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|---|---|---|---|---|---|---|---|
19876585-RR-14
| 19,876,585 | 20,445,129 |
RR
| 14 |
2157-10-31 20:06:00
|
2157-10-31 20:38:00
|
CHEST, TWO VIEWS; ___
HISTORY: ___ male with left-sided rib pain.
COMPARISON: None.
FINDINGS: Frontal and lateral views of the chest. The lungs are clear
without focal consolidation, effusion or pneumothorax. The cardiomediastinal
silhouette is within normal limits. Mid-to-lower thoracic dextroscoliosis is
noted. No displaced rib fracture is identified.
IMPRESSION: No acute cardiopulmonary process. No rib fracture identified on
this non-dedicated exam. If desired, a rib series can be performed.
|
19876585-RR-15
| 19,876,585 | 20,445,129 |
RR
| 15 |
2157-11-01 12:57:00
|
2157-11-01 15:45:00
|
HISTORY: ___ male with alcohol abuse.
COMPARISON: No previous exam for comparison.
FINDINGS:
The hepatic architecture is coarsened in appearance. No concerning liver
lesion is identified. No biliary dilatation is seen and the common duct
measures 0.1 cm. The portal vein is patent with hepatopetal flow. The
gallbladder is contracted as the patient ate prior to the ultrasound. No
gallstones are visualized. The pancreas and spleen are normal. The spleen
measures 11.9 cm. No hydronephrosis is seen in either kidney. The right
kidney measures 12.8 cm and the left kidney measures 10.5 cm. The aorta is of
normal caliber throughout. The visualized portion of the IVC is unremarkable.
No ascites is seen in the abdomen.
IMPRESSION:
Coarsened hepatic architecture. No concerning liver lesion identified.
|
19876636-RR-26
| 19,876,636 | 25,552,151 |
RR
| 26 |
2175-10-25 18:17:00
|
2175-10-25 19:37:00
|
EXAMINATION: CHEST (AP AND LAT)
INDICATION: ___ with cough // ?acute process
COMPARISON: Prior exam is dated ___ and ___
FINDINGS:
AP upright and lateral views of the chest provided. Mild platelike lower lung
atelectasis is noted. There is no focal consolidation, effusion, or
pneumothorax. There are no signs of congestion or edema. The
cardiomediastinal silhouette is normal. Imaged osseous structures are intact.
No free air below the right hemidiaphragm is seen.
IMPRESSION:
No acute intrathoracic process.
|
19876636-RR-27
| 19,876,636 | 25,552,151 |
RR
| 27 |
2175-10-25 18:24:00
|
2175-10-25 19:03:00
|
EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ with cirrhosis, hepatitis C, history of splenectomy, chronic
pancreatitis, alcohol use, chest pain.
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: CT abdomen dated ___.
FINDINGS:
LIVER: Coarsened liver with slightly nodular contour consistent with
reported/known cirrhosis. There is no focal liver mass. The main portal vein
is patent with hepatopetal flow. There is no ascites.
BILE DUCTS: There is unchanged intrahepatic biliary ductal dilation.
CHD: Chronically dilated measuring up to 1.6 cm.
GALLBLADDER: Echogenic nonshadowing material within the lumen of the
gallbladder is most suggestive of sludge. No definite gallstones. No
evidence of acute cholecystitis.
PANCREAS: Not well visualized.
SPLEEN: Status post splenectomy with splenosis in the left upper quadrant
measuring up to 7.4 cm.
KIDNEYS: Limited views of the kidneys show no hydronephrosis.
Right kidney: 12.2 cm. A simple cyst arising from the lower pole of the
right kidney is again seen containing a single thin septation.
Left kidney: 10.7 cm
RETROPERITONEUM: The visualized portions of aorta and IVC are within normal
limits.
IMPRESSION:
1. Hepatic cirrhosis. No ascites.
2. Gallbladder sludge.
3. Stable biliary ductal dilation.
|
19877091-RR-64
| 19,877,091 | 23,067,854 |
RR
| 64 |
2184-05-11 01:00:00
|
2184-05-11 01:36:00
|
INDICATION: History: ___ with productive cough.// Pneumonia?
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest radiograph ___ and ___.
FINDINGS:
The lungs are clear. The pulmonary vasculature is unremarkable. No pleural
effusion or pneumothorax. The heart size is normal. Aortic contour is
tortuous, stable. No acute osseous abnormalities.
IMPRESSION:
No acute process.
|
19877618-RR-32
| 19,877,618 | 20,429,194 |
RR
| 32 |
2185-02-24 14:36:00
|
2185-02-24 16:01:00
|
INDICATION: Colonoscopy, now with fevers. Evaluate for free air.
COMPARISON: Chest radiograph from ___.
FINDINGS: Single AP view of the chest demonstrates clear lungs. The cardiac,
mediastinal, and hilar contours are normal. No pleural abnormality is seen.
No subdiaphragmatic free air is noted. The osseous structures are normal.
IMPRESSION: No evidence of cardiopulmonary process or pneumoperitoneum.
|
19877618-RR-33
| 19,877,618 | 20,429,194 |
RR
| 33 |
2185-02-24 17:37:00
|
2185-02-24 18:52:00
|
HISTORY: History Crohn's disease status post resection with colonoscopy today
presenting with fevers and tachycardia. Evaluate for perforation.
Technique: MDCT images were obtained from the lung bases to the pubic
symphysis after administration of 130 cc of Omnipaque. Multiplanar
reformatted images in coronal and sagittal planes were generated.
DLP: 287 mGy-cm
CTDIvol: 29 mGy
COMPARISON: ___.
FINDINGS:
Lungs: The lung bases are clear, with no pleural effusions, nodules, or
opacities. There is no pericardial effusion.
Abdomen: The liver enhances homogeneously with no focal lesions. There is no
intra or extrahepatic biliary dilatation and the portal veins are patent. The
gallbladder is normal with no stones or pericholecystic fluid. The pancreas
is normal with no peripancreatic fat stranding. The spleen enhances
homogeneously with no focal lesions. The adrenal glands are normal in size
and morphology. The kidneys enhance symmetrically with no focal lesions or
hydronephrosis. There is symmetric contrast excretion.
The patient is status post ileocolectomy without evidence of bowel
obstruction. No intra-abdominal free air or free fluid. No mesenteric or
retroperitoneal lymphadenopathy.
Pelvis: The bladder is well distended and normal appearing. The prostate and
seminal vesicles are normal. No pelvic free fluid. No pathologically
enlarged pelvic sidewall or inguinal lymphadenopathy.
Vessels: The abdominal aorta is normal in caliber. The aorta and its major
branches are patent.
Bones: No blastic or lytic lesions suspicious for malignancy or infection.
IMPRESSION:
No acute intra-abdominal process. No bowel obstruction. No intra-abdominal
free air.
|
19877618-RR-38
| 19,877,618 | 23,626,715 |
RR
| 38 |
2186-12-24 08:43:00
|
2186-12-24 10:37:00
|
EXAMINATION: COMPLETE GU U.S. (BLADDER AND RENAL)
INDICATION: ___ year old man with hx of Crohn's disease and kidney stones
found to have elevated creatinine // eval for stones, obstruction etc.
TECHNIQUE: Grey scale and color Doppler ultrasound images of the kidneys were
obtained.
COMPARISON: Abdominal ultrasound dated ___.
FINDINGS:
The right kidney measures 10.3 cm. The left kidney measures 9.3 cm. There is
moderate hydronephrosis on the right. There is a 8 mm nonobstructing stone
within the interpolar region on the right. There is a 7 mm nonobstructing
stone within the interpolar region on the left. No masses are visualized.
Normal cortical echogenicity and corticomedullary differentiation are seen
bilaterally.
The right proximal ureter is dilated, with a 6 mm stone within the mid ureter.
The bladder is moderately well distended and normal in appearance.
The prevoid bladder volume is 62 cc with normal postvoid residual.
The ureteral jet was visualized on the left, but not on the right.
The prostatic volume is 16.9 cc.
IMPRESSION:
1. 6 mm obstructing stone within the right mid ureter, with moderate
hydroureteronephrosis.
2. Multiple nonobstructing stones within the kidneys bilaterally measuring up
to 8 mm.
NOTIFICATION: The findings were discussed with ___, M.D. by
___, M.D. on the telephone on ___ at 10:34 AM, 15
minutes after discovery of the findings.
|
19877618-RR-39
| 19,877,618 | 23,626,715 |
RR
| 39 |
2186-12-24 21:19:00
|
2186-12-24 22:29:00
|
INDICATION: ___ year old man with crohn's, nephrolithiasis, obstructing stone
on ultrasound, urology requesting CTU for further characterization.
TECHNIQUE: CTU: Multidetector CT of the abdomen and pelvis were acquired
without intravenous contrast administration with the patient in prone
position.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Total DLP (Body) = 261 mGy-cm.
COMPARISON:
1. Complete GU ultrasound ___.
2. CT abdomen pelvis with contrast ___.
FINDINGS:
LOWER CHEST: The partially imaged lung bases are clear. There is no pleural or
pericardial effusion. There is no hiatus hernia.
CT ABDOMEN:
HEPATOBILIARY: The liver demonstrates a normal homogeneous noncontrast
appearance. There is no apparent focal lesion. There is no appreciable
intrahepatic biliary ductal dilation. Lack of IV contrast precludes
evaluation of the portal vein. The gallbladder is unremarkable.
PANCREAS: The pancreas demonstrates homogeneous attenuation throughout. There
is no peripancreatic stranding or ductal dilation.
SPLEEN: There is no splenomegaly or focal splenic lesion.
ADRENALS: The adrenal glands are normal.
URINARY: There are numerous bilateral renal calculi. For example, the largest
stone or cluster of stones on the right in the right interpolar collecting
system measures 7 mm in aggregate (series 601b, image 26). On the left,
multiple nonobstructing renal calculi measure up to 6 mm (series 601b, image
21). Additional scattered nonobstructing renal calculi bilaterally are
subcentimeter. There is mild to moderate right hydronephrosis. There is a
stone in the proximal right ureter measuring 4 mm (series 2, image 35). More
distally in the dilated right ureter, there is an approximately 6 cm long
segment of mid and distal right ureter which contains stacked stones, the
largest of which measures up to 8 mm in diameter series 2, image 57, as well
as series 601b images ___. There are no left ureteral calculi. There are
no bladder calculi identified.
GASTROINTESTINAL: The stomach and duodenum are unremarkable. Non-dilated
small bowel loops are normal in course and caliber without evidence of wall
thickening or obstruction. The patient is status post ileocecectomy.
Remaining colon is filled with air and stool but is otherwise unremarkable.
VASCULAR AND LYMPH NODES: The abdominal aorta is normal in caliber without
evidence of aneurysm or dilation. There is no mesenteric or retroperitoneal
lymphadenopathy by CT size criteria. There is no free intraperitoneal air or
fluid.
CT PELVIS:
The imaged pelvic organs, including the bladder and terminal ureters, are
unremarkable. There is no pelvic sidewall, iliac chain, or inguinal
lymphadenopathy. There is no free pelvic fluid.
MUSCULOSKELETAL: Focal skin thickening along the right perineum is unchanged
in comparison to prior study from ___ (series 2, image 85). The
thoracolumbar vertebral bodies are normally aligned. No concerning focal
lytic or sclerotic osseous lesions are identified.
IMPRESSION:
1. Approximately 6 cm long segment of mid and distal right ureter containing
stacked, obstructing stones measured up to 8 mm in diameter, with resultant
moderate upstream right hydroureteronephrosis. No left ureteral calculi or
left hydronephrosis.
2. Multiple bilateral nonobstructing subcentimeter renal calculi measuring up
to 7 mm on the right and 6 mm on the left.
3. Focal skin thickening along the right perineum is of uncertain
significance, unchanged since ___ correlate clinically with focal
complaints and/or physical exam.
|
19877635-RR-21
| 19,877,635 | 21,648,057 |
RR
| 21 |
2130-05-06 14:32:00
|
2130-05-06 15:00:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ with cough, altered mental status// Pneumonia
COMPARISON: ___
FINDINGS:
PA and lateral views of the chest provided. Patient's chin obscures the
superior mediastinum and portions of the left apex. A linear density in the
left mid to lower lung is likely platelike atelectasis. Otherwise, the lungs
appear clear without focal consolidation, large effusion, or definite
pneumothorax. The aorta is markedly tortuous and moderately calcified. The
heart appears top-normal in size. No signs of congestion or edema. Bony
structures are intact. No free air below the right hemidiaphragm.
IMPRESSION:
No signs of pneumonia.
|
19877635-RR-22
| 19,877,635 | 21,648,057 |
RR
| 22 |
2130-05-06 15:15:00
|
2130-05-06 15:50:00
|
EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ with possible delirium// ?CVA
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) = 702 mGy-cm.
COMPARISON: MRI IAC ___
FINDINGS:
There is no evidence of acute territorial infarction, hemorrhage, edema, or
large mass. Periventricular and subcortical white matter hypodensities are
nonspecific, but likely represent chronic small vessel ischemic disease. There
is prominence of the ventricles and sulci suggestive of involutional changes,
progressed since ___.
There is no evidence of fracture. There are moderate aerosolized secretions
in the right sphenoid sinus. There is mild layering fluid in the left
sphenoid sinus. There is a small mucous retention cysts in the left posterior
ethmoid air cells. The visualized portion of the paranasal sinuses, mastoid
air cells, and middle ear cavities are otherwise essentially clear. The
visualized portion of the orbits are unremarkable. There is bilateral carotid
siphon and right vertebral artery calcification.
IMPRESSION:
1. No acute intracranial process.
2. Prominence of the ventricles is progressed since ___. Difficult to
exclude NPH in the appropriate clinical setting.
|
19877772-RR-15
| 19,877,772 | 26,026,055 |
RR
| 15 |
2184-05-17 20:05:00
|
2184-05-17 20:22:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: History: ___ with chest pain, cough, history of sickle cell
disease// Pneumonia, Acute Chest Syndrome
TECHNIQUE: Chest PA and lateral
COMPARISON: None.
FINDINGS:
Lung volumes are low. Heart size is mildly enlarged. Mediastinal and hilar
contours are normal. The pulmonary vasculature is not engorged. Patchy
opacities within the lung bases are noted without focal consolidation. No
pleural effusion or pneumothorax is detected. No acute osseous abnormalities
visualized.
IMPRESSION:
Patchy opacities within the lung bases are concerning for acute chest syndrome
in the correct clinical context with infection not excluded. Mild
cardiomegaly.
|
19877772-RR-16
| 19,877,772 | 26,026,055 |
RR
| 16 |
2184-05-18 10:50:00
|
2184-05-18 13:26:00
|
EXAMINATION: CT chest without contrast
INDICATION: ___ year old man with h/o sickle cell anemia presenting w/ fever
found to have ?infiltrates on CXR// eval for acute chest/PNA, other acute
process
TECHNIQUE: Contiguous axial images were obtained through the chest without
intravenous contrast. Coronal and sagittal reformats were obtained.
