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10101282-RR-15 | 10,101,282 | 25,540,971 | RR | 15 | 2161-11-06 18:16:00 | 2161-11-06 19:23:00 | INDICATION: NO_PO contrast; History: ___ with left flank pain, dark urine,
history of nephrolithiasisNO_PO contrast// Nephrolithiasis?
TECHNIQUE: Multidetector CT images of the abdomen and pelvis were acquired
without intravenous contrast. Non-contrast scan has several limitations in
detecting vascular and parenchymal organ abnormalities, including tumor
detection.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: ERROR: unknown web service failure, please contact ___
COMPARISON: None.
FINDINGS:
LOWER CHEST: Mild bilateral basilar atelectasis is seen. There is no evidence
of pleural or pericardial effusion.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout.
There is no evidence of focal lesions within the limitations of an unenhanced
scan. There is no evidence of intrahepatic or extrahepatic biliary
dilatation. The gallbladder is within normal limits.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions within the limitations of an unenhanced scan. There is no
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. Ill-defined
hypodensities in the left kidney may represent cysts but are difficult to
completely assess (4:33, 4:32, 4:34). There is equivocal minimal asymmetric
left perinephric stranding. In the inferior pole, a oval hypodensity measures
13 mm and 10 Hounsfield units which likely represents a simple cyst (03:34).
There is no evidence of focal right renal lesions within the limitations of an
unenhanced scan. There is no hydronephrosis. There is no nephrolithiasis.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber and wall thickness throughout. Diverticulosis of the sigmoid
colon is noted, without evidence of wall thickening or fat stranding. The
appendix is normal.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease
is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. Equivocal minimal asymmetric left perinephric stranding. Ill-defined
incompletely assessed hypodensities in the upper pole of the left kidney,
which could represent cysts, but pyelonephritis might have a similar
appearance. Recommend correlation with urinalysis and physical exam.
2. No evidence of urolithiasis or hydronephrosis. Normal appendix.
|
10101287-RR-16 | 10,101,287 | 29,602,007 | RR | 16 | 2155-07-01 11:03:00 | 2155-07-01 12:08:00 | INDICATION: Recent laparoscopic cholecystectomy with epigastric pain.
No comparison studies available.
TECHNIQUE: Ultrasonography of the abdomen.
FINDINGS: The liver echotexture is heterogeneous, which may reflect hepatic
steatosis. There is no focal intrahepatic lesion or intrahepatic bile duct
dilation. The main portal vein is patent, demonstrating proper hepatopetal
flow. The CBD is not dilated, measuring 5 mm in diameter. No proximal ductal
stones are detected. There is no free fluid. Limited views of the pancreatic
head and body are within normal limits. The pancreatic tail is obscured by
overlying bowel gas.
A single live intrauterine pregnancy is noted, demonstrating cardiac activity.
IMPRESSION:
1. No intrahepatic bile duct dilation. Normal caliber CBD. No proximal
ductal stones detected.
2. Coarsened liver echotexture, which may reflect hepatic steatosis. More
advanced disease such as cirrhosis or fibrosis cannot be excluded with this
technique.
|
10101287-RR-17 | 10,101,287 | 29,602,007 | RR | 17 | 2155-07-01 14:40:00 | 2155-07-03 08:59:00 | HISTORY: ___ woman three days post-lap cholecystectomy complaining of
symptoms and lab values consistent with CBD stones. Ultrasound normal. The
patient is ___ weeks pregnant.
TECHNIQUE: Multiplanar T1- and T2-weighted images were acquired on a 1.5
Tesla magnet. Intravenous gadolinium was not administered in view of the
patient's pregnant status.
COMPARISON: Ultrasound abdomen ___.
FINDINGS:
The liver is normal in contour and signal intensity. No focal liver lesions
are seen, although evaluation of the solid abdominal viscera is somewhat
limited in the absence of intravenous contrast. No intrahepatic duct
dilatation. The gallbladder is surgically absent. There is a tiny amount of
free fluid along the tip of the right lobe of the liver (6:15). The common
bile duct is not dilated measuring 4 mm. No intraluminal filling defects are
seen. The pancreatic duct is not dilated measuring 2 mm. The pancreas is
normal in signal intensity and morphology. The spleen is not enlarged
measuring 11.4 cm. Both adrenal glands and both kidneys are unremarkable in
appearance. No upper abdominal lymphadenopathy. No free fluid in the
abdomen. On the coronal T2-weighted images, the uterus is incompletely
visualized but is clearly distended with a single intrauterine gestation. The
visualized osseous structures are unremarkable.
IMPRESSION:
1. No biliary duct dilation or choledocholithiasis. No significant
postoperative fluid collection.
2. Single intrauterine gestation.
|
10101321-RR-26 | 10,101,321 | 26,537,257 | RR | 26 | 2191-03-26 12:11:00 | 2191-03-26 14:36:00 | EXAMINATION: CT abdomen and pelvis with contrast
INDICATION: ___ year old woman with history of breast cancer and now with new
brain mets. Please perform with IV and PO contrast. // Please evaluate for
metastatic disease.
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired
through the abdomen and pelvis following intravenous contrast administration
with split bolus technique.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 0.5 s, 0.4 cm; CTDIvol = 4.8 mGy (Body) DLP = 1.9
mGy-cm.
2) Stationary Acquisition 22.5 s, 0.2 cm; CTDIvol = 297.4 mGy (Body) DLP =
59.5 mGy-cm.
3) Spiral Acquisition 12.9 s, 68.4 cm; CTDIvol = 7.0 mGy (Body) DLP = 480.6
mGy-cm.
4) Spiral Acquisition 5.1 s, 26.9 cm; CTDIvol = 6.8 mGy (Body) DLP = 185.4
mGy-cm.
Total DLP (Body) = 727 mGy-cm.
COMPARISON: CT torso ___. .
FINDINGS:
LOWER CHEST: Please refer to separate report of CT chest performed on the same
day for description of the thoracic findings.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There is no evidence of focal lesions. There is no evidence of intrahepatic
or extrahepatic biliary dilatation. The gallbladder is within normal limits.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
There is no evidence of focal renal lesions or hydronephrosis. There is no
perinephric abnormality.
GASTROINTESTINAL: A small hiatal hernia is noted. Small bowel loops
demonstrate normal caliber, wall thickness, and enhancement throughout. The
colon and rectum are within normal limits. The appendix is normal.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: A 3.6 x 2.3 cm right adnexal cystic lesion, previously
measuring 2.8 x 1.6 cm in ___.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease
is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
Mild multilevel degenerative changes including L4-5 facet joint arthropathy
noted.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. No evidence of metastatic disease in the abdomen or pelvis.
2. A 3.6 cm right adnexal cystic lesion is increased in size since ___.
Recommend further evaluation with pelvic ultrasound.
RECOMMENDATION(S): Pelvic ultrasound.
|
10101321-RR-27 | 10,101,321 | 26,537,257 | RR | 27 | 2191-03-26 12:35:00 | 2191-03-26 17:45:00 | EXAMINATION: CT CHEST W/CONTRAST
INDICATION: ___ woman with history of breast cancer with new brain
metastasis. Assess for metastatic disease.
TECHNIQUE: Multidetector helical scanning of the chest/abdomen/ pelvis.
Chest images were reconstructed as contiguous 5- and 1.25-mm thick axial,
2.5-mm thick coronal and parasagittal, and 8 x 8 mm MIPs axial images.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 0.5 s, 0.4 cm; CTDIvol = 4.8 mGy (Body) DLP = 1.9
mGy-cm.
2) Stationary Acquisition 22.5 s, 0.2 cm; CTDIvol = 297.4 mGy (Body) DLP =
59.5 mGy-cm.
3) Spiral Acquisition 12.9 s, 68.4 cm; CTDIvol = 7.0 mGy (Body) DLP = 480.6
mGy-cm.
4) Spiral Acquisition 5.1 s, 26.9 cm; CTDIvol = 6.8 mGy (Body) DLP = 185.4
mGy-cm.
Total DLP (Body) = 727 mGy-cm.
** Note: This radiation dose report was copied from CLIP ___ (CT ABD AND
PELVIS WITH CONTRAST)
COMPARISON: Chest radiograph ___.
Second opinion CT torso ___.
FINDINGS:
NECK, THORACIC INLET, AXILLAE, CHEST WALL: Status post right mastectomy and
right axillary lymph node dissection with multiple right axillary clips and
associated postsurgical changes.No supraclavicular or left axillary lymph node
enlargement. The thyroid is normal.
UPPER ABDOMEN: Possible small hiatal hernia with distention of the distal
esophagus. Please refer to separate CT abdomen/ pelvis report for additional
findings.
MEDIASTINUM: Mediastinal lymph nodes are nonenlarged. No mediastinal mass or
hematoma.
HILA: Hilar lymph nodes are not enlarged.
HEART and PERICARDIUM: The heart is normal in size without pericardial
effusion. The thoracic aorta is normal in caliber without aneurysmal
dilatation.
PLEURA: No pleural effusion or pleural calcifications. Pleural thickening up
to 0.6 cm of the right minor fissure with adjacent bronchiectasis is noted.
LUNG:
-PARENCHYMA: Mild centrilobular emphysema with an apical predominance is
unchanged. New subpleural reticular right upper lobe parenchymal changes are
consistent with radiation induced fibrosis given proximity to radiation field.
0.4 cm left lower lobe pleural-based nodule (6:173) is stable. Additional
low-density (-3 ___ unit) 0.6 x 0.8 cm (6:144) left lower lobe
pulmonary nodule was 0.5cm in ___.
-AIRWAYS: Right middle and left lower lobe bronchiectasis with mild bronchial
wall thickening. The central airways are patent.
-VESSELS: The main pulmonary artery is normal in caliber and well opacified
to the segmental level without filling defect to suggest pulmonary embolism.
CHEST CAGE: No additional focal lytic or blastic lesions worrisome for
malignancy. Increased sclerosis with cortical irregularity and periosteal
reaction along the anterior right fourth rib is consistent with a subacute to
chronic rib fracture, new since ___.
IMPRESSION:
1. 0.8 cm low-density left lower lobe pulmonary nodule was 0.5 cm in ___.
Differential includes lung cyst, hamartoma, exogenous lipoid pneumonia, mixed
adenocarcinoma, and less likely metastatic lesion. Additional subcentimeter
pulmonary nodule is stable.
2. Right upper lobe radiation fibrosis.
3. Pleural thickening of right minor fissure with adjacent bronchiectasis.
Differential includes post radiation changes for which this is slightly
atypical given medial location and scarring from prior infection.
4. Left lower lobe bronchiectasis with bronchial wall thickening suggests
active infection such as ___.
5. Mild centrilobular emphysema.
RECOMMENDATION(S): Recommend 3 to 6 month follow-up CT chest to assess for
interval change of left lower lobe pulmonary nodule.
NOTIFICATION: The impression and recommendation above was entered by Dr.
___ on ___ at 17:43 into the Department of Radiology critical
communications system for direct communication to the referring provider.
|
10101340-RR-12 | 10,101,340 | 25,615,050 | RR | 12 | 2110-04-02 00:44:00 | 2110-04-02 08:43:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old man with chest pain on inspiration.// Any infiltrate?
IMPRESSION:
In comparison with the study of ___, the cardiomediastinal silhouette is
within normal limits and there is no evidence of vascular congestion or acute
focal pneumonia. The dense streaks of atelectasis at the left base have
cleared.
Shoulder prosthesis is seen on the left.
|
10101340-RR-14 | 10,101,340 | 25,615,050 | RR | 14 | 2110-04-02 00:47:00 | 2110-04-02 18:49:00 | INDICATION: ___ year old man with abd pain, no bowel sounds//
ileus/obstruction
TECHNIQUE: Supine abdominal radiograph was obtained.
COMPARISON: CTA abdomen and pelvis ___
FINDINGS:
No bowel obstruction is identified.
Supine assessment limits detection for free air; there is no gross
pneumoperitoneum. Moderate amount of fecal loading is noted. Stomach is is
moderately distended, similar to prior CT.
IMPRESSION:
Distended stomach is similar to prior CT from ___. No small bowel
obstruction
|
10101340-RR-15 | 10,101,340 | 25,615,050 | RR | 15 | 2110-04-04 00:03:00 | 2110-04-04 08:56:00 | EXAMINATION: MR ___ SPINE W/O CONTRAST ___ MR SPINE
INDICATION: ___ year old man with ___ shooting pains down right leg. Most
prominent in L4-L5 distribution. Recent Abd CT read as prominent fat stranding
mesenteric panniculitis vs lymphoma.// Is there evidence of spinal cord or
nerve root compression? Is there evidence of spinal cord or nerve root
compression?
TECHNIQUE: Sagittal imaging was performed with T2, T1, and STIR technique,
followed by axial T2 imaging.
COMPARISON: CT of the abdomen and pelvis dated ___.
FINDINGS:
Mild retrolistheses of L1 on L 2, L2 on L3, L3 on L4 and L4 on L5 are seen.
Multilevel Schmorl's nodes are seen with osteophyte formation. There is
multilevel loss of signal of the intervertebral discs on the T2 weighted
images there are ___ type 1 signal intensity changes of the vertebral
endplates at L2-3. The spinal cord terminates at the L1 level. ___ type
degenerative changes are seen at L2-3.
T12-L1: No significant spinal canal or foraminal narrowing.
L1-L2: A disc bulge is seen with a central disc protrusion and bilateral facet
arthropathy. There is moderate spinal canal narrowing with mild left
foraminal narrowing.
L2-L3: A disc bulge is seen with a large central disc protrusion. There is
ligamentous hypertrophy and bilateral facet arthropathy. There is severe
spinal canal narrowing with likely compression of the nerve roots. There is
moderate right and severe left foraminal narrowing.
L3-L4: A large disc bulge is seen with ligamentous hypertrophy and bilateral
facet arthropathy. A large disc protrusion extends inferiorly below the level
of the interspace to the right of midline compressing the thecal sac and the
traversing right-sided nerve roots. There is severe spinal canal narrowing
with moderate right and moderate to severe left foraminal narrowing.
L4-L5: A disc bulge is seen with ligamentous hypertrophy and bilateral facet
arthropathy. There is moderate spinal canal narrowing with mild right and
moderate left foraminal narrowing.
L5-S1: A mild disc bulge is seen with bilateral facet arthropathy. There is
no significant spinal canal or foraminal narrowing.
There is no evidence of infection or neoplasm.
IMPRESSION:
1. Severe degenerative changes of the lumbar spine, with a severe spinal canal
narrowing.
2. Large disc protrusions at L2-3 and L3-4 compressing nerve roots in the
thecal sac.
|
10101340-RR-41 | 10,101,340 | 29,910,668 | RR | 41 | 2111-06-22 12:42:00 | 2111-06-22 13:34:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: History: ___ with chest pain, ongoing // Chest pain work-up
TECHNIQUE: Upright AP view of the chest
COMPARISON: Chest radiograph ___, CT chest ___
FINDINGS:
Status post median sternotomy and CABG. Moderate cardiac silhouette size
enlargement is similar to the prior exam. Mediastinal and hilar contours are
grossly similar. There is crowding of bronchovascular structures due to low
lung volumes without frank pulmonary edema. Streaky atelectasis is seen in
the lung bases. No focal consolidation, pleural effusion, or pneumothorax.
Bilateral shoulder arthroplasties are incompletely imaged.
