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19872265-RR-11
| 19,872,265 | 27,756,047 |
RR
| 11 |
2127-06-25 12:00:00
|
2127-06-25 17:40:00
|
EXAMINATION: MRI CERVICAL, THORACIC, AND LUMBAR PT22 MR SPINE
INDICATION: ___ year old man with polyradiculopathy, myelopathy, foot drop
bilaterally, diminished reflexes// Bilateral weakness, polyradiculopathy,
diminished reflexes Bilateral weakness, polyradiculopathy, diminished
reflexes polyradiculopathy
polyradiculopathy
TECHNIQUE: Sagittal imaging was performed with T2, T1, and IDEAL technique.
Axial T2 imaging was performed. Axial GRE images of the cervical spine were
performed.
COMPARISON: CT abdomen and pelvis ___
Chest radiographs ___
FINDINGS:
CERVICAL: Cervical vertebral body height and alignment are preserved. There
are degenerative endplate changes throughout the cervical spine. No
suspicious bone marrow signal abnormality is identified.
The cervical spinal cord appears normal in morphology and signal intensity.
At C2-3, there is moderate spinal canal narrowing due to a broad-based disc
protrusion and ligamentum flavum thickening. There is moderate right and mild
left neural foraminal narrowing due to uncovertebral joint arthropathy.
At C3-4, there is a mild spinal canal narrowing due to a broad-based disc
osteophyte complex. Uncovertebral and facet joint arthropathy result in
severe bilateral neural foraminal narrowing.
At C4-5, there mild spinal canal narrowing due to a broad-based disc
osteophyte complex. Uncovertebral and facet joint arthropathy result in
severe bilateral neural foraminal narrowing.
At C5-6, there is moderate spinal canal narrowing due to broad-based disc
osteophyte complex and ligamentum flavum thickening. Uncovertebral and facet
joint arthropathy result in severe bilateral neural foraminal narrowing.
At C6-7, there is severe spinal canal narrowing with flattening of the cord
due to a broad-based disc osteophyte complex and ligamentum flavum thickening.
Uncovertebral and facet joint arthropathy result in severe bilateral neural
foraminal narrowing.
At C7-T1, there is mild spinal canal narrowing due to a broad-based disc
osteophyte complex. Uncovertebral and facet joint arthropathy result in
severe bilateral neural foraminal narrowing.
The prevertebral and paraspinal soft tissues are unremarkable.
THORACIC: Thoracic vertebral body height and alignment are preserved. There
are degenerative endplate changes throughout the thoracic spine. No
suspicious bone marrow signal abnormality is identified.
The thoracic spinal cord appears normal in morphology and signal intensity.
There is moderate spinal canal narrowing at T9-10 due to a broad-based disc
protrusion and ligamentum flavum thickening. There is mild narrowing of the
levels due to small disc protrusions. There is moderate to severe bilateral
neural foraminal narrowing at T9-10 due to facet arthropathy.
There is a 6 mm focus within the spleen that appears hyperintense on T2
weighted images, indeterminate although likely a benign acquired cyst. A 1.7
cm right sided epidermal inclusion cyst at the T11-T12 level is also noted
(series 11, image 14)..
The prevertebral and paraspinal soft tissues are otherwise unremarkable.
LUMBAR: Lumbar vertebral body height is preserved. There is mild degenerative
spondylolisthesis at L4-5. There are degenerative endplate changes with
severe loss of disc height at L1-2 and L2-3. No suspicious bone marrow signal
abnormality is identified.
The conus medullaris terminates at the T12-L1 level. The conus medullaris
appears normal in morphology and signal intensity. There is undulation of the
cauda equina nerve roots due to spinal stenosis as detailed below.
At T12-L1, there is no spinal canal or neural foraminal narrowing.
At L1-2, there is severe spinal canal narrowing due to a disc bulge with a
superimposed left paracentral disc extrusion with inferior migration,
ligamentum flavum thickening, and facet arthropathy. There is severe left
subarticular zone narrowing with impingement on the traversing left L2 nerve
root. There is moderate bilateral neural foraminal narrowing.
At L2-3, there is severe spinal canal narrowing due to a disc bulge,
ligamentum flavum thickening, and facet arthropathy. There is impingement on
the traversing bilateral L3 nerve roots due to subarticular zone narrowing.
There is severe bilateral neural foraminal narrowing.
At L3-4, there is a severe spinal canal narrowing due to a disc bulge,
ligamentum flavum thickening, and facet arthropathy. There is impingement on
the traversing bilateral or nerve roots within the subarticular zone. There
is severe bilateral neural foraminal narrowing.
At L4-5, there is very severe spinal canal narrowing due to a disc bulge,
ligamentum flavum thickening, and facet arthropathy. There is impingement on
the traversing bilateral L5 and likely other nerve roots. There is severe
bilateral neural foraminal narrowing.
At L5-S1, there is mild spinal canal narrowing and facet arthropathy. There
is possible impingement on the traversing left S1 nerve root within the
subarticular zones. There is very severe bilateral neural foraminal
narrowing.
There is mild degenerative change at the bilateral sacroiliac joints.
There are several subcentimeter lesions within the kidneys that appear
hyperintense on T2 weighted images, indeterminate although likely simple
cysts.
The prevertebral and paraspinal soft tissues are otherwise unremarkable.
IMPRESSION:
1. Lumbar degenerative disc disease with severe spinal canal narrowing at
L1-2, L2-3, L3-4, and L4-5, most severe at L4-5 with impingement of nerve
roots at multiple levels as detailed above.
2. Cervical degenerative disc disease, with severe spinal canal narrowing at
C5-6 and moderate canal narrowing at other levels as detailed above. There is
severe neural foraminal narrowing at multiple levels.
3. Thoracic degenerative disc disease, with moderate spinal canal and neural
foraminal narrowing at T9-10.
4. Additional findings as described above.
|
19872420-RR-38
| 19,872,420 | 28,072,410 |
RR
| 38 |
2138-04-09 14:25:00
|
2138-04-09 15:49:00
|
EXAMINATION: CT abdomen pelvis with contrast
INDICATION: +PO contrast; History: ___ with history of SBO presenting with
abdominal pain similar to prior episode of SBO. +PO contrast// evaluation of
SBO
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were
acquired through the abdomen and pelvis following intravenous contrast
administration with split bolus technique.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Stationary Acquisition 4.0 s, 0.5 cm; CTDIvol = 19.3 mGy (Body) DLP =
9.6 mGy-cm.
2) Spiral Acquisition 6.2 s, 48.6 cm; CTDIvol = 18.4 mGy (Body) DLP = 895.9
mGy-cm.
Total DLP (Body) = 905 mGy-cm.
COMPARISON: CT abdomen pelvis dated ___.
FINDINGS:
LOWER CHEST: Visualized lung fields are within normal limits. There is no
evidence of pleural or pericardial effusion.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There is no evidence of focal lesions. There is no evidence of intrahepatic
or extrahepatic biliary dilatation. The gallbladder is within normal limits.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
Subcentimeter hypodensity in the interpolar left kidney is too small to
characterize, however, this likely represents a simple renal cyst. There is
no evidence of suspicious focal renal lesions or hydronephrosis. There is no
perinephric abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Similar to prior, there is a
small bowel obstruction with transition point in the right lower quadrant
(601:29) at the proximal ileum. Proximal to the site of transition, there is
an approximately 25 cm long segment of fecalized, edematous small bowel with
wall hyperemia, adjacent fat stranding and prominence of the Vasa recta.
These findings suggest acute inflammation, however, ischemia cannot be
excluded. Approximately 6 cm proximal to the transition point, there is an
area of mild focal narrowing (601:30), however, on this single static image it
is difficult to determine if this is a truly fixed point of narrowing. Distal
to the transition point there is an additional 10 cm segment of small bowel
that is relatively decompressed, however, this also demonstrates wall
hyperemia and edema as well as adjacent fat stranding. Distal ileum is
decompressed.
The colon and rectum are within normal limits. The appendix is normal.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is a
trace amount of free fluid (02:54).
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. No atherosclerotic disease
is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
There is a Schmorl's node in the inferior endplate of the T10 vertebral body
(2:7).
SOFT TISSUES: There is a tiny fat containing umbilical hernia.
IMPRESSION:
Small-bowel obstruction with transition point in the proximal ileum in the
right lower quadrant, similar to the prior exam. There is an approximately 25
cm long segment of small bowel wall proximal to the transition point as well
an approximately 10 cm segment of small bowel distal to the transition point
that demonstrates bowel wall and mesenteric edema with mucosal hyperemia and
adjacent stranding suggestive of inflammation. However, bowel ischemia cannot
be excluded. Surgical consultation is advised.
RECOMMENDATION(S): Recommend surgical consult.
|
19872420-RR-39
| 19,872,420 | 28,072,410 |
RR
| 39 |
2138-04-10 01:17:00
|
2138-04-10 07:53:00
|
INDICATION: ___ year old man with SBO, s/p NGT placement// eval for NGT
placement
TECHNIQUE: Chest AP view
COMPARISON: ___
IMPRESSION:
Lungs are well expanded with subsegmental atelectasis in the right lung base.
Heart size is normal. The NG tube projects over the stomach. There is no
pleural effusion. No pneumothorax is seen
|
19873349-RR-10
| 19,873,349 | 22,001,531 |
RR
| 10 |
2120-08-29 01:26:00
|
2120-08-29 02:40:00
|
EXAMINATION: CTA chest
INDICATION: ___ with cough,fever, hemopytsis// r/o pe, malignancy, pna
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 2.5 s, 0.5 cm; CTDIvol = 15.2 mGy (Body) DLP =
7.6 mGy-cm.
2) Spiral Acquisition 4.6 s, 36.6 cm; CTDIvol = 11.8 mGy (Body) DLP = 430.1
mGy-cm.
Total DLP (Body) = 438 mGy-cm.
COMPARISON: No relevant comparison identified
FINDINGS:
The aorta and its major branch vessels are patent, with no evidence of
stenosis, occlusion, dissection, or aneurysmal formation. There is no
evidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.
The pulmonary arteries are well opacified to the subsegmental level. The main
and right pulmonary arteries are normal in caliber, and there is no evidence
of right heart strain.
There is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy.
The thyroid gland appears unremarkable.
There is no evidence of pericardial effusion. There is a small left-sided
pleural effusion.
There is a large, dense focal consolidation with air bronchograms in the left
lower lobe suggestive of acute lobar pneumonia. There are multiple
ground-glass opacities within the lingula and right upper and right middle
lobe, which may represent additional inflammatory/infectious foci. The
airways are patent to the subsegmental level.
Limited images of the upper abdomen are unremarkable.
No lytic or blastic osseous lesion suspicious for malignancy is identified.
IMPRESSION:
No evidence of pulmonary embolism or acute aortic abnormality. Large, dense
focal consolidation with air bronchograms in the left lower lobe suggestive of
acute lobar pneumonia with an associated small left parapneumonic pleural
effusion. Multiple ground-glass opacities within the lingula and right
upper/middle lobes may represent additional foci of inflammation/infection.
|
19873553-RR-10
| 19,873,553 | 23,523,042 |
RR
| 10 |
2187-07-22 08:29:00
|
2187-07-22 11:00:00
|
EXAMINATION: ABDOMEN US (COMPLETE STUDY)
INDICATION: ___ year old man with multiple myeloma s/p ___ velcade treatment
on ___, presenting from his PCP office for weakness and tachycardia, found
to have sepsis secondary to health care associated pneumonia. Now with rising
LFTs, unclear etiology// assess for CBD dilation, obstruction
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: CTA chest ___.
FINDINGS:
LIVER: The hepatic parenchyma appears within normal limits. The contour of the
liver is smooth. There is no focal liver mass. The main portal vein is patent
with hepatopetal flow. There is no ascites.
BILE DUCTS: There is no intrahepatic biliary dilation.
CHD: 0.6 cm
GALLBLADDER: Apparent wall thickening of the gallbladder is likely secondary
to decompressed state (the patient had not been NPO). No gallstones are
identified.
PANCREAS: The imaged portion of the pancreas appears unremarkable, noting that
portions of the pancreatic body and tail are obscured by overlying bowel gas.
The main pancreatic duct is top normal in caliber, measuring up to 2 mm in the
pancreatic body.
SPLEEN: Normal echogenicity.
Spleen length: 7.7 cm.
KIDNEYS: The kidneys demonstrate normal corticomedullary differentiation and
echogenicity bilaterally. A 0.7 cm hyperechoic focus within the cortex of the
left mid kidney is favored to represent interdigitating fat. No
hydronephrosis.
RETROPERITONEUM: The visualized portions of aorta and IVC are within normal
limits.
IMPRESSION:
1. No biliary ductal dilatation. The common hepatic duct measures 0.6 cm.
2. Underdistended gallbladder, without evidence of cholelithiasis.
|
19873553-RR-11
| 19,873,553 | 23,523,042 |
RR
| 11 |
2187-07-22 17:20:00
|
2187-07-22 19:43:00
|
EXAMINATION: Chest radiographs, PA and lateral.
INDICATION: Multifocal pneumonia. Fever and hypoxia.
COMPARISON: Radiographs from ___.
FINDINGS:
Cardiac, mediastinal and hilar contours appear stable. Opacities in each
upper lobe have improved substantially. Small persistent bilateral pleural
effusions. No visible pneumothorax. Left shoulder arthroplasty.
IMPRESSION:
Improving upper lobe opacities. Small persist pleural effusions.
|
19873553-RR-12
| 19,873,553 | 23,523,042 |
RR
| 12 |
2187-07-23 13:22:00
|
2187-07-23 15:31:00
|
EXAMINATION: CT CHEST W/O CONTRAST
INDICATION: ___ year old man with multifocal pneumonia. Was improving but
developed fever 102, increased O2 requirement, higher LDH. In setting of
immunosuppresants// assess for PJP
TECHNIQUE: MDCT axial images were acquired through the thorax without IV
contrast. Coronal, sagittal, and MIPS reformats reviewed in PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 6.5 s, 34.2 cm; CTDIvol = 7.5 mGy (Body) DLP = 258.9
mGy-cm.
Total DLP (Body) = 259 mGy-cm.
COMPARISON: CT chest from ___
FINDINGS:
NECK, THORACIC INLET, AXILLAE AND CHEST WALL:
The unenhanced thyroid gland appears unremarkable. No enlarged lymph nodes in
either axilla or thoracic inlet. Excluding the breast tissue which requires
mammography for evaluation,there are no abnormalities on the chest wall. No
atherosclerotic calcifications in the head and neck arteries.
HEART AND VASCULATURE:
The heart is normal in size and shape. No pericardial effusion. Severe
coronary artery calcifications. The aorta and pulmonary arteries are normal
in caliber throughout.
MEDIASTINUM AND HILA:
The esophagus is unremarkable. Small mediastinal lymph nodes, none
pathologically enlarged by CT size criteria. No right hilus is somewhat bulky
but no discrete lymphadenopathy within the limitations of a nonenhanced scan.
PLEURA:
Small bilateral nonhemorrhagic pleural effusions, slightly enlarged. Mild
bilateral apical scarring.
LUNGS:
Compared to the study from ___, there is improvement of the
previously seen bilateral ground-glass opacities and peribronchovascular
consolidations predominately in the upper lobes, consistent with resolving
multifocal pneumonia. No new focal consolidation is seen.The airways are
patent to the segmental levels, with evaluation of the smaller airways limited
due to motion.
CHEST CAGE:
No acute fractures. Mild dorsal spondylosis. No suspicious lytic or sclerotic
lesions.
UPPER ABDOMEN:
The limited sections of the upper abdomen show no significant abnormal
findings.
IMPRESSION:
1. Residual but improved bilateral ground-glass opacities and
peribronchovascular consolidations, consistent with resolving multifocal
pneumonia. No new consolidation.
2. Small bilateral nonhemorrhagic pleural effusions are slightly worsened.
3. Severe coronary artery calcifications.
|
19873553-RR-13
| 19,873,553 | 23,523,042 |
RR
| 13 |
2187-07-24 17:23:00
|
2187-07-24 18:35:00
|
EXAMINATION: CT SINUS/MANDIBLE/MAXILLOFACIAL W/O CONTRAST Q116 CT HEADSINUS
INDICATION: ___ year old man with MM recent overdose of steroids, received
Velcade- now with fungus (mucor-like species) on sputum cx, has elevated
Beta-glucan// r/o mucor, fungal sinusitis
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, 22.0 cm; CTDIvol = 27.2 mGy (Head) DLP = 581.4
mGy-cm.
Total DLP (Head) = 581 mGy-cm.
COMPARISON: None.
FINDINGS:
There is partial opacification of the right maxillary sinus layering fluid of
intermediate attenuation. There is mild mucosal thickening of the bilateral
anterior ethmoid air cells. The frontal and sphenoid sinuses are clear.
Ostiomeatal units appear patent.
There is no evidence of facial swelling. There is no evidence of abnormal
fluid collections. Bilateral mastoids appear normal. Status post bilateral
lens replacement; the globes, extraocular muscles, optic nerves, and
retrobulbar fat otherwise appear normal. The visualized upper aerodigestive
tract appears normal. The mandible and temporomandibular joints appear
normal.
Bilateral supraclinoid internal carotid artery vascular calcifications are
noted.
IMPRESSION:
Air-fluid level in the right maxillary sinus which is a finding that can
reflect acute sinusitis in the appropriate setting. Intermediate attenuation
fluid but lacking the type of high-density appearance that has somewhat more
specificity for fungal involvement. However fungal sinusitis is a
possibility. Mild anterior ethmoid air cells mucosal thickening. No bone
destruction.
|
19873553-RR-8
| 19,873,553 | 23,523,042 |
RR
| 8 |
2187-07-18 21:13:00
|
2187-07-18 21:56:00
|
INDICATION: ___ yo M pmhx MM here with fevers and URI symptoms, spiked a temp
eval for developing PNA// ___ yo M pmhx MM here with fevers and URI symptoms,
spiked a temp eval for developing PNA
TECHNIQUE: PA and lateral views the chest.
