
RR
9
2110-04-26 20:44:00
2110-04-26 21:36:00
EXAMINATION: CT ABD AND PELVIS WITH CONTRAST INDICATION: ___ year old man POD4 for ex lap, ___ procedure. Evaluate for obstruction, ileus, intra-abdominal process. TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired through the abdomen and pelvis following intravenous contrast administration with split bolus technique. IV Contrast: 130 mL Omnipaque. Oral contrast was not administered. Coronal and sagittal reformations were performed and reviewed on PACS. DOSE: Total DLP (Body) = 1,011 mGy-cm. COMPARISON: CT abdomen pelvis of ___. FINDINGS: LOWER CHEST: There are bilateral moderate sized nonhemorrhagic pleural effusions, with overlying compressive atelectasis. A component of consolidation cannot be excluded. 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 distended, but has a thin wall, and is similar in appearance to the prior CT. Dependent layering gallbladder sludge is identified. 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. Unchanged subcentimeter hypodensities in the right kidney are too small to characterize, but likely cysts. Bilateral peripelvic cysts are also unchanged. GASTROINTESTINAL: Patient is post exploratory laparotomy and ___ pouch. The unremarkable colostomy is identified in the left mid abdomen. There multiple loops of mildly dilated small bowel up to 3.7 cm, predominantly in the left mid abdomen. A gradual transition point is thought to occur on series 2, image 58 in the right mid abdomen. Distal to this, there are multiple loops of nondistended, more collapsed small and large bowel. In the interim, there has been development of multiple fluid collections of simple internal attenuation, although some of which are loculated and demonstrate thin enhancing rims. For instance, in the perisplenic region, there is a loculated fluid collection measuring approximately 13.5 x 11.9 cm with adjacent fat stranding (2:19, 601b:41). In the mid mesentery, 2 fluid collections measuring 6.1 x 2.0 cm (2:70) and 3.5 x 3.5 cm (2:64), respectively, are identified. Finally, in the midline lower pelvis, adjacent to the anastomotic suture line, there is a irregular fluid collection measuring approximately 9.8 x 7.2 cm (602b:48, 2:84). This also demonstrates a thin enhancing rim. A small amount of intra-abdominal ascites in the right paracolic gutter may be postsurgical in nature. PELVIS: The urinary bladder is collapsed around a Foley catheter. REPRODUCTIVE ORGANS: The prostate is mildly enlarged with multiple internal calcifications. LYMPH NODES: Multiple enlarged retroperitoneal mesenteric lymph nodes are again identified, and grossly unchanged since the prior CT. For example, a right mesenteric lymph node measuring 1.7 cm is unchanged (02:46). There is no pelvic or inguinal lymphadenopathy. VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease is noted. BONES: There is no evidence of worrisome osseous lesions or acute fracture. SOFT TISSUES: Except for midline surgical staples and a small fat containing left inguinal hernia, abdominal pelvic walls are grossly within normal limits. Diffuse soft tissue stranding likely relates to anasarca and volume overload. Left-sided small fat containing inguinal hernia. IMPRESSION: 1. Patient is post exploratory laparotomy and ___ pouch. Multiple loops of mildly dilated small bowel, up to 3.7 cm, are identified in the left mid abdomen. A gradual tapering transition point is thought to occur in the right mid abdomen (see series 2, image 58). Distal to this site, multiple loops of nondistended, more collapsed small and large bowel are identified. Findings are thought to represent postoperative although early obstruction might have this appearance as well. 2. Interval development of multiple fluid collections of simple internal attenuation, although some of which are loculated and demonstrate thin enhancing rims. For example, there is a 13.5 x 11.9 cm loculated-appearing perisplenic collection with adjacent fat stranding. A 9.8 x 7.2 cm irregular fluid collection in the midline lower pelvis, and 2 smaller mid mesenteric collections, are also present. 3. Bilateral nonhemorrhagic pleural effusions with overlying compressive atelectasis, likely postsurgical in nature. 4. No significant change in the previously described mesenteric and retroperitoneal lymphadenopathy. NOTIFICATION: The above findings were communicated via telephone by Dr. ___ to Dr. ___ at 21:20 on ___, 1 min after discovery.