COMPARISON: Chest x-ray from the day prior
FINDINGS:
The thyroid is normal. No axillary adenopathy. No mediastinal or hilar
adenopathy. There is trace pericardial effusion.
The thoracic aorta is normal in caliber.
No pleural effusion.
The central tracheobronchial tree is patent.
There is an atelectatic segment right middle lobe seen on image 41 of series
602. Atelectasis/scarring is noted left lower lobe. Linear atelectasis is
noted in left mid lung right upper lobe.
Mild ground-glass opacities with a perivascular distribution and basilar
predominance are noted, nonspecific, potentially a small amount of pulmonary
edema or hemorrhage.
Sclerotic appearance the sternum, ribs, vertebral bodies and H-shaped
vertebral bodies are compatible with the patient's history of sickle cell
disease.
Limited evaluation of the upper abdomen is notable for an auto infarcted
spleen and vicarious excretion of contrast into the gallbladder.
IMPRESSION:
1. Mild perivascular ground glass opacities, nonspecific, potentially related
to microvascular occlusion in the setting of sickle cell, mild pulmonary
edema, or other infectious/inflammatory etiology.
2. Multiple foci of atelectasis/scarring as above.
3. Additional chronic sequelae of sickle cell disease as above.
|
19877772-RR-17
| 19,877,772 | 26,026,055 |
RR
| 17 |
2184-05-18 10:49:00
|
2184-05-18 12:06:00
|
EXAMINATION: CT NECK W/CONTRAST (EG:PAROTIDS) Q22 CT NECK
INDICATION: ___ yo M, from ___, with sickle cell disease, p/w fever, chills,
cough, concerning for acute chest. Also with sore throat and tender neck to
palpation.
TECHNIQUE: Imaging was performed after administration of Omnipaque
intravenous contrast material.
MDCT acquired helical axial images were obtained from the thoracic inlet
through the skull base.
Coronal and sagittal multiplanar reformats were then produced and reviewed.
DOSE: Acquisition sequence:
1) Spiral Acquisition 4.0 s, 31.4 cm; CTDIvol = 7.0 mGy (Body) DLP = 218.6
mGy-cm.
Total DLP (Body) = 219 mGy-cm.
COMPARISON: Same day chest CT
FINDINGS:
Evaluation of the aerodigestive tract demonstrates no mass and no areas of
focal mass effect.
The salivary glands enhance normally and are without mass or adjacent fat
stranding. The thyroid gland appears normal.The neck vessels are patent.
Numerous bilateral cervical lymph nodes are prominent and measure up to 2.0 cm
in the left level IIa station (series 2, image 47). Additional pathologically
enlarged lymph nodes include the left level IIb station measuring 1.5 cm
(series 2, image 42), right level IIa station measuring 1.3 cm (series 2,
image 40), and right level IIb station measuring 1.3 cm (series 2, image 43).
There is moderate maxillary sinus mucosal thickening and mild sphenoid sinus
and ethmoid air cell mucosal thickening.
Heterogeneity of multiple visualized vertebral bodies, the manubrium, and the
partially visualized sternum suggest avascular necrosis in the setting of
sickle cell disease.
Please refer to separate report for same-day CT chest for complete description
of the thoracic findings.
IMPRESSION:
1. Cervical lymphadenopathy as described in the findings, possibly reactive.
No abscess formation.
2. Moderate paranasal sinus disease.
3. Manubrium, sternum, and vertebral body avascular necrosis in the setting of
sickle cell disease.
4. Please refer to separate report for same-day CT chest for complete
description of the thoracic findings.
|
19877772-RR-18
| 19,877,772 | 26,026,055 |
RR
| 18 |
2184-05-18 11:19:00
|
2184-05-18 13:32:00
|
EXAMINATION: UNILAT LOWER EXT VEINS RIGHT
INDICATION: ___ year old man with sickle cell crisis, p/w acute chest, with
right leg larger than left leg.// evidence of DVT
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the bilateral lower extremity veins.
COMPARISON: None.
FINDINGS:
There is normal compressibility, flow, and augmentation of the bilateral
common femoral, femoral, and popliteal veins. Normal color flow and
compressibility are demonstrated in the posterior tibial and peroneal veins.
There is normal respiratory variation in the common femoral veins bilaterally.
No evidence of medial popliteal fossa (___) cyst.
IMPRESSION:
No evidence of deep venous thrombosis in the right or left lower extremity
veins.
|
19877772-RR-19
| 19,877,772 | 26,026,055 |
RR
| 19 |
2184-05-19 03:46:00
|
2184-05-19 10:57:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with h/o sickle cell anemia p/w fever, ?CXR
infiltrates with concern for acute chest// eval for interval change
TECHNIQUE: Single frontal view of the chest
COMPARISON: ___.
FINDINGS:
The right heart border is obscured concerning for an opacity in the right
middle lobe. There is no pneumothorax or pleural effusion.
IMPRESSION:
Obscured right heart border concerning for an opacity in the right middle
lobe. Findings compatible with acute pneumonia.
NOTIFICATION: The findings were discussed with ___, M.D. by ___
___, M.D. on the telephone on ___ at 10:55 am, 10 minutes after
discovery of the findings.
|
19877772-RR-26
| 19,877,772 | 28,508,244 |
RR
| 26 |
2185-06-01 00:09:00
|
2185-06-01 00:48:00
|
EXAMINATION: CTA CHEST WITH CONTRAST
INDICATION: History: ___ with respirophasic chest pain// PE?
TECHNIQUE: Axial multidetector CT images were obtained through the thorax
after the uneventful administration of intravenous contrast. Reformatted
coronal, sagittal, thin slice axial images, and oblique maximal intensity
projection images were submitted to PACS and reviewed.
DOSE: Acquisition sequence:
1) Stationary Acquisition 3.5 s, 0.5 cm; CTDIvol = 21.3 mGy (Body) DLP =
10.6 mGy-cm.
2) Spiral Acquisition 3.9 s, 30.3 cm; CTDIvol = 9.0 mGy (Body) DLP = 272.1
mGy-cm.
Total DLP (Body) = 283 mGy-cm.
COMPARISON: CT chest ___.
FINDINGS:
HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the
subsegmental level without filling defect to indicate a pulmonary embolus. The
thoracic aorta is normal in caliber without evidence of dissection or
intramural hematoma. The heart, pericardium, and great vessels are within
normal limits. No pericardial effusion is seen.
AXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar
lymphadenopathy is present. No mediastinal mass.
PLEURAL SPACES: No pleural effusion or pneumothorax.
LUNGS/AIRWAYS: There similar scattered areas of subsegmental atelectasis and
parenchymal scarring. Otherwise, the remaining lungs are clear without masses
or areas of parenchymal opacification. The airways are patent to the level of
the segmental bronchi bilaterally.
BASE OF NECK: Visualized portions of the base of the neck show no abnormality.
ABDOMEN: Included portion of the upper abdomen is unremarkable.
BONES: Again demonstrated, H-shaped configurations of the vertebral bodies,
sclerotic appearance of the sternum and ribs, and atrophied spleen consistent
with patient's known history of sickle cell disease. Otherwise, no suspicious
osseous abnormality is seen.? There is no acute fracture.
IMPRESSION:
No evidence of pulmonary embolism or aortic abnormality.
|
19877807-RR-9
| 19,877,807 | 24,430,400 |
RR
| 9 |
2144-10-18 17:43:00
|
2144-10-18 18:51:00
|
EXAMINATION: PELVIS U.S., TRANSVAGINAL
INDICATION: ___ year old woman with pelvic pain not improving with treatment
of PID// eval for growth of ovarian cyst, torsion, other pelvic pathology
TECHNIQUE: Grayscale ultrasound images of the pelvis were obtained with
transabdominal approach followed by transvaginal approach for further
delineation of uterine and ovarian anatomy.
COMPARISON: None available at the time of dictation.
FINDINGS:
The uterus is retroverted and measures 7.6 cm x 4.4 cm x 5.4 cm. The
endometrium is homogenous and measures 7 mm.
The right ovary is unremarkable with normal vascularity. A simple appearing
left ovarian cyst measures 3.9 x 3.4 x 3.7 cm and occupies nearly the entirety
of the left ovarian parenchyma. Color flow with appropriate waveforms is seen
within the thin rim of left ovarian tissue. No prior studies available for
comparison. There is no free fluid.
IMPRESSION:
No prior imaging available for comparison. No definite evidence of torsion.
A left ovarian cyst measures up to 3.9 cm in largest diameter, correlation
with outside imaging is recommended.
|
19879535-RR-29
| 19,879,535 | 28,964,260 |
RR
| 29 |
2123-03-16 20:06:00
|
2123-03-16 20:49:00
|
HISTORY: ___ male with pancreatic cancer with pulmonary emboli.
Question intracranial metastases.
TECHNIQUE: Contiguous axial images obtained from skullbase to vertex without
intravenous contrast. Coronal and sagittal reformats were reviewed. DLP:
1,003.42 mGy-cm.
COMPARISON: None.
FINDINGS:
There is no acute intra-axial or extra-axial hemorrhage, mass, midline shift,
or territorial infarct. Subcortical white matter hypodensities are seen,
nonspecific but may be due to chronic small vessel disease. The ventricles
and sulci are unremarkable. Basilar cisterns are patent. Gray-white matter
differentiation is preserved.
Included paranasal sinuses and mastoids are clear. Skull and extracranial
soft tissues are unremarkable.
IMPRESSION:
No acute intracranial process. MRI is more sensitive for detection of
intracranial metastases.
|
19880183-RR-11
| 19,880,183 | 27,749,884 |
RR
| 11 |
2119-07-24 11:30:00
|
2119-07-24 11:53:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: History: ___ with chest pain// ?cardiomegaly, pneumonia, effusion
TECHNIQUE: Upright AP view of the chest
COMPARISON: None.
FINDINGS:
Heart size is mildly enlarged. The mediastinal and hilar contours are norm
unremarkable al. The pulmonary vasculature is normal. Lungs are clear. No
pleural effusion or pneumothorax is seen. There are no acute osseous
abnormalities.
IMPRESSION:
No acute cardiopulmonary abnormality.
|
19880183-RR-12
| 19,880,183 | 27,749,884 |
RR
| 12 |
2119-07-24 12:51:00
|
2119-07-24 13:20:00
|
EXAMINATION: CTA CHEST WITH CONTRAST
INDICATION: History: ___ with chest pain and EKG changes, active cancer// ?PE
TECHNIQUE: Axial multidetector CT images were obtained through the thorax
after the uneventful administration of intravenous contrast. Reformatted
coronal, sagittal, thin slice axial images, and oblique maximal intensity
projection images were submitted to PACS and reviewed.
DOSE: Acquisition sequence:
1) Stationary Acquisition 2.5 s, 0.5 cm; CTDIvol = 12.0 mGy (Body) DLP =
6.0 mGy-cm.
2) Spiral Acquisition 4.6 s, 36.1 cm; CTDIvol = 25.5 mGy (Body) DLP = 920.8
mGy-cm.
Total DLP (Body) = 927 mGy-cm.
COMPARISON: Same day chest x-ray
FINDINGS:
HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the
subsegmental level without filling defect to indicate a pulmonary embolus. The
thoracic aorta is normal in caliber without evidence of dissection or
intramural hematoma. There is left ventricular hypertrophy and the heart is
mildly enlarged. Mild calcification of the mitral annulus is demonstrated.
Otherwise, the pericardium and great vessels are within normal limits. No
pericardial effusion is seen.
AXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar
lymphadenopathy is present. No mediastinal mass.
PLEURAL SPACES: No pleural effusion or pneumothorax.
LUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal
opacification. The airways are patent to the level of the segmental bronchi
bilaterally.
BASE OF NECK: Visualized portions of the base of the neck show no abnormality.
ABDOMEN: Included portion of the upper abdomen is unremarkable.
BONES: No suspicious osseous abnormality is seen.? There is no acute fracture.
IMPRESSION:
1. No evidence of pulmonary embolism or aortic abnormality.
2. Left ventricular hypertrophy.
|
19880882-RR-12
| 19,880,882 | 25,252,749 |
RR
| 12 |
2161-03-22 11:21:00
|
2161-03-22 11:32:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old woman with pain in L back radiating to L chest // L
chest pain
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest radiograph ___
FINDINGS:
Heart size is normal. Tortuosity of the descending thoracic aorta is
relatively unchanged. The mediastinal and hilar contours are otherwise
normal. The pulmonary vasculature is normal. Lungs are clear. No pleural
effusion or pneumothorax is seen. There are no acute osseous abnormalities.
IMPRESSION:
No acute cardiopulmonary abnormality.
|
19880967-RR-17
| 19,880,967 | 24,776,258 |
RR
| 17 |
2174-06-13 11:11:00
|
2174-06-13 13:55:00
|
INDICATION: ___ with AML p/w syncope, fever and tachycardia evaluate for
consolidation.
TECHNIQUE: Single upright AP chest radiograph
COMPARISON: Prior chest radiographs dating back to ___.
FINDINGS:
Compared with the immediate prior study there is new right lower lobe airspace
opacity consistent with pneumonia. There is no pleural effusion,
pneumothorax, or significant pulmonary edema. The cardiomediastinal
silhouette is stable. A right PICC terminates in the cavoatrial junction.
IMPRESSION:
New right lower lung pneumonia.
NOTIFICATION: The findings were discussed with ___, M.D. by
___, M.D. on the telephone on ___ at 1:53 ___, 2 minutes
after discovery of the findings.
|
19880967-RR-18
| 19,880,967 | 24,776,258 |
RR
| 18 |
2174-06-13 12:01:00
|
2174-06-13 13:37:00
|
EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ with AML with syncope, word finding difficulties and
thrombocytopenia. Please eval for intracranial hemorrhage.
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast. Coronal and sagittal reformations as well as bone algorithm
reconstructions were provided and reviewed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 16.0 s, 16.8 cm; CTDIvol = 47.7 mGy (Head) DLP =
802.7 mGy-cm.
2) Sequenced Acquisition 2.0 s, 4.2 cm; CTDIvol = 47.7 mGy (Head) DLP =
200.7 mGy-cm.
Total DLP (Head) = 1,003 mGy-cm.
COMPARISON: None.
FINDINGS:
Images are limited by motion artifact. There is no evidence of large
territorial infarction, acute intracranial hemorrhage, edema, or mass. The
ventricles and sulci are normal in size and configuration. Mild
periventricular white matter hypodensities are nonspecific, but likely sequela
of chronic small vessel ischemic disease.