COMPARISON: Chest x-ray from ___.
FINDINGS:
Since yesterday, there has been development of right perihilar opacity.
Blunting of the posterior costophrenic angle suspicious for small pleural
effusions. Cardiomediastinal silhouette is stable given differences in
positioning, patient is slightly rotated to the right. Left shoulder
arthroplasty is noted. Superior endplate height loss noted in the upper
lumbar spine.
IMPRESSION:
Interval development of right perihilar opacity since yesterday's exam likely
localizing to the right upper lobe. This could be due to blossoming of an
infection.
|
19873553-RR-9
| 19,873,553 | 23,523,042 |
RR
| 9 |
2187-07-19 04:36:00
|
2187-07-19 05:16:00
|
EXAMINATION: CTA CHEST WITH CONTRAST
INDICATION: ___ year old man with myeloma on chemotherapy with tachycardia,
hypoxia, troponin leak// r/o pulmonary embolus
TECHNIQUE: Axial multidetector CT images were obtained through the thorax
after the uneventful administration of intravenous contrast. Reformatted
coronal, sagittal, thin slice axial images, and oblique maximal intensity
projection images were submitted to PACS and reviewed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 0.5 s, 0.2 cm; CTDIvol = 9.2 mGy (Body) DLP = 1.8
mGy-cm.
2) Stationary Acquisition 7.1 s, 0.2 cm; CTDIvol = 120.3 mGy (Body) DLP =
24.1 mGy-cm.
3) Spiral Acquisition 4.9 s, 31.7 cm; CTDIvol = 7.0 mGy (Body) DLP = 217.1
mGy-cm.
Total DLP (Body) = 243 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. Moderate to severe coronary
artery calcifications noted.
AXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar
lymphadenopathy is present. No mediastinal mass.
PLEURAL SPACES: Moderate bilateral pleural effusions with associated
compressive atelectasis. No pneumothorax.
LUNGS/AIRWAYS: Bilateral ground-glass opacities and peribronchovascular
consolidations predominantly in the right upper lobe. Mild pulmonary edema.
The airways are patent to the level of the segmental bronchi bilaterally.
BASE OF NECK: Visualized portions of the base of the neck show no abnormality.
ABDOMEN: Included portion of the upper abdomen is unremarkable.
BONES: No suspicious osseous abnormality is seen.? There is no acute fracture.
IMPRESSION:
No evidence of pulmonary embolism or aortic abnormality given the motion
artifact limitations.
Bilateral ground-glass opacity and peribronchovascular consolidations
predominantly in the right upper lobe are concerning for multifocal pneumonia.
|
19873891-RR-15
| 19,873,891 | 23,955,728 |
RR
| 15 |
2128-04-17 14:35:00
|
2128-04-17 18:07:00
|
INDICATION: ___ year old woman with metastatic carcinoid // Diagnostic and
therapeutic para
TECHNIQUE: Ultrasound guided diagnostic and therapeutic paracentesis
COMPARISON: Abdominal ultrasound dated ___
FINDINGS:
Limited grayscale ultrasound imaging of the abdomen demonstrated moderate
ascites. A suitable target in the deepest pocket in the right lower quadrant
was selected for paracentesis.
PROCEDURE: The procedure, risks, benefits and alternatives were discussed
with the patient and written informed consent was obtained from the healthcare
proxy.
A preprocedure time-out was performed discussing the planned procedure,
confirming the patient's identity with 3 identifiers, and reviewing a
checklist per ___ protocol.
Under ultrasound guidance, an entrance site was selected and the skin was
prepped and draped in the usual sterile fashion. 1% lidocaine was instilled
for local anesthesia.
A 5 ___ catheter was advanced into the largest fluid pocket in the right
lower quadrant and 2.4 L of clear, straw-colored fluid was removed. Fluid
samples were submitted to the laboratory for cell count, differential,
culture, and cytology.
The patient tolerated the procedure well without immediate complication.
Estimated blood loss was minimal.
Dr. ___ supervised the trainee during the key components of the
procedure and reviewed and agrees with the trainee's findings.
IMPRESSION:
Technically successful ultrasound-guided diagnostic and therapeutic
paracentesis yielding 2.4 L of clear yellow fluid from the right lower
quadrant. Samples were sent to the lab as requested.
|
19873891-RR-16
| 19,873,891 | 23,955,728 |
RR
| 16 |
2128-04-16 17:00:00
|
2128-04-16 17:35:00
|
EXAMINATION: CHEST (AP AND LAT)
INDICATION: ___ with metastatic pancreatic neuroendocrine CA p/w altered
mental status
COMPARISON: ___ and chest CT from ___.
FINDINGS:
AP upright and lateral views of the chest provided. There is a small left
pleural effusion with compressive atelectasis in the left lower lung. A tiny
right pleural effusion is also noted. The right lung is clear.
Cardiomediastinal silhouette is normal. Bony structures are intact. A CBD
metallic stent projects over the right upper quadrant. Clips are noted in the
upper abdominal midline. No free air below the right hemidiaphragm.
Gas-filled loops of small bowel in the upper abdomen noted, question mild
ileus.
IMPRESSION:
Pleural effusions, left greater than right, both small. Possible mild
adynamic ileus in the upper abdomen. Please correlate clinically.
|
19873891-RR-17
| 19,873,891 | 23,955,728 |
RR
| 17 |
2128-04-16 16:42:00
|
2128-04-16 17:14:00
|
EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ with metastatic pancreatic neuroendocrine CA p/w altered
mental status
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: Total DLP (Head) = 903 mGy-cm.
COMPARISON: None.
FINDINGS:
The study is degraded by motion artifact. There is no evidence of acute
major infarction, hemorrhage, edema, or large mass. The ventricles and sulci
are normal in size and configuration. No osseous abnormalities seen. The
paranasal sinuses, mastoid air cells, and middle ear cavities are clear. The
orbits are unremarkable.
IMPRESSION:
No acute intracranial process. CT with contrast or MRI would be more
sensitive for assessment of intracranial mass lesions.
|
19873891-RR-18
| 19,873,891 | 23,955,728 |
RR
| 18 |
2128-04-16 17:21:00
|
2128-04-16 19:14:00
|
EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ with met pancreatic CA and portal vein thrombosis, presenting
with altered mental status // eval for acute process, ?resolution/progression
of portal vein thrombosis
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: MRI of the abdomen dated ___ and is CT of the abdomen
pelvis dated ___.
FINDINGS:
LIVER: The liver is diffusely echogenic. The contour of the liver is nodular,
consistent with cirrhosis. There is no focal liver mass. No definite flow is
identified within the main portal vein, although assessment is limited due to
poor sonographic window. Flow within vasculature in the porta hepatis is
likely a dampened waveform within the hepatic artery. There is a large amount
of ascites.
BILE DUCTS: There is no intrahepatic biliary dilation. A common bile duct
stent is present.
SPLEEN: Normal echogenicity, measuring 11 cm.
KIDNEY: Limited views of the right kidney appear grossly unremarkable.
RETROPERITONEUM: Visualized portions of aorta and IVC are within normal
limits.
IMPRESSION:
1. Cirrhosis, with sequela of portal hypertension, including large ascites.
2. No definite flow is seen within the main portal vein.
|
19873891-RR-19
| 19,873,891 | 23,955,728 |
RR
| 19 |
2128-04-20 14:29:00
|
2128-04-20 15:56:00
|
INDICATION: ___ year old woman with neuroendocrine pancreatic cancer with
cirrhosis c/b SPB on ceftriaxone. Needs therapeutic para for discomfort.
Please only remove 3L and send cell count and cytology for work up. Please
send a large bottle for cytology.
TECHNIQUE: Ultrasound guided diagnostic and therapeutic paracentesis.
COMPARISON: Paracentesis dated ___
FINDINGS:
Limited grayscale ultrasound imaging of the abdomen demonstrated a large
amount of ascites. A suitable target in the deepest pocket in the right lower
quadrant was selected for paracentesis.
PROCEDURE: The procedure, risks, benefits and alternatives were discussed
with the patient and written informed consent was obtained.
A preprocedure time-out was performed discussing the planned procedure,
confirming the patient's identity with 3 identifiers, and reviewing a
checklist per ___ protocol.
Under ultrasound guidance, an entrance site was selected and the skin was
prepped and draped in the usual sterile fashion. 1% lidocaine was instilled
for local anesthesia.
A 5 ___ catheter was advanced into the largest fluid pocket in the right
lower quadrant and 3 L of clear, straw-colored fluid was removed. Fluid
samples were submitted to the laboratory for cell count, differential,
culture, and cytology.
The patient tolerated the procedure well without immediate complication.
Estimated blood loss was minimal.
Dr. ___ supervised the trainee during the key components of the
procedure and reviewed and agrees with the trainee's findings.
IMPRESSION:
Technically successful ultrasound guidance guided diagnostic and therapeutic
paracentesis yielding 3 L of clear yellow fluid from the right lower quadrant.
A sample was sent for a labs and a large bottle was sent to cytology as
requested.
|
19874138-RR-15
| 19,874,138 | 28,761,606 |
RR
| 15 |
2189-10-08 08:48:00
|
2189-10-08 10:12:00
|
INDICATION: ___ male with finger pain, rule out fracture.
COMPARISONS: None.
TECHNIQUE: Three views of the right hand were provided.
FINDINGS: There is no acute fracture, dislocation, or degenerative change.
No suspicious lytic or sclerotic lesions are identified. There is no soft
tissue calcification or radiopaque foreign body.
IMPRESSION: No acute fracture.
|
19874138-RR-16
| 19,874,138 | 28,761,606 |
RR
| 16 |
2189-10-08 12:26:00
|
2189-10-08 13:37:00
|
INDICATION: ___ man with history of alcohol abuse with change in
mental status.
COMPARISON: No relevant comparisons available.
TECHNIQUE: Non-contrast MDCT axial images were acquired through the head.
Coronal and sagittal regions were obtained for evaluation.
FINDINGS: There is no evidence of hemorrhage, edema, mass effect or
infarction. Basal cisterns are patent. There is no shift of normally midline
structures. Gray-white matter differentiation is preserved. The globes and
orbits are unremarkable. No osseous abnormality is identified. Secretions
are seen within the posterior and left nasal cavities with mucosal thickening
in the left maxillary sinus and ethmoid air cells. The middle ear cavities
are clear.
IMPRESSION:
Normal study.
|
19874288-RR-11
| 19,874,288 | 23,162,562 |
RR
| 11 |
2147-06-17 15:53:00
|
2147-06-17 21:31:00
|
EXAMINATION: MR ___ AND W/O CONTRAST T___ MR SPINE
INDICATION: ___ female with history of L3-4 laminectomy and L4-5
fusion presenting with urinary retention, numbness and leg weakness. Evaluate
for cauda equina.
TECHNIQUE: Sagittal imaging was performed with T2, T1, and STIR technique,
followed by axial T2 imaging. This was followed by sagittal and axial T1
images obtained after the uneventful intravenous administration of 7 mL of
Gadavist contrast agent.
COMPARISON: CT ___ from ___.
FINDINGS:
Vertebral body signal intensity appears normal. There is multilevel disc
desiccation. The spinal cord appears normal in caliber and configuration.
There is posterior fusion at L4-L5. L3-L5 laminectomy changes are seen.
Stable grade 1 anterolisthesis is seen at L4-L5. T2 hyperintense signal is
noted in the bilateral paraspinal muscles. There is a 4.4 cm x 1.2 cm x 1 cm
centrally T2 hyperintense, minimally peripherally enhancing fluid collection
in the posterior paraspinal soft tissues for, at the level of L4-L5 with no
extension into the spinal canal.
At T12-L1 there is no spinal canal or neural foraminal stenosis.
At L1-2 there is no spinal canal or neural foraminal stenosis. Mild facet
arthropathy is seen.
At L2-3 there is no spinal canal or neural foraminal stenosis. Mild facet
arthropathy is seen.
At L3-4 there is no spinal canal or neural foraminal stenosis. Mild enhancing
granulation tissue is noted without significant encroachment into the spinal.
Mild facet arthropathy is seen.
At L4-5 there is mild enhancing granulation tissue which encroaches on the
spinal canal resulting in mild spinal canal narrowing. There is no
significant neural foraminal narrowing.
At L5-S1 there is mild spinal canal stenosis secondary to moderate facet
arthropathy.
There is a 3.6 cm T2 hyperintense nonenhancing cyst in the left anterior lower
renal pole. Multiple partially visualized T2 hyperintense lesions are seen in
the liver.
IMPRESSION:
1. Postsurgical changes at L4-L5 with a 4.4 cm T2 hyperintense, minimally
peripherally enhancing fluid collection in the paraspinal soft tissues at the
level of L4-L5 which may represents a postoperative seroma, hematoma or
potentially early infection.
2. Posterior fusion at L4-L5 with stable grade 1 anterolisthesis of L4 on L5.
No significant spinal canal or neuroforaminal stenosis.
3. T2 hyperintense signal in the bilateral paraspinal muscles, likely
postsurgical changes or denervation injury.
4. Incompletely characterized renal and hepatic cysts.
RECOMMENDATION(S): Point 1: Clinical correlation with CBC is recommended.
Point 4: Correlation with prior imaging is recommended. Further evaluation
with ultrasound or dedicated MRI as clinically indicated.
|
19874288-RR-12
| 19,874,288 | 23,162,562 |
RR
| 12 |
2147-06-18 14:42:00
|
2147-06-18 15:18:00
|
EXAMINATION: L-SPINE (AP,LAT,FLEX,EXT)
INDICATION: ___ year old woman h/o cLBP s/p laminectomy. Admitted with
weakness and urinary retention. Lumbar MRI without evident compression //
intermittent caudal equinal symptoms intermittent caudal equinal symptoms
IMPRESSION:
In comparison with the study of ___, there is little change in the
appearance of the posterior fusion at L4-L5 with laminectomy with no evidence
of hardware-related complication. Mild anterolisthesis at L4-L5 is again
seen. The remainder of the vertebra and intervertebral disc spaces are within
normal limits, though there is apparent osteopenia.
Bilateral total hip prostheses are in place.
|
19874582-RR-2
| 19,874,582 | 25,101,421 |
RR
| 2 |
2120-06-04 20:43:00
|
2120-06-04 22:15:00
|
INDICATION: History: ___ with right lower quadrant tenderness
TECHNIQUE: MDCT axial images were acquired through the abdomen and pelvis
following intravenous contrast administration with split bolus technique.
Coronal and sagittal reformations were performed and reviewed on PACS.
Oral contrast was administered.
DOSE: DLP: 357 mGy-cm (abdomen and pelvis).
IV Contrast: 130 mL Omnipaque
COMPARISON: None.
FINDINGS:
LOWER CHEST: Lung bases are clear. No pleural effusion.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There is no evidence of focal lesions. There is no evidence of intrahepatic or
extrahepatic biliary dilatation. The gallbladder is normal.
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 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. The
appendix is dilated to 8 mm with thickened and hyperemic walls with adjacent
fat stranding (601:28). Appendix does not fill with oral contrast material.
There is no evidence of periappendiceal abscess or perforation. There is no
evidence of mesenteric lymphadenopathy.
RETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. There is no calcium burden in
the abdominal aorta and great abdominal arteries.
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: Prostate and seminal vesicles are unremarkable.
BONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions.
Abdominal and pelvic wall is within normal limits.
IMPRESSION:
Acute uncomplicated appendicitis.
|
19875127-RR-26
| 19,875,127 | 27,651,507 |
RR
| 26 |
2123-04-12 12:21:00
|
2123-04-12 13:03:00
|
CHEST RADIOGRAPHS
HISTORY: Chest pain and shortness of breath.
COMPARISONS: PET-CT from ___ and radiographs from ___, and ___.
TECHNIQUE: Chest, AP upright and lateral.
FINDINGS:
The cardiac, mediastinal and hilar contours appear stable including fullness
of the upper mediastinal contour to the left of midline, reflecting a combined
shadow of the aorta and main pulmonary artery, which is probably borderline
enlarged. This area did not show involvement for malignancy on the prior
PET-CT but the trachea does appear splayed somewhat more towards the right
with a more horizontal configuration to the left main stem bronchus.
Possibly, this could indicate developing mediastinal lymphadenopathy. An
irregular mass at the left lung apex appears unchanged allowing for
differences in technique. Streaky opacities at the left lung base indicates
minor atelectasis or scarring. There is no pleural effusion or pneumothorax.
There are three new mild compression deformities since remote prior
radiographs from ___, although somewhat difficult to compare to
more recent studies such as radiographs from ___, although the
indication is that at least the lower two, which probably relate to the T10
and T11 vertebral bodies, are new since ___ and similar but more
likely increased since the more recent PET-CT dated ___.
IMPRESSION:
1. No evidence of acute cardiopulmonary disease.
2. Mild change in the configuration of the mediastinum, which raises concern
for developing lymphadenopathy.
3. Several mild compression fractures of the thoracic spine, the lower two of
which (probably involving T10 and T11), likely acute or subacute.
|
19875127-RR-27
| 19,875,127 | 27,651,507 |
RR
| 27 |
2123-04-12 15:38:00
|
2123-04-12 16:31:00
|
HISTORY: History primary lung malignancy, now with hypoxia.
TECHNIQUE: Axial helical MDCT images were obtained from the suprasternal
notch to the upper abdomen following the administration of 100 cc of
Omnipaque. Multiplanar reformatted images in coronal and sagittal axes were
generated. Oblique MIPS were prepared in an independent work station.
COMPARISON: Comparison is made to PET-CT dated ___, and CT torso
dated ___.
FINDINGS:
CT THORAX:
Lung windows demonstrate a 5.7 x 4.5 cm left apical lung mass, unchanged
compared to the prior examination. A few scattered small nodules and nodular
densities also appear unchanged.
Severe, bilateral, panlobular emphysematous changes are noted.
No pleural effusion or pneumothorax is present. The airways are patent to the
subsegmental level. Aerosolized secretions are seen within the right mainstem
bronchus.
