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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.
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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.
|
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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. ___.
|
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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.
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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.
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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.
|
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| 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.
|
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