There is no evidence of fracture. Mild mucosal thickening in the bilateral
maxillary sinuses. The visualized portion of the remaining paranasal sinuses,
mastoid air cells, and middle ear cavities are clear. The visualized portion
of the orbits are unremarkable.
IMPRESSION:
Images are limited by motion artifact. Within this limitation, no acute
intracranial hemorrhage.
|
19880967-RR-36
| 19,880,967 | 22,946,682 |
RR
| 36 |
2175-11-15 10:40:00
|
2175-11-15 11:32:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with fevers, PICC (not new)// verify PICC
placement, eval for consolidation verify PICC placement, eval for
consolidation
IMPRESSION:
Comparison to ___. The patient carries a right-sided PICC line.
The course of the line is unremarkable, the tip of the line projects over the
cavoatrial junction. No pneumothorax or other complications. Borderline size
of the heart. No pleural effusions. No pneumonia. Minimal left basal
atelectasis.
|
19880967-RR-38
| 19,880,967 | 22,946,682 |
RR
| 38 |
2175-11-23 15:07:00
|
2175-11-23 16:47:00
|
EXAMINATION: CT abdomen and pelvis without contrast
INDICATION: ___ year old woman presented with febrile neutropenia, found to
have blood culture positive for oligella urethralis. refusing IV contrast.//
eval for infection
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. Intravenous contrast was not administered due to patient refusal.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 7.7 s, 49.9 cm; CTDIvol = 21.3 mGy (Body) DLP =
1,047.8 mGy-cm.
Total DLP (Body) = 1,048 mGy-cm.
COMPARISON: CT abdomen and pelvis ___.
FINDINGS:
LOWER CHEST: Heart size is normal without significant pericardial effusion.
Coronary artery calcifications are seen. There is hypoattenuation of the
blood pool relative to the cardiac musculature suggestive of anemia. There is
mild linear scarring or atelectasis in the left lung base. The imaged lung
bases are otherwise grossly clear.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout.
There is no evidence of focal lesions within the limitations of an unenhanced
scan. There is no evidence of intrahepatic or extrahepatic biliary
dilatation. The gallbladder is within normal limits.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions within the limitations of an unenhanced scan. There is no
pancreatic ductal dilatation. There is no peripancreatic stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size. There is no evidence
of focal renal lesions within the limitations of an unenhanced scan. There is
no hydroureteronephrosis or nephroureterolithiasis. There is no perinephric
abnormality.
GASTROINTESTINAL: There is a tiny hiatal hernia. The stomach is otherwise
grossly unremarkable. Small bowel loops demonstrate normal caliber and wall
thickness throughout. Very few scattered colonic diverticula are seen. The
colon and rectum are otherwise within normal limits. The appendix is normal.
There is no obstruction. Ingested oral contrast reaches the level of the
cecum.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: The uterus and ovaries are not seen. There is no gross
adnexal abnormality.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic
disease is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
There are mild lumbar degenerative changes. There is a Schmorl's node at the
superior endplate of L4.
SOFT TISSUES: There is paraumbilical rectus diastasis along with a tiny
paraumbilical fat containing hernia to the left of midline (02:53).
IMPRESSION:
1. No acute findings or infectious source in the abdomen or pelvis. No fluid
collection.
2. Tiny fat containing paraumbilical hernia to the left of midline.
3. Tiny hiatal hernia.
4. Findings suggesting anemia.
|
19881062-RR-3
| 19,881,062 | 20,167,909 |
RR
| 3 |
2143-11-09 03:55:00
|
2143-11-09 06:44:00
|
INDICATION: Status post MVC. Evaluate for trauma.
COMPARISON: Outside hospital CT torso from ___.
FINDINGS: The endotracheal tube ends 2.9 cm above the level of the carina.
The NG tube ends at the level of the gastroesophageal junction, although the
side port is in the distal esophagus. Lung volumes are low. There is minimal
bibasilar atelectasis. Heart size is normal. The mediastinal contours are
normal. There are no pleural effusions. No pneumothorax is seen. The bony
thorax is grossly intact.
IMPRESSION:
1. No acute cardiac or pulmonary process.
2. NG tube side port ends in the distal esophagus. Recommend advancing.
|
19881062-RR-4
| 19,881,062 | 20,167,909 |
RR
| 4 |
2143-11-09 04:18:00
|
2143-11-09 06:44:00
|
INDICATION: Status post MVC, car versus tree. Possible contact with
windshield. Evaluate for trauma.
TECHNIQUE: MDCT axial images were acquired through the facial bones without
the administration of intravenous contrast material. Multiplanar reformations
were performed.
COMPARISON: Reference CT head (___) from ___ at
1:08 a.m., roughly three hours earlier.
FINDINGS: There is extensive right orbital emphysema, ___. This
is associated with a right orbital floor blowout fracture (400b:40). There
may be minimal herniation of orbital fat into the superiormost portion of the
right maxillary sinus, although the extraocular muscles are appropriately
situated within the right orbit. Air is seen along the medial aspect of the
right orbit (2:51). The ocular globes are intact. There is a
minimally-displaced coronally-oriented fracture through the bony nasal septum,
without significant deviation (2:46). Mucosal thickening is seen throughout
the bilateral maxillary, frontal and sphenoid sinuses, and ethmoidal air
cells. There is complete opacification of several bilateral ethmoidal air
cells, as well. Secretions with likely hemorrhagic content are seen within
the nasopharynx.
The ostiomeatal units are severely narrowed, bilaterally, secondary to
maxillary sinus mucosal thickening. The laminae papyracea and cribriform
plates appear intact. Note is made of endotracheal and orogastric tubes.
This study was not optimized for evaluation of the intracranial contents. A
subtle left frontotemporal subdural hematoma is better seen on the
accompanying head CT from ___.
IMPRESSION:
1. "Blow-out" fracture of the right orbital floor without evidence of
extraocular muscle entrapment.
2. Minimally displaced fracture of the bony nasal septum.
3. Extensive paranasal sinus inflammatory disease.
NOTE ADDED IN ATTENDING REVIEW: As above, there is a slightly-displaced
fracture of the right orbital floor, with herniation of fat through the
defect. No displacement or frank impalement of the extra-ocular muscles or
other periorbita is seen. However, there is a relatively large "trap-door"
fragment, transgressing the infra-orbital foramen, measuring 22 mm (AP) x 9 mm
(TRV). The right globe is intact with normally-positioned lens, and no blood
in either the anterior or posterior chamber, which appear symmetric with the
contralateral globe.
The minimally-displaced fracture of the bony nasal septum is associated with
corresponding fractures of the nasal bones, also little displaced with no
overall angulation of the nasal skeleton. The nasofrontal process, maxillary
spine and hard palate are intact.
|
19881062-RR-5
| 19,881,062 | 20,167,909 |
RR
| 5 |
2143-11-09 04:27:00
|
2143-11-09 06:53:00
|
INDICATION: Second read request on outside hospital CT. The patient is
status post MVC, car versus tree.
TECHNIQUE: Axial CT images were acquired from the thoracic inlet through the
lesser trochanters at the ___. Multiplanar reformations
were performed.
COMPARISON: None.
CHEST CT: Motion artifact slightly limits evaluation of this study. Diffuse
ground-glass opacities throughout both lungs are consistent with atelectasis
given the expiratory phase of this study. Slightly more consolidative
opacities in the right upper lobe (2:23,2:25) could be small pulmonary
contusions or additional regions of atelectasis. There are no pleural
effusions. No pneumothorax is seen. The airways are patent to the
subsegmental levels bilaterally.
The thoracic aorta is unremarkable. The heart is grossly normal. There is no
pericardial effusion. No pathologically enlarged mediastinal, hilar, or
axillary lymph nodes are seen. The visualized portion of the thyroid gland is
unremarkable.
ABDOMEN CT: The liver is grossly normal. There is no intrahepatic biliary
duct dilatation. The portal vein is patent. The gallbladder, spleen,
pancreas, adrenal glands, and kidneys are unremarkable. The stomach, small
bowel, and colon are grossly normal. There is no free fluid or free air in
the abdomen. No pathologically enlarged abdominal lymph nodes are seen. The
abdominal aorta is normal in caliber and its main branches are patent.
PELVIS CT: The bladder is grossly normal. There is no free fluid in the
pelvis. No pathologically enlarged pelvic lymph nodes are seen.
BONE WINDOW: No suspicious lytic or blastic lesions are identified. No acute
fractures are seen.
IMPRESSION: Possible small right upper lobe pulmonary contusions should be
correlated with the site of impact. Otherwise, no acute intrathoracic,
abdominal, or pelvic process.
|
19881062-RR-6
| 19,881,062 | 20,167,909 |
RR
| 6 |
2143-11-09 05:28:00
|
2143-11-09 07:01:00
|
INDICATION: Unrestrained driver in a motor vehicle collision, car versus
tree. Possible head versus windshield. Question of a left subdural hematoma
seen on outside hospital CT. Evaluate for intracranial hemorrhage.
TECHNIQUE: Sequential axial images were acquired through the head without
administration of intravenous contrast material. Multiplanar reformations
were performed.
COMPARISON: Reference NECT head (___) from ___ at
1:08 a.m.
FINDINGS: A very small subdural hematoma overlying the left frontotemporal
region is not significantly changed in extent or thickness, compared to CT
from approximately five hours earlier. There is no new intracranial
hemorrhage. There is no evidence of acute large vascular territorial
infarction, edema, hydrocephalus, or shift of normally midline structures. No
central herniation is seen.
Details of the right orbital floor "blow-out" fracture are fully described in
the concurrent maxillofacial CT, reported separately. There is extensive
paranasal sinus inflammatory disease, also discussed in detail in that report.
IMPRESSION: No interval change in size of the very thin left frontotemporal
subdural hematoma, with no mass effect. No new hemorrhage.
|
19881159-RR-27
| 19,881,159 | 20,912,393 |
RR
| 27 |
2153-11-07 03:59:00
|
2153-11-07 07:17:00
|
EXAMINATION: MR ___ AND W/O CONTRAST ___ MR SPINE
INDICATION: ___ year old woman with hematoma near R hip prosthesis, Presacral
mass
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 5 mL of
___ contrast agent.
COMPARISON: CT abdomen pelvis from ___.
FINDINGS:
Spinal labeling has been provided on series 5, image 11, and is based on the
last costal process seen on the CT performed on the prior day. There is
sacralization of the L5 vertebral body.
Moderate anterior wedge compression deformity of L1 is demonstrated, however
without definite evidence of increased STIR signal abnormality, of
indeterminate chronicity. Severe compression fracture of L2 with vertebral
plana centrally and moderate retropulsed bowing of the posterior cortex into
the central canal. Mild compression deformity of the L3 vertebral body,
specifically the loss of height of the middle column demonstrates mild
increased STIR/T2 signal abnormality.
Mild enhancement is seen involving the L3 vertebral body.
The presacral mass, is partially visualized and better evaluated on the MRI of
the sacrum performed on the same day.
T12-L1: Mild central disc bulge is seen however there is no significant
spinal canal stenosis. Facet joint and endplate arthropathy contributes to
mild left and moderate right neuroforaminal narrowing.
L1-L2: Left central disc bulge is seen, which in combination with ligamentum
flavum hypertrophy contributes to moderate canal narrowing. Facet joint
arthropathy contributes to mild left neuroforaminal narrowing. The right
neuroforamen is patent.
L2-L3: Left central disc bulge is seen, which in combination with facet joint
arthropathy contributes to mild canal narrowing. Facet joint osteophytes
contribute to severe left and moderate right neuroforaminal narrowing.
L3-L4: Central disc bulge, and ligamentum flavum hypertrophy contributes to
mild canal narrowing. Facet joint osteophytes contribute to severe left and
moderate right neuroforaminal narrowing.
L4-L5: Mild central disc bulge is seen, which in combination with ligamentum
flavum hypertrophy contributes to mild canal narrowing. Facet joint
osteophytes in the left facet joint effusion is seen resulting in moderate to
severe left and moderate right neuroforaminal narrowing.
IMPRESSION:
1. Spinal labeling has been provided on series 5, image 11 based on the last
costal process of the prior CT. Note is made of sacralization of the L5
vertebral body.
2. Moderate anterior wedge compression deformity of L1, is of indeterminate
chronicity.
3. Severe compression fracture with vertebral plana centrally of L2 and
moderate retropulsed bowing of the posterior cortex in the central canal,
results in moderate canal narrowing. This is also of indeterminate
chronicity, and an underlying neoplastic or inflammatory process cannot be
excluded but appears less likely. No definite enhancement is seen.
4. Increased STIR hyperintensity of L3, with mild enhancement and loss of
height of the middle column, suggest a subacute compression deformity.
5. Presacral mass, incompletely visualized on this exam, better evaluated on
the dedicated MRI of the sacrum.
|
19881159-RR-28
| 19,881,159 | 20,912,393 |
RR
| 28 |
2153-11-07 04:59:00
|
2153-11-07 07:12:00
|
EXAMINATION: MRI SACRUM/SI JOINTS WANDW/O CONTRAST
INDICATION: ___ year old woman with pain // fx
TECHNIQUE: Multiplanar images of the sacrum were performed prior to and
following the administration of intravenous contrast using a sacroiliitis MR
protocol.
COMPARISON: MRI right hip ___, CT ___.
FINDINGS:
There is a small right sacroiliac joint effusion. Some minimal marrow edema
is seen in the right sacral ala and right iliac bone, similar perhaps slightly
improved compared to previous MRI. No bone erosion is demonstrated. Small
foci of STIR 6 signal hyperintensity are demonstrated in the left iliac bone
and left sacral ala (series 7, image 18, 17). These are a likely unchanged
allowing for difference in technique compared with previous MRI (STIR sequence
series 3, image 30, 29).
There is no evidence of acute fracture. There is artifact related to right
hip hardware. Some mild edema is demonstrated about the right iliac bone,
likely decreased compared to previous study.
There are degenerative changes at the L5-S1 facet joints more marked on left.
There is sigmoid colon diverticulosis.
There is a mass lesion contacting the anterior aspect of the sacrum. This is
heterogeneous in signal intensity on T1, predominantly hyperintense to
skeletal muscle. The lesion measures 3.5 cm transverse, 2.6 cm anterior to
posterior, 3.6 cm in craniocaudal dimension. The lesion is heterogeneously
STIR hyperintense. Evaluation on precontrast fat suppressed images is limited
by artifact. I suspect some enhancement within lesion based on the
post-contrast images but evaluation is limited due to degraded precontrast
images. In addition to the dominant mass lesion, there is impression of some
more ill-defined soft tissue thickening along the anterior aspect of the mid
and lower sacrum. The previous exam technique did not well evaluate this area
however I suspect the lesion was subtly present on previous axial STIR
sequence (series 5, image 4) of the previous study.