There is no mediastinal, hilar, or axillary lymph node enlargement by CT size
criteria. Heart, pericardium, and great vessels are within normal limits. No
hiatal hernia. The esophagus is mildly thickened, which may be due to
radiation.
CTA THORAX: The aorta and main thoracic vessels are well opacified. The
aorta demonstrates normal caliber throughout the thorax without intramural
hematoma or dissection. The pulmonary arteries are opacified to the segmental
level. The right and left pulmonary arteries are mildly enlarged. There is no
filling defect to suggest pulmonary embolism.
BONES: Vertebral compression deformities of the T10 and T11 vertebral bodies
are noted, not identified on the prior CT Torso. No focal osseous lesions
concerning for malignancy are seen.
Although this study is not designed for assessment of intra-abdominal
structures, the visualized solid organs and stomach are unremarkable.
Bilateral renal hypodensities are incompletely characterized but likely
represent cysts.
IMPRESSION:
1. No evidence of pulmonary embolism or aortic dissection.
2. Stable 5.7 x 4.5 cm left apical lung mass; small scattered nodules and
nodular densities also appear unchanged.
3. Severe, bilateral, panlobular emphysematous changes.
4. Aerosolized secretions are seen within the right mainstem bronchus.
5. New mild superior endplate compression fractures of T10 and T11, new since
the earlier torso CT and probably new or increased since the more recent
PET-CT study.
|
19875364-RR-36
| 19,875,364 | 21,806,591 |
RR
| 36 |
2174-11-08 12:10:00
|
2174-11-08 13:23:00
|
EXAMINATION: CTA HEAD AND CTA NECK PQ147 CT HEADNECK
INDICATION: ___ year old man with altered mental status, concern for stroke.
TECHNIQUE: Contiguous MDCT axial images were obtained through the brain
without contrast material. Subsequently, helically acquired rapid axial
imaging was performed from the aortic arch through the brain during the
infusion of 70 mL of Omnipaque intravenous contrast material.
Three-dimensional angiographic volume rendered, curved reformatted and
segmented images were generated on a dedicated workstation. This report is
based on interpretation of all of these images.
DOSE: DLP 2315 mGy cm
COMPARISON: Head CT from ___. Head MRI from ___,
___
FINDINGS:
CT HEAD WITHOUT CONTRAST:
Large area of hypodensity in the left parietal, posterior temporal, and
occipital lobes, including the left PCA and MCA territories, is larger than
the diffusion abnormalities in the same distribution on the ___ MRI,
with new effacement of the occipital horn of the left lateral ventricle and
new partial effacement of the atrium and posterior body of the left lateral
ventricle. Small hypodensity in the posterior inferior right frontal lobe on
image 3:14 is new compared to the ___ MRI. There is no shift of
normally midline structures. Prominence of the ventricles is again seen,
compatible with age-related parenchymal volume loss. Basal cisterns are not
compressed. There is no acute hemorrhage.
There is mild mucosal thickening in the ethmoid air cells and inferior frontal
sinuses. Mastoid air cells and middle ear cavities are well aerated.
CTA NECK:
There is a 3 vessel aortic arch. Common carotid arteries are widely patent.
There is mild calcified plaque at the left internal carotid artery origin
without any stenosis by NASCET criteria. Right internal carotid artery is
widely patent without stenosis by NASCET criteria. Bilateral vertebral
arteries are widely patent.
CTA HEAD:
There is mild atherosclerosis involving bilateral carotid siphons without
flow-limiting stenosis. There is no flow-limiting stenosis or aneurysm
involving the major intracranial arteries.
There is relatively paucity of the superficial blood vessels along the left
parietal and occipital lobes. Major dural venous sinuses are patent.
OTHER:
The visualized portion of the lungs are clear. The thyroid gland is grossly
unremarkable. There is no cervical or upper mediastinal lymphadenopathy by CT
size criteria.
Degenerative changes involving the visualized cervical spine are noted. A
preliminary report raise the question of a lytic lesion in the right lateral
mass of C1 on image 5:240, but this corresponds to a prominent vascular
channel in the right occipital condyle, which is similar to the ___ CT cervical spine.
IMPRESSION:
1. Large hypodensity in the left parietal, posterior temporal, and occipital
lobes has progressed since ___, with mild mass effect on the left
lateral ventricle and with relative paucity of superficial blood vessels along
the left parietal and occipital lobes. Small hypodensity in the posterior
inferior right frontal lobe is new compared to ___. At the time
of final interpretation, biopsy has been performed, and correlation with
biopsy results is recommended.
2. No evidence for flow-limiting stenosis involving the major cervical or
intracranial arteries.
3. No evidence for intracranial aneurysm or arteriovenous malformation.
Painted major dural venous sinuses.
|
19875364-RR-37
| 19,875,364 | 21,806,591 |
RR
| 37 |
2174-11-08 13:07:00
|
2174-11-08 14:30:00
|
EXAMINATION:
Chest: Frontal and lateral views
INDICATION: History: ___ with altered mental status // Infection?
TECHNIQUE: Chest: Frontal and Lateral
COMPARISON: None.
FINDINGS:
The right costophrenic angle is not fully included on the image. Given this,
no focal consolidation is seen. There is no large pleural effusion or
pneumothorax. The cardiac silhouette is top-normal. The aorta is somewhat
tortuous. No pulmonary edema is seen.
IMPRESSION:
Right costophrenic angle not fully included on the image. Given this, no
acute cardiopulmonary process seen.
|
19875364-RR-38
| 19,875,364 | 21,806,591 |
RR
| 38 |
2174-11-09 10:37:00
|
2174-11-09 11:53:00
|
INDICATION: ___ year old man with newly diagnosed leptomeningeal disease and
brain lesions concerning for metastatic disease. // eval for metastasis
TECHNIQUE: Oncology 3 phase: Multidetector CT of the abdomen and pelvis was
done as part of CT torso without and with IV contrast. Initially the abdomen
was scanned without IV contrast. Subsequently a single bolus of IV contrast
was injected and the abdomen and pelvis were scanned in the portal venous
phase, followed by a scan of the abdomen in equilibrium (3-min delay) phase.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 2.9 s, 31.5 cm; CTDIvol = 8.3 mGy (Body) DLP = 262.3
mGy-cm.
2) Stationary Acquisition 3.5 s, 0.5 cm; CTDIvol = 16.9 mGy (Body) DLP =
8.4 mGy-cm.
3) Spiral Acquisition 6.6 s, 72.9 cm; CTDIvol = 9.3 mGy (Body) DLP = 675.3
mGy-cm.
4) Spiral Acquisition 2.9 s, 31.5 cm; CTDIvol = 8.4 mGy (Body) DLP = 263.9
mGy-cm.
Total DLP (Body) = 1,210 mGy-cm.
COMPARISON: None.
FINDINGS:
LOWER CHEST: Please refer to separate report of CT chest performed on the same
day for description of the thoracic findings.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There is no evidence of focal lesions. There is no evidence of intrahepatic
or extrahepatic biliary dilatation. The gallbladder is within normal limits.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: Both adrenal glands are normal in size and appearance.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
There is no evidence of focal renal lesions or hydronephrosis. There is no
perinephric abnormality. 3.0 cm simple cyst left kidney.
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.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: Marked streak artifact from surgical clips related to
prostatectomy and lymphadenectomy.
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. The celiac axis demonstrates a median arcuate ligament
configuration.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. No evidence of metastatic disease within the abdomen or pelvis.
|
19875364-RR-39
| 19,875,364 | 21,806,591 |
RR
| 39 |
2174-11-09 01:09:00
|
2174-11-09 12:52:00
|
EXAMINATION: MR HEAD W AND W/O CONTRAST T___ MR HEAD
INDICATION: ___ year old man with recently discovered left hemispheric brain
lesions and leptomeningeal disease of unclear etiology while at ___
___ last week. Concern for clinical decline and would like to assess for
interval progression. In the process of obtaining osh CDs for comparison. //
eval for leptomeningeal disease and left hemispheric brain lesions.
TECHNIQUE: Sagittal and axial T1 weighted imaging were performed. After
administration of 7 mL of Gadavist intravenous contrast, axial imaging was
performed with gradient echo, FLAIR, diffusion, and T1 technique. Sagittal
MPRAGE imaging was performed and re-formatted in axial and coronal
orientations.
COMPARISON: CT from ___.
FINDINGS:
There are multiple foci of slow diffusion in the bilateral cerebellar
hemispheres including the vermis, left greater than right. A larger area of
low diffusion is noted in the right caudate. There are multiple additional
punctate foci of slow diffusion in the left frontal, parietal, temporal and
occipital lobes, including both the gray and white matter, and to a lesser
extent in the right frontal lobe. There are multiple punctate foci of
hemorrhage at the areas of slow diffusion, however the majority of the areas
of slow diffusion do not demonstrate hemorrhage. Additional hazy hemorrhage
is noted along the left parietal lobe. Multiple additional areas of T1
hyperintense signal are noted within the gray matter, predominantly of the
left parietal, occipital and temporal gray matter, also suggesting hemorrhage.
Leptomeningeal FLAIR hyperintense signal and contrast enhancement is noted
diffusely along the convexities, left greater than right. There is FLAIR
hyperintense signal with associated sulcal effacement in the a left parietal,
occipital and posterior temporal lobes and to a lesser extent in the left
frontal lobe. Abnormal FLAIR signal extends into both the gray and white
matter. Additional areas of FLAIR hyperintense signal are noted in the
periventricular white matter on the right. There is mild effacement of the
left lateral ventricle.
The major vascular flow voids are preserved. The orbits, paranasal sinuses
and mastoids are normal. The visualized soft tissues are normal. Minimal
layering fluid is noted in the nasopharynx.
IMPRESSION:
1. Multiple supra and infratentorial subacute infarctions, with associated
petechial hemorrhage, left greater than right, involving both the gray and
white matter, which may be secondary to an embolic etiology from a cardiac
source. Recommend correlation with echocardiogram. Associated edema
resulting in sulcal effacement, predominantly along the left parietal,
occipital and temporal lobes which may be a sequelae of the evolving infarcts.
Alternatively, this could represent amyloid associated angiography with
superimposed infarctions.
2. Multi focal abnormal leptomeningeal signal with associated contrast
enhancement, which may represent subarachnoid hemorrhage from the infarctions,
or infection, although infection is less likely given patient's clinical
condition. Leptomeningeal carcinomatosis were inflammation are also less
likely given negative results of prior CSF sample from the lumbar puncture.
Infection could give rise to infarction and hemorrhage. Carcinomatosis or
inflammation would be difficult to at reconciled with the evidence of
infarction and hemorrhage.
|
19875364-RR-40
| 19,875,364 | 21,806,591 |
RR
| 40 |
2174-11-09 10:55:00
|
2174-11-09 11:33:00
|
EXAMINATION: CT CHEST W/CONTRAST
INDICATION: Evaluation for metastatic disease.
TECHNIQUE: Volumetric CT acquisitions over the entire thorax in inspiration,
administration of intravenous contrast material, multiplanar reconstructions.
DOSE: DLP: Given in abdominal CT report.
COMPARISON: No comparison.
FINDINGS:
No incidental thyroid findings. No supraclavicular, infraclavicular or
axillary lymphadenopathy. No enlarged lymph nodes at the hilar or mediastinal
level. Mild dilatation of the main pulmonary artery. Moderate coronary
calcifications, no valvular calcifications. No pericardial effusion.
Unremarkable posterior mediastinum. The upper abdominal organs are described
in detail in the dedicated abdominal CT report. No osteolytic lesions at the
level of the ribs, the sternum or the vertebral bodies. Mild degenerative
vertebral disease. No pleural effusions. No pleural thickening. The larger
airways are patent. No diffuse lung disease. Minimal atelectasis at the
right lung basis (5, 199). No suspicious lung nodules or masses.
IMPRESSION:
No lymphadenopathy. No suspicious lung nodules or masses. No pleural
abnormalities.
|
19875364-RR-41
| 19,875,364 | 21,806,591 |
RR
| 41 |
2174-11-10 18:02:00
|
2174-11-11 08:57:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man getting brain biopsy tomorrow. // pre-op scan,
?PNA pre-op scan, ?PNA
IMPRESSION:
Heart size and mediastinum are stable. Lungs are essentially clear. No
pleural effusion or pneumothorax.
|
19875364-RR-42
| 19,875,364 | 21,806,591 |
RR
| 42 |
2174-11-11 05:04:00
|
2174-11-11 08:55:00
|
EXAMINATION: MR HEAD W AND W/O CONTRAST T___ MR HEAD
INDICATION: ___ year old man with brain lesion // OR guidance brain biopsy
___
TECHNIQUE: WAND study of the brain was performed consisting of axial T1
postcontrast, axial MPRAGE images with coronal and sagittal reconstructions
COMPARISON: Head MRI from ___ at ___
___ and ___ at ___"
FINDINGS:
As seen on prior head MRI, there are extensive areas of leptomeningeal
thickening and enhancement, left greater than right. There is associated mass
effect with mild effacement of the left lateral ventricle. These findings
have significantly progressed compared to the prior MRI from ___.
Given the rapid interval progression, this is favored to be infectious or
inflammatory in etiology. The rapid progression and evidence of infarction
and hemorrhage argue against leptomeningeal carcinomatosis. Sarcoidosis is
also less likely given the absence of any supporting findings on other
imaging, the cortical infarction and hemorrhage and the rapid interval
progression.
The evaluation of previously seen areas of slow diffusion and extensive areas
of FLAIR hyperintensity cannot be performed on today's study given the Wand
protocol.
The orbits appear unremarkable. The visualized paranasal sinuses and mastoid
air cells are clear. The dural venous sinuses are patent
IMPRESSION:
1. Marked interval progression of extensive leptomeningeal enhancement with
areas of nodular thickening and enhancement, left greater than right with some
mass effect and effacement of left lateral ventricle compared to the prior MRI
from ___. Given the rapid interval progression, infectious or
inflammatory etiologies, especially fungal are favored to be most likely. The
other possible etiology is leptomeningeal carcinomatosis though favored to be
less likely given the absence of any primary malignancy identified so far.
Sarcoidosis is unlikely given the rapid progression.
|
19875364-RR-43
| 19,875,364 | 21,806,591 |
RR
| 43 |
2174-11-11 12:52:00
|
2174-11-11 19:01:00
|
EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ year old man with vasculitis, s/p brain biopsy, please
evaluate for post operative changes. Please obtain by 1pm.
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 4.8 s, 16.6 cm; CTDIvol = 51.1 mGy (Head) DLP =
848.0 mGy-cm.
Total DLP (Head) = 848 mGy-cm.
COMPARISON: CTA head and neck on ___. MRI with and without
contrast ___, and limited presurgical postcontrast MRI head with
contrast on ___.
FINDINGS:
Extensive hypodensity involving the left parietal, temporal, and occipital
cortex and white matter appears stable from the prior CT on ___.
There is no evidence of acute intracranial hemorrhage. There is unchanged
compression of the occipital horn of the left lateral ventricle, and unchanged
partial effacement of the atrium and posterior body of the left lateral
ventricle. Temporal horns of the lateral ventricles remain symmetric without
left-sided dilatation. There is stable 3 mm of rightward shift of normally
midline structures.
The patient is status post left-sided craniotomy. The visualized portion of
the paranasal sinuses, mastoid air cells, and middle ear cavities are clear.
IMPRESSION:
Stable hypodensity involving the left parietal, temporal, and occipital cortex
and white matter compared to ___, with stable mass effect left
lateral ventricle and stable mild rightward shift of midline structures. No
acute hemorrhage. Please correlate with biopsy results.
|
19875364-RR-44
| 19,875,364 | 21,806,591 |
RR
| 44 |
2174-11-12 14:45:00
|
2174-11-12 17:34:00
|
INDICATION: ___ year old man with constipation, abd tenderness // ___ year old
man with constipation, abd tenderness
TECHNIQUE: AP supine and lateral decubitus views of the abdomen.
COMPARISON: CT abdomen and pelvis on ___.
FINDINGS:
There is air in the colon and small bowel. No dilation of the bowel. No
intraperitoneal free air. No air-fluid levels. There are clips throughout
the pelvis. There is dextroscoliosis of the lumbar spine.
IMPRESSION:
Normal bowel gas pattern. No evidence of bowel obstruction.
|
19875364-RR-45
| 19,875,364 | 21,806,591 |
RR
| 45 |
2174-11-17 15:22:00
|
2174-11-18 08:16:00
|
EXAMINATION: MR HEAD W AND W/O CONTRAST T___ MR HEAD
INDICATION: ___ year old man with possible inflammatory CAA s/p steroids. //
Evaluate for interval change.
TECHNIQUE: Sagittal and axial T1 weighted imaging were performed. After
administration of 7 mL of Gadavist intravenous contrast, axial imaging was
performed with gradient echo, FLAIR, diffusion, and T1 technique. Sagittal
MPRAGE imaging was performed and re-formatted in axial and coronal
orientations.
COMPARISON: Head CT from ___ and head MRI from ___.
FINDINGS:
Compared to the prior MRI from ___, there has been interval left
parietal bowel hole for histological sampling.
There is interval decrease in the amount of leptomeningeal thickening and
enhancement compared to the prior MRI with persistent left cerebral
enhancement greater than the right. There is interval decrease in the amount
of mass effect on the left lateral ventricle.
There is associated extensive FLAIR signal abnormality, especially in the left
parietal temporal lobes, relatively unchanged compared to the prior MRI from ___. There are some new areas of susceptibility in the left
parietal lobe near the biopsy tract, likely secondary to post biopsy
hemorrhage.
There is interval evolution of the previously seen multiple infarcts in
bilateral cerebral hemispheres, left greater than right, especially in the
left parietal and temporal lobes. There are few scattered foci of new
infarcts in the right frontal centrum semiovale as seen on image 5 02:21 in
the right insular cortex on image 502:19. There are few other new foci of
punctate infarcts in bilateral cerebellar hemispheres.
There is interval increase in the areas of T1 intrinsic hyperintensity in the
left parietal, temporal add occipital cortex, likely a combination of
hemorrhage and some areas of the laminar necrosis given the acute infarcts.