IMPRESSION:
Low lung volumes with mild bibasilar atelectasis.
|
10101340-RR-42 | 10,101,340 | 29,910,668 | RR | 42 | 2111-06-22 20:31:00 | 2111-06-22 21:09:00 | EXAMINATION: CTA CHEST WITH CONTRAST
INDICATION: History: ___ with extensive cardiac hx presenting with ongoing
chest pain and continued hypoxia despite Lasix // assess for PE
TECHNIQUE: Axial multidetector CT images were obtained through the thorax
after the uneventful administration of intravenous contrast. Reformatted
coronal, sagittal, thin slice axial images, and oblique maximal intensity
projection images were submitted to PACS and reviewed.
DOSE:
Total DLP (Body) = 581 mGy-cm.
COMPARISON: CT chest from ___.
FINDINGS:
HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the
subsegmental level without filling defect to indicate a pulmonary embolus.
Main pulmonary artery diameter is increased at 3.6 cm, previously 3.1 cm.
The thoracic aorta is normal in caliber without evidence of dissection or
intramural hematoma.
The heart is mildly enlarged. Coronary calcifications are severe. Post CABG
changes are noted. There is no pericardial effusion.
AXILLA, HILA, AND MEDIASTINUM: Borderline left axillary lymph nodes measuring
up to 1.2 cm in the short axis are unchanged (3:37).
PLEURAL SPACES: Small dependent right pleural effusion and trace dependent
left pleural effusion are new. No pneumothorax.
LUNGS/AIRWAYS: There is mild bilateral dependent atelectasis, right greater
than left. Right fissural nodules measuring up to 0.8 cm (3:106) are
unchanged, and may represent intrapulmonary lymph nodes. A small calcified
granuloma is again noted in the middle lobe. There is mild interlobular
septal thickening. The airways are patent to the level of the segmental
bronchi bilaterally.
BASE OF NECK: There is similar heterogeneous appearance of thyroid gland,
without a discrete nodule identified.
ABDOMEN: Included portion of the upper abdomen is unremarkable.
BONES: No suspicious osseous abnormality is seen.? There is no acute fracture.
Bilateral shoulder arthroplasties are partly imaged.
IMPRESSION:
1. No evidence of pulmonary embolism or aortic abnormality.
2. Mild pulmonary edema.
3. Enlargement of the main pulmonary artery up to 3.6 cm is suggestive of
pulmonary arterial hypertension.
4. Small right, trace left dependent pleural effusions and mild bibasilar
atelectasis.
|
10101340-RR-44 | 10,101,340 | 29,910,668 | RR | 44 | 2111-06-26 14:25:00 | 2111-06-26 16:47:00 | EXAMINATION: ABDOMEN US (COMPLETE STUDY)
INDICATION: ___ year old man with new onset RUQ pain // ?eval for gallstones,
hepatobiliary process
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: Prior abdominal CT from ___.
FINDINGS:
LIVER: The liver is diffusely echogenic. The contour of the liver is smooth.
There is a well-defined hypodense structure in the right hepatic lobe, in
proximity to the gallbladder fossa, suggestive of fatty sparing.. The main
portal vein is patent with hepatopetal flow. There is no ascites.
BILE DUCTS: There is no intrahepatic biliary dilation.
CHD: 4 mm
GALLBLADDER: Large gallstone in the fundus without gallbladder wall
thickening. Numerous polyps are seen throughout the gallbladder wall
measuring up to 0.8 cm.
PANCREAS: The imaged portion of the pancreas appears within normal limits,
without masses or pancreatic ductal dilation, with portions of the pancreatic
tail obscured by overlying bowel gas.
SPLEEN: Normal echogenicity.
Spleen length: 10.7 cm
KIDNEYS: Limited views of the kidneys show no hydronephrosis.Multiple
cortical cysts are seen bilaterally measuring up to 2.0 cm bilaterally.
Coarse calcification in the mid third of the right kidney.
Right kidney: 12.0 cm
Left kidney: 11.8 cm
RETROPERITONEUM: The visualized portions of aorta and IVC are within normal
limits.
IMPRESSION:
Echogenic liver consistent with steatosis.
Uncomplicated cholelithiasis.
Multiple gallbladder polyps measuring up to 8 mm.
RECOMMENDATION(S): Radiological evidence of fatty liver does not exclude
cirrhosis or significant liver fibrosis which could be further evaluated by
___. This can be requested via the ___ (FibroScan), or the
Radiology Department with MR ___, in conjunction with a GI/Hepatology
consultation" *
* Chalasani et al. The diagnosis and management of nonalcoholic fatty liver
disease: Practice guidance from the ___ Association for the Study of
Liver Diseases. Hepatology ___ 67(1):328-357
|
10101585-RR-10 | 10,101,585 | 23,354,592 | RR | 10 | 2130-03-15 13:03:00 | 2130-03-15 17:57:00 | CHEST RADIOGRAPH
HISTORY: Lower extremity swelling.
COMPARISONS: None.
TECHNIQUE: Chest, AP upright portable.
FINDINGS: The heart is mild to moderately enlarged. The aortic arch is
partly calcified. The mediastinal and hilar contours are otherwise
unremarkable. There is no cephalization of pulmonary vascularity. Upper lung
fields appear clear. There is a fine reticular abnormality which is fairly
widespread in both visualized lower lobes and suggestive of a more chronic
abnormality such as underlying interstitial lung disease or extensive
scarring. An acute abnormality is felt more likely. Correlation to prior
films could be helpful, if clinically indicated, to investigate further.
IMPRESSION: Reticulation in the lower lungs, probably chronic and suggestive
of scarring or interstitial lung disease. If available, correlation with
prior radiographs may be helpful if clinically indicated.
|
10101585-RR-11 | 10,101,585 | 23,354,592 | RR | 11 | 2130-03-17 13:49:00 | 2130-03-17 16:00:00 | CT CHEST
CLINICAL HISTORY: Chronic atrial fibrillation, on Coumadin and diltiazem.
Chronic kidney disease. Lateral T-wave inversions and new peripheral edema
for one week. Evaluate for pulmonary edema.
COMPARISON: Radiograph on ___.
TECHNIQUE: Unenhanced axial CT images were acquired through the thorax in
soft tissue and lung algorithms as well as high-resolution thin slices.
Coronal and sagittal reformats were provided. No contrast was administered,
per routine chest protocol.
FINDINGS: The airways are clear to the subsegmental levels. There is no
mediastinal or hilar lymphadenopathy. There is cardiomegaly and there are
small bilateral pleural effusions, slightly larger on the left than the right.
On the right, fluid tracks into the major fissure.
The thyroid is grossly unremarkable. There are coarse calcifications in the
aortic arch and the annulus. There is a small amount of atherosclerotic
calcification in the descending aorta. The aorta and pulmonary arteries are
normal in caliber.
In the lungs, there is no consolidation. There is mild bibasilar linear
atelectasis and ground glass opacity at the left dependent lung base. There
is moderate to severe diffuse centrilobular emphysema, more pronounced at the
lung apices. There are no lung nodules. No evidence of interstitial lung
disease.
In the limited non-contrast evaluation of the upper abdomen, there are
multiple rounded hepatic hypodensities, not completely characterized but
likely representing cysts.
There are multilevel degenerative changes in the thoracic spine but no
worrisome lytic or sclerotic lesions.
IMPRESSION:
1. Moderate centrilobular emphysema.
2. Bilateral small pleural effusions and mild left lower lobe ground glass
opacity most likely represent pulmonary edema in this clinical setting.
|
10101585-RR-13 | 10,101,585 | 24,233,638 | RR | 13 | 2131-02-07 15:54:00 | 2131-02-07 16:59:00 | HISTORY: Right upper extremity ataxia and right lower extremity weakness.
TECHNIQUE: Multi detector computed tomography images were obtained through
the head without the administration of intravenous contrast. Standard soft
tissue algorithms common bone algorithms and multiplanar reformats were
obtained and reviewed. Motion degraded images were repeated to good effect.
COMPARISON: No relevant comparisons available.
FINDINGS:
No acute intracranial hemorrhage, large vascular territory infarct, shift of
midline structures or mass effect is present. The ventricles and sulci are
normal in size and configuration. There is diffuse confluent bihemispheric
periventricular white matter hypoattenuation which likely represent sequelae
of small vessel ischemic disease. The visible paranasal sinuses and mastoid
air cells are well aerated.
IMPRESSION:
No acute intracranial process.
|
10101585-RR-14 | 10,101,585 | 24,233,638 | RR | 14 | 2131-02-07 16:23:00 | 2131-02-07 17:04:00 | CHEST RADIOGRAPH PERFORMED ON ___
COMPARISON: Chest CT from ___.
CLINICAL HISTORY: Weakness, question pneumonia.
FINDINGS: AP upright and lateral views of the chest provided. The heart is
top normal in size and the aorta is unfolded. There is no focal
consolidation, effusion, or pneumothorax. The hyperexpanded appearance of the
lungs is compatible with underlying known emphysema. Bony structures are
intact. Anterior spurring in the mid thoracic spine noted.
IMPRESSION: Emphysema without superimposed pneumonia.
|
10101585-RR-15 | 10,101,585 | 24,233,638 | RR | 15 | 2131-02-08 14:33:00 | 2131-02-08 16:15:00 | RIGHT KNEE SERIES
CLINICAL INDICATION: ___ with right knee pain, question underlying
pathology.
No comparison studies.
AP, lateral and oblique views of the right knee are submitted dated ___
at 1441.
The bones are osteopenic. There is spurring of the tibial spines and mild
degenerative change. No displaced fracture or dislocation is evident. There
may be a small joint effusion.
IMPRESSION:
1. Mild degenerative change with possible small joint effusion. No evidence
of displaced fracture or dislocation of the right knee.
|
10101585-RR-16 | 10,101,585 | 24,233,638 | RR | 16 | 2131-02-08 14:33:00 | 2131-02-08 16:17:00 | RIGHT HIP SERIES ___ AT 1441
CLINICAL INDICATION: ___ with right hip pain, question pathology.
No comparison studies.
An AP view of the pelvis and two additional views of the right hip are
submitted.
The bones are osteopenic. No displaced fracture or dislocation is seen.
There are mild-to-moderate degenerative changes involving both hips.
IMPRESSION:
1. Degenerative changes of the right hip without evidence of displaced
fracture or dislocation.
|
10101585-RR-17 | 10,101,585 | 24,233,638 | RR | 17 | 2131-02-08 22:47:00 | 2131-02-09 10:06:00 | EXAM: MRI brain and MRA head and neck.
CLINICAL INFORMATION: Patient with mental status change, question of infarct.
TECHNIQUE: T1 sagittal and FLAIR T2 susceptibility and diffusion axial images
of the brain were acquired. Gadolinium-enhanced MRA of the neck and 3D
time-of-flight MRA of the circle of ___ were obtained.
FINDINGS:
BRAIN MRI:
There is an acute subcortical lacunar infarct in the periventricular white
matter. There are extensive severe changes of small vessel disease and
moderate brain atrophy. No midline shift or hydrocephalus. No
micro-hemorrhages.
IMPRESSION: Acute left periventricular subcortical lacunar infarct.
MRA NECK:
The neck MRA demonstrates normal flow in the carotid and vertebral arteries.
Although the evaluation is slightly limited by motion, no vascular occlusion
or stenosis is seen. The great vessels also appear normal at the thoracic
inlet.
IMPRESSION:
Normal MRA of the neck.
MRA OF THE HEAD:
The head MRA demonstrates no evidence of vascular occlusion or stenosis.
Slightly diminished visualization of the sylvian branches is artifactual.
IMPRESSION: Slightly limited normal MRA of the head.
|
10101585-RR-18 | 10,101,585 | 24,233,638 | RR | 18 | 2131-02-09 20:07:00 | 2131-02-09 21:23:00 | HISTORY: Ischemic left internal capsule stroke assess for hemorrhagic
conversion.
TECHNIQUE: Contiguous axial images were obtained of the brain without
intravenous contrast. Multiplanar reformations were prepared.
COMPARISON: ___ and ___
FINDINGS:
The examination is limited by motion. Within this limitation, there is no
evidence of acute intracranial hemorrhage. Evolving left periventricular
white matter infarct is seen without evidence of hemorrhagic conversion.
Diffuse subcortical and periventricular white matter hypodensities suggest
chronic small vessel ischemic disease. There is no shift of normally midline
structures. Ventricles and sulci are prominent compatible with age related
involutional changes. There is no fracture. The imaged paranasal sinuses and
mastoid air cells are well aerated.
IMPRESSION:
Markedly motion limited study with continued evolution of the left
periventricular white matter lacunar infarct without findings to suggest
hemorrhagic conversion.
|
10101881-RR-24 | 10,101,881 | 27,682,479 | RR | 24 | 2141-06-06 21:07:00 | 2141-06-06 21:28:00 | EXAMINATION: RENAL U.S.
INDICATION: History: ___ with new renal failure // hydro ureter other
pathology to explain sx
TECHNIQUE: Grey scale and color Doppler ultrasound images of the kidneys were
obtained.
COMPARISON: None.
FINDINGS:
There is no hydronephrosis, stones, or masses bilaterally. There is trace
perinephric fluid bilaterally. Normal cortical echogenicity and
corticomedullary differentiation are seen bilaterally. Again seen is a 4.1 x
3.9 x 3.1 cm parapelvic cyst on the right, mildly enlarged compared to prior
CT from ___ but remains simple appearing.
Right kidney: 11.8 cm
Left kidney: 10.0 cm
The bladder is decompressed and a Foley catheter balloon is noted. The
prostate is enlarged with a volume of 173 cc.
IMPRESSION:
1. Trace perinephric fluid bilaterally, more conspicuous on the right, without
sonographic evidence of stones or hydronephrosis.
2. Prostatomegaly with a volume of 173 cc.
|
10102862-RR-10 | 10,102,862 | 23,353,872 | RR | 10 | 2159-12-06 14:17:00 | 2159-12-06 18:22:00 | EXAMINATION: RENAL U.S.
INDICATION: ___ year old man with ___ with history of obstructive R ureteral
stone s/p multiple stents// evaluate for hydronephrosis
TECHNIQUE: Grey scale and color Doppler ultrasound images of the kidneys were
obtained.
COMPARISON: Appear since made to MR abdomen performed ___.
FINDINGS:
The right kidney measures 7.2 cm. The left kidney measures 8.9 cm.
Multiple small nonobstructing right renal stones measure up to 0.4 cm. There
is a 1.7 x 2.4 x 2.3 cm left lower pole cyst with internal septations. A 6.8
x 5.2 x 7.2 cm isoechoic mass in upper pole of the left kidney with central
anechoic stellate scar-like appearance, was better characterized on MR abdomen
pelvis performed ___ and is not associated with increased
vascularity.
No evidence of hydronephrosis bilaterally. No evidence of left
nephrolithiasis.
Normal cortical echogenicity and corticomedullary differentiation are seen
bilaterally.
The bladder is moderately well distended and normal in appearance with stent
in appropriate position.
IMPRESSION:
1. Multiple small nonobstructing right renal calculi measuring up to 0.4 cm.
No evidence of hydronephrosis bilaterally.
2. A 7.2 cm isoechoic exophytic lesion without internal flow arising from the
upper pole of the left kidney was better characterized on MR abdomen pelvis
performed on ___ and was not associated with increased enhancement
.
3. 2.4 cm left lower pole cyst with internal septations.
