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10104945-RR-8 | 10,104,945 | 23,927,263 | RR | 8 | 2137-10-04 19:22:00 | 2137-10-04 20:33:00 | EXAMINATION: CT LEFT TIBIA/FIBULA, NO IV CONTRAST
INDICATION: ___ year old man with tib fib fx// eval fx, preop, extend thru
ankle
TECHNIQUE: Thin cut noncontrast axial CT of the tibia/fibula, with coronal
sagittal reformats, using soft tissue and bone windows.
DOSE: Acquisition sequence:
1) Spiral Acquisition 3.6 s, 56.7 cm; CTDIvol = 10.2 mGy (Body) DLP = 578.0
mGy-cm.
Total DLP (Body) = 578 mGy-cm.
COMPARISON: Plain radiograph of the left tibia/fibula performed on the same
day at 12:36, at another institution.
FINDINGS:
With respect to the tibiofemoral articulation, there is a mildly displaced,
impacted and comminuted transverse fracture of the proximal tibial
metadiaphysis, with vertical split components extending to the lateral tibial
plateau and tibial spines involving the cruciate footplates, and ___ of the
articular surface with at least 8 mm articular step-off, and resultant
lipohemarthrosis.
With respect to the proximal tibiofibular joint, there is also a
intra-articular comminuted, minimally displaced and impacted fracture of the
proximal metadiaphysis and head of the fibula, involving the styloid process,
in close proximity to the course of the common fibular nerve.
Distal tibiofibular joint, ankle mortise maintained.
IMPRESSION:
Schatzker type VI lateral tibial plateau fracture, with tibial
metaphyseal/diaphyseal dissociation, and fibular head fracture involving the
proximal tibiofibular joint.
|
10104945-RR-9 | 10,104,945 | 23,927,263 | RR | 9 | 2137-10-04 20:00:00 | 2137-10-04 20:20:00 | INDICATION: History: ___ with pna// pna
TECHNIQUE: Upright AP view of the chest
COMPARISON: Chest radiograph ___
FINDINGS:
Cardiac silhouette size remains mildly enlarged. Mediastinal contour is
similar. Lungs are hyperinflated with diffuse increased interstitial
opacities appearing similar compared to the prior exam. Mild pulmonary
vascular congestion is noted without frank pulmonary edema. No pleural
effusion or pneumothorax. No focal consolidation. No acute osseous
abnormalities detected.
IMPRESSION:
Mild pulmonary vascular congestion. No definite focal consolidation to
suggest pneumonia.Diffuse increased interstitial markings compatible with
chronic interstitial lung disease.
|
10105017-RR-15 | 10,105,017 | 24,900,930 | RR | 15 | 2147-11-26 17:34:00 | 2147-11-26 18:29:00 | EXAMINATION: CHEST (AP AND LAT)
INDICATION: ___ with colon cancer, mets, here w/ SOB // PNA? pleural
effusions?
COMPARISON: Prior liver MR from ___ and prior chest CT from ___.
FINDINGS:
AP upright and lateral views of the chest provided.
Right chest wall Port-A-Cath is seen with catheter tip in the mid SVC. There
are multiple bilateral pulmonary nodules compatible with known metastatic
disease. Bilateral pleural effusions are present. Lower lobe consolidation,
right greater than left is concerning for atelectasis and/or pneumonia. No
pneumothorax. Cardiomediastinal silhouette is stable. Bony structures are
intact.
IMPRESSION:
Multiple pulmonary nodules concerning for metastatic disease. Small pleural
effusions with lower lobe consolidation concerning for atelectasis versus
pneumonia.
|
10105017-RR-16 | 10,105,017 | 24,900,930 | RR | 16 | 2147-11-27 07:46:00 | 2147-11-27 16:21:00 | EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ woman with metastatic colon cancer and rising LFTs
and new ascites evaluate for biliary obstruction or progression of cancer
involvement in the liver, as well as dopplers to evaluate for portal vein
thrombus.
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: No prior abdominal ultrasound is available on PACS at the time
this dictation.
MRI liver dated ___.
FINDINGS:
LIVER: Markedly heterogeneous with numerous masses consistent with known
metastases, better characterized on prior MRI in ___. The liver surface
contour is nodular, secondary to hepatic metastases. The main portal vein is
patent with hepatopetal flow although the main portal vein velocity appears
low at approximately 12 cm/sec. There is small ascites.
BILE DUCTS: There is no intrahepatic biliary dilation. The CHD measures 0.4
mm.
GALLBLADDER: The gallbladder is near completely decompressed, similar to the
prior MR. ___ of stones or wall thickening.
PANCREAS: The pancreas is not well imaged, obscured by overlying bowel gas.
SPLEEN: Normal echogenicity, measuring 12.2 cm.
KIDNEYS: Limited views of the right kidney show no hydronephrosis.
RETROPERITONEUM: Very limited views of visualized portions of aorta and IVC
are within normal limits.
There is a small left pleural effusion.
IMPRESSION:
1. Numerous hepatic masses, better characterized on prior MR.
2. Patent main portal vein which however demonstrates slow flow.
3. Small volume ascites and small left pleural effusion.
4. No intrahepatic or extrahepatic biliary ductal dilation.
|
10105017-RR-17 | 10,105,017 | 24,900,930 | RR | 17 | 2147-11-27 07:46:00 | 2147-11-27 16:22:00 | EXAMINATION: ___ DUP EXTEXT BIL (MAP/DVT)
INDICATION: ___ woman with colon cancer and lower extremity edema.
Evaluate for deep venous thrombosis.
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the bilateral lower extremity veins.
COMPARISON: None.
FINDINGS:
There is normal compressibility, flow, and augmentation of the bilateral
common femoral, 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.
|
10105017-RR-18 | 10,105,017 | 24,900,930 | RR | 18 | 2147-11-27 09:31:00 | 2147-11-27 10:43:00 | EXAMINATION: Ultrasound-guided diagnostic and therapeutic paracentesis
INDICATION: ___ woman with metastatic colon cancer presenting with
ascites and leukocytosis, requiring diagnostic and therapeutic paracentesis.
TECHNIQUE: Ultrasound guided diagnostic and therapeutic paracentesis
FINDINGS:
Limited grayscale ultrasound imaging of the abdomen demonstrated small
ascites. A suitable target in the deepest pocket in the right lower quadrant
was selected for paracentesis.
PROCEDURE: The procedure, risks, benefits and alternatives were discussed
with the patient and written informed consent was obtained.
A preprocedure time-out was performed discussing the planned procedure,
confirming the patient's identity with 3 identifiers, and reviewing a
checklist per ___ protocol.
Under ultrasound guidance, an entrance site was selected and the skin was
prepped and draped in the usual sterile fashion. 1% lidocaine was instilled
for local anesthesia.
A 5 ___ catheter was advanced into the largest fluid pocket in the right
lower quadrant and 1.85 L of yellow, slightly turbid fluid was removed. Fluid
samples were submitted to the laboratory for cell count, differential,
culture, and cytology.
The patient tolerated the procedure well without immediate complication.
Estimated blood loss was minimal.
Dr. ___ supervised the trainee during the key components
of the procedure and reviewed and agrees with the trainee's findings.
IMPRESSION:
Technically successful ultrasound-guided diagnostic and therapeutic
paracentesis (1.85L RLQ).
|
10105017-RR-19 | 10,105,017 | 24,900,930 | RR | 19 | 2147-11-27 19:06:00 | 2147-11-27 20:11:00 | INDICATION: ___ with metastatic colon cancer, admitted with worsening
abdominal distention and shortness of breath, evaluate for staging of
metastatic colon cancer with known lung, liver, and brain mets.
TECHNIQUE: Oncology 2 phase: Multidetector CT of the abdomen and pelvis was
done as part of CT torso with IV contrast. A single bolus of IV contrast was
injected and the abdomen and pelvis were scanned in the portal venous phase,
followed by scan of the abdomen in equilibrium (3-min delay) phase.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 0.5 s, 0.2 cm; CTDIvol = 9.3 mGy (Body) DLP = 1.9
mGy-cm.
2) Stationary Acquisition 10.8 s, 0.2 cm; CTDIvol = 184.2 mGy (Body) DLP =
36.8 mGy-cm.
3) Spiral Acquisition 6.7 s, 74.6 cm; CTDIvol = 4.2 mGy (Body) DLP = 309.3
mGy-cm.
4) Spiral Acquisition 3.3 s, 37.1 cm; CTDIvol = 4.3 mGy (Body) DLP = 157.9
mGy-cm.
Total DLP (Body) = 506 mGy-cm.
COMPARISON: Prior liver ultrasound dated ___, MRI liver dated ___, and outside hospital CTs of the abdomen and pelvis dated ___
and ___.
FINDINGS:
LOWER CHEST: Please refer to separate report of CT chest performed on the same
day for description of the thoracic findings.
ABDOMEN:
HEPATOBILIARY: Innumerable metastatic lesions throughout the liver involving
every hepatic segment are grossly similar to the recent liver MRI and markedly
progressed compared with ___. There is no intrahepatic biliary ductal
dilatation. The gallbladder is collapsed. The portal vein is patent with
mixing artifact noted. There is a moderate amount of perihepatic free fluid
with associated pelvic ascites, new from ___. Trace fluid and
stranding is noted within the left upper quadrant without definite malignant
peritoneal disease.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
There is no evidence of focal renal lesions or hydronephrosis. There is no
perinephric abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Diffuse low-density of the
small bowel wall likely reflects chronic inflammation. The colon and rectum
are within normal limits with changes related to partial sigmoidectomy noted.
The appendix is not visualized.
PELVIS: The urinary bladder and distal ureters are unremarkable.
REPRODUCTIVE ORGANS: Multiple exophytic fibroids are noted in the uterus.
There is no adnexal abnormality.
LYMPH NODES: Multiple enlarged retroperitoneal and porta hepatis lymph nodes
are similar to the prior MRI (4:70, 8:28). 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. Innumerable hepatic metastases with associated upper retroperitoneal and
porta hepatis lymphadenopathy, grossly similar to the recent MRI and markedly
progressed compared with ___.
2. Small to moderate ascites without definite associated peritoneal disease.
3. Please see the separately submitted report of the same day CT Chest for
findings above the diaphragm.
|
10105017-RR-20 | 10,105,017 | 24,900,930 | RR | 20 | 2147-11-27 19:07:00 | 2147-11-27 20:17:00 | EXAMINATION: CT CHEST W/CONTRAST
INDICATION: ___ with metastatic colon cancer, admitted with worsening
abdominal distention and shortness of breath. // staging CT for metastatic
colon cancer, known lung, liver, and brain mets
TECHNIQUE: Multi-detector helical scanning of the chest was coordinated with
intravenous infusion of nonionic, iodinated contrast agent, reconstructed as
contiguous 5 mm and 1.0 or 1.25 mm thick axial, 2.5 or 5 mm thick coronal and
parasagittal, and 8 mm MIP axial images. Sequential scanning of the abdomen
and pelvis will be reported separately. Images of the chest were reviewed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 0.5 s, 0.2 cm; CTDIvol = 9.3 mGy (Body) DLP = 1.9
mGy-cm.
2) Stationary Acquisition 10.8 s, 0.2 cm; CTDIvol = 184.2 mGy (Body) DLP =
36.8 mGy-cm.
3) Spiral Acquisition 6.7 s, 74.6 cm; CTDIvol = 4.2 mGy (Body) DLP = 309.3
mGy-cm.
4) Spiral Acquisition 3.3 s, 37.1 cm; CTDIvol = 4.3 mGy (Body) DLP = 157.9
mGy-cm.
Total DLP (Body) = 506 mGy-cm.
** Note: This radiation dose report was copied from CLIP ___ (CT ABD AND
PELVIS WITH CONTRAST)
COMPARISON: Compared to chest CT scanning since ___, most recently ___.
FINDINGS:
Supraclavicular and axillary lymph nodes are not enlarged and there is no soft
tissue abnormality in the chest wall suspicious for malignancy. Breast
evaluation requires mammography.
Thyroid is unremarkable. Atherosclerotic calcification is not apparent head
neck vessels, but is present in left anterior descending coronary artery.
Aorta and pulmonary arteries and cardiac chambers are not enlarged. This
study is not appropriate for assessing pulmonary emboli, but no large central
filling defects are seen. There is no pericardial effusion. Small
nonhemorrhagic pleural effusions layer posteriorly. No definite pleural
nodules.
Findings below the diaphragm will be reported separately.
There are dozens of pulmonary metastases, ranging in diameter up to 25 mm,
many with surrounding ground-glass opacification suggesting hemorrhage.
Consolidation in the right lower lobe is probably atelectasis common due in
part to elevation of the diaphragm by the liver enlarged with metastases.
There is no evidence of bronchial obstruction or pneumonia.
Given the severity of pulmonary metastases, central adenopathy is relatively
mild, 14 mm rib right upper paratracheal and heterogeneously enhancing 10 mm
subcarinal nodes. No hilar adenopathy.
There are no large destructive bone lesions, compression or pathologic
fractures, but it should be noted that radionuclide bone and FDG PET scanning
are more sensitive than chest CT in detecting early osseous metastases.
IMPRESSION:
Many pulmonary metastases, possible associated pulmonary hemorrhage.
Right lower lobe consolidation more likely atelectasis common due to diaphragm
elevation, than pneumonia.
Small bilateral pleural effusions do not contribute to respiratory compromise.
No pericardial effusion. No bronchial occlusion.
|
10105017-RR-21 | 10,105,017 | 24,900,930 | RR | 21 | 2147-11-28 20:07:00 | 2147-11-29 09:14:00 | EXAMINATION: MR HEAD W AND W/O CONTRAST T___ MR HEAD
INDICATION: Metastatic colon cancer with known liver and brain metastases
after radiation therapy.
TECHNIQUE: Sagittal and axial T1 weighted imaging were performed. After
administration of 7 mL of Gadavist intravenous contrast, axial imaging was
performed with gradient echo, FLAIR, diffusion, and T1 technique. Sagittal
MPRAGE imaging was performed and re-formatted in axial and coronal
orientations.
COMPARISON: Outside hospital MR head ___.
FINDINGS:
There is no evidence of hemorrhage, edema, masses, mass effect, midline shift
or infarction. The ventricles and sulci are normal in caliber and
configuration. Few punctate areas of scattered nonspecific white matter
T2/FLAIR hyperintensity are unchanged, of doubtful clinical significance.
There is no abnormal focus of slow diffusion. The visualized paranasal
sinuses are grossly clear. The principal intracranial vascular flow voids are
preserved.
There is bone marrow infiltration of the left frontoparietal calvarium best
noted on the axial T1 series with post-contrast enhancement with asymmetric
expansion with underlying leptomeningeal thickening and enhancement (900:122,
901:105). These findings are new compared to the most recent available
outside MR study from ___, though official medical record notes state
a newer interval examination with leptomeningeal enhancement. There is no
abnormal parenchymal enhancing lesion.
There is layering fluid within the right sphenoid air cell. The remainder of
the paranasal sinuses are grossly clear. The principal intracranial vascular
flow voids are preserved.
IMPRESSION:
1. Expansion and enhancing bone marrow infiltration of the left frontoparietal
calvarium with underlying pachymeningeal thickening and enhancement most
suggestive of osseous metastasis with secondary dural involvement. This is
new compared to the most recent available comparison study from ___,
though OMR note state a newer study was performed at an outside hospital
mentioning " diffuse leptomeningeal enhancement." This newer study is not
available for comparison.
2. No parenchymal enhancing mass.
|
10105017-RR-23 | 10,105,017 | 24,900,930 | RR | 23 | 2147-12-01 18:34:00 | 2147-12-01 20:52:00 | INDICATION: ___ year old woman with metastatic colon cancer / ascites.
Hospice. // ascites. request pleurex. if not enough ascites to place, please
drain whatever ascites is present if possible.
COMPARISON: None.
TECHNIQUE: OPERATORS: Dr. ___ resident and Dr. ___,
___ radiologist performed the procedure. Dr. ___ supervised
the trainee during the key components of the procedure and has reviewed and
agrees with the trainee's findings.
ANESTHESIA: Conscious sedation
MEDICATIONS: 2 mg of Versed at and 150 mcg of fentanyl.
CONTRAST: 0 ml of Optiray contrast.
FLUOROSCOPY TIME AND DOSE: 120 min, 45 mGy
PROCEDURE:
1. Limited abdominal ultrasound
2. Peritoneal PleurX catheter placement
The procedure, risks, benefits and alternatives were discussed with the
patient and written informed consent was obtained. The abdomen was cleaned
and draped in standard sterile fashion. A pre-procedure time-out was performed
as per ___ protocol.
Under ultrasound guidance, an entrance site was selected in the right lower
quadrant. 1% lidocaine was instilled for local anesthesia. Under direct
ultrasound guidance, a A 5 ___ catheter was advanced into the ascitic
fluid. A ___ wire was passed through the catheter and crossed to the right
side of the abdominal cavity. A location for the subcutaneous tunnel was
chosen and 1% lidocaine and epinephrine was administered at the skin entry
site and along the tunnel tract. A skin incision was made and the catheter was
tunneled to the peritonotomy site. The ___ catheter site was dilated and a
peel-away sheath was inserted. The wire and inner cannula were removed and the
PleurX catheter was passed through the peel-away sheath. Final position of the
catheter was confirmed with fluoroscopy. The catheter was secured to the skin
with 0 silk suture. The ___ catheter site was closed with ___ Vicryl
subcuticular suture and Steri-Strips. The patient tolerated the procedure well
without any immediate postprocedure complications.
FINDINGS:
Limited grayscale ultrasound imaging of the abdomen demonstrated
moderateascites. A suitable target in the deepest pocket in the right lower
quadrant was selected for PleurX catheter placement.
IMPRESSION:
Successful right peritoneal PleurX catheter placement
|
10105440-RR-5 | 10,105,440 | 29,406,428 | RR | 5 | 2170-01-28 03:51:00 | 2170-01-28 07:52:00 | INDICATION: Patient with bilateral subdural hematomas. Assess for interval
change.
COMPARISONS: Reference CT head from an outside hospital dated ___.
TECHNIQUE: MDCT-acquired contiguous images through the brain were obtained
without intravenous contrast at 5-mm slice thickness.
FINDINGS: Diffuse bilateral subdural hematomas are unchanged in size when
compared to study obtained one day prior. For example, right subdural
collection at the level of the vertex measures 2.1 cm, unchanged (2:26). The
left subdural collection overlying the parietal lobe 1.2 cm, stable (2:25).
The subdural collections extend inferiorly to the level of temporal lobe and
are also unchanged in size since prior. These subdural collections
demonstrate heterogeneous attenuation. Hematocrit levels are more apparent on
today's exam, which may be related to redistribution of blood products. No
large vascular territorial infarction. The sulci and ventricles are unchanged
in size and configuration. No hydrocephalus. Basilar cisterns appear patent.
There is no significant shift of normally midline structures. Imaged mastoid
air cells and paranasal sinuses appear well aerated. Orbits are unremarkable.
No acute fracture is noted.
IMPRESSION:
In comparison to study obtained one day prior, there is no significant change
in diffuse bilateral subdural hematomas. These subdural collections display
heterogeneous attenuation. Hematocrit levels are more apparent on today's
exam, perhaps due to redistribution of blood products.
|
10105456-RR-7 | 10,105,456 | 20,186,962 | RR | 7 | 2181-01-17 13:44:00 | 2181-01-17 14:09:00 | HISTORY: Syncope with possible head injury
COMPARISON: None
TECHNIQUE: CT images of the brain were acquired without IV contrast.
Sagittal and coronal reformatted images were subsequently reviewed.
DLP: 891 mGy-cm
FINDINGS:
There is no evidence of hemorrhage, edema, mass or acute territorial
infarction. The ventricles and sulci are appropriate in size and
configuration for age. The basal cisterns appear patent and there is
preservation of gray-white matter differentiation.