The orbits are unremarkable. There is mild mucosal thickening in bilateral
ethmoid air cells. The remaining visualized paranasal sinuses and mastoid air
cells are clear. Intracranial flow voids are maintained.
IMPRESSION:
1. Interval decrease in the amount of leptomeningeal thickening and
enhancement, especially along the left parietal, temporal and occipital lobes.
Relatively stable surrounding FLAIR signal abnormality and mass effect.
2. Interval evolution of previously seen multiple foci of infarcts in
bilateral cerebral and cerebellar hemispheres with few due punctate foci of
infarcts.
3. Interval increase in the about of intrinsic T1 hyperintensity in the left
parietal, occipital and temporal lobes, likely a combination of laminar
necrosis and hemorrhage.
4. The constellation of findings suggest the possibility of cerebral amyloid
angiopathy related inflammation.
|
19875364-RR-48
| 19,875,364 | 23,970,540 |
RR
| 48 |
2174-11-26 01:35:00
|
2174-11-26 03:53:00
|
INDICATION: ___ with abdominal tenderness in the left lower quadrant.
Evaluate for diverticulitis.
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: Acquisition sequence:
1) Stationary Acquisition 3.5 s, 0.5 cm; CTDIvol = 16.9 mGy (Body) DLP =
8.4 mGy-cm.
2) Spiral Acquisition 4.9 s, 53.5 cm; CTDIvol = 9.1 mGy (Body) DLP = 484.3
mGy-cm.
Total DLP (Body) = 493 mGy-cm.
COMPARISON: CT abdomen pelvis from ___
FINDINGS:
LOWER CHEST: Visualized lung fields are within normal limits. There is no
evidence of pleural or pericardial effusion.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There is no evidence of focal lesions. There is no evidence of intrahepatic
or extrahepatic biliary dilatation. The gallbladder is within normal limits.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
There is a simple cyst at the interpolar region of the left kidney. There is
no hydronephrosis or concerning renal lesion. There is no perinephric
abnormality.
GASTROINTESTINAL: The distal esophagus, stomach, and small bowel are normal.
There is significant colonic fecal loading, in the right colon, as well as
sigmoid and rectum. The appendix is normal. There is no free fluid in the
abdomen or pelvis. There is no mesenteric or retroperitoneal lymphadenopathy.
PELVIS: Streak artifact from prostatectomy and lymphadenectomy partially
obscures the pelvis. The urinary bladder is normal. There is no pelvic
lymphadenopathy or free fluid.
REPRODUCTIVE ORGANS: The patient is status post prostatectomy.
VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease
is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
IMPRESSION:
1. No evidence of diverticulitis or colitis.
2. Significant colonic fecal loading, particularly in the right colon and
rectum.
|
19875364-RR-50
| 19,875,364 | 23,970,540 |
RR
| 50 |
2174-11-26 16:35:00
|
2174-11-26 21:07:00
|
EXAMINATION: MR HEAD W AND W/O CONTRAST T___ MR HEAD
INDICATION: ___ male history of cerebral amyloid angiopathy and
traumatic intraparenchymal hemorrhage experiencing worsening confusion.
Evaluate for cerebral amyloid angiopathy and/or stroke.
TECHNIQUE: Sagittal and axial T1 weighted imaging were performed. After
administration of 7 mL of Gadavist intravenous contrast, axial imaging was
performed with gradient echo, FLAIR, diffusion, and T1 technique. Sagittal
MPRAGE imaging was performed and re-formatted in axial and coronal
orientations.
COMPARISON: ___ head CT. ___ head MRI.
FINDINGS:
There is motion artifact on the post-contrast MPRAGE sequence which degrades
spatial resolution.
There are scattered foci of slow diffusion bilaterally within the cerebellar
hemispheres, subcortical white matter, and cortices which have overall
improved in comparison to prior study. This slow diffusion is most prominent
and confluent at the left inferior parietal lobule. There are new punctate
foci of slow diffusion at the anterior right temporal lobe (5 02:11), right
lateral cerebellar hemisphere (502:8), and at the left anterior centrum
semiovale (502:22). There is unchanged linear gradient echo hypointensity at
the left parietal cortex. There is a punctate focus of gradient echo
hypointensity at the right parietal cortex (___). There is cortical
intrinsic T1 hyperintensity throughout the left parietal cortex, which is
relatively unchanged. There is patchy low a linear cortical enhancement
involving the left parietal cortex. There is sulcal FLAIR hyperintensity and
leptomeningeal enhancement throughout the bilateral cerebral convexities, left
greater than right, and within the cerebellar folia, which has mildly
increased in comparison to prior study. There is parenchymal enhancement at
the anterior right caudate nucleus consistent with subacute infarct.
There is extensive confluent FLAIR hyperintensity involving the left parietal
and temporal cortex, without significant mass effect. There is unchanged
prominence of the ventricles in comparison ___. There is
periventricular subcortical white matter FLAIR hyperintensity consistent with
sequela of chronic microangiopathy. The vascular flow voids are preserved.
The dural venous sinuses and cortical veins enhance normally.
The orbits are unremarkable. There is a left parietal craniotomy. There is
no fluid signal from the paranasal sinuses are mastoid air cells. The soft
tissues are unremarkable.
IMPRESSION:
1. Scattered foci of slow diffusion probably involving the left parietal
cortex with associated linear gradient echo hypointensity and T1
hyperintensity consistent with petechial hemorrhage and/or laminar necrosis.
Additional foci of slow diffusion involving the bilateral cerebellar
hemispheres and cerebrum. Overall the extent of slow diffusion as a decreased
in comparison to prior study consistent with evolving ischemic change, however
there several new foci of slow diffusion involving the right cerebellar
hemisphere, anterior right temporal cortex, and left anterior centrum semi
ovale.
2. Leptomeningeal enhancement involving the bilateral cerebral hemispheres and
cerebellar folia which have mildly increased in comparison to prior study.
Overall, findings are suspicious for inflammatory cerebral amyloid angiopathy
with differential including embolic infarcts, vasculitis, or
meningoencephalitis.
|
19875364-RR-51
| 19,875,364 | 23,970,540 |
RR
| 51 |
2174-11-28 14:49:00
|
2174-11-28 15:22:00
|
EXAMINATION: RENAL U.S.
INDICATION: ___ right-handed man with a recent diagnosis of
inflammatory CAA based on brain bx in the setting of neurologic decline s/p
recent discharge who presents for recurrent neurologic decline now with
hyponatremia and concern for obstruction // eval for obstruction
TECHNIQUE: Grey scale and color Doppler ultrasound images of the kidneys were
obtained.
COMPARISON: Abdomen and pelvis CT ___
FINDINGS:
The right kidney measures 9.2 cm. The left kidney measures 11.8 cm. There is
no hydronephrosis, stones, or masses bilaterally. Normal cortical
echogenicity and corticomedullary differentiation are seen bilaterally. A
simple partially exophytic cyst is seen in the interpolar region of the left
kidney measuring 2.2 x 3.1 x 2.4 cm.
The bladder is markedly distended with a volume of approximately 1000 cc. The
patient was not able to void.
IMPRESSION:
1. No hydronephrosis. Simple left renal cyst incidentally noted.
2. Markedly distended urinary bladder with approximately 1000 cc. The patient
was unable to void.
NOTIFICATION: Findings of markedly distended urinary bladder were discovered
at 15:10 on ___ and were conveyed by ___ by telephone to
Dr. ___ at 15:15 on the same day.
|
19875364-RR-52
| 19,875,364 | 23,970,540 |
RR
| 52 |
2174-12-04 08:45:00
|
2174-12-04 10:22:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with inflammatory CAA s/p Cytoxan now with fever
and ams // eval for pna
IMPRESSION:
In comparison a ___ chest radiograph, the lungs remain clear, with
no areas of consolidation to suggest the presence of pneumonia.
|
19875364-RR-53
| 19,875,364 | 23,358,906 |
RR
| 53 |
2174-12-07 14:33:00
|
2174-12-07 14:57:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: History: ___ with cerebral amyloidosis presenting with fever,
question of neutropenia
TECHNIQUE: Portable upright AP view of the chest
COMPARISON: Chest radiograph ___
FINDINGS:
Heart size is mildly enlarged. The mediastinal and hilar contours are
unremarkable. Pulmonary vasculature is not engorged. No focal consolidation,
pleural effusion or pneumothorax is present. Minimal atelectasis is noted in
lung bases. There are no acute osseous abnormalities degenerative changes are
seen within the right acromioclavicular joint and thoracic spine.
IMPRESSION:
No acute cardiopulmonary abnormality.
|
19875364-RR-54
| 19,875,364 | 23,358,906 |
RR
| 54 |
2174-12-07 17:43:00
|
2174-12-07 18:54:00
|
EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ man with cerebral amyloidosis presenting with fever,
?neutropenia. Evaluate for mass (for possible LP planning).
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast. Coronal and sagittal reformations as well as bone algorithm
reconstructions were provided and reviewed.
DOSE: Total DLP (Head) = 1,204 mGy-cm.
COMPARISON: CT head, noncontrast dated ___.
FINDINGS:
The patient has had prior left parietal craniotomy a brain biopsy that showed
cerebral amyloidosis. Since the prior exam on ___, the confluent
extensive white matter hypodensities in the left parietal, temporal, and
occipital lobes are overall unchanged. Gray-white matter differentiation is
preserved throughout. Tiny hypodensity in the right centrum semiovale is also
unchanged. No evidence of acute hemorrhage. The overall size and
configuration of the ventricles is unchanged with mild-to-moderate atrophy.
The basal cisterns remain patent. No mass effect.
Mucosal thickening of the left frontal sinus, incompletely imaged, is mild.
The visualized portion of the remaining paranasal sinuses, mastoid air cells,
and middle ear cavities are essentially clear. The visualized portion of the
orbits are unremarkable.
IMPRESSION:
1. No significant interval change in the confluent left parietal, occipital,
and temporal white matter hypodensity that could reflect sequela of patient's
inflammatory amyloid angiopathy.
2. No evidence of acute hemorrhage.
3. No mass effect.
|
19875364-RR-55
| 19,875,364 | 23,358,906 |
RR
| 55 |
2174-12-07 20:20:00
|
2174-12-07 23:24:00
|
EXAMINATION: MRI CERVICAL, THORACIC, AND LUMBAR PT22 MR SPINE
INDICATION: History: ___ with cerebral amyloidosis presenting with
neutropenic feverIV contrast to be given at radiologist discretion as
clinically needed // please eval for abscess please eval for abscess
please eval for abscess
please eval for abscess
TECHNIQUE: Sagittal imaging was performed with T2, T1, and STIR technique.
Axial T2 imaging was performed. Axial GRE images of the cervical spine were
performed. After the uneventful administration of 6 mL of Gadavist contrast
agent, additional axial and sagittal T1 images were obtained.
COMPARISON: CT ABDOMEN AND PELVIS ___ AND CT CHEST ___.
FINDINGS:
CERVICAL:
Alignment is normal.There are no findings to suggest infection. There is no
encroachment on the spinal cord. There are changes of degenerative disc
disease including disc bulges and loss of signal of the intervertebral discs
on the T2 weighted images. There is no abnormal enhancement after contrast
administration. The spinal cord appears normal in caliber and
configuration.There is no evidence of infection or neoplasm.
THORACIC:
Alignment is normal.There is loss of signal of the intervertebral discs on the
T2 weighted images, a manifestation of degenerative disc disease. There is a
small midline protrusion of the T6-7 disc that indents the spinal cord. There
is no other evidence of canal encroachment. The spinal cord appears normal in
caliber and configuration. There is no evidence of infection or neoplasm.
There is no abnormal enhancement after contrast administration.
LUMBAR:
Alignment is normal.There is near complete loss of the L5-S1 disc with loss of
signal of the remaining disc material. There are osteophytes at L5-S1 mildly
encroach on the spinal canal. There is a right neural foraminal narrowing at
L5-S1 due to intervertebral and facet osteophytes. There is no other canal
encroachment. There is no evidence of infection or neoplasm. There is no
abnormal enhancement after contrast administration
OTHER:
IMPRESSION:
1. Degenerative disc disease with disc protrusion at T6-7 encroaching on the
spinal cord. No evidence of infection.
|
19875364-RR-56
| 19,875,364 | 23,358,906 |
RR
| 56 |
2174-12-08 12:09:00
|
2174-12-08 14:56:00
|
EXAMINATION: LUMBAR PUNCTURE (W/ FLUORO) N8 RF SPINE
INDICATION: ___ year old man with CAA pw neutropenic fever and encephalopathy.
Please perform spinal tap.
TECHNIQUE: After informed consent was obtained from the patient explaining
the risks, benefits, and alternatives to the procedure, the patient was laid
in prone position on the fluoroscopic table. A pre-procedure time-out was
performed confirming the patient's identity, relevant history, procedure to be
performed and labs.
Puncture was performed at L3-4.
Approximately 5 cc of 1% lidocaine was administered for local anesthesia.
Under fluoroscopic guidance, a spinal needle was inserted into the thecal sac.
There was good return of clear CSF. Approximately 16 mls of CSF were
collected in 4 tubes and sent for requested analysis.
COMPARISON: MRI of the Cervical, Thoracic, and Lumbar spine from ___.
FINDINGS:
16 mls of CSF were collected in 4 tubes.
IMPRESSION:
1. Lumbar puncture at L3/4 without complication.
I, Dr. ___ supervised the trainee during the key components of
the above procedure and I reviewed and agree with the trainee's findings and
dictation.
|
19875364-RR-57
| 19,875,364 | 23,358,906 |
RR
| 57 |
2174-12-10 20:04:00
|
2174-12-11 11:06:00
|
EXAMINATION: MR HEAD W AND W/O CONTRAST T___ MR HEAD
INDICATION: ___ year old man with hx of CAA, now with AMS and neutropenic
fevers after receiving cyclophosphamide on ___. ANC has normalized now but
neuro would like MRI brain // Any evidence of acute process?
TECHNIQUE: Sagittal and axial T1 weighted imaging were performed. After
administration of mL of Gadavist intravenous contrast, axial imaging was
performed with gradient echo, FLAIR, diffusion, and T1 technique. Sagittal
MPRAGE imaging was performed and re-formatted in axial and coronal
orientations.
COMPARISON: MRI head with and without contrast of ___.
FINDINGS:
The examination is moderately motion degraded. Within these confines:
Left parietal craniotomy is identified.
Since the prior exam of ___, is interval development of a new 6 mm
right temporal lobe acute infarct (series 6, image 11). Additional punctate
new foci of slow diffusion of the left frontal lobe (series 6, image 23), left
anterior temporal lobe (series 6, image 14) and left cerebellar hemisphere
(series 6, image 6) are identified. There is now new enhancement of a right
anterior temporal lobe infarct seen on prior exam (series 13, image 9).
Superimposed diffusely scattered foci of slow diffusion of the bilateral
cerebral and cerebellar hemispheres are re-identified, many of which
demonstrate postcontrast enhancement. Unchanged linear gradient echo
hypointensity of the left parietal cortex with associated patchy cortical
enhancement. Additional, punctate peripheral foci of gradient echo
susceptibility artifact are also unchanged. Diffuse enhancing FLAIR
hyperintense sulcal and leptomeningeal signal is also similar in appearance to
prior examination.
Confluent FLAIR hyperintense signal of the left parietal and temporal lobes is
re-identified, with slightly increased involvement of the inferior left
temporal lobe, corresponding to regions of new infarct. Periventricular and
subcortical T2/FLAIR white matter hyperintensities are re-identified, which
are nonspecific but may be seen in the setting of chronic microangiopathy in a
patient of this age. The major intracranial flow voids are preserved. The
dural venous sinuses are patent. The paranasal sinuses are essentially clear.
The orbits are unremarkable. The mastoid air cells are clear.
IMPRESSION:
1. Interval development of new infarcts of the right and left temporal lobe,
left frontal lobe and left cerebellar hemisphere from examination of ___. The dominant lesion is in the right temporal lobe measuring
approximately 6 mm.
2. Confluent FLAIR hyperintense signal of the left parietal and temporal lobes
are re-identified, increased in extent along the anterior inferior left
temporal lobe, corresponding to regions of new infarct.
3. Additional regions of previously described infarcts and left parietal
cortical laminar necrosis and/or petechial hemorrhage are re-identified.
Expected evolution of prior infarcts, including new enhancement of a right
anterior temporal lobe infarct is identified.
4. Leptomeningeal enhancement and FLAIR hyperintense signal of the bilateral
cerebral and cerebellar hemispheres is similar appearance to prior
examination.
5. The constellation of findings are suspicious for cerebral amyloid angitis
with differential considerations including vasculitis, embolic infarcts and
meningoencephalitis.
|
19875364-RR-58
| 19,875,364 | 23,358,906 |
RR
| 58 |
2174-12-13 10:25:00
|
2174-12-13 11:06:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with new altered mental status. Evaluate for
aspiration.
TECHNIQUE: Single portable AP view of the chest.
COMPARISON: Chest radiograph from ___.
FINDINGS:
Cardiomediastinal silhouette is stable. Lungs are clear without focal
consolidation, pleural effusion, or pneumothorax.
IMPRESSION:
No focal consolidation concerning for aspiration and/or pneumonia.
|
19875364-RR-59
| 19,875,364 | 23,358,906 |
RR
| 59 |
2174-12-15 17:51:00
|
2174-12-16 03:47:00
|
EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ year old man with h/o CAA and multiple strokes with worsening
mental status // please evaluate for acute changes
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 5.4 s, 18.5 cm; CTDIvol = 51.5 mGy (Head) DLP =
954.0 mGy-cm.
Total DLP (Head) = 954 mGy-cm.
COMPARISON: Brain MRI from ___ and head CT from ___
FINDINGS:
Redemonstrated are extensive hypodensities involving the left occipital,
parietal, and temporal lobes. Hypodensities in the inferior left frontal lobe
are more pronounced and corresponds evolving infarcts. Additional smaller
infarcts seen on MRI are not well appreciated on CT. There are no new
abnormalities since the most recent MRI of ___. There is no
evidence of hemorrhage. The ventricles are moderately prominent with a stable
in size and configuration compared to the prior examinations. There is no
shift of normally midline structures.