4. Unremarkable bladder with stent in appropriate position.
|
10102862-RR-11 | 10,102,862 | 23,353,872 | RR | 11 | 2159-12-13 00:25:00 | 2159-12-13 09:22:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with CKD, shortness of breath// SOB SOB
IMPRESSION:
Lungs are well expanded and clear. Heart size normal. No pleural
abnormality. Right PIC line ends in the mid SVC.
|
10102862-RR-9 | 10,102,862 | 23,353,872 | RR | 9 | 2159-12-06 05:57:00 | 2159-12-06 06:13:00 | EXAMINATION:
Chest: Frontal and lateral views
INDICATION: History: ___ with C3 fx s/p fall, ?vertebral artery dissection?//
Pt with C3 fx, ?vertebral artery dissection
TECHNIQUE: Chest: Frontal and Lateral
COMPARISON: Chest CT from ___.
FINDINGS:
Right upper extremity PICC tip projects over the mid SVC. There lungs are
mildly hyperinflated with flattened diaphragms. 5 mm nodule projecting over
the left upper lobe likely corresponds with the known pulmonary nodule seen on
the CT from ___. Other nodules in the right lower lobe and upper lobe
are not well demonstrated on the current modality. There is no focal
consolidation. No pleural effusion or pneumothorax is seen. The cardiac and
mediastinal silhouettes are unremarkable.
IMPRESSION:
Right upper extremity PICC tip projecting over the mid SVC.
Multiple lung nodules are better seen on the chest CT from ___. No
focal consolidation.
|
10102878-RR-31 | 10,102,878 | 22,406,437 | RR | 31 | 2173-09-07 09:45:00 | 2173-09-07 10:00:00 | EXAMINATION: CHEST (PA AND LAT) PORT
INDICATION: History: ___ with shortness of breath, uncertain etiology// eval
for pulmonary edema, signs of CHF
COMPARISON: Chest radiograph ___
FINDINGS:
PA and lateral views of the chest provided.
There is no focal consolidation. There is no pleural effusion or
pneumothorax. Suggestion of mildly coarsened interstitial markings and
possible peribronchial thickening. Cardiomediastinal silhouette is within
normal limits. Median sternotomy wires are noted. No significant change
compared to prior radiograph.
IMPRESSION:
Suggestion of mildly coarsened interstitial markings and possible
peribronchial thickening could represent mild pulmonary vascular congestion or
bronchitis.
|
10102878-RR-32 | 10,102,878 | 22,406,437 | RR | 32 | 2173-09-08 11:11:00 | 2173-09-08 12:02:00 | EXAMINATION: UNILAT LOWER EXT VEINS LEFT
INDICATION: ___ year old man with SOB, thought likely bronchitis, but also
with chronic asymmetric LLE edema.// rule out 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 and compressibility
are demonstrated in the posterior tibial and peroneal veins.
There is normal respiratory variation in the common femoral veins bilaterally.
No evidence of medial popliteal fossa (___) cyst.
IMPRESSION:
No evidence of deep venous thrombosis in the left lower extremity veins.
|
10103318-RR-19 | 10,103,318 | 26,916,277 | RR | 19 | 2158-11-15 12:25:00 | 2158-11-15 15:07:00 | HISTORY: ___ male with history of pneumothorax and diminished breath
sounds on the right.
COMPARISON: Chest radiograph from ___.
AP PORTABLE FRONTAL CHEST RADIOGRAPH: There is a new moderate right
pneumothorax as compared to prior examination. There is no significant shift
of the mediastinal structures, although there is some mild splaying of the
ipsilateral ribs, suggesting some degree of tension. The left lung is well
expanded and clear. There is no vascular congestion, edema, or pleural
effusions. Cardiomediastinal and hilar contours are within normal limits.
Surgical material is again visualized within the medial right lung apex.
IMPRESSION: New moderate right pneumothorax. No significant shift of the
mediastinal structures, although there is some mild splaying of the
ipsilateral ribs, suggesting some degree of tension.
Ordering physician aware on ___ and CT scan performed shortly after
this examination.
|
10103318-RR-20 | 10,103,318 | 26,916,277 | RR | 20 | 2158-11-15 13:56:00 | 2158-11-15 15:09:00 | INDICATION: Right pneumothorax with history of pleurodesis. Right-sided
chest pain.
TECHNIQUE: Multidetector helical CT scan of the chest was obtained without
the administration of contrast. Coronal and sagittal reformations were
prepared.
COMPARISON: Correlation with multiple prior radiographs, most recent dated
___.
FINDINGS: There is a moderate right-sided pneumothorax with no evidence of
significant mediastinal shift to suggest tension. Post-surgical changes from
blebectomy are seen at the right apex. A small amount of scarring is present
at the left base. Otherwise, the lung parenchyma is clear. A triangular
fissural thickening is seen on the left, possibly a lymph node (2:24). No
evidence of endobronchial lesion is seen. The heart and great vessels appear
grossly unremarkable without pericardial effusion. No lymphadenopathy is
identified.
No concerning osseous lesion is seen.
Limited views of the upper abdomen are grossly unremarkable.
IMPRESSION: Right-sided pneumothorax. No significant shift of mediastinal
structures.
|
10103318-RR-21 | 10,103,318 | 26,916,277 | RR | 21 | 2158-11-15 19:56:00 | 2158-11-16 15:05:00 | HISTORY: ___ male with right-sided pneumothorax.
STUDY: Portable AP upright chest radiograph.
COMPARISON: Chest radiograph and chest CT from ___.
FINDINGS: The heart size is within normal limits. The mediastinal contours
may be slightly shifted to the left rather than exaggeration by patient
rotation. Again is noted a small right apical pneumothorax with gas also
tracking along the lateral and inferior portions of the pleural space. There
does not appear to be right hemidiaphragmatic flattening. The lungs are clear
with a suture chain in the right apex. There is no pleural effusion.
IMPRESSION: Right pneumothorax with minimal leftward mediastinal shift;
findings were relayed to interventional pulmonology team as they were placing
a chest tube at 11:22 am on ___ by ___ over the phone.
|
10103318-RR-23 | 10,103,318 | 26,916,277 | RR | 23 | 2158-11-16 12:34:00 | 2158-11-16 13:57:00 | CHEST RADIOGRAPH
INDICATION: Spontaneous pneumothorax, status post chest tube placement.
COMPARISON: ___.
FINDINGS: As compared to the previous radiograph, the patient received a
right-sided pigtail catheter. The lung is better expanded than on the
previous image, the apical pneumothorax is minimal.
Linear density at the upper margin of the right clavicle represents a staples
line.
No evidence of tension. Unremarkable cardiac silhouette and left lung.
|
10103318-RR-25 | 10,103,318 | 26,916,277 | RR | 25 | 2158-11-17 10:15:00 | 2158-11-17 12:12:00 | HISTORY: ___ male status post right decortication with a new right
pneumothorax, status post talc pleurodesis.
STUDY: Portable AP upright chest radiograph.
COMPARISON: Multiple chest radiographs from ___ and ___.
FINDINGS: There continues to be a pigtail catheter entering the right lower
chest wall, with the pigtail in the right apical pleural space. A tiny
pneumothorax persists along the right apex and along the right lateral chest
wall. There is no evidence of diaphragmatic flattening or mediastinal shift.
Otherwise, the cardiomediastinal contours and lungs are within normal limits.
There is a small amount of right sided pleural fluid.
IMPRESSION: Continued tiny right apical lateral pneumothorax without evidence
of tension.
|
10103318-RR-26 | 10,103,318 | 26,916,277 | RR | 26 | 2158-11-18 10:46:00 | 2158-11-18 12:27:00 | AP CHEST 10:43 A.M. ON ___
HISTORY: ___ male with spontaneous pneumothorax following talc
pleurodesis.
IMPRESSION:
AP chest compared to ___ shows little change in the volume of
the very small pleural air collection primarily along the upper costal surface
of the right lung, but a significant increase in moderate right pleural
effusion. Secondary atelectasis is relatively mild. The heart is normal size
and the mediastinum is not shifted. Left lung is clear. Apical pleural
pigtail drain unchanged in position. Dr. ___ and I discussed these
findings by telephone at the time of dictation.
|
10103318-RR-27 | 10,103,318 | 26,916,277 | RR | 27 | 2158-11-18 16:41:00 | 2158-11-18 17:44:00 | HISTORY: VATS pleurodesis with pigtail removal, to assess for pneumothorax.
FINDINGS: In comparison with the earlier study of this date, the right
pigtail catheter has been removed. There is a small amount of loculated gas
in the apical region on the right. Substantial collection of pleural fluid on
this side persists.
|
10103318-RR-29 | 10,103,318 | 20,701,942 | RR | 29 | 2158-12-23 11:02:00 | 2158-12-23 11:45:00 | CLINICAL HISTORY: ___ man with shortness of breath.
COMPARISON: Multiple prior chest x-rays, most recently from ___.
PA AND LATERAL VIEWS OF THE CHEST: There is a small left-sided apical
pneumothorax. The right side shows no evidence of pneumothorax. The left lung
is clear. The right lung has persistent opacity at the right lung base along
the pleura consistent with the patient's history of pleurodesis. No rib
fractures are seen. The cardiomediastinal silhouette is unremarkable. The
hilar contours are unremarkable. No signs of tension are seen.
IMPRESSION: Small left apical pneumothorax with no signs of tension.
These findings were discussed with Dr. ___ from the ED at 11:35 a.m. by
Dr. ___ via telephone on ___.
|
10103318-RR-30 | 10,103,318 | 20,701,942 | RR | 30 | 2158-12-23 15:47:00 | 2158-12-23 17:10:00 | CLINICAL HISTORY: ___ man with spontaneous left pneumothorax. Please
evaluate for interval change.
COMPARISON: ___ at 10:57.
PA AND LATERAL VIEWS OF THE CHEST: A left apical pneumothorax is once again
present and largely unchanged in size. The right lung is again clear. The
remainder of the left lung is again clear. The cardiomediastinal silhouette
is unremarkable. No new findings are seen.
IMPRESSION: Continued small left apical pneumothorax, stable in size from the
prior examination.
|
10103318-RR-31 | 10,103,318 | 20,701,942 | RR | 31 | 2158-12-24 08:42:00 | 2158-12-24 10:59:00 | PA AND LATERAL VIEWS OF THE CHEST:
REASON FOR EXAM: Follow up left pneumothorax.
Comparison is made with prior study performed a day before.
Moderate left pneumothorax is unchanged. Cardiomediastinal contours are
unchanged and midline. Surgical chain sutures are present in the right apex.
Blunting of the cardiophrenic angles on the right could be due to small
pleural effusion, pleural thickening, or findings post pleurodesis. Right
lower opacity secondary to pleurodesis, is also unchanged. There are no new
lung abnormalities.
|
10103318-RR-32 | 10,103,318 | 20,701,942 | RR | 32 | 2158-12-25 16:17:00 | 2158-12-25 17:07:00 | CHEST RADIOGRAPH
INDICATION: Recurrent spontaneous pneumothorax. Status post blebectomy.
COMPARISON: ___.
FINDINGS: As compared to the previous radiograph, the patient has undergone a
left blebectomy. Two left-sided chest tubes after VATS are visible. The
presence of a minimal millimetric pneumothorax cannot be excluded, but the
pneumothorax is smaller than before the intervention, as documented on the
previous image from ___.
No evidence of tension. Mild retrocardiac atelectasis. Normal right lung.
|
10103318-RR-33 | 10,103,318 | 20,701,942 | RR | 33 | 2158-12-26 15:51:00 | 2158-12-26 18:33:00 | CLINICAL HISTORY: Recurrent spontaneous pneumothorax status post left VATS
for blebectomy.
CHEST:
Two chest tubes are present. One extends up the lateral border of the thorax
over the apex and down the medial border to the left costophrenic angle. The
other chest tube extends to the left apex. There is no pneumothorax. Some
atelectasis of the left base is present. Right lung is clear.
|
10103318-RR-34 | 10,103,318 | 20,701,942 | RR | 34 | 2158-12-27 13:25:00 | 2158-12-27 14:43:00 | PA AND LATERAL CHEST FILMS, ___ AT 13:34
CLINICAL INDICATION: ___, status post left VATS with talc
pleurodesis, chest tubes x2; question pneumothorax, question pleural effusion.
Comparison is made to the patient's prior study of ___ at 15:57.
PA and lateral views of the chest, ___ at 13:34, are submitted.
IMPRESSION:
Two left-sided chest tubes remain in place, one of which terminates in the
apex and the other of which extends over the apex and down the medial border
into the left costophrenic angle. There is some soft tissue containing
loculated air at the left apex, but this appearance is unchanged from
___ and may reflect a combination of postoperative changes and/or a
loculated pneumothorax. Continued followup imaging would be advised. A small
amount of residual subcutaneous emphysema is seen in the lower lateral left
chest wall. No focal airspace consolidation or pleural effusions are seen.
Overall, cardiac and mediastinal contours are stable. Interval decrease in
the amount of gas within the stomach. Surgical chain sutures are again seen
at both apices. Right lateral pleural thickening is stable and may be result
of talc pleurodesis, pleural thickening, less likely effusion.
|
10103318-RR-35 | 10,103,318 | 20,701,942 | RR | 35 | 2158-12-28 08:57:00 | 2158-12-28 11:53:00 | INDICATION: Status post VATS with talc pleurodesis. 2 left-sided chest tubes.
COMPARISON: PA and lateral chest radiographs ___.
TECHNIQUE: PA and lateral chest radiographs.
IMPRESSION: 2 left-sided chest tubes remain unchanged in position. First chest
tube terminates in the apex; the second extends over the apex and inferiorly
along the medial border into the left costophrenic angle. Left apical
loculated air and fluid is unchanged in size and appearance. There is a
stable small right pleural effusion and left lower lobe atelectasis. Residual
subcutaneous emphysema in the lower left lateral chest wall remains. There is
stable right lateral pleural thickening. Cardiomediastinal silhouette is
normal.
IMPRESSION: Unchanged very small left apical pleural air and fluid
collection.
|
10103318-RR-36 | 10,103,318 | 20,701,942 | RR | 36 | 2158-12-28 13:37:00 | 2158-12-28 14:17:00 | CHEST RADIOGRAPH
INDICATION: Status post VATS, status post blebectomy, evaluation for interval
change.
COMPARISON: ___, 9:08.
FINDINGS: As compared to the previous radiograph, the two left-sided chest
tubes have been removed. There is a remnant left pneumothorax, best seen at
the level of the apex and the lateral chest wall. The diameter of the
pneumothorax is approximately 5 mm. There is no evidence of tension. Clips
at the apex of the right lung. Minimal air collections in the left lateral
soft tissues. Postoperative very subtle opacities at the left lung base but
no evidence of acute change.
|
10103318-RR-37 | 10,103,318 | 20,701,942 | RR | 37 | 2158-12-28 17:32:00 | 2158-12-29 07:57:00 | CHEST RADIOGRAPH
INDICATION: Status post left-sided VATS, pleurodesis. Evaluation for
interval change.
COMPARISON: ___.
FINDINGS: As compared to the previous radiograph, the left pneumothorax is
unchanged. Also unchanged is the mild collection in the left soft tissues and
the subtle post-surgical changes at the left lung bases. There is no evidence
of tension. Unchanged appearance of the right lung, with post-surgical apical
right-sided clips.
|
10103763-RR-39 | 10,103,763 | 21,104,905 | RR | 39 | 2131-05-31 18:42:00 | 2131-05-31 20:05:00 | EXAMINATION: UNILAT LOWER EXT VEINS RIGHT
INDICATION: ___ woman with leg swelling// ?R DVT
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the right lower extremity veins.