10100342-RR-22
10,100,342
20,148,204
RR
22
2167-09-21 20:54:00
2167-09-21 21:12:00
EXAMINATION: CHEST (AP AND LAT) INDICATION: History: ___ with SOB, decreased breath sounds R base// PNA? TECHNIQUE: Upright AP and lateral views of the chest COMPARISON: Chest radiograph ___ FINDINGS: A moderate to large right pleural effusion has increased in the interval. There is associated right basilar opacification likely reflective of compressive atelectasis. Patchy atelectasis is also seen in the left lung base. Cardiac and mediastinal contours appear grossly unchanged. No pulmonary edema or pneumothorax. No acute osseous abnormality. IMPRESSION: Increased size of right pleural effusion, now moderate to large, with right basilar compressive atelectasis. Infection in the right lung base is difficult to exclude. Mild left basilar atelectasis.
10100342-RR-23
10,100,342
20,148,204
RR
23
2167-09-21 23:40:00
2167-09-22 00:21:00
EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN) INDICATION: History: ___ with cirrhosis, new effusion. Evaluate for portal vein thrombosis. TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were obtained. COMPARISON: Outside hospital CT abdomen performed ___. Abdominal ultrasound performed ___. FINDINGS: LIVER: The hepatic parenchyma appears coarsened. The contour of the liver is smooth. There is no focal liver mass. The main portal vein is patent with hepatopetal flow. The left portal vein is patent with hepatopetal flow. The right portal vein is not visualized. There is moderate volume ascites. Again demonstrated is a 14.6 x 5.7 x 9.0 cm perihepatic anechoic collection with septations corresponding to the collection seen on the recent outside hospital CT abdomen pelvis. This previously measured 12.8 x 5.3 x 11.3 cm on most recent prior abdominal ultrasound. Right-sided pleural effusion is noted. BILE DUCTS: There is no intrahepatic biliary dilation. CHD: 2 mm GALLBLADDER: The gallbladder wall is slightly thickened, likely secondary to fluid third spacing. No evidence of gallstones. 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: Unremarkable echogenicity. Spleen length: 18.0 cm, similar to prior. KIDNEYS: Limited views of the kidneys show no hydronephrosis. RETROPERITONEUM: The visualized portions of aorta and IVC are within normal limits. IMPRESSION: 1. Redemonstration of a 14.6 cm perihepatic anechoic collection, slightly increased in size compared to prior abdominal ultrasound performed ___, and better assessed on the same-day abdominal CT. Findings may reflect loculated ascites in the setting of background moderate volume ascites 2. Patent main portal vein and left portal vein. The right portal vein is not visualized, but appears pain on the same-day abdominal CT. 3. Cirrhotic liver without evidence for a focal lesion. 4. Unchanged splenomegaly, which along with the ascites is consistent with portal hypertension. 5. Right pleural effusion.
10100342-RR-24
10,100,342
20,148,204
RR
24
2167-09-22 15:33:00
2167-09-22 16:53:00
EXAMINATION: Diagnostic and therapeutic paracentesis INDICATION: ___ year old man with cirrhosis p/w recurrent loculated ascites// Paracentesis COMPARISON: Abdominal ultrasound ___. FINDINGS: Limited grayscale ultrasound imaging of the abdomen demonstrated loculated ascites in the upper mid abdomen. A suitable target in the deepest pocket in the upper mid abdomen was selected for paracentesis. PROCEDURE: Ultrasound guided diagnostic and therapeutic paracentesis Location: Upper mid abdomen Fluid: 620 cc of clear, straw-colored fluid Samples: Fluid samples were submitted to the laboratory the requested analysis (chemistry, hematology, microbiology). 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. Ascites fluid was aspirated via a 6 ___ pigtail catheter advanced into the loculated fluid pocket. The patient tolerated the procedure well without immediate complication. Estimated blood loss was minimal. Dr. ___ 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. 620 cc of fluid were removed and sent for requested analysis.