No fractures are identified. The visualized paranasal sinuses, mastoid air
cells and middle ear cavities are clear. The globes and orbits are
unremarkable.
IMPRESSION:
No evidence of hemorrhage or acute territorial infarction.
|
10105456-RR-8 | 10,105,456 | 20,186,962 | RR | 8 | 2181-01-17 13:52:00 | 2181-01-17 14:18:00 | CHEST RADIOGRAPHS
HISTORY: Dyspnea on exertion.
COMPARISONS: ___.
TECHNIQUE: Chest, AP upright and lateral.
FINDINGS: The cardiac, mediastinal, and hilar contours appear unchanged.
There is no pleural effusion or pneumothorax. The lungs appear clear.
IMPRESSION: No evidence of acute disease.
|
10105456-RR-9 | 10,105,456 | 20,186,962 | RR | 9 | 2181-01-18 22:53:00 | 2181-01-18 23:58:00 | INDICATION: History of DVT, on Coumadin, would like stop as there is no DVT.
COMPARISON: No prior studies available for comparison.
FINDINGS: Grayscale and color Doppler sonograms performed of the left common
femoral, superficial femoral, popliteal, posterior tibial and peroneal veins.
Normal compressibility, flow and augmentation noted throughout.
IMPRESSION: No deep vein thrombosis in the left lower extremity.
|
10105515-RR-11 | 10,105,515 | 29,408,813 | RR | 11 | 2140-12-02 19:37:00 | 2140-12-02 20:02:00 | INDICATION: History: ___ with hip pain// ?fx
TECHNIQUE: AP view of the pelvis, two views of the right hip
COMPARISON: None.
FINDINGS:
An impacted fracture of the right femoral neck is demonstrated with slight
medial displacement and minimal valgus angulation of the distal fracture
fragment. No dislocation. Patient is status post left hip hemiarthroplasty
which grossly appears unremarkable, though the inferior aspect of the femoral
stem is not imaged on this exam. Deformity of the left inferior pubic ramus
suggest a healed remote fracture. No diastases of the pubic symphysis or
sacroiliac joints. Mild degenerative changes of the lower lumbar spine. No
suspicious lytic or sclerotic osseous abnormality.
IMPRESSION:
Impacted, mildly displaced fracture of the right femoral neck with mild valgus
angulation.
|
10105515-RR-12 | 10,105,515 | 29,408,813 | RR | 12 | 2140-12-02 20:41:00 | 2140-12-02 21:33:00 | INDICATION: History: ___ with hip fx// preop
TECHNIQUE: Supine AP view of the chest
COMPARISON: None.
FINDINGS:
Cardiac silhouette size is normal. Aorta appears mildly unfolded.
Mediastinal and hilar contours are unremarkable. Pulmonary vasculature is
normal. No focal consolidation, pleural effusion, or pneumothorax. Remote
fracture of the right fifth posterior rib is demonstrated. No acute osseous
abnormality.
IMPRESSION:
No acute cardiopulmonary process.
|
10105515-RR-13 | 10,105,515 | 29,408,813 | RR | 13 | 2140-12-02 20:41:00 | 2140-12-02 21:32:00 | INDICATION: History: ___ with fem head fx// ?fx
TECHNIQUE: Right femur, two views
COMPARISON: Pelvis and right hip radiographs ___ at 19:50
FINDINGS:
Re-demonstrated is a mildly impacted and medially displaced right femoral neck
fracture with slight valgus angulation, not substantially changed in alignment
from the prior exam. No dislocation. Patient is status post ORIF of a distal
femoral diaphyseal fracture transfixed by lateral plate with multiple screws.
No hardware complications are identified. No suspicious lytic or sclerotic
osseous abnormality. Imaged aspect of the right knee demonstrates no acute
abnormality. No soft tissue calcification.
IMPRESSION:
1. No interval change in appearance of mildly impacted and medially displaced
femoral neck fracture. No dislocation.
2. Status post ORIF of a distal femoral diaphyseal fracture without hardware
complications.
|
10105515-RR-14 | 10,105,515 | 29,408,813 | RR | 14 | 2140-12-02 23:00:00 | 2140-12-02 23:59:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: History: ___ with s/p fall// ?fx ?bleed
TECHNIQUE: Contiguous axial images from skullbase to vertex were obtained
without intravenous contrast. Coronal and sagittal reformations and bone
algorithms reconstructions were also performed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 16.0 s, 17.5 cm; CTDIvol = 45.8 mGy (Head) DLP =
802.7 mGy-cm.
Total DLP (Head) = 803 mGy-cm.
COMPARISON: None.
FINDINGS:
Mildly motion limited exam. Within these limits, there is no evidence of
large acute territory infarction, intracranial hemorrhage, edema, or mass. The
ventricles and sulci are prominent compatible with involutional changes.
No acute fracture seen. The paranasal sinuses, mastoid air cells, and middle
ear cavities are clear. The orbits are unremarkable.
IMPRESSION:
Mildly motion limited exam.
No acute findings.
|
10105515-RR-15 | 10,105,515 | 29,408,813 | RR | 15 | 2140-12-02 23:00:00 | 2140-12-03 00:04:00 | EXAMINATION: CT C-SPINE W/O CONTRAST Q311 CT SPINE
INDICATION: History: ___ with s/p fall// ?fx ?bleed ?fx ?bleed
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 5.3 s, 20.8 cm; CTDIvol = 22.9 mGy (Body) DLP = 475.3
mGy-cm.
Total DLP (Body) = 475 mGy-cm.
COMPARISON: None.
FINDINGS:
The patient is rotated. A 2 mm of anterolisthesis of C7 on T1. Otherwise,
alignment is normal. No acute fractures are identified.There is no
prevertebral soft tissue swelling.Multilevel degenerative changes are present
worst from C3 through C7 including disc space height loss, osteophytosis,
endplate changes, and facet arthropathy. These probably cause moderate spinal
canal. Multilevel moderate foraminal narrowing.
IMPRESSION:
1. No acute fracture or traumatic malalignment.
2. Multilevel advanced degenerative changes.
|
10105515-RR-16 | 10,105,515 | 29,408,813 | RR | 16 | 2140-12-03 15:16:00 | 2140-12-03 16:47:00 | EXAMINATION: FEMUR (AP AND LAT) IN O.R. RIGHT
INDICATION: Surgical fixation right femoral neck fracture.
TECHNIQUE: AP and lateral fluoroscopic images were obtained of the right hip
intraoperatively.
Fluoroscopy time: 58.3 seconds
Total dose: 541.25 mrad
COMPARISON: Right femur radiographs ___.
FINDINGS:
Intraoperative images of the right hip were acquired without a Radiologist
present. There is a right femoral neck fracture which is transfixed with
three cannulated screws. Alignment is improved.
IMPRESSION:
Intraoperative images were obtained during surgical fixation of the right
femoral neck fracture. Please refer to the operative note for details of the
procedure.
|
10105515-RR-5 | 10,105,515 | 28,439,066 | RR | 5 | 2137-10-07 23:24:00 | 2137-10-08 00:09:00 | EXAMINATION: CT T-SPINE W/O CONTRAST Q321 CT SPINE
INDICATION: ___ female who was recently diagnosed with an acute T11
compression fracture by MRI performed last weekend, presenting for further
evaluation.
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 8.6 s, 33.8 cm; CTDIvol = 48.4 mGy (Body) DLP =
1,638.1 mGy-cm.
Total DLP (Body) = 1,638 mGy-cm.
COMPARISON: Not available.
FINDINGS:
Numbering of the thoracic spine is provided on series 602b, images 40 and 47.
The first rib-bearing vertebra was designated as T1.
There is a severe compression fracture involving the T11 vertebral body.
There is approximately 7 mm of retropulsion, which compresses the cord at this
level (602b:35). This represents at least a 2-column fracture. However, the
left T11 pedicle is sclerotic in appearance (602b:42) and is directly
contiguous with the sclerotic appearance of the posterior vertebral body at
this level. Additionally, there is a focus of cortical irregularity
posteriorly in the left transverse process (2:98). Therefore, this likely
represents a healing fracture.
A non-displaced fracture involving the T10 spinous process is also noted
(602b:34). No other fractures are identified in the thoracic spine. Remote
right ___ and 11th rib fractures are also noted.
Thyroid gland is unremarkable in appearance. Thoracic aorta contains mild
atherosclerotic calcifications but is normal in course and caliber. Heart
size appears at least mildly enlarged. Imaged portions of the lungs are
without concerning nodular opacities. There is bibasilar dependent
atelectasis. No pleural effusions. Imaged intra-abdominal structures are
unremarkable in appearance.
IMPRESSION:
1. Severe T11 burst fracture of undetermined age likely subacute to chronic.
There is 7mm retropulsion with thecal sac and likely cord compression at this
level.
2. Non-displaced T10 spinous process fracture.
3. Remote right ___ and 11th rib fractures.
|
10105515-RR-6 | 10,105,515 | 28,439,066 | RR | 6 | 2137-10-07 23:25:00 | 2137-10-08 00:21:00 | EXAMINATION: CT L-SPINE W/O CONTRAST Q331 CT SPINE
INDICATION: ___ female with a known T11 compression fracture.
Evaluate for evidence of lumbar spine injury.
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 8.0 s, 31.3 cm; CTDIvol = 32.4 mGy (Body) DLP =
1,014.4 mGy-cm.
Total DLP (Body) = 1,014 mGy-cm.
COMPARISON: None.
FINDINGS:
Imaging of the lumbar spine is provided on series 601b, image 39. Vertebral
bodies are counted from the top with the first rib-bearing vertebral body
designated as T1. As such, there are 4 lumbar-type vertebra.
There is grade I anterolisthesis of L4 on S1. Moderate dextrocurvature of the
lumbar spine. Alignment of the lumbar spine is otherwise normal. There is no
acute fracture involving the lumbar spine. Mild multilevel degenerative
changes are noted in the form of small anterior/posterior osteophytes, facet
joint arthropathy and evidence of degenerative disc disease.
Remote fractures of the right tenth and eleventh ribs.
Thoracic spine findings are dictated separately.
The included intra-abdominal structures are unremarkable in appearance.
IMPRESSION:
1. No lumbar spine fracture.
2. Remote right ___ and 11th rib fractures.
|
10105515-RR-8 | 10,105,515 | 28,439,066 | RR | 8 | 2137-10-09 14:20:00 | 2137-10-09 14:53:00 | EXAMINATION: T-SPINE
INDICATION: ___ year old woman with unstable T11 compression fracture s/p TLSO
// Please do AP and lateral with brace. s/p TLSO Please do AP and lateral
with brace. s/p TLSO
IMPRESSION:
No previous images. There is severe loss of height of the T11 vertebral body
with suggestion of a separated fractured fragment anteriorly. Dorsal
displacement of the T11 vertebral body into the spinal canal is well seen on
the CT scan of the same date. The additional fractures of the posterior
elements are not appreciated on plain radiographs.
|
10105515-RR-9 | 10,105,515 | 26,900,189 | RR | 9 | 2138-11-03 00:00:00 | 2138-11-03 03:06:00 | EXAMINATION: MR ___ SPINE W/O CONTRAST ___ MR SPINE
INDICATION: History: ___ with low back pain, bowel incontinence, urinary
retention. Please evaluate.
TECHNIQUE: Sagittal imaging was performed with T2, T1, and STIR technique,
followed by axial T2 imaging.
COMPARISON: CT from ___.
FINDINGS:
Please note that numbering has been performed based on the first rib-bearing
vertebral body designated as T1 on the prior CT. Based on this numbering,
there is sacralization of the L5 vertebral body, with the numbering provided
on series 3, image 12.
Acute, minimally displaced fracture is seen involving the sacrum at the S1
vertebral body, series 5 image 14 and series 4, image 15 extensive surrounding
bone marrow and paraspinal soft tissue edema. Re-demonstrated is a burst
compression fracture of the T11 vertebral body, with retropulsion of fragments
into the spinal canal by approximately 0.9 cm resulting in mass effect upon
the spinal cord and at least mild-to-moderate spinal canal narrowing. No
associated cord signal abnormality is seen. Subtle increased STIR signal
abnormality is seen involving the fractured T11, which may be secondary to
edema.
The cord terminates at L1. No terminal cord signal abnormalities are
identified. Diffuse loss of normal T2 signal is seen throughout the
intervertebral discs of the lumbar spine. The alignment at the remainder of
the levels is normal.
T12-L1: There is no spinal canal or neural foraminal narrowing.
L1-L2: Mild disc bulge is seen, which in conjunction with facet joint
osteophytes results in bilateral subarticular zone narrowing. Facet joint
osteophytes results in mild bilateral neural foraminal narrowing.
L2-L3: Disc bulge, facet joint arthropathy and ligamentum flavum thickening
results in mild spinal canal narrowing. Facet joint osteophytes results in
moderate left and mild right neural foraminal narrowing.
L3-L4: Mild disc bulge, facet joint arthropathy and ligamentum flavum
thickening results in mild spinal canal narrowing. Facet joint osteophytes
contribute to moderate right and mild left neural foraminal narrowing.
L4-L5: Disc bulge with a focal central disc protrusion is seen, which in
conjunction with facet joint osteophytes and ligamentum flavum thickening
results in mild spinal canal narrowing. Facet joint osteophytes contribute to
severe right and mild left neural foraminal narrowing.
Moderate dextroscoliosis centered at L2-L3 appears similar to the prior exam
from ___.
IMPRESSION:
1. Please note that numbering is been performed based on the first rib-bearing
vertebral body designated as T1 on the prior CT from ___.
2. Acute, minimally displaced fracture is seen involving the S1 vertebral
body, with extensive paraspinal edema, not seen on the prior CT from ___.
3. Late subacute to chronic compression deformity is seen involving the T11
vertebral body, unchanged compared to the prior CT from ___.
retropulsion of fragments by approximately 0.9 cm causes at least mild to
moderate spinal canal narrowing at this level. No cord signal abnormalities
identified.
4. Moderate to severe lumbar spondylosis as described above.
NOTIFICATION: Updated findings were discussed with Dr. ___. by ___
___, M.D. on the telephone on ___ at 11:10 am, 10 minutes after
discovery of the findings.
|
10105529-RR-31 | 10,105,529 | 27,539,048 | RR | 31 | 2158-04-18 16:36:00 | 2158-04-18 17:00:00 | EXAMINATION: CTA HEAD AND CTA NECK Q16 CT NECK
INDICATION: History: ___ with headache. diplopia and weakness// eval for ICH
or Ischemia
TECHNIQUE: Contiguous MDCT axial images were obtained through the brain
without contrast material. Subsequently, helically acquired rapid axial
imaging was performed from the aortic arch through the brain during the
infusion of intravenous contrast material. Three-dimensional angiographic
volume rendered, curved reformatted and segmented images were generated on a
dedicated workstation. This report is based on interpretation of all of these
images.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 16.0 s, 16.0 cm; CTDIvol = 50.2 mGy (Head) DLP =
802.7 mGy-cm.
2) Stationary Acquisition 6.5 s, 0.5 cm; CTDIvol = 70.8 mGy (Head) DLP =
35.4 mGy-cm.
3) Spiral Acquisition 5.0 s, 39.7 cm; CTDIvol = 31.1 mGy (Head) DLP =
1,231.7 mGy-cm.
Total DLP (Head) = 2,070 mGy-cm.
COMPARISON: None.
FINDINGS:
CT HEAD WITHOUT CONTRAST:
There is no evidence of infarction, hemorrhage, edema, or mass. Prominence of
the ventricles and cerebral sulci are compatible with age related involutional
changes.
The visualized portion of the paranasal sinuses, mastoid air cells, and middle
ear cavities are clear. The visualized portion of the orbits are unremarkable.
CTA HEAD:
The vessels of the circle of ___ and their principal intracranial branches
appear normal without stenosis, occlusion, or aneurysm formation. The dural
venous sinuses are patent.
CTA NECK:
The common carotid arteries have a common origin. There is a tortuous origin
of the right common carotid artery which demonstrates focal kinking and
mild-to-moderate narrowing (03:59). Moderate calcifications are present at
the left carotid bifurcation. There is medialization of a portion of the left
cervical ICA. There are atherosclerotic calcifications of the carotid
siphons.
The right ACA A1 segment is hypoplastic, likely congenital. There is a 3 mm
infundibulum at the right carotid terminus at the origin of the posterior
communicating artery. There are mild calcifications and mild focal ectasia of
the left vertebral artery V4 segment measuring up to 6 mm. The carotid and
vertebral arteries and their major branches appear otherwise normal with no
evidence of stenosis or occlusion. There is no evidence of internal carotid
stenosis by NASCET criteria.
OTHER:
The visualized portion of the lungs are clear. There is a 3 mm hypodense
nodule within the right thyroid lobe for which no follow-up imaging is
recommended. The right pulmonary artery is enlarged measuring up to 3.5 cm,
which can be seen in setting of pulmonary arterial hypertension. There is no
lymphadenopathy by CT size criteria.
IMPRESSION:
1. No acute intracranial abnormality.
2. Tortuous origin of the right common carotid artery which demonstrates focal
kinking and mild-to-moderate narrowing.
3. Evidence of a right carotid terminus 3 mm infundibulum at the origin of the
posterior communicating artery.
4. Mild focal ectasia of the left vertebral artery V4 segment measuring up to
6 mm.
5. Generalized parenchymal volume loss, likely age related.
6. Enlarged right pulmonary artery measuring up to 3.5 cm can be seen in
setting of pulmonary arterial hypertension.
|
10105529-RR-32 | 10,105,529 | 27,539,048 | RR | 32 | 2158-04-20 10:15:00 | 2158-04-20 11:47:00 | EXAMINATION: MR HEAD W/O CONTRAST T9113 MR HEAD.
INDICATION: patient with resolved visual symptoms. r/o stroke//stroke.
TECHNIQUE: Sagittal T1 weighted imaging was performed. Axial imaging was
performed with gradient echo, FLAIR, diffusion, and T2 technique were then
obtained.
COMPARISON CTA head and neck ___.
FINDINGS:
There is no evidence of hemorrhage, edema, masses, mass effect, midline shift
or infarction. Prominence of ventricles and sulci are likely involutional
changes. Confluent periventricular and scattered foci subcortical white
matter FLAIR hyperintensities are nonspecific, likely reflect chronic small
vessel disease.
Major intracranial vascular flow voids are preserved. The orbits are
unremarkable, the paranasal sinuses and mastoid air cells are clear.
IMPRESSION:
1. There is no evidence of acute intracranial process or hemorrhage,
specifically no diffusion abnormalities are seen to indicate acute/subacute
ischemic changes.
|
10105747-RR-15 | 10,105,747 | 21,346,337 | RR | 15 | 2151-06-21 15:33:00 | 2151-06-22 14:53:00 | EXAMINATION: MR HEAD W AND W/O CONTRAST
INDICATION: ___ year old man with hx of traumatic skull injury to R
fronto-temporal region now presenting with purulent drainage from supraorbital
wound/sinus // soft tissue infection around R orbit? any extension into
calavarium?
TECHNIQUE: MRI of the brain is performed and includes the following
sequences: sagittal T-weighted, axial fast spin echo T2-weighted,axial flair,
axial diffusion weighted and axial gradient echo images. The T1 weighted
images were repeated after the administration of intravenous gadolinium
contrast.
COMPARISON: Prior CT of the brain dated ___.
FINDINGS:
Patient is status post reconstructive right frontal skull surgery. There is
dural thickening and enhancement in the right frontal lobe which is most
likely related to prior surgery and the history of infection. There are
central regions within this enhancement that do not enhance after contrast.
However, these areas correspond to calcification seen on the CT scan. There is
minimal increased FLAIR signal seen in the right frontal lobe in this region
which also is likely secondary to prior surgery. There is no abnormal
parenchymal enhancement.