COMPARISON: None.
FINDINGS:
There is normal compressibility, flow, and augmentation of the right common
femoral, femoral, and popliteal veins. Normal color flow and compressibility
are demonstrated in the posterior tibial and peroneal veins.
There is normal respiratory variation in the common femoral veins bilaterally.
No evidence of medial popliteal fossa (___) cyst.
IMPRESSION:
No evidence of deep venous thrombosis in the right lower extremity veins.
|
10103763-RR-40 | 10,103,763 | 21,104,905 | RR | 40 | 2131-06-01 16:20:00 | 2131-06-01 17:42:00 | EXAMINATION: Chest radiograph, semi-upright AP portable.
INDICATION: Enlarged pericardial effusions status post pericardiocentesis.
COMPARISON: Prior day.
FINDINGS:
New pericardial drain projects to the left of midline. Associated pericardial
air is found. Cardiac shadow is somewhat reduced in size, although it is
difficult to the separated change in the size of the cardiac shadow from
coinciding reduction in atelectasis at the lung bases and in bilateral pleural
effusions. There is no pneumo thorax.
IMPRESSION:
Pericardial drain in place with small quantity of anticipated air in the
pericardium. Decreasing pleural effusions and opacities suggesting
atelectasis the lung bases.
|
10103763-RR-41 | 10,103,763 | 21,104,905 | RR | 41 | 2131-06-02 12:30:00 | 2131-06-02 15:59:00 | EXAMINATION: Portable AP chest
INDICATION: ___ year old woman with large pericardial effusion s/p
pericardiocentesis.// r/o pneumothorax
TECHNIQUE: Portable AP chest
COMPARISON: Portable AP chest from ___
FINDINGS:
In comparison the previous film, there is little overall change. There is no
evidence of pneumothorax. Pericardial drain is unchanged in position. There
is a small amount of air in the pericardium which is decreased in size from
the prior film. There continues to be bibasilar atelectasis. There are
bilateral pleural effusions that have decreased from the prior exam. Hardware
is unchanged.
IMPRESSION:
1. Pericardial drain in place with decreased amount of air in the pericardium.
There is no pneumothorax.
2. Decreased bilateral pleural effusions
3. Bibasilar atelectasis
|
10103763-RR-42 | 10,103,763 | 21,104,905 | RR | 42 | 2131-06-04 08:48:00 | 2131-06-04 09:38:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ with h/o rheumatic heart disease (mild MS, Moderate AS),
MSSAbacteremia ___ T4-5 epidural abscess and discitis in ___ s/pmultiple
courses of antibiotic therapy, recent NSTEMI w/ normalstress, HCV, CKD stage
3, remote IVDU, mild cognitive impairment,presents with fevers, worsened
shortness of breath and found tohave new large pericardial effusion, now s/p
pericardiocentesis.// cardiopulmonary reason for shortness of breath?
reaccumulation of pericardial evidence?
IMPRESSION:
In comparison with the study of ___, the pericardial drain has been
removed. There may be a small residual component of air in the pericardium.
There is decreasing opacification at the right base consistent with mild
decrease in pleural effusion, though residual atelectasis is again seen. Left
hemidiaphragm is obscured consistent with substantial volume loss in the left
lower lobe and possible small effusion.
|
10103763-RR-49 | 10,103,763 | 21,104,905 | RR | 49 | 2131-06-10 15:22:00 | 2131-06-10 17:36:00 | EXAMINATION: CT T-SPINE W/O CONTRAST
INDICATION: ___ year old woman s/p T5-T6 corpectomy and T3-T8 posterior fusion
who presented with pericardial effusion requiring pericardiocentesis. Evidence
of spine hardware infection seen on ___ PET scan.// evidence of hardware
infection? evidence of hardware infection?
TECHNIQUE: Non-contrast helical multidetector CT was performed. Soft tissue
and bone algorithm images were generated. Coronal and sagittal reformations
were then constructed.
DOSE: Acquisition sequence:
1) Spiral Acquisition 4.0 s, 31.9 cm; CTDIvol = 27.2 mGy (Body) DLP = 866.4
mGy-cm.
Total DLP (Body) = 866 mGy-cm.
COMPARISON: MR ___ dated ___. Prior CT T spine dated ___
FINDINGS:
Exaggerated thoracic kyphosis with spondylosis is persistent otherwise
alignment is unchanged. There are unchanged multilevel degenerative changes
in the lower cervical and upper thoracic spine. The anterior fusion involves
T5-T6 level with biomechanical device in place. The posterior fixation rods
spanning with by medical device placement at T5-T6. Fusion involves T2-T8.
The anterior fusion of T5-T6. At the vertebral body of T5 there is the
previously described lucency around the left lateral margin of the
intervertebral biomechanical device, (series 2, image 44), is no longer
demonstrated. However, there is streak artifact from hardware and evaluation
of the spinal canal is limited.
Again demonstrated is the right T3 pedicular screw at the lateral margin of
the T3 vertebral body with less than a mm of perihardware lucency (series 602
image 34). There is no evidence of periarticular fracture.
There is no evidence of spinal canal or neural foraminal stenosis. There is no
prevertebral soft tissue swelling. No evidence of drainable fluid collection
within the paraspinal musculature or visualized spinal canal. Re-demonstrated
are small bilateral pleural effusions, left greater than right. There mild
interval improvement of loculated effusion along the right oblique fissure.
However there still is layering of pleural fluid along the oblique fissures.
There are bibasilar ground-glass opacification likely representative of
atelectasis.
IMPRESSION:
1. No evidence of hardware complication within the limitations of streak
artifact.
2. Bilateral small pleural effusions left greater than right with bibasilar
atelectasis.
|
10103763-RR-50 | 10,103,763 | 21,104,905 | RR | 50 | 2131-06-13 16:55:00 | 2131-06-13 18:02:00 | EXAMINATION: THORACIC SINGLE VIEW IN OR
INDICATION: POST. RMVL T2-8 HARDWARE
TECHNIQUE: Frontal view radiograph of the thoracic spine.
COMPARISON: CT Thoracic Spine ___.
FINDINGS:
There has been interval removal of the posterior spinal fixation hardware in
the thoracic spine. The expandable vertebral body cage in the midthoracic
spine is still present.
The endotracheal tube terminates 3.5 cm above the carina. An tubular
structure which projects of the cervical and thoracic spine may represent a
surgical drain.
There is cardiomegaly. Hazy opacities in the partially visualized lower lungs
may represent pleural effusions.
IMPRESSION:
Interval removal of the posterior thoracic spinal fixation hardware.
|
10103763-RR-51 | 10,103,763 | 21,104,905 | RR | 51 | 2131-06-14 11:37:00 | 2131-06-14 12:08:00 | INDICATION: ___ year old woman with PICC// Pt had a L PICC,44cm ___ ___
Contact name: ___: ___
TECHNIQUE: Chest AP
COMPARISON: ___
IMPRESSION:
Left-sided PICC line projects to the cavoatrial junction. Lungs are low
volume with bibasilar atelectasis. Pulmonary edema is slightly improved.
Cardiomediastinal silhouette is stable. Small bilateral effusions are
unchanged. No pneumothorax is seen. The spinal hardware has been removed in
the interim.
|
10103763-RR-52 | 10,103,763 | 22,549,868 | RR | 52 | 2131-07-04 18:57:00 | 2131-07-04 20:08:00 | INDICATION: History: ___ with fever n/v and recent spine hardware revision//
PICC location
TECHNIQUE: Single AP upright portable view of the chest
COMPARISON: ___
FINDINGS:
Left-sided PICC terminates at the low SVC without evidence of pneumothorax.
There are relatively low lung volumes. Opacity over the mid to lower lateral
right chest may relate to a right pleural effusion, but underlying
consolidation due to infection or aspiration is not excluded. No large left
pleural effusion is seen. Cardiac silhouette remains moderately enlarged.
Vertical line of staples projects over the midline. The spine is not well
assessed on this study.
IMPRESSION:
Left PICC terminates at the low SVC without evidence of pneumothorax.
Opacity over the mid to lower lateral right chest may relate to a right
pleural effusion, but underlying consolidation due to infection or aspiration
is not excluded.
Cardiomegaly.
|
10103763-RR-53 | 10,103,763 | 22,549,868 | RR | 53 | 2131-07-05 09:00:00 | 2131-07-05 11:40:00 | EXAMINATION: Chest radiograph
INDICATION: Patient is a ___ with history of rheumatic heart disease, T4-5
epidural abscess/discitis c/b MSSA bacteremia ___ s/p multiple course of
antibiotics, HCV, CKD stage III, opiate use disorder with prior intravenous
drug use currently on methadone, and mild cognitive impairment who presents
with fevers and nausea/vomiting, found to have R lateral lung opacity on
portable film.// would like better evaluation of R lung opacity
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest radiographs from ___, CT T-spine from
___
FINDINGS:
Lung volumes are low. A focal peripheral opacification in the right lower
lobe is consistent with loculated pleural fluid. Pleural fluid is also seen
layering posteriorly and in the right minor fissure. Bibasilar atelectasis is
mild. There is no focal consolidation or pneumothorax. The cardiomediastinal
silhouette is moderately enlarged and stable, and may be partially attributed
to persistent pericardial effusion.
A left PICC terminate in the low SVC. Midline surgical staples are again
seen. A biomechanical spinal device is in stable position.
IMPRESSION:
1. Small right pleural effusion with loculated fluid along the lateral pleural
surface.
2. Stable moderate cardiomegaly may be partially attributed to persistent
pericardial effusion.
|
10103763-RR-54 | 10,103,763 | 27,193,103 | RR | 54 | 2131-09-21 11:34:00 | 2131-09-21 13:59:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: History: ___ with fever// ? pna
TECHNIQUE: Single frontal view of the chest
COMPARISON: ___
FINDINGS:
Moderate enlargement of the cardiac silhouette is again seen, slightly
decreased compared to the prior study. There is bibasilar atelectasis. Right
midlung opacity, relatively ground-glass in appearance, is nonspecific, but
underlying infection is not excluded. It could potentially relate to some
residual loculated pleural effusion. No large pleural effusion is seen.
There is no evidence of pneumothorax.
IMPRESSION:
Right midlung ground-glass opacity, nonspecific, but underlying infection not
excluded and could be present. It could potentially relate to some residual
loculated pleural effusion.
|
10103763-RR-55 | 10,103,763 | 27,193,103 | RR | 55 | 2131-09-21 15:15:00 | 2131-09-21 17:07:00 | EXAMINATION: MR CODE CORD COMPRESSION PT27 MR SPINE
INDICATION: *** CODE CORD *** History: ___ with history of T2-T4 epidural
abscessIV contrast to be given at radiologist discretion as clinically needed.
Evaluate for epidural abscess. -
TECHNIQUE: Sagittal imaging was performed with T2, T1, and STIR technique,
followed by axial T2 imaging.
COMPARISON: MRI cervical, thoracic, and lumbar spine ___.
FINDINGS:
Cervical spine:
Cervical spine alignment is normal. Mild, multilevel loss of intervertebral
disc signal intensity. Vertebral body signal intensity appears normal. The
spinal cord appears normal in caliber and configuration. No evidence of
epidural collection. Mild, multilevel degenerative changes of the cervical
spine, including mild vertebral canal narrowing, most prominent at C3-C4 and
C4-C5. Probable bilateral perineural cysts at C6-C7 and C7-T1.
Thoracic spine:
There is exaggerated kyphosis of the thoracic spine. Interval removal of
fusion hardware of the upper thoracic spine. Postoperative changes after
laminectomy within the upper thoracic spine are again seen. No evidence of
severe spinal canal narrowing or cord signal abnormality. No evidence of
epidural collection. The esophagus is distended and fluid-filled. Bilateral,
right greater than left, lung parenchymal opacities are seen.
Lumbar spine:
The lumbar spine alignment is normal. Moderate central canal narrowing is
most prominent at L2-L3. Mild central canal narrowing at L4-L5. No evidence
of cord compression or cord signal abnormality. Mild, diffuse loss of
intervertebral disc signal intensity. No evidence of epidural collection.
Mild-to-moderate right hydroureteronephrosis is incompletely evaluated. The
cauda equina nerve roots appear mildly thickened and clumped, adherent to the
peripheral thecal sac, similar to prior.
IMPRESSION:
1. No evidence of cord compression or cord signal abnormality. No evidence of
epidural collection.
2. Postoperative changes following laminectomy and anterior and posterior
fusion of the upper thoracic spine, with interval removal of thoracic spinal
hardware.
3. Multilevel degenerative changes of the cervical, thoracic, and lumbar
spine, most prominent at L2-L3, where there is moderate central canal
narrowing.
4. Stable appearance of thickened and clumped cauda equina nerve roots,
adherent to the peripheral thecal sac, suggestive of arachnoiditis.
5. Dilated, fluid-filled esophagus.
6. Bilateral, right greater than left, lung parenchymal opacities.
7. Mild to moderate right hydroureteronephrosis, incompletely evaluated.
8. Please note that although imaging can make the anatomic diagnosis of cauda
equina COMPRESSION, cauda equina SYNDROME is a clinical diagnosis based on
physical examination and clinical history. Imaging alone cannot make a
diagnosis of cauda equina SYNDROME.
|
10103763-RR-56 | 10,103,763 | 27,193,103 | RR | 56 | 2131-09-21 18:01:00 | 2131-09-21 19:28:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ with sepsis// CVC placement
COMPARISON: Most recent prior from 6 hours earlier.
FINDINGS:
AP portable upright view of the chest provided. There has been interval
placement of a right IJ central venous catheter terminating in the low SVC
likely extending into the right atrium. Overlying EKG leads are present.
Ill-defined opacity in the right mid to lower lung is more conspicuous and
likely progressed from prior concerning for pneumonia or sequelae of
aspiration. Left lung is clear. No pneumothorax or effusion. No gross signs
for edema. Cardiomediastinal silhouette appears normal. A metallic device
projects over the mediastinum and represents hardware within the thoracic
spine.
IMPRESSION:
1. Interval placement of a right IJ central venous catheter terminating in the
region of the right atrium. Recommend retraction by 4-5 cm for more optimal
positioning.
2. Increased ill-defined opacity in the right mid to lower lung concerning for
pneumonia or sequelae of aspiration.
NOTIFICATION: The findings were discussed with ___, M.D.
by ___, M.D. on the telephone on ___ at 6:28 pm, 2
minutes after discovery of the findings.
|
10103763-RR-57 | 10,103,763 | 27,193,103 | RR | 57 | 2131-09-21 22:25:00 | 2131-09-21 23:08:00 | EXAMINATION: UNILAT LOWER EXT VEINS RIGHT
INDICATION: ___ with history of rheumatic heart disease, T4-5 epidural
abscess/discitis c/b MSSA bacteremia ___ s/p multiple course of antibiotics,
presenting with fever and cough. Also with assymetri R>L lower extremity
edema. Eval for DVT.
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the right lower extremity veins.
COMPARISON: Comparison is made to ___.
FINDINGS:
There is normal compressibility, flow, and augmentation of the right common
femoral, femoral, and popliteal veins. Normal color flow and compressibility
are demonstrated in the posterior tibial and peroneal veins.
