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10108435-RR-264
10,108,435
21,831,401
RR
264
2192-01-06 23:42:00
2192-01-07 00:06:00
EXAMINATION: CT HEAD W/O CONTRAST INDICATION: ___ year old man with dCHF and dyspnea endorsing multiple falls at home, now aaox1. Evaluate for acute intra hemorrhage. TECHNIQUE: Contiguous axial images of the brain were obtained without contrast. Coronal and sagittal reformations as well as bone algorithm reconstructions were provided and reviewed. DOSE: Acquisition sequence: 1) Sequenced Acquisition 18.0 s, 18.5 cm; CTDIvol = 48.8 mGy (Head) DLP = 903.1 mGy-cm. Total DLP (Head) = 903 mGy-cm. COMPARISON: CT head of ___. FINDINGS: There is no evidence of acute intracranial hemorrhage, large territorial infarction, edema, or mass/mass-effect. There is prominence of the ventricles and sulci suggestive of involutional changes. There is no evidence of fracture. Mild left maxillary sinus mucosal thickening. There is a dental caries and periapical lucency of a left maxillary lateral incisor (series 3, image 2). The visualized portion of the remaining paranasal sinuses, mastoid air cells, and middle ear cavities are clear. The visualized portion of the orbits are unremarkable. IMPRESSION: 1. Study is mildly degraded by motion. Within this confine: 2. No acute intracranial abnormality on noncontrast head CT. Specifically no intracranial hemorrhage. 3. Dental caries and periapical lucency of a left maxillary lateral incisor with left maxillary sinus mucosal thickening. Correlation with odontogenic sinusitis is recommended.
10108435-RR-265
10,108,435
21,831,401
RR
265
2192-01-07 08:39:00
2192-01-07 14:52:00
EXAMINATION: ABDOMEN US (COMPLETE STUDY) PORT INDICATION: ___ year old man with dCHF and COPD p/w dyspnea and cough, found to have caput medusa on exam // evaluate for ascites and cirrhosis, please perform with Doppler TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were obtained. COMPARISON: None. FINDINGS: LIVER: The left lobe is not well seen. Within this limitation, the visualized hepatic parenchyma appears within normal limits. The contour of the liver is smooth. There is no focal liver mass. There is no ascites. Complete Doppler evaluation of the liver was performed which demonstrates a patent splenic vein and main portal vein, coursing in the appropriate direction. Intrahepatic branches of the main portal vein are patent and demonstrate normal directional flow. The right and middle hepatic veins are patent and demonstrate normal waveforms, and the left hepatic vein was not well seen. The hepatic artery is patent and demonstrates a normal waveform. BILE DUCTS: There is no intrahepatic biliary dilation. The CHD measures 5 mm. GALLBLADDER: There is no evidence of stones or gallbladder wall thickening. PANCREAS: The pancreas is not well visualized, largely obscured by overlying bowel gas. SPLEEN: Normal echogenicity, measuring 16 cm. KIDNEYS: The right kidney measures 12.7 cm. The left kidney measures 12 cm. Normal cortical echogenicity and corticomedullary differentiation is seen bilaterally. No hydronephrosis. RETROPERITONEUM: The visualized portions of aorta and IVC are within normal limits. IMPRESSION: No ascites. Limited evaluation of the liver, however no morphological features of cirrhosis are identified. Doppler evaluation of the liver is normal. Venous collaterals in the abdominal wall are related to occlusion of the inferior vena cava below the IVC filter.
10108435-RR-266
10,108,435
26,448,261
RR
266
2192-01-24 19:09:00
2192-01-24 19:28:00
EXAMINATION: CHEST (AP AND LAT) INDICATION: ___ with CAD, History of DVT, COPD, diastolic CHF, presents with multiple complaints, including chest pain and dyspnea COMPARISON: ___ FINDINGS: AP upright and lateral views of the chest provided. Cardiomegaly is unchanged and there is persistent hilar engorgement. Mild pulmonary interstitial edema likely present. No large effusion or pneumothorax. No convincing signs of pneumonia. Mediastinal contour is unchanged. Bony structures are intact. IMPRESSION: As above.
10108435-RR-267
10,108,435
26,448,261
RR
267
2192-01-25 00:50:00
2192-01-25 16:28:00
EXAMINATION: ABDOMEN (SUPINE AND ERECT) INDICATION: ___ year old man with one week abdominal pain, n/v and minimal flatus in last day, concern for sbo // evidence of obstruction TECHNIQUE: Portable abdomen COMPARISON: ___ FINDINGS: Gas and stool are seen in multiple nondilated loops of large and small bowel. The largest loop of bowel is in the left lower quadrant measuring up to 5.6 cm and is felt to be the sigmoid colon. No free air seen on decubitus films. An IVC filter is present. There degenerative changes of the spine with a mild scoliosis convex right. IMPRESSION: Nonspecific bowel-gas pattern.
10108435-RR-268
10,108,435
26,448,261
RR
268
2192-01-25 08:06:00
2192-01-25 09:04:00
EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN) INDICATION: ___ year old man with one week of abdominal pain and poor historian so difficult to characterize pain, has caput medusae on exam but no history of liver disease, evaluate for cirrhosis or cholecystitis TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were obtained. COMPARISON: Abdominal ultrasound ___ FINDINGS: LIVER: The hepatic parenchyma appears within normal limits although the left lobe of the liver is not well seen. 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 CHD measures 6 mm. GALLBLADDER: There is no evidence of stones or gallbladder wall thickening. PANCREAS: The imaged portion of the pancreas appears within normal limits, without masses or pancreatic ductal dilation, with portions of the pancreatic tail obscured by overlying bowel gas. SPLEEN: Normal echogenicity, measuring 15.9 cm. KIDNEYS: The right kidney measures 11.8 cm and the left kidney measures 11.2 cm. RETROPERITONEUM: The visualized portions of aorta and IVC are within normal limits. IMPRESSION: 1. Limited evaluation of the left lobe of the liver however, no focal lesions or parenchymal abnormalities are seen. 2. Mild splenomegaly. 3. Normal biliary tree.
10108435-RR-269
10,108,435
26,448,261
RR
269
2192-01-27 08:15:00
2192-01-27 10:16:00
EXAMINATION: CHEST (PORTABLE AP) INDICATION: ___ year old man with CHF and COPD exacerbation with worsening cough and chest pain. // Chest pain and worsening sputum production, question of PNA Chest pain and worsening sputum production, question of PNA IMPRESSION: Compared to chest radiographs since ___, most recently ___. Pulmonary vascular congestion has improved, but there is now mild interstitial edema. Mild cardiac enlargement is stable. There is no pleural effusion. There are no focal pulmonary abnormalities to suggest pneumonia and no appreciable pleural effusion or evidence of pneumothorax.
10108435-RR-271
10,108,435
25,239,067
RR
271
2192-03-14 03:45:00
2192-03-14 05:40:00
EXAMINATION: CT abdomen/pelvis with IV contrast. INDICATION: ___ with chest and abdominal pain, vomiting. 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 DLP (Body) = 1,046 mGy-cm. COMPARISON: ___ CT abdomen pelvis FINDINGS: LOWER CHEST: Cardiomegaly is again noted, mild. No pericardial effusion. Mild thickening of the distal esophagus is unchanged possibly reflecting a mild esophagitis. There is septal thickening at the imaged lung bases consistent with interstitial pulmonary edema. Trace pleural fluid is noted on the right. ABDOMEN: The liver appears normal. Main portal vein is patent. No biliary ductal dilation. The gallbladder is normal. The spleen appears enlarged measuring 15 cm in length, unchanged from prior. Adrenal glands appear normal. The pancreas appears atrophic. The kidneys enhance symmetrically with prompt excretion noted bilaterally. No hydronephrosis or signs of pyelonephritis or worrisome renal lesion. The abdominal aorta is moderately calcified and within normal limits of caliber. Numerous retroperitoneal lymph nodes are small and likely reactive. The stomach is decompressed. The duodenum appears normal. No free air or free fluid. An IVC filter is in place with chronic appearing thrombosis of the IVC inferior to the filter. Bilateral common femoral veins are patent due to collateral flow. There is re- cannulization of the left internal and external iliac veins also due to collateral pathways. PELVIS: Small bowel loops demonstrate no signs of ileus or obstruction. The appendix is small and normal. The colon is thin walled containing mild fecal load. No signs of colonic inflammation or obstruction. The urinary bladder is only partially distended and appears normal. No pelvic free fluid or pelvic sidewall or inguinal adenopathy. Small pelvic sidewall lymph nodes do not meet size criteria for pathologic enlargement and are likely reactive. SOFT TISSUES: There is body wall edema extending into the lower extremities, right greater than left. As stated above, the common femoral veins appear patent at the level of the upper thigh. BONES: No worrisome bony lesion. A chronic compression deformity is again noted at L1. IMPRESSION: 1. Mild cardiomegaly with interstitial pulmonary edema partially visualized in the lower lungs. Trace right pleural effusion. 2. Chronic occlusion of the IVC in this patient with filter with extensive venous collaterals in the body wall. 3. Mild body wall edema extending into the lower extremities, right greater than left. 4. Unchanged splenomegaly. 5. Prominent retroperitoneal and pelvic sidewall lymph nodes likely reactive. Please note, these do not meet size criteria for pathologic enlargement. 6. Chronic L1 compression deformity. 7. Apparent thickening of the distal esophagus appears unchanged, correlate for esophagitis.
10108435-RR-272
10,108,435
25,239,067
RR
272
2192-03-14 05:24:00
2192-03-14 08:09:00
EXAMINATION: Portable AP chest radiograph INDICATION: ___ with SOB, cough, chest pain. // pneumonia? pulm edema? TECHNIQUE: Portable AP chest COMPARISON: ___ chest radiographs FINDINGS: There is moderately severe bilateral pulmonary edema, which has substantially increased since ___. Moderate cardiomegaly is essentially unchanged. No focal consolidation, pleural effusion, or pneumothorax. IMPRESSION: Worsening bilateral pulmonary edema.
10108435-RR-287
10,108,435
21,003,300
RR
287
2192-07-06 00:18:00
2192-07-06 06:55:00
EXAMINATION: Chest: Frontal and lateral views INDICATION: History: ___ with cough, shortness of breath // Eval for acute process TECHNIQUE: Chest: Frontal and Lateral COMPARISON: Chest radiograph on ___ FINDINGS: Patchy opacity at the right lung base may represent atelectasis or pneumonia. There is elevated pulmonary vascular congestion, with no frank pulmonary edema. No pleural effusion or pneumothorax is seen. Moderate cardiomegaly is similar to prior. The aorta is tortuous. IMPRESSION: 1. Elevated pulmonary vascular congestion, with no frank pulmonary edema. 2. Patchy opacity at the right lung base may represent atelectasis or pneumonia.
10108435-RR-288
10,108,435
21,003,300
RR
288
2192-07-06 01:36:00
2192-07-06 02:59:00
EXAMINATION: CT HEAD W/O CONTRAST INDICATION: History: ___ with hx small L parietal hemorrhage, fall today w/o head strike, also RLQ abd pain // Eval for acute process, ICH, appy, ?R inguinal hernia TECHNIQUE: Contiguous axial images of the brain were obtained without contrast. Coronal and sagittal reformations as well as bone algorithm reconstructions were provided and reviewed. DOSE: Acquisition sequence: 1) Sequenced Acquisition 18.0 s, 18.4 cm; CTDIvol = 49.1 mGy (Head) DLP = 903.1 mGy-cm. 2) Sequenced Acquisition 6.0 s, 12.0 cm; CTDIvol = 50.2 mGy (Head) DLP = 602.1 mGy-cm. 3) Sequenced Acquisition 5.0 s, 10.0 cm; CTDIvol = 50.2 mGy (Head) DLP = 501.7 mGy-cm. Total DLP (Head) = 2,007 mGy-cm. COMPARISON: CT head on ___ FINDINGS: There is no evidence of infarction, hemorrhage, edema, or mass. There is prominence of the ventricles and sulci suggestive of involutional changes. There are atherosclerotic calcifications of the bilateral cavernous carotids. There is no evidence of fracture. The visualized portion of the paranasal sinuses, mastoid air cells, and middle ear cavities are clear. The visualized portion of the orbits are unremarkable. IMPRESSION: No fracture or acute intracranial process.
10108435-RR-289
10,108,435
21,003,300
RR
289
2192-07-06 01:36:00
2192-07-06 03:07:00
EXAMINATION: CT C-SPINE W/O CONTRAST INDICATION: History: ___ with fall // eval for c-spine fx TECHNIQUE: Contiguous axial images obtained through the cervical spine without intravenous contrast. Coronal and sagittal reformats were reviewed. DOSE: Acquisition sequence: 1) Spiral Acquisition 5.5 s, 21.3 cm; CTDIvol = 37.2 mGy (Body) DLP = 794.0 mGy-cm. Total DLP (Body) = 794 mGy-cm. COMPARISON: CT cervical spine on ___ FINDINGS: Alignment is normal. No fractures are identified. Multilevel facet arthropathy and uncovertebral hypertrophy result in up to mild neural foraminal narrowing. There is no significant central canal narrowing. There is no prevertebral edema. The thyroid and included lung apices are unremarkable. IMPRESSION: No fracture or traumatic malalignment.
10108435-RR-290
10,108,435
21,003,300
RR
290
2192-07-06 01:36:00
2192-07-06 03:26:00
EXAMINATION: CT abdomen and pelvis with contrast INDICATION: ___ with hx small L parietal hemorrhage, fall today w/o head strike, also RLQ abd pain // Eval for acute process, ICH, appy, ?R inguinal hernia 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 DLP (Body) = 894 mGy-cm. COMPARISON: CT abdomen and pelvis on ___ FINDINGS: LOWER CHEST: There is minimal bibasilar atelectasis. There is no pleural effusion. There is a trace pericardial effusion, similar to prior. 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 is enlarged, measuring 14 cm, similar to prior. 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 subcentimeter cortical hypodensity in the right kidney is too small to characterize, however likely represents a cyst. There is no hydronephrosis. There is no perinephric abnormality. GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate normal caliber, wall thickness, and enhancement throughout. The colon and rectum are within normal limits. The appendix is normal (2:53). PELVIS: The urinary bladder and distal ureters are unremarkable. There is no free fluid in the pelvis. REPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal. LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There is no pelvic or inguinal lymphadenopathy. VASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic disease is noted. An IVC filter is in place, with chronic IVC thrombus below the filter. Bilateral common femoral veins are patent due to extensive collateral flow. There is recannulization of the left internal and external iliac veins, due to multiple large collateral pathways, similar to prior. BONES: A compression deformity of the L1 vertebral body with 6 mm of retropulsion of the posterior aspect of the vertebral body into the canal is not significantly changed. Multilevel degenerative changes in the lumbar spine, including a superior endplate compression deformity of L3, are not significantly changed. SOFT TISSUES: There is diastases of the anterior abdominal wall muscles, with protrusion of several loops of unobstructed bowel. IMPRESSION: 1. No acute process in the abdomen or pelvis. 2. Splenomegaly, similar to prior. 3. Chronic occlusion of the IVC, with a filter in place, and extensive venous collaterals.
10108435-RR-291
10,108,435
24,751,909
RR
291
2192-12-11 13:47:00
2192-12-11 14:08:00
EXAMINATION: CHEST (PA AND LAT) INDICATION: History: ___ with cough and fever of 104// eval for pneumonia TECHNIQUE: Chest PA and lateral COMPARISON: ___ FINDINGS: Cardiomediastinal contours are stable with mild to moderate cardiomegaly.. Left lower lobe opacities are consistent with atelectasis. There is minimal vascular congestion.. There is no pneumothorax or pleural effusion. The osseous structures are unremarkable IMPRESSION: No evidence of pneumonia. Stable cardiomegaly. Mild vascular congestion.
10108435-RR-293
10,108,435
24,751,909
RR
293
2192-12-11 15:54:00
2192-12-11 17:04:00
EXAMINATION: CT HEAD W/O CONTRAST INDICATION: ___ with fall from bed on blood thinners complaining of headache// Eval for intracranial hemorrhage 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. 2) Sequenced Acquisition 1.0 s, 2.0 cm; CTDIvol = 50.2 mGy (Head) DLP = 100.3 mGy-cm. Total DLP (Head) = 903 mGy-cm. COMPARISON: Noncontrast head CT from ___. FINDINGS: There is no evidence of acute large territorial infarction, hemorrhage, edema, or mass. The ventricles and sulci are mildly prominent, compatible age appropriate involutional changes. Mild periventricular white-matter hypodensities are nonspecific, but likely reflect the sequela of chronic microvascular infarction. Moderate atherosclerotic calcifications of the cavernous carotid arteries are demonstrated. No acute osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and middle ear cavities are clear. The visualized aspects the orbits are unremarkable. IMPRESSION: No acute intracranial process.
10108435-RR-294
10,108,435
24,751,909
RR
294
2192-12-11 22:18:00
2192-12-11 23:11:00
EXAMINATION: CT LOWER EXT W/C RIGHT INDICATION: Fever. Unclear from surface exam if there is RLE soft tissue infection. Assess for any deep infection or drainable collections. DOSE: Acquisition sequence: 1) Spiral Acquisition 9.3 s, 60.7 cm; CTDIvol = 14.2 mGy (Body) DLP = 850.4 mGy-cm. Total DLP (Body) = 850 mGy-cm. COMPARISON: CTA of the lower extremity dated ___ FINDINGS: The bones are diffusely osteopenic. No acute fracture is identified. There are mild to moderate tricompartmental degenerative changes around the knee. No joint effusion. Diffuse circumferential soft tissue thickening of the right leg and the visualized portions of the left leg. No focal fluid collection or abscess is identified. No abnormal muscular enlargement or enhancement. The visualized vessels of the right lower extremity are patent. Extensive superficial varices are noted in both lower limbs. IMPRESSION: No evidence of a soft tissue infection or abscess in the right lower limb. Diffuse circumferential skin thickening/edema.