There is chronic appearing opacification of the left sphenoid sinus. There
appears to be inspissated mucus within an expanded sinus, reflecting a
mucocele. There is fluid and mucosal thickening in the frontal sinus on the
left. On the right, there is partial aeration of the frontal sinus with air
and fluid extending into a component of the sinus that has a defect in the
posterior wall on the CT. The in the setting of known infection, this would be
a route towards intracranial involvement. There is mucosal thickening in the
ethmoid air cells bilaterally and in the left maxillary sinus.
There is no evidence of infarction, hemorrhage, midline shift or mass effect.
No diffusion abnormalities are detected. The cerebral volume is appropriate
for the patient's stated age. There are a few scattered foci of T2/FLAIR
signal hyperintensity in the subcortical white matter which are nonspecific.
The major vascular flow voids are maintained. The orbits are unremarkable.
IMPRESSION:
Right frontal craniotomy with postoperative changes as described above. There
is dural thickening and enhancement underlying the surgical site. This may be
this dural postoperative change. However, in the setting of a history of
infection, opacification of an adjacent right frontal sinus air cell, and a
defect in the posterior wall of the sinus, these findings are worrisome for
superimposed infection.
Prior MRI studies for comparison would be helpful to determine if this finding
has demonstrated interval change.
|
10105747-RR-16 | 10,105,747 | 21,346,337 | RR | 16 | 2151-06-22 22:12:00 | 2151-06-22 23:46:00 | INDICATION: ___ year old man s/p craniectomy for infected bone flap. History
of right traumatic skull injury.
TECHNIQUE: Contiguous axial MDCT images were obtained from the skull base
through the vertex, without IV administration of contrast. Reformatted coronal
and sagittal and thin-section bone algorithm-reconstructed images were
acquired, and all images are viewed in brain and bone window on the
workstation.
DOSE: DLP (mGy-cm): 892
COMPARISON: ___ CT from ___ and ___ brain
MRI performed here
FINDINGS:
Patient is status post right frontal/parietal craniectomy at the site of prior
craniotomy, with a drain in place in the soft tissues of the scalp. Hyperdense
material containing locules of air within the craniectomy site is consistent
with postsurgical blood products. There is no associated mass effect on the
brain parenchyma. There is no parenchymal hemorrhage or edema. Ventricles are
normal in size and configuration. The basal cisterns are patent. Gray-white
matter differentiation is preserved.
New blood in the right frontal sinus is likely postsurgical. There is
persistent fluid and mucosal thickening in bilateral anterior ethmoid and left
frontal sinuses. Left sphenoid sinus remains completely opacified. Mastoid air
cells and middle ear cavities remain clear.
IMPRESSION:
S/p right craniectomy at the site of prior craniotomy, with blood at the
craniectomy site which does not exert mass effect on the brain parenchyma. No
parenchymal hemorrhage or edema.
|
10105747-RR-17 | 10,105,747 | 21,346,337 | RR | 17 | 2151-06-23 13:13:00 | 2151-06-23 18:09:00 | EXAMINATION: CT SINUS W/O CONTRAST FOR SURGICAL PLANNING
INDICATION: ___ year old man with sinusitis, please evaluate for surgical
planning. // ___ year old man with sinusitis, please evaluate for surgical
planning.
TECHNIQUE: Helical axial images were acquired through the paranasal sinuses.
Coronal reformatted images were also obtained
DOSE: DLP: 727.61 mGy-cm; CTDI: 36 mGy
COMPARISON: CT head without contrast ___
FINDINGS:
There is a right craniectomy. There is opacification the sphenoid, with
sclerosis at the margins suggestive of chronic sinusitis and possible
mucocele. There is a dehiscence of the bony covering of the left foramen
Rotundum, on covering the ophthalmic branch of the trigeminal nerve. There is
bilateral mucosal thickening in the maxillary sinuses. There is bilateral
obstruction of the ostiomeatal units. There is a drain in the soft tissue, the
posterior wall of the right frontal sinus is not well seen.
IMPRESSION:
Extensive disease of the left sphenoid sinus soft-tissue changes as noted
above with dehiscence of the bone covering left foramen Rotundum as noted
above.
|
10105747-RR-18 | 10,105,747 | 21,346,337 | RR | 18 | 2151-06-27 09:31:00 | 2151-06-27 11:49:00 | EXAMINATION: Portable AP chest x-ray
INDICATION: ___ year old man with new line // new right basilic PICC 48 cm
___ ___ Contact name: ___: ___
TECHNIQUE: AP projection.
COMPARISON: No priors available for comparison.
FINDINGS:
There is a right-sided PICC line whose distal tip courses superiorly and
projects above the upper limit of the film and is not visualized, likely
entering the right internal jugular vein. This requires repositioning.
The cardio mediastinal silhouettes are normal. The bilateral hila are normal.
There is leftward rotation. The lungs are clear without evidence of focal
consolidation. There is no pulmonary vascular congestion.
There are no pneumothoraces or effusions.
IMPRESSION:
1. Malpositioned right PICC line which likely enters right IJ. Requires
repositioning.
2. No evidence of acute cardiopulmonary process.
NOTIFICATION: The above findings regarding positioning of right-sided PICC
line were discussed over the phone by Dr. ___ with IV nurse ___ on ___ at 10:15, at the time of discovery.
|
10105747-RR-19 | 10,105,747 | 21,346,337 | RR | 19 | 2151-06-27 11:29:00 | 2151-06-27 14:00:00 | EXAMINATION: Portable AP chest x-ray.
INDICATION: ___ year old man with repositioned Picc // repeat xreay right
Picc ___ ___ Contact name: ___: ___
TECHNIQUE: AP projection.
COMPARISON: Portable AP chest x-ray obtained earlier today, ___ at
09:36
FINDINGS:
There is unchanged appearance of right-sided PICC line, coursing superiorly
and appearing to enter right IJ, with distal tip projecting above the upper
limit of without radiograph and not visualized. This requires repositioning.
The cardio mediastinal silhouettes are unchanged and normal in appearance. The
bilateral hila are normal. There is no pulmonary vascular congestion. There
are no new focal lung consolidations, pneumothoraces, or effusions.
IMPRESSION:
Unchanged malpositioned right PICC line which enters right internal jugular
vein. Requires repositioning or exchange.
NOTIFICATION: The above findings regarding the malpositioned right-sided PICC
line were discussed over the phone by Dr. ___ with IV nurse ___
___ on ___ at 13:57, approximately 5 minutes after discovery.
|
10105747-RR-20 | 10,105,747 | 21,346,337 | RR | 20 | 2151-06-27 15:18:00 | 2151-06-27 18:19:00 | INDICATION: ___ male with PICC malpositioned.
COMPARISON: Portable chest x-ray from 1136 hr earlier the same day.
TECHNIQUE: OPERATORS: Dr. ___ radiology fellow) and Dr. ___
___ radiology attending) performed the procedure. The attending,
Dr. ___ was present and supervising throughout the procedure.
ANESTHESIA: None.
MEDICATIONS: None.
CONTRAST: None.
FLUOROSCOPY TIME AND DOSE: None.
PROCEDURE: 1. Repositioning of right PICC.
PROCEDURE DETAILS: Scout imaging of the upper chest demonstrates the right
upper extremity PICC terminating in good position in the distal superior vena
cava. The PICC appears to have repositioned itself with patient respiration.
No procedure was performed.
FINDINGS:
1. Existing right arm approach PICC with tip repositioned in the distal
superior vena cava on its own. No procedure performed.
IMPRESSION:
Pre-existing PICC with tip in the distal superior vena cava. The line is ready
to use.
|
10105826-RR-16 | 10,105,826 | 29,397,818 | RR | 16 | 2128-02-07 01:15:00 | 2128-02-07 04:15:00 | CLINICAL INFORMATION: A ___ female who swallowed batteries.
COMPARISON: Films performed ___ at ___ Cod ___ and scanned into
PACS for reference.
FINDINGS: Two cylindrical objects are seen superimposed upon the distal
esophagus consistent with history of ingested batteries (double A). The lungs
are clear, the heart size is normal, the mediastinal contours are
unremarkable. Gas is seen throughout the colon and small bowel consistent
with pneumophagia. There is no intraperitoneal free air. There is a gentle
S-shaped scoliosis of the thoracolumbar spine.
IMPRESSION: Two double A batteries are seen in the distal esophagus.
|
10105923-RR-28 | 10,105,923 | 27,532,611 | RR | 28 | 2122-09-21 16:51:00 | 2122-09-21 17:28:00 | EXAMINATION: Chest radiographs, AP and lateral views.
INDICATION: Tachycardia and dyspnea.
COMPARISON: Prior studies from ___ and ___.
FINDINGS:
Heart is partly obscured but appears at least mildly enlarged. Small to
medium-sized bilateral pleural effusions are present bilaterally in addition
to suspected atelectasis at each lung base. Fissures are thickened. There is
also a mild interstitial process suggestive of mild pulmonary edema. Bones
appear demineralized. A sclerotic focus in the proximal left humerus suggests
a bone island, partly visualized on one of the remote prior studies.
IMPRESSION:
Pleural effusions and mild pulmonary edema. Suspected parenchymal opacities
with volume loss at each lung base, very typical for atelectasis.
|
10105923-RR-29 | 10,105,923 | 27,532,611 | RR | 29 | 2122-09-21 19:47:00 | 2122-09-21 20:15:00 | EXAMINATION: CTA CHEST WITH CONTRAST
INDICATION: ___ with CHF and previous PEs, afib on apixaban// Pulmonary
embolism vs pneumonia?
TECHNIQUE: Axial multidetector CT images were obtained through the thorax
after the uneventful administration of intravenous contrast. Reformatted
coronal, sagittal, thin slice axial images, and oblique maximal intensity
projection images were submitted to PACS and reviewed.
DOSE: Acquisition sequence:
1) Stationary Acquisition 5.0 s, 0.5 cm; CTDIvol = 30.4 mGy (Body) DLP =
15.2 mGy-cm.
2) Spiral Acquisition 4.3 s, 33.6 cm; CTDIvol = 11.9 mGy (Body) DLP = 399.8
mGy-cm.
Total DLP (Body) = 415 mGy-cm.
COMPARISON: Same day chest radiograph.
FINDINGS:
HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the
subsegmental level without filling defect to indicate a pulmonary embolus. The
thoracic aorta is normal in caliber without evidence of dissection or
intramural hematoma. There is mild calcific and noncalcific atherosclerotic
plaque involving the aortic arch and descending thoracic aorta. Coronary
artery calcifications are mild-to-moderate. The heart is mild-to-moderately
enlarged. No pericardial effusion is seen.
AXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar
lymphadenopathy is present. No mediastinal mass.
PLEURAL SPACES: Moderate-to-large bilateral pleural effusions free-flowing,
right greater than left. No pneumothorax.
LUNGS/AIRWAYS: Mild-to-moderate bibasilar compressive atelectasis. Diffuse
bilateral ground-glass opacities suggest pulmonary edema. There is a ___ mm
left upper lobe pulmonary nodule (3: 60). The airways are patent to the level
of the segmental bronchi bilaterally.
BASE OF NECK: Visualized portions of the base of the neck show no abnormality.
ABDOMEN: Included portion of the upper abdomen is unremarkable.
BONES: 1.3 cm sclerotic focus in the left humeral head may reflect a bone
island (03:10). There is no acute fracture.
IMPRESSION:
1. No evidence of pulmonary embolism or acute aortic abnormality.
2. Mild-to-moderate cardiac enlargement.
3. Moderate enlarged bilateral pleural effusions, right greater than left.
4. Diffuse bilateral ground-glass opacities suggest mild-to-moderate pulmonary
edema.
5. 3 to 4 mm left upper lobe pulmonary nodule. Please refer to ___
criteria below for follow-up recommendations.
RECOMMENDATION(S): For incidentally detected single solid pulmonary nodule
smaller than 6 mm, no CT follow-up is recommended in a low-risk patient, and
an optional CT in 12 months is recommended in a high-risk patient.
See the ___ ___ Society Guidelines for the Management of Pulmonary
Nodules Incidentally Detected on CT" for comments and reference:
___
|
10105923-RR-30 | 10,105,923 | 27,532,611 | RR | 30 | 2122-09-25 15:31:00 | 2122-09-25 16:08:00 | EXAMINATION: CHEST (SINGLE VIEW)
INDICATION: ___ with AF with RVR, HTN, CKD, dementia, RA, and ___
transferred from ___ with HF borderline EF (47%) exacerbation.// Any
evidence of pulmonary edema? Improvement from CTA chest?
IMPRESSION:
In comparison with the study of ___, there again is enlargement of the
cardiac silhouette with layering bilateral pleural effusions and compressive
atelectasis at the bases.
Sclerotic focus in the humeral head on the left is again seen. In addition to
a possible bone island, calcified enchondroma should be considered.
|
10105923-RR-31 | 10,105,923 | 27,532,611 | RR | 31 | 2122-10-11 21:21:00 | 2122-10-11 22:27:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with newly implanted ppm.// ?PTX
TECHNIQUE: AP portable chest radiograph
COMPARISON: ___
FINDINGS:
A new left chest wall dual lead pacemaker is present with the leads projecting
over the expected locations of the right atrial appendage and right ventricle.
There is blunting of the right costophrenic angle likely reflective of a
residual trace pleural effusion. There is no pneumothorax identified. The
size of the cardiac silhouette is within normal limits.
IMPRESSION:
No pneumothorax following placement of a left chest wall dual lead pacemaker.
|
10105923-RR-32 | 10,105,923 | 27,532,611 | RR | 32 | 2122-10-12 08:22:00 | 2122-10-12 09:02:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old woman with newly implanted ppm.// lead placement
IMPRESSION:
In comparison with the study of ___, there is no change in the
appearance of the dual channel pacer device and no evidence of pneumothorax.
Hyperexpansion of the lungs suggests underlying chronic pulmonary disease. No
evidence of appreciable vascular congestion or acute focal pneumonia.
Amorphous area of opacification in the left humeral head suggests either a
bone island or calcified enchondroma.
|
10106244-RR-37 | 10,106,244 | 22,486,493 | RR | 37 | 2148-05-11 14:36:00 | 2148-05-11 14:57:00 | EXAMINATION: CHEST (AP AND LAT)
INDICATION: History: ___ with dyspnea// eval for pneumonia
TECHNIQUE: Upright AP and lateral views of the chest
COMPARISON: Chest radiograph ___
FINDINGS:
Cardiac silhouette size is normal. Mediastinal and hilar contours are
unchanged. Lungs are hyperinflated. Pulmonary vasculature is not engorged.
No focal consolidation, pleural effusion or pneumothorax is present. No acute
osseous abnormality is visualized.
IMPRESSION:
No acute cardiopulmonary abnormality.
|
10106244-RR-38 | 10,106,244 | 22,486,493 | RR | 38 | 2148-05-11 14:50:00 | 2148-05-11 15:15:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: History: ___ with confusion// eval for stroke
TECHNIQUE: Contiguous axial images from skullbase to vertex were obtained
without intravenous contrast. Coronal and sagittal reformations and bone
algorithms reconstructions were also performed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 16.0 s, 16.0 cm; CTDIvol = 50.2 mGy (Head) DLP =
802.7 mGy-cm.
Total DLP (Head) = 803 mGy-cm.
COMPARISON: CT head ___.
FINDINGS:
There is no evidence of acute large vascular territory infarction, hemorrhage,
edema, or mass effect. The ventricles and sulci are slightly prominent in
size and configuration consistent with age related involutional changes.
Hypodensities in the periventricular and subcortical white matter are
nonspecific but likely represents chronic small vessel ischemic changes.
No osseous abnormalities seen. Mild atherosclerotic calcifications of the
cavernous portions of bilateral internal carotid arteries. The paranasal
sinuses, mastoid air cells, and middle ear cavities are clear. The orbits
demonstrate bilateral lens replacements.
IMPRESSION:
No acute intracranial process.
|
10106244-RR-39 | 10,106,244 | 22,486,493 | RR | 39 | 2148-05-12 13:03:00 | 2148-05-12 16:40:00 | EXAMINATION: MRI AND MRA BRAIN AND MRA NECK PT11 MR ___
INDICATION: ___ year old woman with subacute confusion, gait changes, poor
memory and executive function. Evaluate for leukoencephalopathy and vascular
abnormalities
TECHNIQUE: Three dimensional time of flight MR arteriography was performed
through the brain with maximum intensity projection reconstructions.
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: ___ and ___ noncontrast head CT
FINDINGS:
Study is moderately degraded by motion, especially on MR angiography.
MRI BRAIN:
There are moderate scattered bilateral confluent and more punctate
periventricular, subcortical, and deep white matter areas of T2/FLAIR
hyperintense signal without associated slow diffusion or enhancement. These
are nonspecific, but often attributed to chronic microangiopathy. There is no
abnormal focus of slow diffusion to suggest acute infarction. There is no
evidence of hemorrhage, edema, mass, mass effect, or shift of normally midline
structures. The ventricles and sulci are age appropriate. Principal
intracranial vascular flow voids are preserved there is fluid signal in some
of the right mastoid air cells there is mild mucosal thickening in the ethmoid
air cells. There is no abnormal enhancement.
MRA BRAIN:
The intracranial vertebral and internal carotid arteries and their major
branches appear normal without evidence of stenosis, occlusion, or aneurysm
formation.
MRA NECK:
There is approximately 30% narrowing of the origin of bilateral internal
carotid arteries, likely from atherosclerotic disease. Bilateral common
carotid and right vertebral artery origins are patent. The left vertebral
artery origins not well visualized. The aortic arch and branch vessels are
unremarkable. The vertebral arteries are patent.
IMPRESSION:
1. Study is moderately degraded by motion.
2. Extensive relatively symmetric bilateral periventricular, subcortical, and
deep white matter lesions are nonspecific, but correspond to hypodensities
seen on prior CT scans dating back to ___. The distribution
suggests chronic microangiopathy as a possible etiology.
3. Within limits of study, no evidence of hemorrhage, mass, mass effect, or
acute infarction.
4. Grossly patent circle of ___.
5. Approximately 30% narrowing of bilateral internal carotid artery origins by
NASCET criteria.
6. Left origin vertebral artery not well visualized on current motion degraded
exam. Otherwise, grossly patent bilateral cervical vertebral and carotid
arteries as described.
|
10106244-RR-41 | 10,106,244 | 22,486,493 | RR | 41 | 2148-05-15 11:40:00 | 2148-05-15 14:00:00 | EXAMINATION: MRI CERVICAL, THORACIC, AND LUMBAR PT22 MR SPINE
INDICATION: ___ year old woman with memory impairment, hallucinations, and
difficulty with gait in the setting of COPD, coronary artery disease,
hypertension, diabetes. Evaluate for cord pathology.
TECHNIQUE: Sagittal imaging was performed with T2, T1, and STIR technique.
Axial T2 imaging was performed. Axial GRE images of the cervical spine were
performed.
COMPARISON: Thoracic and lumbar spine CTs from ___.
___ brain MRI.
FINDINGS:
The localizer sequence, image 3:3, demonstrates 7 cervical, 12 thoracic, and 5
lumbar-type vertebrae. The localizer sequence also demonstrates incompletely
evaluated S-shaped thoracolumbar scoliosis with a dextroconvex curvature of
the cervical spine.
CERVICAL:
Vertebral body heights are preserved. There is minimal retrolisthesis of C5
on C6. No suspicious bone marrow signal abnormalities are seen. There is a
predominantly fatty hemangioma versus a focal fat deposit in the C6 vertebral
body.
The cerebellar tonsils are normally positioned. Visualized posterior fossa is
unremarkable.
No signal abnormalities are seen in the cervical spinal cord allowing for
motion artifact.
Multilevel degenerative disease is present. Evaluation of the neural foramina
is limited by motion artifact on axial images.
C2-C3: No spinal canal narrowing. Left facet arthropathy without significant
neural foraminal narrowing.
C3-C4: Left paracentral disc protrusion indents the ventral thecal sac without
significant spinal canal narrowing. There is mild to moderate left neural
foraminal narrowing by uncovertebral and facet osteophytes.