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:
1. No evidence of hemorrhage or midline shift.
2. Multiple evolving infarcts and chronic white matter changes are overall
similar in distribution to the most recent MR examination.
|
19875442-RR-12
| 19,875,442 | 20,035,597 |
RR
| 12 |
2119-07-22 19:52:00
|
2119-07-23 00:38:00
|
INDICATION: Posterior knee dislocation. Evaluate for vascular injury.
COMPARISONS: None.
TECHNIQUE: Contiguous axial MDCT images were obtained through the lower
extremities after the administration of IV contrast per the CTA runoff
protocol. Sagittal and coronal reformatted images were obtained and reviewed.
3D volume rendered and curved oblique reformatted images were also obtained of
the lower extremity arteries.
FINDINGS:
PELVIS: The visualized portions of large and small bowel are unremarkable
without evidence of obstruction. A Foley catheter is in place in the bladder.
Small amount of air is present in the bladder, which is expected after
instrumentation. The prostate is unremarkable. There is no free fluid in the
pelvis. There is a large left inguinal hernia containing a segment of large
bowel. This segment of large bowel has diverticulosis without evidence of
diverticulitis. There are no pelvic fractures. There are no concerning lytic
or sclerotic bone lesions.
RIGHT LOWER EXTREMITY: There are three displaced fragment fractures adjacent
to the medial condyle of the distal femur (3a, 232, 230 and 231). No other
fractures are identified. There is enlargement of the muscle medial to the
mid femur which measures 5.7 x 3.3 cm (3a, 196). This is consistent with
intramuscular hematoma. There is evidence of multiple foci of active
extravasation within this muscle.
LEFT LOWER EXTREMITY: There is no evidence of fracture, hematoma, or other
traumatic injury to the left lower extremity.
CTA PELVIS: There is moderate atherosclerotic disease of the infrarenal
aorta. The common iliac arteries are unremarkable. The bilateral internal
iliac arteries have mild atherosclerotic disease. The external iliac arteries
are unremarkable. There is no evidence of occlusion, stenosis or aneurysm.
RIGHT LOWER EXTREMITY CTA: The common femoral artery and profunda are
unremarkable. There is active extravasation within a mid thigh intramuscular
hematoma (3a, 198), likely off a branch of the superficial femoral artery.
There is a small filling defect within the superficial femoral artery (___,
197), which is likely a small intimal flap. The popliteal artery is
unremarkable. The posterior tibial artery is diffusely diseased with
calcified atherosclerotic plaques. It is occluded beyond the mid portion,
which is likely a chronic finding. A two-vessel runoff to the foot is noted
with a patent anterior tibial artery and peroneal artery. There is mild
diffuse atherosclerotic disease seen within the proximal peroneal and anterior
tibial arteries. Dorsalis pedis in the foot is well opacified, but the
posterior tibial artery in the foot is not seen.
LEFT LOWER EXTREMITY CTA: The common femoral artery, profunda, superficial
femoral artery, and popliteal artery are unremarkable without evidence of
significant atherosclerotic disease or traumatic injury. There is scattered
diffuse atherosclerotic disease within the dorsalis pedis and distal anterior
tibial artery with moderate to severe narrowing. Mild atherosclerotic disease
is noted in the proximal left peroneal artery and diffusely within the left
posterior tibial with mild to moderate narrowing. Posterior tibial artery in
the foot is patent.
IMPRESSION:
1. Filling defect within the right superficial femoral artery is likely a
small intimal flap.
2. Active extravasation into a mid-thigh intramuscular hematoma from a branch
of the superficial femoral artery.
3. Multiple fracture fragments of the medial condyle of the distal right
femur.
4. Atherosclerotic disease of the right posterior tibial artery with chronic
occlusion beyond the mid portion.
5. Scattered atherosclerotic disease with moderate to severe narrowing in the
left distal anterior tibial artery and dorsalis pedis artery.
6. Large left inguinal hernia containing segments of large bowel without
evidence of obstruction.
7. Diverticulosis without evidence of diverticulitis.
|
19875442-RR-13
| 19,875,442 | 20,035,597 |
RR
| 13 |
2119-07-22 19:53:00
|
2119-07-22 21:19:00
|
INDICATION: Trauma. Pedestrian struck by car. Evaluate for cervical spine
fracture.
COMPARISONS: None.
TECHNIQUE: Helical axial MDCT images were obtained from the base of the skull
to the apices of the lungs without the administration of IV contrast.
Sagittal and coronal reformatted images were obtained and reviewed.
FINDINGS: There is no abnormality of the prevertebral soft tissues. No
fracture or subluxation is identified. Multilevel degenerative changes are
noted with disc space narrowing, anterior and posterior osteophyte formation,
and facet arthrosis. Moderate-sized posterior disc osteophyte complexes are
present at C5-6 and C6-7 causing mild-to-moderate spinal canal narrowing.
Mild multilevel neural formaminal narrowing is noted bilaterally, but no
critical narrowing is present.
There is mild biapical pleuro-parenchymal scarring. The apices of the lungs
are otherwise unremarkable. Atherosclerotic disease is noted within the
carotid arteries. The thyroid is unremarkable. There is no lymphadenopathy.
The visualized portions of the brain are normal.
IMPRESSION:
1. No fracture or malalignment.
2. Multilevel degenerative changes, most severe at C5-6 and C6-7 with
mild-to-moderate spinal canal narrowing at these levels.
3. Mild biapical pulmonary scarring.
|
19875442-RR-14
| 19,875,442 | 20,035,597 |
RR
| 14 |
2119-07-22 19:53:00
|
2119-07-22 21:16:00
|
INDICATION: Trauma. Pedestrian struck by car.
COMPARISONS: None.
TECHNIQUE: Contiguous axial MDCT images were obtained through the brain
without the administration of IV contrast. Sagittal, coronal, and thin slice
bone image reformations were obtained and reviewed.
FINDINGS: The exam is somewhat limited by motion. Within these limitations,
there is no evidence of hemorrhage, edema, mass, mass effect, mass effect, or
infarction. The ventricles and sulci are prominent, consistent with
age-related atrophy. The basal cisterns are patent. Periventricular
confluent white matter hypodensities are consistent with chronic small vessel
ischemic disease.
No fracture is identified. There is near-complete opacification of the left
maxillary sinus with volume loss and associated bony sclerosis, suggesting
chronic sinusitis. There is a small mucus retention cyst within the right
maxillary sinus. There are no air-fluid levels. The remainder of the
visualized paranasal sinuses, mastoid air cells, and middle ear cavities are
clear. There is a trace scalp hematoma overlying the left frontal bone.
IMPRESSION:
1. No acute intracranial abnormality.
2. Age-related volume loss and chronic small vessel ischemic disease.
3. Chronic sinus disease, predominantly involving the left maxillary sinus.
4. Trace left frontal scalp hematoma.
|
19875442-RR-16
| 19,875,442 | 20,035,597 |
RR
| 16 |
2119-07-23 13:47:00
|
2119-07-23 21:02:00
|
STUDY: Right hand, three views, ___.
CLINICAL HISTORY: ___ man status post pedestrian strike with hand
pain.
FINDINGS: There are no previous studies available for direct comparison.
There is some irregularity and widening between the base of the fourth and
fifth metacarpals. Irregularity and lucency involving the lateral base of the
fifth metacarpal is suspicious for a small nondisplaced fracture. Please
correlate with pain at this location. There is some adjacent soft tissue
swelling. Please note that the tips of the index and small fingers have been
excluded on the field of view on the AP image, however, they are unremarkable
on the other images. There is some irregularity seen at the distal aspect of
the ulna, likely degenerative.
IMPRESSION:
Irregularity and subtle lucency involving the lateral aspect of the base of
the fifth metacarpal suspicious for a small nondisplaced fracture. There is
also widening between the base of the fourth and fifth metacarpals suggestive
of ligamentous injury. Please correlate with pain at this location.
discussed with Dr. ___.
|
19875442-RR-17
| 19,875,442 | 20,035,597 |
RR
| 17 |
2119-07-24 14:51:00
|
2119-07-24 18:53:00
|
HISTORY: Pain lateral aspect right ankle.
RIGHT ANKLE, THREE VIEWS.
There is prominent soft tissue swelling about the right ankle and in the
visualized portion of the right foot. The mortise joint is congruent and the
mortise joint space is preserved. No talar dome OCD is identified. Small
marginal spurs are noted along the distal tibia anteriorly and posteriorly.
Of note, on the lateral view, there is linear lucency projecting over the
distal fibula raising the question of a subtle non-displaced distal fibular
fracture. No other fracture and no dislocation is detected about the right
ankle.Incidental note is made of some cortical thickening along the distal
fibula and distal fibular diaphysis anteriorly, of doubtful acute
significance. Minimal calcaneal spurring noted.
IMPRESSION:
1) Likely subtle non-displaced distal right fibular fracture.
2) No other evidence of fracture or dislocation.
Findings discussed with covering house officer ___ at the time of
discovery at approximately 6:36 p.m. on the day of exam ___, phone).
|
19875442-RR-18
| 19,875,442 | 20,035,597 |
RR
| 18 |
2119-07-24 15:17:00
|
2119-07-24 18:03:00
|
HISTORY: Fracture at the base of the fifth metacarpal, evaluate.
COMPARISON: Hand radiographs ___.
TECHNIQUE: Contiguous thin section helical images were obtained from the
distal forearm through the distal tuft and reconstructed using both bone and
soft tissue algorithm. Coronal and sagittal reformats were also generated.
FINDINGS:
A splint is in place, with flexion of the digit slightly limiting assessment.
There is a comminuted fracture at the base of the fifth metacarpal, with
impaction. There are relatively large dorsal (8.5 mm) and palmar (12.6 mm)
fragments, displaced dorsally and volarly respectively.
A curvilinear fragment lying immediately adjacent to the ulnar base of the
fourth metacarpal more likely arises from the base of the fifth metacarpal
(3:91).
No donor site or other fracture is detected involving the base of fourth
metacarpal. No other fractures are identified about the right hand.
Incidental note is made of cyst along the palmar aspect of the lunate bone.
Limited assessment of soft tissues about the hand shows diffuse soft tissue
stranding, dense cyst about the base of the fifth metacarpal.
IMPRESSION:
Comminuted fracture at the base of the fifth metacarpal, extending to the
carpometacarpal joint.
|
19875442-RR-19
| 19,875,442 | 20,035,597 |
RR
| 19 |
2119-07-28 23:26:00
|
2119-07-29 13:35:00
|
STUDY: Right wrist intraoperative study ___.
CLINICAL HISTORY: Patient fifth metacarpal ORIF.
FINDINGS: Several images of the right hand from the operating room
demonstrate interval placement of two percutaneous pins stabilizing a fracture
involving the base of the fifth metacarpal. Please refer to the operative
note for additional details. There are no signs for hardware-related
complications.
|
19875502-RR-5
| 19,875,502 | 28,825,856 |
RR
| 5 |
2189-08-28 00:24:00
|
2189-08-28 01:04:00
|
EXAMINATION: MR HEAD W/O CONTRAST T___ MR HEAD
INDICATION: ___ man with right frontal/parietal hemorrhage.
TECHNIQUE: Sagittal T1 weighted imaging was performed. Axial imaging was
performed with gradient echo, FLAIR, diffusion, and T2 technique were then
obtained.
COMPARISON ___ noncontrast head CT at 19:21
FINDINGS:
The patient had difficulty holding still due to claustrophobia. Sagittal T1
weighted and gradient echo images are mildly limited by motion artifact, but
FLAIR and T2 weighted images were obtained with the available motion reducing
techniques.
There is subarachnoid hemorrhage in the right central sulcus, frontal and
parietal sulci. The extent of hemorrhage is better appreciated on MRI than
CT, as both acute and subacute hemorrhage is seen on MRI.
There is no evidence for blood products in the brain parenchyma. There is no
parenchymal edema or mass effect. There is no acute infarction. A small
chronic right cerebellar hemisphere infarct is noted. Confluent areas and
discrete foci of high T2 signal in the periventricular, deep, and subcortical
white matter of the cerebral hemispheres are nonspecific but likely sequelae
of chronic small vessel ischemic disease in this age group. Prominence of the
ventricles and sulci is unchanged and consistent with age related involutional
changes. There is mild mucosal thickening in the ethmoid sinuses, and small
mucous retention cysts in the maxillary sinuses.
Principal intracranial vascular flow voids are preserved. Intracranial
vasculature is better assessed on the concurrent CTA of the head and neck.
IMPRESSION:
1. Right frontal and parietal subarachnoid hemorrhage is again demonstrated.
The extent of hemorrhage is better appreciated on MRI than on the preceding
CT, as both acute and subacute subarachnoid hemorrhage is visible on MRI.
2. No evidence for parenchymal blood products to clearly indicate amyloid
angiopathy.
|
19875502-RR-6
| 19,875,502 | 28,825,856 |
RR
| 6 |
2189-08-28 01:06:00
|
2189-08-28 01:36:00
|
EXAMINATION: CTA HEAD AND CTA NECK Q16 CT NECK
INDICATION: ___ man with right frontal/parietal subarachnoid
hemorrhage. Evaluate for dissection, AVM.
TECHNIQUE: Contiguous MDCT axial images were obtained through the brain
without contrast material. Subsequently, helically acquired rapid axial
imaging was performed from the aortic arch through the brain during the
infusion of 70 mL of Omnipaque intravenous contrast material.
Three-dimensional angiographic volume rendered, curved reformatted and
segmented images were generated on a dedicated workstation. This report is
based on interpretation of all of these images.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 18.0 s, 18.0 cm; CTDIvol = 50.2 mGy (Head) DLP =
903.1 mGy-cm.
2) Stationary Acquisition 7.5 s, 0.5 cm; CTDIvol = 81.7 mGy (Head) DLP =
40.8 mGy-cm.
3) Spiral Acquisition 5.1 s, 40.4 cm; CTDIvol = 31.0 mGy (Head) DLP =
1,253.5 mGy-cm.
Total DLP (Head) = 2,197 mGy-cm.
COMPARISON: ___ noncontrast head CT
___ noncontrast brain MRI
FINDINGS:
CT HEAD WITHOUT CONTRAST:
Right frontoparietal subarachnoid hemorrhage is not significantly changed. No
new hemorrhage is seen. A small chronic infarct is again seen in the right
posterior inferior cerebellar hemisphere. Confluent areas of low-density in
the periventricular, deep, and subcortical white matter of the cerebral
hemispheres are nonspecific but likely sequela of chronic small vessel
ischemic disease in this age group. Prominence of the ventricles and sulci is
again seen, consistent with moderate global parenchymal volume loss.
There are mucous retention cysts along the floors of bilateral maxillary
sinuses with adjacent periapical lucency of a right maxillary molar, image
3:200. There is mild mucosal thickening in the anterior ethmoid air cells and
frontal sinuses.
CTA NECK:
There is common origin of the innominate and left common carotid arteries, a
normal variant. There is mild calcified plaque at the left subclavian artery
origin and in the proximal left subclavian artery without flow-limiting
stenosis. Common carotid and internal carotid arteries are widely patent
without stenosis by NASCET criteria. There is mild calcified plaque at the
right vertebral artery origin with mild narrowing. Remaining right vertebral
artery is widely patent. The left vertebral artery is widely patent.
CTA HEAD:
There is calcified plaque in bilateral carotid siphons without evidence for
flow-limiting stenosis. No flow-limiting stenosis is seen elsewhere in the
anterior circulation. Vertebral, basilar, superior cerebellar, and posterior
cerebral arteries are patent without evidence for flow-limiting stenosis, with
normal variant fetal type right posterior cerebral artery. Right ___ is not
visualized. There is a large left ___ with branches extending into the right
___ territory. There are two foci of mild narrowing in the left ___,
including to the right of midline, see images ___:41, ___:25.
The anterior communicating artery is hypoplastic. There is 2 mm medially
directed outpouching at the junction of the left anterior cerebral artery with
the anterior communicating artery, images 3:266, 456:9, 457:3, consistent with
small aneurysm.
The dural venous sinuses are patent. The left transverse and sigmoid sinuses
are hypoplastic.
There is no evidence for abnormal blood vessels in the region of the right
subarachnoid hemorrhage to suggest an arteriovenous fistula.
OTHER:
Evaluation of partially imaged upper lungs is limited by respiratory motion
artifact. Within this limitation, there is no suspicious pulmonary nodule or
consolidation. Centrilobular emphysema is noted. There is an 8 mm exophytic
nodule arising from the posterior right lobe of the thyroid gland (series 3,
image 94). There is no lymphadenopathy by CT size criteria. There are
degenerative changes in the cervical spine.
IMPRESSION:
1. Unchanged right frontal/parietal subarachnoid hemorrhage. No new
hemorrhage.
2. No evidence for an arteriovenous fistula in the region of the right
subarachnoid hemorrhage.
3. 2 mm medially directed aneurysm at the junction of the left anterior
cerebral artery with a hypoplastic anterior communicating artery.
4. Nonvisualization of the right ___. Large left ___ with branches
extending into the right ___ territory. Two foci of mild narrowing in the
left ___, including to the right of midline.
5. Calcified plaque mildly narrowing the right vertebral artery origin.
6. Emphysema in the included upper lungs.
7. 8 mm right thyroid nodule. According to current ___ College of
Radiology guidelines, no follow up is needed in the absence of specific
personal risk factors for thyroid malignancy.
RECOMMENDATION(S): The 2 mm left anterior cerebral artery aneurysm is not
related to the right frontal/parietal subarachnoid hemorrhage, and it should
be followed in the outpatient setting to assess stability.
NOTIFICATION: Impression items 3 and 4, and the recommendation above, were
emailed to the ED QA nurses list by Dr. ___ at 20:41 on ___, 2
minutes after discovery.
|
19875661-RR-10
| 19,875,661 | 21,531,623 |
RR
| 10 |
2177-11-10 18:58:00
|
2177-11-10 20:49:00
|
INDICATION: ___ year old woman with abd pain, distention// eval for
obstruction
TECHNIQUE: Portable supine abdominal radiograph was obtained.