10108435-RR-295
10,108,435
24,751,909
RR
295
2192-12-13 14:06:00
2192-12-13 18:23:00
EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN) INDICATION: ___ year old man with untreated HCV. Known venous collaterals ___ to clotted IVC filter. Known splenomegaly on previous studies. Difficult to asses for presence of ascites on exam. Admitted for fever of unclear source.// 1. assess for ascites2. evidence of portal hypertension3. ? cirrhosis (not seen on CT ___ TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were obtained. COMPARISON: CT abdomen and pelvis with contrast dated ___. FINDINGS: LIVER: The liver is diffusely echogenic. 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 CHD measures 4 mm. GALLBLADDER: There is no evidence of stones or gallbladder wall thickening. PANCREAS: The imaged portion of the pancreas appears within normal limits, without masses or pancreatic ductal dilation, with portions of the pancreatic tail obscured by overlying bowel gas. SPLEEN: The spleen is mildly enlarged, measuring approximately 15.7 cm, unchanged since prior CT from ___. KIDNEYS: The right kidney measures 11.3 cm. The left kidney measures 10.8 cm. There is no evidence of hydronephrosis, stones or masses in either kidney. RETROPERITONEUM: The visualized portions of aorta and IVC are within normal limits. IMPRESSION: 1. Echogenic liver is most likely from steatosis. More advanced liver disease including steatohepatitis, hepatic fibrosis, and cirrhosis cannot be excluded on this study. 2. No focal concerning hepatic lesions identified. 3. Stable mild splenomegaly. No ascites.
10108435-RR-296
10,108,435
24,751,909
RR
296
2192-12-16 22:43:00
2192-12-17 08:48:00
EXAMINATION: CHEST (PORTABLE AP) INDICATION: ___ year old man with hx of CHF, CAD, recent pna s/p outpatient abx, admitted for fever, now with acute ___ transferred to FICU// Please eval for pna, pulm edema Please eval for pna, pulm edema IMPRESSION: Heart lung mediastinum is stable. Lungs are overall clear except for right lung base where minimal opacity is present most likely representing atelectasis but attention on the subsequent studies is recommended.
10108435-RR-297
10,108,435
24,751,909
RR
297
2192-12-17 13:17:00
2192-12-17 14:29:00
EXAMINATION: DX CHEST PORTABLE PICC LINE PLACEMENT INDICATION: ___ year old man with right PICC// Right 44cm PICC ___ ___ Contact name: ___: ___ Right 44cm PICC ___ ___ IMPRESSION: HEART SIZE AND MEDIASTINUM ARE UNCHANGED INCLUDING MILD CARDIOMEGALY. RIGHT PICC LINE TIP IS AT THE CAVOATRIAL JUNCTION. LUNGS OVERALL CLEAR. NO APPRECIABLE PLEURAL EFFUSION. NO PNEUMOTHORAX.
10108435-RR-299
10,108,435
24,751,909
RR
299
2192-12-20 15:17:00
2192-12-20 17:13:00
EXAMINATION: CT abdomen and pelvis without contrast INDICATION: ___ year old man with severe acute on chronic anemia on lovenox requiring PRBC X7. Complaining of back pain.// r/o retroperitoneal bleed, other intrabdominal/pelvic bleeding. TECHNIQUE: Multidetector CT images of the abdomen and pelvis were acquired without intravenous contrast. Non-contrast scan has several limitations in detecting vascular and parenchymal organ abnormalities, including tumor detection. Oral contrast was not administered. Coronal and sagittal reformations were performed and reviewed on PACS. DOSE: Acquisition sequence: 1) Spiral Acquisition 7.7 s, 49.9 cm; CTDIvol = 15.9 mGy (Body) DLP = 785.0 mGy-cm. Total DLP (Body) = 785 mGy-cm. COMPARISON: CT abdomen and pelvis with contrast ___ FINDINGS: LOWER CHEST: Dependent atelectatic changes noted at the lung bases. Small pericardial effusion noted. ABDOMEN: HEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. There is no evidence of focal lesions within the limitations of an unenhanced scan. There is no evidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder is within normal limits. PANCREAS: The pancreas has normal attenuation throughout, without evidence of focal lesions within the limitations of an unenhanced scan. There is no pancreatic ductal dilatation. There is no peripancreatic stranding. SPLEEN: The spleen is enlarged, measuring 15 cm. ADRENALS: The right and left adrenal glands are normal in size and shape. URINARY: The kidneys are of normal and symmetric size. There is no evidence of focal renal lesions within the limitations of an unenhanced scan. There is no hydronephrosis. There is no nephrolithiasis. There is no perinephric abnormality. GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate normal caliber and wall thickness throughout. The colon and rectum are within normal limits. The appendix is normal. PELVIS: The urinary bladder and distal ureters are unremarkable. There is no free fluid in the pelvis. REPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable. LYMPH NODES: There are prominent lymph nodes throughout the retroperitoneum. 13 mm aortocaval node is unchanged. 11 mm right external iliac node (image 54, series 2) is unchanged. 12 mm right external iliac node is unchanged. VASCULAR: There are extensive collaterals along the anterior abdominal wall, from the patient's known chronic IVC occlusion. IVC filter again noted. Moderate atherosclerotic disease is noted. BONES: No concerning osseous lesions, noting and contained compression deformities of L1 and L3. SOFT TISSUES: There is diastasis of the rectus abdominus musculature, as well as extensive venous collateralization in the subcutaneous tissues. IMPRESSION: 1. Chronic occlusion of the IVC, with extensive collaterals the subcutaneous tissues of the abdominal wall. 2. Mildly enlarged pelvic and retroperitoneal lymph nodes, measuring up to 13 mm, unchanged. 3. Splenomegaly.
10108435-RR-300
10,108,435
24,751,909
RR
300
2192-12-30 11:14:00
2192-12-30 23:53:00
EXAMINATION: CT Colonography INDICATION: ___ year old man with GI bleeding, Failed Colonoscopy (unable to proceed to cecum)// assess for mass, large ulcer TECHNIQUE: Axial contiguous slices were obtained from the lung bases to the pubis symphysis after insufflation of intrarectal air in the prone and supine positions. Intravenous contrast was not administered. DOSE: Total DLP (Body) = 396 mGy-cm. FINDINGS: CT COLONOGRAPHY: There is mild fluid within the ascending colon with minimal retained fecal matter. The fluid displaces with repositioning. There is a 5-7 cm segment of proximal descending colon which is persistently decompressed, limiting evaluation. Allowing for this, no suspicious lesions are seen. There is no evidence of polyps or mass. There is no evidence of stricture or inflammatory disease. CT ABDOMEN WITHOUT IV CONTRAST: Portions of the upper abdomen are not well visualized due to beam hardening artifact from the patient's upper extremities. Allowing for this, the liver, gallbladder, adrenals, kidneys, and pancreas are within normal limits. The spleen is enlarged, measuring 16.0 cm. The stomach and bowel loops are unremarkable. There is no free fluid, free air, or adenopathy. An IVC filter is in place, with the IVC inferior to the filter not well visualized secondary to chronic clot. Numerous superficial collateral veins are noted in the abdominal wall. Severe atherosclerosis is noted. CT PELVIS WITHOUT IV CONTRAST: The bladder and rectum are within normal limits. Prostate is unremarkable. There is no free fluid BONE WINDOWS: There are no suspicious osseous lesions. Multiplanar reformatted images and 3D endoluminal navigation performed in the antegrade and retrograde direction were utilized to confirm the above findings. IMPRESSION: No significant polyp or mass identified (greater than 1 cm), though there is a 5-7 cm segment of descending colon that was collapsed and a mass small or flat mass here cannot be excluded. The sensitivity of CT colonography for polyps greater than 1 cm is 85-90%. The sensitivity for polyps 6-9 mm is about 60-70%. Flat lesions may be missed with CT Colonography.
10108435-RR-305
10,108,435
27,447,491
RR
305
2193-03-23 07:39:00
2193-03-23 09:43:00
EXAMINATION: CHEST (PORTABLE AP) INDICATION: History: ___ with diminished right sided chest sounds// ? pneumonia, pneumothorax, pulm pulmonary edema, cardiomegaly TECHNIQUE: Supine AP view of the chest COMPARISON: Chest radiograph ___ FINDINGS: Moderate cardiac enlargement is unchanged. The mediastinal and hilar contours are similar. Mild pulmonary edema is not substantially changed in the interval. No focal consolidation, large pleural effusion, or pneumothorax is seen, though the extreme left costophrenic angle is not included in the field of view. Electronic device projects over the left mid chest wall. IMPRESSION: Mild pulmonary edema, as seen previously.
10108435-RR-306
10,108,435
27,447,491
RR
306
2193-03-23 11:03:00
2193-03-23 11:26:00
EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD INDICATION: ___ man status post fall. Please evaluate for intracranial injury. TECHNIQUE: Contiguous axial images of the brain were obtained without contrast. Coronal and sagittal reformations as well as bone algorithm reconstructions were provided and reviewed. DOSE: Acquisition sequence: 1) Sequenced Acquisition 18.0 s, 18.0 cm; CTDIvol = 50.2 mGy (Head) DLP = 903.1 mGy-cm. 2) Spiral Acquisition 1.6 s, 12.5 cm; CTDIvol = 24.6 mGy (Head) DLP = 309.0 mGy-cm. Total DLP (Head) = 1,212 mGy-cm. COMPARISON: Head CT ___ FINDINGS: There is no evidence of acute large territorial infarction,hemorrhage,edema,or mass effect. There is prominence of the ventricles and sulci suggestive of involutional changes. Periventricular and subcortical white matter hypodensities are re-demonstrated, likely the sequela of chronic small vessel ischemic disease. Intracranial atherosclerotic calcifications are again noted. There is a large right frontal and periorbital hematoma measuring roughly 5 cm in craniocaudal dimension. No underlying fracture is present. Globes are intact. No retrobulbar hematoma. The visualized portion of the paranasal sinuses are clear aside from minimal mucosal thickening involving the right maxillary sinus. The mastoid air cells and middle ear cavities are clear. A single partial left maxillary tooth demonstrates mild periapical lucency. IMPRESSION: 1. Large right frontal and periorbital hematoma without underlying fracture. Globes intact without retrobulbar hematoma. 2. No acute intracranial abnormality including no intracranial hemorrhage or mass effect.
10108435-RR-307
10,108,435
27,447,491
RR
307
2193-03-23 11:04:00
2193-03-23 11:36:00
EXAMINATION: CT C-SPINE W/O CONTRAST Q311 CT SPINE INDICATION: History: ___ with neck pain after fall// ?fracture ?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 5.6 s, 22.0 cm; CTDIvol = 22.7 mGy (Body) DLP = 499.6 mGy-cm. Total DLP (Body) = 500 mGy-cm. COMPARISON: CT cervical spine without contrast dated ___ FINDINGS: Alignment is normal. No fractures are identified.Mild degenerative changes including intervertebral disc space narrowing, minimal endplate spurring, and uncovertebral joint hypertrophy are noted, without significant spinal canal narrowing. Up to mild, multilevel, bilateral neural foraminal narrowing is noted, worse at C3-4. There is no prevertebral soft tissue swelling. There is no evidence of infection or neoplasm. Thyroid is normal. Lung apices are clear. Expansile lucency in the right posterior second rib may reflect fibrous dysplasia. IMPRESSION: No acute fracture or subluxation.
10108435-RR-308
10,108,435
27,447,491
RR
308
2193-03-23 11:06:00
2193-03-23 11:57:00
EXAMINATION: CT ABDOMEN AND PELVIS WITHOUT CONTRAST INDICATION: ___ man status post fall. Please evaluate for it intra-abdominal or intrapelvic trauma. TECHNIQUE: Multidetector CT images of the abdomen and pelvis were acquired without intravenous contrast. Non-contrast scan has several limitations in detecting vascular and parenchymal organ abnormalities, including tumor detection. Oral contrast was not administered. Coronal and sagittal reformations were performed and reviewed on PACS. DOSE: Acquisition sequence: 1) Spiral Acquisition 6.5 s, 51.1 cm; CTDIvol = 23.7 mGy (Body) DLP = 1,211.2 mGy-cm. Total DLP (Body) = 1,211 mGy-cm. COMPARISON: CT abdomen and pelvis with contrast dated ___, ___ FINDINGS: LOWER CHEST: The lung bases demonstrate bibasilar atelectasis. There is no pericardial effusion. Apical myocardial calcifications are most likely the sequela of prior infarct. ABDOMEN: HEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. There is no evidence of focal lesions within the limitations of an unenhanced scan. There is no evidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder is within normal limits. PANCREAS: The pancreas is atrophic. No focal lesion is identified. There is no pancreatic ductal dilatation. There is no peripancreatic stranding. SPLEEN: The spleen is stably enlarged, measuring up to 15.5 cm in the AP dimension, similar to the prior examination. ADRENALS: The right and left adrenal glands are normal in size and shape. URINARY: The kidneys are of normal and symmetric size. Previously seen subcentimeter hypodensities are not well demonstrated on the current study. Right renal cortical hyperdensity may represent subtle calcification. There is no hydronephrosis. There is no nephrolithiasis. There is no perinephric abnormality. GASTROINTESTINAL: Surgical clips in the gastric fundus are unchanged. There is no evidence of small or large bowel obstruction. A moderate amount of stool is seen within the colon. The appendix is not visualized. PELVIS: The urinary bladder and distal ureters are unremarkable. There is no free fluid in the pelvis. REPRODUCTIVE ORGANS: The prostate appears unremarkable. LYMPH NODES: A number of enlarged retroperitoneal, right pelvic and inguinal lymph nodes are re-demonstrated, similar to the current examination, but more prominent than on more remote priors. For example, a right external iliac node (2:149) measures up to 1.7 cm in short axis. Another bulky right pelvic sidewall lymph node measures up to 1.9 cm in short axis (2:144), previously 1.8 cm. An enlarged aortocaval lymph node (2:67) measures 1.6 cm in short axis previously 1.6 cm as well. VASCULAR: Extensive body wall collateral vessels are noted, the sequela of known occluded IVC. There is no abdominal aortic aneurysm. IVC filter is in place. Moderate atherosclerotic disease is noted. BONES: Re-demonstrated is chronic, unchanged compression deformity of the L1 vertebral body, with similar retropulsion. Anterior wedging of the L3 vertebral body is also similar to the prior examination. SOFT TISSUES: A small fat containing umbilical hernia is noted. IMPRESSION: 1. No acute sequela of trauma. No retroperitoneal hematoma. 2. Retroperitoneal and right pelvic and inguinal lymphadenopathy is similar since the most recent examination, but more prominent than on remote priors. 3. Extensive body wall collateral vessels, the sequela of known IVC occlusion, with IVC filter in place. 4. Stable splenomegaly. 5. Chronic compression fracture of the L1 vertebral body with similar retropulsion.
10108435-RR-309
10,108,435
27,447,491
RR
309
2193-03-25 15:51:00
2193-03-25 17:57:00
EXAMINATION: KNEE (AP, LAT AND OBLIQUE) RIGHT INDICATION: Mr. ___ is a ___ male with history of opioid ependence/chronic pain on methadone, AF on Coumadin, CAD s/p PCI, diastolic heart failure, COPD on 2L chronically, DVT/PE and recurrent falls who presented to the ED with right eye pain and swelling following fall// Assess right knee for fracture after fall. Assess right knee for fracture after fall. TECHNIQUE: Frontal, lateral, and sunrise view radiographs of the right knee. COMPARISON: CTA lower extremity runoff ___. FINDINGS: No fracture or dislocation is seen. There is mild narrowing of the medial compartment joint space. There is mild patellar degenerative spurring. There is a small joint effusion without layering levels. There is normal osseous mineralization. A serpiginous right rim circumscribed sclerotic lesion in the distal femur measuring 19 mm appears unchanged compared the prior CT examination and likely represents an area of bone infarct. IMPRESSION: No fracture or dislocation. Small joint effusion. Mild degenerative changes. Probable distal femoral bone infarct, unchanged.
10108435-RR-312
10,108,435
23,333,218
RR
312
2193-04-08 14:40:00
2193-04-08 14:54:00
EXAMINATION: CHEST (PA AND LAT) INDICATION: ___ w/ PMH of CAD s/p STEMI, HFpEF (EF 50-55%), recurrent VTE c/bchronic venous stasis ulcers, opioid dependence on methadone, CADs/p stents, Diastolic Heart Failure, COPD who presented forworsening bilateral leg pain, febrile on arrival to floor concern for pneumonia// concern for pneumonia, previous CXR portable IMPRESSION: In comparison with the study of ___, in comparison with study ___, there again is substantial enlargement of the cardiac silhouette. The pulmonary vascular congestion has decreased. No evidence of pleural effusion. Electronic device is again projected over the left mid chest wall. Specifically, no evidence of acute focal pneumonia. However, the retrocardiac area is not well seen so that, in the absence of a lateral view, it would be difficult to unequivocally exclude superimposed aspiration/pneumonia in the appropriate clinical setting.
