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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.
|
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