10100342-RR-25
10,100,342
20,148,204
RR
25
2167-09-22 20:17:00
2167-09-22 22:36:00
EXAMINATION: Chest radiograph, portable AP upright INDICATION: Right pleural effusion. COMPARISON: ___. FINDINGS: Right-sided pleural effusion has resolved. No evidence of pneumothorax. Minimal right basilar atelectasis. Otherwise, no significant change. IMPRESSION: Status post right thoracentesis.
10100810-RR-35
10,100,810
26,011,156
RR
35
2169-03-06 16:24:00
2169-03-06 17:32:00
INDICATION: Swelling and redness of the chest. Evaluate for infection. COMPARISONS: Chest radiograph, ___. CT chest, ___. FINDINGS: The lungs are clear without consolidation or edema. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is normal. There has been interval removal of the left PICC. The soft tissues are not well evaluated, but no gross abnormality or subcutaneous air is identified. IMPRESSION: No acute cardiopulmonary process.
10100810-RR-36
10,100,810
26,011,156
RR
36
2169-03-08 10:56:00
2169-03-08 15:43:00
INDICATION: ___ man with swollen left lower leg. Evaluate for DVT. COMPARISON: No previous exam for comparison. FINDINGS: Grayscale, color and Doppler images were obtained of the left common femoral, femoral, popliteal and tibial veins. Normal flow, compression and augmentation is seen in all of the vessels. IMPRESSION: No evidence of deep vein thrombosis in the left leg.
10100810-RR-37
10,100,810
26,011,156
RR
37
2169-03-08 16:28:00
2169-03-08 19:12:00
INDICATION: ___ man status post resection of sternoclavicular joint and first rib for osteomyelitis. Assess for edema or pneumothorax. COMPARISONS: Chest radiograph from ___. Portable upright radiograph was obtained. Surgical packing material projects over the operative site without pneumothorax. The lungs are clear with normal heart size and mediastinal contours.
10100810-RR-38
10,100,810
26,011,156
RR
38
2169-03-13 14:59:00
2169-03-13 16:25:00
TYPE OF EXAMINATION: Chest AP portable single view. INDICATION: ___ male patient with new PICC line from left side. Check position. FINDINGS: AP single view of the chest has been obtained with patient in sitting semi-upright position. Comparison is made with the next preceding portable chest examination of ___. On the present examination, the patient has received a left-sided PICC line which is well identified and seen to terminate in the lower third of the SVC just above the expected entrance into the right atrium. No pneumothorax or any other placement-related complication is identified. Previously detectable postoperative packing following right sternoclavicular resection has been removed. Paged Dr. ___ to ___ at 4:10 p.m. as requested.
10100918-RR-6
10,100,918
27,236,715
RR
6
2179-08-27 14:42:00
2179-08-27 15:05:00
HISTORY: Chest pain for 3 weeks, escalating in frequency and intensity. Evaluation for possible dissection. TECHNIQUE: MDCT images were obtained through the thorax during the dynamic intravenous injection of 100 cc of Omnipaque contrast, injected at a rate of 4 cc/second. Re-formatted coronal, sagittal and oblique images were reviewed. COMPARISON: Comparison is made to renal ultrasound from ___. FINDINGS: CTA THORAX: The aorta and great vessels are well opacified with no evidence of aneurysmal formation, intramural hematoma or dissection. The intrathoracic aorta is of normal caliber throughout. The pulmonary arteries are well opacified to the subsegmental level with no evidence of filling defects within the main, right, left, lobar, segmental or subsegmental pulmonary arteries. There is no evidence of right heart strain. CT THORAX: The airways are patent to the subsegmental level. There is no axillary, hilar or mediastinal lymph node enlargement. No pleural or pericardial effusion is present. Lung windows demonstrate no evidence of focal opacity within the lungs. The thyroid gland enhances homogeneously. The esophagus is unremarkable. Although this study is not designed for evaluation of subdiaphragmatic structures, there is a partially imaged intermediate density complex cyst within the upper pole of the left kidney, previously identified on renal ultrasound from ___. Otherwise, the visualized solid organs and stomach are unremarkable. OSSEOUS STRUCTURES: No lytic or blastic lesions suspicious for malignancy is present. IMPRESSION: 1. No evidence of pulmonary embolism or aortic dissection. 2. Partially visualized intermediate density complex cyst within the upper pole of the left kidney for which follow up ultrasound is recommended to ensure stability from the prior ultrasound of ___.