10108435-RR-313
10,108,435
23,333,218
RR
313
2193-04-08 21:32:00
2193-04-09 10:31:00
EXAMINATION: CT ABDOMEN AND PELVIS WITHOUT CONTRAST. INDICATION: ___ w/ PMH of CAD s/p STEMI, HFpEF (EF 50-55%), recurrent VTE c/b chronic venous stasis ulcers, opioid dependence on methadone, PE on Coumadin, COPD, now with abdominal pain, fevers, decreased PO intake, evaluate for intra-abdominal infection vs obstruction, as well as pneumonia; please perform with oral but NOT IV contrast (given ___ TECHNIQUE: Multidetector CT images of the abdomen and pelvis were acquired without intravenous contrast. Non-contrast scan has several limitations in detecting vascular and parenchymal organ abnormalities, including tumor detection. Oral contrast was not administered. Coronal and sagittal reformations were performed and reviewed on PACS. DOSE: Acquisition sequence: 1) Spiral Acquisition 5.0 s, 79.7 cm; CTDIvol = 19.3 mGy (Body) DLP = 1,538.2 mGy-cm. Total DLP (Body) = 1,538 mGy-cm. COMPARISON: CT abdomen and pelvis ___ FINDINGS: LOWER CHEST: Please refer to separate report of CT chest performed on the same day for description of the thoracic findings. ABDOMEN: HEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. There is no evidence of focal lesions within the limitations of an unenhanced scan. There is no evidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder is within normal limits. PANCREAS: The pancreas demonstrates severe fatty atrophy. No focal lesion is identified. SPLEEN: The spleen is stably enlarged measuring 15.0 cm. ADRENALS: The right and left adrenal glands are normal in size and shape. URINARY: The kidneys are of normal and symmetric size. There is no evidence of focal renal lesions within the limitations of an unenhanced scan. There is no hydronephrosis. There is no nephrolithiasis. There is no perinephric abnormality. GASTROINTESTINAL: Surgical clips are noted in the gastric fundus. The there is a small hiatal hernia. There is no small bowel obstruction or small bowel wall thickening. The colon is normal in caliber without wall thickening. The appendix is not visualized but there are no secondary signs of appendicitis in the right lower quadrant. There is trace intra-abdominal free fluid. PELVIS: The urinary bladder and distal ureters are unremarkable. There is no free fluid in the pelvis. REPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable. LYMPH NODES: There are numerous retroperitoneal lymph nodes and pelvic sidewall lymph nodes which demonstrate short-term stability but have increased from more remote priors. Examples of enlarged lymph nodes include a 14 mm aortocaval lymph node (Series 2, image 78) and a right external iliac lymph node measuring 19 mm (series 2, image 118). There is no mesenteric adenopathy. VASCULAR: There is no abdominal aortic aneurysm. Moderate to severe atherosclerotic disease is noted. An IVC filter is in place with a dimunitive IVC noted. BONES: There is a severe chronic compression fracture of L1. There is mild compression deformity of the L3 vertebral body. There are no suspicious bony lesions. SOFT TISSUES: There are extensive abdominal wall collateral vessels. IMPRESSION: 1. No acute intra-abdominal or pelvic process. 2. Enlarged retroperitoneal and pelvic sidewall lymphadenopathy which demonstrates shorts term stability, but have increased in size from more remote prior examinations. 3. Extensive abdominal wall varicosities. 4. Splenomegaly.
10108435-RR-314
10,108,435
23,333,218
RR
314
2193-04-08 21:34:00
2193-04-09 10:33:00
EXAMINATION: CT CHEST W/O CONTRAST INDICATION: Abdominal pain, fevers, and decreased PO intake, evaluate for source of an infection. TECHNIQUE: MDCT axial images were obtained through the chest without intravenous contrast. Coronal and sagittal reformatted images were acquired. DOSE: Acquisition sequence: 1) Spiral Acquisition 5.0 s, 79.7 cm; CTDIvol = 19.3 mGy (Body) DLP = 1,538.2 mGy-cm. Total DLP (Body) = 1,538 mGy-cm. ** Note: This radiation dose report was copied from CLIP ___ (CT ABD AND PELVIS W/O CONTRAST) COMPARISON: Chest CTA ___ FINDINGS: The thyroid is normal. There is no axillary or supraclavicular adenopathy. There is no mediastinal adenopathy. Heart size is enlarged. There is a small pericardial effusion. Low density of the blood pool suggests underlying anemia. There are severe coronary artery calcifications. The main pulmonary trunk is dilated measuring 3.9 cm. There is no thoracic aortic aneurysm. There is moderate atherosclerotic disease. The airways are patent to the segmental level however evaluation for subsegmental airways is limited by severe respiratory motion. Respiratory motion also limits evaluation of the lung parenchyma. There is no pleural effusion or pneumothorax. There is linear right middle lobe opacity, consistent with plate-like atelectasis. There is also mild bibasilar atelectasis. The thoracic esophagus is mildly thickened in its superior aspect. Please see dedicated same-day abdominal CT for subdiaphragmatic details. Superficial soft tissues are notable for extensive body wall collateral vessels. There is no suspicious bony lesion. There are multilevel degenerative changes. Note is made of gynecomastia. Cardiac monitoring device noted in the left chest wall. IMPRESSION: 1. Limited examination secondary to respiratory motion. Within these limitations, no acute thoracic process identified. 2. Enlarged main pulmonary trunk suggesting underlying pulmonary hypertension. 3. CT findings of anemia.
10108435-RR-315
10,108,435
23,333,218
RR
315
2193-04-10 15:01:00
2193-04-10 17:05:00
EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN) INDICATION: ___ w/ PMH of CAD s/p STEMI, HFpEF (EF 50-55%), recurrent VTE c/b chronic venous stasis ulcers, opioid dependence on methadone, PE on Coumadin, COPD who presented for worsening bilateral leg pain now febrile with unclear source. Eval for GB pathology, ductal dilation. TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were obtained. COMPARISON: CT abdomen pelvis of ___. FINDINGS: Images were limited due to patient's right lateral decubitus position and inability to move for optimal positioning. LIVER: Imaged portion of 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 CHD measures 4 mm. GALLBLADDER: There is no evidence of stones or gallbladder wall thickening. PANCREAS: The pancreas is not well visualized, largely obscured by overlying bowel gas. SPLEEN: Normal echogenicity, measuring 15.1 cm. KIDNEYS: Limited views of the right kidney show no hydronephrosis. RETROPERITONEUM: The visualized portions of aorta and IVC are within normal limits. IMPRESSION: 1. Images were limited due to the patient's right lateral decubitus position and inability to move for better acoustic windows. Within this limitation, no evidence of gallstones or gallbladder distention. 2. No intrahepatic or extrahepatic biliary dilatation. 3. Splenomegaly measuring up to 15.1 cm.
10108435-RR-316
10,108,435
23,333,218
RR
316
2193-04-11 15:52:00
2193-04-11 17:56:00
EXAMINATION: CHEST (PORTABLE AP) INDICATION: ___ year old man with ___ w/ PMH of CAD s/p STEMI, HFpEF (EF 50-55%), recurrent VTE c/b chronic venous stasis ulcers, opioid dependence on methadone, PE on Coumadin, COPD with increasing oxygen requirement // eval for pneumonia eval for pneumonia IMPRESSION: Compared to chest radiographs since ___ most recently ___. Severe consolidation right mid and lower lung has worsened substantially since ___ probably pneumonia. Hemorrhage is not excluded. Mild cardiomegaly stable. No definite left lung abnormality. No pneumothorax or pleural effusion. NOTIFICATION: The findings were discussed with ___ , M.D. by ___ ___, M.D. on the telephone on ___ at 5:53 pm, 2 minutes after discovery of the findings.
10108435-RR-317
10,108,435
23,333,218
RR
317
2193-04-17 10:18:00
2193-04-17 11:43:00
EXAMINATION: CHEST (PORTABLE AP) INDICATION: ___ yoM with known PNA s/p treatment, CHF and COPD with acute new O2 requirement. please assess for interval change // ___ yoM with known PNA s/p treatment, CHF and COPD with acute new O2 requirement. please assess for interval change ___ yoM with known PNA s/p treatment, CHF and COPD with acute new O2 requirement. please assess for interval change IMPRESSION: Compared to chest radiographs ___ through ___. Previous severe right lower lobe pneumonia has improved, if not cleared. A much less severe abnormality, predominantly linear, persists at the right base and has developed on the left. This is more likely edema due to cardiac decompensation. Mild cardiomegaly stable. No appreciable pleural effusion.
10108435-RR-318
10,108,435
27,067,429
RR
318
2193-05-16 14:09:00
2193-05-16 14:45:00
EXAMINATION: BILAT LOWER EXT VEINS INDICATION: ___ year old man with recurrent VTE c/b chronic venous stasis ulcers, noncompliance with Coumadin, with worsening B/L leg pain// increase in clot burden TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed on the bilateral lower extremity veins. COMPARISON: ___. 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. Once again seen is an AV fistula involving the right common femoral vein an influence seeing the venous waveforms more distally in the leg. The AV fistula makes compression of the right common femoral vein more difficult but the vein does compress and flow is wall to wall. There is normal respiratory variation in the common femoral veins bilaterally. Moderate edematous changes are seen in both lower extremities. IMPRESSION: No evidence of deep venous thrombosis in the right or left lower extremity veins. Right common femoral AV fistula again noted.
10108435-RR-322
10,108,435
29,537,226
RR
322
2193-09-25 17:14:00
2193-09-25 18:45:00
INDICATION: ___ year old man with sudden onset hypoxia, cough// please assess for acute process TECHNIQUE: Portable chest x-ray COMPARISON: Portable chest x-ray ___ FINDINGS: Minimal atelectatic changes are seen at the lung bases. The heart is enlarged, similar to previous. There are no large pleural effusions. The aorta is atherosclerotic and tortuous. There may be mild pulmonary venous congestion versus patient positioning. The bones are diffusely osteopenic. Degenerative changes are seen at the left glenohumeral joint. Clips are noted in the left upper quadrant. IMPRESSION: As above
10108435-RR-323
10,108,435
29,537,226
RR
323
2193-09-26 05:01:00
2193-09-26 08:11:00
INDICATION: ___ M with acute mixed hypoxemic and hypercarbic respiratory distress.// aspiration event? pulmonary edema? TECHNIQUE: Chest AP COMPARISON: ___ IMPRESSION: Lungs are low volume with bibasilar atelectasis. Cardiomediastinal silhouette is stable. A recorder device projects over the left mid chest, unchanged. There is bibasilar atelectasis. Atherosclerotic calcification is seen involving the aorta. There is no pleural effusion. No pneumothorax is seen
10108435-RR-334
10,108,435
21,634,956
RR
334
2194-01-22 17:19:00
2194-01-22 17:50:00
EXAMINATION: CHEST (AP AND LAT) INDICATION: History: ___ with complex PMH and several recent admissions, including one c/b CAP PNA, presenting w chest pain and SOB in setting of several days w/o home medications, also decently hypertensive// evidence of PNA? TECHNIQUE: Upright AP and lateral views of the chest COMPARISON: Chest radiograph ___ FINDINGS: Mild cardiomegaly is re-demonstrated. Left-sided cardiac loop recorder is re-demonstrated. Mediastinal and hilar contours are unchanged with similar tortuosity of the thoracic aorta. Lungs are hyperinflated. Mild interstitial pulmonary edema is present. No pleural effusion or pneumothorax. No acute osseous abnormalities. Mild loss of height is seen within a mid thoracic vertebral body. IMPRESSION: Mild interstitial pulmonary edema.
10108435-RR-335
10,108,435
21,634,956
RR
335
2194-01-22 17:34:00
2194-01-22 18:37:00
EXAMINATION: UNILAT LOWER EXT VEINS RIGHT INDICATION: ___ year old man with profound venous stasis, hx of "60" DVTs, on Coumadin, w R>L leg swelling, chest pain. Evaluate for evidence of DVT. TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed on the right lower extremity veins. COMPARISON: Limited ultrasound from ___. FINDINGS: Similar to the study from ___ there is demonstration of an AV fistula involving the right common femoral vein, with arterialized waveform and elevated velocity, largely unchanged. Otherwise, there is normal compressibility, flow, and augmentation of the right common femoral, femoral, and popliteal veins. Normal color flow and compressibility are demonstrated in the posterior tibial and peroneal veins. There is normal respiratory variation in the common femoral veins bilaterally. No evidence of medial popliteal fossa (___) cyst. IMPRESSION: 1. No evidence of deep venous thrombosis in the right lower extremity veins. 2. Right common femoral arteriovenous fistula, similar to prior.
10108435-RR-336
10,108,435
21,634,956
RR
336
2194-01-22 18:06:00
2194-01-22 19:23:00
EXAMINATION: CTA CHEST WITH CONTRAST INDICATION: ___ year old man with sudden onset chest pain at rest and increased O2 requirements, profound ___ venous stasis, hx of DVTs, on warfarin, coming to ED w chest pain. Also notes recent episodes of hemoptysis (?malignancy). Evaluate for PE, mass that could be causing hemoptysis. 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 3.5 s, 0.5 cm; CTDIvol = 21.3 mGy (Body) DLP = 10.6 mGy-cm. 2) Spiral Acquisition 4.1 s, 32.1 cm; CTDIvol = 13.8 mGy (Body) DLP = 443.3 mGy-cm. Total DLP (Body) = 454 mGy-cm. COMPARISON: Chest CTs from ___, and ___. FINDINGS: HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the subsegmental level without filling defect to indicate a pulmonary embolus. Thoracic aorta is normal in caliber for age without evidence of dissection or intramural hematoma. The heart is moderately enlarged. Mild scattered atherosclerotic calcifications are present in the aorta. Chronic infarct of the left ventricle apex with associated aneurysm, mural calcification, and adjacent mural thrombus is re-demonstrated. Coronary artery calcifications are re-demonstrated. The main pulmonary artery measures 3.8 cm, similar to the previous study, and may reflect pulmonary arterial hypertension. Otherwise, the pericardium and great vessels are within normal limits. Small amount of pericardial fluid is seen within the superior pericardial recess, unchanged. AXILLA, HILA, AND MEDIASTINUM: Again seen is subcarinal and right hilar lymphadenopathy, similar in appearance to the study of ___. There is no axillary or subclavicular lymphadenopathy. PLEURAL SPACES: No pleural effusion or pneumothorax. LUNGS/AIRWAYS: There is mild bilateral peribronchial thickening, most notable at the bases. Otherwise, lungs are clear without masses or areas of parenchymal opacification. 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. Clips are noted within the fundus of the stomach. BONES/SOFT TISSUES: No suspicious osseous abnormality is seen.? There is no acute fracture. Extensive venous collaterals are seen along the chest wall bilaterally, largely unchanged from the previous study, related to chronic IVC occlusion. Bilateral gynecomastia is again noted. Loop recorder device is noted in the left chest wall anteriorly. IMPRESSION: 1. No evidence of pulmonary embolism or acute aortic abnormality. 2. Mild peribronchial thickening suggestive of chronic airways disease. No focal consolidation. 3. Unchanged dilatation of the main pulmonary artery which could suggest underlying pulmonary arterial hypertension. 4. Similar right hilar and mediastinal lymphadenopathy. 5. Redemonstration of chronic left ventricular apical infarct with associated aneurysm and thrombus.
10108435-RR-342
10,108,435
20,850,610
RR
342
2194-08-22 10:23:00
2194-08-22 13:25:00
EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD INDICATION: History: ___ with multiple falls on Coumadin. History of CHF// CT head: ?bleed, CT neck: ?fracture, CT torso: occult trauma TECHNIQUE: Contiguous axial images of the brain were obtained without contrast. Coronal and sagittal reformations as well as bone algorithm reconstructions were provided and reviewed. DOSE: Acquisition sequence: 1) Sequenced Acquisition 18.0 s, 18.4 cm; CTDIvol = 49.0 mGy (Head) DLP = 903.1 mGy-cm. 2) Sequenced Acquisition 4.0 s, 4.1 cm; CTDIvol = 49.0 mGy (Head) DLP = 200.7 mGy-cm. Total DLP (Head) = 1,104 mGy-cm. COMPARISON: Head CT from ___ FINDINGS: There is no evidence of acute infarction,hemorrhage,edema, or mass effect. There is prominence of the ventricles and sulci suggestive of involutional changes. Mild periventricular and subcortical white matter hypodensities are nonspecific, per likely due to chronic small vessel ischemic disease in this age group. There is no evidence of acute fracture. Postsurgical changes are noted from left parietal craniotomy. The visualized portion of the paranasal sinuses, mastoid air cells, and middle ear cavities are clear. Soft tissue density in the left external auditory canal is nonspecific, though likely cerumen. IMPRESSION: No acute intracranial abnormalities on the noncontrast head CT.
10108435-RR-343
10,108,435
20,850,610
RR
343
2194-08-22 10:24:00
2194-08-22 13:22:00
EXAMINATION: CT C-SPINE W/O CONTRAST Q311 CT SPINE INDICATION: History: ___ with multiple falls on Coumadin. History of CHF// CT head: ?bleed, CT neck: ?fracture, CT torso: occult trauma CT head: ?bleed, CT neck: ?fracture, CT torso: occult trauma TECHNIQUE: Non-contrast helical multidetector CT was performed. Soft tissue and bone algorithm images were generated. Coronal and sagittal reformations were then constructed. DOSE: Acquisition sequence: 1) Spiral Acquisition 5.5 s, 21.8 cm; CTDIvol = 22.7 mGy (Body) DLP = 494.1 mGy-cm. Total DLP (Body) = 494 mGy-cm. COMPARISON: CT from ___ FINDINGS: No traumatic malalignment is seen. No acute fracture is identified. Degenerative changes of the cervical spine is mild. No severe neuroforaminal or spinal canal narrowing is seen. There is no prevertebral soft tissue swelling. The included lung apices are clear aside from persistent septal thickening as seen on prior exam. The thyroid gland is unremarkable. Expansile lucent lesion in the right second rib is unchanged. IMPRESSION: No traumatic malalignment or acute fracture.