Bladder diverticula are noted.
Compression deformities at multiple levels in the lumbar spine are
demonstrated. I note that dedicated lumbar spine imaging was performed same
day, more completely evaluating these.
IMPRESSION:
1. Small effusion at the right sacroiliac joint, but no bone erosion. Mild
bone edema about the right sacroiliac joint appears similar or slightly
improved compared to prior.
2. Small nonspecific foci of STIR hyperintensity in the left sacral ala and
left iliac bone are likely stable from previous exam.
3. No acute fracture.
4. Presacral soft tissue mass is nonspecific but could represent
extramedullary hematopoiesis. Alternative neoplastic etiology is not
completely excluded. The lesion however was likely present on previous exam
from ___ without gross change although direct comparison is limited
by difference in scan technique.
5. Sigmoid colon diverticulosis.
6. Bladder diverticulosis.
7. Lumbar spine compression deformities better evaluated on MRI sacrum
performed same day.
|
19881159-RR-29
| 19,881,159 | 20,912,393 |
RR
| 29 |
2153-11-08 10:39:00
|
2153-11-08 11:33:00
|
EXAMINATION: UNILAT LOWER EXT VEINS RIGHT
INDICATION: ___ year old woman with history of R thigh pseudotumor,
essentially bedbound with decreased mobility, R > L ___ edema. Evaluate for
right lower extremity DVT.
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the right lower extremity veins.
COMPARISON: Right lower extremity CT of ___.
FINDINGS:
There is normal compressibility, flow, and augmentation of the right common
femoral, femoral, and popliteal veins. Normal color flow and compressibility
are demonstrated in the posterior tibial and peroneal veins.
There is normal respiratory variation in the common femoral veins bilaterally.
No evidence of medial popliteal fossa (___) cyst.
IMPRESSION:
No evidence of deep venous thrombosis in the right lower extremity veins.
|
19881159-RR-30
| 19,881,159 | 20,912,393 |
RR
| 30 |
2153-11-08 17:18:00
|
2153-11-08 18:01:00
|
INDICATION: ___ yo female with history of Afib on Eliquis, osteoporosis s/p R
hip replacement and repair, c/b pseudotumor and hematoma s/p recent revision
and evacuation who presents with back and leg pain, found to have spinal
compression fractures. ? moderate effusion on CXR // ? eval effusion,
atelectasis
TECHNIQUE: Chest PA and lateral
COMPARISON: ___
FINDINGS:
There is a moderate to large left pleural effusion with overlying atelectasis.
The right lung is clear.
The size of the cardiomediastinal silhouette is enlarged but unchanged.
Multiple compression deformities of the thoracic spine, age indeterminate.
Chronic appearing right posterior rib fractures.
IMPRESSION:
Moderate to large left pleural effusion with overlying atelectasis, not
significantly changed from prior.
Age indeterminate thoracic vertebral body compression deformities.
|
19881159-RR-31
| 19,881,159 | 20,912,393 |
RR
| 31 |
2153-11-11 08:12:00
|
2153-11-11 09:52:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with pleural effusion s/p ___ // pleural
effusion post ___, r/o PNX pleural effusion post ___, r/o PNX
IMPRESSION:
Comparison to ___. Decrease in extent of the known left pleural
effusion. Decrease in extent of the associated atelectasis. No pneumothorax.
Stable appearance of the cardiac silhouette.
|
19881376-RR-100
| 19,881,376 | 20,585,454 |
RR
| 100 |
2171-09-22 15:52:00
|
2171-09-22 17:31:00
|
HISTORY: ___ years old man with BMT; CKD on HD; atrial fibrillation, off from
Coumadin, SDH (resolved), occipital HA, and posterior neck pain. Please
assess for progression of right apical lung nodule and sign of malignancy in
the lung.
TECHNIQUE: MDCT of the chest was obtained from thoracic inlet to upper
abdomen in supine position after administration of 75 cc of Omnipaque nonionic
intravenous contrast material agent. Axial images were reviewed in
conjunction with coronal and sagittal reformats.
COMPARISON: Exam is compared to CTA of ___.
FINDINGS: The thyroid gland is unremarkable. There are no pathologically
enlarged lymph nodes in the axillary, supraclavicular, mediastinal and hilar
region according to CT criteria. Cluster of subcentimeter lymph nodes in the
lower paratracheal region (2:16), unchanged since ___. Ascending aorta and
main pulmonary artery are normal, measuring 29 and 30 mm (2:21). Heart size
is moderate-to-severely enlarged by enlargement of all four chambers but in
particular left atrium (2:32). Patient is status post sternotomy for CABG.
Moderate-to-severe aortic valve calcification and coronary artery
calcification involving the LAD, circumflex and right coronary artery (2:29)
are unchanged since ___. Moderate-to-severe aortosclerosis is stable since
___, (2:14) with sign of chronic aortic arch dissection.
There is no pleural effusion.
Even though this exam is not tailored for abdominal imaging, it shows normal
appearance of liver in patient after cholecystectomy. Mild ascites
distributed anterior to the liver (2:49). Multiple kidney cysts are in the
left kidney (2:61), stable since ___. Spleen and adrenals are normal.
BONES: There are no bone lesions suspicious for malignancy or infection. The
bone density is low as for osteopenia (602b:36), but without vertebral
fracture. Degenerative changes are moderate, mainly in the mid portion and
stable since ___.
LUNGS AND AIRWAYS: Airways are patent to the subsegmental level bilaterally.
The ground-glass nodule in right upper lobe (4:29), is unchanged since ___,
measuring 10 mm. Despite ___ years of stability a third followup in one year
is recommended according to evolving guidelines to rule out minimally invasive
adenocarcinoma. Punctate subpleural nodule in the right upper lobe (4:40,
72), are likely benign and stable since ___.
Ground-glass opacities in the anterior segment of the right upper lobe (4:49),
is not visible in prior examination of ___, due to different technique.
The left lung is completely clear except for minimal scarring at the lung base
(4:171). Small atelectasis is in the posterobasal segment of the right lower
lobe (4:211), and in the medial segment of the right middle lobe (4:143).
IMPRESSION:
1. The right upper lobe ground-glass nodule is stable over a period of ___
years. However, a third followup in one year is recommended to rule out
minimally invasive adenocarcinoma. All the other nodules are not concerning
for malignancy. A new ground-glass nodule was not visible on prior
examination due to different technique. Minimal atelectases are in the right
middle lobe and right lower lobe. A small scarring is at the left lung base.
2. There is no central lymphadenopathy.
3. Heart size is moderately-to-severe enlarged with moderate aortic valve,
coronary artery and aortic calcification.
4. Mild ascites and multiple left kidney cysts are redemonstrated.
|
19881376-RR-101
| 19,881,376 | 20,585,454 |
RR
| 101 |
2171-09-24 20:52:00
|
2171-09-24 21:16:00
|
HISTORY:
___ man with acute change in mental status.
TECHNIQUE: MDCT images were obtained through the brain without the
administration of intravenous contrast. Reformatted coronal, sagittal and
thin slice bone images were also reviewed.
DLP: 1025.72 mGy-cm.
CTDIvol: 64.105 mGy.
COMPARISON: Comparison is made to CT of the head from ___.
FINDINGS:
There is no evidence of intracranial hemorrhage, vascular territorial
infarction, shift of the normally midline structures, or mass, mass effect or
edema. The ventricles and sulci are prominent, in keeping with age-related
involutional changes or atrophy. The basal cisterns appear patent. The
gray-white matter differentiation is preserved. No fractures identified. The
cranial and facial soft tissues are unremarkable. The globes are intact
bilaterally.
The paranasal sinuses, mastoid air cells and middle ear cavities are clear.
IMPRESSION:
No acute intracranial process.
The above findings were communicated to Dr. ___ by Dr. ___ in person, at
21:10, 1 min after discovery.
|
19881376-RR-102
| 19,881,376 | 20,585,454 |
RR
| 102 |
2171-09-24 21:45:00
|
2171-09-25 00:30:00
|
HISTORY: ___ man with acute confusional state. Evaluation for
pneumonia.
COMPARISON: Comparison is made to radiograph of the chest from ___.
FINDINGS: Portable upright radiograph of the chest again demonstrates median
sternotomy wires. There is no evidence of pleural effusion, pulmonary edema,
pneumothorax or focal pneumonia within the bilateral lungs. The
cardiomediastinal silhouette is unchanged.
IMPRESSION: No acute cardiopulmonary process.
|
19881376-RR-110
| 19,881,376 | 26,006,446 |
RR
| 110 |
2172-07-18 01:51:00
|
2172-07-18 02:54:00
|
INDICATION: ___ with left leg pain.
TECHNIQUE: AP view view of the pelvis with 5 additional views of the left
femur and knee.
COMPARISON: CT abdomen pelvis ___, hip radiographs ___, left femur radiographs ___.
FINDINGS:
Status post right total hip arthroplasty and left hip bipolar
hemiarthroplasty. Hardware configuration is unchanged with no new signs of
hardware loosening or failure. No fracture. Diffuse marked osteopenia is
noted. An irregular mixed lucent and sclerotic lesion is noted in the shaft of
the left femur, increased in size compared to the ___ study, without definite
cortical destruction. There are vascular calcifications. No suprapatellar
joint effusion.
IMPRESSION:
1. No fracture hardware failure.
2. Incidental enlarging lesion mid shaft of left femur. Correlation with
history of malignancy is recommended.
|
19881376-RR-112
| 19,881,376 | 26,006,446 |
RR
| 112 |
2172-07-22 09:28:00
|
2172-07-22 14:33:00
|
INDICATION: ___ year old man with LLE pain, xray concerning for lytic mass //
please assess for lytic mass
TECHNIQUE: A contrast enhanced MRI was attempted of the left thigh. Due to
patient discomfort the exam was terminated prematurely and no contrast was
administered. Only axial T1 and STIR sequences were obtained on a 3 Tesla
machine utilizing a body coil.
COMPARISON: Radiographs of the left femur and pelvis ___.
FINDINGS:
The exam is markedly limited secondary to patient movement and discomfort.
Hardware related susceptibility artifact is noted within the proximal femur
and acetabulum related to the patient's total left hip arthroplasty. No gross
mass is seen.
IMPRESSION:
Limited exam. No gross mass is seen within the region of abnormality
visualized on previous radiographs.
Please see the separate report of the CT of the left femur of the same day for
further details.
|
19881376-RR-113
| 19,881,376 | 26,006,446 |
RR
| 113 |
2172-07-22 15:38:00
|
2172-07-22 17:59:00
|
INDICATION: ___ year old man with LLE pain, concern for lucency on xray, not
well seen on incomplete MRI. // assess LLE femur lucency
TECHNIQUE: A noncontrast CT head of the left femur was performed the with 2
mm contiguous axial slices from just above the left hip to the distal left
femur. Subsequent coronal and sagittal reconstructed images were obtained.
DOSE: Total DLP of 1097.94 mGy-cm.
COMPARISON: MRI of the left thigh ___, pelvic and left femur
radiographs ___ and CT abdomen and pelvis ___.
FINDINGS:
The patient is again noted to be status post left total hip prosthesis.
Lucency with overlying cortical thinning is noted at the greater trochanter
and within the superolateral acetabulum, adjacent to the hardware, which is
not significantly changed from the prior radiographic exam of ___, which
however appears progressed since the CT exam of ___. Additionally, there
is asymmetry of the femoral head component within the acetabular component
suggestive of polyethylene liner wear. There is suggestion of increased soft
tissue density anteriorly adjacent to the acetabulum, with limited evaluation
secondary to hardware related streak artifact.
Within the region of concern from the patient's prior radiograph at the distal
femur, there is osteopenia with associated endosteal sclerosis which is likely
related to the patient's altered stress/weight bearing dynamics after
arthroplasty. No mass is seen within this region.
There is no fracture. There is no significant heterotopic ossification.
There is diffuse muscular atrophy. Visualized tendons are unremarkable.
There are several subcentimeter left inguinal lymph nodes which are
nonenlarged by size criteria. Vascular calcifications are seen. There is a
small left fat containing inguinal hernia. Visualized portions of the left
hemipelvis are otherwise unremarkable.
IMPRESSION:
Osteopenia and endosteal sclerosis within the distal femur corresponding to
the region of abnormality on prior radiography, without obvious intraossoeus
bone lesion to account for it.
Medullary lucency with overlying cortical thinning within the greater
trochanter and within the superolateral acetabulum adjacent to the prosthesis
with associated asymmetry of the femoral head within the acetabular component
suggestive of polyethylene liner wear with associated particle disease related
osteolysis. These findings are not significantly changed from the prior exam
of ___, however they have progressed since the CT exam of ___.
Suggestion of increased soft tissue density anteriorly adjacent to the
acetabulum, with limited evaluation secondary to hardware related streak
artifact an which may correspond to a pseudotumor.
|
19881376-RR-121
| 19,881,376 | 28,229,589 |
RR
| 121 |
2173-06-26 01:00:00
|
2173-06-26 08:38:00
|
EXAMINATION: TIB/FIB (AP AND LAT) LEFT
INDICATION: History: ___ with tib/fib frx, s/p reduction
TECHNIQUE: Multiple views of the left tibia and fibula post reduction.
COMPARISON: Radiographs on ___ performed at an outside institution.
FINDINGS:
A fracture of the proximal tibia metaphysis and proximal diaphysis (which
probably extends into the knee joint) as well as fracture of the proximal
fibula are not changed in position from exam 1 day previous on ___.
Interval placement of a cast extensive arterial calcifications and soft tissue
clips. Knee joint is probably normal
IMPRESSION:
No position change post casting of the proximal tibial and fibular fractures
|
19881376-RR-122
| 19,881,376 | 28,229,589 |
RR
| 122 |
2173-06-26 01:04:00
|
2173-06-26 08:30:00
|
EXAMINATION: HIP UNILAT MIN 2 VIEWS RIGHT
INDICATION: ___ with painful R hip // ? acute process
TECHNIQUE: Two views of the right hip. Exam does not include AP radiograph
of the pelvis
COMPARISON: Radiographs on ___
FINDINGS:
There is a normal appearing total right hip arthroplasty. No evidence of
hardware failure or fracture. No suspicious osseous lesion is seen in the
partially visualized right pelvis or proximal right femur.