C4-C5: There is thickening of the left ligamentum flavum without significant
spinal canal narrowing. Mild right and mild-to-moderate left neural foraminal
narrowing by uncovertebral and facet osteophytes.
C5-C6: Minimal retrolisthesis, broad-based posterior endplate osteophytes and
thickening of the left ligamentum flavum causes moderate to severe spinal
canal narrowing with deformation of the spinal cord, but no evidence for focal
cord signal abnormality allowing for motion artifact. There is severe right
and moderate to severe left neural foraminal narrowing by uncovertebral and
facet osteophytes.
C6-C7: Central disc protrusion indents the ventral thecal sac and mildly
narrows the spinal canal without mass effect on the spinal cord. Left facet
arthropathy without significant neural foraminal narrowing.
C7-T1: No spinal canal or neural foraminal narrowing.
THORACIC:
T11 vertebral body demonstrates minimal loss of height (less than 10%) with
mild superior endplate deformity, slightly progressed compared to the ___ CT. There is high T1 and T2 signal parallel to the superior
endplate, consistent with fatty change, without evidence for marrow edema.
Other vertebral body heights are preserved. There is a levoconvex thoracic
curvature, as stated above. The thoracic spinal cord demonstrates normal
signal intensity. There is a mild disc bulge at T10-T11 without spinal canal
narrowing.
LUMBAR:
L2 vertebral body demonstrates approximately 40% loss of height, progressed
since the ___ CT, with superior endplate deformity. There is mild
retropulsion of L 2, also new since the prior CT, which mildly narrows the
ventral thecal sac without mass effect on the intrathecal nerve roots. High
signal on STIR images and low T1 signal along the superior endplate of L2 is
compatible either residual marrow edema, ___ type 1 discogenic bone marrow
change, or combination of both. There is also extensive ___ type 1
discogenic bone marrow change in the endplates at L3-L4. minimal
retrolisthesis of L3 on L4 is unchanged.
The conus medullaris appears unremarkable, terminating at L1.
L1-L2: A mild disc bulge, mild retropulsion of the L1 superior endplate, and
mild facet arthropathy mildly narrow the thecal sac without mass effect on the
intrathecal nerve roots. There is mild bilateral neural foraminal narrowing
without mass effect on the exiting nerve roots.
L2-L3: Mild disc bulge and facet arthropathy without significant spinal canal
narrowing. Mild right neural foraminal narrowing without mass effect on the
exiting nerve roots.
L3-L4: Moderate disc bulge and facet arthropathy mildly narrow the thecal sac
without mass effect on the intrathecal nerve roots. There is a left
paracentral, foraminal, and extraforaminal disc protrusion, which contacts the
traversing left L4 nerve root in the subarticular zone, and which in
combination with left facet arthropathy causes moderate left neural foraminal
narrowing with abutment and likely impingement of the exiting left L3 nerve
root. There is no significant right neural foraminal narrowing.
L4-L5: Mild disc bulge, central disc protrusion, mild to moderate right and
moderate left facet arthropathy are present. The thecal sac is mildly
narrowed without mass effect on the intrathecal nerve roots. There is right
subarticular zone narrowing with possible abutment, but no compression of the
traversing right L5 nerve root. There is moderate right and mild-to-moderate
left neural foraminal narrowing with abutment of the exiting right L4 nerve
root.
L5-S1: Moderate disc bulge, severe right and moderate left facet arthropathy
are present without significant spinal canal narrowing. There is mild right
subarticular zone narrowing with slight displacement, but no evidence for
compression of the traversing right S1 nerve root. There is mild right neural
foraminal narrowing with abutment of the exiting right L5 nerve root, but no
significant left neural foraminal narrowing.
OTHER:
T2 hyperintense circumscribed lesions in both kidneys were characterized as
cysts on the ___ renal ultrasound.
IMPRESSION:
1. At C5-C6, minimal retrolisthesis, broad-based posterior endplate
osteophytes, and thickening of the ligamentum flavum cause moderate to severe
spinal canal stenosis with spinal cord deformation, but no evidence for cord
signal abnormalities allowing for motion artifact. There is also severe right
and moderate to severe left neural foraminal narrowing at C5-C6. Mild
degenerative changes are present at other cervical levels without mass effect
on the spinal cord.
2. Normal appearance of the thoracic spinal cord and conus medullaris.
3. Previously seen T11 vertebral body fracture demonstrates slightly
increased, less than 10% loss of height without retropulsion or marrow edema.
4. Previously seen L2 vertebral body fracture demonstrates new, approximately
40% loss of height, new mild retropulsion with mild spinal canal narrowing but
no mass effect on the intrathecal nerve roots. Residual marrow edema is
likely present, with superimposed ___ type 1 discogenic bone marrow change.
5. Multilevel lumbar degenerative disease with mass effect on several
traversing and exiting nerve roots, as detailed above. No significant mass
effect on the intrathecal nerve roots.
|
10106244-RR-42 | 10,106,244 | 22,486,493 | RR | 42 | 2148-05-13 12:32:00 | 2148-05-13 15:09:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with COPD, new cough, leukocytosis// eval for
pneumonia eval for pneumonia
IMPRESSION:
Compared to chest radiographs since ___ most recently ___.
Mild dependent interstitial abnormality, usually pulmonary edema, is new.
Heart size is normal. No focal pulmonary abnormality is present in the upper
lungs. No appreciable pleural effusion.
|
10106434-RR-8 | 10,106,434 | 27,363,634 | RR | 8 | 2182-07-07 01:10:00 | 2182-07-07 02:12:00 | HISTORY: ___ female with GI bleed and left lower quadrant tenderness.
COMPARISON: None.
TECHNIQUE: MDCT images were obtained from the lung bases to the pubic
symphysis after administration of 150 cc of IV Omnipaque contrast. Axial
images were interpreted in conjunction with coronal and sagittal reformats.
DLP: 1062 mGy-cm
FINDINGS:
The visualized heart is normal. There is small right lung base dependent
atelectasis. The pericardium and pleura are intact without effusion.
ABDOMEN:
The liver has a nodular contour with hypertrophy of the left hepatic lobe,
most suggestive of cirrhosis. No focal hepatic lesion is visualized on this
single phase exam. The gallbladder wall is calcified and contains numerous
calcified gallstones. The intra and extrahepatic bile ducts, pancreas, and
adrenal glands are normal. The spleen is enlarged, measuring up to 18.1 cm.
The kidneys enhance symmetrically. The ureters have a normal course and
caliber.
The stomach is unremarkable. The small and large bowel have a normal course
and caliber. Colonic diverticulosis is present without evidence for
diverticulitis.
No retroperitoneal or mesenteric lymphadenopathy. Splenic and gastric varices
are present. The portal and intra-abdominal systemic vasculature are
otherwise unremarkable. A small to moderate amount of low density ascites is
primarily perihepatic but also tracking along both pericolic gutters into the
pelvis. No abdominal wall hernia, pneumoperitoneum, or free abdominal fluid.
PELVIS: The bladder and terminal ureters are normal. The uterus and adnexa
are unremarkable. No pelvic side-wall or inguinal lymphadenopathy. No
inguinal hernia.
OSSEOUS STRUCTURES: Moderate thoracolumbar spine degenerative changes are
present. L1 superior endplate deformity is of uncertain chronicity, probably
non-acute. No focal lytic or sclerotic lesion concerning for malignancy.
IMPRESSION:
1. Cirrhosis with splenomegaly, varices, and small amount ascites.
2. Diverticulosis without evidence of diverticulitis.
3. Porcelain gallbladder containing numerous calcified gallstones, which
increases risk for gallbladder carcinoma. Non-emergent surgical consult is
recommended.
4. L1 superior endplate deformity, of uncertain chronicity.
|
10106434-RR-9 | 10,106,434 | 27,363,634 | RR | 9 | 2182-07-07 13:14:00 | 2182-07-07 15:28:00 | HISTORY: ___ female with new diagnosis of cirrhosis, porcelain
gallbladder, evaluate for biliary pathology and assess hepatic veins.
COMPARISON: Abdomen CT ___.
FINDINGS:
The hepatic architecture is nodular in appearance consistent with the
patient's known cirrhosis. No concerning liver lesion is identified. No
biliary dilatation is seen and the common duct measures 0.4 cm. The wall of
the gallbladder is calcified consistent with the patient's known porcelain
gallbladder. The pancreas is unremarkable, but is only partially visualized
due to overlying bowel gas. The spleen is enlarged measuring 17.3 cm. There
is no hydronephrosis on limited views of the kidneys. A trace of ascites is
seen in the right upper quadrant. There is a small right pleural effusion.
DOPPLER EXAMINATION: Color Doppler and spectral waveform analysis was
performed. The main and right portal veins are patent with hepatopetal flow.
Flow within the left portal vein is difficult to detect likely representing
extremely slow flow. Hepatopetal flow is seen in the SMV and the splenic vein
in the midline. The hepatic veins and IVC are patent. Appropriate arterial
waveforms are seen in the main, right and left hepatic arteries.
IMPRESSION:
1. No biliary dilatation identified.
2. Nodular hepatic architecture with splenomegaly and a trace of ascites.
3. Porcelain gallbladder.
4. Patent hepatic vasculature. Flow within the left portal vein is noted to
be difficult to detect likely representing slow flow.
|
10107132-RR-10 | 10,107,132 | 28,170,894 | RR | 10 | 2176-03-19 04:16:00 | 2176-03-19 05:56:00 | EXAMINATION: CT C-SPINE W/O CONTRAST
INDICATION: History: ___ with s/p fall with neck pain // ?fracture
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 5.8 s, 22.6 cm; CTDIvol = 37.1 mGy (Body) DLP = 838.7
mGy-cm.
Total DLP (Body) = 839 mGy-cm.
COMPARISON: None available.
FINDINGS:
Minimal anterolisthesis of C3 on C4 and C7 on T1 is likely degenerative in
nature, however there are no priors for comparison. Otherwise, alignment is
normal. No acute fractures are identified. There is no prevertebral soft
tissue swelling.
Multilevel degenerative disc disease, most prominent at C5-6 and C6-7. Small
posterior intervertebral osteophytes cause mild narrowing of the spinal canal
at multiple levels. No high-grade spinal canal stenosis. Multilevel moderate
neural foraminal stenosis due to a combination of uncovertebral and facet
osteophytes.
There is a hypodense right thyroid nodule measuring 1.7 x 1.2 cm. No cervical
lymphadenopathy. The visualized lung apices are grossly clear.
IMPRESSION:
1. Minimal anterolisthesis of C3 on C4 and C7 on T1, likely degenerative in
nature, however acuity cannot be definitively establish without prior
examination. If there is high clinical suspicion for ligamentous injury, MRI,
if there no contraindications would be more sensitive.
2. No evidence of acute fracture.
3. Multilevel multifactorial degenerative changes.
4. Right thyroid nodule measuring up to 1.7 cm, for which further follow-up
with thyroid ultrasound is suggested by current ACR recommendations for
incidentally noted thyroid nodules.
RECOMMENDATION(S):
Thyroid nodule. Ultrasound follow up recommended.
___ College of Radiology guidelines recommend further evaluation for
incidental thyroid nodules of 1.0 cm or larger in patients under age ___ or 1.5
cm in patients age ___ or ___, or with suspicious findings.
Suspicious findings include: Abnormal lymph nodes (those displaying
enlargement, calcification, cystic components and/or increased enhancement) or
invasion of local tissues by the thyroid nodule.
___, et al, "Managing Incidental Thyroid Nodules Detected on Imaging: White
Paper of the ACR Incidental Findings Committee". J ___ ___
12:143-150.
.
|
10107132-RR-12 | 10,107,132 | 28,170,894 | RR | 12 | 2176-03-20 05:42:00 | 2176-03-20 07:40:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ year old man with left sdh, on Coumadin. obtain at 1700
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast. Coronal and sagittal reformations as well as bone algorithm
reconstructions were provided and reviewed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 16.0 s, 16.2 cm; CTDIvol = 49.5 mGy (Head) DLP =
802.7 mGy-cm.
2) Sequenced Acquisition 5.0 s, 10.0 cm; CTDIvol = 50.2 mGy (Head) DLP =
501.7 mGy-cm.
3) Sequenced Acquisition 1.0 s, 2.0 cm; CTDIvol = 50.2 mGy (Head) DLP =
100.3 mGy-cm.
Total DLP (Head) = 1,405 mGy-cm.
COMPARISON: Head CT dated ___.
FINDINGS:
This examination is limited by motion artifact. Within these limitations,
there is an acute on chronic left subdural hematoma measuring 1.2 cm in
maximal thickness. Stable small amount of hemorrhage layering along the left
tentorium and anterior falx. No evidence of new hemorrhage. Stable 4 mm of
left-to-right midline shift.
Unchanged size and configuration of the ventricular system. The basal
cisterns are patent. There is no evidence of acute territorial
infarction,edema, or mass. Periventricular and subcortical white matter
hypodensities are nonspecific, but likely represent the sequela of chronic
microvascular ischemia.
Status post right parietal craniotomy. There is no evidence of fracture. The
visualized portion of the paranasal sinuses, mastoid air cells, and middle ear
cavities are clear. The patient is status post bilateral lens resections.
IMPRESSION:
1. Limited examination due to motion artifact. Within these limitations,
acute on chronic left subdural hematoma measures 1.2 cm in maximal thickness
without evidence of new hemorrhage. Stable small volume subdural hemorrhage
layering along the left tentorium and anterior falx.
2. Stable 4 mm of left-to-right midline shift. Patent basal cisterns.
|
10107132-RR-9 | 10,107,132 | 28,170,894 | RR | 9 | 2176-03-19 04:16:00 | 2176-03-19 05:40:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: History: ___ with altered mental status and headache //
?subdural hematoma
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast. Coronal and sagittal reformations as well as bone algorithm
reconstructions were provided and reviewed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 16.0 s, 16.3 cm; CTDIvol = 49.3 mGy (Head) DLP =
802.7 mGy-cm.
Total DLP (Head) = 803 mGy-cm.
COMPARISON: None.
FINDINGS:
There is an acute on chronic left subdural hematoma measuring 1.5 cm in
maximal thickness. There is also a small amount of subdural hemorrhage
layering along the left tentorium and left anterior falx (series 2, image 23).
Effacement of the adjacent left frontal parietal convexity sulci and an
associated 4 mm of left-to-right midline shift is identified. The ventricles
are normal in size and configuration. The basal cisterns are patent.
There is no evidence of acute territorial infarction,edema, or mass effect.
There periventricular and subcortical white matter hypodensities, which are
nonspecific, but compatible with chronic microangiopathy in a patient of this
age.
The patient is status post right parietal craniotomy. There is no evidence of
fracture. A mucous retention cyst is seen within the right maxillary sinus.
Otherwise, the visualized portion of the paranasal sinuses, mastoid air cells,
and middle ear cavities are clear. The patient is status post bilateral lens
resections.
IMPRESSION:
1. Acute on chronic left subdural hematoma measuring 1.5 cm in maximal
thickness. Subdural hematoma layering along the anterior left falx and left
tentorial leaflet is also identified.
2. 4 mm of left-to-right midline shift. Patent basal cisterns.
3. Additional findings as described above.
|
10107231-RR-17 | 10,107,231 | 27,138,036 | RR | 17 | 2133-11-17 15:43:00 | 2133-11-17 16:40:00 | INDICATION: ___ with right hip pain s/p fall // ? fracture
TECHNIQUE: AP view of pelvis. AP and lateral views of the proximal distal
right femur.
COMPARISON: Correlation made to CT abdomen pelvis from ___.
FINDINGS:
Bones are diffusely demineralized. There is an acute impacted right femoral
neck fracture. Femoroacetabular joint remains anatomically aligned.
Cortical step-offs involving both the superior and inferior pubic rami raise
the possibility of additional fractures. No additional fracture identified.
Distally the femur is unremarkable. Right total knee arthroplasty identified.
Pubic symphysis and SI joints are unremarkable.
IMPRESSION:
Acute impacted right femoral neck fracture.
Suspected right superior and inferior pubic rami fractures.
|
10107231-RR-18 | 10,107,231 | 27,138,036 | RR | 18 | 2133-11-17 16:09:00 | 2133-11-17 17:26:00 | EXAMINATION: WRIST(3 + VIEWS) RIGHT
INDICATION: ___ with fall w/ wrist and hip pain // hip fx, getting full
length fx for op fx? wrist fx?
TECHNIQUE: Frontal, oblique, and lateral view radiographs of right wrist.
COMPARISON: None
FINDINGS:
The bones are diffusely demineralized. There is buckling along the posterior
surface of the distal right radius within cortical step-off seen medially as
well. Findings raise concern for an acute fracture. Elsewhere, no acute
fractures or dislocation are seen. There are severe degenerative changes of
the first carpometacarpal joint. There is joint space narrowing at the
radiocarpal and ulnar call per joints. There are calcifications of the TFCC.
Mineralization is normal. There are no erosions.
IMPRESSION:
Diffusely demineralized bones with suspicion for distal right radius fracture.
Severe degenerative changes of first carpometacarpal joint. Calcifications of
the TFCC suggesting CPPD.
|
10107231-RR-19 | 10,107,231 | 27,138,036 | RR | 19 | 2133-11-17 19:03:00 | 2133-11-17 19:41:00 | INDICATION: History: ___ with fall, c/o pain // r/o PTX, rib fracture
TECHNIQUE: Supine AP view of the chest
COMPARISON: Chest radiograph ___ to thirtieth ___
FINDINGS:
Normal heart size. Atherosclerotic calcifications of the aortic knob.
Mediastinal and hilar contours are unchanged. Pulmonary vasculature is not
engorged. Lung volumes are low. Minimal atelectasis in the lung bases. No
focal consolidation, pleural effusion, or pneumothorax. No acute osseous
abnormality. Mild S shaped scoliosis of the thoracic spine.
IMPRESSION:
No acute cardiopulmonary process.
|
10107231-RR-20 | 10,107,231 | 27,138,036 | RR | 20 | 2133-11-17 19:02:00 | 2133-11-17 19:40:00 | INDICATION: History: ___ with finger pain // r/o fracture
TECHNIQUE: Three views of the right ring finger
COMPARISON: Same day right wrist radiographs.
FINDINGS:
Osseous structures are diffusely demineralized. No acute fracture or
dislocation. Moderate degenerative changes involving the DIP joint with joint
space narrowing, subchondral sclerosis and osteophyte formation are
demonstrated. No suspicious lytic or sclerotic osseous abnormality. Severe
degenerative changes of the first CMC and triscaphe joints are also
demonstrated along with chondrocalcinosis of the triangular fibrocartilage.
No radiopaque foreign body.
IMPRESSION:
No acute fracture or dislocation of the ring finger. Moderate degenerative
changes of the DIP joint of the ring finger.
|
10107231-RR-21 | 10,107,231 | 27,138,036 | RR | 21 | 2133-11-17 18:31:00 | 2133-11-17 19:21:00 | EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: History: ___ with fall // r/o bleed/fracture
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast. Coronal and sagittal reformations as well as bone algorithm
reconstructions were provided and reviewed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 4.0 s, 16.0 cm; CTDIvol = 46.7 mGy (Head) DLP =
747.8 mGy-cm.
Total DLP (Head) = 748 mGy-cm.
COMPARISON: Prior CT of the head dated ___.
FINDINGS:
There is no evidence of fracture, acute large vascular territory
infarction,hemorrhage,edema,or mass. Subcortical and periventricular white
matter hypodensities are nonspecific, however likely represent sequela of
chronic small vessel ischemic disease. There is prominence of the ventricles
and sulci suggestive of involutional changes.
Mild mucosal thickening of the ethmoid air cells, and aerosolized secretions
in the left sphenoid sinus. The visualized portion of the mastoid air cells,
and middle ear cavities are clear. The visualized portion of the orbits are
normal.