10108435-RR-344
10,108,435
20,850,610
RR
344
2194-08-22 10:30:00
2194-08-22 14:01:00
EXAMINATION: CT torso without contrast INDICATION: History: ___ with multiple falls on Coumadin. History of CHF// CT head: ?bleed, CT neck: ?fracture, CT torso: occult trauma TECHNIQUE: Contiguous axial images were obtained through the chest, abdomen and pelvis without intravenous contrast. Coronal and sagittal reformats were performed. DOSE: Acquisition sequence: 1) Spiral Acquisition 9.6 s, 75.8 cm; CTDIvol = 21.9 mGy (Body) DLP = 1,656.7 mGy-cm. Total DLP (Body) = 1,657 mGy-cm. COMPARISON: CT from ___ and ___ FINDINGS: CHEST: HEART AND VASCULATURE: The thoracic aorta is normal in caliber without evidence of acute injury based on an unenhanced scan. Trace pericardial effusion is seen, unchanged from prior exam. Coronary artery calcifications are severe. The heart is moderately enlarged, not significantly changed from prior exam. Calcification of the left ventricular apex is re-demonstrated. AXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy is present. Scattered mediastinal lymph nodes are stably enlarged, measuring up to 1.0 cm. No mediastinal hematoma. PLEURAL SPACES: No pleural effusion or pneumothorax. LUNGS/AIRWAYS: Scattered areas of septal thickening with ground-glass opacities in the right middle lobe likely represents mild pulmonary edema. There is mild bibasilar atelectasis. 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. CHEST WALL: Innumerable varices are noted, anastomosing into the bilateral subclavian veins. Heart monitoring device is noted in the left chest wall. Moderate symmetric gynecomastia is seen. ABDOMEN: HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There is no evidence of focal lesion or laceration within the limitation of an unenhanced scan.There is no perihepatic free fluid. 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 lesion or laceration within the limitation of an unenhanced scan. ADRENALS: The right and left adrenal glands are normal in size and shape. URINARY: The kidneys are of normal and symmetric size. As previously, there are scattered subcentimeter hyperdensities, presumably hemorrhagic cysts. Otherwise, the overall contour of the kidneys are stable compared to ___. There is no perinephric abnormality. GASTROINTESTINAL: The stomach is unremarkable and contains clips. Small bowel loops demonstrate normal caliber. The colon and rectum are within normal limits. The appendix is not visualized. There is no evidence of mesenteric injury. There is no free fluid or free air in the abdomen. PELVIS: The urinary bladder and distal ureters are unremarkable. Subtle hypodensity lining the inner wall of the urinary bladder in nondependent portion is nonspecific. There is no free fluid in the pelvis. REPRODUCTIVE ORGANS: The prostate and seminal vesicles are unremarkable. LYMPH NODES: Scattered retroperitoneal and mesenteric lymph nodes are not pathologically enlarged, though notable for their number. There is no pelvic or inguinal lymphadenopathy. VASCULAR: There is no abdominal aortic aneurysm or retroperitoneal hematoma. Extensive atherosclerotic disease is noted. There is an infrarenal IVC filter. There is evidence of chronic occlusion of the infrarenal IVC. Innumerable varices that are intraperitoneal and extraperitoneal within the body wall are noted, the largest arising from the femoral vessels, in anastomosing with the subclavian veins. Peripheral calcification is noted around the mildly enlarged splenic artery. BONES: There is no acute fracture. No focal suspicious osseous abnormality. Chronic deformity at L1 with 5 mm retropulsion is unchanged. Multiple anterior wedging deformities of the thoracic spine are similar to ___. Superior endplate deformity at L3 is similar to prior exam. SOFT TISSUES: Extensive varices are again noted. Mild stranding at the right thigh at the level of the greater trochanter may represent sequela of injury (601:106). No drainable hematoma is seen. IMPRESSION: 1. Subcutaneous stranding at the right upper thigh at the level of the right greater trochanter, likely related to trauma versus nonspecific subcutaneous edema. Otherwise, no evidence of acute intrathoracic or intraabdominal injury within the limitation of an unenhanced scan. 2. Extensive varices in the subcutaneous tissue, likely secondary to IVC filter thrombosis.
10109025-RR-18
10,109,025
29,389,462
RR
18
2136-12-17 15:54:00
2136-12-17 16:40:00
EXAMINATION: CHEST (PORTABLE AP) INDICATION: ___ year old woman with very large pancreatic pseudocyst and sudden onset ___ abdominal pain c/f perforation// *** UPRIGHT FILM *** ? free air ? perforation TECHNIQUE: Chest single view COMPARISON: ___ FINDINGS: No free air. Shallow inspiration. Normal heart size, pulmonary vascularity. No sizable effusion. Lungs are clear. Few mildly prominent loops of bowel in the right abdomen, no evidence of obstruction. No pneumothorax. IMPRESSION: No free air.
10109025-RR-19
10,109,025
29,389,462
RR
19
2136-12-18 05:28:00
2136-12-18 09:33:00
INDICATION: ___ year old woman with pancreatic pseudocyst, severe abdominal and back pain. Now tachycardia and hypoxic.// any evidence of free air? TECHNIQUE: Supine and upright abdominal radiographs were obtained. COMPARISON: CT abdomen pelvis ___. FINDINGS: There are no abnormally dilated loops of large or small bowel. There is no free intraperitoneal air. Osseous structures are unremarkable. Radiodensity projecting over the right upper quadrant consistent with known gallstones. There are no unexplained soft tissue calcifications or radiopaque foreign bodies. IMPRESSION: No evidence of free air. Nonspecific bowel gas pattern.
10109025-RR-20
10,109,025
29,389,462
RR
20
2136-12-18 18:44:00
2136-12-18 20:16:00
INDICATION: ___ year old woman with abd pain, triggering with increased HR and fever// r/o pna TECHNIQUE: AP portable chest radiograph COMPARISON: ___ FINDINGS: The tip of an enteric tube courses below the level the diaphragms but beyond the field of view of this radiograph. Low bilateral lung volumes. New left basal consolidation is concerning for atelectasis and/or pneumonia. No pleural effusion or pneumothorax is identified. The size of the cardiomediastinal silhouette is within normal limits. IMPRESSION: New left basal opacity is concerning for pneumonia.
10109025-RR-21
10,109,025
29,389,462
RR
21
2136-12-21 13:58:00
2136-12-21 14:20:00
EXAMINATION: CHEST (PA AND LAT) INDICATION: ___ year old woman with LLL infiltrate and effusion, differential for which includes aspiration pneumonia VERSUS complication/leakage from known large pancreatic pseudocyst into pleural cavity.// ? interval enlargement of pleural effusion IMPRESSION: In comparison with the study of ___, there has been some improvement in the opacification at the left base. Some of this probably represents pleural fluid and atelectasis, though in the appropriate clinical setting superimposed pneumonia could not be excluded. Calcified gallstones are seen. The
10109025-RR-22
10,109,025
29,389,462
RR
22
2136-12-21 22:07:00
2136-12-22 12:12:00
EXAMINATION: MRCP INDICATION: ___ year old woman with large pancreatic pseudocyst I/s/o gallstone pancreatitis and ERCP// ? characterize large pancreatic pseudocyst in anticipation of surgical management TECHNIQUE: T1- and T2-weighted multiplanar images of the abdomen were acquired in a 1.5 T magnet. Intravenous contrast: 8 mL Gadavist. Oral contrast: 1 cc of Gadavist mixed with 50 cc of water was administered for oral contrast. COMPARISON: CT from ___ FINDINGS: Lower Thorax: Trace right and small left effusion. There is some left base atelectasis. Cardiomediastinal structures are normal. Liver: Normal in morphology. Parenchyma is normal in signal and enhancement. No solid mass. No evidence of hepatic steatosis on the dual-echo GRE images. Biliary: There is segmental intra hepatic bile duct dilation in hepatic segment 4a. There is no evidence of cholangitis and there is no obstructing mass seen. This may be due to scarring as sequela of prior cholangitis. No additional intrahepatic biliary duct dilation. CBD is not dilated. Gallbladder wall is of normal caliber. No pericholecystic fluid. Gallbladder is contracted around numerous gallstones. No choledocholithiasis. Pancreas: Arising anteriorly from the body and tail of the pancreas there is a thick walled 13 x 13 x 10 cm fluid collection which extends into the lesser sac and abuts the posterior aspect of the stomach compressing the stomach anteriorly. The collection also extends to the left within the left anterior perirenal space. There is some debris noted at the dependent aspect of the collection. This consistent with complex walled off necrosis. There is significant mass effect on the body and tail of the pancreas noting that the distal 3 to 4 cm of the pancreatic tail are relatively not compressed. This portion of the tail shows heterogeneous enhancement. In the pancreatic head there is a 1.1 x 1.4 cm fluid collection with some debris in it, this is also consistent with walled off necrosis. Visualized pancreatic parenchyma at the head demonstrates enhancement. Spleen: Size is normal. No focal lesion. Adrenal Glands: Normal in signal and enhancement. No nodularity. Kidneys: No hydronephrosis. Bilateral mild striated nephrograms are noted. This may be due to medication causing ATN. No infarct. No perinephric abnormality. No mass. No solid mass. Gastrointestinal Tract: Normal caliber loops of small bowel and colon. Enteric tube is in place, tip is within the proximal jejunum. Stomach is compressed anteriorly by the large pancreatic collection. Lymph Nodes: No enlarged mesenteric or retroperitoneal lymph node. Vasculature: Aorta is of normal caliber. Normal branching pattern of the celiac axis. Origin of the celiac artery and superior mesenteric artery are patent. Portal veins and hepatic veins are patent. There is mass effect on the SMV at the confluence with a small amount of intraluminal thrombus at the confluence of the SMV and main portal vein. This is less conspicuous when compared to prior CT. There is mass effect on the splenic vein and its central aspect is not visualized with a collateral flow from the splenic vein to the SMV through the gastroepiploic veins consistent with splenic vein occlusion. Osseous and Soft Tissue Structures: No soft tissue mass. Normal bone marrow signal. IMPRESSION: 1. Arising anteriorly from the body and tail of the pancreas there is a multiloculated thick walled 13 x 13 x 10 cm fluid collection which extends into the lesser sac and abuts the posterior aspect of the stomach compressing the stomach anteriorly, it also extends into the left anterior pararenal space. There is some debris noted at the dependent aspect of the collection consistent with mildly complex walled off necrosis. In the pancreatic head there is a 1.1 x 1.4 cm fluid collection with some debris in it. This is also consistent with focal walled off necrosis. 2. Large pancreatic walled off necrosis exerts mass effect on the SMV at the confluence with the main portal vain with a small amount of intraluminal thrombus at the confluence which is less conspicuous when compared to prior CT. Apparent splenic vein occlusion. 3. Bilateral mild striated nephrograms are noted. This may be due to medication causing ATN. There is no infarct, perinephric abnormality, or renal mass. 4. Gallbladder is contracted around numerous gallstones. No evidence of acute cholecystitis. No choledocholithiasis.
10109025-RR-23
10,109,025
29,389,462
RR
23
2136-12-22 16:13:00
2136-12-22 16:51:00
EXAMINATION: DX CHEST PORT LINE/TUBE PLCMT 1 EXAM INDICATION: ___ year old woman with right PICC// Right 41cxm ___ ___ Contact name: ___: ___ TECHNIQUE: Single frontal view of the chest COMPARISON: ___. FINDINGS: The right PICC terminates in the right atrium. An enteric tube is extends beyond the GE junction with tip projecting over the left hemiabdomen. The heart is enlarged. Lung volumes are low. Retrocardiac opacity likely represents atelectasis, however an infectious process cannot be excluded. There is no pneumothorax. IMPRESSION: 1. The right PICC terminates in the right atrium. The recommend retraction by approximately 3.5 cm. 2. Retrocardiac opacity likely represents atelectasis, however an infectious process cannot be excluded. NOTIFICATION: The findings were discussed with ___, M.D. by ___, M.D. on the telephone on ___ at 5:07 pm, 5 minutes after discovery of the findings.
10109025-RR-24
10,109,025
29,389,462
RR
24
2136-12-22 17:49:00
2136-12-22 19:44:00
INDICATION: ___ year old woman with new PICC placement, now repositioned// ? PICC line position after being drawn back TECHNIQUE: AP portable chest radiograph COMPARISON: ___ FINDINGS: The tip of the right PICC line projects over the cavoatrial junction. An enteric tube extends below the level the diaphragms but beyond the field of view of this radiograph. Unchanged cardiopulmonary findings. No pneumothorax. IMPRESSION: The tip of the right PICC line now projects over the cavoatrial junction. No pneumothorax.
10109085-RR-105
10,109,085
28,083,201
RR
105
2187-08-28 17:27:00
2187-08-28 18:37:00
HISTORY: ___ female with fall on right leg with hip pain. COMPARISON: Scout from CT and torso dated in ___. FINDINGS: Frontal views of the pelvis with frontal and cross-table lateral views of the right hip and AP and lateral views of the distal right femur. There is a lucency through the cortex of the lateral greater trochanter compatible with an acute fracture. Extent of this fracture is uncertain, whether it is isolated to the greater trochanter or extends through the femoral neck. The bones are osteopenic. No other fractures visualized. Pubic symphysis and SI joints are unremarkable. Vascular stent projects over the right iliac region. Vascular calcifications are identified. Distally, the femur is unremarkable IMPRESSION: Lucency through the right greater trochanter worrisome for acute fracture. The extent of this fracture is uncertain, whether it is isolated to the trochanter or involves the femoral neck.
10109085-RR-106
10,109,085
28,083,201
RR
106
2187-08-28 17:33:00
2187-08-28 18:22:00
HISTORY: Status post fall with pain, here to evaluate for acute intracranial injury. COMPARISON: Non-contrast head CT dated ___. MRI of the head dated ___. TECHNIQUE: MDCT- acquired axial images were obtained through the head without intravenous contrast. Coronal and sagittal reformatted images as well as thin section axial images in a bone window algorithm were generated and reviewed. FINDINGS: There is no evidence of acute intracranial hemorrhage, diffuse edema, or shift of normally midline structures. Hypodensity in the right parietal region near the vertex with trace internal hyperdensity corresponds to the patient's known cerebral metastasis seen on prior MR of ___. Cerebellar lesions are better assessed on the prior MR. ___ periventricular ___ matter hypodensities are compatible with sequelae of mild chronic microvascular ischemic disease. The gray-white matter interface is preserved without evidence of acute major vascular territorial infarct. The ventricles and sulci are slightly prominent but normal in configuration, compatible with age related parenchymal volume loss. Vascular calcification of the bilateral carotid siphons and vertebral arteries is incidentally noted. The orbits and globes are intact. There is trace fluid in the left sphenoid sinus. The remainder of the imaged paranasal sinuses, middle ear cavities and mastoid air cells are clear bilaterally. The bony calvaria appear intact. IMPRESSION: 1. No evidence of acute intracranial process. 2. Evidence of mild chronic microvascular ischemic disease and atrophy. 3. Right parietal hypodensity corresponds to known cerebral metastasis seen on prior MR. ___ lesions are better seen by MRI.
10109085-RR-107
10,109,085
28,083,201
RR
107
2187-08-28 19:32:00
2187-08-29 00:44:00
INDICATION: Right hip pain, here to evaluate extent of trochanteric fracture. COMPARISON: Same day radiographs at the right hip performed at 17:22 p.m. CT torso dated ___. TECHNIQUE: MDCT-acquired axial images were obtained through the pelvis and right hip without intravenous contrast in soft tissue and bone window algorithms. Coronal and sagittal reformatted images were generated and reviewed. FINDINGS: CT PELVIS: There is diffuse atherosclerotic disease at the iliac vessels bilaterally. The right external iliac artery contains a stent. There is severe atherosclerosis at the left common iliac artery with proximal ectasia measuring 1.6 x 1.4 cm (2:12). The urinary bladder, prostate, seminal vesicles and rectum are within normal limits. Diffuse diverticulosis is seen in the sigmoid colon and distal descending colon. Trace mesenteric fluid is seen along the left paracolic gutter. No free pelvic fluid or inguinal/pelvic lymphadenopathy is detected. OSSEOUS STRUCTURES AND SOFT TISSUES: A small fat-containing right inguinal hernia is incidentally noted. There is no soft tissue hematoma. There is an acute fracture of the right greater trochanter without significant distraction of the fracture fragment. There is no extension of the fracture line into the femoral neck. No additional fracture is detected. There is evidence of mild degenerative change in the right femoroacetabular joint with joint space narrowing, endplate sclerosis and peripheral osteophyte formation. Irregularity of the pubic symphysis is likely degenerative. There is no pubic symphysis diastasis or widening of either sacroiliac joint. Facet joint arthropathy is noted in the imaged lower lumbar spine. IMPRESSION: 1. Acute fracture of the right greater trochanter without significant distraction of the fracture fragment. No fracture involvement of the femoral neck. 2. Colonic diverticulosis without evidence of diverticulitis. 3. Severe atherosclerotic disease with left common iliac artery ectasia measuring 1.6 cm.
10109085-RR-108
10,109,085
28,083,201
RR
108
2187-08-30 23:45:00
2187-08-31 12:25:00
CHEST RADIOGRAPH INDICATION: Evaluation for pulmonary edema or pneumonia. COMPARISON: ___. FINDINGS: As compared to the previous radiograph, there is no relevant change. Elevation of the right hemidiaphragm, caused by slightly distended right bowel loops. Atelectasis at the right lung bases and mild parenchymal opacities in the lateral parts of the right upper lobe base. These have not substantially changed as compared to the prior image. Moderate cardiomegaly with moderate tortuosity of the thoracic aorta. No pleural effusions.
10109398-RR-10
10,109,398
23,860,604
RR
10
2112-06-06 03:59:00
2112-06-06 05:20:00
INDICATION: Right lower extremity swelling. COMPARISON: None available. FINDINGS: There is normal phasicity in the common femoral veins bilaterally. There is normal compression, augmentation and flow in the common femoral, superficial femoral, and popliteal veins of the right leg. Calf veins are not well visualized. IMPRESSION: No evidence of DVT in the right leg. Calf veins not well visualized.
10109398-RR-11
10,109,398
23,860,604
RR
11
2112-06-06 06:25:00
2112-06-06 06:52:00
INDICATION: Lower extremity infection, plan the OR, evaluate for cardiopulmonary process. COMPARISON: None available. FINDINGS: PA and lateral views of the chest. There are low lung volumes, which crowd the pulmonary vasculature. There is elevation of the right hemidiaphragm. There is moderate cardiomegaly. Given the significant overlying soft tissue, low lung volumes are difficult to assess for subtle consolidation; however, no definite consolidation is identified. No pleural effusion or pneumothorax. IMPRESSION: Moderate cardiomegaly. Limited study but no definite acute cardiopulmonary process.
10109398-RR-12
10,109,398
23,860,604
RR
12
2112-06-08 13:36:00
2112-06-09 20:24:00
HISTORY: This patient is a ___ man with severe diabetic foot infection and who previously underwent open amputations of the second through fourth toes on the left foot. Arterial Doppler and pulse volume recordings were performed of both lower extremities. This Doppler waveforms were triphasic throughout all levels. Ankle-brachial indices were 1.54/1.46 suggesting arterial calcification. Pulse volume recordings demonstrated normal pulsatility at all levels. IMPRESSION: Normal resting arterial study without evidence of occlusive disease.
10109398-RR-9
10,109,398
23,860,604
RR
9
2112-06-06 03:45:00
2112-06-06 05:16:00
INDICATION: Lower extremity redness and pain with necrotic tissue, question of free air on outside plain film, evaluate for air within the soft tissues. COMPARISON: None available. TECHNIQUE: MDCT images were obtained through the right lower extremity from the knee to the toes without contrast. Coronal and sagittal reformations were performed. Bone algorithm was obtained. FINDINGS: Confluent foci of air seen in the forefoot and mid foot. More locules of air are seen tracking along the extensor digitorum longus tendon up to the level of the ankle. There is soft tissue and subcutaneous stranding seen throughout the right lower leg up to the level of the knee. There is a trace joint effusion in the right knee. No fracture is identified. There is no evidence of bony destruction. The majority of the air within the soft tissues is surrounding the second, third and fourth digits. There are atherosclerotic calcifications seen of the posterior tibial, peroneal and anterior tibial arteries. There is a small radio-opaque foreign body within the soft tissues of the forefoot. IMPRESSION: 1. Air is seen within the soft tissues of the forefoot and mid foot and tracking along the extensor digitorum longus tendon up to the level of the ankle. 2. Significant soft tissue swelling from the toes to the knee. 3. Small radio-opaque foreign body within the soft tissues of the forefoot. These findings were discussed with Dr. ___ by Dr. ___ at 4:15 a.m. on ___ by telephone at time of discovery.