IMPRESSION:
Limited examination is normal. No fracture
|
19881376-RR-124
| 19,881,376 | 28,229,589 |
RR
| 124 |
2173-06-26 07:34:00
|
2173-06-26 08:22:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with tib/fib fracture, preop for surgery //
preop for surgery Surg: ___ (OPEN REDUCTION INTERNAL FIXATION LEFT
TIBIAL/FIBULA FRACTURE ) preop for surgery
COMPARISON: Prior chest radiographs ___ and ___ at 23:43.
IMPRESSION:
Patient has had median sternotomy remotely. Heart is borderline enlarged and
pulmonary vasculature caliber is exaggerated by low lung volumes but there is
no pulmonary edema or pleural abnormality.
Previously questioned right lung lesion is barely visible. Conventional chest
radiographs or chest CT, as recommended, would be helpful in confirming it.
|
19881376-RR-126
| 19,881,376 | 28,229,589 |
RR
| 126 |
2173-06-26 20:28:00
|
2173-06-27 08:11:00
|
INDICATION: ___ year old man with history of fall, diagnosed with left tib/fib
fracture with significant pain in left foot // Please assess for evidence of
fracture in the left foot
COMPARISON: Radiographs performed on ___ at 01:11
IMPRESSION:
There is an overlying cast material which limits fine bony detail. Evaluation
for fractures involving the foot is very limited. There is also extensive
bony demineralization. Extensive vascular calcifications are present. Single
surgical clip is seen within the medial ankle soft tissues.
|
19881376-RR-127
| 19,881,376 | 28,229,589 |
RR
| 127 |
2173-06-30 09:01:00
|
2173-06-30 10:14:00
|
INDICATION: ___ year old man with rising white count // Pneumonia?
COMPARISON: Radiographs from ___
IMPRESSION:
There is marked cardiomegaly which is stable. Mediastinal wires are again
seen. There is no overt pulmonary edema. There is minimal basilar
subsegmental atelectasis. No focal consolidation, large pleural effusions, or
pneumothoraces are seen.
|
19881376-RR-128
| 19,881,376 | 28,229,589 |
RR
| 128 |
2173-07-01 18:47:00
|
2173-07-01 19:26:00
|
EXAMINATION: CTA CHEST WANDW/O CANDRECONS, NON-CORONARY
INDICATION: ___ year old man with tib/fib fracture, hypoxia, tachycardia,
please assess for evidence of PE // please comment on evidence of pulmonary
embolism
TECHNIQUE: Axial multidetector CT images were obtained through the thorax
after the uneventful administration of 100 cc of Omnipaque intravenous
contrast.
Reformatted coronal, sagittal, thin slice axial images, and oblique maximal
intensity projection images were submitted to PACS and reviewed.
This study involved 4 CT acquisition phases with dose indices as follows:
1) CT Localizer Radiograph
2) CT Localizer Radiograph
3) Stationary Acquisition 2.0 s, 0.5 cm; CTDIvol = 6.1 mGy (Body) DLP = 3.0
mGy-cm.
4) Spiral Acquisition 4.2 s, 33.3 cm; CTDIvol = 14.6 mGy (Body) DLP = 487.4
mGy-cm.
Total DLP (Body) = 490 mGy-cm.
COMPARISON: CT of the chest dated ___ and ___, and
chest radiograph dated ___, and CT of the abdomen and pelvis dated ___.
FINDINGS:
The aorta and its major branch vessels are patent, with no evidence of
stenosis, occlusion, dissection, or aneurysmal formation. Note is made of
calcified and soft plaque throughout the thoracic aorta, which appears
tortuous. There is no evidence of penetrating atherosclerotic ulcer or aortic
arch atheroma present.
Assessment of segmental and subsegmental pulmonary arteries is limited
secondary to respiratory motion. There is no filling defect in the main or
lobar pulmonary arteries.
There is no supraclavicular, axillary, or hilar lymphadenopathy by CT size
criteria. Numerous prominent although not technically enlarged mediastinal
lymph nodes are present, and have a similar appearance to ___.
There is no evidence of pericardial effusion. There is no pleural effusion.
The heart appears enlarged. There is no pericardial effusion. Note is made
of diffuse coronary artery calcifications as well as aortic valvular
calcifications.
The airways are patent at least to the lobar level; assessment of smaller
airways is limited secondary to respiratory motion. Note is made of small
bibasilar consolidative opacities containing air bronchograms, and trace
bilateral pleural effusions. A focal ground-glass opacity in the right upper
lobe appears grossly unchanged from ___.
This study is not tailored for assessment of subdiaphragmatic structures. The
patient is status post cholecystectomy. Multiple renal cysts are seen
bilaterally, and are not fully characterized on this study. The spleen is
top-normal in size.
No lytic or blastic osseous lesion suspicious for malignancy is identified.
Compression deformities of the mid thoracic vertebral bodies appear chronic in
nature.
IMPRESSION:
Please of the study is limited secondary to respiratory motion artifact.
1. No evidence of pulmonary embolism to the lobar level.
2. Bibasilar consolidative opacities, right greater than left, likely reflect
a combination of atelectasis and respiratory motion, however pneumonia could
be considered in the appropriate clinical setting.
3. Focus of ground-glass in the right apex is unchanged from ___.
|
19881376-RR-129
| 19,881,376 | 28,229,589 |
RR
| 129 |
2173-07-04 12:16:00
|
2173-07-04 15:33:00
|
EXAMINATION: Chest radiograph
INDICATION: ___ man status post left PICC placement.
TECHNIQUE: Portable AP chest radiograph
COMPARISON: Multiple prior chest radiographs, most recent from ___.
FINDINGS:
Median sternotomy wires are intact and aligned. Left PICC terminates in the
upper SVC. Widened mediastinum likely secondary to aortic tortuosity. Severe
cardiomegaly. Septal lines at the left base are unchanged.
IMPRESSION:
Left PICC terminating in the upper SVC.
Severe cardiomegaly with chronic septal thickening at the left base.
NOTIFICATION: Findings communicated to the PICC nurse at 14:10.
|
19881376-RR-93
| 19,881,376 | 23,142,070 |
RR
| 93 |
2171-06-06 20:15:00
|
2171-06-06 21:40:00
|
HISTORY: Headache and word finding difficulty.
COMPARISON: None available.
TECHNIQUE: Contiguous axial MDCT images were obtained of the head without
contrast. Multiplanar reformatted images were generated in the coronal and
sagittal planes as well as thin section bone algorithm images.
DLP: 1025.72 mGy-cm.
FINDINGS: There is an 8-mm acute on chronic subdural hematoma along the left
lateral convexity with local mass effect effacing the left-sided sulci. There
is no acaute vascular territorial infarct. There is minimal 3-mm rightward
shift of midline structures. Prominent ventricles and sulci are suggestive of
age-related involutional change. The basal cisterns remain patent and there
is no evidence of herniation. Gray-white matter differentiation is preserved.
No fracture is identified. The visualized paranasal sinuses, mastoid air
cells and middle ear cavities are clear. The globes are intact. Dense
atherosclerotic calcifications are noted within the carotid siphons.
IMPRESSION: 8-mm left-sided acute on chronic subdural hematoma with local
mass effect and 3 mm rightward shift.
|
19881376-RR-94
| 19,881,376 | 23,142,070 |
RR
| 94 |
2171-06-07 14:47:00
|
2171-06-07 16:46:00
|
INDICATION: Subdural hemorrhage; evaluate for interval change.
COMPARISON: NECT head, ___.
TECHNIQUE: Non-contrast MDCT axial images were acquired through the head.
FINDINGS: Compared to the prior study, performed roughly 18 hours earlier,
there is no significant change. The mixed-density subdural hemorrhage along
the left convexity is unchanged in thickness measuring 8 mm from the inner
table, and unchanged in extent, density and degree of mass effect with
effacement of adjacent sulci. There is no acute blood within the collection
and no new hemorrhage elsewhere. 4 mm rightward shift of normally midline
structures is unchanged. There is no major vascular territorial infarct.
Prominent ventricles and sulci are compatible with global age-related atrophy.
Basal cisterns are preserved. No osseous abnormality is identified. The
visualized paranasal sinuses, mastoid air cells and middle ear cavities are
clear. Vascular calcifications are noted in the intracranial internal carotid
arteries.
IMPRESSION: Stable mixed-density subdural hematoma layering over the left
cerebral convexity, with unchanged degree of mass effect.
|
19881376-RR-95
| 19,881,376 | 23,142,070 |
RR
| 95 |
2171-06-08 17:56:00
|
2171-06-08 19:25:00
|
INDICATION: Holohemispheric acute on chronic subdural hematoma with neck
pain. Evaluate for fracture.
COMPARISONS: CT of the cervical spine from ___. CT of the
chest from ___.
TECHNIQUE: Helical axial MDCT images were obtained through the cervical spine
from the base of the skull through the apices of the lungs without the
administration of IV contrast. Sagittal, coronal, and thin section bone
reformatted images were obtained and reviewed.
FINDINGS: There is no abnormality of the prevertebral soft tissues. No
fracture is identified. Alignment is maintained. There are moderate to
severe multilevel degenerative changes with disc space narrowing, disc
osteophyte complexes, subchondral cysts, and facet hypertrophy. Overall, this
is not significantly changed from the prior exam. There is no critical
central canal narrowing. Calcification is noted of the atlantoaxial
ligaments, also unchanged.
There is no cervical lymphadenopathy. Moderate-to-severe atherosclerotic
calcifications are noted in the carotid arteries. The thyroid gland is
normal. There is a partially imaged ground-glass opacity which measures 7 mm
in the right apex (3, 73). This is slightly bigger than in the prior exam in
___, at which point it measured 6 mm.
IMPRESSION:
1. No fracture or acute malalignment.
2. Moderate multilevel degenerative changes.
3. Partially imaged 7-mm right apical ground-glass nodule, slightly increased
in size since ___. Although this is nonspecific, a low-grade adenocarcinoma
is included in the differential diagnosis, and if clinically indicated, could
be followed up with a repeat CT of the chest in six months.
|
19881376-RR-97
| 19,881,376 | 20,585,454 |
RR
| 97 |
2171-09-21 05:07:00
|
2171-09-21 06:04:00
|
HISTORY: Headache with previous history of subdural hematoma.
COMPARISON: Non-contrast head CT ___.
TECHNIQUE: Contiguous axial MDCT images were obtained of the head without
contrast. Multiplanar reformatted images were generated in the coronal and
sagittal planes as well as thin section bone algorithm images.
DLP: 1025.72 mGy-cm.
CTDIvol: 63.63 mGy.
FINDINGS: There is no hemorrhage, edema, mass effect or acute infarct. Prior
left lateral convexity subdural hematoma has completely resolved. Prominent
ventricles and sulci are suggestive of age-related involutional change. The
basal cisterns are patent, and there is preservation of gray-white matter
differentiation. No fracture is identified. The visualized paranasal
sinuses, mastoid air cells and the middle ear cavities are clear. Dense
atherosclerotic calcifications are noted within the carotid siphons. The
globes are unremarkable.
IMPRESSION: No acute intracranial abnormality. Complete interval resolution
of left lateral convexity subdural hematoma.
|
19881376-RR-98
| 19,881,376 | 20,585,454 |
RR
| 98 |
2171-09-22 13:10:00
|
2171-09-22 15:24:00
|
HISTORY: Neck and shoulder pain with no history of trauma.
TECHNIQUE: Flexion and extension views of the C-spine.
COMPARISON: CT of the C-spine dated ___.
FINDINGS: C1-C6 are visible on the lateral view. C7 is not seen on either
view. There is generalized bone demineralization. No prevertebral soft
tissue swelling is noted. There is slight anterolisthesis of C4 on C5 and C5
on C6, with no change with flexion or extension. Soft tissue calcifications
anterior to the C3 and C4 vertebral bodies are noted, and correlate to
arterial calcifications from the recent CT scan. There is no instability with
flexion or extension. Dental implants are noted.
IMPRESSION: Mild anterolisthesis of C4 on C5 and C5 on C6 with no instability
with flexion or extension.
|
19881376-RR-99
| 19,881,376 | 20,585,454 |
RR
| 99 |
2171-09-22 15:52:00
|
2171-09-22 17:38:00
|
HISTORY: The ___ male with a resolved subdural hematoma and an
occipital headache and posterior neck pain, assess for pathologic fracture.
COMPARISON: C-spine Radiograph ___.
TECHNIQUE: Helical axial MDCT sections were obtained from the skullbase
through the cervical spine. Reformatted images in sagittal and coronal axes
were obtained.
Total Exam DLP: 775mGy-cm
CTDIvol 32mGy
FINDINGS:
The study is somewhat limited by motion. There is no acute cervical spine
fracture or traumatic malalignment. There is periodontoid ligamentous
calcification and soft tissue pannus. There are multi-level degenerative
changes of the cervical spine including disc osteophyte complexes. There are
no destructive bony lesions. There is no lymphadenopathy by CT size criteria.
The paravertebral soft tissues are unremarkable.
IMPRESSION:
No acute cervical spine fracture or traumatic malalignment. MRI is more
sensitive for ligamentous injury.
|
19881395-RR-20
| 19,881,395 | 26,515,341 |
RR
| 20 |
2184-11-17 11:39:00
|
2184-11-17 12:59:00
|
INDICATION: History: ___ with fall, chest pain // eval for traumatic
injuries
TECHNIQUE: TECHNIQUE: MDCT images were obtained from the thoracic inlet to
the pubic symphysis. No IV contrast was administered. Axial images were
interpreted in conjunction with sagittal and coronal reformats.
DLP: ___ MGy-cm
COMPARISON: Radiographs of the chest and pelvis dated ___.
FINDINGS:
CHEST:
There is a 0.7 x 0.8 cm hypodense nodule in the right lobe of thyroid.
Axillary, supraclavicular, mediastinal, and hilar lymph nodes are not
pathologically enlarged. The great vessels are unremarkable. The heart is
enlarged. There is dense atherosclerotic disease involving the ascending and
descending aorta, and the coronary arteries. The pericardium is intact without
effusion. The airways are patent to the subsegmental levels.
There is mild dependent atelectasis. The pleura is intact without effusion. No
pneumothorax or pneumomediastinum.
The esophagus is unremarkable.
There multiple fractures involving the right lateral posterior ribs, which
appear chronic, difficult to exclude superimposed acute injury, for example
the second rib on the right (2:12). Additionally, there is a chronic
appearing anterior dislocation of right glenohumeral joint with marked
abnormal remodeling at the glenoid. In addition to these chronic changes, some
linear calcific densities are present posteriorly in in joint, there is some
periarticular soft tissue swelling inferiorly, and cortical ill- definition
posteriorly at the humeral head which may reflect a small area of superimposed
cortical fragmentation.
ABDOMEN:
Assessment of abdominal viscera is limited without intravenous contrast.