IMPRESSION:
No acute intracranial abnormality.
|
10107231-RR-22 | 10,107,231 | 27,138,036 | RR | 22 | 2133-11-17 18:31:00 | 2133-11-17 19:30:00 | EXAMINATION: CT C-SPINE W/O CONTRAST
INDICATION: History: ___ with fall // r/o bleed/fracture
TECHNIQUE: Contiguous axial images obtained through the cervical spine
without intravenous contrast. Coronal and sagittal reformats were reviewed.
DOSE: Acquisition sequence:
1) Spiral Acquisition 4.0 s, 15.9 cm; CTDIvol = 20.7 mGy (Body) DLP = 329.9
mGy-cm.
Total DLP (Body) = 330 mGy-cm.
COMPARISON: None available.
FINDINGS:
Minimal anterolisthesis of C7 on T1 is of indeterminate age, likely
degenerative in etiology. No acute fractures are identified. Moderate
multilevel degenerative changes of the cervical spine including loss of
intervertebral disc space height, endplate irregularity, anterior and
posterior osteophytosis resulting in up to mild to moderate spinal canal
narrowing, worst at the C3-4 and C4-5 levels. Facet arthropathy and
uncovertebral hypertrophy resulting in up to moderate neural foraminal canal
narrowing worst at the C4-C5 level. There is no prevertebral edema.
The thyroid and included lung apices are unremarkable.
IMPRESSION:
1. No acute fracture.
2. Moderate cervical spondylosis. Minimal C7 on T1 anterolisthesis is likely
degenerative in etiology.
|
10107231-RR-23 | 10,107,231 | 27,138,036 | RR | 23 | 2133-11-17 22:15:00 | 2133-11-17 23:13:00 | INDICATION: History: ___ with distal radius fx, splinted // post splint xr
TECHNIQUE: Right wrist, three views
COMPARISON: Right wrist radiographs ___ at 16:11
FINDINGS:
Overlying splint limits fine osseous detail. The osseous structures are
diffusely demineralized. Previously noted distal radial fracture is not well
visualized, but osseous fragments appear to be in near anatomic alignment.
Severe degenerative changes of the first CMC and triscaphe joints are
redemonstrated. Chondrocalcinosis of the triangular fibrocartilage is also
present.
IMPRESSION:
Limited assessment of the distal radial fracture due to diffuse
demineralization and overlying splint material. Fracture fragments appear to
be in near anatomic alignment.
|
10107231-RR-24 | 10,107,231 | 27,138,036 | RR | 24 | 2133-11-18 12:13:00 | 2133-11-18 12:48:00 | EXAMINATION: HIP 1 VIEW
INDICATION: Right hemi, fracture
TECHNIQUE: Single AP view of the right hip obtained at the patient's bedside
COMPARISON: Pelvis and right hip radiographs ___
FINDINGS:
Compared to the prior study there has been interval surgery with placement of
a right hip hemiarthroplasty. Alignment appears appropriate. No
periprosthetic fracture seen. There appears to be right superior and inferior
pubic ramus fractures, this is more conspicuous than on the prior study.
|
10107231-RR-25 | 10,107,231 | 27,138,036 | RR | 25 | 2133-11-20 10:26:00 | 2133-11-20 11:01:00 | EXAMINATION: WRIST(3 + VIEWS) RIGHT
INDICATION: ___ with history of CKD, diverticulitis, ___ who suffered
a fall and presents with minimally displaced DRFx, LC1, nondisplaced R FNFx
s/p R hip hemi ___ ___. Splint removed and replaced - looking for any
interval change. // Post-splint XR
IMPRESSION:
In comparison with the study of ___, cast again greatly obscures bony
detail of the distal radial fracture. The overall alignment appears to be
anatomic. Severe degenerative changes are again seen in the first CMC and
triscaphe joints.
|
10107267-RR-43 | 10,107,267 | 29,833,625 | RR | 43 | 2174-05-27 09:31:00 | 2174-05-27 12:16:00 | HISTORY: ___ female with weight loss, fevers and low CD4 count.
Question pneumonia.
COMPARISON: Chest x-ray from ___ and chest CT from ___.
FINDINGS:
Frontal and lateral views of the chest. There is a persistent opacity in the
lingula in the region of previously identified consolidation. It may be due
to scarring with component of atelectasis, especially given that it is more
conspicuous on the frontal than on the lateral view. Linear right basilar
opacities are also seen potentially due to atelectasis. There is no new large
consolidation nor effusion. The cardiomediastinal silhouette is within normal
limits. No acute osseous abnormality detected.
IMPRESSION:
Asymmetric left greater than right basilar opacities. On the left it may
represent a combination of scarring and atelectasis noting that acute
infection is not completely excluded. No new region of consolidation.
|
10107267-RR-44 | 10,107,267 | 29,833,625 | RR | 44 | 2174-05-28 09:19:00 | 2174-05-28 11:52:00 | HISTORY: ___ female with HIV, UTI, fevers, right upper quadrant pain
and transaminitis.
COMPARISON: Abdomen ultrasound ___.
FINDINGS:
The liver is normal in size and appearance. No focal liver lesion. No
concerning liver lesion is identified. No biliary dilatation is seen and the
common duct measures 0.2 cm. The portal vein is patent with hepatopetal flow.
The gallbladder is normal. The pancreas is unremarkable but is only minimally
visualized due to overlying bowel gas. The spleen is normal measuring 11.0
cm. No hydronephrosis is seen in either kidney. Note is made that
visualization of the left kidney is limited due to the limited sonographic
window. The proximal aorta is of normal caliber. The distal aorta is not
visualized. The visualized portion of the IVC is unremarkable.
IMPRESSION:
Unremarkable abdomen ultrasound.
|
10107664-RR-42 | 10,107,664 | 22,578,905 | RR | 42 | 2160-05-20 14:55:00 | 2160-05-20 16:18:00 | EXAMINATION: MR ___ AND W/O CONTRAST T___ MR SPINE
INDICATION: History: ___ with spinal stenosis p/w severe lower back pain and
parastesias in bilateral feetIV contrast to be given at radiologist discretion
as clinically needed// eval of known spinal stenosis eval of known spinal
stenosis
TECHNIQUE: Sagittal imaging was performed with T2, T1, and STIR technique,
followed by axial T2 imaging. This was followed by sagittal and axial T1
images obtained after the uneventful intravenous administration of 10 mL of
Gadavist contrast agent.
COMPARISON: Lumbar spine MR ___ and ___.
FINDINGS:
Again seen are severe changes of degenerative disc disease with loss of height
of the intervertebral discs, anterior and posterior osteophyte formation loss
of signal of the intervertebral discs on the T2 weighted images and fluid
filled clefts within several intervertebral discs. Overall, the degenerative
findings appear similar to the study of ___ and ___.
However, the fluid-filled clefts within the L3-4 and L4-5 intervertebral discs
appear new since the prior studies. Diffuse hypointensity of the marrow on
the T1 weighted images appears unchanged.
Axial images at T12-L1 demonstrate minimal bulging of the disc with no
significant encroachment on the thecal sac or neural foramina.
At L1-2, there is spinal canal narrowing due to disc bulging and facet
osteophytes bilaterally. This reduces most of the cerebral spinal fluid
surrounding the nerve roots but does not appear to cause nerve root
compression. The neural foramina appear normal.
At L2-3, there is mild canal narrowing due to disc bulging. There is no
evidence of nerve root compression. The neural foramina appear normal.
At L3-4, there is severe spinal canal narrowing due to bulging of the disc and
intervertebral osteophytes and thickening of the ligamentum flavum.
Compromises the right side of the spinal canal to a greater 2 degree than the
left and it appears likely that the traversing L4 nerve roots are compressed
between the upper intervertebral osteophytes and the ligamentum flavum. There
is bilateral neural foraminal narrowing due to osteophytes.
At L4-5, there is diffuse bulging of the intervertebral disc. This narrows
the neural foramina bilaterally. In addition, there is a left-sided
protrusion of the disc that contacts the exiting left L4 nerve root. There is
moderate-severe narrowing of the spinal canal due to ligamentum flavum
thickening, disc bulging and intervertebral osteophytes.
At L5-S1, there is bulging of the disc and intervertebral osteophyte
formation. These produce mild spinal canal narrowing. However, the disc
bulging and intervertebral osteophytes appear to compress the traversing S1
nerve roots against prominent facet osteophytes bilaterally.
There is mild enhancement of the remnants of the L3-4 and L4-5 intervertebral
discs along with a small amount of enhancement in the L5-S1 disc. These are
common manifestations of degenerative disc disease. There is mild enhancement
of the posterior annulus of the L5-S1 disc.
Again seen and unchanged are apparent left renal cysts and an enlarged spleen,
incompletely imaged.
IMPRESSION:
1. Interval development of fluid within the L3-4 and L4-5 intervertebral discs
a since the study of ___. Although this finding could be seen in
the setting of infection, the adjacent vertebral endplates appear normal and
there is only minimal enhancement of the discs after contrast administration.
Thus, this is most likely a manifestation of degenerative disc disease.
2. Severe degenerative disc disease otherwise appears unchanged since the
prior study.
|
10107664-RR-61 | 10,107,664 | 25,136,353 | RR | 61 | 2161-12-19 19:34:00 | 2161-12-19 20:50:00 | EXAMINATION: SPLEEN ULTRASOUND
INDICATION: ___ year old man with recent splenic AA embo for splenomegaly//
Changing size of subcapsular hematoma; advancement of infarct. hemoperitoneum?
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: ___ CTA abdomen and pelvis.
FINDINGS:
SPLEEN: The spleen is enlarged and measures 19.6 cm. There are at least 2
peripheral wedge-shaped echogenic areas within the spleen demonstrating a
similar distribution to the prior CTA which consistent with areas of known
splenic infarcts. These have not significantly changed since prior CT. Also,
given the differences in technique, small perisplenic fluid has also not
significantly changed since prior.
IMPRESSION:
Allowing for differences in technique, the perisplenic fluid has not
significantly changed since the most recent prior CT. Echogenic areas in the
spleen compatible with infarcts.
|
10107664-RR-62 | 10,107,664 | 25,136,353 | RR | 62 | 2161-12-20 00:17:00 | 2161-12-20 02:16:00 | EXAMINATION: da
INDICATION: ___ with pain out of proportion on exam and L sided abd pain s/p
splenic AA embolization// dissection of celiac trunk or splenic artery.
Mesenteric ischemia.
TECHNIQUE: Abdomen and pelvis CTA: Non-contrast and multiphasic post-contrast
images were acquired through the abdomen and pelvis.
Oral contrast was not administered.
MIP reconstructions were performed on independent workstation and reviewed on
PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 6.2 s, 48.6 cm; CTDIvol = 3.9 mGy (Body) DLP = 191.3
mGy-cm.
2) Stationary Acquisition 2.5 s, 0.5 cm; CTDIvol = 10.1 mGy (Body) DLP =
5.1 mGy-cm.
3) Spiral Acquisition 6.2 s, 48.8 cm; CTDIvol = 9.3 mGy (Body) DLP = 453.4
mGy-cm.
4) Spiral Acquisition 6.2 s, 48.8 cm; CTDIvol = 9.3 mGy (Body) DLP = 452.8
mGy-cm.
Total DLP (Body) = 1,103 mGy-cm.
COMPARISON: CT studies from ___, and ___.
FINDINGS:
VASCULAR:
There is no abdominal aortic aneurysm. There is minimal calcium burden in the
abdominal aorta and great abdominal arteries. Embolization coils are noted
within the proximal splenic artery in keeping with the recent embolization
procedure. There is no evidence of dissection. A calcified splenic artery
aneurysm measuring 1.4 cm is again noted.
LOWER CHEST: 4 mm right middle lobe subpleural nodule is unchanged.
Bibasilar atelectasis is noted. There is no pleural or pericardial effusion.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There
is no evidence of focal lesions. There is no evidence of intrahepatic or
extrahepatic biliary dilatation. The gallbladder is within normal limits,
without stones or gallbladder wall thickening.
PANCREAS: The pancreatic parenchyma especially in the region of tail is
atrophic. The main duct is not dilated.
SPLEEN: Massive splenomegaly measuring up to 24 cm craniocaudally. There is a
crescentic subcapsular hematoma along the outer margin of the spleen which has
not significantly increased in size compared to the pre embolization scan. No
active extravasation of contrast to suggest ongoing bleed.
There are new areas of decreased enhancement along the margin of the spleen
suggestive of new large splenic infarcts.
Innumerable small air locules are present within the subcapsular hematoma and
within the region of infarction. These locules of air are likely related to
aseptic necrosis; infection is in the differential only in the appropriate
clinical scenario.
There is a small volume of intermediate density fluid extending from the
inferior splenic pole to the left paracolic gutter (02:52).
Streak artifact from a metallic object inferolateral to the spleen remains
unchanged.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: Bilateral cortical renal cysts measuring up to 2.7 cm in the left
kidney are unchanged. Otherwise, the kidneys are of normal and symmetric size
with normal nephrogram. There is no evidence of stones, focal renal lesions,
or hydronephrosis. There are no urothelial lesions in the kidneys or ureters.
The left kidney is compressed and displaced inferiorly by the enlarged spleen.
GASTROINTESTINAL: No bowel obstruction. Sigmoid colon diverticuli without
acute diverticulitis. Small right inguinal hernia containing nonobstructed
loops of small bowel.
RETROPERITONEUM: Multiple retroperitoneal including para-aortic and bilateral
common iliac lymph nodes measuring up to 1.2 cm are present (5: 105), likely
related to the patient's known lymphoma.
PELVIS: The urinary bladder and distal ureters are unremarkable. High-density
small volume free fluid in the pelvis is new compared to the pre embolization
scan and demonstrates a small hyperdense hematocrit level, likely representing
a small hemoperitoneum.
REPRODUCTIVE ORGANS: The prostate and seminal vesicles appear unremarkable.
BONES: Multilevel degenerative changes with redemonstration of stable
sclerotic lesion in the right iliac bone.
SOFT TISSUES: Bilateral inguinal hernias the one on the right containing and
loop of small bowel are demonstrated.
IMPRESSION:
1. Massive splenomegaly with multiple new areas of infarction associated with
tiny locules of air secondary to aseptic necrosis. Infection is in the
differential only in the appropriate clinical scenario, please note air
locules may be present without infection following splenic embolization.
2. Stable size of subcapsular hematoma, that was also noted on the pre
embolization scan. No active extravasation of contrast to suggest ongoing
bleed seen. Small hemoperitoneum.
3. Artifact from embolization coil at the proximal splenic artery without
evidence of dissection. There is narrowing of the native splenic artery
caliber distal to the embolization without presence of a thrombus.
|
10107664-RR-63 | 10,107,664 | 25,136,353 | RR | 63 | 2161-12-20 14:23:00 | 2161-12-20 14:50:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old man with MDS/MPN p/w LUQ pain and pleuritic pain,
with white count 115 and left shift, e/f pna// ___ year old man with MDS/MPN
p/w LUQ pain and pleuritic pain, with white count 115 and left shift, e/f pna
IMPRESSION:
In comparison with the study of ___, the there are lower lung volumes
that accentuate the prominence of the transverse diameter of the heart.
Nevertheless, the cardiac silhouette is within normal limits and there is
tortuosity of the descending thoracic aorta. No evidence of vascular
congestion or pleural effusion.
In the retrocardiac region there is increased opacification that could merely
reflect atelectatic changes. However, in the appropriate clinical setting,
superimposed pneumonia would have to be considered.
|
10107664-RR-64 | 10,107,664 | 25,136,353 | RR | 64 | 2161-12-20 23:49:00 | 2161-12-21 08:11:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with MDS/MPN with splenic infarct after splenic
artery embolization w/ acute desat// ___ year old man with MDS/MPN with splenic
infarct after splenic artery embolization w/ acute desat, new oxygen
requirement-- e/f volume overload, pna ___ year old man with MDS/MPN with
splenic infarct after splenic artery embolization w/ acute desat, new oxygen
requirement-- e/f volume overload, pna
IMPRESSION:
Comparison to ___. Lung volumes have decreased. The patient
has developed new areas of platelike atelectasis at both the left and the
right lung basis. The size of the cardiac silhouette remains unchanged.
There is no pleural effusion, no pulmonary edema and no pneumonia. No
pneumothorax.
|
10107664-RR-65 | 10,107,664 | 25,136,353 | RR | 65 | 2161-12-21 00:49:00 | 2161-12-21 05:19:00 | EXAMINATION: CTA chest
INDICATION: ___ year old man with MDS/MPN coming in with auto infarction of
spleen after splenic artery embolization, acutely desaturated, large Aa
gradient, tachycardic. e/f PE// ___ year old man with MDS/MPN coming in with
auto infarction of spleen after splenic artery embolization, acutely
desaturated, large Aa gradient, tachycardic. e/f PE
TECHNIQUE: Axial multidetector CT images were obtained through the thorax
after the uneventful administration of intravenous contrast.
Reformatted coronal, sagittal, thin slice axial images, and oblique maximal
intensity projection images were submitted to PACS and reviewed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 0.5 s, 0.2 cm; CTDIvol = 7.2 mGy (Body) DLP = 1.4
mGy-cm.
2) Stationary Acquisition 0.8 s, 0.2 cm; CTDIvol = 10.6 mGy (Body) DLP =
2.1 mGy-cm.
3) Spiral Acquisition 5.4 s, 35.1 cm; CTDIvol = 5.9 mGy (Body) DLP = 202.8
mGy-cm.
Total DLP (Body) = 206 mGy-cm.
COMPARISON: CT chest ___
FINDINGS:
The aorta and its major branch vessels are patent, with no evidence of
stenosis, occlusion, dissection, or aneurysmal formation. There is no
evidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.
The pulmonary arteries are well opacified to the the lobar level, with no
evidence of filling defect. Evaluation of the segmental subsegmental
pulmonary arteries is limited due to artifact related to respiratory motion.
The main and right pulmonary arteries are normal in caliber, and there is no
evidence of right heart strain.
There is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy.
The thyroid gland appears unremarkable.
There is no evidence of pericardial effusion. There is a trace left-sided
pleural effusion.
The following nodules are unchanged as compared to CT chest ___: 3
mm ground-glass nodule in the right upper lobe (5:90), 3 mm nodule in the
right upper lobe (5:107), 4 mm perifissural nodule along the right major
fissure (5:132), 3 mm left apical nodule (05:58). 6 mm subpleural nodule in
the left lower lobe noted on ___ is not clearly identified on the
study. There is subsegmental and dependent atelectasis in the bilateral lower
lobes.
Limited images of the upper abdomen are unremarkable.
No lytic or blastic osseous lesion suspicious for malignancy is identified.
IMPRESSION:
1. Limited evaluation of the segmental and subsegmental pulmonary arteries in
the lower lobes of both lungs due to degradation from respiratory motion.
Otherwise, no evidence of pulmonary embolism.
2. Trace left pleural effusion and bibasilar atelectasis.
3. Multiple pulmonary nodules measuring up to 3 mm in the right upper lobe are
unchanged as compared to CT chest ___. Previously characterized 6
mm subpleural nodule left lower lobe noted on chest CT ___ is not
identified on the study.
For incidentally detected multiple solid pulmonary nodules smaller than 6mm,
no CT follow-up is recommended in a low-risk patient, and an optional CT
follow-up in 12 months is recommended in a high-risk patient.
See the ___ ___ Society Guidelines for the Management of Pulmonary
Nodules Incidentally Detected on CT" for comments and reference:
___
|
10107664-RR-66 | 10,107,664 | 25,136,353 | RR | 66 | 2161-12-23 14:39:00 | 2161-12-24 10:04:00 | INDICATION: ___ year old man with oliguric renal failure iso CIN/ATN. Needs HD
semi-urgently, renal plans to dialyze later today if possible.// Please place
temporary HD line. Thank you!
COMPARISON: None
TECHNIQUE: OPERATORS: Dr. ___,
performed the procedure.