10109413-RR-20
10,109,413
28,210,277
RR
20
2189-06-05 10:06:00
2189-06-05 10:58:00
HISTORY: Back pain, to assess for fracture. FINDINGS: There is minimal scoliosis of the thoracic spine convex to the right and centered at approximately T6. Minimal hypertrophic spurring is seen at several levels. However, the intervertebral disc spaces are quite well maintained. Specifically, no evidence of compression fracture.
10109413-RR-21
10,109,413
28,210,277
RR
21
2189-06-05 10:06:00
2189-06-05 10:48:00
HISTORY: ___ female with back pain radiating to the chest. COMPARISON: None available. PA AND LATERAL CHEST RADIOGRAPH: Lungs are clear without confluent consolidation. There is no pulmonary edema or pleural effusions. Cardiomediastinal and hilar contours are within normal limits. The thoracic aorta follows a tortuous course, though is non-aneurysmal. IMPRESSION: No acute cardiopulmonary process If there is clinical concern for vascular pathology (aorta) as a cause of the patient's pain, recommend CTA of the chest for further assessment.
10109413-RR-22
10,109,413
28,210,277
RR
22
2189-06-05 13:26:00
2189-06-05 17:50:00
CT ABDOMEN AND PELVIS WITH CONTRAST INDICATION: ___ female with left lower quadrant pain. Evaluate for diverticular disease. COMPARISON: None. TECHNIQUE: Multiple axial CT images were obtained through the abdomen and pelvis following the administration of 130 cc of Omnipaque 350 IV contrast. Sagittal and coronal reconstructions were obtained. No adverse contrast reactions were reported. TOTAL DOSE: 713.16 mGy-cm. FINDINGS: No pulmonary nodule, mass, or confluent consolidation in the visible lung bases. Heart size is normal without pericardial effusion. No pleural effusions. ABDOMEN: The liver, spleen, pancreas, kidneys, and adrenal glands demonstrate homogeneous enhancement without focal lesions. Gallbladder is well distended without stones. No intrahepatic or extrahepatic biliary ductal dilatation. Normal caliber common bile duct tapers smoothly to the ampulla. There is a small hiatal hernia. Enteric contrast reaches the level of the proximal transverse colon. The colon is stool filled. Scattered colonic diverticulosis without diverticulitis. Normal caliber bowel loops. No mesenteric or retroperitoneal lymphadenopathy. Abdominal aorta is normal caliber without aneurysmal dilatation or dissection. Atherosclerosis of the abdominal aorta just proximal to the bifurcation with mild atherosclerosis of the distal branches. PELVIS: The urinary bladder is markedly distended without wall thickening. Status post hysterectomy. Neither ovary is visualized. No pelvic lymphadenopathy, mass, or fluid collection. No hydronephrosis or hydroureter. Bilateral ureteral jets are present. BONES AND SKELETAL SOFT TISSUES: No acute fracture or destructive osseous process. Mild multilevel degenerative disc disease. There is a tiny fat-containing umbilical hernia. The remaining soft tissues are normal. IMPRESSION: 1. Normal caliber bowel loops with scattered colonic diverticulosis without diverticulitis. Stool filled colon. 2. Markedly distended urinary bladder without wall thickening. 3. Status post hysterectomy. Neither ovary is visualized.
10109413-RR-23
10,109,413
28,210,277
RR
23
2189-06-08 16:53:00
2189-06-09 09:17:00
HISTORY: Urinary retention and thoracic back pain, with history of "failure to thrive." COMPARISON: Radiographs from ___, and CT from ___. TECHNIQUE: Multiplanar MR images were acquired through the thoracic spine including sequences acquired prior to and following the uneventful intravenous administration of gadolinium based contrast. FINDINGS: Images are partially degraded by patient motion. Note is again made of minimal dextroscoliosis, apex at T6. The vertebral body height and alignment are normal. Bone marrow signal reveals no concerning focal abnormality. There is no space-occupying mass or abnormal focus of enhancement. There is no severe spinal canal narrowing. The spinal cord is normal in signal intensity. The conus medullaris terminates posterior to the L1 vertebral body. A small disc bulge at C7-T1 minimally narrows the spinal canal, though does not deform the spinal cord. The thyroid gland appears diffusely enlarged, without focal nodularity. IMPRESSION: 1. No space-occupying mass, abnormal focus of enhancement or significant spinal canal narrowing. 2. Apparent diffuse enlargement of the thyroid gland; correlate with clinical and laboratory data.
10109413-RR-24
10,109,413
28,210,277
RR
24
2189-06-09 14:06:00
2189-06-09 18:18:00
INDICATION: History of nausea, vomiting, dysphagia, weight loss, back pain. Evaluate for dysphagia, obstruction, and dysmotility. COMPARISON: None. DOUBLE CONTRAST BARIUM ESOPHAGRAM: Barium passes freely into the stomach with normal primary peristaltic contractions. There is a small pulsion diverticulum involving the distal esophagus. Additionally, there is a very tiny smooth, likely submucosal filling defect in the mid esophagus, which appears benign. There is no hiatal hernia seen. No reflux was identified. Limited views of the stomach are unremarkable. There is no evidence of narrowing or stricture in the esophagus. IMPRESSION: Small pulsion diverticulum in the distal esophagus and a tiny submucosal filling defect in the mid esophagus of doubtful clinical significance. The results were telephoned to Dr. ___ by Dr. ___ at 2:50 p.m., ___, five minutes after discovery.
10109413-RR-26
10,109,413
23,642,706
RR
26
2190-07-28 08:14:00
2190-07-28 10:06:00
EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN) INDICATION: ___ year old woman with elevated LFTs // evaluation of elevated LFTs TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were obtained. COMPARISON: ___. FINDINGS: LIVER: The echogenicity of the liver is heterogeneous, which is new when compared examination from ___. There are patchy regions which are echogenic throughout the liver. In addition, 3 discrete lesions which are somewhat hypoechoic are also noted. In the region of segment ___ in a subcapsular location is a 1.0 x 1.1 x 1.0 cm lesion. Another lesion within segment 5 measures 2.2 x 2.4 x 2.5 cm. A third lesion in the region of segment 4b-5 measures 3.6 x 1.8 x 3.2 cm. Main portal vein is patent with hepatopetal flow. There is no ascites. BILE DUCTS: There is no intrahepatic biliary dilation. The CBD measures 3 mm. GALLBLADDER: Numerous gallstones and sludge are seen within the gallbladder without evidence of sonographic ___ sign. There may be slight thickening of the gallbladder wall, but without obvious edema. PANCREAS: Head, body and tail of the pancreas are within normal limits, without masses or pancreatic ductal dilatation. Adjacent to the pancreatic tail (image 12) is a lesion which measures 0.9 x 1.3 x 1.0 cm and is slightly hypoechoic. It is unclear whether this is arising from the pancreas or may represent an adjacent lymph node. SPLEEN: Normal echogenicity, measuring 7.5 cm. Echogenic focus measuring 4 mm is seen along the inferior aspect of the spleen, possibly representing a calcified granuloma. KIDNEYS: The right kidney measures 9.7 cm. The left kidney measures 9.2 cm. Normal cortical echogenicity and corticomedullary differentiation is seen bilaterally. There is no evidence of masses, stones or hydronephrosis in the kidneys. RETROPERITONEUM: Visualized portions of aorta is of normal caliber. A filling defect measuring 1.3 x 0.8 x 1.1 cm is seen within the IVC (image 71), although it is unclear whether this has definite vascularity. A moderate-sized right-sided pleural effusion is seen. IMPRESSION: 1. Numerous hepatic masses as described. Given that these are new since the examinations from ___, recommend multiphasic MRI if possible, or alternatively a multiphasic CT for further assistance. The peripancreatic lesion and IVC filling defect can be evaluated at the same time. 2. Moderate right-sided pleural effusion. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the telephone on ___ at 8:50 AM, 10 minutes after discovery of the findings.
10109413-RR-29
10,109,413
23,642,706
RR
29
2190-07-29 13:19:00
2190-07-29 17:12:00
EXAMINATION: CT ABD AND PELVIS W AND W/O CONTRAST, ADDL SECTIONS INDICATION: ___ year old woman with metastatic liver lesions with unknown primary // MULTIPHASIC LIVER CT TECHNIQUE: Helical CT acquisition was performed during multiple phases after the administration of nonionic IV contrast. Oral water was also administered. Multiplanar reformats were obtained. DOSE: 763 mGy-cm COMPARISON: Ultrasound ___, CT ___ FINDINGS: Partially visualized moderate to large right pleural effusion. Multiple nodules are visualized within the right lung base, concerning for metastatic disease. Please see chest CT report for further details. Numerous hypodense enhancing liver lesions are demonstrated throughout both lobes, demonstrating central hypodensity, peripheral slightly increased attenuation, less than liver parenchyma. Findings are concerning for metastatic disease. Largest lesions measure 2.9 x 2.1 cm within segment ___ and 3 x 2.5 cm within segment 5. Nnondistended gallbladder. Ill-defined hypoenhancing mass within the pancreatic body/tail measures 4 x 3.5 cm, demonstrating atrophy of the pancreatic tail with main ductal dilatation, highly concerning for pancreatic adenocarcinoma. This invades the splenic vein, which is occluded, with multiple perisplenic and perigastric varices. Soft tissue continues to extend surround the SMA and portosplenic confluence, with narrowing of the patent main portal vein. Intrahepatic portal vein branches are patent. Normal caliber CBD and pancreatic duct within the head. Hypodense nodularity of bilateral adrenal glands, likely metastases, with probable direct invasion of the left adrenal. No hydronephrosis. Subcentimeter bilateral hypodense renal foci, too small characterize, likely cysts. Decompressed stomach with multiple intramural varices. Stool within the colon. Note is made of mural thickening and mucosal hyperenhancement involving the cecum. No small bowel dilatation. In addition, a hypodense enhancing 1.2 x 1.1 cm well-circumscribed structure within the IVC, just caudal to renal veins, is noted, likely representing tumor thrombus. Fat stranding within the abdomen and pelvis and free fluid is noted within the pelvis is demonstrated. Corkscrew like appearance of the celiac trunk, splenic artery, common hepatic artery, left gastric artery with surrounding abnormal soft tissue, likely stenosis secondary to tumor invasion. Foley catheter within decompressed bladder. Absent uterus. Thrombus is also noted within the right saphenous vein extending to the common femoral vein. Numerous sclerotic lesions within the thoracolumbar spine and bony pelvis are demonstrated, concerning for metastatic disease. IMPRESSION: -Large irregular hypodense pancreatic body/tail lesion, as detailed above, concerning for pancreatic adenocarcinoma. The mass appears to invade the splenic vein, surrounds the SMA and celiac arterial branches, and also invades the left adrenal gland. Soft tissue extends to the porta hepatis, with narrowing of the main portal vein, which maintains patency. -Metastatic disease throughout the liver, bones and visualized portion of the lower chest. -Thrombus within the infrarenal IVC, enhancing, likely tumor thrombus. Additional thrombus is visualized within the cephalad right saphenous vein into the common femoral vein. -Mural thickening and mucosal hyperenhancement of the cecum. Findings may be related to upstream venous congestion from neoplastic burden as noted above. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ in person on ___ at 3:15 ___.
10109413-RR-30
10,109,413
23,642,706
RR
30
2190-07-29 14:07:00
2190-07-29 16:33:00
EXAMINATION: CT CHEST W/CONTRAST INDICATION: Unexplained weight loss and liver lesions on right upper quadrant ultrasound. Perform study for diagnostic/staging purposes. TECHNIQUE: Multidetector helical scanning of the chest was coordinated with intravenous infusion of nonionic iodinated contrast agent reconstructed as contiguous 5- and 1.25-mm thick axial, 2.5-mm thick coronal and parasagittal, and 8 x 8 mm MIPs axial images. DOSE: Please see the CT abdomen and pelvis report. COMPARISON: CT abdomen pelvis ___ FINDINGS: A 14 x 14 mm hypodense nodule in the lower right thyroid lobe and a coarse calcification in the upper right thyroid lobe were not seen on the thyroid ultrasound of ___. There is no axillary or supraclavicular lymphadenopathy. There is no mediastinal lymphadenopathy. The heart is normal size. Fluid is seen within the superior pericardial recesses. The aorta is unremarkable and the main pulmonary artery is top normal in caliber. There is a large right, nonhemorrhagic pleural effusion with overlying compressive atelectasis. The right upper and middle lobes are well-aerated. Enhancing soft tissue seen along the pleural surface (i.e. 6:42, 62) are worrisome for metastatic deposits. As an example of other pleural-based disease, nodules in the right lung measure 1.4 cm (6:126) and 1 cm (6:94). Numerous intraparenchymal nodules are also seen in the right lung, the largest noted in the upper lobe measuring 9 mm (06:51). Increased soft tissue surrounding the right hilus is worrisome for malignant involvement. There is a small left pleural effusion. Numerous pulmonary nodules are also seen in the left lung, the largest noted in the left lower lobe measuring 9 mm (06:22).) The esophagus is unremarkable. Findings below the diaphragm are reported independent of this study. The soft tissues of the chest are unremarkable, however, the breasts are incompletely evaluated. In addition to the bone findings seen in the abdomen and pelvis, mixed sclerotic and lytic lesions are seen in T5 and T10, T11 without collapse. IMPRESSION: 1. Large right pleural effusion with bilateral pulmonary, pleural and osseous metastatic disease. 2. Abdominal findings reported separately.
10109413-RR-31
10,109,413
23,642,706
RR
31
2190-07-30 15:43:00
2190-07-30 17:52:00
EXAMINATION: Ultrasound-guided liver biopsy INDICATION: ___ year old woman with unexplained weightloss, liver lesions on RUQ u/s with multiple lesions (pulm, liver, pancreas, bone) seen on CT torso yesterday. // characterization of liver lesion for staging purposes COMPARISON: CT scan of the abdomen from ___ PROCEDURE: Ultrasound-guided targeted liver biopsy. OPERATORS: Dr. ___ fellow and Dr. ___ radiologist, who was present and supervising throughout the total procedure time. FINDINGS: Limited preprocedure grayscale and Doppler ultrasound imaging of the right hepatic lobe was performed which demonstrates innumerable hypoechoic liver lesions. The lesion for biopsy was identified in segment V/VIII. A suitable approach for targeted liver biopsy was determined. TECHNIQUE: The risks, benefits, and alternatives of the procedure were explained to the patient. After a detailed discussion, informed written consent was obtained. A pre-procedure timeout using three patient identifiers was performed per ___ protocol. Based on the preprocedure imaging, an appropriate skin entry site for the biopsy was chosen. The site was marked. The skin was then prepped and draped in the usual sterile fashion. The superficial soft tissues to the liver capsule were anesthetized with 10 mL 1% lidocaine. Under real-time ultrasound guidance, two 18-gauge core biopsy samples were obtained in two passes. The skin was then cleaned and a dry sterile dressing was applied. There was no immediate complications. SEDATION: Moderate sedation was provided by administering divided doses of 50 mcg fentanyl throughout the total intra-service time of 10 minutes during which patient's hemodynamic parameters were continuously monitored by an independent trained radiology nurse. IMPRESSION: Uncomplicated 18-gauge targeted liver biopsy x 2, with specimen sent to pathology.
10109555-RR-77
10,109,555
24,579,922
RR
77
2120-06-18 15:41:00
2120-06-18 16:02:00
EXAMINATION: CHEST (PORTABLE AP) INDICATION: History: ___ with pmh R lobectomy with metastatic ca// ? effusion ? pneumothorax,?PNA with TECHNIQUE: Upright AP view of the chest COMPARISON: Chest radiograph ___ FINDINGS: Left-sided dual-lumen central lumen catheter tip terminates in the proximal right atrium. Heart size is obscured due to the presence of a large left pleural effusion, increased from the prior exam. Small to moderate right pleural effusion has also increased from the prior exam. Left basilar opacification may reflect compressive atelectasis. Similarly, patchy right basilar opacity could reflect atelectasis. No pneumothorax is detected. Mediastinal contours appear unchanged. No acute osseous abnormalities seen. IMPRESSION: Increased size of bilateral pleural effusions, large on the left and small to moderate on the right. Bibasilar airspace opacities could reflect compressive atelectasis, though infection or aspiration cannot be excluded in the correct clinical setting.
10109555-RR-78
10,109,555
24,579,922
RR
78
2120-06-18 17:14:00
2120-06-18 17:47:00
EXAMINATION: CHEST (PORTABLE AP) INDICATION: ___ w/chest tube placement// please eval for chest tube position COMPARISON: Prior from 1 hour earlier FINDINGS: AP portable upright view of the chest. There has been interval placement of a left sided pigtail chest tube. There has been no significant reduction of left-sided pleural effusion. Residual aeration in the left upper lobe is similar to prior. A Port-A-Cath is unchanged terminating in the cavoatrial junction. A small right pleural effusion is similar to prior. IMPRESSION: Left chest tube in place without change in pleural effusion.
10109555-RR-79
10,109,555
24,579,922
RR
79
2120-06-19 09:08:00
2120-06-19 10:14:00
EXAMINATION: CHEST (PORTABLE AP) INDICATION: ___ year old man with malignant pleural effusion s/p chest tube, assess for interval change and PTX// assess for interval change and PTX assess for interval change and PTX IMPRESSION: Comparison to ___. Minimal decrease in extent of the left pleural effusion with subsequent improved ventilation of the left lung. The left pleural pigtail catheter is in stable position. On the right, the effusion has minimally increased.