COMPARISON: ___
FINDINGS:
Dilated small and large bowel is again seen throughout the abdomen and pelvis.
The small bowel is distended up to 3.9 cm.
Supine assessment limits detection for free air; there is no gross
pneumoperitoneum.
Osseous structures are notable for degenerative changes of the lumbar spine.
The patient is post median sternotomy. A left pleural effusion is partially
evaluated.
There are no unexplained soft tissue calcifications or radiopaque foreign
bodies.
IMPRESSION:
Dilated small and large bowel loops are most likely reflective of an ileus.
|
19875661-RR-11
| 19,875,661 | 21,531,623 |
RR
| 11 |
2177-11-12 05:30:00
|
2177-11-12 08:12:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with fall and broken ribs// please assess for
interval change
IMPRESSION:
In comparison with the study of ___, there is little overall change.
Opacification at the left base is again consistent with layering fluid and
volume loss in the left lower lobe. No evidence pneumothorax.
|
19875661-RR-13
| 19,875,661 | 21,531,623 |
RR
| 13 |
2177-11-13 05:11:00
|
2177-11-13 09:50:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ fall from standing, R 10th rib fx, L ___ rib fxs, small
hemoptx// Short of breath iso rib fx Short of breath iso rib fx
IMPRESSION:
Compared to chest radiographs ___.
Moderate to large left pleural effusion is no smaller. Increased, mild
pulmonary edema is best appreciated in the right lung. Heart size is
obscured, was at least moderately enlarged on ___. No pneumothorax.
Left lower lobe is probably still poorly aerated.
Multiple left rib fractures noted. Left hemidiaphragm is not displaced
upwards.
|
19875661-RR-14
| 19,875,661 | 21,531,623 |
RR
| 14 |
2177-11-13 15:06:00
|
2177-11-13 16:18:00
|
INDICATION: ___ year old woman with distension// eval SBO, KUB and upright
TECHNIQUE: Supine abdominal radiograph was obtained.
COMPARISON: Abdominal radiograph from ___.
FINDINGS:
There is progressive dilation of small and large bowel consistent with a
worsening ileus.
Osseous structures are unremarkable.
Sternotomy wires are noted. Surgical clips are seen in the mid abdomen.
There are no unexplained soft tissue calcifications or radiopaque foreign
bodies.
IMPRESSION:
Increased dilation of small and large bowel consistent with a progressive
ileus.
|
19875661-RR-16
| 19,875,661 | 21,531,623 |
RR
| 16 |
2177-11-13 23:39:00
|
2177-11-14 01:41:00
|
EXAMINATION: CT CHEST W/O CONTRAST
INDICATION: ___ year old woman with SOB// eval pna
TECHNIQUE: Multi detector helical scanning of the chest was reconstructed as
5 and 1.25 mm thick axial, 2.5 mm thick coronal and parasagittal, and 8 mm MIP
axial images. Contrast agent was not administered. All images were reviewed.
DOSE: Found no primary dose record and no dose record stored with the sibling
of a split exam.
!If this Fluency report was activated before the completion of the dose
transmission, please reinsert the token called CT DLP Dose to load new data.
COMPARISON: Chest CT ___ from ___. Read in
conjunction with conventional chest radiographs ___ through ___.
FINDINGS:
CHEST PERIMETER: No thyroid findings require any further imaging evaluation.
No supraclavicular or axillary adenopathy. Breast evaluation is reserved
exclusively for mammography. No soft tissue abnormality in the chest wall
despite multiple left rib fractures. Study is not designed for evaluation of
the abdomen but there is no adrenal mass or immediate subphrenic collection.
CARDIO-MEDIASTINUM:Hiatus hernia is small. Esophagus is unremarkable.
Atherosclerotic calcification is mild in head and neck vessels. Patient has
had median sternotomy for CABG.. Sternum is well-healed and there are no
findings to suggest wound complications. Native coronary arteries are heavily
calcified. Aorta and pulmonary arteries are normal size. Cardiac evaluation
would require echocardiography. Pericardium is physiologic.
THORACIC LYMPH NODES: None enlarged.
LUNGS, AIRWAYS, PLEURAE: Moderate size layering nonhemorrhagic left pleural
effusion has enlarged since ___ when it was partially hemorrhagic.
Left lower lobe is now entirely collapsed, although there is no responsible
bronchial obstruction.
Two small regions of new consolidation at the right apex are active or
residual pneumonia, ___. Another small region of peribronchial
infiltration with a ground-glass halo, right upper lobe, 5:72 could be
residual edema or either active or residual pneumonia. Right middle lobe
atelectasis above the elevated right hemidiaphragm has increased. No
bronchial obstruction present. Mild subpleural atelectasis in the right lower
lobe is new.
CHEST CAGE: More than half a dozen fractures lateral and posterolateral left
middle and lower ribs are no more displaced today than on ___,
including the most severe, proximal left tenth rib, displaced more than the
width of the rib, 5:215. Nevertheless there is no associated fluid or soft
tissue abnormality in either the chest wall or the extrapleural space.
Moderate loss of height lower thoracic vertebral body due to upper endplate
depression, no vertebral canal compromise, unchanged, probably chronic,
10:103.
IMPRESSION:
New left lower lobe collapse accompanied by increase in moderate
nonhemorrhagic layering left pleural effusion.
Several very small foci possible pneumonia, right lung.
Multiple, mid and lower left rib fractures, stable since ___, no
evidence of associated bleeding.
|
19875661-RR-17
| 19,875,661 | 21,531,623 |
RR
| 17 |
2177-11-14 15:53:00
|
2177-11-14 17:12:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with NG tube placed// eval NG tube placement
TECHNIQUE: AP view of the chest
COMPARISON: CT chest ___, chest radiographs from ___
FINDINGS:
NG tube in place with the side port in the mid to distal esophagus,
advancement is recommended.
Mid sternotomy wires are well aligned and intact, mediastinal and upper
abdomen surgical clips are unchanged.
Moderate left pleural effusion and volume loss of the left lower lobe are
redemonstrated, better seen on recent chest CT, stable since last radiograph.
Ground-glass opacity in the right upper lobe better seen on recent chest CT.
Severe pulmonary dilation is again seen.
Stable elevation of the right diaphragm and obscuration of the
cardiomediastinal silhouette.
IMPRESSION:
1. Newly placed NG tube should be advanced.
2. Stable moderate left pleural effusion with left lower lobe collapse.
NOTIFICATION: The findings were discussed with ___, MD. By ___
___, M.D. on the telephone on ___ at 4:58 pm, 1 minutes after
discovery of the findings.
|
19875661-RR-18
| 19,875,661 | 21,531,623 |
RR
| 18 |
2177-11-14 21:55:00
|
2177-11-14 22:33:00
|
INDICATION: ___ year old woman with abd distention, no BM// eval for worsening
ileus
TECHNIQUE: Portable supine abdominal radiograph was obtained.
COMPARISON: ___
FINDINGS:
Dilated loops of small and large bowel are again seen, difficult to
differentiate between the two and for the assessment of free intraperitoneal
gas.
Osseous structures are unremarkable.
There are no unexplained soft tissue calcifications or radiopaque foreign
bodies.
IMPRESSION:
Dilated loops of small and large bowel are again seen. The extent of the
dilatation is such that it is difficult to differentiate between large and
small bowel and to assess whether there is any free intraperitoneal gas.
Consider a lateral decubitus view or upright views if the patient is able to
stand up.
|
19875661-RR-19
| 19,875,661 | 21,531,623 |
RR
| 19 |
2177-11-15 04:46:00
|
2177-11-15 09:14:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with pleural effuion// eval for interval change
eval for interval change
IMPRESSION:
Compared to chest radiographs ___ through ___.
Large left pleural effusion may have increased, responsible for rightward
mediastinal shift and probable left lower lobe collapse. Low volume in the
right lung makes it difficult to exclude mild pulmonary edema. Heart is
moderately enlarged. No pneumothorax. Nasogastric drainage tube passes below
the diaphragm and out of view. Gastric distention is difficult to distinguish
from colonic.
|
19875661-RR-2
| 19,875,661 | 21,531,623 |
RR
| 2 |
2177-11-06 03:25:00
|
2177-11-06 04:14:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: History: ___ with 7 rib fractures. Evaluation for pneumothorax.
TECHNIQUE: Chest AP view
COMPARISON: Comparison to reference CT chest from outside hospital performed
on ___.
FINDINGS:
Median sternotomy wires are intact. Multiple surgical clips are seen
projecting over the mediastinum. Heart size is mildly enlarged. Tortuosity
of the descending thoracic aorta. Rightward deviation of the trachea, likely
secondary to patient rotation. Mild bibasilar atelectasis is noted. Focal
opacification at the left lung base is likely due to combination of pleural
fluid and likely pulmonary contusion, as better seen on CT chest from ___. Small left pleural effusion. Subtle pleural marking along the
left apex, likely representing small hemo-pneumothorax. Multiple left-sided
rib fractures are again demonstrated.
IMPRESSION:
1. Multiple left-sided rib fractures with equivocal trace left
hemopneumothorax.
2. Focal opacification at the left lung base, likely due to combination of
pleural fluid and likely pulmonary contusion, as better seen on CT chest from
outside hospital performed on ___.
3. Rightward deviation of the trachea, most likely related to patient
rotation.
NOTIFICATION: The findings were discussed with ___, M.D. by
___, M.D. on the telephone on ___ at 4:00 am, approximately
5 minutes after discovery of the findings.
|
19875661-RR-20
| 19,875,661 | 21,531,623 |
RR
| 20 |
2177-11-16 05:13:00
|
2177-11-16 08:44:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ with a history of AF on coumadin, COPD, CAD, HTN who presents
with R10th rib fx, L5-12th rib fx after a fall with elevated INR ___ s/p
reversal w/ FFP// interval change interval change
IMPRESSION:
Comparison to ___. Stable correct position of the feeding tube.
Minimal decrease in extent of a pre-existing left pleural effusion that is
still moderate in severity. Subsequent left basal atelectasis. Status post
CABG with correct alignment of the sternal wires. Stable correct appearance
of the right lung.
|
19875661-RR-4
| 19,875,661 | 21,531,623 |
RR
| 4 |
2177-11-07 05:14:00
|
2177-11-07 09:51:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with rib fractures s/p fall// eval for interval
change eval for interval change
IMPRESSION:
Compared to chest radiograph ___, read in conjunction with chest CT
___.
No appreciable pneumothorax. Small left pleural or extrapleural fluid
collection unchanged, alongside multiple displaced rib fractures in the left
lower hemithorax.
Right lung grossly clear. Right hemidiaphragm is elevated, chronicity
unknown. Cardiomegaly is moderate. Thoracic aorta is at least tortuous,
probably dilated. Aortic injury cannot be assessed by this examination but
there has been no progressive mediastinal widening to suggest active bleeding.
|
19875661-RR-5
| 19,875,661 | 21,531,623 |
RR
| 5 |
2177-11-07 05:14:00
|
2177-11-07 13:45:00
|
INDICATION: ___ year old woman with abd distention// eval for dilated bowels,
acute process
TECHNIQUE: Portable abdomen supine three views
COMPARISON: None
FINDINGS:
There are dilated loops of large or small bowel. The small bowel is dilated
to 3.8 cm. The transverse colon is dilated to 6.1 cm. There is air in the
rectum.
There is no free intraperitoneal air.
Osseous structures are unremarkable.
There are no unexplained soft tissue calcifications or radiopaque foreign
bodies. Surgical clips are identified in the epigastrium.
IMPRESSION:
Dilated small and large bowel consistent with ileus.
|
19875661-RR-6
| 19,875,661 | 21,531,623 |
RR
| 6 |
2177-11-08 05:12:00
|
2177-11-08 10:01:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with rib fractures s/p fall// eval for interval
change eval for interval change
IMPRESSION:
Comparison to ___. The lung volumes are low. Moderate
cardiomegaly. Minimal left pleural effusion. Retrocardiac atelectasis.
Moderate pulmonary edema. No pneumonia. The known rib fractures, known from
the CT performed on ___, are partially visualized on the chest
x-ray. Currently, there is no evidence of a pneumothorax.
|
19875661-RR-7
| 19,875,661 | 21,531,623 |
RR
| 7 |
2177-11-09 05:04:00
|
2177-11-09 10:02:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with fall and broken ribs// eval for interval
change eval for interval change
IMPRESSION:
Comparison to ___. No relevant change is noted. Low lung
volumes. Moderate left pleural effusion with subsequent left basilar
atelectasis. Mild to moderate pulmonary edema. Stable alignment of the
sternal wires. No pneumonia.
|
19875661-RR-8
| 19,875,661 | 21,531,623 |
RR
| 8 |
2177-11-10 05:37:00
|
2177-11-10 13:12:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with fall and broken ribs// eval for interval
change eval for interval change
IMPRESSION:
AP dural catheter is projecting over the mediastinum. Heart size is normal.
Mediastinum is unchanged in appearance. Left pleural effusion has increased,
currently moderate to large. Multiple left rib fractures are re-demonstrated.
Effusion might potentially represent progression of hemothorax. No
pneumothorax.
Mild pulmonary edema.
|
19875661-RR-9
| 19,875,661 | 21,531,623 |
RR
| 9 |
2177-11-11 05:43:00
|
2177-11-11 08:27:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with fall and broken ribs// eval for interval
change
IMPRESSION:
In comparison with the study of ___, there is little overall change.
Cardiomediastinal silhouette is stable. Hazy opacification of the left
hemithorax is consistent with layering pleural effusion and volume loss in the
lower lung. Multiple rib fractures are again seen, but there is no evidence
of pneumothorax.
|
19875974-RR-17
| 19,875,974 | 26,922,347 |
RR
| 17 |
2117-10-23 12:14:00
|
2117-10-23 15:07:00
|
CHEST RADIOGRAPH
INDICATION: ___ man with congestive heart failure, resolved aortic
dissection.
TECHNIQUE: Semi-erect portable chest view was reviewed. No prior chest
radiograph was available for comparison.
FINDINGS:
The tip of endotracheal tube ends approximately 8.4 cm above the carina at the
level of the clavicles. Consider advancing the ET tube by additional 2-2.5 cm
for better seating. Gastric tube courses below the diaphragm into the stomach
and is appropriately positioned. An aortic stent graft is present extending
from the level of the aortic arch till the mid descending thoracic aorta.
Remarkable for engorged pulmonary vasculature and perihilar haziness
suggestive of elevated pulmonary venous pressure. The heart size is normal.
There is no pleural effusion or pneumothorax.
|
19875974-RR-18
| 19,875,974 | 26,922,347 |
RR
| 18 |
2117-10-24 20:04:00
|
2117-10-25 19:09:00
|
MR THORACIC SPINE WITHOUT CONTRAST, ___
HISTORY: Bilateral lower extremity hemiparesis after type B aortic
dissection. Is there evidence of hematoma or spinal cord ischemia?
This is a nondiagnostic, incomplete study. The patient has an aortic stent
that is not confirmed as safe for MR imaging. A single localizing scan was
obtained, and then the study was discontinued. These images obtained are
severely degraded by susceptibility artifact from the stent. Limited views of
the inferior thoracic spine and perhaps the superior lumbar spine are so
degraded by artifact that they are not diagnostic.
A preliminary report was entered that read "The patient came for thoracic and
lumbar spine MR. ___ of susceptibility artifact in the thoracic spine. The
patient has a new endovascular stent (placed ___. When the techs
looked up information in the catalog, it is unclear if this is safe for MRI.
Incident report filed. ___ discussed with Dr. ___ (pager
___, vascular surgery resident) by phone at 9:30 p.m. about safety concern.
Techs were unable to reach the manufacturer at this hour. The resident
indicated that he will check with his attending about safety and get back to
us. The patient was taken off the table and returned to the floor. ___.
___ 10:18 p.m., ___. Discussed with Dr. ___ at 11:20 p.m. No MRI
as a need to wait eight weeks (they will confirm this with their chairman).
We will obtain CT instead."
CONCLUSION: Nondiagnostic incomplete study due to severe artifacts from the
aortic stent and uncertainty about the safety of MR in this patient.
|
19875974-RR-19
| 19,875,974 | 26,922,347 |
RR
| 19 |
2117-10-25 00:15:00
|
2117-10-25 02:26:00
|
INDICATION: Status post aortic dissection repair, right renal and right
external iliac artery stent, presenting with paraplegia, please assess for
epidural hematoma.
TECHNIQUE: Contiguous MDCT images through the lumbar spine were obtained.
Axial, coronal, and sagittal reformats were acquired.
COMPARISON: CT of the torso from ___.
FINDINGS:
A stent is seen from the distal aorta extending into the right common iliac
artery and the right external iliac artery.
Both kidneys are hyperdense, consistent with ATN (acute tubular necrosis)
after contrast administration. An NG tube passes beyond the GE junction, with
tip not visualized. There are moderate-to-large bilateral pleural effusions.
There is moderate amount of free fluid in the abdomen.
A drain enters the spinal canal at L5-S1 and extends cranially with the tip
ending at T12/L1. There is superior endplate depression of T12.
Evaluation of the spinal canal is limited; however, there is no evidence of
epidural hematoma. this possibility, along with other causes paraplegia such
as infection or infarction, would be far better assessed with spinal MR.
___:
1. Hyperdense kidneys consistent with ATN after IV contrast (IV nephropathy).
2. Bilateral large pleural effusions.
3. No evidence of epidural hematoma; however, evaluation is limited on CT. An
MR would be far more sensitive for this and other possible causes of
paraplegia.
4. Superior endplate compression fracture of T12, unchanged from the prior
study of ___.
5. Moderate amount of free fluid in the abdomen.
|
19875974-RR-20
| 19,875,974 | 26,922,347 |
RR
| 20 |
2117-10-25 00:16:00
|
2117-10-25 02:37:00
|
INDICATION: ___ with aortic dissection repair, right renal stent, and
right external iliac artery stent.