10101070-RR-27
10,101,070
29,592,610
RR
27
2153-12-24 02:41:00
2153-12-24 04:47:00
INDICATION: Right upper quadrant pain and fever. COMPARISONS: CT of the abdomen and pelvis from ___. CT of the abdomen from ___. CT of abdomen and pelvis from ___. TECHNIQUE: Contiguous axial MDCT images were obtained through the abdomen and pelvis after the administration of IV contrast. Sagittal and coronal reformatted images were obtained and reviewed. FINDINGS: LUNG BASES: There is bibasilar atelectasis and minimal right pleural thickening, not significantly changed from the prior exam. The heart size is normal. There is no pericardial effusion. Severe atherosclerotic calcifications are noted along the coronary arteries. There is a prosthetic aortic valve. ABDOMEN: The liver is normal in shape and contour. There are no focal hepatic lesions. The portal vein is patent. The previously identified subcapsular fluid collection has resolved. An internal-external biliary drain appears to be in satisfactory position. Soft tissues around the drain are not included in the field of view. There is no intrahepatic biliary duct dilation. Evaluation of the common bile duct is obscured by artifact from the drains. Multiple stones are noted within the gallbladder. It is distended with hyperemia and surrounding stranding, most consistent with cholecystitis. Metallic metallic clips are seen in the first and second portions of the duodeum, unchanged from the prior exam, likely those described on recent endoscopy of ___. The spleen, adjacent splenule and adrenal glands are normal. There is fatty replacement of the pancreas. There are multiple cysts in the bilateral kidneys, which are stable to minimally complex, not significantly changed from prior imaging. These are best characterized on the prior ultrasound. No new renal lesions are identified. The kidneys enhance and excrete contrast symmetrically. There is no evidence of hydronephrosis. There is a small hiatal hernia. The stomach and small bowel are normal in course and caliber. There is no evidence of bowel obstruction. There is no free air or free fluid. There is no mesenteric or abdominal lymphadenopathy. The abdominal vasculature is normal in course and caliber. There is moderate-to-severe atherosclerotic disease along its course including at the origins of the celiac artery and SMA, there is mild narrowing. PELVIS: Sigmoid colon is redundant, though unremarkable. There is diverticulosis in the transverse colon. In the hepatic flexure, there is surrounding stranding as it runs below the gallbladder which is most likely secondary inflammation from cholecystitis. The bladder is unremarkable. The prostate is enlarged measuring up to 5.6 cm. There is no pelvic or inguinal lymphadenopathy. There is no free fluid in the pelvis. OSSEOUS STRUCTURES: Cortical thickening and medullary irregularity in the right hemipelvis and multiple vertebral bodies is unchanged and consistent with Paget's disease. Moderate multilevel degenerative changes are present in the lumbar spine. A small sclerotic focus in the right femoral neck is unchanged. No fracture is identified. IMPRESSION: 1. Cholelithiasis with distention of the gallbladder, gallbladder wall hyperemia and significant surrounding stranding is most consistent with cholecystitis. 2. Stranding in the transverse colon as it courses by the gallbladder is most likely secondary inflammation. Diverticulitis is a consideration given the diverticulosis in the region, though this is thought to be less likely. 3. Satisfactory position of the internal-external intrahepatic biliary drain. No intrahepatic biliary duct dilation. 4. Unchanged bilateral simple and minimally complex renal cysts. 5. Unchanged appearance of Paget's disease.