There is normal respiratory variation in the common femoral veins bilaterally.
No evidence of medial popliteal fossa (___) cyst.
IMPRESSION:
No evidence of deep venous thrombosis in the right lower extremity veins.
|
10103763-RR-60 | 10,103,763 | 29,541,803 | RR | 60 | 2132-11-03 17:05:00 | 2132-11-03 21:34:00 | INDICATION: ___ with recurrent bacteremia and multiple recent sick contacts,
p/w fevers, tachycardia, and malaise // Evaluate for consolidations, edema,
effusions
TECHNIQUE: Frontal lateral views the chest.
COMPARISON: Chest x-ray from ___.
FINDINGS:
There has been interval clearance of the previously seen right basilar
consolidation. There is faint retrocardiac opacity on the left also seen
posteriorly on the lateral view is suspicious for infection. Previously seen
right-sided central venous catheter is no longer visualized.
Cardiomediastinal silhouette is stable. No acute osseous abnormalities,
vertebral body cage noted in the midthoracic spine.
IMPRESSION:
Left lower lobe consolidation compatible with pneumonia in the proper clinical
setting.
|
10103795-RR-10 | 10,103,795 | 22,741,814 | RR | 10 | 2176-07-03 13:56:00 | 2176-07-03 15:51:00 | EXAMINATION: CHEST PORT. LINE PLACEMENT
INDICATION: ___ year old man with malignant MCA syndrome, s/p central line
placement// central line placement Contact name: ___: ___
central line placement
IMPRESSION:
A right internal jugular line tip heart at the level of lower SVC. Heart size
and mediastinum are stable. Left basal consolidation is concerning for
infectious process, more conspicuous than on the prior study. Rest of the
lungs are essentially clear. No pleural effusion. No pneumothorax
|
10103795-RR-11 | 10,103,795 | 22,741,814 | RR | 11 | 2176-07-03 21:21:00 | 2176-07-03 22:17:00 | EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ year old man with right CVA, now s/p right craniectomy//
post-op eval for interval change/hemorrhage- please obtain @ ___
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Total exam DLP 749.19 mGy-cm.
CTDIvol 46.71 mGy.
COMPARISON: Unenhanced head CT ___.
FINDINGS:
In comparison to the prior study of ___ performed at 05:30, the
patient has undergone interval right craniectomy. Expected postsurgical
changes are seen in the region of the craniectomy defect including overlying
skin staples, subcutaneous edema and fluid, and dural thickening subjacent to
the defect. There is a drain within the subgaleal space within a small fluid
collection with mixed low and high density products, likely trace blood as
well as containing interspersed foci of air (for example see series 2, image
16).
There is diffuse, patchy hypodensity involving much of the right cerebral
hemisphere including nearly all of the imaged temporal lobe, parietal and
occipital lobes, and most of the frontal lobe, consistent with known infarct.
Additionally, there is hypodensity of the ipsilateral basal ganglia.
Distribution of infarcts are stable since ___. New from the prior
exam are diffuse areas predominantly subcortical intraparenchymal hemorrhage
involving the right frontoparietal and superior temporal lobes, consistent
with hemorrhagic conversion, with largest confluent component measuring 4 cm x
3.3 cm.
There is diffuse swelling of the right cerebral hemisphere with diffuse right
greater than left cerebral hemispheric sulcal effacement persistent however
improved right-to-left shift of normally midline structures of now 6 mm,
previously 10 mm. Right uncal herniation has improved. The suprasellar
cistern, quadrigeminal plate cistern is less effaced. The cerebellar tonsils
are normally positioned. Patent pre pontine cistern, foramen magnum.
There is opacification of much of the ethmoid air cells, with trace mucosal
thickening involving the frontal and sphenoid sinuses as well as the bilateral
maxillary sinuses. Trace fluid layers dependently in the maxillary sinuses.
The mastoid air cells and middle ear cavities are well pneumatized and clear.
Aerosolized secretions are seen within the nasopharynx. The globes and bony
orbits are intact and unremarkable.
IMPRESSION:
1. Extensive, multifocal areas of acute hemorrhagic conversion in the
extensive infarcted area of right cerebral hemisphere. Stable extent of right
MCA, PCA distribution infarcts.
2. Improved mass effect following decompression craniectomy.
NOTIFICATION: The findings were discussed with ___, N.P. by
___, M.D. on the telephone on ___ at 9:49 pm, 10 minutes
after discovery of the findings.
|
10103795-RR-12 | 10,103,795 | 22,741,814 | RR | 12 | 2176-07-04 08:50:00 | 2176-07-04 09:33:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with vent dependence// ETT placement ETT
placement
IMPRESSION:
In comparison with study of ___, this and placement of an endotracheal
tube with its tip approximately 5.5 cm above the carina. Nasogastric tube
extends to the stomach with the side port just distal to the esophagogastric
junction. Right IJ catheter extends to about the level of the cavoatrial
junction.
The left hemidiaphragm is not sharply seen, suggesting layering pleural
effusion and underlying basilar atelectatic changes. In the appropriate
clinical setting, superimposed pneumonia could be considered.
|
10103795-RR-13 | 10,103,795 | 22,741,814 | RR | 13 | 2176-07-05 08:47:00 | 2176-07-05 11:32:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: Mr. ___ is a ___ year-old man who presented with fall and found
to have extensive right hemisphere strokes.// ?aspiration/ PNA
TECHNIQUE: Single frontal view of the chest
COMPARISON: ___
FINDINGS:
Enteric tube terminates in the proximal stomach. Endotracheal tube is stable
in position. Right IJ catheter terminates in the low SVC. No new focal
consolidation is seen. There is no pleural effusion or pneumothorax. Cardiac
and mediastinal silhouettes are stable. The left hemidiaphragm is more
defined on the current study and prior findings may have been due to
atelectasis.
IMPRESSION:
No new focal consolidation.
|
10103795-RR-14 | 10,103,795 | 22,741,814 | RR | 14 | 2176-07-05 12:18:00 | 2176-07-05 12:59:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ year old man with s/p hemicraniectomy, s/p drain pull//
interval change
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Total DLP: 749.92 mGy-cm.
COMPARISON: CT head on ___
FINDINGS:
Patient is status post right hemicraniectomy for large right infarct. There
has been interval removal of a postsurgical drain. Again seen is diffuse
edema involving nearly the entire right cerebral hemisphere with sulcal
effacement and loss of gray-white matter differentiation, increased from prior
with increased herniation through the craniectomy defect. Effacement of the
right lateral ventricle is slightly increased from prior, with increased
leftward midline shift, currently measuring up to 9 mm, compared with 6 mm
previously. The occipital and temporal horns of the left lateral ventricle
are increased in size compared with prior. There has been interval increase
in hemorrhagic transformation in the right frontoparietal lobes (2:22). There
is uncal herniation, and interval increase in effacement of the
perimesencephalic cisterns.
There is no evidence of fracture. There are air-fluid levels in the bilateral
maxillary and frontal sinuses, right sphenoid sinus, and opacification
multiple ethmoid air cells. The visualized portion of the mastoid air cells
and middle ear cavities are clear. The visualized portion of the orbits are
unremarkable.
IMPRESSION:
Interval increase in diffuse right cerebral edema and hemorrhagic
transformation of a large right infarct, with increased effacement of the
right lateral ventricle and leftward midline shift, currently measuring up to
9 mm, compared with 6 mm previously, increased effacement of the
perimesencephalic cisterns, and increased herniation through the craniectomy
defect. Interval increase in size of the occipital and temporal horns of the
left lateral ventricle, concerning for entrapment.
NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___
on the telephone on ___ at 12:56 pm, 2 minutes after discovery of the
findings.
|
10103795-RR-15 | 10,103,795 | 22,741,814 | RR | 15 | 2176-07-06 03:46:00 | 2176-07-06 10:59:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year-old man who presented with fall and found to have
extensive right hemisphere strokes.// interval change interval change
IMPRESSION:
ET tube tip is 5 cm above the carinal. NG tube tip is in the stomach. Right
internal jugular line tip is at the level of the proximal right atrium. Heart
size and mediastinum are unchanged in appearance. There are bibasal
retrocardiac areas of atelectasis most likely related to low lung volumes but
no focal consolidations to suggest pneumonia noted. No pulmonary edema.
|
10103795-RR-16 | 10,103,795 | 22,741,814 | RR | 16 | 2176-07-07 05:10:00 | 2176-07-07 09:48:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with stroke, intubated// eval for pna, ett
eval for pna, ett
IMPRESSION:
Right internal jugular line tip is at the level of lower SVC. ET tube tip is
4.2 cm above the carinal. NG tube tip is in the stomach. Heart size and
mediastinum are stable. Vascular congestion is noted, moderate. Left basal
consolidation is similar to previous examination or enlarged.
|
10103795-RR-17 | 10,103,795 | 22,741,814 | RR | 17 | 2176-07-08 04:26:00 | 2176-07-08 09:51:00 | INDICATION: ___ year old man with MCA stroke, intubated/trach// eval for pna
TECHNIQUE: Single portable view of the chest.
COMPARISON: Chest x-ray from ___.
FINDINGS:
Tracheostomy tube is now seen with tip 3.8 cm from the carina. Right-sided
central venous catheter seen with tip at the cavoatrial junction. Enteric
tube is no longer seen. Retrocardiac opacity silhouetting the medial
hemidiaphragm is unchanged. Elsewhere, lungs are clear.
IMPRESSION:
Interval placement of tracheostomy tube.
|
10103795-RR-18 | 10,103,795 | 22,741,814 | RR | 18 | 2176-07-08 07:10:00 | 2176-07-08 08:59:00 | EXAMINATION: BILAT LOWER EXT VEINS
INDICATION: ___ year old man with stroke, intubated, bed bound// r/o DVT as
source of fever
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the bilateral lower extremity veins.
COMPARISON: None.
FINDINGS:
There is normal compressibility, flow, and augmentation of the bilateral
common femoral, femoral, and popliteal veins. Normal color flow is
demonstrated in the posterior tibial and peroneal veins.
There is normal respiratory variation in the common femoral veins bilaterally.
No evidence of medial popliteal fossa (___) cyst.
IMPRESSION:
No evidence of deep venous thrombosis in the right or left lower extremity
veins.
|
10103795-RR-19 | 10,103,795 | 22,741,814 | RR | 19 | 2176-07-11 16:01:00 | 2176-07-11 18:02:00 | EXAMINATION: Carotid Doppler Ultrasound
INDICATION: ___ year old man with cryptogenic R MCA malignant stroke, please
eval for carotid disease// eval for carotid disease
TECHNIQUE: Real-time grayscale, color, and spectral Doppler ultrasound
imaging of the carotid arteries was obtained.
COMPARISON: None.
FINDINGS:
RIGHT:
The right carotid vasculature has no atherosclerotic plaque.
The peak systolic velocity in the right common carotid artery is 120 cm/sec.
The peak systolic velocities in the proximal, mid, and distal right internal
carotid artery are 30, 53, and 43 cm/sec, respectively. The peak end
diastolic velocity in the right internal carotid artery is 14 cm/sec.
The ICA/CCA ratio is 0.53.
The external carotid artery has peak systolic velocity of 100 cm/sec.
The vertebral artery is patent with antegrade flow.
LEFT:
The left carotid vasculature has no atherosclerotic plaque.
The peak systolic velocity in the left common carotid artery is 105 cm/sec.
The peak systolic velocities in the proximal, mid, and distal left internal
carotid artery are 59, 62, and 79 cm/sec, respectively. The peak end
diastolic velocity in the left internal carotid artery is 36 cm/sec.
The ICA/CCA ratio is 0.75.
The external carotid artery has peak systolic velocity of 76 cm/sec.
The vertebral artery is patent with antegrade flow.
IMPRESSION:
No stenosis in the bilateral internal carotid arteries (0% bilaterally).
|
10103795-RR-33 | 10,103,795 | 25,579,029 | RR | 33 | 2177-02-17 17:06:00 | 2177-02-17 18:28:00 | INDICATION: History: ___ with seizure// r/o PNA
TECHNIQUE: Chest AP and lateral
COMPARISON: Chest radiograph dated ___ and ___.
FINDINGS:
No focal consolidation to suggest pneumonia. The pulmonary vasculature is
unremarkable. No pleural effusion or pneumothorax. The cardiomediastinal
silhouette is unremarkable.
IMPRESSION:
No acute cardiopulmonary process.
|
10103795-RR-5 | 10,103,795 | 22,741,814 | RR | 5 | 2176-07-01 21:45:00 | 2176-07-01 23:32:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with stroke, ?aspiration// eval for consolidation
TECHNIQUE: Chest single-view
COMPARISON: None
FINDINGS:
Shallow inspiration. Mildly prominent pulmonary vascularity. Mild basilar
atelectasis. No definite infiltrates. No pleural effusion. No pneumothorax.
IMPRESSION:
Mild basilar atelectasis.
|
10103795-RR-6 | 10,103,795 | 22,741,814 | RR | 6 | 2176-07-02 09:09:00 | 2176-07-02 13:39:00 | EXAMINATION: MRI ___ AND MRA NECK PT13
INDICATION: ___ year old man with stroke// eval for extent of infarct
TECHNIQUE: Dynamic MRA of the neck was performed during administration of 15
mL of Multihance intravenous contrast.
Brain imaging was performed with sagittal T1 and axial FLAIR, T2, gradient
echo and diffusion technique.
Three dimensional maximum intensity projection and segmented images were
generated. This report is based on interpretation of all of these images. The
examination was performed using a 1.5T MRI.
COMPARISON: Outside CTA head on ___
FINDINGS:
Exam is slightly limited by motion.
MRI BRAIN:
There is a large area of slow diffusion in right frontal, parietal, occipital
and temporal lobes, and also involving the right basal ganglia, with
associated FLAIR signal hyperintensity, consistent with acute to subacute
infarct. There is mass effect with effacement of the lateral ventricles,
right greater than left, and 5 mm of leftward midline shift, slightly
increased from prior. The major intracranial flow voids are preserved. Note
is made of a fetal right PCA. Note is made of engorgement of the right
cerebral vasculature after contrast administration.
There is mucosal thickening in the bilateral maxillary sinuses and ethmoid air
cells. The remainder of the visualized paranasal sinuses and mastoid air
cells are clear. The globes are grossly unremarkable.
MRA NECK:
The common, internal and external carotid arteries appear normal. There is no
evidence of internal carotid artery stenosis by NASCET criteria. The origins
of the great vessels, subclavian and vertebral arteries appear normal
bilaterally.
IMPRESSION:
-Large acute to subacute infarct in the right cerebral hemisphere involving
the right frontal, parietal, occipital and temporal lobes as well as the right
basal ganglia, raising concern for central embolic source in the setting of a
right fetal PCA.
-Slight interval increase in mass effect on the lateral ventricles, right
greater than left, with 5 mm of leftward midline shift. Basal cisterns are
patent.
-Normal MRA neck, with no source of embolism identified.
|
10103795-RR-8 | 10,103,795 | 22,741,814 | RR | 8 | 2176-07-03 05:29:00 | 2176-07-03 05:47:00 | EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ year old man with large territory right MCA stroke// Interval
change, midline shift. Please perform ___ AM.
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, 17.4 cm; CTDIvol = 46.0 mGy (Head) DLP =
802.7 mGy-cm.
Total DLP (Head) = 803 mGy-cm.