10109555-RR-80
10,109,555
24,579,922
RR
80
2120-06-19 17:35:00
2120-06-19 18:26:00
EXAMINATION: CT SINUS/MANDIBLE/MAXILLOFACIAL W/O CONTRAST Q116 CT HEADSINUS INDICATION: ___ year old man with metastatic RCC and dental implants now with mucosal defect of upper gum in midline with visible screw eroding and necrotic tissue with concern for infection.// Please perform CT maxillofaicla w/o contrast. Please evaluate for mucosal defect, sinus infection. TECHNIQUE: Helically-acquired multidetector CT axial images were obtained through the maxillofacial bones and mandible. Intravenous contrast was not administered. Axial images reconstructed with soft tissue and bone algorithm to display images with 1.25 mm slice. Coronal and sagittal reformations were also constructed. All produced images were evaluated in production of this report. DOSE: Acquisition sequence: 1) Spiral Acquisition 3.4 s, 22.3 cm; CTDIvol = 32.7 mGy (Head) DLP = 707.5 mGy-cm. Total DLP (Head) = 708 mGy-cm. COMPARISON: MRI dated ___ FINDINGS: There are lucencies beginning posterior to the bilateral medial incisor implants extending up the maxillary spine to the level of the base of the nasal bone. 2 hyperdense implants are noted anterior to this lucency suggestive of fracture through the maxillary spine with anterior displacement of the recently placed dental implants (series 2; image 76). There is anterior displacement of the left first premolar equivalent dental implant (2:78) without fracture of the maxillary bone. There is stranding anterior to the maxillary bone in this region without definite underlying collection, although visualization is mildly limited due to streak artifact. There is mild mucosal thickening of the bilateral maxillary sinuses and anterior ethmoid air cells. Frontal sinuses, bilateral mastoid air cells, and middle ear cavities overall appear clear. Multiple lytic lesions are seen within the visualized cervical spine consistent with the patient's known metastatic disease. Lytic lucency and osseous destruction are seen involving the left foramen transversarium of C1, and bilaterally at C4. The vertebral body heights of C 2, C3 and C4 are preserved. No suspicious osseous lesions of the visualized skull. The globes, extraocular muscles, optic nerves, and retrobulbar fat appear normal. The visualized upper aerodigestive tract appears normal. The mandible and temporomandibular joints appear normal. IMPRESSION: 1. Fracture through the maxillary spine with anterior displacement of medial incisor equivalents of the recently placed dental implants. There is also anterior displacement of the left first premolar equivalent of the dental implants without maxillary bone fracture. Stranding is noted in this area without drainable collection. 2. Mild mucosal thickening the bilateral maxillary sinuses and anterior ethmoid air cells. 3. Lytic metastatic lesions within the visualized cervical spine without evidence of vertebral body height loss. Osseous destruction is seen involving the left foramen transversarium at C1 and bilaterally at C4, new since the MRI dated ___. A CTA of the neck is recommended to evaluate the vertebral artery integrity. NOTIFICATION: The findings were discussed with ___, M.D. by ___ ___, M.D. on the telephone on ___ at 6:19 pm, 5 minutes after discovery of the findings.
10109555-RR-82
10,109,555
24,579,922
RR
82
2120-06-20 08:13:00
2120-06-20 09:00:00
EXAMINATION: CHEST (PORTABLE AP) INDICATION: ___ year old man with Lt chest tube for PLEFF// r/o PTX r/o PTX IMPRESSION: Comparison to ___. The pigtail catheter in the left pleural space is in stable position. Large amounts of the pre-existing left pleural effusion have been drained. There is a relatively substantial basal pneumothorax on the left, at the site of tube insertion, without evidence of tension. The size of the cardiac silhouette and the extent of the right pleural effusion is stable.
10109555-RR-83
10,109,555
24,579,922
RR
83
2120-06-21 07:28:00
2120-06-21 09:56:00
EXAMINATION: CHEST (PORTABLE AP) INDICATION: ___ year old man with pleural effusion s/p chest tube.// Eval for interval change. Plan for pleurx. Eval for interval change. Plan for pleurx. IMPRESSION: Compared to chest radiographs ___ through ___. Previous left pneumothorax has nearly resolved, replaced in part by very small left pleural effusion. Basal thoracostomy tube still in place. Moderate right pleural effusion stable. Left basal atelectasis unchanged. Heart size normal. Indwelling, left subclavian central venous infusion catheter ends in the right atrium.
10109555-RR-84
10,109,555
24,579,922
RR
84
2120-06-21 09:03:00
2120-06-21 12:00:00
EXAMINATION: CHEST (PORTABLE AP) INDICATION: ___ year old man with left pleural effusion s/p pleurX catheter placement. Evaluation for pneumothorax, catheter placement. TECHNIQUE: Chest PA and lateral COMPARISON: Comparison to radiographs spanning from ___ through ___. FINDINGS: Left-sided central venous catheter remains in unchanged position, with tip ending in the right atrium. There has been interval removal of the left basilar pleural pigtail catheter, with interval placement of a left basilar PleurX catheter. The previously seen small left pleural effusion has been replaced by small volume pneumothorax. Moderate sized right pleural effusion is increased at in size. Stable bibasilar opacities likely reflect atelectasis. Cardiomediastinal silhouette is stable and within normal limits. IMPRESSION: 1. Removal of left basilar pleural pigtail catheter which has been replaced by a left basilar PleurX catheter. A small volume left basal pneumothorax has replaced the previously seen small left pleural effusion. 2. Moderate right pleural effusion, increased in size compared to prior study.
10109555-RR-85
10,109,555
24,579,922
RR
85
2120-06-21 16:19:00
2120-06-21 18:02:00
EXAMINATION: CTA NECK WANDW/OC AND RECONS Q25 CT NECK INDICATION: ___ year old man with metastatic RCC and bone mets with osseious destruction of foramen transversarium at C1 and C4.// Please evaluate for vertebral artery integrity. TECHNIQUE: Rapid axial imaging was performed from the aortic arch through the skull base during infusion of mL of Omnipaque intravenous contrast material. Three-dimensional angiographic volume rendered, curved reformatted and segmented images were generated. This report is based on interpretation of all of these images. DOSE: Acquisition sequence: 1) Sequenced Acquisition 0.5 s, 0.2 cm; CTDIvol = 16.1 mGy (Head) DLP = 3.2 mGy-cm. 2) Stationary Acquisition 5.0 s, 0.2 cm; CTDIvol = 88.2 mGy (Head) DLP = 17.6 mGy-cm. 3) Spiral Acquisition 4.6 s, 29.8 cm; CTDIvol = 35.9 mGy (Head) DLP = 1,047.1 mGy-cm. Total DLP (Head) = 1,068 mGy-cm. COMPARISON: Prior CT C spine done ___ and prior CT chest done ___ FINDINGS: The carotid and vertebral arteries and their major branches are patent with no evidence of stenoses. Extensive bony metastatic disease is again noted most notably involving the transverse neural foramina of C1 left and C4 bilaterally and abutting the vertebral arteries in this positions, but no evidence of vertebral artery invasion. There is mild calcific atherosclerotic changes of the proximal ICAs, but there is no stenosis by NASCET criteria. Large right-sided pleural effusion with associated interstitial thickening in dependent ground-glass opacity suggesting pulmonary edema. Incompletely imaged left loculated pneumothorax or bullae. Pulmonary metastasis again noted for example left upper lobe (series 3, image 12). Curvilinear atelectasis/scarring in the left upper lobe. Mild mucosal thickening involving the inferior aspects of the maxillary sinuses. Extensive bony metastatic disease for which reference to prior CT C spine done ___ is advised. IMPRESSION: 1. The carotid and vertebral arteries are patent. 2. No ICA stenosis by NASCET criteria. 3. Extensive bony metastatic disease is again noted most notably involving the transverse neural foramina of C1 left and C4 bilateral and abutting the vertebral arteries in these positions, but no evidence of vertebral artery invasion. 4. For a full description of bony metastatic disease please refer to CT C-spine report done ___ 5. Large right-sided pleural effusion, left upper lung metastatic nodule and loculated left pneumothorax/bullae is incompletely imaged and if clinically indicated dedicated chest imaging should be performed.
10109613-RR-25
10,109,613
23,183,024
RR
25
2132-01-16 23:43:00
2132-01-16 09:13:00
EXAMINATION: MRI AND MRA BRAIN AND MRA NECK PT11 MR ___ INDICATION: ___ year old woman with factor v leiden, known R svt, on coumadin, presenting with worsening headache// MP rage sequence to look at R SVT 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 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: MRI/MRA head ___. MRI head ___. FINDINGS: MRI BRAIN: There has been a slight interval increase in thrombus within the right sigmoid/transverse sinus (series 111, image 59). No significant change in the likely trace residual thrombus within the superior sagittal sinus just above the confluence. There has been continued improvement in diffuse pachymeningeal thickening/enhancement. Also slightly improved is the subtle leptomeningeal enhancement of the bilateral cerebral hemispheres near the vertex, right temporoparietal lobe and left ___ lobes with continued areas of serpiginous and punctate, which likely represents opacification of collateral veins. There has been interval decrease in sulcal tubular susceptibility on gradient echo images at the bilateral vertex and left parietal occipital lobe. Also decreased is the small amount of diffusion abnormality and sulcal FLAIR hyperintensity within the bilateral occipital lobes and right parietal lobe. Serpiginous slow diffusion overlying bilateral parietal lobes is grossly unchanged. The ventricles and sulci are stable in caliber and configuration. Redemonstrated are areas of chronic patchy, cortically based T2/FLAIR hyperintensity without associated abnormal diffusion involving the right frontal, right temporal and medial left frontal lobes which are nonspecific and may relate to sites of old ischemic injury or trauma. There are mild scattered Subcortical and deep white matter T2/FLAIR hyperintensities that are nonspecific but can be seen in setting of chronic small vessel ischemic disease. The major intracranial vascular flow voids are maintained. Note is made of bilateral lens replacements. No significant change in a moderate amount of fluid within the left mastoid air cells. The paranasal sinuses are normal. 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: Irregular narrowing of the left common carotid artery is likely secondary to adjacent susceptibility artifact and less likely stenosis. This could be further evaluated with a nonurgent carotid ultrasound. The common, internal and external carotid arteries appear otherwise normal. There is no evidence of internal carotid artery stenosis by NASCET criteria. The origins of the great vessels, subclavian and vertebral arteries appear normal bilaterally. IMPRESSION: 1. Slight interval increase in thrombus within the right sigmoid/transverse sinus and unchanged trace residual thrombus in the superior sagittal sinus cyst above the confluence. 2. Otherwise there has been improvement in the multiple associated abnormal intracranial findings including improved pachymeningeal thickening/enhancement, improved areas of leptomeningeal enhancement, decrease in the previously described areas of tubular/sulcal susceptibility and FLAIR/diffusion signal abnormality 3. Irregular narrowing of the left common carotid artery on the MRA neck is likely secondary to adjacent susceptibility artifact and less likely stenosis. This could be further evaluated with a nonurgent carotid ultrasound if clinically indicated. Otherwise, patent bilateral cervical carotid and vertebral arteries. 4. Patent circle of ___ without definite evidence of aneurysm, occlusion or stenosis. 5. Unchanged moderate amount of fluid within the left mastoid air cells. NOTIFICATION: The findings were discussed with ___, M.D. by ___, M.D. on the telephone on ___ at 9:10 am, 10 minutes after discovery of the findings.
10109613-RR-28
10,109,613
23,526,345
RR
28
2132-09-13 15:49:00
2132-09-13 16:48:00
EXAMINATION: Chest: Frontal and lateral views INDICATION: History: ___ with headache, dizziness, weakness// assess for ICH pna TECHNIQUE: Chest: Frontal and Lateral COMPARISON: ___ FINDINGS: Large hiatal hernia is again seen. No focal consolidation is seen. There is no pleural effusion or pneumothorax. The cardiac and mediastinal silhouettes are stable. Cervical surgical hardware is again noted. IMPRESSION: Large hiatal hernia. No acute cardiopulmonary process.
10109613-RR-29
10,109,613
23,526,345
RR
29
2132-09-13 19:10:00
2132-09-13 21:18:00
EXAMINATION: CTA HEAD AND CTA NECK Q16 CT NECK INDICATION: History: ___ with headache, history of cerebral venous thrombosis. Please obtain CTA/CTV sequences to assess for venous sinus thrombosis. TECHNIQUE: Contiguous MDCT axial images were obtained through the brain without contrast material. Subsequently, helically acquired rapid axial imaging was performed through the brain during the infusion of intravenous contrast material in the arterial phase. Delayed venous phase images through the brain were then obtained. 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 14.0 s, 14.0 cm; CTDIvol = 50.2 mGy (Head) DLP = 702.4 mGy-cm. 2) Stationary Acquisition 5.5 s, 0.5 cm; CTDIvol = 59.9 mGy (Head) DLP = 30.0 mGy-cm. 3) Spiral Acquisition 4.7 s, 36.9 cm; CTDIvol = 31.0 mGy (Head) DLP = 1,143.0 mGy-cm. 4) Spiral Acquisition 2.6 s, 20.4 cm; CTDIvol = 30.0 mGy (Head) DLP = 612.4 mGy-cm. Total DLP (Head) = 2,488 mGy-cm. COMPARISON: ___ brain MRI with and without contrast. Head CT from ___. Brain MRI/MRA from ___. FINDINGS: CT HEAD WITHOUT CONTRAST: There is no acute hemorrhage, mass effect, or evidence for an acute major vascular territorial infarction. Unchanged areas of encephalomalacia/gliosis in the right inferior frontal and anterior temporal lobes which may be secondary to chronic infarcts. Unchanged periventricular/deep white matter hypodensity, nonspecific but likely secondary to chronic small vessel ischemic disease in this age group. Age-related mild parenchymal volume loss with associated prominence of the ventricles and sulci. There is partial left mastoid air cell opacification. Paranasal sinuses appear grossly well-aerated. Status post bilateral cataract surgery. Torus tubarius is incidentally noted. CTA NECK: There is mild calcified plaque in the proximal right internal carotid artery without stenosis by NASCET criteria. Proximal left internal carotid artery demonstrates no evidence for thorough sclerosis and no stenosis for NASCET criteria. Evaluation of the medialized mid left common carotid artery is limited by streak artifact from lower cervical ACDF hardware. Evaluation of bilateral mid internal carotid arteries is limited by streak artifact from bilateral C2-C3 posterior element screws. Evaluation of V1 and proximal V2 segments of the vertebral arteries is limited by streak artifact from lower cervical ACDF hardware, as well as concentrated contrast in the right subclavian vein refluxing into the lower right internal jugular vein. There is otherwise no evidence for vertebral artery stenosis. CTA HEAD: The vessels of the circle of ___ and their principal intracranial branches appear widely patent without evidence for flow-limiting stenosis or aneurysm. Normal-variant early branching of bilateral A2 segments is noted. CTV HEAD: There is a nonocclusive filling defect involving the right transverse sinus, right sigmoid sinus, and the right jugular fossa, without extension into the right internal jugular vein below the skullbase, in the same distribution as on ___ and ___ MRI, images 4:221-196. The filling defect appears larger than on the most recent ___ MRI, though this could in part be secondary to differences in modalities. There is also partial filling defect in the superior sagittal sinus, image 4:252, not significantly changed since the most recent ___ MRI allowing for differences in modalities. A Other dural venous sinuses appear patent. Previously noted left parietal developmental venous anomaly is again faintly visualized, for example on image 5:59. OTHER: The thyroid is grossly unremarkable allowing for streak artifact from dental amalgam. No pathologically enlarged lymph nodes by CT criteria. Evaluation of the included upper lungs is limited by respiratory motion artifact, with slightly mosaic attenuation which may be secondary to expiratory phase of imaging and slight air trapping. There are bilateral screws traversing the C3-C4 facet joints and posterior elements. There is ACDF at C5-C7. No evidence for hardware related complications on axial images; sagittal and coronal MIPS images are not technically suitable for evaluating the surgical hardware. There is mild anterolisthesis of C3 on C4 and of C4 on C5, and other multilevel degenerative changes in the cervical spine. IMPRESSION: 1. No evidence for acute hemorrhage or large acute infarction. 2. Stable areas of encephalomalacia/gliosis in the right inferior frontal and anterior temporal lobes. 3. Cervical spine hardware related streak artifacts limit evaluation of the left mid common carotid and bilateral mid internal carotid arteries, and of the V1 and proximal V2 vertebral artery segment. Otherwise, no evidence for carotid stenosis by NASCET criteria or flow-limiting vertebral stenosis. 4. Normal CTA of the circle of ___. 5. Nonocclusive filling defect involving the right transverse sinus, right sigmoid sinus, and right jugular fossa appears slightly larger than on the ___ and ___ MRI, but differences in appearance may in part be secondary to differences in modalities. 6. Stable nonocclusive filling defect in the superior sagittal sinus, consistent with chronic thrombus. RECOMMENDATION(S): Contrast enhanced brain MRI with MP RAGE images could offer more adequate comparison of the right transverse and sigmoid sinus filling defect to the ___ MRI, if clinically warranted. NOTIFICATION: Electronic preliminary report, including the possible enlargement of the right transverse/sigmoid sinus filling defect, was provided at 21:18 on ___ by Dr. ___.
10109613-RR-32
10,109,613
29,052,334
RR
32
2133-02-21 02:45:00
2133-02-21 03:22:00
EXAMINATION: CTA CHEST WITH CONTRAST INDICATION: ___ with elevated trop, intermittent CP, subtherapeutic INR. 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 3.5 s, 0.5 cm; CTDIvol = 21.3 mGy (Body) DLP = 10.6 mGy-cm. 2) Spiral Acquisition 3.5 s, 27.8 cm; CTDIvol = 9.5 mGy (Body) DLP = 264.5 mGy-cm. Total DLP (Body) = 275 mGy-cm. COMPARISON: CT chest performed ___. 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, pericardium, and great vessels are within normal limits. No pericardial effusion is seen. AXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar lymphadenopathy is present. No mediastinal mass. PLEURAL SPACES: No pleural effusion or pneumothorax. LUNGS/AIRWAYS: Subtle opacification in the bilateral lower lobes was not present on the prior study and may reflect mild interstitial edema. Otherwise, lungs are clear without masses or areas of parenchymal opacification. 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: Large hiatal hernia is noted. Included portion of the upper abdomen is unremarkable. BONES: No suspicious osseous abnormality is seen.? There is no acute fracture. IMPRESSION: 1. No pulmonary embolus or acute aortic abnormality. 2. New bilateral lower lobe opacification may reflect mild interstitial edema. 3. Large hiatal hernia.