10101070-RR-28
10,101,070
29,592,610
RR
28
2153-12-24 04:36:00
2153-12-24 11:11:00
INDICATION: Fever and right upper quadrant pain. Evaluation of left IJ catheter placement. COMPARISON: ___. FINDINGS: Portable AP chest radiograph. Left-sided IJ catheter tip is in the mid SVC. Median sternotomy wires are intact. Prosthetic aortic valve is in similar position. Lung volumes are still low with bibasilar atelectasis and a small pleural effusion on the right. However, there is no interstitial edema. The cardiomediastinal silhouette is stable. IMPRESSION: 1. Left-sided IJ catheter tip is in the mid SVC. 2. Bibasilar atelectasis and small right pleural effusion.
10101070-RR-29
10,101,070
29,592,610
RR
29
2153-12-24 06:56:00
2153-12-24 15:21:00
HISTORY: ___ male with history of prior episodes of cholangitis now presenting with fever and right upper quadrant pain, CT demonstrating findings suggestive of acute cholecystitis. Patient presents for percutaneous cholecystostomy tube placement. COMPARISON: CT from earlier the same day. Operators: Dr. ___, abdominal imaging fellow, and Dr. ___ ___ radiologist. FINDINGS: Limited ultrasound imaging of the right upper quadrant with attention to the gallbladder was performed demonstrating multiple gallstones, wall thickening, and wall edema suggestive of acute cholecystitis. Given these findings and in conjunction with prior CT a diagnosis of acute cholecystitis was made and decision was made to proceed with percutaneous cholecystostomy tube placement. PROCEDURE: The patient was unable to consent for himself due to baseline dementia. Therefore, informed consent was obtained via telephone from the patient's son ___ after the risks, benefits, and alternatives of the procedure were explained. After consent was obtained and a time-out procedure was performed, an approach for cholecystostomy tube placement was determined and mark was placed on the skin at the desired entry site in the right upper quadrant. The skin entry site was prepped and draped in the usual sterile fashion. The skin and soft tissues were anesthetized with 5 mL 1% lidocaine. A small skin incision was created through which an ___ cholecystostomy tube was then advanced into the gallbladder under ultrasound guidance using trocar technique. Approximately 100 mL of bilious fluid was removed and a sample was sent to the lab for microbiology. The catheter was attached to gravity drainage, a Stat lock device and a sterile dressing were applied. There were no immediate complications and the patient's care was subsequently resumed by the ICU team. Medications: 25 mcg of fentanyl and 0.5 mg of Versed were administered IV. IMPRESSION: Successful 8 ___ percutaneous cholecystostomy tube placement under ultrasound guidance. A fluid sample was sent to the lab for microbiologic analysis.
10101070-RR-32
10,101,070
29,592,610
RR
32
2153-12-25 03:47:00
2153-12-25 11:14:00
HISTORY: ___ male with acute cholecystitis in septic shock, requiring pressors. Please evaluate for pulmonary pneumonia and volume overload. TECHNIQUE: Portable AP semi supine chest radiograph was obtained. COMPARISON: Chest radiograph from ___. FINDINGS: Lung volumes continue to be low, and mild bilateral effusions and interstitial edema have increased since ___. Heart size is normal and the lungs are clear of focal consolidation. Left IJ central venous line ends in the mid SVC, and the median sternotomy wires are intact. Right upper quadrant drainage catheter is seen in the abdomen. IMPRESSION: Increasing bilateral pleural effusions and interstitial edema. No consolidation to suggest pneumonia.