Allowing for this limitation the liver is normal in size without evidence of
intrahepatic biliary ductal dilatation. The gallbladder contains a calcified
gallstone. The spleen, pancreas, and bilateral adrenal glands are
unremarkable.
The kidneys are normal in size. There are no perinephric abnormalities seen.
There are multiple cysts in the bilateral kidneys. Additionally, there are two
hyperdense lesion seen in the upper pole of the right kidney, largest of which
measures 1 cm, and a third hyperdense lesion seen in the lower pole left
kidney, which measures 7 mm. While these likely represent cysts with a
hemorrhagic component, solid renal mass cannot be excluded. No stones are seen
within the kidneys.
The stomach is grossly normal. The small bowel does not show abnormal
dilatation or focal wall thickening. The large bowel is not show obstructive
mass lesions or wall thickening. There is diverticulosis without
diverticulitis. There is no intraperitoneal free air or free fluid. The
appendix is not definitely visualized, however there are no secondary signs of
appendicitis.
No retroperitoneal or mesenteric lymphadenopathy. No abdominal wall hernia,
pneumoperitoneum, or free abdominal fluid.
There is a small anterior abdominal wall hernia.
PELVIS:
The bladder is decompressed by Foley catheter. There is a fibroid uterus.
There is no pelvic free fluid. There are no pathologically enlarged pelvic
sidewall or inguinal lymph nodes by CT size criteria.
OSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for
malignancy. Multilevel degenerative changes are seen throughout the thoracic
and lumbar spine. There are fractures involving the left superior and inferior
pubic rami at the junction with the left pubic bone. Difficult to exclude
nondisplaced additional left sacral ala fracture (7:28). There is an impacted
subcapital left femoral neck fracture.
IMPRESSION:
1. Bony injuries: Impacted left subcapital fracture. Left inferior and
superior pubic rami fractures at junction with left pubic bone. Chronic
anterior dislocation and degenerative changes the right glenohumeral joint,
with probable small focal area of posterior humeral head acute fracture with
flake like posterior humeral head cortical fragmentation. Predominantly
chronic right-sided rib fractures, with equivocal superimposed injury for
example right second rib.
2. Nodule in the right lobe of the thyroid. Recommend nonemergent thyroid
ultrasound for additional evaluation of this is not already been performed.
3. Bilateral hyperdense lesions in the kidneys which likely represent cysts
with hemorrhage, or less likely solid masses. Recommend nonemergent ultrasound
for additional evaluation.
4. Cholelithiasis
NOTIFICATION: Updated WET READ was discussed with Dr. ___ by Dr. ___
___ telephone at 14:00 on ___, 5 min after discovery.
Impression point number 1 was further discussed with Dr. ___ by Dr. ___
telephone at 10:30pm on ___.
|
19881395-RR-21
| 19,881,395 | 26,515,341 |
RR
| 21 |
2184-11-17 17:18:00
|
2184-11-17 19:48:00
|
INDICATION: ___ with s/p fall // chroncity of fracture
TECHNIQUE: Two views of the right shoulder including a scapular Y-view.
COMPARISON: CT of the chest from earlier the same day.
FINDINGS:
There is anterior dislocation of the right glenohumeral joint, similar to CT
scan. Deformity of the posterosuperior aspect of the humeral head is
suggestive of a ___ deformity. The glenoid is better seen is
chronically deformed on prior CT scan. Please note that a subtle acute
component of the fracture is not excluded. Chronic appearing right
anterolateral rib fractures are identified.
IMPRESSION:
Chronic appearing anterior dislocation of the right glenohumeral joint.
___ deformity and deformity of the glenoid. Please note that
superimposed acute fracture would be difficult to exclude.
|
19881395-RR-22
| 19,881,395 | 26,515,341 |
RR
| 22 |
2184-11-18 10:23:00
|
2184-11-18 15:59:00
|
EXAMINATION: Intraoperative radiographs.
INDICATION: Percutaneous pinning of the left femoral neck
COMPARISON: None available.
FINDINGS:
12 intraoperative radiographs, obtained without a radiologist present,
demonstrate instrumentation through the left femoral neck. The total
fluoroscopic time was 55 seconds. For further details, please see the
operative report in the ___ medical record.
IMPRESSION:
Percutaneous pinning of the left femoral neck. Please refer to the operative
report for further details.
|
19881395-RR-23
| 19,881,395 | 26,515,341 |
RR
| 23 |
2184-11-20 11:55:00
|
2184-11-20 13:58:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman POD ___ S/P Left femoral neck ORIF. +Crackles on
exam. No SOB. low grade fever overnight. // evaluate for atelectasis,
pneumonia evaluate for atelectasis, pneumonia
IMPRESSION:
In comparison with the study of ___ from an outside facility, there is
again enlargement of the cardiac silhouette with suggestion of some central
pulmonary vascular congestion. The hemidiaphragms are not well seen, raising
the possibility of a small pleural effusion and compressive atelectasis. In
the left mid to lower zone, there is a suggestion of a somewhat ill-defined
area of increased opacification. This could possibly represent a pulmonary
nodule.
Extensive posttraumatic changes are seen in the right ribs as well as
dislocation about the right shoulder joint.
|
19881444-RR-102
| 19,881,444 | 20,672,000 |
RR
| 102 |
2160-10-08 14:57:00
|
2160-10-08 15:22:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ history limited stage small cell cancer, on chemotherapy and
radiation therapy last this morning, with fever/rigors/cough
TECHNIQUE: Chest PA and lateral
COMPARISON: ___ chest radiograph and ___ CT chest
FINDINGS:
Heart size is normal. Right mainstem bronchial stent is not well visualized
on the current examination. Previously noted right hilar mass on chest
radiograph has markedly decreased in size, and the right paratracheal
adenopathy has also apparently resolved. Left hilum is normal. Lungs are
clear without focal consolidation. No pleural effusion or pneumothorax is
present. Central venous catheter within the inferior vena cava terminates in
the right atrium. Multiple clips are noted in the upper abdomen as well as
within the left chest wall and axilla. Dextroscoliosis of the thoracolumbar
spine is re- demonstrated.
IMPRESSION:
Marked interval reduction in size of right hilar mass and apparent resolution
of the right paratracheal lymphadenopathy compared to the previous chest
radiograph from ___. No acute cardiopulmonary abnormality.
|
19881444-RR-107
| 19,881,444 | 28,510,941 |
RR
| 107 |
2161-03-25 11:10:00
|
2161-03-25 11:57:00
|
EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: History: ___ with metastatic cancer, recent brain radiation with
deteriorating mental status fever weakness
TECHNIQUE: Routine unenhanced head CT was performed and viewed in brain,
intermediate and bone windows. Coronal and sagittal reformats were also
performed.
DOSE: Total DLP (Head) = 1,070 mGy-cm.
COMPARISON: MRI head ___
FINDINGS:
There is no intra-axial or extra-axial hemorrhage, edema, shift of normally
midline structures, or evidence of acute major vascular territorial
infarction. Ventricles and sulci are prominent, compatible with mild atrophy
which is age appropriate. Minimal periventricular white matter hypodensities
are likely the sequelae of chronic small vessel ischemic change and were seen
on the previous MRI. The imaged paranasal sinuses are clear. Mastoid air
cells and middle ear cavities are well aerated. The bony calvarium is intact.
There are mild atherosclerotic calcifications of the cavernous portions of the
bilateral internal carotid arteries.
IMPRESSION:
No acute intracranial process.
|
19881444-RR-108
| 19,881,444 | 28,510,941 |
RR
| 108 |
2161-03-25 12:08:00
|
2161-03-25 12:49:00
|
EXAMINATION: CHEST PA AND LATERAL
INDICATION: ___ with lung cancer and fever/decreased PO/body pain
COMPARISON: CT chest ___
FINDINGS:
PA and lateral view of the chest. Patient is rotated
Surgical clips overlie the left axilla and breast.
There is no focal consolidation, effusion, or pneumothorax. The
cardiomediastinal silhouette is normal. Significant dextroconvex scoliosis of
the lower thoracic spine is re- demonstrated.
IMPRESSION:
No acute intrathoracic process.
|
19881444-RR-109
| 19,881,444 | 28,510,941 |
RR
| 109 |
2161-03-26 13:49:00
|
2161-03-26 18:00:00
|
INDICATION: ___ year old woman with history of lung cancer comes in with
failure to thrive // restaging to see if recurrence/progression of lung
cancer
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
and pelvis 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: Total DLP (Body) = 1,454 mGy-cm.
COMPARISON: CT abdomen pelvis dated ___
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. Mild center intrahepatic and
extrahepatic biliary dilatation with the common bile duct measuring up to 1 cm
is unchanged, likely related to post cholecystectomy state The gallbladder is
surgically absent.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
There is a 1.3 cm hyperdense nonenhancing lesion in the upper pole the left
kidney likely representing a hemorrhagic or proteinaceous cyst. There is no
evidence of focal renal lesions or hydronephrosis. Punctate nonobstructing
stones are seen in the right collecting system. There is no perinephric
abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. The colon and
rectum are within normal limits. The appendix is not visualized.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is a
small amount of nonhemorrhagic free fluid in the pelvis.
REPRODUCTIVE ORGANS: The uterus is of normal size and enhancement. There is no
evidence of adnexal abnormality bilaterally.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic
disease is noted. Nonocclusive thrombus is again seen in the infrarenal
inferior vena cava, increased in size compared to prior. There has been
interval removal of the central catheter. The thrombus appears to extend into
the right common iliac vein.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits. There is
no evidence of retroperitoneal hematoma.
IMPRESSION:
1. No evidence of metastatic disease in the abdomen or pelvis.
2. Thrombus in the infrarenal inferior vena cava appears increased compared to
the prior study and appears to extend into the right common iliac vein.
3. Nonobstructing right nephrolithiasis
For details regarding the chest please see dedicated chest CT report.
NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on
the telephone on ___ at 4:15 ___, 20 minutes after discovery of the
findings.
|
19881444-RR-110
| 19,881,444 | 28,510,941 |
RR
| 110 |
2161-03-26 13:50:00
|
2161-03-26 15:46:00
|
EXAMINATION: Chest CT
INDICATION: ___ year old woman with failure to thrive history of lung cancer
// eval for progression of lung cancer
TECHNIQUE: MDCT of the chest was obtained from thoracic inlet to upper
abdomen. Axial images were reviewed in conjunction with coronal and sagittal
reformats
COMPARISON: ___
FINDINGS:
Aorta and pulmonary arteries are unremarkable. Heart size is normal. There
is no pericardial or pleural effusion demonstrated. No appreciable
mediastinal hilar or axillary pathologic lymphadenopathy seen. Image portion
of the upper abdomen will be reviewed separately is part of the CT abdomen and
corresponding report will be issued
Airways are patent to the subsegmental level bilaterally. No new nodules
masses are consolidations demonstrated. Thickening surrounding the right
hilus is stable as well as multiple pulmonary nodules some of them
centrilobular and some of them discrete, series 9, images 91, 122, 145, as
well as endobronchial secretions in the right lower lobe, series 9, image 146.
No a new abnormalities within the chest demonstrated.
There are no lytic or sclerotic lesions worrisome for infection or neoplasm.
Scoliosis is substantial, unchanged.
IMPRESSION:
Unchanged pulmonary nodules.
Stable appearance of paratracheal mediastinal and right hilar lymph nodes with
no interval increase.
Unchanged bronchiectasis.
Image portion of the upper abdomen will be reviewed separately in
corresponding report will be issued.
Previously seen pericardial effusion has resolved with currently no
pericardial effusion seen and no pleural effusion demonstrated.
|
19881444-RR-127
| 19,881,444 | 29,133,463 |
RR
| 127 |
2162-02-12 12:20:00
|
2162-02-12 15:49:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: History: ___ with sob // PNA? PNA?
IMPRESSION:
Compared to chest radiographs ___.
Mild interstitial abnormality is new, either edema or atypical pneumonia.
There is no consolidation to suggest bacterial pneumonia. Heart size is
normal though increased compared to ___. No pleural effusion.
|
19881444-RR-141
| 19,881,444 | 22,089,593 |
RR
| 141 |
2163-03-10 12:59:00
|
2163-03-10 13:50:00
|
INDICATION: ___ with L ankle deformity, fall// eval for ankle fx
COMPARISON: Left ankle pain
FINDINGS:
AP, lateral, oblique views of the left ankle were provided. Bimalleolar
fractures are noted, with associated lateral talar subluxation. There is a
transverse oriented fracture of the medial malleolus with approximately 13 mm
lateral displacement of the distal fracture fragment. A fracture involving
the distal fibula appears oblique in orientation with mild lateral and
posterior displacement of the distal fracture fragment. Bones appear
demineralized. The talar dome appears smooth. No definite posterior
malleolar fracture seen.
IMPRESSION:
Bimalleolar fractures with associated lateral talar subluxation.
|
19881444-RR-142
| 19,881,444 | 22,089,593 |
RR
| 142 |
2163-03-10 12:59:00
|
2163-03-10 15:00:00
|
EXAMINATION: CHEST (AP AND LAT)
INDICATION: ___ with fall, pre-op, dyspnea
COMPARISON: Prior exam is dated ___ and ___
FINDINGS:
AP upright and lateral views of the chest provided. Surgical clips are noted
in the left axilla. The lungs are clear bilaterally. Cardiomediastinal
silhouette appears grossly within normal limits. There is a dextroscoliosis
again noted of the thoracic spine. No acute bony abnormalities.
IMPRESSION:
No acute intrathoracic process.
|
19881444-RR-143
| 19,881,444 | 22,089,593 |
RR
| 143 |
2163-03-10 13:02:00
|
2163-03-10 14:17:00
|
EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ with head injury, fall// eval for c-spine, intracranial
injury
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) = 803 mGy-cm.
COMPARISON: Head CT dated ___.
FINDINGS:
There is no intra-axial or extra-axial hemorrhage, edema, shift of normally
midline structures, or evidence of acute major vascular territorial
infarction. Ventricles and sulci are prominent, suggestive of involutional
change. Stable mild to moderate periventricular and subcortical white matter
hypodensities are nonspecific, but likely represent sequela of chronic small
vessel ischemic disease. Re-demonstrated is a prominent VR space inferior to
the left basal ganglia. The imaged paranasal sinuses are clear aside from
mild mucosal thickening in the bilateral ethmoid sinuses. Mastoid air cells
and middle ear cavities are well aerated. The bony calvarium is intact. The
patient is status post bilateral lens replacement.