ANESTHESIA:. 1% lidocaine was injected in the skin and subcutaneous tissues
overlying the access site.
MEDICATIONS:
CONTRAST: 0 ml of Optiray contrast.
FLUOROSCOPY TIME AND DOSE: 0.1 min, 1 mGy
PROCEDURE: PROCEDURE DETAILS: Following the explanation of the risks,
benefits and alternatives to the procedure, written informed consent was
obtained from the patient. The patient was then brought to the angiography
suite and placed supine on the exam table. A pre-procedure time-out was
performed per ___ protocol. The right neck was prepped and draped in the
usual sterile fashion.
Under continuous ultrasound guidance, the patent right internal jugular vein
was compressible and accessed using a micropuncture needle. Permanent
ultrasound images were obtained before and after intravenous access, which
confirmed vein patency. Subsequently a Nitinol wire was passed into the right
atrium using fluoroscopic guidance. The needle was exchanged for a
micropuncture sheath.
The Nitinol wire was removed and a short ___ wire was advanced into the IVC.
A triple-lumen central venous catheter was advanced over the wire into the
superior vena cava with the tip in the cavoatrial junction. All 3 access ports
were aspirated, flushed and capped. The catheter was secured to the skin with
a 0 silk suture and sterile dressings were applied. Final spot fluoroscopic
image demonstrating good alignment of the catheter and no kinking. The patient
tolerated the procedure well without immediate complications.
FINDINGS:
Patent right internal jugular vein. Final fluoroscopic image showing triple
lumen central venous catheter with catheter tip terminating in the distal
superior vena cava.
IMPRESSION:
Successful placement of a temporary triple lumen catheter (Trialysis) via the
right internal jugular venous approach. The tip of the catheter terminates in
the distal superior vena cava. The catheter is ready for use.
|
10107664-RR-67 | 10,107,664 | 25,136,353 | RR | 67 | 2161-12-23 22:31:00 | 2161-12-24 09:16:00 | INDICATION: ___ year old man with MDS/MPN, DLBCL, smoldering myeloma, remote
gastric cancer, cirrhosis, who presents after splenic arterial embolization
for splenomegaly found to have splenicinfarcts and subcapsular hematoma.
Subsequently has developed large leukocytosis, acute kidney injury, and
multiple electrolyte abnormalities. More somnolent with HD with intermittent
hypoxia.// Eval for pleural effusions given hypoxia, somnolence
TECHNIQUE: Chest AP view
COMPARISON: None
IMPRESSION:
Lungs are low volume with bibasilar atelectasis. There are small bilateral
effusions right greater than left. Right-sided central line projects to the
cavoatrial junction. Cardiomediastinal silhouette is stable. No pneumothorax
is seen
|
10107664-RR-68 | 10,107,664 | 25,136,353 | RR | 68 | 2161-12-24 00:47:00 | 2161-12-24 02:17:00 | EXAMINATION: CTA ABD AND PELVIS
INDICATION: ___ year old man with MDS, cirrhosis, subcapsular splenic
hematoma, splenomegaly s/p ___ splenic artery embolization c/b progressive
splenic infarction, now w/ hypotension and acute drop in Hgb// Rule out
active/worsening subcapsular splenic hemorrhage/ alternate source of
intra-abdominal bleed
TECHNIQUE: Abdomen and pelvis CTA: Non-contrast and multiphasic post-contrast
images were acquired through the abdomen and pelvis.
Oral contrast was not administered.
MIP reconstructions were performed on independent workstation and reviewed on
PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 7.0 s, 45.4 cm; CTDIvol = 3.4 mGy (Body) DLP = 152.1
mGy-cm.
2) Spiral Acquisition 2.5 s, 16.4 cm; CTDIvol = 3.4 mGy (Body) DLP = 53.5
mGy-cm.
3) Sequenced Acquisition 0.5 s, 0.2 cm; CTDIvol = 9.2 mGy (Body) DLP = 1.8
mGy-cm.
4) Stationary Acquisition 4.7 s, 0.2 cm; CTDIvol = 78.4 mGy (Body) DLP =
15.7 mGy-cm.
5) Spiral Acquisition 8.5 s, 55.3 cm; CTDIvol = 8.7 mGy (Body) DLP = 476.8
mGy-cm.
6) Spiral Acquisition 8.5 s, 55.3 cm; CTDIvol = 8.7 mGy (Body) DLP = 476.8
mGy-cm.
Total DLP (Body) = 1,177 mGy-cm.
COMPARISON: Multiple prior comparisons, most recent from ___
FINDINGS:
VASCULAR:
There is no abdominal aortic aneurysm. There are mild atherosclerotic
calcifications of the abdominal aorta. The Amplatzer plug is again noted
within the proximal splenic artery in keeping with recent embolization
procedure. There is persistent flow within the distal splenic artery and its
branches. The common hepatic artery is patent.
LOWER CHEST: A 2 mm nodule is noted in the right middle lobe (series 10; image
2). There are small bilateral pleural effusions, which are mildly increased
compared to most recent prior exam on ___ with adjacent
compressive atelectasis. There is no pericardial effusion.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There
is no evidence of focal lesions. There is no evidence of intrahepatic or
extrahepatic biliary dilatation. The gallbladder is within normal limits. No
cholelithiasis is seen; however, there is dense material within the
gallbladder lumen, likely due to prior contrast administration.
PANCREAS: Pancreatic parenchyma, especially in the region of the pancreatic
tail, remains atrophic without focal lesion or main pancreatic ductal
dilatation.
SPLEEN: Again seen is massive splenomegaly, measuring up to 21.3 cm cranio
caudally (previously 24 cm). Crescentic subcapsular hematoma spleen has
slightly increased in thickness compared to prior post embolization scan from
___. Locules of air within this hemorrhage likely represent
aseptic necrosis and are unchanged compared to ___. Infection
is in the differential, although only in the appropriate clinical scenario. No
active extravasation of contrast to suggest ongoing splenic bleeding. There
irregularity and areas of decreased enhancement along the margin of the
spleen, compatible with large infarctions, unchanged.
There has been interval increase in extension of perisplenic fluid into left
pericolic gutter as well as an increase in fluid in the perihepatic region,
the mesentery, and in the deep pelvis. This fluid measures intermediate
density (for example, 38 Hounsfield units in the pelvis) and shows a
hematocrit level in the pelvis, consistent with hemoperitoneum.
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.
Left kidney remains inferiorly displaced by massive splenomegaly. There is no
evidence of stones or hydronephrosis. Unchanged bilateral, cortical renal
cysts measure up to 2.6 cm in the midleft kidney. No concerning focal lesions
are identified. There are no urothelial lesions in the kidneys or ureters.
There is no perinephric abnormality.
GASTROINTESTINAL: There is no small bowel obstruction. Multiple sigmoid
colonic diverticula are noted without surrounding inflammation to suggest
diverticulitis. Surrounding fluid, likely hemoperitoneum, obscures ability to
assess for subtle stranding. Small right inguinal hernia contains fluid only
and no longer contains loops of small bowel.
RETROPERITONEUM: There are multiple prominent and enlarged retroperitoneal
lymph nodes measuring up to 1.0 cm in short axis (series 10; image 72),
overall similar compared to prior, likely related to patient's known lymphoma.
Prominent mesenteric lymph nodes measuring up to 0.8 cm short axis are also
unchanged.
PELVIS: Urinary bladder is decompressed with Foley catheter in situ. Increase
in hemoperitoneum in the pelvis is described above in the "spleen" section.
REPRODUCTIVE ORGANS: Prostate and seminal vesicles appear unremarkable.
BONES: There are unchanged moderate to severe degenerative changes of the
visualized thoracolumbar spine, most notable at L5-S1 with retrolisthesis,
loss of intervertebral disc height, and vacuum disc phenomena at this level.
There is a stable sclerotic lesion of the right iliac bone (series 6; image
117).
SOFT TISSUES: Bilateral inguinal hernias are again seen.
IMPRESSION:
1. Redemonstration of massive splenomegaly (measuring up to 21.3 cm,
previously 24 cm) with large areas of infarction, and subcapsular splenic
hematoma with associated locules of air, likely aseptic necrosis. Superimposed
infection cannot be excluded in the appropriate clinical setting. The
subcapsular hematoma has slightly decreased in thickness, however there is
interval increase in patient's hemoperitoneum in the abdomen and pelvis.
2. Status post embolization of the proximal splenic artery, with persistent
flow to the distal splenic branches. No evidence of active contrast
extravasation.
3. Unchanged lymphadenopathy in the mesentery and retroperitoneum, consistent
with patient's known history of lymphoma.
4. Interval increase in small bilateral pleural effusions with adjacent
compressive atelectasis. Lung bases show no findings concerning for active
infection. 2 mm nodule in the right middle lobe requires no follow-up in low
risk population. See full set of recommendations below, if clinically
indicated.
RECOMMENDATION(S): For incidentally detected single solid pulmonary nodule
smaller than 6 mm, no CT follow-up is recommended in a low-risk patient, and
an optional CT in 12 months is recommended in a high-risk patient.
See the ___ ___ Society Guidelines for the Management of Pulmonary
Nodules Incidentally Detected on CT" for comments and reference:
___
|
10107664-RR-70 | 10,107,664 | 25,136,353 | RR | 70 | 2161-12-28 18:09:00 | 2161-12-28 19:14:00 | EXAMINATION: CTA ABDOMEN AND PELVIS
INDICATION: ___ year old man with splenic infarct/necrosis after splenic
artery embolization, also found to have hemoperitoneum and splenic hematoma.
Now with Hgb drop overnight, Hgb not-responsive to 1u pRBC concern for active
bleeding.// Evidence of bleeding?Please obtain 3 phase arterial and venous
phase scan
TECHNIQUE: CTA 3 phase: Multidetector CT of the abdomen and pelvis without
and with IV contrast. Initially the abdomen and pelvis was scanned without IV
contrast. Subsequently a single bolus of IV contrast was injected and the
abdomen and pelvis was scanned in the arterial and portal venous phases.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 8.2 s, 53.4 cm; CTDIvol = 3.2 mGy (Body) DLP = 168.0
mGy-cm.
2) Sequenced Acquisition 0.5 s, 0.2 cm; CTDIvol = 3.7 mGy (Body) DLP = 0.7
mGy-cm.
3) Stationary Acquisition 3.2 s, 0.2 cm; CTDIvol = 27.3 mGy (Body) DLP =
5.5 mGy-cm.
4) Spiral Acquisition 8.2 s, 53.2 cm; CTDIvol = 7.5 mGy (Body) DLP = 395.3
mGy-cm.
5) Spiral Acquisition 8.2 s, 53.2 cm; CTDIvol = 7.5 mGy (Body) DLP = 395.3
mGy-cm.
Total DLP (Body) = 965 mGy-cm.
COMPARISON: CTA abdomen pelvis ___.
FINDINGS:
LOWER CHEST: The visualized lung fields are unremarkable aside from mild basal
atelectasis and a 2 mm right middle lobe nodule, described previously. There
is a trace right pleural effusion.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation on the portal
venous phase. There is no evidence of focal lesions. There is no evidence of
intrahepatic or extrahepatic biliary dilatation. The gallbladder is within
normal limits.
PANCREAS: A 0.9 x 2.0 cm cystic lesion in the pancreatic head is unchanged
from recent prior studies, most likely an IPMN. The pancreas is otherwise
unremarkable. There is no peripancreatic stranding.
SPLEEN: There is stable gross splenomegaly, measuring up to 22 cm in maximal
coronal dimension. There is a stable pattern of extensive infarct, engulfing
greater than 50% of the parenchyma. Subcapsular hematoma is also grossly
stable.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
There is a left renal cyst and a subcentimeter hypodensity in the upper pole,
likely also a cyst. There is no hydronephrosis.
GASTROINTESTINAL: The bowel is grossly unremarkable aside from sigmoid
diverticulosis.
There is large volume intermediate to high density ascites in keeping with
hemoperitoneum. This has increased mildly from ___.
PELVIS: The bladder is grossly unremarkable.
REPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable aside
from prostate calcifications.
LYMPH NODES: There are numerous prominent but stable retroperitoneal, pelvic,
porta hepatis, mesenteric and inguinal lymph nodes, some measuring slightly
greater than 1 cm. Notably, the patient has a history of lymphoma and MDS.
VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease
is noted. There has been previous embolization of the proximal splenic
artery, and the vessel again feels distally by collaterals. There is no
contrast extravasation to suggest active hemorrhage.
BONES: Degenerative changes are seen in the lumbar spine.
SOFT TISSUES: There is diffuse subcutaneous edema.
IMPRESSION:
1. No evidence of active hemorrhage.
2. Stable marked splenomegaly with extensive infarction and subcapsular
hematoma. Mildly increased volume of ascites, with increased density in
keeping with hemoperitoneum.
3. Stable appearance of mild abdominal and pelvic lymphadenopathy.
NOTIFICATION: Absence of active bleeding was discussed with ___,
M.D. by ___, M.D. on the telephone on ___ at 7:12 pm, 5 minutes
after discovery of the findings.
|
10107664-RR-71 | 10,107,664 | 25,136,353 | RR | 71 | 2162-01-01 18:05:00 | 2162-01-01 21:59:00 | EXAMINATION: BILAT LOWER EXT VEINS
INDICATION: ___ year old man with bilateral, asymmetric lower extremity
swelling// ? New ___ DVT
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the bilateral lower extremity veins.
COMPARISON: Duplex ultrasound dated ___.
FINDINGS:
There is normal compressibility, flow, and augmentation of the bilateral
common femoral, femoral, and popliteal veins. Normal color flow and
compressibility are demonstrated in the tibial and peroneal veins.
There is normal respiratory variation in the common femoral veins bilaterally.
A morphologically normal right inguinal lymph node measuring up to 0.6 cm is
noted.
IMPRESSION:
No evidence of deep venous thrombosis in the right or left lower extremity
veins.
|
10107664-RR-72 | 10,107,664 | 25,136,353 | RR | 72 | 2162-01-03 10:14:00 | 2162-01-03 11:22:00 | EXAMINATION: Therapeutic paracentesis
INDICATION: ___ man with MDS/MPN, DLBCL, smoldering myeloma, remote gastric
cancer, cirrhosis, who presents with severe LUQ pain hours after splenic
arterial embolization for splenomegaly found to have splenic infarcts and
subcapsular hematoma. Subsequently has developed large leukocytosis, acute
kidney injury, and multiple electrolyte abnormalities. Now with
hemoperitoneum. ? possible drainage versus diuresis.// Paracentesis
TECHNIQUE: Ultrasound guided therapeutic paracentesis
COMPARISON: Multiple prior comparisons, most recent CT examination from ___
FINDINGS:
Limited grayscale ultrasound imaging of the abdomen demonstrated
moderateascites. A suitable target in the deepest pocket in the right lower
quadrant was selected for paracentesis.
PROCEDURE: The procedure, risks, benefits and alternatives were discussed
with the patient and written informed consent was obtained.
A preprocedure time-out was performed discussing the planned procedure,
confirming the patient's identity with 3 identifiers, and reviewing a
checklist per ___ protocol.
Under ultrasound guidance, an entrance site was selected and the skin was
prepped and draped in the usual sterile fashion. 1% lidocaine was instilled
for local anesthesia.
A 5 ___ catheter was advanced into the largest fluid pocket in the right
lower quadrant and 2 L of bloodyfluid was removed.
The patient tolerated the procedure well without immediate complication.
Dr. ___ attending radiologist, was present throughout the critical
portions of the procedure.
IMPRESSION:
Technically successful ultrasound-guided therapeutic paracentesis. 2 L of
bloody fluid was removed.
|
10107664-RR-73 | 10,107,664 | 25,136,353 | RR | 73 | 2162-01-04 10:24:00 | 2162-01-04 19:07:00 | EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ man with MDS/MPN, DLBCL, smoldering myeloma, here s/p splenic
arterial embolization,// ? Progression of splenic infarcts, hematoma. Also RUQ
US for ascites and liver appearance given question of cirrhosis
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: Ultrasound from ___. CTA from ___.
FINDINGS:
LIVER: The hepatic parenchyma appears within normal limits. The contour of
the liver is smooth. There is no focal liver mass. The main portal vein is
patent with hepatopetal flow. There is moderate ascites.
BILE DUCTS: There is no intrahepatic biliary dilation.
CHD: 3 mm
GALLBLADDER: A round heterogeneous hyperechoic 4 mm focus in the wall of the
gallbladder is noted, could represent a polyp or a stone.
PANCREAS: The pancreas is not well visualized, largely obscured by overlying
bowel gas.
SPLEEN: The spleen is enlarged and demonstrates heterogeneous echogenicity
with irregular and wedge-shaped hypoechoic regions, concordant with findings
demonstrated on recent CT. Perisplenic fluid is noted.
Spleen length: 24.3 cm
RETROPERITONEUM: The visualized portions of aorta and IVC are unremarkable.
IMPRESSION:
1. Splenomegaly with multiple hypoechoic splenic infarcts, overall unchanged
compared to the recent CT abdomen.
2. 4 mm hyperechoic focus in the gallbladder, could represent a polyp or
stone. No sonographic signs of acute cholecystitis.
|
10107664-RR-74 | 10,107,664 | 25,136,353 | RR | 74 | 2162-01-11 04:16:00 | 2162-01-11 10:41:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with hypoxia, fever and hypotension after plt
transfusion// eval for pulmonary edema
TECHNIQUE: Chest AP view
COMPARISON: ___
IMPRESSION:
Lungs are low volume with moderate pulmonary edema. Right-sided central line
is unchanged. Cardiomediastinal silhouette is stable. Bilateral effusions
left greater than right are unchanged. No pneumothorax is seen
|
10107664-RR-75 | 10,107,664 | 25,136,353 | RR | 75 | 2162-01-13 17:15:00 | 2162-01-13 17:58:00 | EXAMINATION: ABDOMEN US (COMPLETE STUDY)
INDICATION: ___ man with MDS/MPN, DLBCL, smoldering myeloma, remote
gastriccancer, cirrhosis, who presents with severe LUQ pain hours aftersplenic
arterial embolization for splenomegaly found to have splenicinfarcts and
subcapsular hematoma. Subsequently has developed large leukocytosis, acute
kidney injury with chemotherapy// Monitor progressive changes in spleen.
**please also evaluate for portal vein thrombosis with Doppler**
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: Ultrasound dated ___ and CT scans of the abdomen and
pelvis dated ___ and ___.
FINDINGS:
LIVER: The hepatic parenchyma appears within normal limits. The contour of
the liver is smooth. There is no focal liver mass. The main portal vein is
patent with hepatopetal flow. There is moderate ascites.
BILE DUCTS: There is no intrahepatic biliary dilation.
CHD: 3 mm
GALLBLADDER: There is a 4 mm nonobstructing stone within the gallbladder
lumen. There is no evidence of gallbladder wall thickening.
PANCREAS: The pancreas is not well visualized, largely obscured by overlying
bowel gas.
SPLEEN: There is a heterogeneous appearance of the spleen, similar to prior.
The perisplenic fluid now contains at least 1 septation and this fluid could
represent evolving hemorrhage or loculated ascites.
Spleen length: 22.3 cm
KIDNEYS: Normal cortical echogenicity and corticomedullary differentiation is
seen bilaterally. There is no evidence of masses, stones, or hydronephrosis
in the kidneys. A simple cyst measuring up to 2.4 cm is seen in the left
renal midpole.
Right kidney: 11.7 cm
Left kidney: 11.0 cm
RETROPERITONEUM: The visualized portions of aorta and IVC are not visualized
due to shadowing bowel gas.
IMPRESSION:
Splenomegaly measuring 22.3 cm with a heterogeneous appearance compatible with
previously described splenic infarcts. Anechoic fluid surrounding the spleen
with at least one septation could reflect an evolving subcapsular hematoma or
loculated pleural fluid.
Cholelithiasis.