10101070-RR-33
10,101,070
29,592,610
RR
33
2153-12-26 16:37:00
2153-12-26 18:30:00
HISTORY: ___ male with cholangitis in the setting of choledocholithiasis and failed ERCP. Followup cholangiogram requested. COMPARISON: Biliary catheter check ___ OPERATORS: Dr. ___ (atending physician) and Dr. ___ (fellow). The attending physician was present throughout the entirety of the procedure. Anesthesia: Moderate sedation was provided by administering divided doses of fentanyl and Versed throughout the total intra service time of 20 min. The patients hemodynamic parameters were continuously monitored. A total dose of 25 mcg of fentanyl and 0.5 mg of Versed and were used. 1% lidocaine was also used for local anesthesia. PROCEDURE: 1. Cholangiogram 2. Exchange of internal external biliary catheter over wire. FINDINGS: The procedure was discussed in detail with the patient and his son. ___ and benefits were emphasized. Informed written consent was obtained from the son. When the patient arrived in the angiography suite they were placed supine on the procedure table. A pre-procedure timeout was performed per ___ protocol. The region of the biliary drain was prepped and draped in usual sterile fashion. 1% local lidocaine was used for anesthesia. Initial cholangiogram demonstrated the catheter in proper positioning with free-flowing contrast into the duodenum. The biliary catheter was cut and ___ wire passed through the catheter, coiling distally in the duodenum. The old catheter was removed over the wire and a new ___ F modified biliary drain (with 2 extra side holes proximal to the radio-opaque marker) was placed under fluoroscopic guidance. The distal end was formed in the duodenum. The peripheral side hole was in appropriate position. The biliary catheter was sutured to the skin and sterile dressings were applied. The patient left the department in stable condition. No complications. IMPRESSION: Successful replacement of ___ biliary catheter over a wire. The catheter should be exchanged in 3 months.
10101070-RR-34
10,101,070
29,592,610
RR
34
2153-12-29 12:58:00
2153-12-29 14:09:00
PORTABLE CHEST, ___ COMPARISON: ___ radiograph. FINDINGS: Left internal jugular central venous catheter terminates at the junction of the left brachiocephalic vein and superior vena cava but does not make the expected downward turn within the SVC. Cardiomediastinal contours are within normal limits for technique. The lung volumes are low. Improved aeration at both lung bases with residual minor atelectasis remaining as well as small pleural effusions, right greater than left.
10101070-RR-35
10,101,070
29,592,610
RR
35
2153-12-30 09:39:00
2153-12-30 12:14:00
HISTORY: New right PICC, eval placement. COMPARISON: ___. FINDINGS: Portable single frontal chest radiograph was obtained with patient in upright position. A right PICC line terminates in the mid SVC. There is no evidence of complication or pneumothorax. No focal consolidation, pleural effusion, or pulmonary edema is seen. Heart size is normal. Mediastinal contours are normal. There is sclerosis and trabecular thickening of the right humeral head, consistent with patient's history of Paget's disease. IMPRESSION: Right PICC line in the mid SVC. Findings were communicated with ___ by ___ telephone at time of observation at 09:50 on ___.
10101070-RR-36
10,101,070
29,592,610
RR
36
2153-12-31 10:36:00
2153-12-31 11:14:00
HISTORY: ___ man with acute cholecystitis, PTC drain with minimal output and new onset of right upper quadrant pain. COMPARISON: Ultrasound-guided gallbladder drainage ___. FINDINGS: The percutaneous cholecystostomy drain is identified in the right upper quadrant and appears to be in place in the gallbladder. The gallbladder is not distended. The gallbladder contains numerous stones and sludge. There is no biliary dilatation identified. No fluid collection is identified. No pericholecystic fluid is seen. The portal vein is patent with hepatopetal flow. IMPRESSION: Percutaneous cholecystostomy drain in proper position within the gallbladder. The gallbladder is not distended but contains stones and sludge. There is no biliary dilatation and no fluid collection identified.
10101282-RR-14
10,101,282
25,540,971
RR
14
2161-11-06 16:51:00
2161-11-06 17:37:00
EXAMINATION: CHEST (PORTABLE AP) INDICATION: ___ with likely nephrolithiasis, difficult peripheral access, has a port// port placement confirmation so we can access it COMPARISON: Prior chest radiograph dated ___ FINDINGS: AP portable upright view of the chest. Left chest wall Port-A-Cath terminates in the mid SVC. No focal consolidation concerning for pneumonia. No large effusion or pneumothorax. Cardiomediastinal silhouette appears normal. Bony structures are intact. IMPRESSION: Port-A-Cath positioned with its tip in the mid SVC.