IMPRESSION:
No acute intracranial hemorrhage or fracture. Mild to moderate small vessel
disease.
|
19881444-RR-144
| 19,881,444 | 22,089,593 |
RR
| 144 |
2163-03-10 13:02:00
|
2163-03-10 14:05:00
|
EXAMINATION: CT C-SPINE W/O CONTRAST
INDICATION: eval for c-spine, intracranial injury
TECHNIQUE: Noncontrast CT cervical spine with axial, coronal, sagittal
reformations.
Dose: Total DLP (Body) = 523 mGy-cm.
COMPARISON: Neck CT from ___
FINDINGS:
No acute fracture or change in overall alignment when compared with ___ CT neck exam. There is ankylosis spanning C4-5 levels with
intervertebral disc height narrowing again noted at multiple levels though
most pronounced at C5-6 and C6-7. No prevertebral edema. No critical
narrowing of the central spinal canal or at the neural foraminal level. There
is slight reversal of cervical lordosis. Mild scarring at the lung apices
noted with mild upper lobe emphysema. The imaged thyroid is unremarkable.
IMPRESSION:
No acute fracture or traumatic alignment abnormality. Degenerative changes as
stated above.
|
19881444-RR-145
| 19,881,444 | 22,089,593 |
RR
| 145 |
2163-03-10 15:45:00
|
2163-03-10 16:23:00
|
EXAMINATION: DX TIB/FIB AND ANKLE
INDICATION: ___ with left ankle pain// eval for interval reduction and for
any asccoiated fractures of the tibia, fibula, or bones of the foot
TECHNIQUE: Frontal, lateral and oblique views of the left ankle.
COMPARISON: Same day ___ left ankle radiograph.
FINDINGS:
Fine osseous detail is obscured by the overlying cast. Transverse fracture of
the medial malleolus is unchanged in orientation with approximately 13 mm of
lateral displacement. Tibiotalar subluxation is unchanged. The oblique
fracture of the distal fibula remains slightly posteriorly and laterally
displaced. No additional fracture seen.
IMPRESSION:
As above.
|
19881444-RR-146
| 19,881,444 | 22,089,593 |
RR
| 146 |
2163-03-10 15:46:00
|
2163-03-10 16:35:00
|
INDICATION: ___ with left ankle pain// eval for interval reduction and for
any asccoiated fractures of the tibia, fibula, or bones of the foot
COMPARISON: None
FINDINGS:
Three views of the left foot provided. Patient is wearing a plaster cast
which significantly limits evaluation of the underlying structures. No
definite fracture is seen involving the bones of the left foot. Please note,
if there is further concern, removal of the plaster cast and repeat imaging is
advised.
IMPRESSION:
As above.
|
19881444-RR-147
| 19,881,444 | 22,089,593 |
RR
| 147 |
2163-03-10 18:07:00
|
2163-03-10 18:25:00
|
INDICATION: History: ___ with left ankle pain// eval for interval change
after ___ reduction attempt
TECHNIQUE: Two views of the left ankle
COMPARISON: Left ankle radiographs ___ at 15: 57
FINDINGS:
Overlying splint limits fine osseous detail. Re-demonstrated is a
transversely oriented medial malleolar fracture with interval improvement in
alignment compared to the prior study, nearly anatomic. Mildly displaced
oblique fracture is without substantial interval change. Previously seen
lateral talar subluxation has resolved. The ankle mortise is grossly
symmetric.
IMPRESSION:
Bimalleolar fractures, now in near anatomic alignment.
|
19881444-RR-148
| 19,881,444 | 22,089,593 |
RR
| 148 |
2163-03-13 13:30:00
|
2163-03-13 15:28:00
|
EXAMINATION: Fluoroscopy
INDICATION: Open reduction internal fixation left ankle fracture
TECHNIQUE: Fluoroscopy
COMPARISON:
X-rays ___
FINDINGS:
0 intraoperative images were acquired without a radiologist present.
Fluoroscopy was used for 18.3 seconds without a radiologist present.
IMPRESSION:
Fluoroscopy
|
19881444-RR-159
| 19,881,444 | 21,220,346 |
RR
| 159 |
2164-01-25 16:27:00
|
2164-01-25 16:43:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: History: ___ with 1 week productive cough shortness of breath//
Pneumonia present? Pleural effusion present?
TECHNIQUE: Chest PA and lateral
COMPARISON: CT chest ___ and ___
FINDINGS:
There has been interval development of a large right pleural effusion with
right basilar opacity likely reflective of compressive atelectasis. This
obscures assessment of the cardiac silhouette and right hilar contours, though
right hilar prominence suggestive of underlying mass lesion is present.
Mediastinal contours are unchanged. Increased interstitial markings in the
imaged right upper lobe could reflect lymphangitic spread of tumor. Left lung
is clear. No left-sided pleural effusion. No pneumothorax. Multiple clips
are seen in the left chest wall and axilla.
IMPRESSION:
Interval development of large right pleural effusion and right basilar
compressive atelectasis. Right hilar mass is not well assessed, with
increased interstitial markings in the visualized right upper lobe suggestive
of lymphangitic spread of tumor.
|
19881444-RR-160
| 19,881,444 | 21,220,346 |
RR
| 160 |
2164-01-26 17:43:00
|
2164-01-26 19:12:00
|
EXAMINATION: CT chest with contrast
INDICATION: ___ year old woman with history of small cell lung cancer now with
right pleural effusion// Recurrent malignancy? Post-obstructive pneumonia?
TECHNIQUE: Contiguous axial images were obtained through the chest without
intravenous contrast. Coronal and sagittal reformats were obtained.
COMPARISON: CT ___
FINDINGS:
HEART AND VASCULATURE: The thoracic aorta is normal in caliber. The heart,
pericardium, and great vessels are within normal limits based on an unenhanced
scan. No pericardial effusion is seen.
AXILLA, HILA, AND MEDIASTINUM: Redemonstration of post treatment changes with
infiltrative mediastinal adenopathy that encases the lower trachea near the
carina. A soft tissue nodule along the right epicardium (series 5, image 27)
measures 1.1 cm in the short axis and is new from prior. No discrete left
hilar lymphadenopathy. No axillary or supraclavicular lymphadenopathy.
PLEURAL SPACES: There is a small, low-density right pleural effusion. Patchy
areas of enhancement are seen along the right inferior pleura, within the area
of the effusion (series 5, image 34). No left pleural effusion demonstrated.
No pneumothorax.
LUNGS/AIRWAYS: There is diffuse opacification of the inferior right upper
lobe, right middle lobe and right lower lobes. Heterogeneous enhancement is
demonstrated diffusely, with relatively increased enhancement centrally.
Nodular opacities in ground-glass are seen throughout the remaining
non-opacified right upper lobe. There is collapse of the right middle lobe
and partial collapse of the right lower lobe. Tracheal deviation toward the
right appears unchanged from ___. There is compression and
nonvisualization of the distal airways most prominently in the right bronchus
intermedius right middle and lower lobar branches. The trachea is clear. The
left lung airway is intact.
BASE OF NECK: Visualized portions of the base of the neck show no abnormality.
ABDOMEN: Redemonstration of a patulous esophagus. Please see dedicated
abdominal/pelvic CT report for full description of intra-abdominal findings.
BONES/SOFT TISSUES: No suspicious osseous abnormality is seen.? There is no
acute fracture. Status post left breast reconstruction and left axillary
dissection.
IMPRESSION:
1. Interval opacification of the entire right lower, right middle and much of
the right upper lobe, with nodular opacification, irregular intra and
interlobular septal thickening and ground-glass throughout the remaining
aerated right upper lobe is concerning for lymphangitic spread of the known
malignancy with mass effect on the right-sided airway. Enhancement in a
central distribution throughout the lung and along the pleura inferiorly are
concerning for possible underlying mass.
2. New soft tissue nodule along the right epicardium.
3. Atelectatic collapse of right middle lobe, with mild collapse of the right
lower lobe.
|
19881444-RR-161
| 19,881,444 | 21,220,346 |
RR
| 161 |
2164-01-26 17:57:00
|
2164-01-26 20:07:00
|
EXAMINATION: CT ABD AND PELVIS WITH CONTRAST
INDICATION: ___ woman with history of small cell lung cancer now with
right pleural effusion. Rule out recurrent malignancy, postobstructive
pneumonia.
TECHNIQUE: Oncology 2 phase: Multidetector CT of the abdomen was done with IV
contrast. A single bolus of IV contrast was injected and the abdomen and
pelvis was scanned in the portal venous phase, followed by scan of the abdomen
in equilibrium (3-min delay) phase.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 0.5 s, 0.2 cm; CTDIvol = 7.3 mGy (Body) DLP = 1.5
mGy-cm.
2) Stationary Acquisition 11.2 s, 0.2 cm; CTDIvol = 190.6 mGy (Body) DLP =
38.1 mGy-cm.
3) Spiral Acquisition 9.9 s, 64.4 cm; CTDIvol = 10.7 mGy (Body) DLP = 680.1
mGy-cm.
4) Spiral Acquisition 3.1 s, 20.4 cm; CTDIvol = 8.5 mGy (Body) DLP = 168.4
mGy-cm.
Total DLP (Body) = 888 mGy-cm.
COMPARISON: CT abdomen and pelvis with contrast ___
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.
Numerous subcentimeter hypodense lesions throughout the liver are new compared
to ___. Mildly dilated intra and extrahepatic bile ducts are likely
related to post cholecystectomy status.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
There is no evidence of focal renal lesions or hydronephrosis. There is no
perinephric abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. The colon and
rectum are within normal limits. Appendix is not visualized.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: Uterus is unremarkable. Subcentimeter focus of coarse
calcification is noted in left adnexa.
LYMPH NODES: Markedly enlarged lymph nodes are identified in the celiac,
superior mesenteric, and retroperitoneal regions, new compared to ___.
The largest lymph node conglomerate is located superior to the celiac artery
and measures 4.7 x 3.6 cm (12:13).
VASCULAR: There is no abdominal aortic aneurysm. Heavy atherosclerotic
disease is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: Postsurgical changes are noted in the anterior abdominal wall.
IMPRESSION:
1. New mesenteric and retroperitoneal lymphadenopathy are concerning for nodal
metastasis.
2. New numerous subcentimeter hypodense lesions throughout the liver
suspicious for liver metastasis.
|
19881444-RR-162
| 19,881,444 | 21,220,346 |
RR
| 162 |
2164-01-30 16:18:00
|
2164-01-31 09:36:00
|
EXAMINATION: MR HEAD W AND W/O CONTRAST T9112 MR HEAD
INDICATION: ___ year old woman with known SCLC s/p treatment now with presumed
recurrence in R lung and evidence of metastatic disease// evaluate for new
metastatic disease in the brain
TECHNIQUE: Sagittal and axial T1 weighted imaging were performed. After
administration of intravenous contrast, axial imaging was performed with
gradient echo, FLAIR, diffusion, and T1 technique. Sagittal MPRAGE imaging was
performed and re-formatted in axial and coronal orientations.
COMPARISON: MR head ___.
FINDINGS:
There is no evidence of infarction, hemorrhage, edema, mass, or mass effect.
No abnormal enhancement.
The ventricles and sulci are prominent, compatible with global parenchymal
volume loss.
Bilateral periventricular and confluent deep white matter foci of T2/FLAIR
signal hyperintensity are nonspecific but compatible with moderate to severe
changes of chronic white matter microangiopathy.
Trace left mastoid fluid. Otherwise, the visualized paranasal sinuses and
right mastoid appear clear.
Aside from bilateral lens extraction, the globes and orbits are within normal
limits.
Major intracranial vascular flow voids are preserved.
Major dural venous sinuses are patent.
IMPRESSION:
1. No acute intracranial abnormality. No evidence of intracranial metastases.
2. Moderate to severe changes of chronic white matter microangiopathy.
|
19881444-RR-164
| 19,881,444 | 28,475,591 |
RR
| 164 |
2164-02-24 14:00:00
|
2164-02-24 15:16:00
|
EXAMINATION: CTA CHEST WITH CONTRAST
INDICATION: History: ___ with breast and lung CA, dyspnea, hypoxic,
tachycardia// ? PE ? post obstructive 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) Spiral Acquisition 4.4 s, 34.6 cm; CTDIvol = 9.4 mGy (Body) DLP = 323.2
mGy-cm.
Total DLP (Body) = 323 mGy-cm.
COMPARISON: Chest CT ___.
FINDINGS:
HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the
subsegmental level without filling defect to indicate a pulmonary embolus. The
thoracic aorta is normal in caliber without evidence of dissection or
intramural hematoma. The heart, pericardium, and great vessels are within
normal limits. No pericardial effusion is seen.
AXILLA, HILA, AND MEDIASTINUM: No axillary lymphadenopathy. Numerous
mediastinal lymph nodes are noted, including a 15 mm subcarinal lymph node
(3:101). There is also left hilar lymphadenopathy measuring up to 12 mm
(3:91). Right hilar lymph nodes are not well seen due to adjacent
consolidated lung.
PLEURAL SPACES: Moderate right pleural effusion, increased from prior. No
left pleural effusion.
LUNGS/AIRWAYS: There is complete opacification of the right middle and lower
lobes as before, with mass effect upon the right middle and lower lobe
bronchus. Overall, the appearance is slightly worsened in comparison with 1
month prior. In addition, there is extensive interlobular septal thickening
which is nodular in appearance extending into the right upper lobe concerning
for lymphangitic spread of tumor. It is difficult to see a discrete mass.
BASE OF NECK: Visualized portions of the base of the neck show no abnormality.
ABDOMEN: Numerous hepatic metastases appear increased in both size and number.
Bulky retroperitoneal lymphadenopathy is partially imaged.
BONES: No suspicious osseous abnormality is seen.? There is no acute fracture.
IMPRESSION:
1. No evidence of pulmonary embolism or aortic abnormality.
2. Re-demonstrated ill-defined right hilar mass producing mass effect upon the
right middle and lower lobes, with complete opacification of both of these
lobes. Re-demonstrated nodular interlobular septal thickening in the right
upper lobe concerning for lymphangitic tumor spread, as before. Moderate
right pleural effusion, increased from prior. It is difficult to exclude
superimposed postobstructive infection.
3. Increasing hepatic metastases. Re-demonstrated retroperitoneal bulky
lymphadenopathy.
|
19881444-RR-165
| 19,881,444 | 28,475,591 |
RR
| 165 |
2164-02-24 17:06:00
|
2164-02-24 18:03:00
|
EXAMINATION: DX CHEST PORTABLE PICC LINE PLACEMENT
INDICATION: ___ with R picc line placement// ? pICC line placement
TECHNIQUE: Chest AP
COMPARISON: Chest CT ___ at 14:10.
FINDINGS:
A right PICC has been placed, the tip is about 9 cm below the carina likely in
the right atrium, although this is impossible to tell given complete
opacification of the right hemithorax. Retraction by about 4 cm should put
the PICC in the low SVC/superior cavoatrial junction.