COMPARISON: Head CT dated ___
Brain MR dated ___.
FINDINGS:
Study is mildly degraded by motion. Evolving hypodensity within the right
middle cerebral artery territory reflects large MCA territory stroke. There
is effacement of sulci diffusely within the right cerebral hemisphere but also
involving the left cerebral hemisphere, progressed since ___. There
is leftward shift of normally midline structures approximately 10 mm, also
increased, with effacement of the right lateral ventricle. There is partial
effacement of the suprasellar cistern and minimal effacement of the
quadrigeminal cistern. There is no hemorrhage.
The orbits are unremarkable. Imaged paranasal sinuses demonstrate near
complete opacification of ethmoidal air cells and bilateral fluid within the
maxillary sinuses, which may be related intubation status. Mastoid air cells
and middle ear cavities are clear.
IMPRESSION:
1. Study is mildly degraded by motion.
2. Large right MCA territory infarction with increasing mass-effect,
effacement of sulci, and 1 cm leftward midline shift, previously 5 mm, and no
evidence of hemorrhagic conversion.
NOTIFICATION: The findings were discussed with Dr. ___. by ___
___, M.D. on the telephone on ___ at 5:43 am, 2 minutes after
discovery of the findings.
|
10103795-RR-9 | 10,103,795 | 22,741,814 | RR | 9 | 2176-07-02 20:49:00 | 2176-07-02 22:19:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with desaturation and new oxygen requirement in
setting of extensive R MCA stroke, concern for aspiration// eval for new onset
hypoxia, concern for infection
TECHNIQUE: Chest single-view
COMPARISON: ___
FINDINGS:
Shallow inspiration. Left perihilar, basilar opacities, interstitial
prominence are more prominent, may represent asymmetric edema or infection,
with probable component of basilar atelectasis in view of shallow inspiration.
Right lung is clear. No pulmonary edema. No pleural effusion. No
pneumothorax.
IMPRESSION:
Left perihilar, basilar opacities may represent asymmetric edema or infection,
with component of left basilar atelectasis.
|
10104012-RR-21 | 10,104,012 | 23,867,813 | RR | 21 | 2189-12-03 02:02:00 | 2189-12-03 10:09:00 | EXAMINATION: PELVIS (AP ONLY)
INDICATION: ___ year old man with trauma s/p mvc // eval hip injury
eval hip injury
TECHNIQUE: Portable AP supine pelvis radiograph
COMPARISON: Same-day CT torso
FINDINGS:
There is contrast in a decompressed bladder, from recent contrast-enhanced CT,
which is obscures a small portion of the superior pubic rami and coccyx.
Foley catheter is in place.
The pelvic girdle is congruent, without SI joint or pubic symphysis diastasis.
Hip joints and proximal femora are within normal limits on this AP view.
Lucency seen in the left subtrochanteric femur is thought to represent film
artifact. The sacrum is partially obscured by bowel gas, but, where visible,
is grossly unremarkable.
IMPRESSION:
No fracture or dislocation detected about the pelvis.
Please see separate report of torso CT obtained several hours earlier. .
|
10104012-RR-22 | 10,104,012 | 23,867,813 | RR | 22 | 2189-12-03 02:02:00 | 2189-12-03 10:13:00 | EXAMINATION: HAND (PA,LAT AND OBLIQUE) RIGHT
INDICATION: ___ year old man with r hand swelling // eval fracture eval
fracture
TECHNIQUE: Right hand, three views
COMPARISON: None.
FINDINGS:
A pulse oximeter obscures small portions of the mid and distal phalanges of
the middle finger and of the distal phalanx of the thumb. In addition, the
index and middle fingers overlap on the lateral view.
No localizing history is available. Allowing for this, there is soft tissue
swelling along the dorsum of the hand. No fracture or dislocation is detected
about the right hand. No fracture, dislocation, or degenerative change is
detected. No bone erosion or periostitis identified. No suspicious lytic or
sclerotic lesion is identified. No soft tissue calcification or radio-opaque
foreign body is detected.
IMPRESSION:
Prominent soft tissue swelling along the dorsum of the hand. No fracture or
dislocation detected about the right hand.
Please note that small portions of the middle and index fingers and distal
thumb are obscured by overlapping anatomy or by the pulse oximeter.
Correlation with any specific site of symptoms is requested for full
assessment.
|
10104012-RR-24 | 10,104,012 | 23,867,813 | RR | 24 | 2189-12-03 09:45:00 | 2189-12-03 21:57:00 | EXAMINATION: KNEE (2 VIEWS) RIGHT
INDICATION: ___ year old man with swollen right knee // possible injury
COMPARISON: None.
FINDINGS:
There is a moderate-sized joint effusion, with fat-fluid level, indicative of
an intra-articular fracture.
Longitudinal linear lucency in the proximal tibia is concerning for fracture.
There is also subtle irregularity along the medial tibial plateau, which is
concerning for tibial plateau fracture.
No other fractures are identified about the right knee. The proximal
tibiofibular, femorotibial and patellofemoral joints appear grossly congruent.
Punctate calcification is seen at the lateral edge of the lateral tibial
plateau, but no donor site to suggest a Segond fracture is identified. No
obvious radiopaque foreign bodies detected.
IMPRESSION:
Findings compatible with fracture of the right medial tibial plateau and
proximal tibia, including joint effusion lipohemarthrosis. If clinically
indicated, CT could help for more detailed characterization of the fracture.
|
10104012-RR-26 | 10,104,012 | 23,867,813 | RR | 26 | 2189-12-03 14:49:00 | 2189-12-03 16:18:00 | EXAMINATION: CT RIGHT LOWER EXTREMITY.
INDICATION: ___ year old man intubated in field for trauma and found to have
right knee effusion and clinching while RLE moved on exam - please r/o fx from
right knee down to foot // r/o right tibia fx
TECHNIQUE: Axial computed tomographic images were obtained from the mid thigh
through the foot. Sagittal and coronal reformats were produced and reviewed
on PACS.
DOSE:
Total DLP (Body) = 717 mGy-cm.
COMPARISON: Right lower extremity radiographs from ___
FINDINGS:
Knee and tibia/fibula: There is a comminuted, depressed fracture primarily
involving the posterior medial tibial plateau (series 6b, image 213).
However, a vertically oriented linear fracture begins anteriorly along the
medial tibial spine (series 6b, image 194). Hand extends along the posterior
cortex from the tibial plateau distally to the mid tibia, approximately 12 cm
distal to the tibial plateau. There is extensive lipohemarthrosis in the knee
joint, with layering of blood product (series 4, image 21).
Ankle joint: A well corticated ossific fragment adjacent to the lateral
malleolus compatible with sequela of old trauma, either heterotopic
ossification or, less likely, all avulsion injury (for example series 3, image
233). The ankle mortise is congruent on this nonstress view. The tibiotalar
joint space is maintained. There is no large joint effusion.
Foot: There are comminuted, minimally displaced fractures at the second
through fourth metatarsal heads (series 6, image 94, 96, and 104).
Soft tissues: There is soft tissue swelling about the foot and knee joint.
Limited views of the left lower extremity are grossly unremarkable.
IMPRESSION:
1. Comminuted, depressed fracture of the posterior lateral tibial plateau
with associated lipohemarthrosis.
2. Vertically-oriented non-displaced fracture extending from the tibial
plateau through the posterior cortex of the tibia, terminating 12 cm distal to
the tibial plateau.
3. Comminuted, minimally displaced fractures of the second through fourth
metatarsal heads.
NOTIFICATION: The findings of second through fourth metatarsal head
comminuted fracture were discussed with the covering trauma resident by ___
___, M.D. on the telephone on ___ at 15:00 30 minutes after discovery
of the findings.
|
10104012-RR-27 | 10,104,012 | 23,867,813 | RR | 27 | 2189-12-03 14:49:00 | 2189-12-03 15:25:00 | EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ year old man with trauma, not following commands. Evaluate
for interval change since previous CT head.
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 10.0 s, 17.5 cm; CTDIvol = 47.4 mGy (Head) DLP =
829.0 mGy-cm.
Total DLP (Head) = 844 mGy-cm.
COMPARISON: Noncontrast head CT ___ at 23:25.
FINDINGS:
There is no acute hemorrhage, edema, mass effect, or loss of gray/ white
matter differentiation. Ventricles, sulci, and basal cisterns are normal in
size without change since the prior CT.
There is mild soft tissue swelling in in the right posterior/inferior parietal
scalp and in the left anterior parietal scalp, similar to prior. There is no
evidence of fracture. There is mild mucosal thickening or fluid in the
bilateral ethmoid air cells, and small amount of fluid in the right sphenoid
sinus, new since the prior CT, and persistent secretions in the nasopharynx,
likely related to endotracheal intubation.
IMPRESSION:
Unchanged appearance of the brain compared to approximately 15.5 hr earlier.
No evidence for acute intracranial abnormalities.
|
10104289-RR-5 | 10,104,289 | 28,149,025 | RR | 5 | 2140-11-15 00:58:00 | 2140-11-15 05:56:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: History: ___ with MVC// trauma
TECHNIQUE: Single frontal view of the chest
COMPARISON: Outside hospital chest CT ___.
FINDINGS:
Median sternotomy wires are intact. Mediastinal clips are noted. Subtle
opacity in the lingula better seen on the outside hospital chest CT likely
represents a focal area of atelectasis. Cardiomediastinal silhouette is
otherwise unremarkable. Small bilateral pleural effusions are better
appreciated on outside hospital chest CT from ___.
IMPRESSION:
1. Subtle opacity in the lingula better seen on the outside hospital chest CT
likely represents focal area of atelectasis.
2. Small bilateral pleural effusions are better appreciated on outside
hospital chest CT from ___.
|
10104289-RR-6 | 10,104,289 | 28,149,025 | RR | 6 | 2140-11-15 10:15:00 | 2140-11-15 12:39:00 | EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ year old man with right temporal SAH,// Assess follow up
interval change of hemorrhage please do around 10 am
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 4.0 s, 16.0 cm; CTDIvol = 46.7 mGy (Head) DLP =
747.3 mGy-cm.
Total DLP (Head) = 747 mGy-cm.
COMPARISON: Outside hospital CT head without contrast of ___.
FINDINGS:
Essentially unchanged appearance of subarachnoid hemorrhage layering along the
right sylvian fissure. No new intracranial hemorrhage is identified. No
intra or extra-axial mass effect or acute large territory infarct. The sulci,
ventricles and cisterns are within expected limits for the patient's age.
The visualized paranasal sinuses are essentially clear. The orbits are
unremarkable. The mastoid air cells middle ears well pneumatized and clear.
Skin closure staples overlying the skull vertex is re-identified. No evidence
for acute displaced calvarial fracture.
IMPRESSION:
1. Essentially unchanged appearance of subarachnoid hemorrhage layering along
the right sylvian fissure.
2. No ventriculomegaly.
3. Additional findings described above.
|
10104308-RR-94 | 10,104,308 | 24,307,783 | RR | 94 | 2161-05-06 19:16:00 | 2161-05-06 20:01:00 | HISTORY: ___ man with chest pain and left lower lobe crackles assess
for pneumonia.
TECHNIQUE: Portable AP upright chest radiograph obtained.
___.
PROCEDURE:
FINDINGS:
Cardiomegaly is noted with pulmonary edema and trace pleural effusions, right
greater than left. No pneumothorax. Bony structures intact. Degenerative AC
joint arthropathy.
IMPRESSION:
Findings compatible with congestive heart failure.
NOTIFICATION:
|
10104308-RR-95 | 10,104,308 | 24,307,783 | RR | 95 | 2161-05-13 08:15:00 | 2161-05-13 11:40:00 | INDICATION: ___ man with end-stage renal disease and immature AV
fistula requiring dialysis after catheter placement.
PHYSICIANS: Dr. ___ (radiology fellow) and Dr. ___
___ (radiology attending) who was present and supervised throughout.
MEDICATIONS: The patient received moderate conscious sedation with 50 mcg of
fentanyl and 2 mg of Versed in divided doses for a total intraservice time of
27 minutes, during which time the patient's hemodynamic parameters were
continuously monitored.
RADIATION: 46 mGy, 4.4 minutes fluoroscopy time.
PROCEDURE DETAILS: Following discussion of the risks, benefits and
alternatives to the procedure, informed written patient consent was obtained.
The patient was brought to the angiographic suite and placed supine on the
table. A preprocedure timeout was performed using three patient identifiers.
The skin in the right neck and chest was prepped and draped in the usual
sterile fashion. Using approximately 3 ml of 1% lidocaine were infiltrated
into the skin and subcutaneous tissues for local anesthesia. Using ultrasound
guidance, a micropuncture needle was advanced into the right internal jugular
vein, ultrasound images demonstrating patency of the vein prior to and after
venopuncture were saved. A nitinol wire was advanced via the micropuncture
needle, which was then exchanged for a micropuncture sheath. The inner
portion of the microsheath and nitinol wire were removed and ___ wire was
advanced via the microsheath into the IVC. We then addressed the
tunnel/access point. A further 2 cc of 1% lidocaine were infiltrated into the
skin and subcutaneous tissues for an access point approximately four-finger
breadth below the clavicle in the right anterior chest wall. A small skin
___ was made with subsequent administration of 10 cc of 1% lidocaine with
adrenaline along the planned course of the tunnel. A 32 cm total length, 15.5
___ tunneled hemodialysis catheter was selected for placement. This was
flushed and attached to the tunneling device. The catheter was tunneled from
the right anterior chest wall access point at the venotomy site with minimal
difficultly. The microsheath was removed at this stage and serial dilation
was performed down to the right internal jugular vein, with subsequent
placement of a 16 ___ peel-away sheath. The catheter was advanced through
the peel-away sheath, the peel-away sheath was removed and the catheter
advanced until the tip lay within the right atrium. The catheter was
aspirated and flushed without difficulty. ___ Vicryl sutures were used over
the venotomy skin ___. Sterile dressings were applied. There were no
immediate post-procedure complications.
IMPRESSION:
Technically successful placement of a dual-lumen tunneled hemodialysis
catheter with the tip in the right atrium, the catheter was flushed and is
ready for use.
|
10104308-RR-96 | 10,104,308 | 24,307,783 | RR | 96 | 2161-05-14 11:43:00 | 2161-05-14 13:11:00 | CHEST RADIOGRAPH
INDICATION: Dialysis, new cough, evaluation for pneumonia.
COMPARISON: ___.
FINDINGS: As compared to the previous radiograph, there is no relevant
change. Moderate fluid overload, combined to cardiomegaly and a small right
pleural effusion. Hemodialysis catheter in situ. The retrocardiac
atelectasis that pre-existed is less severe than on the previous exam. No
newly appeared focal parenchymal opacities suggesting pneumonia.
|
10104308-RR-97 | 10,104,308 | 26,552,670 | RR | 97 | 2162-07-10 16:40:00 | 2162-07-10 19:46:00 | CT SCAN OF THE ABDOMEN AND PELVIS PERFORMED ON ___
Comparison is made with a prior CT dated ___.
CLINICAL HISTORY: ___ man status post ___ takedown in ___,
now complaining of abdominal pain. Question of hernia, abscess, or bowel
obstruction.
TECHNIQUE: Multidetector CT through the abdomen and pelvis was performed
following oral and IV contrast administration with multiplanar reformations
provided.
FINDINGS:
The imaged lung bases are clear. The imaged portion of the heart appears top
normal in size without pericardial or pleural effusion seen.