Moderate ascites.
|
10107664-RR-76 | 10,107,664 | 25,136,353 | RR | 76 | 2162-01-19 12:50:00 | 2162-01-19 14:09:00 | INDICATION: ___ year old man with MDS/MPN overlap, moderate ascites//
Diagnostic/Therapeutic paracentesis for relief of abd symptoms and
re-examination of fluid
TECHNIQUE: Ultrasound-guided diagnostic and therapeutic paracentesis.
COMPARISON: Abdominal ultrasound dated ___.
FINDINGS:
Limited grayscale ultrasound imaging of the abdomen demonstrated moderate
ascites. A suitable target in the deepest pocket in the right lower quadrant
was selected for paracentesis.
PROCEDURE: Ultrasound guided diagnostic and therapeutic paracentesis
Location: right lower quadrant
Fluid: 2 L of blood-tinged clear fluid
Samples: Fluid samples were submitted to the laboratory the requested analysis
(chemistry, hematology, microbiology, and cytology).
The procedure, risks, benefits and alternatives were discussed with the
patient and written informed consent was obtained.
A preprocedure time-out was performed discussing the planned procedure,
confirming the patient's identity with 3 identifiers, and reviewing a
checklist per ___ protocol.
Under ultrasound guidance, an entrance site was selected and the skin was
prepped and draped in the usual sterile fashion. 1% lidocaine was instilled
for local anesthesia.
Ascites fluid was aspirated via a 5 ___ catheter advanced into the largest
fluid pocket.
The patient tolerated the procedure well without immediate complication.
Estimated blood loss was minimal.
Dr. ___ personally supervised the trainee during the key
components of the procedure and reviewed and agrees with the trainee's
findings.
IMPRESSION:
1. Technically successful ultrasound guided diagnostic and therapeutic
paracentesis.
2. 2 L of fluid were removed and sent for requested analysis.
|
10107664-RR-77 | 10,107,664 | 25,136,353 | RR | 77 | 2162-01-19 17:04:00 | 2162-01-19 17:34:00 | INDICATION: ___ year old man with MDS/MPN, splenomegaly, persistent abd pain//
Evaluate cause of abd pain (concern for high stool burden ?constipation)
TECHNIQUE: Portable supine abdominal radiograph was obtained.
COMPARISON: Abdominal ultrasound ___.
FINDINGS:
There are no abnormally dilated loops of large or small bowel. Supine
assessment limits detection for free air; there is no gross pneumoperitoneum.
There are multilevel degenerative changes of the visualized thoracolumbar
spine. No suspicious radiopaque calculi are identified. There is a surgical
clip in the left mid abdomen.
IMPRESSION:
No radiographic evidence of constipation or bowel obstruction.
|
10107664-RR-78 | 10,107,664 | 25,136,353 | RR | 78 | 2162-01-20 15:24:00 | 2162-01-20 18:01:00 | EXAMINATION: CT ABD AND PELVIS WITH CONTRAST
INDICATION: ___ year old man with MDS/MPN, splenomegaly, s/p ___ emobolization
with splenic infarcts/hematoma, and s/p paracentesis on ___. Now with severe
rectal pain, persistent abd discomfort, and dropping H/H// 1) Bleeding: Given
recent para and splenic issues, want to rule out evidence of active abdominal
bleeding2) Rule out evidence of active GI pathology that could cause abd
pain3) Scan pelvis to evaluate for perirectal abscess or fistula that could be
causing rectal pain.
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired
through the abdomen following intravenous contrast administration with split
bolus technique.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 0.5 s, 0.2 cm; CTDIvol = 9.3 mGy (Body) DLP = 1.9
mGy-cm.
2) Stationary Acquisition 4.3 s, 0.2 cm; CTDIvol = 73.4 mGy (Body) DLP =
14.7 mGy-cm.
3) Spiral Acquisition 9.5 s, 61.9 cm; CTDIvol = 11.1 mGy (Body) DLP = 682.4
mGy-cm.
Total DLP (Body) = 699 mGy-cm.
COMPARISON: CTA ___
FINDINGS:
LOWER CHEST: Moderate bibasilar atelectasis. No pleural effusion. No
pericardial effusion.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There is no evidence of focal lesions. There is no evidence of intrahepatic or
extrahepatic biliary dilatation. The gallbladder is within normal limits.
PANCREAS: There is a 1.3 x 1.0 cm hypodensity at the pancreatic head/uncinate
process (series 4, image 41), consistent with known cystic lesion within the
head of the pancreas, better characterized on prior CTA from ___.
Otherwise, the pancreas has normal attenuation throughout, without pancreatic
ductal dilatation. There is no peripancreatic stranding.
SPLEEN: Amplatzer plug is seen within the proximal splenic artery. There is
redemonstration of severe splenomegaly up to 18.3 cm with diffuse splenic
infarction, which appears similar in extent to prior. Hypodense portion of
the infarct likely include a component of chronic subcapsular hematoma without
indication of acute hemorrhage.
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.
A 2.4 cm simple renal cyst in the left kidney is unchanged. Subcentimeter
hypodensity in the superior left renal pole is too small to characterize by CT
but likely also represents a cyst. There is no evidence of suspicious focal
renal lesions or hydronephrosis. There is no perinephric abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. Diverticulosis of
the sigmoid colon is noted, without evidence of wall thickening and fat
stranding. There is a large stool burden within the rectum (series 4, image
81). The appendix is normal. There is moderate thickening of the anus and
rectum (series 4, image 95-97), more prominent than on the prior study. No
focal fluid collections or abscesses. No perianal stranding is demonstrated.
Moderate amount of low-density abdominal and pelvic ascites. Mild enhancement
of the peritoneal lining and a small amount of hyperdense blood products in
the right paracolic gutter may be related to recent paracentesis.
PELVIS: The urinary bladder and distal ureters are unremarkable.
REPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.
LYMPH NODES: No enlarged abdominal or pelvic lymph nodes by CT size criteria.
VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease
is noted.
BONES: Degenerative changes are seen in the lumbar spine.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. Small amount of layering hyperdensity within the right paracolic gutter and
mild peritoneal enhancement, which may be related to recent paracentesis.
2. Moderate amount of stool within the rectum with surrounding bowel wall
thickening and enhancement and thickening of the anus, which may represent
fecal impaction with developing stercoral colitis.
3. Unchanged severe splenomegaly with extensive parenchymal infarction.
4. Redemonstration of a possible cystic lesion within the pancreatic head,
better characterized on prior multiphasic CTA studies.
|
10107664-RR-79 | 10,107,664 | 25,136,353 | RR | 79 | 2162-01-25 19:54:00 | 2162-01-25 21:39:00 | EXAMINATION: CR - CHEST PORTABLE AP
INDICATION: ___ year old man with MDS ___ dialysis line removal with shortness
of breath, chest pain, hypoxia.// Eval for fluid overload, acute process.
TECHNIQUE: AP radiograph of the chest.
COMPARISON: Chest radiograph ___.
IMPRESSION:
The right IJ central venous catheter has been removed. There are low lung
volumes. Linear opacities in the bilateral lung bases most likely represent
subsegmental atelectasis. There is no focal consolidation, pleural effusion
or pneumothorax. The cardiomediastinal silhouette is within normal limits.
There is no significant pulmonary edema. There are no acute osseous
abnormalities.
|
10108132-RR-10 | 10,108,132 | 23,202,997 | RR | 10 | 2174-05-27 16:02:00 | 2174-05-27 18:07:00 | INDICATION: ___ year old man with appendicitis, interval increase in abscess//
please drain pelvic abscess secondary to appendicitis
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.
DOSE: Acquisition sequence:
1) Spiral Acquisition 11.0 s, 25.4 cm; CTDIvol = 34.2 mGy (Body) DLP =
831.2 mGy-cm.
Total DLP (Body) = 852 mGy-cm.
COMPARISON: CT examination performed on ___ and ___.
FINDINGS:
Preprocedure imaging of the lower abdomen and pelvis were performed for
localization of periappendiceal abscess as seen on prior imaging.
Mild residual thickening of the terminal ileum is again seen (series 3, images
40-60).
Previously noted periappendiceal collection is again noted. Overall size
measures approximately 6 cm, but is predominantly soft tissue phlegmon and
inflammatory change rather than fluid. There is a small focus within this
measuring approximately 1 cm which contains enteric contrast (series 3, image
54), and a tiny 1.4 cm air pocket seen more superiorly (series 3, image 50).
However, on the current examination, there does not appear to be any
meaningfully residual drainable fluid collection.
Remainder of visualized structures are unremarkable allowing for noncontrast
imaging technique.
IMPRESSION:
Soft tissue phlegmon seen in the right lower quadrant. With the phlegmon is a
small focus of extravasated contrast and a small focus of air, but no
drainable fluid component. Given the absence of drainable fluid, percutaneous
drainage was not attempted. This was discussed by telephone with Dr. ___
___ at the time of the preprocedure scan.
|
10108132-RR-9 | 10,108,132 | 23,202,997 | RR | 9 | 2174-05-25 21:16:00 | 2174-05-25 22:18:00 | EXAMINATION: CT abdomen and pelvis with intravenous contrast.
INDICATION: ___ on Coumadin for saddle PE since ___ who presents with
likely perforated appendicitis with 3x3cm abscess// small To determine whether
periappendiceal abscess is resolving
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 not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Total exam DLP: 1399.99 mGy-cm
COMPARISON: None.
FINDINGS:
Somewhat limited study due to body habitus.
LOWER CHEST: There is subsegmental atelectasis in the lower lobes.. There is
no evidence of pleural or pericardial effusion.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There is no evidence of focal lesions. There is no evidence of intrahepatic
or extrahepatic biliary dilatation. The gallbladder is within normal limits.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
There is no evidence of focal renal lesions or hydronephrosis. There is no
perinephric abnormality.
GASTROINTESTINAL: In the right lower quadrant, there is a periappendiceal
abscess with adjacent fatty stranding which measures 6.7 x 5.6 cm (series
2:71), significantly increased in size from CT abdomen pelvis ___,
previously measuring 3.4 x 3.2 cm. There is no free intraperitoneal gas. The
small and large bowel loops are otherwise unremarkable without evidence of
obstruction. The stomach is unremarkable.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: The prostate is not enlarged.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease
is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
Interval enlargement of a periappendiceal abscess which now measures 6.7 x 5.6
cm, previously measuring 3.4 x 3.2 cm on CT abdomen and pelvis ___.
|
10108233-RR-4 | 10,108,233 | 25,975,579 | RR | 4 | 2161-12-18 11:14:00 | 2161-12-18 12:21:00 | EXAMINATION: ___ DUP EXTEXT BIL (MAP/DVT)
INDICATION: ___ year old woman with b/l PEs // eval for DVTs
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the bilateral lower extremity veins.
COMPARISON: None.
FINDINGS:
Left lower extremity:
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 veins. There is intraluminal
thrombus in one of the left peroneal veins.
No evidence of medial popliteal fossa (___) cyst.
Right lower extremity:
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.
No evidence of a medial popliteal fossa (___) cyst.
There is normal respiratory variation in the common femoral veins bilaterally.
IMPRESSION:
1. Deep venous thrombosis in one of the left peroneal veins.
2. No evidence of deep venous thrombosis in the right lower extremity.
NOTIFICATION: The findings were discussed with ___, M.D. by
___, M.D. on the telephone on ___ at 12:10 ___, 2 minutes after
discovery of the findings.
|
10108233-RR-5 | 10,108,233 | 25,975,579 | RR | 5 | 2161-12-18 17:52:00 | 2161-12-18 21:46:00 | INDICATION: ___ year old woman with submassive PE and right heart strain.
COMPARISON: Outside chest CT dated ___.
TECHNIQUE: OPERATORS: Dr. ___ and Dr.
___ radiologist performed the procedure. Dr. ___
___ supervised the trainee during the key components of the procedure
and has reviewed and agrees with the trainee's findings.
ANESTHESIA: Moderate sedation was provided by administrating divided doses of
25mcg of fentanyl and 0.5 mg of midazolam throughout the total intra-service
time of 55 minutes during which the patient's hemodynamic parameters were
continuously monitored by an independent trained radiology nurse. 1% lidocaine
was injected in the skin and subcutaneous tissues overlying the access site.
MEDICATIONS: Fentanyl, midazolam, 1% lidocaine.
CONTRAST: 80 ml of Optiray contrast.
FLUOROSCOPY TIME AND DOSE: 15.1 min, 46 mGy
PROCEDURE:
1. Right internal jugular venous access.
2. Main pulmonary artery pressure measurement.
3. Limited Left pulmonary arteriogram
4. Limited Right pulmonary arteriogram.
5. EKOS Lysis Catheter placement in the right lower lobe pulmonary artery.
6. EKOS Lysis Catheter placement in the left lower lobe pulmonary artery.
PROCEDURE DETAILS: Following the discussion of the risks, benefits and
alternatives to the procedure, written informed consent was obtained from the
patient. The patient was then brought to the angiography suite and placed
supine on the exam table. A pre-procedure time-out was performed per ___
protocol. The right neck was prepped and draped in the usual sterile fashion.
Ultrasound confirmed patency of the right internal jugular vein. Under
continuous ultrasound guidance, the patent and compressible right internal
jugular vein was accessed using a micropuncture set. A small skin ___ was
made at the skin entry site. An Amplatz wire was advanced easily through the
micropuncture sheathinto the inferior vena cava. The microsheath was then
exchanged for a 12 ___ sheath after predilatation with a 10 ___ dilator.
A 12 ___ sheath was placed. The Amplatz wire was removed. Using a C2 Cobra
Glidecath and angled Glidewire, the main pulmonary artery was carefully
selected. A main pulmonary artery pressure of 54/23 (35) was obtained.
The catheter and wire were then used to select the right pulmonary artery. A
right pulmonary arteriogram was performed showing significant pulmonary
embolism most pronounced in the right main and lower lobe pulmonary arteries.
Next, an exchange length ___ wire was advanced through the C2 catheter to
select the right lower lobe pulmonary artery. The C2 catheter was removed. A
___ x ___ cm x 12 cm treatment zone EKOS catheter was then advanced over the
___ wire into the right lower pulmonary artery. The ___ wire was removed.
The EKOS ultrasound wire was then inserted through the catheter.
The C2 catheter and glidewire were then used to select the left pulmonary
artery. A left pulmonary arteriogram was performed showing significant
pulmonary embolism most pronounced in the left lower lobe pulmonary artery.
Next, an exchange length ___ wire was advanced through the C2 catheter to
select the left lower lobe pulmonary artery. The C2 catheter was removed. A ___
x ___ cm x 6 cm treatment zone EKOS catheter was then advanced over the ___
wire into the left lower pulmonary artery. The ___ wire was removed. The
EKOS ultrasound wire was then inserted through the catheter.
At this point, the tPA lines, coolant lines and ultrasound wires were secured
and attached to proper attachments. Initiation of 1 mg/hour of tPA was then
infused through each catheter for a total of 2 mg/hour. 1000 units of heparin
/ 500 cc NS at 50 cc hour were then infused through the sidearm of the sheath.
The sheath was secured with two 0-silk sutures and Tegaderm. Sterile dressings
were applied.
The patient tolerated the procedure well and there were no immediate
post-procedure complications.
FINDINGS:
1. Bilateral pulmonary emboli most pronounced in the main right and lower
pulmonary arteries and left lower lobe pulmonary artery.
2. Successful placement of bilateral pulmonary artery EKOS catheters.
IMPRESSION:
Successful placement of bilateral EKOS pulmonary lysis catheters.
RECOMMENDATION(S): 1 mg/hr alteplase through each ___ (2 mg/hr total) for
12 hours. Will clinically reassess in AM.
|
10108380-RR-43 | 10,108,380 | 27,148,430 | RR | 43 | 2154-07-12 14:06:00 | 2154-07-12 15:42:00 | INDICATION: Patient with upper epigastric pain for the past ___ hr,
evaluate for intra-abdominal process.
COMPARISON: CT abdomen pelvis from ___.
TECHNIQUE: Axial helical MDCT scan of the abdomen and pelvis was performed
following the intravenous administration of 130 cc of Omnipaque in a split
bolus technique. Multiplanar reformatted images in coronal and sagittal axes
were generated.
DLP: 547 mGy-cm
FINDINGS:
LOWER CHEST: There is mild dependent atelectasis bilaterally. The lungs are
otherwise clear. The visualized heart and pericardium are unremarkable.
LIVER: The liver enhances homogeneously without focal lesions. There is mild
intrahepatic biliary duct dilatation. The gallbladder is surgically absent
and the portal vein is patent. The common bile duct is prominent and measures
up to 9 mm, in keeping with history of cholecystectomy.
PANCREAS: Within the pancreas, there is a 6 x6 mm hypodense lesion, stable
since ___. There is no peripancreatic stranding or fluid
collection.
SPLEEN: The spleen is homogeneous and normal in size.
ADRENALS: The adrenal glands are unremarkable.
KIDNEYS: The kidneys do not show solid or cystic lesions and demonstrate
symmetric nephrograms and excretion of contrast. No pelvicaliceal dilatation
or perinephric abnormalities are present.
GI TRACT: The stomach, duodenum and small bowel are within normal limits,
without evidence of wall thickening or obstruction. The colon is non-dilated
without evidence of obstructive lesions. There is mild nonspecific fat
stranding around the ascending colon as well as equivocal mild colonic wall
edema. The appendix is normal.
VASCULAR: The aorta is of normal caliber without aneurysmal dilatation. The
IVC and major abdominal vessels are patent.
RETROPERITONEUM AND ABDOMEN: There is no retroperitoneal or mesenteric lymph
node enlargement. No ascites, free air or abdominal wall hernias are noted.
PELVIC CT: The urinary bladder and terminal ureters are normal. No pelvic
wall or inguinal lymph node enlargement is seen. There is no pelvic free
fluid. An IUD is appropriately positioned within the uterus, which appears
fibroid. There is a right adnexal corpus luteal cyst.
OSSEOUS STRUCTURES: No blastic or lytic lesion suspicious for malignancy is
present.
IMPRESSION:
1. No evidence of acute intra-abdominal pathology by CT exam. Mild intra and
extra hepatic ductal dilatation in keeping with history of cholecystectomy.
2. 6mm hypodense pancreatic lesion, stable since ___ and likely benign. A
non-urgent MRCP may be performed for further characterization if clinically
indicated.
Findings were discussed with ___ by ___ telephone at 6pm on day of
exam.
|
10108433-RR-11 | 10,108,433 | 21,634,827 | RR | 11 | 2123-08-20 04:45:00 | 2123-08-20 06:16:00 | EXAMINATION: CTA CHEST WITH CONTRAST
INDICATION: History: ___ with tachycardia, hypoxemia// evaluate 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: Acquisition sequence:
1) Stationary Acquisition 4.0 s, 0.5 cm; CTDIvol = 24.3 mGy (Body) DLP =
12.1 mGy-cm.
2) Spiral Acquisition 3.8 s, 29.8 cm; CTDIvol = 14.7 mGy (Body) DLP = 437.8
mGy-cm.
Total DLP (Body) = 450 mGy-cm.
COMPARISON: CT torso from ___
FINDINGS:
HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the
subsegmental level without filling defect to indicate a pulmonary embolus. The
thoracic aorta is normal in caliber without evidence of dissection or
intramural hematoma. The heart remains enlarged. Ascending thoracic aorta is
dilated, measuring up to 4.5 cm. Main pulmonary artery is dilated, measuring
up to 3.9 cm. No pericardial effusion.
AXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar
lymphadenopathy is present. No mediastinal mass.
PLEURAL SPACES: Trace bilateral pleural effusions are noted, right greater
than left, similar to the prior study. No pneumothorax.
LUNGS/AIRWAYS: Rounded atelectasis at both lung bases is similar. Additional
areas of scarring are noted in the left upper lobe and posterior right upper
lobe. Bronchial wall thickening is compatible with chronic small airways
disease.