10109613-RR-33
10,109,613
29,052,334
RR
33
2133-02-26 08:04:00
2133-02-26 13:50:00
EXAMINATION: CARDIAC STRUCTURE/MORPH, 3D, FUNCTION INDICATION: ___ with PMH of TBI, Factor V Leiden w/ prior DVT and venoussinus thrombosis (VST) on coumdin and IVC filter, anxiety c/bpanic disorder, hiatal hernia with GERD who presented with threedays of worsening head pain, VST ruled out on MR, now withuptrending trops and EKG changes c/f NSTEMI given 1 months ofintermittent chest pain.// Evaluate for clinically significant CAD TECHNIQUE: A 320-slice multidetector CTA ___ Building) of the coronary arteries was obtained using ECG gating with 80 cc Omnipaque contrast administered intravenously. To provide better evaluation of the anatomy and disease process, advanced 3D post-processing techniques, including multiplanar reconstruction, maximal intensity projections, curved reconstructions, and volume rendering were performed on a separate workstation. Calcium score was calculated using Vitrea V-Score software. No intravenous contrast material was administered for this portion of the exam. Medications: 0.4 mg nitroglycerin sublingual x1 Procedure complications/allergic reactions: none DOSE: Total DLP (Body) = 135 mGy-cm. COMPARISON: CTA chest ___. FINDINGS: Image Quality: The overall quality of the CT angiographic examination is good AGATSTON SCORE: The total (aggregate) calcium score using the AJ 130 method is 0. Total volume score is 0. 0% of similar patients have less coronary artery calcium (this is reported using the interactive ___ form found at (___). Individual major vessel AJ 130 scores are: LM: NA LAD: 0 LCX: 0 RCA: 0 CORONARY CTA: Stenoses are reported as maximum percentage diameter stenosis and graded using the CAD-RADS classification (___ Cardiovasc Imaging ___ Sep;9(9):1099-113). CAD-RADS 0: 0%, no stenosis CAD-RADS 1: ___, minimal stenosis or plaque with no stenosis CAD-RADS 2: ___, mild stenosis CAD-RADS 3: 50-69%, moderate stenosis CAD-RADS 4A: 70-99%, severe stenosis CAD-RADS 4B: >50% stenosis of the left main or >=70% stenosis of the left anterior descending, the left circumflex, and the right coronary, severe stenosis CAD-RADS 5: 100%, total occlusion CAD-RADS N: Non-diagnostic study, obstructive CAD cannot be excluded Dominance of the coronary artery system: right with normal origins and course. Left Main: The left main is a normal caliber vessel which gives rise to the LAD and circumflex arteries. The left main has no stenosis with no plaque. Left Anterior Descending Artery: The proximal left anterior descending artery and first diagonal branch have no stenosis with no plaque. The mid-distal LAD have no stenosis with no plaque. Left Circumflex Artery: The left circumflex artery and its obtuse marginal branches have no stenosis with no plaque. Right Coronary Artery: The right coronary artery, acute marginal, right posterior descending artery, and right posterolateral branches have no stenosis with no plaque. CARDIAC MORPHOLOGY: The right atrium is normal. The right ventricle is normal. The left atrium is normal. The left ventricle is normal. The pericardium is normal and there is no pericardial effusion. The aortic valve is tricuspid with normal leaflets. EXTRACARDIAC FINDINGS: There is a moderate to large hiatal hernia. There is mild bibasilar ground-glass opacities and mild bronchial wall thickening. Otherwise, unremarkable. IMPRESSION: 1. CAD-RADS 0- No plaque or stenosis. 2. Moderate to large hiatal hernia. 3. Mild bibasilar ground-glass opacities and mild bronchial wall thickening may be secondary to aspiration, atelectasis and/or mild interstitial edema.
10109613-RR-34
10,109,613
24,933,592
RR
34
2133-08-09 18:27:00
2133-08-09 19:32:00
EXAMINATION: CHEST (PORTABLE AP) INDICATION: ___ female transferred for pneumothorax with chest tube in place, assess for residual pneumothorax TECHNIQUE: Single upright portable AP chest radiograph COMPARISON: Outside chest radiograph and chest CT performed ___ FINDINGS: Tip of right-sided pigtail catheter projects over the right upper lung on this frontal only view. The sideholes appear within the confines of the thorax. There is no definite pneumothorax. Other than mild left subsegmental atelectasis, the lungs are otherwise well inflated and clear. No large pleural effusion. The heart is top-normal in size. Hiatal hernia is noted. The mediastinal and hilar contours are unremarkable. ACDF plate projects over the lower cervical spine. There are mild degenerative changes about the bilateral acromioclavicular joints. Clips are seen about the right upper quadrant. IMPRESSION: No definite pneumothorax. Tip of right-sided pigtail catheter projects over the right upper lung on this frontal only view.
10109613-RR-35
10,109,613
24,933,592
RR
35
2133-08-09 21:25:00
2133-08-09 22:35:00
EXAMINATION: Chest radiograph, portable AP upright. INDICATION: Status post fall with right-sided rib fractures and pneumothorax status post chest tube. COMPARISON: Prior study from ___. FINDINGS: Heart is borderline in size. Mediastinal and hilar contours appear stable. Moderate-sized hiatal hernia is also unchanged. There is no definite pleural effusion. Chest tube has been removed. There is a tiny right apical pneumothorax that is probably unchanged although perhaps better depicted on this study. Right-sided rib fractures are not well visualized with this technique. IMPRESSION: Trace probably unchanged right apical pneumothorax. Status post chest tube removal.
10109613-RR-36
10,109,613
24,933,592
RR
36
2133-08-10 08:32:00
2133-08-10 09:09:00
EXAMINATION: CHEST (PA AND LAT) INDICATION: ___ on warfarin and IVC filter for DVT, Factor V Leiden, and cerebral venous sinus thrombosis s/p mechanical fall w/ 3 R rib fx and PTX s/p chest tube.// resolution of PTX resolution of PTX IMPRESSION: There is interval increase in right pneumothorax in both apical and basal component. Basal air might potentially communicated between the pleura and the chest wall, with to the size of 12 x 6 cm, R adjacent to rib fractures. No pleural effusion is seen. Lungs overall clear. Moderate hiatal hernia is re-demonstrated.
10109613-RR-37
10,109,613
24,933,592
RR
37
2133-08-09 22:43:00
2133-08-09 23:25:00
EXAMINATION: Chest radiograph, portable AP upright. INDICATION: Follow-up of pneumothorax. COMPARISON: Earlier on the same day FINDINGS: Very small right apical pneumothorax shows no definite change. More generally, no significant change. IMPRESSION: Very small right apical pneumothorax.
10109613-RR-39
10,109,613
24,933,592
RR
39
2133-08-10 14:37:00
2133-08-10 16:15:00
EXAMINATION: CHEST (PA AND LAT) INDICATION: ___ on warfarin and IVC filter for DVT, Factor V Leiden, and cerebral venous sinus thrombosis s/p mechanical fall w/ 3 R rib fx and PTX s/p chest tube.// Please eval for interval change of PTX at 2PM. Please eval for interval change of PTX at 2PM. IMPRESSION: No substantial change in the appearance of the apical pneumothorax on the right although minimal decrease is a possibility as well as the air bubble projecting over the right lower lung. Hiatal hernia. No new findings otherwise.
10109613-RR-40
10,109,613
24,933,592
RR
40
2133-08-11 09:04:00
2133-08-11 11:14:00
INDICATION: ___ on warfarin and IVC filter for DVT, Factor V Leiden, and cerebral venous sinus thrombosis s/p mechanical fall w/ 3 R rib fx and PTX.// interval change COMPARISON: Radiographs from ___ IMPRESSION: Minimally displaced fractures at the right lower rib cage is again seen. There there is a moderate sized pneumothorax at the right lateral base. Also a tiny right apical pneumothorax. These are unchanged. Lung fields are hyperexpanded suggestive of COPD. There is a large hiatus hernia with an air-fluid level. Lungs are grossly clear without focal consolidation. Heart size is grossly within normal limits. Hardware seen within the lower cervical spine. There are mild-to-moderate degenerative changes of the thoracic spine.
10109613-RR-44
10,109,613
25,772,481
RR
44
2134-02-13 17:15:00
2134-02-13 18:05:00
EXAMINATION: CT HEAD W/O CONTRAST INDICATION: ___ with headache, confusion. Evaluate for 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: Total DLP (Head) = 803 mGy-cm. COMPARISON: CT head noncontrast ___, MR brain ___ FINDINGS: There is no evidence of fracture, acute large territory infarction,hemorrhage,edema,or mass effect. Chronic appearing encephalomalacia at the inferior right frontal and temporal lobes is unchanged from prior MRI. Periventricular and subcortical white matter hypodensities are nonspecific but likely sequelae of chronic small vessel ischemic disease. There is prominence of the ventricles and sulci suggestive of involutional changes. The visualized portion of the paranasal sinuses, mastoid air cells, and middle ear cavities are clear. Patient is status post bilateral lens surgery. IMPRESSION: 1. No acute intracranial process. 2. Chronic small vessel ischemic disease. 3. Small foci of encephalomalacia in the right inferior frontal and temporal lobes unchanged from prior MRI.
10109613-RR-45
10,109,613
25,772,481
RR
45
2134-02-13 22:41:00
2134-02-14 00:02:00
EXAMINATION: MR HEAD W AND W/O CONTRAST T___ MR HEAD INDICATION: History: ___ with hx of venous sinus thrombosis, recurrent severe HA. with MPRAGE // new/change in venous sinus thrombosis. with MPRAGE TECHNIQUE: Sagittal and axial T1 weighted imaging were performed. After administration of 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: MRI head dated ___ and ___ FINDINGS: There is resolution of the filling defect in the right jugular vein with trace residual in the right sigmoid sinus and posterior superior sagittal sinus near the confluence of sinuses, best visualized on the axial T1 postcontrast images (series 14 images ___. There is similar T2/FLAIR hyperintensity within the posterosuperior sagittal sinus, right transverse and right sigmoid sinus compatible with slow flow. There are similar regions of leptomeningeal enhancement along the posterolateral right temporal lobe, likely related to collateral vessels from prior dural venous sinus thrombosis. There are similar small vessels along the posterior left parietal lobe extending into the ventricular surface of the atria of the lateral ventricle, likely related to transcortical venous collaterals. Similar foci of susceptibility are noted along the left parietal lobe, possibly related to the small collateral vessels or chronic microhemorrhages. There is similar encephalomalacia and gliosis involving the right anterolateral temporal lobe and bilateral anterior frontal lobes, greater on the right compatible with chronic infarcts. There are scattered foci of T2/FLAIR hyperintensity within the subcortical and periventricular white matter, nonspecific but likely sequelae of chronic small vessel ischemic disease. There is no evidence of acute hemorrhage, edema, masses, mass effect, midline shift or acute infarction. The ventricles and sulci are normal in caliber and configuration. There is mucosal thickening within the ethmoid air cells. Fluid signal intensity is noted in the bilateral mastoid air cells, greater on the left. There are postsurgical changes related to bilateral ocular lens replacement. IMPRESSION: 1. No new dural venous sinus thrombosis. No evidence of new gradient echo susceptibility artifact or diffusion-weighted signal abnormality. 2. Resolved thrombosis within the right internal jugular vein with similar trace residual filling defect in the sigmoid sinus and posterior aspect of the superior sagittal sinus near the confluence of sinuses. 3. Persistent increased T2/FLAIR signal intensity along the superior sagittal right transverse and right sigmoid sinus consistent with slow flow with unchanged regional collateral vessels. 4. Similar chronic encephalomalacia and gliosis involving the anterolateral right temporal lobe and primarily right anterior frontal lobe. 5. No acute territorial infarction or intracranial hemorrhage.
10109613-RR-46
10,109,613
25,772,481
RR
46
2134-02-18 08:51:00
2134-02-18 09:36:00
EXAMINATION: Carotid Artery ultrasound INDICATION: ___ year old woman with a Factor V Leiden c/b prior cerebral venous sinus thrombosis and DVT (on Coumadin), anxiety, and migraines who presents with acute on subacute headache. // Narrowing? TECHNIQUE: Real-time grayscale, color, and spectral Doppler ultrasound imaging of the carotid arteries was obtained. FINDINGS: RIGHT: There is mild heterogenous atherosclerotic plaque in the right carotid artery. Segment: PSV (cm/s) / EDV (cm/s) ---------------------------------------------- CCA ___: 52.1 cm/s / 10.8 cm/s CCA Distal: 44.3 cm/s / 11 cm/s ICA ___: 50.1 cm/s / 15.8 cm/s ICA Mid: 44 cm/s / 13.5 cm/s ICA Distal: 46.7 cm/s / 17.5 cm/s ECA: 63.5 cm/s Vertebral: 35.9 cm/s ICA/CCA Ratio: 1.13 The right vertebral artery flow is antegrade with a pre-steal spectral waveform. LEFT: There is mild heterogenous atherosclerotic plaque in the left carotid artery. Segment: PSV (cm/s) / EDV (cm/s) ---------------------------------------------- CCA ___: 63.1 cm/s / 15.2 cm/s CCA Distal: 61.9 cm/s / 14 cm/s ICA ___: 52.3 cm/s / 9.18 cm/s ICA Mid: 55.5 cm/s / 22 cm/s ICA Distal: 46.3 cm/s / 17.5 cm/s ECA: 44.3 cm/s Vertebral: 37.5 cm/s ICA/CCA Ratio: 0.9 The left vertebral artery flow is antegrade with a normal spectral waveform. IMPRESSION: Right ICA <40% stenosis. Left ICA <40% stenosis.
10109613-RR-47
10,109,613
25,772,481
RR
47
2134-02-18 15:27:00
2134-02-18 17:37:00
EXAMINATION: US RENAL ARTERY DOPPLER INDICATION: ___ year old woman with a Factor V Leiden c/b prior cerebral venous sinus thrombosis and DVT (on Coumadin), anxiety, and migraines who presents with acute on subacute headache and new onset HTN. // Renal artery stenosis? TECHNIQUE: Grey scale, color and spectral Doppler ultrasound images of the kidneys were obtained. COMPARISON: CT of the abdomen and pelvis dated ___.. FINDINGS: There is no hydronephrosis, or masses bilaterally. There is a small echogenic focus in the left kidney, possibly representing renal calculi measuring up to 0.3 cm. The cortex is thinned bilaterally, suggesting underlying chronic kidney disease. Right kidney: 10.8 cm Left kidney: 11.7 cm Renal Doppler: Intrarenal arteries show normal waveforms with sharp systolic peaks and continuous antegrade diastolic flow. The resistive indices of the right intra renal arteries range from 0.63 to 0.74. The resistive indices on the left range from 0.63 to 0.67. Bilaterally, the main renal arteries are patent with normal waveforms. The peak systolic velocity on the right is 111 centimeters/second. The peak systolic velocity on the left is 70 centimeters/second. Main renal veins are patent bilaterally with normal waveforms. The bladder is moderately well distended and normal in appearance. IMPRESSION: 1. No sonographic evidence of renal artery stenosis.. 2. Thinning of the cortex bilaterally suggestive of underlying chronic medical renal disease.
10109613-RR-48
10,109,613
20,466,771
RR
48
2134-03-10 00:57:00
2134-03-10 04:01:00
EXAMINATION: CT ABD AND PELVIS WITH CONTRAST INDICATION: NO_PO contrast; History: ___ with rectal bleeding, decreasing mental status, abd painNO_PO contrast // ? intaabdominal process TECHNIQUE: Single phase contrast: MDCT axial images were acquired through the abdomen and pelvis following intravenous contrast administration. Oral contrast was administered. Coronal and sagittal reformations were performed and reviewed on PACS. DOSE: Acquisition sequence: 1) Stationary Acquisition 6.0 s, 0.5 cm; CTDIvol = 28.9 mGy (Body) DLP = 14.4 mGy-cm. 2) Spiral Acquisition 6.4 s, 50.6 cm; CTDIvol = 19.7 mGy (Body) DLP = 997.8 mGy-cm. Total DLP (Body) = 1,012 mGy-cm. COMPARISON: Outside study dated ___ FINDINGS: LOWER CHEST: There is bibasilar atelectasis, left worse than right. ABDOMEN: HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There is no evidence of focal lesions. There is mild intrahepatic and extrahepatic biliary dilatation, likely secondary prior cholecystectomy. The gallbladder is surgically absent. 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 solid renal lesions or hydronephrosis. A nonobstructing left renal stone is noted measuring approximately 7 mm in diameter (series 601: Image 42) there is no perinephric abnormality. GASTROINTESTINAL: A moderate compound hiatal hernia is noted. Small bowel loops demonstrate normal caliber, wall thickness, and enhancement throughout. There is a large stool burden. Diverticulosis of the sigmoid colon is noted, without evidence of wall thickening or fat stranding. The appendix is not visualized. PELVIS: The urinary bladder and distal ureters are unremarkable. There is no free fluid in the pelvis. REPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable. LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There is no pelvic or inguinal lymphadenopathy. VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease is noted. An IVC filter is demonstrated. BONES: There is no evidence of worrisome osseous lesions or acute fracture. Patient is status post left hip total arthroplasty. There are multilevel degenerative changes. SOFT TISSUES: The abdominal and pelvic wall is within normal limits. IMPRESSION: 1. No acute findings in the abdomen or pelvis. 2. Nonobstructing left renal calculi. No hydronephrosis 3. Moderate compound hiatal hernia. 4. Diverticulosis without evidence of diverticulitis. 5. Large stool burden.