TECHNIQUE: Contiguous MDCT images of the thoracic spine were obtained.
Axial, coronal, and sagittal reformats were acquired.
COMPARISON: CT of the L-spine from the same day, CT of the torso from ___.
FINDINGS:
An aortic graft is seen from the mid aortic arch to the proximal descending
thoracic aorta without evidence of mediastinal hemorrhage or
pneumomediastinum. There is no large pericardial effusion. There are large
bilateral pleural effusions, new compared to the prior study. A right renal
artery stent is seen.
The kidneys are hyperdense, likely due to IV contrast nephropathy. There is a
moderate amount of free fluid in the abdomen.
A spinal catheter ends at T12/L1. There is a small amount air posteriorly in
the thoracic spine, presumably related to the catheter placement. Evaluation
of the spinal canal structures is limited on CT; however, there is no evidence
of epidural hematoma. Superior endplate depression fracture of T12 is
unchanged.
IMPRESSION:
1. No evidence of large epidural hematoma; however, evaluation is limited on
CT.
2. Appropriate position of the thoracic aortic graft and right iliac artery
stent.
3. Large bilateral pleural effusions are new compared to ___.
4. There is a moderate amount of free fluid in the abdomen.
5. IV contrast nephropathy.
|
19875974-RR-21
| 19,875,974 | 26,922,347 |
RR
| 21 |
2117-10-25 13:29:00
|
2117-10-25 16:25:00
|
INDICATION: Evaluation of patient with history of recent EVAR with renal
stent placement with increasing creatinine and decreasing urine output.
COMPARISON: CT torso from ___.
FINDINGS:
The right kidney measures 12.6 cm.
The left kidney measures 12.5 cm.
The left kidney contains a 1.7 x 1.6 cm anechoic structure in the upper pole
consistent with a simple cyst. Bilateral kidneys are without evidence of
hydronephrosis or stones. A right renal artery stent is visualized.
COLOR AND SPECTRAL DOPPLER:
Systolic flow is visualized in the main and intrarenal right as well as left
renal arteries without appreciable diastolic flow. The main renal vein is
noted to be patent.
IMPRESSION:
Bilaterally symmetric systolic flow is visualized in right and left main renal
arteries and intrarenal arteries with no sonographically evident diastolic
flow, consistent with high-resistance parenchymal beds. Appropriate flow noted
in bilateral main renal veins.
These findings suggest high parenchymal resistance may be due to acute tubular
necrosis or other intrinsic renal interstitial disease or edema in bilateral
kidneys.
These findings were discussed by Dr. ___ with Dr. ___ at approximately 3
p.m. on ___ via telephone.
|
19875974-RR-22
| 19,875,974 | 26,922,347 |
RR
| 22 |
2117-10-25 17:47:00
|
2117-10-26 09:44:00
|
PORTABLE CHEST X-RAY.
COMPARISON: 5, ___ radiograph.
FINDINGS: Right internal jugular vascular catheter terminates in the mid
superior vena cava, with no visible pneumothorax. Other indwelling devices
remain in standard position. Appearance of aortic stent graft and adjacent
aortic contour are unchanged. Heart size remains normal. Pulmonary vascular
congestion is again demonstrated, as well as a left-sided predominant hazy and
reticular pattern, likely due to asymmetrical pulmonary edema. Moderate
layering left pleural effusion is apparently new since the prior chest
radiograph, but is evident on more recent CT exam of ___.
|
19875974-RR-23
| 19,875,974 | 26,922,347 |
RR
| 23 |
2117-10-26 07:27:00
|
2117-10-26 09:18:00
|
PORTABLE CHEST
COMPARISON: Radiograph, ___.
FINDINGS: Tip of endotracheal tube terminates about 9 cm above the carina and
could be advanced for standard positioning. Other indwelling devices are in
standard position. The patient is status post recent aortic stent graft
placement, with similar appearance of the stent graft and aortic contour
compared to the recent radiograph. Heart size is normal. Pulmonary vascular
congestion has slightly improved, with associated improving asymmetrical
opacities in the left lung, likely due to asymmetrical edema, although other
process such as aspiration is also possible in the appropriate clinical
setting. Persistent layering left pleural effusion is also noted.
|
19875974-RR-24
| 19,875,974 | 26,922,347 |
RR
| 24 |
2117-10-27 16:05:00
|
2117-10-27 17:03:00
|
CHEST RADIOGRAPH
INDICATION: To evaluate for pleural effusion, infiltrate or congestion.
TECHNIQUE: Single portable upright chest view was reviewed in comparison with
prior chest radiograph from ___.
FINDINGS:
Right internal jugular line ends at upper SVC. There is an aortic stent graft
extending from the level of the aortic arch to the mid descending thoracic
aorta. Mild-to-moderate left pleural effusion has minimally increased whereas
right-sided small pleural effusion associated with right basal atelectasis is
new. Heart size, mediastinal and hilar contours are within normal limits.
Upper lungs are clear.
IMPRESSION: Mild-to-moderate left pleural effusion associated with left lower
lung atelectasis has worsened whereas small right pleural effusion and mild
right basilar atelectasis is new since ___.
Stable cardiomediastinal silhouette.
|
19875974-RR-25
| 19,875,974 | 26,922,347 |
RR
| 25 |
2117-10-28 11:55:00
|
2117-10-28 14:59:00
|
INDICATION: ___ male status post TEVAR complicated by lower extremity
paresis, here to evaluate for intra-abdominal pathology.
COMPARISON: CT of the torso performed on ___.
FINDINGS: A single supine frontal view of the abdomen demonstrates a
nonspecific bowel gas pattern with gas in non-dilated loops of small and large
bowel as well as the rectum. There is no evidence of a large amount of free
intraperitoneal air. A vascular stent is present within the right hemipelvis.
Multiple cutaneous surgical staples are present in the bilateral proximal
lower extremities. The visualized lung bases are clear. The osseous
structures are within normal limits.
IMPRESSION: Nonspecific bowel gas pattern without evidence of ileus or
obstruction.
|
19875974-RR-26
| 19,875,974 | 26,922,347 |
RR
| 26 |
2117-10-30 08:59:00
|
2117-10-30 11:13:00
|
INDICATION: ___ male with fever and elevated white blood count.
COMPARISON: ___.
TECHNIQUE: Single frontal chest radiograph was obtained portably with the
patient in an upright position.
FINDINGS: Right pleural effusion has increased and left pleural effusion
appears unchanged. Bibasilar atelectasis is seen. No pneumothorax is seen.
Heart and mediastinal contours are stable. Aortic stent graft is again noted.
Right internal jugular catheter is similarly positioned.
IMPRESSION: Bilateral pleural effusions with adjacent atelectasis, increased
on the right.
|
19875974-RR-27
| 19,875,974 | 26,922,347 |
RR
| 27 |
2117-11-01 11:57:00
|
2117-11-01 13:40:00
|
INDICATION: Paraplegia after aortic dissection.
TECHNIQUE: Left lower extremity Doppler ultrasound.
FINDINGS: Grayscale and Doppler sonograms of the left common femoral,
superficial femoral, popliteal, posterior tibial and peroneal veins were
performed. There is normal compressibility, flow and augmentation. The right
common femoral vein could not be assessed due to overlying bandage.
IMPRESSION: No evidence of deep venous thrombosis in the left lower
extremity.
|
19875974-RR-28
| 19,875,974 | 26,922,347 |
RR
| 28 |
2117-11-01 11:58:00
|
2117-11-01 13:42:00
|
INDICATION: Paraplegia and acute renal injury after aortic dissection.
Evaluate renal arteries.
TECHNIQUE: Renal ultrasound.
COMPARISON: Ultrasound dated ___.
FINDINGS: Renal ultrasound demonstrates echogenic kidneys, bilaterally which
is unchanged. No stones, masses or hydronephrosis is seen. The right kidney
measures 14.0 cm. The left kidney measures 12.2 cm and contains a 1.7 cm
simple cyst in the interpolar region.
Doppler evaluation of the renal arteries and veins were performed. The
vessels appear widely patent. On the right, a stent is seen within the main
renal artery. Within the stent, the peak systolic velocity measures 251
cm/sec. This is similar to minimally decreased in velocity from the prior
examination. On the left, the main renal artery appears patent with normal
waveforms and peak systolic velocities of 122 and 144 cm/sec. Both renal
veins are patent. The intraparenchymal renal arteries were not evaluated.
The bladder is not evaluated due to overlying bowel gas.
There are bilateral pleural effusions.
IMPRESSION: Patent renal arteries bilaterally with unchanged waveforms and
velocities. Unchanged echogenic appearance of both kidneys. No
hydronephrosis.
|
19876093-RR-20
| 19,876,093 | 26,612,181 |
RR
| 20 |
2120-01-05 17:34:00
|
2120-01-05 18:13:00
|
EXAMINATION: RENAL U.S.
INDICATION: ___ with renal failure// Renal obstruction?
TECHNIQUE: Grey scale and color Doppler ultrasound images of the kidneys were
obtained.
COMPARISON: Renal ultrasound ___
FINDINGS:
There is no hydronephrosis or concerning masses bilaterally. Again seen is
increased cortical echogenicity with diffuse cortical thinning. 2 simple
cysts measuring up to 0.9 cm are again seen in the upper pole of the right
kidney. A 1.3 by 0.4 cm echogenic focus in the interpolar region of the right
kidney exhibits possible posterior shadowing and twinkle artifact.
Right kidney: 10.4 cm
Left kidney: 11.0 cm
The bladder is moderately well distended and normal in appearance. No left
ureteral jet was seen.
IMPRESSION:
1. Possible 1.3 x 0.4 cm nonobstructing stone in the interpolar region of the
right kidney. No hydronephrosis.
2. Similar findings suggestive of underlying medical renal disease, including
increased cortical echogenicity and thinning.
|
19876093-RR-21
| 19,876,093 | 26,612,181 |
RR
| 21 |
2120-01-06 00:42:00
|
2120-01-06 09:41:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ female with acute renal failure. Borderline
hypoxemic.// Evaluate for pulmonary edema, pleural effusion. Evaluate for
pulmonary edema, pleural effusion.
COMPARISON: Chest x-ray ___
FINDINGS:
PA and lateral views of the chest show the costophrenic angles to be sharp.
The heart is borderline in size. Atherosclerotic vascular calcifications are
seen in the thoracic and abdominal aorta. No pneumothorax. There is bilateral
interstitial pulmonary edema more on the right than the left.
IMPRESSION:
Interstitial pulmonary edema.
|
19876093-RR-22
| 19,876,093 | 26,612,181 |
RR
| 22 |
2120-01-07 10:56:00
|
2120-01-07 12:20:00
|
INDICATION: ___ year old woman with subacute on chronic renal failure and
nephrotic syndrome, will be starting HD.// tunneled HD line placement
COMPARISON: None available.
TECHNIQUE: OPERATORS: Dr. ___ Interventional ___
ANESTHESIA: 1% lidocaine was injected in the skin and subcutaneous tissues
overlying the access site.
FLUOROSCOPY TIME AND DOSE: 1 minute, 1 mGy
PROCEDURE: PROCEDURE DETAILS: Following the explanation of the risks,
benefits and alternatives to the procedure, written informed consent was
obtained from the patient. The patient was then brought to the angiography
suite and placed supine on the exam table. A pre-procedure time-out was
performed per ___ protocol. The neck was prepped and draped in the usual
sterile fashion.
Under continuous ultrasound guidance, the patent right internal jugular vein
was compressible and accessed using a micropuncture needle. Permanent
ultrasound images were obtained before and after intravenous access, which
confirmed vein patency. Subsequently a Nitinol wire was passed into the right
atrium using fluoroscopic guidance. The needle was exchanged for a
micropuncture sheath.
The Nitinol wire was removed and a short ___ wire was advanced into the IVC.
After sequential dilation of the soft tissue tract using 12 ___ and 14
___ dilators, a double lumen 14 ___ Trialysis catheter was advanced over
the wire into the superior vena cava with the tip in the distal SVC. Both
access ports were aspirated, flushed and capped. The catheter was secured to
the skin with a 0 silk suture and sterile dressings were applied. Final spot
fluoroscopic image demonstrating good alignment of the catheter and no
kinking.
The patient tolerated the procedure well without immediate complications.
FINDINGS:
Patent right internal jugular vein. Final fluoroscopic image showing double
lumen temporary Trialysis catheter with catheter tip terminating in the distal
superior vena cava.
IMPRESSION:
Successful placement of a right internal jugular approach Trialysis temporary
catheter. The line is ready to use.
|
19876093-RR-23
| 19,876,093 | 26,612,181 |
RR
| 23 |
2120-01-09 03:28:00
|
2120-01-09 04:31:00
|
EXAMINATION: RENAL U.S.
INDICATION: ___ year old woman with nephrotic syndrome of unknown etiology now
on HD with severe flank pain after HD today// Please eval if there is evidence
of hydronephrosis in the right kidney given known stone with now worsening
flank pain
TECHNIQUE: Grey scale and color Doppler ultrasound images of the kidneys were
obtained.
COMPARISON: Renal ultrasound dated ___.
FINDINGS:
There is no hydronephrosis or masses bilaterally. Similar to prior, the
bilateral kidneys demonstrate increased cortical echogenicity with diffuse
cortical thinning. 2 simple cysts measuring up to 1.2 cm in the right upper
pole are again seen. The previously seen echogenic focus in the interpolar
region of the right kidney is not visualized on the current study. However,
there is a 4 mm echogenic focus in the left lower pole with posterior
shadowing and twinkle artifact, consistent with a nonobstructing renal
calculus.
Right kidney: 10.6 cm
Left kidney: 9.0 cm
The bladder is only minimally distended and can not be fully assessed on the
current study.
IMPRESSION:
1. 4 mm nonobstructing calculus in the left lower pole kidney.
2. No hydronephrosis.
3. Echogenic appearance of the kidneys suggests chronic medical renal
disease.
|
19876093-RR-24
| 19,876,093 | 26,612,181 |
RR
| 24 |
2120-01-09 16:21:00
|
2120-01-09 18:52:00
|
INDICATION: ___ year old woman with CKD now with acute renal failure requiring
HD initiation.// place tunneled dialysis line
COMPARISON: Temporary dialysis line placement ___
TECHNIQUE: OPERATORS: Dr. ___ Interventional ___ performed
the procedure.
ANESTHESIA: Moderate sedation was provided by administrating divided doses of
25mcg of fentanyl and 0 mg of midazolam throughout the total intra-service
time of 10 minutes during which the patient's hemodynamic parameters were
continuously monitored by an independent trained radiology nurse. 1% lidocaine
was injected in the skin and subcutaneous tissues overlying the access site.
MEDICATIONS: None
CONTRAST: 0 ml of Optiray contrast
FLUOROSCOPY TIME AND DOSE: 49 seconds, 1 mGy
PROCEDURE: PROCEDURE DETAILS: Following the explanation of the risks,
benefits and alternatives to the procedure, written informed consent was
obtained from the patient. The patient was then brought to the angiography
suite and placed supine on the exam table. A pre-procedure time-out was
performed per ___ protocol. The right upper chest was prepped and draped in
the usual sterile fashion.
A short Amplatz wire was advanced through the indwelling catheter into the IVC
and the catheter was removed over the wire and a 6 ___ vascular sheath was
placed.
Next, attention was turned towards creation of a tunnel over the upper
anterior chest wall. After instilling superficial and deeper local anesthesia
using lidocaine, a small skin incision was made at the tunnel entry site. A
19cm tip-to-cuff length catheter was selected. The catheter was tunneled from
the entry site towards the venotomy site from where it was brought out using a
tunneling device. The venotomy tract was dilated using the introducer of the
peel-away sheath supplied. Following this, the peel-away sheath was placed
over the Amplatz wire through which the catheter was threaded into the right
side of the heart with the tip in the right atrium. The sheath was then peeled
away. The catheter was sutured in place with 0 silk sutures. Steri-strips were
also used to close the venotomy incision site. Final spot fluoroscopic image
demonstrating good alignment of the catheter and no kinking. The tip is in the
right atrium. The catheter was flushed and both lumens were capped. Sterile
dressings were applied. The patient tolerated the procedure well.
FINDINGS:
Patent right internal jugular vein. Final fluoroscopic image showing dialysis
catheter with tip terminating in the right atrium.
IMPRESSION:
Successful placement of a 19cm tip-to-cuff length tunneled dialysis line.
The tip of the catheter terminates in the right atrium. The catheter is ready
for use.
|
19876093-RR-25
| 19,876,093 | 26,612,181 |
RR
| 25 |
2120-01-10 04:28:00
|
2120-01-10 10:08:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with ESRD and acute hypoxia s/p HD initiation//
pulm edema, consolidation pulm edema, consolidation
IMPRESSION:
Diffuse infiltrative pulmonary abnormality has improved in all areas.
Asymmetric distribution suggested either edema due to to mitral regurgitation
or, alternatively, widespread infection.
Heart size normal. Pleural effusions small if any. New right supraclavicular
dialysis catheter ends in the right atrium. No pneumothorax. Configuration
of the trachea suggest and may be a small associated hematoma just above the
thoracic inlet. Clinical examination advised.
RECOMMENDATION(S): Please examine the neck for any evidence of bleeding.
NOTIFICATION: The findings were discussed with ___, M.D. by ___,
M.D. on the telephone on ___ at 9:59 am, 1 minutes after discovery of
the findings.
|
19876093-RR-26
| 19,876,093 | 26,612,181 |
RR
| 26 |
2120-01-10 15:02:00
|
2120-01-10 16:02:00
|
EXAMINATION: CT CHEST W/O CONTRAST
INDICATION: ___ year old woman with CKD newly on dialysis with HD line on
right placed. CXR with concern for ? tracheal shift and hematoma// Evaluate
for ?hematoma on CXR
TECHNIQUE: Multi detector helical scanning of the chest was reconstructed as
5 and 1.25 mm thick axial, 2.5 mm thick coronal and parasagittal, and 8 mm MIP
axial images. Contrast agent was not administered. All images were reviewed.