BASE OF NECK: There is a large, multinodular thyroid gland with
calcifications. There is at least one discrete thyroid nodule measuring up to
1.9 cm in the right lobe of the thyroid gland (series 2, image 7).
ABDOMEN: Included portion of the upper abdomen is unremarkable.
BONES: Several subacute-to-chronic bilateral posterior rib fractures are
re-demonstrated, as is multilevel thoracic vertebral body height loss. Pectus
excavatum is present.
IMPRESSION:
1. No evidence of pulmonary embolism or aortic abnormality.
2. Similar appearance of the lungs, with multifocal scarring and rounded
atelectasis at the lung bases.
3. Bilateral subacute-to-chronic rib fractures.
4. Dilated main pulmonary artery is suggestive of pulmonary arterial
hypertension.
5. Dilated ascending thoracic aorta measuring up to 4.5 cm.
6. Enlarged heterogenous thyroid gland with calcifications and nodules.
Recommend follow-up ultrasound of the thyroid gland.
RECOMMENDATION(S): Thyroid nodule. Ultrasound follow up recommended.
___ College of Radiology guidelines recommend further evaluation for
incidental thyroid nodules of 1.0 cm or larger in patients under age ___ or 1.5
cm in patients age ___ or older, or with suspicious findings.
Suspicious findings include: Abnormal lymph nodes (those displaying
enlargement, calcification, cystic components and/or increased enhancement) or
invasion of local tissues by the thyroid nodule.
___, et al, "Managing Incidental Thyroid Nodules Detected on Imaging: White
Paper of the ACR Incidental Findings Committee". J ___ ___
12:143-150.
|
10108433-RR-12 | 10,108,433 | 21,634,827 | RR | 12 | 2123-08-23 01:03:00 | 2123-08-23 09:48:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with Aflutter// New pulmonary infilterates
New pulmonary infilterates
IMPRESSION:
Comparison to ___. Lung volumes have decreased. As a consequence,
the vascular diameters have slightly increased, overall the severity of the
changes is not substantially different from the previous image. The nodules
and vascular changes previously visualized on the CT examination from ___ are not visualized on the chest x-ray.
|
10108433-RR-14 | 10,108,433 | 21,634,827 | RR | 14 | 2123-08-24 13:56:00 | 2123-08-24 15:50:00 | EXAMINATION: Video oropharyngeal swallow
INDICATION: ___ year old man with dysphagia/odynophagia, h/o multinodular
thyroid// motility issue? mass effect from thyroid?
TECHNIQUE: Oropharyngeal swallowing videofluoroscopy was performed in
conjunction with the Speech-Language Pathologist from the Voice, Speech &
Swallowing Service. Multiple consistencies of barium were administered.
DOSE: Fluoro time: 2.53 min.
COMPARISON: None available.
FINDINGS:
There is penetration of thin liquid consistencies without aspiration
identified. Residue was noted to multiple consistencies, solids greater than
liquids.
IMPRESSION:
Penetration of thin liquids without aspiration identified.
Please note that a detailed description of dynamic swallowing as well as a
summative assessment and recommendations are reported separately in a
standalone note by the Speech-Language Pathologist (OMR, Notes, Rehabilitation
Services).
|
10108433-RR-15 | 10,108,433 | 21,634,827 | RR | 15 | 2123-08-26 14:45:00 | 2123-08-27 08:20:00 | EXAMINATION: CT NECK W/CONTRAST (EG:PAROTIDS) Q22 CT NECK
INDICATION: ___ man with history of ETOH abuse, who presented after a
fall with a head laceration now being treated for community-acquired pneumonia
due to presumed aspiration. Please evaluate for obstructing mass.
TECHNIQUE: Imaging was performed after administration of Omnipaque
intravenous contrast material.
MDCT acquired helical axial images were obtained from the thoracic inlet
through the skull base.
Coronal and sagittal multiplanar reformats were then produced and reviewed.
DOSE: Acquisition sequence:
1) Spiral Acquisition 4.8 s, 31.4 cm; CTDIvol = 7.1 mGy (Body) DLP = 217.0
mGy-cm.
Total DLP (Body) = 217 mGy-cm.
COMPARISON: CT C-spine from ___.
FINDINGS:
There is mild retrolisthesis of C4 to C5. There are no acute fractures. No
evidence of prevertebral soft tissue swelling. Multilevel severe
degenerative changes best seen at C2 to C4 with osteophyte formation and
joint-space narrowing.
A large heterogeneous calcified thyroid is seen. There is extension to the
manubrial clavicular joint. Follow-up with ultrasound is recommended.
Evaluation of the aerodigestive tract demonstrates no mass and no areas of
focal mass effect.
The salivary glands enhance normally and are without mass or adjacent fat
stranding. There is no lymphadenopathy by CT criteria. The neck vessels are
patent. A catheter seen inside the right subclavian.
The imaged portion of the lung apices are clear and there are no concerning
pulmonary nodules. There are no osseous lesions.
IMPRESSION:
1. No mass or obstruction seen in the upper airway.
2. Severe degenerative changes of C2 to C 5.
3. Ultrasound follow-up is recommended for large heterogeneous thyroid.
|
10108433-RR-19 | 10,108,433 | 21,634,827 | RR | 19 | 2123-08-29 03:09:00 | 2123-08-29 11:46:00 | INDICATION: ___ w/ hyperthyroidism ___ toxic multinodular goiter, a-flutter,
and newly dx HFrEF// ?pulm edema
COMPARISON: ___
IMPRESSION:
There are low lung volumes. Heart size is prominent. There are small
bilateral effusions. Pleural effusion on the left side has increased since
previous. There is prominence of the pulmonary vascular markings. There are
bibasilar opacities, stable. There are no pneumothoraces. Deformity of the
left proximal humerus is seen.
|
10108435-RR-242 | 10,108,435 | 26,693,769 | RR | 242 | 2191-01-15 08:11:00 | 2191-01-15 10:58:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: History: ___ with recurrent VTE, PE w/ IVC filter, COPD, c/o
recurrent falls and dyspnea. Evaluate for consolidation.
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest radiograph from ___ and ___.
FINDINGS:
The cardiomediastinal and hilar contours are stable. The lungs are grossly
clear, except for mild atelectasis in the right base. No focal consolidation,
pleural effusion, or pneumothorax. There has been improvement in the
previously noted pulmonary vascular engorgement. An electronic rectangular
device overlying the left chest is again seen, similarly to the prior chest
radiograph. Mild compression deformities of the thoracic spine are unchanged
since ___.
IMPRESSION:
No acute cardiopulmonary process.
|
10108435-RR-243 | 10,108,435 | 26,693,769 | RR | 243 | 2191-01-15 07:56:00 | 2191-01-15 09:08:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: History: ___ with HCV cirrhosis, CAD, COPD, recent CTH w/
punctate hemorrhage, on coumadin, poor coagulation, p/w recurrent falls and
lightheadedness. Eval ? worsening bleed.
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
Coronal and sagittal as well as thin bone-algorithm reconstructed images were
obtained.
DOSE: This study involved 3 CT acquisition phases with dose indices as
follows:
1) CT Localizer Radiograph
2) CT Localizer Radiograph
3) Sequenced Acquisition 16.0 s, 16.2 cm; CTDIvol = 54.9 mGy (Head) DLP =
891.9 mGy-cm.
Total DLP (Head) = 892 mGy-cm.
COMPARISON: CT head from ___ and ___.
FINDINGS:
The previously described left parietal punctate hemorrhage is not identified
on the current study. There is no evidence of acute large territorial
infarction, edema, or mass. The ventricles and sulci are mildly prominent,
consistent with age related volume loss. Periventricular and subcortical
white matter hypodensities are nonspecific but likely sequela of chronic small
vessel ischemic disease.
No osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and
middle ear cavities are clear. The orbits are unremarkable.
IMPRESSION:
The previously described left parietal punctate hemorrhage is not identified
on the current study. No evidence of intracranial hemorrhage.
|
10108435-RR-244 | 10,108,435 | 26,693,769 | RR | 244 | 2191-01-18 11:35:00 | 2191-01-18 12:37:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with h/o COPD now with increased sputum
production, SOB, and general malaise. Afebrile // Pneumonia v COPD
exacerbation
TECHNIQUE: Portable chest
___.
FINDINGS:
Lung volumes are slightly lower than on the prior exam. There compressive
changes at the bases versus early infiltrates. Otherwise the appearance of
the lungs are unchanged
IMPRESSION:
Volume loss versus early infiltrates in the lower lobes
|
10108435-RR-245 | 10,108,435 | 26,693,769 | RR | 245 | 2191-01-18 13:31:00 | 2191-01-18 14:42:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: History of punctate left parietal hemorrhage, on warfarin for
recurrent venous thrombosis status post IVC filter, presenting with new onset
blurry vision and headache.
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast. Some of the images were repeated due to motion artifact.
Coronal and sagittal as well as thin bone-algorithm reconstructed images were
obtained.
DOSE: DLP: 1226.4 mGy-cm
CTDI: 53.72 mGy
COMPARISON: Several noncontrast head CT examinations dating from ___ through ___.
FINDINGS:
There is no evidence of acute hemorrhage, edema, or mass effect. The
ventricles and sulci are stable in size, with mild age-related prominence.
Scattered small foci of periventricular white matter hypodensity likely
represent sequela of mild chronic small vessel ischemic disease, not
significantly changed. Carotid siphon calcifications are again seen.
No osseous abnormalities seen. There is mild mucosal thickening in the
inferior frontal sinuses, anterior ethmoid air cells, and the partially
visualized left maxillary sinus. Mastoid air cells are clear.
IMPRESSION:
No evidence for acute intracranial abnormalities.
|
10108435-RR-246 | 10,108,435 | 24,531,107 | RR | 246 | 2191-06-25 12:27:00 | 2191-06-25 13:30:00 | INDICATION: History: ___ with hypotension
TECHNIQUE: Semi-upright AP view of the chest
COMPARISON: Chest radiograph ___
FINDINGS:
Mild to moderate enlargement of the cardiac silhouette is unchanged. The
aorta remains tortuous. Mediastinal and hilar contours are similar. There is
mild upper zone vascular redistribution without overt pulmonary edema.
Minimal atelectasis is noted in the lung bases. No focal consolidation,
pleural effusion or pneumothorax is present. An electronic device projects
over the left mid hemi thorax.
IMPRESSION:
Mild pulmonary vascular congestion and mild bibasilar atelectasis.
|
10108435-RR-247 | 10,108,435 | 24,531,107 | RR | 247 | 2191-06-25 12:06:00 | 2191-06-25 12:32:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ with hypotension. Evaluate for intracranial hemorrhage.
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast. Coronal and sagittal reformations as well as bone algorithm
reconstructions were provided and reviewed.
DOSE: Total DLP (Head) = 1,204 mGy-cm.
COMPARISON: CT from ___.
FINDINGS:
Study is mildly degraded by motion. There is no evidence of acute infarction,
hemorrhage, edema, or mass. There is prominence of the ventricles and sulci
suggestive of involutional changes. Periventricular and subcortical white
matter hypodensities are consistent with chronic small vessel ischemic
disease.
There is no evidence of fracture. The visualized portion of the paranasal
sinuses, mastoid air cells, and middle ear cavities are clear. The visualized
portion of the orbits are unremarkable. Calcification of the carotid siphons
are noted bilaterally. There is a concha bullosa on the left.
IMPRESSION:
Study is mildly degraded by motion. No acute intracranial abnormalities.
|
10108435-RR-248 | 10,108,435 | 24,531,107 | RR | 248 | 2191-06-25 12:06:00 | 2191-06-25 12:44:00 | EXAMINATION: CT C-SPINE W/O CONTRAST
INDICATION: ___ with hypotension and fall. Evaluate for fractures.
TECHNIQUE: Non-contrast helical multidetector CT was performed.Soft tissue
and bone algorithm images were generated. Coronal and sagittal reformations
were then constructed.
DOSE: Total DLP (Body) = 753 mGy-cm.
COMPARISON: None.
FINDINGS:
Alignment is normal. No acute fractures are identified. Mild degenerative
changes of the cervical spine is seen, with uncovertebral hypertrophy at
multiple levels. There is mild central disc bulges at C2-3, and C4-5, mildly
narrowing the spinal canal. However, there is no evidence of critical spinal
canal or neural foraminal stenosis. There is no prevertebral soft tissue
swelling. Biapical scarring is noted. Tonsilliths are noted in the left
tonsil, likely due to prior infection. Nuchal calcification is noted
posterior to spinous process of C6.
IMPRESSION:
1. No acute fracture or traumatic malalignment.
2. Mild degenerative changes as noted above.
|
10108435-RR-249 | 10,108,435 | 24,531,107 | RR | 249 | 2191-06-25 21:05:00 | 2191-06-26 00:07:00 | EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ year old man with hx cirrhosis, CHF, admitted for fall, also
with ___ and abd distention, hypotension, evaluate for ascites, portal vein
clot.
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON:
1. CT abdomen and pelvis ___.
2. Liver/gallbladder ultrasound ___.
FINDINGS:
LIVER: The hepatic parenchyma appears within normal limits. The contour of the
liver is smooth. There is no focal liver mass. The main portal vein is patent
with hepatopetal flow. There is no ascites.
BILE DUCTS: There is no intrahepatic biliary dilation. The CBD measures 6 mm.
GALLBLADDER: The gallbladder is collapsed.
PANCREAS: The pancreas is not well visualized, largely obscured by overlying
bowel gas.
SPLEEN: Enlarged spleen with normal echogenicity, measuring 16.5 cm.
KIDNEYS: Limited sagittal views of the right kidney demonstrate no evidence
of hydronephrosis.
RETROPERITONEUM: Visualized portions of aorta and IVC are within normal
limits.
IMPRESSION:
Patent portal vein with hepatopetal flow. No ascites. Splenomegaly.
|
10108435-RR-251 | 10,108,435 | 23,827,733 | RR | 251 | 2191-08-11 00:15:00 | 2191-08-11 01:18:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: History: ___ with recent fall, on coumadin // please evaluate
for acute fracture, bleed
TECHNIQUE: Contiguous axial images from skullbase to vertex were obtained
without intravenous contrast. Coronal and sagittal reformations and bone
algorithms reconstructions were also performed.
DOSE: Acquisition sequence:
1) CT Localizer Radiograph
2) CT Localizer Radiograph
3) Sequenced Acquisition 7.2 s, 18.1 cm; CTDIvol = 49.9 mGy (Head) DLP =
903.1 mGy-cm.
4) Sequenced Acquisition 1.6 s, 4.0 cm; CTDIvol = 49.9 mGy (Head) DLP =
200.7 mGy-cm.
Total DLP (Head) = 1,104 mGy-cm.
COMPARISON: CT head ___
FINDINGS:
There is no evidence of infarction, hemorrhage, edema, or mass. The
ventricles and sulci are normal in caliber and configuration. Calcification
of the carotid siphons are seen bilaterally.
No fracture seen. The paranasal sinuses, mastoid air cells, and middle ear
cavities are clear. The orbits are unremarkable.
IMPRESSION:
Normal study.
|
10108435-RR-252 | 10,108,435 | 23,827,733 | RR | 252 | 2191-08-11 03:00:00 | 2191-08-11 04:47:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ year old man with recent negative head ct, elevated INR, now
s/p fall with unclear hx if headstrike // eval for bleed
TECHNIQUE: Contiguous axial images from skullbase to vertex were obtained
without intravenous contrast. Coronal and sagittal reformations and bone
algorithms reconstructions were also performed.
DOSE: Acquisition sequence:
1) CT Localizer Radiograph
2) CT Localizer Radiograph
3) Sequenced Acquisition 8.0 s, 16.1 cm; CTDIvol = 49.9 mGy (Head) DLP =
802.7 mGy-cm.
Total DLP (Head) = 803 mGy-cm.
COMPARISON: CT head from earlier the same day
FINDINGS:
There is no evidence of infarction, hemorrhage, edema, or mass.
Calcification of the carotid siphons is seen bilaterally.
No fracture seen. The paranasal sinuses, mastoid air cells, and middle ear
cavities are clear. The orbits are unremarkable.
IMPRESSION:
Normal study.
|
10108435-RR-262 | 10,108,435 | 21,831,401 | RR | 262 | 2192-01-06 11:55:00 | 2192-01-06 13:16:00 | EXAMINATION:
Chest: Frontal and lateral views
INDICATION: History: ___ with dyspnea and leg swelling // r/o acute process
TECHNIQUE: Chest: Frontal and Lateral
COMPARISON: ___
FINDINGS:
Mild pulmonary vascular congestion is seen with central pulmonary vascular
engorgement. There is minor linear left base atelectasis. No pleural
effusion is seen. There is no pneumothorax. Enlargement of the cardiac and
mediastinal silhouettes is stable. A battery pack overlies the left hemi
thorax.
IMPRESSION:
Persistent cardiomegaly. Mild pulmonary vascular congestion.
|
10108435-RR-263 | 10,108,435 | 21,831,401 | RR | 263 | 2192-01-06 16:34:00 | 2192-01-06 20:08:00 | EXAMINATION: CTA chest
INDICATION: ___ man with hypoxia. Evaluate for pulmonary embolus.
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) = 459 mGy-cm.
COMPARISON: CTA torso dated ___.
FINDINGS:
The aorta and its major branch vessels are patent, with no evidence of
stenosis, occlusion, dissection, or aneurysmal formation. The heart remains
enlarged with extensive coronary artery calcifications. Trace pericardial
effusion is likely physiologic. There is fluid in the pericardial recess.
Linear eccentric web-like filling defect at the bifurcation of the right
interlobar pulmonary artery is consistent with chronic clot/scar, best seen on
series 2 image 54. No evidence of an acute pulmonary embolus. The main
pulmonary artery is dilated up to 3.7 cm, suggesting sequelae of chronic
pulmonary hypertension, unchanged.
No supraclavicular or axillary lymphadenopathy. Mediastinal lymph nodes are
measurable up to 2.6 cm in the subcarinal station. Other probable lymph nodes
are more prominent from the prior exam in ___ and could be related to
esophagitis (e.g., series 3, image 109). Prominence of right hilar soft
tissues likely reactive lymphadenopathy, similar to the prior exam. No left
hilar lymphadenopathy.
The thyroid gland appears unremarkable. The esophageal wall appears uniformly
thickened, which can be seen with esophagitis.
Bilateral, lower lobe predominant peribronchiolar wall thickening, mucous
plugging, and parenchymal opacities are consistent with bronchiolar
inflammation, progressed from the prior exam. Mild lower lobe dependent
interlobular septal thickening and ground-glass opacities suggest edema. More
confluent parenchymal opacities in the bilateral lower lobes may suggest
concurrent atypical infection. No pleural effusion or pneumothorax.
Upper abdomen: This exam is not dedicated for imaging of the abdomen.
Limited images of the upper abdomen show: Abdominal wall collaterals are
incompletely imaged and are related to chronic infrarenal IVC occlusion on
prior CT. The spleen appears mildly enlarged, measuring up to 14 cm on the
axial images.
Bones: No lytic or blastic osseous lesion suspicious for malignancy is
identified. Appearance of the thoracic spine is unchanged with mild superior
compression deformity of a mid thoracic vertebral body.
Soft tissues: There is bilateral gynecomastia. Multiple venous collaterals
in the body wall reflect chronic IVC occlusion.
IMPRESSION:
1. No evidence of acute pulmonary embolism or aortic abnormality.
2. Cardiomegaly with mi pulmonary edema.
3. Moderate chronic small airways disease with mucous plugging, particularly
in the lower lobes, worse from ___. Areas of more confluent opacity in
the lower lobes suggest atypical infection.
4. Dilated main pulmonary artery suggests sequelae of chronic pulmonary
hypertension.
5. Thickened esophageal wall suggests esophagitis.
6. Interval increased size of mediastinal lymph nodes which could be reactive
and related to esophagitis and current infection. Close interval follow-up to
ensure resolution.
7. Mild splenomegaly.
|
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