10109613-RR-49
10,109,613
20,466,771
RR
49
2134-03-10 00:58:00
2134-03-10 03:51:00
EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD INDICATION: History: ___ with AMS // eval for ic bleed 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, 16.4 cm; CTDIvol = 48.9 mGy (Head) DLP = 802.7 mGy-cm. Total DLP (Head) = 803 mGy-cm. COMPARISON: Multiple priors, most recently MR head ___, CT head ___ FINDINGS: There is no evidence of fracture, acute large territory infarct infarction,hemorrhage,edema,or mass effect. There is subtle volume loss of the right frontal lobe (series 2, image 11 and anterior right temporal lobe (series 2, image 12). There is prominence of the ventricles and sulci suggestive of involutional changes. Periventricular deep white matter hypodensities are nonspecific, but most likely related to chronic small vessel ischemia. The visualized portion of the paranasal sinuses, mastoid air cells, and middle ear cavities are clear. The visualized portion of the orbits are unremarkable. Incidental note is made of a metopic suture. IMPRESSION: 1. No acute intracranial abnormality on noncontrast CT head. Specifically, no evidence of acute large territory infarct or intracranial hemorrhage. 2. Subtle volume loss of the right frontal and anterior right temporal lobes (series 11 and 12 respectively), compatible with encephalomalacia, potentially sequela of prior infarct. 3. Additional findings described above.
10109899-RR-101
10,109,899
24,741,636
RR
101
2163-10-31 19:12:00
2163-10-31 21:45:00
EXAMINATION: CTA ABD AND PELVIS INDICATION: ___ year old woman with newly found likely adenoCA of pancrease with liver mets, s/p ERCP with Bx, needs staging CTA pancrease and CT chest.// assess for pancreatic CA and mets 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 3.0 s, 33.1 cm; CTDIvol = 14.0 mGy (Body) DLP = 451.2 mGy-cm. 2) Spiral Acquisition 9.8 s, 63.4 cm; CTDIvol = 12.9 mGy (Body) DLP = 807.3 mGy-cm. Total DLP (Body) = 1,259 mGy-cm. COMPARISON: None. FINDINGS: PANCREATIC CANCER STAGING: Morphologic Evaluation Appearance (in the pancreatic parenchymal phase): hypoattenuating Size (maximal axial dimension in cm): 4 cm Location (head right of SMV, body left of SMV): head/uncinate Pancreatic duct narrowing/abrupt cutoff with or without upstream dilatation: present Biliary tree abrupt cutoff with or without upstream dilatation: present, CBD stent in place Arterial evaluation SMA involvement: present Solid soft-tissue contact: >180° Increased hazy attenuation/stranding contact: >180° Focal vessel narrowing or contour irregularity: present Extension to first SMA branch: present Celiac Axis involvement: absent Common hepatic artery involvement: absent Variant anatomy: none Venous evaluation MPV involvement: absent SMV involvement: present Degree of solid soft-tissue contact: >180° Degree of increased hazy attenuation/stranding contact: >180° Focal vessel narrowing or contour irregularity (tethering or tear drop): present Extension to first draining vein: present Thrombus within vein: absent Venous collaterals: absent Extrapancreatic evaluation Liver lesions: suspicious Peritoneal or omental nodules: absent Ascites: absent Suspicious lymph nodes: SMA Other extrapancreatic disease (invasion of adjacent structures): Pancreatic mass is inseparable from the second/third portion of the duodenum. ABDOMEN: HEPATOBILIARY: There are numerous ill-defined hypodense lesions throughout the liver highly concerning for metastatic disease. Index lesions are as follows: 2.5 cm lesion in segment 2 (series 6, image 66) 1.6 cm lesion in segment 5 (series 6, image 77) There is mild intrahepatic biliary duct dilatation predominantly in the left lobe. CBD stent is in place. A pneumobilia indicates stent patency. The gallbladder is not distended. However, there is mild thickening of the gallbladder wall which may be secondary to recent CBD stent insertion. PANCREAS: Please see pancreatic cancer staging above. SPLEEN: The spleen shows normal size and attenuation throughout, without evidence of focal lesions. ADRENALS: The right and left adrenal glands are normal in size and shape. URINARY: The kidneys are of normal and symmetric size with normal nephrogram. There is no evidence of stones, focal renal lesions, or hydronephrosis. There are no urothelial lesions in the kidneys or ureters. There is no perinephric abnormality. GASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness and enhancement throughout. Colon and rectum are within normal limits. RETROPERITONEUM: There are multiple prominent upper retroperitoneal and mesenteric lymph nodes: Gastrohepatic ligament node (series 6, image 78) measures 8 mm Right para-aortic node (series 6, image 96) measures 8 mm Necrotic appearing mesenteric node along the first branch of the SMA (series 6, image 104) measures 11 mm PELVIS: The urinary bladder and distal ureters are unremarkable. There is no evidence of pelvic or inguinal lymphadenopathy. There is no free fluid in the pelvis. REPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable. VASCULAR: There is no abdominal aortic aneurysm. There is moderate calcium burden in the abdominal aorta and great abdominal arteries. BONES: There is no evidence of worrisome osseous lesions or acute fracture. Degenerative changes are noted in the spine. SOFT TISSUES: The abdominal and pelvic wall is within normal limits. LOWER CHEST: Please refer to the separate report of CT chest performed on the same day for description of the thoracic findings. IMPRESSION: 1. Ill-defined pancreatic uncinate mass with locally invasive disease involving the SMA and SMV as detailed above. 2. Numerous ill-defined hypodense lesions throughout the liver are highly concerning for liver metastases. 3. Enlarged upper retroperitoneal and mesenteric lymph nodes some of which appear necrotic.
10109899-RR-102
10,109,899
24,741,636
RR
102
2163-10-31 19:11:00
2163-10-31 21:37:00
EXAMINATION: CT CHEST W/CONTRAST INDICATION: ___ year old woman with newly found likely adenoCA of pancrease with liver mets, s/p ERCP with Bx, needs staging CTA pancrease and CT chest.// assess for mets TECHNIQUE: Multi detector helical scanning of the chest was coordinated with intravenous infusion of nonionic iodinated contrast agent and reconstructed as 5 and 1.25 mm thick axial, 5 mm thick coronal and parasagittal, and 8 mm MIP axial images. All images were reviewed. DOSE: Acquisition sequence: 1) Spiral Acquisition 3.0 s, 33.1 cm; CTDIvol = 14.0 mGy (Body) DLP = 451.2 mGy-cm. 2) Spiral Acquisition 9.8 s, 63.4 cm; CTDIvol = 12.9 mGy (Body) DLP = 807.3 mGy-cm. Total DLP (Body) = 1,259 mGy-cm. ** Note: This radiation dose report was copied from CLIP ___ (CTA ABD AND PELVIS) COMPARISON: ___ FINDINGS: NECK, THORACIC INLET, AXILLAE, CHEST WALL: There is no pathologic enlargement of lymph nodes in the supraclavicular or axillary stations. The breasts which should be evaluated by mammography, else there are no soft tissue abnormalities in the chest wall to suggest chest wall metastasis. CHEST CAGE: Healed fracture of left scapular wing. Multiple healed left rib fractures. Diffuse spondylotic changes are predominantly of mid thoracic level. T7 and T9 degenerative moderate wedge compression fractures are unchanged. No evidence of osteo destructive lesions in the chest cage. UPPER ABDOMEN: Please see separately dictated CT of the abdomen and pelvis for complete description of subdiaphragmatic findings. MEDIASTINUM: There is no pathologic enlargement of lymph nodes in the mediastinum. The esophagus is mildly patulous containing few air-fluid levels, no evidence of hiatal hernia or obstructing masses. 1.5 x 2 cm cystic lesion in the prevascular space is stable. HILA: There is no gross hilar lymphadenopathy. HEART and PERICARDIUM: There are extensive pulmonary emboli involving the lobar, segmental, and subsegmental branches of the right middle and lower lobes as well as the left upper and lower lobes. Thrombi are also likely present in the segmental and subsegmental branches of right upper lobe. Mild expansion of the right ventricle and flattening or slight leftward bowing of the interventricular septum can be seen with right heart strain (series 7, image 154). No pericardial effusion. Pulmonary artery measures 3.4 cm, suggesting pulmonary hypertension, in prior was 3.1 cm. PLEURA: Bilateral trace pleural effusions are unchanged since ___. LUNG: Minimal secretions in the lower trachea. In the lower lobes scattered bronchial impactions and likely secondary subsegmental atelectasis. No evidence of pulmonary infarct, no consolidations to suggest pneumonia. No discernible pulmonary nodules. IMPRESSION: -Extensive pulmonary embolism involving both the right and left main pulmonary arteries extending into the lobar and segmental branches. Right heart strain is suggested. No evidence of pulmonary infarct. -No evidence of intrathoracic metastasis.
10109899-RR-81
10,109,899
24,286,545
RR
81
2162-09-04 13:35:00
2162-09-04 13:47:00
INDICATION: History: ___ with cough and dyspnea // ? PNA TECHNIQUE: AP and lateral chest radiograph COMPARISON: Chest radiograph dated ___ FINDINGS: AP upright and lateral chest radiograph demonstrate low lung volumes with resultant bibasilar atelectasis. Heart size is stable as is mediastinal contours. There is no pneumothorax or pleural effusion. There is no lung consolidation appreciable. No evidence of pulmonary edema. IMPRESSION: Low lung volumes with atelectasis. No convincing evidence to suggest pneumonia.
10109899-RR-82
10,109,899
24,286,545
RR
82
2162-09-05 14:13:00
2162-09-05 16:07:00
EXAMINATION: CT CHEST W/O CONTRAST INDICATION: ___ year old woman with few months history of dyspnea, wheezing, productive cough. No improvement despite 2 courses of antibiotics, oral prednisone as outpatient. Evaluate for etiology. TECHNIQUE: Multi detector helical scanning of the chest was performed without intravenous contrast and reconstructed as contiguous 5 - and 1.25 - mm thick axial, 2.5 - mm thick coronal, sagittal and 8 x 8 mm MIP axial images. DOSE: Acquisition sequence: 1) Spiral Acquisition 4.3 s, 33.5 cm; CTDIvol = 22.3 mGy (Body) DLP = 746.2 mGy-cm. Total DLP (Body) = 746 mGy-cm. COMPARISON: Multiple prior chest radiographs, most recently ___ ; CT torso ___ FINDINGS: NECK, THORACIC INLET, AXILLAE, CHEST WALL: The thyroid is not well evaluated. Unchanged scattered calcifications in visualized portions of the left breast. Prominent, though nonenlarged, bilateral axillary lymph nodes. Extensive calcification of the aorta and its branches. UPPER ABDOMEN: Small hiatus hernia. The esophagus is dilated and contains inspissated food contents. A round 1.0 cm calcific density is present in the stomach, likely representing a swallowed pill. MEDIASTINUM: Prominent, though nonenlarged, mediastinal lymph nodes. No mediastinal mass. HILA: No lymphadenopathy. HEART and PERICARDIUM: Heart size is normal. No pericardial effusion. Scattered LAD and RCA calcifications. No valvular calcifications. PLEURA: No pleural effusion. No pneumothorax. LUNG: 1. PARENCHYMA AND AIRWAYS: Mild upper lobe predominant centrilobular emphysema and mild left paraseptal emphysema. Multiple, new centrilobular ground-glass nodules, consistent with small airway inflammation. Bronchial wall thickening and secretions in the bilateral lower segmental bronchi. No frank bronchiectasis. There is right lower lobe atelectasis, which could be related to diaphragmatic/phrenic nerve dysfunction. 2. VESSELS: No evidence of pulmonary embolism on this non PE protocol study. CHEST CAGE: No acute fractures. Unchanged T7 anterior compression deformity with approximately 50% height loss (602 B/68) and T9 anterior compression deformity with approximately 40% height loss (602 B/ 70). Unchanged 0.7 cm sclerotic focus in the right lateral third rib (___). Unchanged multiple bilateral rib fractures. Extensive degenerative changes of the visualized spine. IMPRESSION: 1. Multiple new centrilobular ground-glass nodules and bilateral lower lobe segmental bronchial wall thickening and secretions, consistent with small airway inflammation. Recommend correlation for asthma and/or allergies. 2. No evidence of interstitial lung disease, central obstructing lesion or pulmonary edema. 3. Right lower lobe atelectasis, could be related to diaphragmatic/phrenic nerve dysfunction. Consider sniff test for further evaluation. RECOMMENDATION(S): Consider sniff test for further evaluation of right hemidiaphragm function.
10109899-RR-96
10,109,899
22,481,282
RR
96
2163-09-22 13:44:00
2163-09-22 14:43:00
INDICATION: History: ___ with constipation presenting with abdominal distention.// Rule out fecal impaction. Evaluate bowel distension. TECHNIQUE: Frontal and cross-table lateral views of the abdomen COMPARISON: Radiographs from ___ and CT abdomen pelvis from ___. FINDINGS: Mildly dilated loop of small bowel projecting over the left upper abdomen is grossly unchanged since ___. Otherwise, there are no abnormally dilated small or large bowel in the abdomen. Fecal loading is moderate to severe throughout the colon. Supine assessment limits detection for free air; there is no gross pneumoperitoneum. Osseous structures are notable for moderate degenerative changes of the lower lumbar spine. There are no unexplained soft tissue calcifications or radiopaque foreign bodies. IMPRESSION: Stable mildly dilated loop of small bowel in the left upper abdomen since ___. Moderate to severe stool volume throughout the colon.
10109899-RR-97
10,109,899
22,481,282
RR
97
2163-09-23 08:57:00
2163-09-23 09:54:00
EXAMINATION: CHEST (AP AND LAT) INDICATION: ___ with hypoxia// ?pneumonia COMPARISON: ___ and CT from ___ FINDINGS: AP upright and lateral views of the chest provided. Lung volumes are low. Atelectasis is again noted in the lower lungs, right greater than left. Difficult to exclude a superimposed pneumonia in the correct clinical setting. No large effusion or pneumothorax. Overall cardiomediastinal silhouette appears grossly unchanged. Bony structures appear intact. Chronic left-sided ribcage and left scapular deformity unchanged. IMPRESSION: Bibasilar opacities likely atelectasis, difficult to exclude a superimposed pneumonia in the correct clinical setting.
10110107-RR-21
10,110,107
23,646,062
RR
21
2138-10-06 12:57:00
2138-10-06 13:43:00
INDICATION: ___ with post arrest// Post arrest TECHNIQUE: Single supine portable view of the chest. COMPARISON: None. FINDINGS: Endotracheal tube tip is 3.1 cm from the carina. Enteric tube passes below the field of view. Lung volumes are low. There is no focal consolidation, large effusion or edema. Cardiomediastinal silhouette is within normal limits. No displaced fractures. IMPRESSION: Support lines and tubes appropriately positioned. No acute cardiopulmonary process.
10110107-RR-22
10,110,107
23,646,062
RR
22
2138-10-06 14:19:00
2138-10-06 15:08:00
EXAMINATION: CTA CHEST WITH CONTRAST INDICATION: ___ status post cardiac arrest. 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 3.0 s, 0.5 cm; CTDIvol = 18.2 mGy (Body) DLP = 9.1 mGy-cm. 2) Spiral Acquisition 3.6 s, 28.1 cm; CTDIvol = 17.1 mGy (Body) DLP = 479.4 mGy-cm. Total DLP (Body) = 488 mGy-cm. COMPARISON: None 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, pericardium, and great vessels are within normal limits. No pericardial effusion is seen. AXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar lymphadenopathy is present. No mediastinal mass. PLEURAL SPACES: No pleural effusion or pneumothorax. LUNGS/AIRWAYS: The distal tip of an endotracheal projects approximately 3 cm above the carina. There is atelectasis of the right lower lobe. Lungs are otherwise clear without masses or areas of parenchymal opacification. A small amount of mucous is seen at the carina without evidence for obstruction (02:27). The airways are otherwise patent to the level of the segmental bronchi bilaterally. BASE OF NECK: Visualized portions of the base of the neck show no abnormality. ABDOMEN: An enteric tube is partially imaged. Partly imaged stomach appears mildly distended. BONES: No suspicious osseous abnormality is seen.? There is no acute fracture. Mild degenerative changes of the imaged cervicothoracic spine. IMPRESSION: 1. No evidence of pulmonary embolism or aortic abnormality. 2. Right lower lobe atelectasis. 3. Appropriately positioned endotracheal tube. Partly imaged, mildly distended stomach. Partially imaged enteric tube.
10110107-RR-23
10,110,107
23,646,062
RR
23
2138-10-06 14:19:00
2138-10-06 14:43:00
EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD INDICATION: ___ male status post cardiac arrest. TECHNIQUE: Contiguous axial images of the brain were obtained without contrast. Coronal and sagittal reformations as well as bone algorithm reconstructions were provided and reviewed. DOSE: Acquisition sequence: 1) Sequenced Acquisition 16.0 s, 17.3 cm; CTDIvol = 46.5 mGy (Head) DLP = 802.7 mGy-cm. Total DLP (Head) = 803 mGy-cm. COMPARISON: None. FINDINGS: There is no evidence of acute infarction,hemorrhage,edema, or mass. The ventricles and sulci are normal in size and configuration. Approximately 1 cm left frontal extra-axial calcified structure is noted (02:17; 601:20). There is no evidence of fracture. There is a small amount of fluid layering in the right posterior sphenoid sinus. Bilateral ethmoid air cell minimal coastal thickening is present. Findings may be related intubation status. IMPRESSION: 1. No acute intracranial abnormality. Please note MRI of the brain is more sensitive for the detection of acute infarct. 2. Approximate 1 cm left frontal extra-axial calcified structure. While finding may represent dural calcification, calcified meningioma is not excluded on the basis of this examination.
10110107-RR-24
10,110,107
23,646,062
RR
24
2138-10-07 10:09:00
2138-10-07 11:34:00
EXAMINATION: CHEST (PORTABLE AP) INDICATION: ___ year old man with DM2, s/p cardiac arrest// Interval change TECHNIQUE: Chest AP COMPARISON: ___ IMPRESSION: The ET and NG tube has been removed. Lungs are low volume with bibasilar atelectasis. Cardiomediastinal silhouette is stable. There is no pleural effusion. No pneumothorax.
10110107-RR-25
10,110,107
23,646,062
RR
25
2138-10-10 13:58:00
2138-10-10 14:47:00
EXAMINATION: CHEST (PORTABLE AP) INDICATION: ___ year old man s/p PEA arrest, now with rising white counts and AMS.// Consolidation consistent with PNA or other infectious process? Consolidation consistent with PNA or other infectious process? IMPRESSION: Comparison to ___. No relevant change is seen. Minimal left basilar atelectasis. No pleural effusions. No pneumonia, no pulmonary edema. Borderline size of the cardiac silhouette. No pneumothorax.