DOSE: Acquisition sequence:
1) Spiral Acquisition 2.1 s, 33.7 cm; CTDIvol = 10.8 mGy (Body) DLP = 363.4
mGy-cm.
Total DLP (Body) = 363 mGy-cm.
COMPARISON: None available.
FINDINGS:
NECK, THORACIC INLET, AXILLAE AND CHEST WALL:
The thyroid is heterogeneous with a 1.8 cm nodules to the left, somewhat is of
fatigue (302:1). No enlarged lymph nodes in either axilla or thoracic inlet.
No abnormalities on the chest wall. Moderate atherosclerotic calcifications
in the head and neck arteries. Large-bore catheter in the right jugular vein
with tip in the lower SVC.
HEART AND VASCULATURE:
The heart is normal size and shape. No pericardial effusion. Moderate
atherosclerotic calcifications in the coronary arteries and aorta, none mild
in the aortic valve. The pulmonary arteries and aorta are normal caliber
throughout.
MEDIASTINUM AND HILA:
The esophagus is unremarkable. Small mediastinal lymph nodes, the largest
measuring up to 1.2 cm in the right lower paratracheal station. No hilar
lymphadenopathy.
PLEURA:
No pleural effusions. No apical scarring bilaterally.
LUNGS:
The airways are patent to the subsegmental levels. No bronchiectasis or mucus
plugging. Mild bronchial wall thickening. Mild interlobular septal
thickening associated to scattered ground-glass opacities bilaterally. More
nodular ground-glass opacities are noted in the left lower lobe (302:120).
There is moderate background centrilobular and paraseptal emphysema, upper
lobe predominant. 5 mm and 3 mm subpleural nodule in the middle lobe (302:78
and 102).
CHEST CAGE:
Mild dorsal spondylosis. No acute fractures. No suspicious lytic or
sclerotic lesions.
UPPER ABDOMEN:
The limited sections of the upper abdomen show severe atherosclerotic disease
in the intra-abdominal vessels. Left adrenal myelolipoma measuring 2.0 cm
(02:54).
IMPRESSION:
No evidence of mediastinal bleeding. Appropriately placed hemodialysis
large-bore catheter in the right jugular vein.
Moderate bilateral pulmonary edema with likely reactive mediastinal
lymphadenopathy.
There are nodular ground-glass opacities in the left lower lobe that might
represent superimposed infectious/inflammatory process.
NOTIFICATION: The findings were discussed with ___, M.D. by ___
___, M.D. on the telephone on ___ at 3:50 pm.
|
19876093-RR-27
| 19,876,093 | 26,612,181 |
RR
| 27 |
2120-01-13 18:19:00
|
2120-01-13 19:37:00
|
EXAMINATION: CT ABDOMEN AND PELVIS WITHOUT CONTRAST
INDICATION: ___ with history of CKD with nephrotic-range proteinuria, chronic
hematuria, and HTN, admitted for hypoxia in setting of volume overload
requiring urgent HD, incidentally found to have bilateral kidney stones on
renal US and with ongoing flank pain// Further characterize renal stones
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 3.8 s, 50.2 cm; CTDIvol = 11.0 mGy (Body) DLP = 550.6
mGy-cm.
Total DLP (Body) = 551 mGy-cm.
COMPARISON: Ultrasound from ___.
FINDINGS:
LOWER CHEST: Scattered ground-glass opacities are seen bilaterally with
increased nodularity in the left lower lobe, similar to prior study. No
pleural or pericardial effusion
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout.
There is no evidence of focal lesions within the limitations of an unenhanced
scan. There is no evidence of intrahepatic or extrahepatic biliary
dilatation. The gallbladder is within normal limits.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions within the limitations of an unenhanced scan. There is no
pancreatic ductal dilatation. There is no peripancreatic stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right adrenal gland is normal in size and shape. A 1.9 x 1.7 cm
fat containing lesion is seen arising from the left adrenal gland consistent
with an adrenal myelolipoma.
URINARY: The kidneys are of symmetric size. Bilateral kidneys demonstrate
cortical thinning. A 1 cm lesion of intermediate density is seen arising from
the upper pole of the right kidney, previously characterized as a cyst. There
is no hydronephrosis. Nonobstructing stones are seen in the right kidney
measuring up to 4 mm in the interpolar region. A nonobstructing stone in the
lower pole of the left kidney measures 3 mm. There is no perinephric
abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber and wall thickness throughout. Diverticulosis of the colon is
noted, without evidence of wall thickening and fat stranding. The appendix is
normal.
PELVIS: The urinary bladder is decompressed. The distal ureters are
unremarkable. There is no free fluid in the pelvis.
REPRODUCTIVE ORGANS: The uterus is not visualized. No adnexal abnormality is
seen.
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. A left common and external iliac artery stent is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. Bilateral nonobstructing renal calculi measuring up to 4 mm.
2. No acute intra-abdominal abnormality.
3. 1.9 cm left adrenal myelolipoma.
|
19876231-RR-7
| 19,876,231 | 25,241,919 |
RR
| 7 |
2124-05-19 20:16:00
|
2124-05-19 21:01:00
|
EXAMINATION: RENAL U.S.
INDICATION: ___ year old man with acute renal failure// any evidence of
obstruction?
TECHNIQUE: Grey scale and color Doppler ultrasound images of the kidneys were
obtained.
COMPARISON: None.
FINDINGS:
The right kidney measures 11.1 cm. The left kidney measures 12.8 cm. There
are multiple bilateral simple appearing renal cysts measuring up to 4.1 x 4.1
x 4.0 cm in the lower pole of the right kidney and 2.7 x 2.4 x 2.3 cm in the
interpolar left kidney. There is no hydronephrosis, stones, or solid masses
bilaterally. Normal cortical echogenicity and corticomedullary differentiation
are seen bilaterally.
The bladder is moderately well distended and normal in appearance. Bilateral
ureteral jets are seen.
IMPRESSION:
No hydronephrosis. No evidence of acute pathology.
|
19876293-RR-10
| 19,876,293 | 27,053,236 |
RR
| 10 |
2187-04-19 21:59:00
|
2187-04-19 22:42:00
|
INDICATION: NO_PO contrast; History: ___ with fall, on coumadinNO_PO contrast
// Please eval for intraabdominal hemorrhage/injury
TECHNIQUE: MDCT data were acquired through the abdomen and pelvis after the
uneventful administration of oral and intravenous contrast. Images were
displayed in multiple planes.
DOSE: DLP: 452.04 mGy-cm
COMPARISON: None.
FINDINGS:
There is a small left anterior hemopneumothorax and there is a small dependent
right hemorrhagic effusion. In the left lung base alveolar opacity likely
represents hemorrhage and/or contusion. Opacity in the right lung base
represents atelectasis and/or contusion. There are nondisplaced fractures of
the posterior left ninth and tenth ribs. There are no right-sided rib
fractures. There is right atrial enlargement. Coronary artery calcifications
are noted. The mitral annulus is calcified.
CT ABDOMEN: The liver is nodular in architecture consistent with cirrhosis.
There is a recannulized umbilical vein and a vein of Sappey. There are no
focal liver lesions. The portal and hepatic veins are patent. There is no
intra or extrahepatic biliary dilatation. The gallbladder is normal. The
pancreas enhances homogeneously. The spleen and adrenal glands are normal.
Kidneys enhance and excrete contrast promptly. There are no concerning renal
lesions. There is no retroperitoneal or abdominal adenopathy. No ascites is
present. The aorta is densely calcified and contains atheromatous plaque. A
small focal outpouching of the infrarenal aorta measures 2.3 cm in diameter.
The stomach and intra-abdominal loops of bowel are normal caliber. There are
a few scattered colonic diverticula but no evidence of acute diverticulitis.
CT PELVIS: The remainder of the bowel is normal. The bladder is collapsed and
contains a Foley catheter. There is no free pelvic fluid. There is no
inguinal or pelvic adenopathy.
OSSEOUS STRUCTURES: Round lucent lesion in the L2 vertebral body most likely
represents a hemangioma. There are multilevel degenerative changes including
intervertebral displaced narrowing and sclerosis throughout the lumbar spine.
IMPRESSION:
Left lower rib fractures.
Small left anterior hemopneumothorax. Small left hemorrhagic effusion.
No acute intra-abdominal process.
Nodular liver consistent with cirrhosis.
|
19876293-RR-11
| 19,876,293 | 27,053,236 |
RR
| 11 |
2187-04-19 22:16:00
|
2187-04-20 00:30:00
|
INDICATION: History: ___ with L wrist deformity, R hip pain, L femur
pain/swelling s/p fall // Please eval for bony fx/injury
TECHNIQUE: Frontal view of the pelvis and two views of the left hip.
COMPARISON: None.
FINDINGS:
No fracture or dislocation. There is marked joint space narrowing in the
bilateral femoral acetabular joints and small spur formation consistent with
degenerative osteoarthritis. The sacroiliac joints and pubic symphysis also
show degenerative changes. There are degenerate changes in the lumbar spine.
There is a catheter ending in the bladder. Contrast is noted in the bladder,
which is mostly empty.
IMPRESSION:
No fracture or dislocation.
|
19876293-RR-12
| 19,876,293 | 27,053,236 |
RR
| 12 |
2187-04-19 22:29:00
|
2187-04-20 00:54:00
|
EXAMINATION: RIGHT HIP RADIOGRAPHS
INDICATION: Right hip pain after trauma.
COMPARISON: None.
TECHNIQUE: Right hip, two views.
FINDINGS:
The right hip joint space appears mildly narrowed. There is no evidence for
fracture, dislocation or bone destruction. The bones appear demineralized.
Intravenous contrast is present within the partly visualized bladder, which is
mostly empty.
IMPRESSION:
No right hip fracture identified.
|
19876293-RR-13
| 19,876,293 | 27,053,236 |
RR
| 13 |
2187-04-20 05:08:00
|
2187-04-20 07:56:00
|
INDICATION: ___ year old woman with left ___ rib fx and small ptx on CT //
Interval change
TECHNIQUE: Portable frontal view of the chest.
COMPARISON: Chest radiograph ___.
FINDINGS:
A tiny left apical pneumothorax is unchanged. Opacity left lower lobe
corresponds to a known hemothorax in the left lower lobe contusion.
Cardiomegaly is stable. The aortic knob is calcified. Multiple rib fractures
are better characterized on the prior CT chest.
IMPRESSION:
Tiny left apical pneumothorax is unchanged.
|
19876293-RR-14
| 19,876,293 | 27,053,236 |
RR
| 14 |
2187-04-20 02:51:00
|
2187-04-20 03:37:00
|
EXAMINATION: WRIST(3 + VIEWS) LEFT
INDICATION: History: ___ with L radius reduction, reduced? movement of
metacarpal fxs? // reduced? reduced?
TECHNIQUE: Three views left wrist.
COMPARISON: Left wrist radiographs ___.
FINDINGS:
An overlying cast obscures the fine bony detail. Fractures of the distal
radius and ulna are unchanged in alignment. The previously seen metacarpal
fractures are not identified.
IMPRESSION:
Interval casting of the distal radius and ulna fractures. The alignment is
unchanged.
|
19876293-RR-15
| 19,876,293 | 27,053,236 |
RR
| 15 |
2187-04-20 10:43:00
|
2187-04-20 15:15:00
|
EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ year old woman with afib on coumadin s/p fall // eval for
interval change
TECHNIQUE: Contiguous axial MDCT images were obtained through the brain
without administration of IV contrast. Reformatted coronal, sagittal and
thin-section bone algorithm-reconstructed images were acquired.
DOSE: DLP: 891 mGy-cm; CTDI: 52 mGy
COMPARISON: Outside Hospital CT Head ___
FINDINGS:
There is subarachnoid hemorrhage in the right frontal lobe (2:23), unchanged
the prior CT. Two additional foci of subarachnoid hemorrhage are noted within
the left temporal lobe; the focus located more anteriorly (2:10) appears
slightly larger, but the one located more posteriorly at the level of the
sylvian fissure (2:13) is smaller; some of the rest of the foci are stable.
Minimal left frontal hemorrhage is stable.
There is no new hemorrhage. Prominence of ventricles and sulci in are normal
for patient's age. Basal cisterns are patent. Gray-white matter
differentiation is preserved.
Thin lucent line in left occipital bone-? Related to suture or subtle
fracture. (se 3, im 6)
A small lucent focus in the right occipital bone along the inner table is
stable compared to recent study; no remote priors.
There is mucosal thickening within the left maxillary sinus, not significantly
changed from prior. Remainder of the visualized paranasal sinuses are clear.
Mastoid air cells are clear. Bilateral orbits are unremarkable.
IMPRESSION:
1. Stable right frontal SAH.
2. Interval mild increase in one of the foci of the left anterior temporal
SAH (2:10).
3. Left temporal SAH located more posteriorly at the level of the Sylvian
fissure is smaller (2:13).
4. No new hemorrhage.
5. Thin lucent line in left occipital bone-? Related to suture or subtle
fracture. (se 3, im 6)
6. A small lucent focus in the right occipital bone along the inner table is
stable compared to recent study; no remote priors.
NOTIFICATION: Findings telephoned to Dr. ___ by ___ on
___ at 3:09PM, time of read.
|
19876293-RR-17
| 19,876,293 | 27,053,236 |
RR
| 17 |
2187-04-20 13:26:00
|
2187-04-20 17:00:00
|
INDICATION: ___ w/ hx afib on coumadin, HTN p/w traumatic SAH and multiple
rib fractures from OSH. // please do second read of C spine
TECHNIQUE: Second read requested on outside hospital C-spine CT dated ___. Axial thin section and bone algorithm reconstructed images and
coronal and sagittal reformats were provided for review.
DOSE: None available
COMPARISON: None
FINDINGS:
There is no evidence of acute cervical spine fracture or traumatic
malalignment. Minimally displaced fractures of the left first, second and
third ribs are noted. A fracture of the left clavicle is partially visualized.
Multilevel degenerative change with loss of disc height and anterior and
posterior osteophytes worse at C5-6 and C6-7. Disc osteophyte complexes indent
the thecal sac anteriorly at C3-4, C4-5, C5-6 and C6-7. No lymphadenopathy is
present by CT size criteria. There is biapical pleural thickening.
Atherosclerotic calcification of the bilateral carotid bifurcations noted.
IMPRESSION:
1. No evidence of acute cervical spine fracture or traumatic malalignment
2. Fractures of the left first, second and third rib is an the left clavicle.
Attending physician ___ has reviewed the images and agree with the
findings.
|
19876293-RR-18
| 19,876,293 | 27,053,236 |
RR
| 18 |
2187-04-21 11:10:00
|
2187-04-21 16:32:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with rib fractures // eval for interval change
of atelectasis, rib fractures
TECHNIQUE: Single portable AP view radiograph of the chest.
COMPARISON: Prior chest radiographs dating back ___.
FINDINGS:
Compared with the prior study of ___, numerous left-sided rib
fractures have become moderately displaced with inward collapse at the
fracture site. No definite pneumothorax is appreciated. Increased density of
both lung bases is likely related to compression atelectasis from the partial
chest wall collapse. There may be small bilateral pleural effusions.
IMPRESSION:
1. New moderate displacement and angulation of multilevel rib fractures.
2. Increased bibasilar opacification likely due to compressive atelectasis.
3. No definite pneumothorax.
NOTIFICATION: The findings were discussed by Dr. ___ with Dr.
___ On the telephone on ___ at 4:32 ___, 10 minutes after
the discovery of the findings.
|
19876293-RR-8
| 19,876,293 | 27,053,236 |
RR
| 8 |
2187-04-19 22:16:00
|
2187-04-19 23:07:00
|
EXAMINATION: LEFT WRIST RADIOGRAPHS
INDICATION: Left wrist deformity after fall.
COMPARISON: None.
TECHNIQUE: Left wrist, five views.
FINDINGS:
There is a mildly impacted fracture involving the distal radius with very mild
dorsal angulation and associated positive ulnar variance. The ulnar styloid is
also avulsed. In addition, there is a there are fractures involving the distal
shafts of both the third and fourth metatarsals, the latter somewhat impacted.
The bones appear demineralized.
IMPRESSION:
Fractures of the distal radius, ulna and third and fourth metacarpals.
|
19876293-RR-9
| 19,876,293 | 27,053,236 |
RR
| 9 |
2187-04-19 22:17:00
|
2187-04-19 23:12:00
|
EXAMINATION: CHEST RADIOGRAPH
INDICATION: Follow-up of known left-sided pneumothorax.
TECHNIQUE: Chest, AP supine.
COMPARISON: Chest CT from earlier on the same day at ___ as
scanned into the ___ pacs system.
FINDINGS:
The cardiac, mediastinal and hilar contours appear stable including
cardiomegaly and calcification of both the aorta and anulus of the mitral
valve. There is a very small pneumothorax which collects at the lateral left
lung base, very similar to prior findings. Allowing for differences in
technique, the extent is probably unchanged. There is again elevation of the
left hemidiaphragm and associated with mild volume loss. The lungs appear
otherwise clear. Contrast associated with performing a recent prior CT is
noted in partly visualized renal collecting systems.
IMPRESSION:
Small left-sided pneumothorax, collecting at the left lung base, probably
unchanged.
|
19876585-RR-13
| 19,876,585 | 20,445,129 |
RR
| 13 |
2157-10-31 18:41:00
|
2157-10-31 20:08:00
|
HISTORY: ___ male with altered mental status and head laceration.
TECHNIQUE: Contiguous axial images obtained from skullbase to vertex without
intravenous contrast. Coronal and sagittal reformats were reviewed.
COMPARISON:
FINDINGS:
There is no acute intra-axial or extra-axial hemorrhage, mass, midline shift,
or territorial infarct. The ventricles and sulci are unremarkable. Basilar
cisterns are patent. Gray-white matter differentiation is preserved.
There is bilateral ethmoid air cell and right maxillary sinus opacification.
Other included paranasal sinuses and mastoids are clear. Skull and
extracranial soft tissues are unremarkable.
IMPRESSION:
No acute intracranial process.
|
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