ABDOMEN: The liver enhances normally without focal lesion. The gallbladder
is moderately distended containing a subtle dependent hyperdensity on series
2, image 27, likely representing a gallstone. The spleen appears normal.
Both adrenal glands are normal in configuration and size. The pancreas is
unremarkable. The kidneys enhance symmetrically with a tiny non-obstructing
stone again seen in the left renal interpolar region. There is perinephric
stranding which is nonspecific and unchanged. There is no renal excretion of
contrast at this time and clinical correlation for possible underlying renal
dysfunction.
The abdominal aorta and major branches appear widely patent. There is no
retroperitoneal lymphadenopathy.
The stomach is mostly decompressed. The duodenum is normal.
PELVIS: Loops of small bowel demonstrate no signs of ileus or obstruction.
There is a normal appendix. There is moderate-to-large fecal load within the
colon extending to the level of the mid descending colon. There has been
reversal of colostomy with colonic anastomosis in the region of the sigmoid
colon appearing unremarkable without evidence of abscess or significant free
fluid. No free air is seen. There is no bowel obstruction. Calcification of
the vas deferens is noted. The prostate gland is not significantly enlarged.
The urinary bladder appears unremarkable. There is no pelvic or inguinal
lymphadenopathy.
BONES: No worrisome lytic or blastic osseous lesion is seen. Spurring is
noted in the mid-to-low lumbar spine with preservation of disc spaces. No
abdominal wall hernia is seen.
IMPRESSION:
1. Interval reversal of colostomy with no evidence of hernia, abscess or
bowel obstruction. Moderate-to-large fecal load in the right hemicolon.
2. Perinephric stranding without evidence of renal contrast excretion.
Please correlate for underlying renal dysfunction.
|
10104335-RR-28 | 10,104,335 | 20,429,397 | RR | 28 | 2182-11-14 10:00:00 | 2182-11-14 11:00:00 | CLINICAL HISTORY: ___ woman with right arm weakness, question
ischemia.
COMPARISON: ___ and ___ head CTs.
TECHNIQUE: MDCT axially-acquired images through the brain were obtained. No
IV contrast was administered. Coronal and sagittal reformats were prepared.
FINDINGS: There is no evidence of acute hemorrhage, shift of normally midline
structures, or vascular territorial infarct. Increased periventricular white
matter hypodensities, consistent with small vessel ischemic disease, are
unchanged from prior examination. Ventricles and sulci are prominent
consistent with age-related atrophy. Hypodense lesion in the right centrum
semiovale is consistent with a small chronic lacune, unchanged. An additional
small posterior limb internal capsule hypodensity is minimally larger than the
prior and represents a lacunar infarct.
There is widening of the extra-axial space which is unchanged, most prominent
in the right posterior fossa which causes flattening of the right lateral
hemisphere. The visualized paranasal sinuses are unremarkable.
Visualized osseous structures and soft tissues are unremarkable.
IMPRESSION:
1. No evidence of acute hemorrhage or vascular territorial infarct.
2. Prominent extraaxial spaces, including within the posterior fossa on the
right. While this could be age related atrophy changes, the location is
unusual and could possibly represent an arachnoid cyst. Importantly, it is
unchanged from the ___ and ___ CT of the head.
|
10104335-RR-29 | 10,104,335 | 20,429,397 | RR | 29 | 2182-11-14 12:31:00 | 2182-11-14 15:26:00 | INDICATION: ___ woman with altered mental status, evaluate for acute
change.
COMPARISON: ___.
PA AND LATERAL CHEST RADIOGRAPHS: There is cardiomegaly, stable since ___. Mediastinal and hilar contours appear unchanged. Diffuse reticular
nodular changes persist. Bibasilar opacification appears more pronounced on
today's study compared to the most recent prior examination and likely
represents bibasilar atelectasis; however, underlying infectious process
cannot be excluded in the correct clinical setting. Apical pleural thickening
and opacification along the right upper lung zone, appears slightly more
pronounced on today's study and may represent infectious etiology in the
appropriate clinical setting. Mild blunting of bilateral costophrenic angles
may represent trace pleural effusion.
|
10104335-RR-30 | 10,104,335 | 20,429,397 | RR | 30 | 2182-11-16 00:18:00 | 2182-11-16 12:15:00 | INDICATION: CVA.
COMPARISON: CT head ___.
TECHNIQUE: Multiplanar, multisequence MRI of the brain was obtained without
contrast. 3D TOF MRA of the brain was obtained without contrast and 2D TOF
MRA of the neck was obtained. The patient was agitated and contrast could not
be administered for the MRA of the neck.
FINDINGS:
MRI HEAD: There is an area of slow diffusion seen in the left medial temporal
lobe, occipital lobe and in the left thalamus consistent with a left posterior
cerebral artery territory stroke. There are no foci of abnormal
susceptibility to suggest hemorrhagic conversion. Ventricles and sulci appear
age appropriate. There is no mass effect seen. Old infarcts are seen in
bilateral cerebellar hemispheres. Multiple scattered T2/FLAIR high-signal
foci are seen in bilateral periventricular white matter consistent with small
vessel ischemic disease. The left vertebral artery flow void is not well
appreciated. Rest of the major arterial flow voids appear preserved.
MRA HEAD: The distal left vertebral artery flow signal is not visualized
which may represent vertebral arterial occlusion. Bilateral intracranial
internal carotid arteries, the right vertebral artery, basilar artery and
their major branches are patent with no evidence of stenosis, occlusion or
aneurysm formation.
MRA NECK: Limited MRI study of the neck was obtained as contrast could not be
administered. Bilateral common carotid arteries and vertebral artery flow
voids in the neck appear normal with no evidence of stenosis or occlusion.
There appears to be moderate stenosis of the left internal carotid artery just
beyond the bifurcation.
IMPRESSION:
1. Acute infarct left PCA territory.
2. Chronic infarcts in bilateral cerebellar hemispheres.
3. Non-visualized flow signal in distal left vertebral artery may represent a
congenital variation/occlusion. This may be confirmed on a CTA.
4. Moderate stenosis of the left internal carotid artery just beyond the
bifurcation with restoration of flow signal in the distal ICA.
Findings discussed in ___ conference on ___ at 9:30 am
|
10104346-RR-17 | 10,104,346 | 20,521,668 | RR | 17 | 2130-02-20 18:52:00 | 2130-02-20 19:48:00 | HISTORY: ___ female with history of breast cancer status post
chemotherapy, confused. Question metastases.
COMPARISON: None listed.
FINDINGS:
Frontal and lateral views of the thoracic and lumbar spine. Multilevel
degenerative changes are seen particularly at thoracolumbar junction. There
is mild anterior wedging of the T12 vertebral body which could be degenerative
given significant disc height loss with endplate sclerosis with osteophyte
formation at the T12-L1 level similar extensive degenerative changes also seen
at L1-2. The T6 and T7 vertebral bodies appear partially fused which is
likely congenital. Degenerative changes are seen throughout the lumbar spine
notable for disc height loss and endplate osteophyte formation and significant
facet joint hypertrophic changes. Note is made of partial lumbarization of
the S1 vertebrae. Atherosclerotic calcifications noted in the abdominal
aorta.
IMPRESSION:
Degenerative changes particularly in the thoracolumbar junction. Mild
anterior wedging of T12 which may be old however clinical correlation is
suggested. MR is more sensitive for the detection of metastases or acuity of
fracture.
|
10104346-RR-18 | 10,104,346 | 20,521,668 | RR | 18 | 2130-02-20 19:45:00 | 2130-02-20 20:28:00 | INDICATION: ___ woman with change in speech, to evaluate for
metastasis.
COMPARISON: None.
TECHNIQUE: Axial CT images of the head were obtained without intravenous
contrast. Sagittal and coronal reformations were performed and reviewed.
FINDINGS: There is no evidence of intracranial hemorrhage, edema, mass or
mass effect. The gray-white matter differentiation is preserved. The
ventricles and sulci are mildly prominent, consistent with mild involutional
changes. Periventricular white matter hypodensities suggest mild small vessel
ischemic disease. The basal cisterns are normal. Bilateral vertebral and
cavernous internal carotid artery calcifications are noted. An extra-axial
CSF density lesion in the central posterior cranial fossa may represent ___
cisterna magna versus an arachnoid cyst. No lytic or sclerotic bone lesion is
identified. The imaged portion of the paranasal sinuses, mastoid air cells
and middle ear cavities are clear. The orbits are unremarkable.
IMPRESSION: No acute intracranial pathology. An MRI with contrast is more
sensitive for evaluating metastatic disease.
|
10104346-RR-19 | 10,104,346 | 20,521,668 | RR | 19 | 2130-02-20 20:47:00 | 2130-02-21 16:44:00 | INDICATION: ___ woman with metabolic alkalosis.
COMPARISON: None.
PA AND LATERAL CHEST RADIOGRAPHS: There is mild cardiomegaly. The hilar and
mediastinal contours are normal. The lungs are clear, without consolidation,
pulmonary edema, pleural effusion or pneumothorax. Surgical clips overlying
the right hemithorax relate to prior right mastectomy.
IMPRESSION: No acute cardiopulmonary pathology.
|
10104346-RR-20 | 10,104,346 | 20,521,668 | RR | 20 | 2130-02-21 14:42:00 | 2130-02-21 16:18:00 | CLINICAL INFORMATION: ___ woman with history of breast cancer, who
presents with hypercalcemia and altered mental status. Evaluate for acute
process, metastatic disease.
COMPARISON: Head CT dated ___.
TECHNIQUE: Sagittal T1, axial T1, susceptibility, FLAIR, T2, and
diffusion-weighted images were acquired. Following the administration of 12
mL of ProHance, sagittal MP-RAGE and axial T1-weighted images were acquired as
well as coronal and axial reformatted images.
FINDINGS: The ventricles, sulci, subarachnoid spaces are unremarkable in size
and in configuration. There is no evidence of mass lesion, mass effect, or
shift of normal midline structures. There are scattered areas of punctate
signal hyperintensity within the periventricular and subcortical white matter
bilaterally, which likely reflect sequela of mild chronic small vessel
disease. There is no evidence of hemorrhage or acute/subacute ischemia. The
post-contrast images reveal no evidence of enhancing mass lesion. There is
mildly increased pachymeningeal enhancement.
There is no bony lesion identified. Mild degenerative changes are noted in
the upper cervical spine with a disc bulge at C3-C4. The visualized portions
of the paranasal sinuses, mastoids, and orbits are unremarkable, and normal
intracranial flow voids are preserved.
IMPRESSION:
1. No metastatic disease to the brain.
2. Mild pachymeningeal enhancement. Correlate for recent lumbar puncture.
|
10104473-RR-8 | 10,104,473 | 23,712,120 | RR | 8 | 2178-04-10 17:33:00 | 2178-04-10 18:46:00 | EXAMINATION: MR CERVICAL SPINE W/O CONTRAST ___ MR ___ SPINE
INDICATION: History: ___ with ? C3-C4 c-spine fracture. IV contrast to be
given at radiologist discretion as clinically needed*** WARNING *** Multiple
patients with same last name!// spine ligamentous injury? cord compression.
spine ligamentous injury? cord compression.
TECHNIQUE: Sagittal imaging was performed with T2, T1, and STIR technique.
Axial T2 and gradient echo imaging were next performed. Sagittal diffusion
weighted imaging was then performed.
COMPARISON: CT cervical spine from outside facility dated ___ at
11:05.
FINDINGS:
Cervical spine alignment is within normal limits. T1 hypointense, T2/STIR
hyperintense signal within the superior aspect of the C4 vertebral body likely
represents marrow edema in the setting of known fracture seen involving the
right anterosuperior C4 endplate, better evaluated on earlier same-day CT
cervical spine performed at an outside facility. Otherwise, marrow signal is
within normal limits.
The cervical spinal cord is normal in caliber. There is faint abnormal high
T2/STIR signal within the cord spanning approximately C4-C6, best appreciated
on sagittal images (series 2, images 7 and 8). No abnormal signal within the
cervical spinal cord on diffusion-weighted images. There is no epidural
collection.
Spanning from approximately the level of the C2 spinous process to the C5
spinous process, there is posterior paraspinal soft tissue high T2/STIR
signal, likely representing edema from extension injury. There is apparent
focal disruption in the medial left ligamentum flavum at the level of C3-4
(06:15 and 3:9) as well as findings concerning for interspinous ligamentous
injury. Fluid signal anterior to C3-C4 involving the anterior longitudinal
ligament this level raises concern for ligamentous injury.
There are at least moderate multilevel cervical spine degenerative changes.
Specifically:
C2-3: Unremarkable.
C3-4: Posterior endplate osteophytes and prominent posterior disc bulge causes
severe spinal canal narrowing with effacement of the CSF space around the
cord, and flattening of the spinal cord in the AP dimension, without cord
signal abnormality at this level. No neural foraminal narrowing.
C4-5: Endplate osteophytes cause moderate spinal canal narrowing with
effacement of the CSF space around the spinal cord and slight remodeling of
the cord at this level. There is mild left neural foraminal narrowing due to
uncovertebral and facet osteophytes at this level (05:20).
C5-6: Combination of endplate osteophytes and posterior disc bulge causes
moderate spinal canal narrowing with remodeling of the spinal cord at this
level. There is mild, left worse than right neural foraminal narrowing due to
uncovertebral and facet osteophytes.
C6-7: Unremarkable.
C7-T1: Unremarkable.
Preserved flow voids in the neck vessels bilaterally. No cervical
lymphadenopathy identified.
IMPRESSION:
1. High STIR signal in the superior endplate of C4 likely corresponds to
marrow edema in the setting of probable acute fracture; fracture line itself
is not well seen on this study, better evaluated on prior CT cervical spine.
2. Disc protrusion at C3-C4 resulting in severe spinal canal stenosis may be
sequelae of the patient's acute injury.
3. Faint abnormal high signal on the T2/STIR sequences within the cord
spanning C4-C6 without definite DWI signal abnormality. Cord contusion cannot
be excluded.
4. Posterior paraspinal soft tissue edema spanning C2-C5, including likely
focal disruption of the medial left ligamentum flavum and interspinous
ligaments at the level of C3-4 and C4-5, likely reflecting sequelae of
extension component of flexion-extension injury.
5. Subtle increased signal along the anterior longitudinal ligament of C3-C4
concerning for ligamentous injury.
6. At least moderate cervical spondylosis, causing severe spinal canal
narrowing at C3-4 with flattening of the spinal cord without cord signal
abnormality at this level. Moderate spinal canal narrowing at C4-5 and C5-6.
Further details, as above.
NOTIFICATION: Updated findings were discussed with ___, M.D. by ___
___, M.D. on the telephone on ___ at 12:18 pm, 30 minutes after
discovery of the findings.
|
10104473-RR-9 | 10,104,473 | 23,712,120 | RR | 9 | 2178-04-11 12:58:00 | 2178-04-11 14:17:00 | EXAMINATION: CTA NECK WANDW/OC AND RECONS Q25 CT NECK
INDICATION: ___ fall off horse, C4 fracture and L acetabular fracture. Eval
for vascular damage.
TECHNIQUE: Rapid axial imaging was performed from the aortic arch through the
skull base during infusion of 70 mL of Omnipaque intravenous contrast
material. Three-dimensional angiographic volume rendered, curved reformatted
and segmented images were generated. This report is based on interpretation of
all of these images.
DOSE: Acquisition sequence:
1) Spiral Acquisition 2.1 s, 34.0 cm; CTDIvol = 13.1 mGy (Body) DLP = 443.2
mGy-cm.
2) Stationary Acquisition 0.5 s, 0.5 cm; CTDIvol = 2.7 mGy (Body) DLP = 1.4
mGy-cm.
3) Stationary Acquisition 4.5 s, 0.5 cm; CTDIvol = 24.4 mGy (Body) DLP =
12.2 mGy-cm.
Total DLP (Body) = 457 mGy-cm.
COMPARISON: MRI cervical spine dated ___.
CT head and neck without contrast dated ___ from outside facility.
FINDINGS:
The carotid and vertebral arteries and their major branches are patent with no
evidence of stenoses. No evidence for dissection is seen.
Redemonstration of an acute fracture of the right uncovertebral joint and
right anterolateral superior endplate of the C4 vertebral body with extension
toward the right vertebral artery foramen.
At C3-C4, there is disc protrusion with spinal canal narrowing and suggested
flattening of the spinal cord, better demonstrated on the recent MRI cervical
spine.
There is mild mucosal thickening of the left greater than right maxillary
sinuses. The mastoid air cells are clear.
IMPRESSION:
1. Patent carotid and vertebral artery vasculature with no evidence of
traumatic injury, dissection, focal stenosis, or aneurysm formation. No signs
of vertebral injury adjacent to the fracture seen on CT.
2. Disc protrusion at C3-C4 with spinal canal narrowing, better demonstrated
on the recent MRI cervical spine.
|
10104549-RR-201 | 10,104,549 | 25,502,861 | RR | 201 | 2202-02-25 04:55:00 | 2202-02-25 09:13:00 | HISTORY: ET tube placement.
FINDINGS: In comparison with the study of ___, there is little overall
change in the appearance of the heart and lungs. Cardiac silhouette is at the
upper limits of normal in size or slightly enlarged and there is some evidence
of elevated pulmonary venous pressure and possible atelectatic changes at the
left base.
There has been placement of an endotracheal tube with its tip approximately
2.3 cm above the carina.
|
10104549-RR-202 | 10,104,549 | 25,502,861 | RR | 202 | 2202-02-25 05:59:00 | 2202-02-25 07:10:00 | HISTORY: Hypertension, altered mental status and seizure activity while
intubated and sedated.
COMPARISON: Non contrast head CT dated ___.
Technique: Multi detector CT axial imaging of the head was obtained without
intravenous contrast. Coronal and sagittal reformatted images as well as thin
section images in a bone window algorithm were generated and reviewed.
DLP: 1026 mGy-cm.
FINDINGS:
There is no acute intracranial hemorrhage. In the interim from the most
recent prior CT of ___, there are new small areas of paramedian
biparietal cortical and subcortical white matter hypodensity, right larger
than left. A hypodensity in the central pons (2:9) is more conspicuous since
the prior CT. The sulci and bifrontal extraaxial spaces over the convexities
are mildly prominent, compatible with sequela of parenchymal volume loss,
unchanged. Atherosclerotic calcification of the bilateral carotid siphons and
left vertebral artery is noted. The orbits and globes are unremarkable.
There is a small mucous retention cyst in the left sphenoid sinus. Moderate
mucosal thickening is seen in the bilateral ethmoid air cells and
frontoethmoid recesses. The remainder of the visualized paranasal sinuses and
mastoid air cells are clear bilaterally. The bony calvaria appear intact.
IMPRESSION:
1. No acute intracranial hemorrhage.
2. Subacute or chronic right parietal infarct, which is new from the most
recent prior CT of ___.
3. Global atrophy more prominent in the bifrontal regions.
Findings were communicated by Dr. ___ to Dr. ___ medicine via
telephone at 06:50 on ___.
NOTES ON ATTENDING REVIEW:
1. Small paramedian biparietal areas of cytotoxic edema, right greater than
left, may represent postictal sequela, atypical PRES, or infarctions.
Recommend further evaluation by MRI.
2. The central hypodensity in the pons may reflect a chronic infarct, as
there is not a lot of bone-related artifact through the pons on today's study.
|
10104549-RR-203 | 10,104,549 | 25,502,861 | RR | 203 | 2202-02-27 15:02:00 | 2202-02-27 15:36:00 | SINGLE FRONTAL VIEW OF THE CHEST
REASON FOR EXAM: Assess NG tube. Patient with seizures.
NG tube tip is in the stomach. There are low lung volumes. There is
bilateral atelectasis, left greater than right, minimally increased from prior
study. Mild cardiomegaly is accentuated by the projection. Widened
mediastinum is likely due to the projection. There is no pneumothorax or
enlarging pleural effusions.
|
10104549-RR-205 | 10,104,549 | 25,502,861 | RR | 205 | 2202-03-01 11:54:00 | 2202-03-01 12:57:00 | TECHNIQUE: MRI of the brain without and with gad.
HISTORY: Past history of drug abuse with vague complaints, altered mental
status.
COMPARISON: ___. ___.
FINDIGS: There are bilateral, right greater than left parietal white matter
hyperintensities with some extension to the gray matter on the right. There
is enhancement noted in the right parietal lobe in the area of white and gray
matter abnormality. No blood products are seen on the susceptibility imaging
on the right. On the left, there appear to be foci of susceptibility dropout.
There are additional hyperintense changes in the subcortical white matter in
the right frontal lobe, corona radiata and basal ganglion likely reflecting
lacunar infarctions. Hyperintensity in the pons is also seen.
Intracranial flow voids are maintained. There is no evidence for acute
ischemia or hydrocephalus.
IMPRESSION: Biparietal, right greater than left signal abnormality in the
white and gray matter. Findings are most suggestive of PRES.Differential
includes vasculitis or inflammatory etiology.
There are additional white matter changes in the subcortical right frontal
lobe as well as in bilateral basal ganglion , corona radiata and pons, none of
which demonstrate significant enhancement or mass effect. These findings
could represent small vessel ischemic changes or less likely, manifestations
of osmotic demyelination in the appropriate clinical scenario.
|
10104549-RR-210 | 10,104,549 | 28,611,747 | RR | 210 | 2204-10-12 12:35:00 | 2204-10-12 15:07:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with anemia, fatigue, and bilateral wheezing on
exam. She has a PMH of COPD, smoking, and lung cancer s/p resection. // Acute
process to explain wheezing on exam?
TECHNIQUE: Single frontal view of the chest
COMPARISON: ___
FINDINGS:
The patient is rotated somewhat to the right. Given this, the cardiac and
mediastinal silhouettes are stable. There appears to be some volume loss in
the right lung. The cardiac and mediastinal silhouettes left stable. No
large pleural effusion is seen on the be difficult to exclude a trace right
pleural effusion. No pneumothorax is seen.
|
10104732-RR-5 | 10,104,732 | 29,256,816 | RR | 5 | 2183-11-07 16:18:00 | 2183-11-07 17:32:00 | HISTORY: Abdominal pain, elevated LFTs.
COMPARISON: No relevant comparisons available.
FINDINGS: Evaluation of the liver is limited study due patient difficulty with
breath hold and cooperation. The liver is diffusely echogenic, compatible with
fatty deposition. Doppler assessment of the main portal vein shows patency and
normal hepatopetal flow. There is no intra or extrahepatic bile duct dilation.
The common duct is not dilated measuring 5 mm. A stone and sludge are seen
within the gallbladder, which is dilated. Wall thickness is difficult to
evaluate because of fatty liver. A thin strip of pericholecystic fluid is
nonspecific in the setting of fatty liver. Sonographic ___ sign is
equivocal. The spleen is normal measuring 8.0 cm. The visualized portions of
the pancreatic head and body are normal although the inferior head and tail
are not seen due to overlying bowel gas. The IVC is not well assessed. There
is no ascites in the upper abdomen.
IMPRESSION:
1. Nonspecific gallbladder dilation with stones. Correlate clinically for any
concern regarding cholecystitis. Hepatic dysfunction could explain the
findings as well. If further imaging is needed, HIDA may be helpful. No bile
duct dilation.
2. Echogenic liver compatible with fatty deposition. Other forms of liver
disease and more advanced liver disease including significant hepatic
fibrosis/cirrhosis cannot be excluded on this study.
|
10104732-RR-6 | 10,104,732 | 29,256,816 | RR | 6 | 2183-11-08 02:51:00 | 2183-11-08 10:28:00 | HISTORY: ___ male with HIV and suprapubic pain as well as abnormal
LFTs and elevated lipase; question cause for pain.
TECHNIQUE: Helical CT images were acquired of the abdomen and pelvis without
oral or IV contrast and reformatted into coronal and sagittal planes.
FINDINGS:
LUNG BASES: There is minimal bibasilar atelectasis. The lungs are otherwise
clear. The heart is normal in size. There is no pleural or pericardial
effusion.
ABDOMEN: The liver, spleen, and adrenals are normal in appearance. The
gallbladder is normal in morphology, with several dense gallstones seen in the
region of the gallbladder neck. There is no evidence of acute cholecystitis.
There is no intra- or extra-hepatic biliary ductal dilatation. The pancreas
demonstrates mild inflammatory fat stranding around it, extending along the
anterior pararenal space bilaterally, right greater than left, and down the
right paracolic gutter. There is a moderate amount of free fluid within the
pelvis. The stomach is collapsed. Loops of small bowel are normal in caliber.
PELVIS: The bladder is normal appearing. The prostate is unremarkable. The
colon is normal in appearance, with adjacent fat stranding, likely reflecting
pancreatic pathology. There is no intraperitoneal free air.
There is no bony or soft tissue abnormality.
IMPRESSION:
1. Stranding around the pancreas, extending into the right greater than left
anterior pararenal space, likely reflecting resolving pancreatitis in the
appropriate clinical setting.
2. No evidence of acute cholecystitis, despite the presence of gallstones.
|
10104732-RR-7 | 10,104,732 | 25,583,405 | RR | 7 | 2184-01-04 16:15:00 | 2184-01-04 17:57:00 | CTA HEAD AND NECK, CT PERFUSION, ___
INDICATION: ___ man with history of CNS lymphoma, now with left upper
extremity weakness and numbness.
COMPARISON: Non-contrast head CT from ___.
TECHNIQUE: Following a non-contrast head CT, CT perfusion study was performed
during intravenous contrast administration, with post-process cerebral blood
flow, cerebral blood volume, and cerebral mean transit time maps. During
additional intravenous contrast administration, axial multidetector CT images
of the head and neck were obtained, with maximal intensity projection,
multiplanar reformatted images, curved reformatted images, and volume-rendered
three-dimensional reformatted images.
FINDINGS:
NON-CONTRAST HEAD CT: There is no acute intracranial hemorrhage. A
moderately sized area of encephalomalacia is again seen in the left parietal
lobe. There are confluent areas of low density in the subcortical, deep, and
periventricular white matter of the cerebral hemispheres, grossly unchanged.
There are multiple periventricular calcifications as well, which are
nonspecific, but possibly related to prior lymphoma treatment or prior
intracranial infection. Right basal ganglia calcifications are also noted,
unusual for age, and therefore possibly also related to prior lymphoma
treatment or prior infection. There is unchanged enlargement of the
ventricles and sulci, abnormal for age, indicating moderate cerebral atrophy.
The calvarium is diffusely mottled, as seen previously. There is left greater
than right mastoid air cell opacification, similar to the prior study. There
is a small focus of mucosal thickening or secretions in the right sphenoid
sinus, unchanged. A left globe prosthesis is again seen.
CT PERFUSION: The study is limited by patient motion. There is increased
mean transit time and decreased cerebral blood volume in the area of the left
parietal encephalomalacia. No other definite symmetry is seen to suggest
large area of acute ischemia or acute infarction.
CTA NECK: There is a three-vessel aortic arch. The common carotid arteries
are widely patent bilaterally. There is moderate calcified plaque in the
proximal right internal carotid artery with mild, less than 40% stenosis. The
distal cervical right internal carotid artery measures 4.0 mm in diameter.
Mild calcified plaque is also noted in the proximal right external carotid
artery, without hemodynamically significant stenosis. The cervical left
internal carotid and external carotid arteries are widely patent. The distal
cervical left internal carotid artery measures 4.0 mm in diameter. Cervical
vertebral arteries are widely patent bilaterally. The bones of the cervical
spine and imaged upper thoracic spine appear mottled, to a milder extent than
the calvarium. Mild degenerative changes are present in the spine.
Mild dependent atelectasis is noted in the imaged upper lungs. Two small
lucencies are noted in the imaged right upper lobe, with the larger lucency
demonstrating thin walls, suggesting that they may represent cysts rather than
centrilobular emphysema. The left thyroid lobe is absent. The right thyroid
lobe is enlarged, without definite focal lesions. No pathologically enlarged
cervical lymph nodes are seen.
CTA HEAD: The intracranial internal carotid and vertebral arteries, and their
major branches, are patent without evidence for hemodynamically significant
stenoses or aneurysms. The non-dominant right vertebral artery is hypoplastic
distal to the origin of the posterior-inferior cerebellar artery.
IMPRESSION:
1. No acute hemorrhage or evidence of acute major vascular territorial
infarction on non-contrast head CT. Motion-limited CT perfusion study
demonstrates no clear evidence for a large area of acute ischemia or acute
infarction. MRI would be more sensitive for excluding an acute infarction, if
clinically warranted.
2. No evidence of arterial occlusion in the head and neck. Moderate
calcified plaque at the origin of the right internal carotid artery with mild,
less than 40% stenosis.
3. Unchanged moderate area of encephalomalacia in the left parietal lobe.
Unchanged extensive supratentorial white matter hypodensities. These findings
could be related to prior infarction and chronic small vessel ischemic
disease, respectively, but they could also be related to the patient's known
central nervous system lymphoma and post-treatment changes. Comparison with
prior MRIs is needed for better interpretation. MRI could be obtained for
assessing the status of the patient's lymphoma, if clinically indicated.
4. Moderate cerebral atrophy, unexpected for age.
5. Diffusely mottled bones, particularly in the calvarium, in part related to
demineralization, but lymphomatous involvement cannot be excluded.
6. Left greater than right mastoid air cell opacification.
|
10104732-RR-8 | 10,104,732 | 25,583,405 | RR | 8 | 2184-01-04 20:18:00 | 2184-01-04 20:31:00 | HISTORY: HIV, elevated white count, feeling well.
TECHNIQUE: PA and lateral views of the chest.
COMPARISON: None.
FINDINGS:
Cardiac, mediastinal and hilar contours are normal. The pulmonary vascularity
is normal. Lungs are clear without focal consolidation. No pleural effusion
or pneumothorax is present. No acute osseous abnormality seen.
IMPRESSION:
No acute cardiopulmonary process.
|
10104945-RR-12 | 10,104,945 | 23,927,263 | RR | 12 | 2137-10-07 09:58:00 | 2137-10-07 12:54:00 | EXAMINATION: TIB/FIB (AP AND LAT) LEFT
INDICATION: Tibial fracture. External fixation versus ORIF.
TECHNIQUE: Intraoperative fluoroscopic images.
COMPARISON: CT dated ___.
FINDINGS:
5 intraoperative images were acquired without a radiologist present. Total
fluoroscopy time was 24.1 seconds.
Images show fixation the fracture of the proximal left tibia.
IMPRESSION:
Please refer to the operative note for details of the procedure.
|
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