There is opacification of the majority of the right hemithorax, better
assessed on same day CT. There is also a right pleural effusion, also better
assessed on CT. The left lung is essentially clear. Left heart border is
unremarkable. No pneumothorax.
IMPRESSION:
1. Precise location of the PICC is very difficult to evaluate given complete
opacification of the right hemithorax. Given this limitation, the PICC likely
lies within the right atrium and retraction by approximately 4 cm should put
it near the superior cavoatrial junction or in the low SVC.
2. Opacification of the majority of the right hemithorax as well as a right
pleural effusion is better assessed on same day CT.
|
19881444-RR-166
| 19,881,444 | 28,475,591 |
RR
| 166 |
2164-02-25 12:00:00
|
2164-02-25 12:21:00
|
EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ year old woman with SCLC, presented with hypoxia, now with
AMS, r/o stroke or bleed. Evaluate for stroke or bleed.
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Acquisition sequence:
1) Stationary Acquisition 4.0 s, 15.1 cm; CTDIvol = 49.8 mGy (Head) DLP =
752.0 mGy-cm.
Total DLP (Head) = 752 mGy-cm.
COMPARISON: Head MRI ___.
FINDINGS:
There is no evidence of acute, large territorial infarction,hemorrhage,edema,
or mass. There is prominence of the ventricles and sulci suggestive of
involutional changes. Periventricular and subcortical white matter
hypodensities are nonspecific, likely sequela of chronic ischemic small vessel
disease.
There is no evidence of fracture. The visualized portion of the paranasal
sinuses, mastoid air cells, and middle ear cavities are clear. Aside from
bilateral lens replacements, the visualized portion of the orbits are
unremarkable.
IMPRESSION:
No acute intracranial abnormality.
|
19881444-RR-167
| 19,881,444 | 28,475,591 |
RR
| 167 |
2164-02-25 17:06:00
|
2164-02-25 20:13:00
|
EXAMINATION: MR HEAD W AND W/O CONTRAST T9112 MR HEAD
INDICATION: ___ PMH of ___ s/p chemoradiation, recently found to
haverecurrent metastatic small cell carcinoma (s/p C1Carbo/Etoposide/
Atezolizumab), Tobacco abuse, Chronic back pain(on opiates), presented with
shortness of breath, nowencephalopathic, word finding difficulty, r/o stroke//
___ PMH of ___ s/p chemoradiation, recently found to haverecurrent metastatic
small cell carcinoma (s/p C1Carbo/Etoposide/ Atezolizumab), Tobacco abuse,
Chronic back pain(on opiates), presented with shortness of breath,
nowencephalopathic, word finding difficulty, r/o stroke
TECHNIQUE: Sagittal and axial T1 weighted imaging were performed. After
administration of intravenous contrast, axial imaging was performed with
gradient echo, FLAIR, diffusion, and T1 technique. Sagittal MPRAGE imaging was
performed and re-formatted in axial and coronal orientations.
COMPARISON: CT head without contrast ___
MRI head with and without contrast ___.
FINDINGS:
Evaluation is suboptimal due to motion artifact. Within this confine:
There is no evidence of hemorrhage, edema, masses, mass effect, midline shift
or infarction. The ventricles and sulci are prominent, consistent with global
cerebral volume loss. Patchy periventricular T2 hyperintensities are most
consistent with chronic microvascular angiopathy. There is no abnormal
enhancement after contrast administration.
The paranasal sinuses, mastoid air cells and middle ear cavities are clear.
The patient is status post bilateral cataract surgery.
IMPRESSION:
1. No evidence of metastatic disease.
2. No acute infarct or intracranial hemorrhage.
3. Chronic microvascular angiopathy changes.
|
19881444-RR-92
| 19,881,444 | 20,158,003 |
RR
| 92 |
2160-08-22 16:58:00
|
2160-08-22 17:55:00
|
EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ with headaches in setting of new tumor
TECHNIQUE: Contiguous multidetector CT scan through the head was performed
without intravenous contrast. Axial images displayed as separate 5 mm soft
tissue and 2.5 mm bone algorithm image series
DOSE: This study involved 3 CT acquisition phases with dose indices as
follows:
1) CT Localizer Radiograph
2) CT Localizer Radiograph
3) Sequenced Acquisition 14.0 s, 14.0 cm; CTDIvol = 55.8 mGy (Head) DLP =
780.4 mGy-cm.
Total DLP (Head) = 780 mGy-cm.
COMPARISON: None.
FINDINGS:
There is no evidence of acute large territorial infarction, acute intracranial
hemorrhage, edema, or mass. The ventricles and sulci are normal in size and
configuration. A 1 x 0.7 cm (2:9) hypodensity is seen within the left putamen
and is most consistent with a prominent Virchow ___ space or chronic lacune.
No osseous abnormalities seen. The visualized portion of the paranasal
sinuses, mastoid air cells, and middle ear cavities are clear. The visualized
portion of the orbits are unremarkable. Calcification of the cavernous
portions of bilateral internal carotid arteries are noted.
IMPRESSION:
1. No acute intracranial abnormality. No large intracranial mass. Of note MR
is more sensitive in detection of subtle mass lesions.
2. 1 cm hypodensity within the left putamen is most consistent with a
prominent Virchow ___ space or chronic lacune.
|
19881444-RR-93
| 19,881,444 | 20,158,003 |
RR
| 93 |
2160-08-24 13:48:00
|
2160-08-24 16:52:00
|
INDICATION: ___ year old woman with stent placement. // ? ptx
COMPARISON:
Scout image from chest CT of ___.
FINDINGS:
Interval placement of stent in the region of the bronchus intermedius, with no
evidence of postprocedural pneumothorax or pneumomediastinum. Large mass in
the right juxta hilar region has been more fully characterized by a recent CT
and is contiguous with extensive lymphadenopathy in the mediastinum. Poorly
defined opacities in the right mid and lower lung could reflect a combination
of atelectasis and aspiration although developing infectious pneumonia should
also be considered in the appropriate clinical setting. Small right pleural
effusion is also demonstrated. Note is made of new moderate gastric
distension.
|
19881444-RR-95
| 19,881,444 | 20,158,003 |
RR
| 95 |
2160-08-26 08:51:00
|
2160-08-26 12:05:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with intrathoracic malignancy type unknown,
s./p bronchial stent now with worsening SOB and cough // ? pneumonia vs pulm
edema ? pneumonia vs pulm edema
COMPARISON: Prior chest radiograph ___.
IMPRESSION:
There has been little change in the appearance of the chest since ___
except for improvement in minimal edema in the right lung. There is a short
stent projecting over the bronchus intermedius, that may originate at the
level of the upper lobe takeoff. It has not migrated appreciably. More
careful assessment would require CT scanning. Right hilar mass and lower
paratracheal adenopathy unlikely. Left lung is clear. Heart size is normal.
Vascular clips projecting over the left axilla and breast suggest patient may
have a history of breast cancer.
Thoracic scoliosis is moderately severe. No pneumothorax.
|
19881444-RR-96
| 19,881,444 | 20,158,003 |
RR
| 96 |
2160-08-26 12:27:00
|
2160-08-26 14:10:00
|
EXAMINATION: MR HEAD W AND W/O CONTRAST T9112 MR HEAD
INDICATION: ___ year old woman with new malignancy in the chest (path pending)
and headaches and SVC compression/SVC syndrome // eval for intracranial
edema/malignancy
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: ___ noncontrast CT head.
FINDINGS:
There is no evidence of hemorrhage, edema, masses, mass effect, midline shift
or infarction. The ventricles and sulci are normal in caliber and
configuration. There are nonspecific bilateral frontal lobe small
hyperintensities on T2W imaging, which likely represent chronic small vessel
disease. There is no abnormal enhancement after contrast administration.
IMPRESSION:
1. No acute intracranial abnormality or abnormal enhancement on
contrast-enhanced imaging.
2. Nonspecific bilateral frontal lobe hyperintensities, suggestive of chronic
small vessel disease.
|
19881444-RR-98
| 19,881,444 | 20,158,003 |
RR
| 98 |
2160-08-29 21:26:00
|
2160-08-30 08:47:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old woman with newly diagnosed small cell lung cancer s/p
stenting in the right side. Significant rhonchi, wheezing. // Please evaluate
for interval changes. ? Mucus plugging. Please evaluate for interval
changes. ? Mucus plugging.
IMPRESSION:
In comparison with the study of ___, there is again a right hilar mass
with the lower paratracheal adenopathy. However, otherwise there is little
interval change and increased expansion of the lungs.
|
19881466-RR-63
| 19,881,466 | 22,620,062 |
RR
| 63 |
2168-05-29 17:16:00
|
2168-05-29 19:31:00
|
EXAMINATION: MRI CERVICAL AND THORACIC PT21 MR SPINE
INDICATION: ___ female with worsening ascending numbness, saddle
paresthesia, and symmetric lower extremity weakness. Evaluate for mass,
subluxation, fracture, or nerve root or spinal cord compromise.
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. After the uneventful administration of 5 mL of Gadavist contrast
agent, additional axial and sagittal T1 images were obtained.
COMPARISON: ___ contrast cervical spine MRI.
___ noncontrast thoracic spine MRI.
FINDINGS:
CERVICAL SPINE:
There is stable reversal of the cervical lordosis. Vertebral body heights are
preserved. There is no marrow signal abnormality.
There is a short-segment nonenhancing T2 hyperintense lesion within the right
lateral cervical cord measuring 2 mm at the C2 level (6:7; 03:10).
There is a short segment nonenhancing T2 hyperintense lesion within the
ventral midline cervical cord measuring 3 mm at the C3-C4 level (3:9; 06:14)
There is a short segment nonenhancing T2 hyperintense lesion within the dorsal
midline cervical cord measuring 2 mm at the C3 level (3:9; 06:11).
There is loss of intervertebral disc signal at all levels of the cervical
spine. There is no evidence of infection or neoplasm. There is no
prevertebral soft tissue swelling.. The visualized portion of the posterior
fossa, cervicomedullary junction are preserved.
At C2-C3 there is no significant neural foramina or spinal canal stenosis.
At C3-C4 there is no significant neural foraminal spinal canal stenosis.
At C4-C5 there are uncovertebral osteophytes causing moderate bilateral neural
foraminal stenosis without significant spinal canal stenosis.
At C5-C6 there are uncovertebral osteophytes causing moderate right and mild
left neural foraminal stenosis without significant spinal canal stenosis.
At C6-C7 there is no significant neural foramina or spinal canal stenosis.
THORACIC SPINE:
There is a rightward dextroscoliosis of the thoracic spine. The vertebral
body heights are preserved. The marrow signal is unremarkable. There is mild
low intervertebral disc signal. There is no significant neural foramina or
spinal canal stenosis.
There is central cord T2 hyperintensity centered at the T9 level measuring up
to 4 mm in diameter (13:11) extending for 3 cm and craniocaudad dimension
there is associated underlying enhancement measuring 3 mm AP x 9 mm CC x 4 mm
AP (16:11; 14:16).
There is mild prominence central cord T2 signal from a T3-T4 through T6-T7
measuring between 1 and 2 mm without associated postcontrast enhancement.
There are small sub cm cysts versus hemangiomas within the liver.
IMPRESSION:
1. Short-segment central T2 hyperintense enhancing lesion within the thoracic
cord at the T9 level suspicious for demyelination.
2. Additional short-segment T2 hyperintense nonenhancing peripheral lesions at
the C2 and C3 levels, as described.
3. Prominent central T2 hyperintense signal throughout thoracic spinal cord,
measuring up to 1 mm without associated postcontrast enhancement from T3-T4
through T6-T7. Finding may represent a small degenerative syrinx versus
nonenhancing lesion. Compared to ___ prior exam, extent of hydromyelia is
increased between T8 through T10 levels.
|
19881466-RR-64
| 19,881,466 | 22,620,062 |
RR
| 64 |
2168-05-30 04:53:00
|
2168-05-30 10:22:00
|
EXAMINATION: MR HEAD W AND W/O CONTRAST T___ MR HEAD
INDICATION: ___ year old female with suspected multiple sclerosis thoracic
lesion. Evaluate for intracranial demyelinating disease.
TECHNIQUE: Sagittal and axial T1 weighted imaging were performed. After
administration of 6 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: ___ contrast cervical and thoracic spine MRI.
FINDINGS:
The parenchymal signal is unremarkable without acute infarct, hemorrhage,
mass, or mass effect. There are no definite FLAIR hyperintense white matter
lesions or abnormal postcontrast enhancement. On the 3D FLAIR acquisition, a
single white matter lesion is suggested in the right external capsule with
adjacent artifact (see 100:95), with no corresponding finding on axial FLAIR
imaging (see 04:14), suggesting this finding is artifactual. The ventricles
and cortical sulci are normal in caliber and configuration. The extra-axial
spaces are unremarkable.
There are short segment FLAIR hyperintense lesions within the cervical cord at
the C2 and C3 levels (2: 69, 73), without associated postcontrast enhancement.
These are better characterized on prior dedicated cervical spine MRI.
The right lens is absent and there is a scleral buckle in place, otherwise the
orbits are unremarkable. The calvarium and soft tissues are unremarkable.
The paranasal sinuses mastoid air cells are clear.
IMPRESSION:
1. No acute intracranial abnormality.
2. No definite evidence of intracranial demyelinating lesions or abnormal
postcontrast enhancement.
3. Redemonstration of short segment nonenhancing FLAIR hyperintense cervical
cord lesions, which are better characterized on prior dedicated cervical spine
MRI.
|
19881493-RR-3
| 19,881,493 | 27,120,524 |
RR
| 3 |
2125-06-17 02:45:00
|
2125-06-17 03:18:00
|
EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ with epigastric pain// assess for cholecystitis
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: None.
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: 3 mm
GALLBLADDER: The gallbladder is distended with internal sludge. No gallstones
are visualized. The gallbladder wall is not thickened. There is trace
pericholecystic fluid. Sonographic ___ sign was negative.
PANCREAS: The imaged portion of the pancreas appears within normal limits,
without masses or pancreatic ductal dilation, with portions of the pancreatic
tail obscured by overlying bowel gas.
SPLEEN: Normal echogenicity.
Spleen length: 9.5 cm
KIDNEYS: Limited views of the right kidney shows no hydronephrosis.
RETROPERITONEUM: The visualized portions of aorta and IVC are within normal
limits.
IMPRESSION:
Mildly distended gallbladder containing sludge with trace pericholecystic
fluid without wall thickening or mural edema are not definite for acute
cholecystitis. If there is a persistent concern for acute cholecystitis a
HIDA scan can be considered for further evaluation.
|
19881566-RR-17
| 19,881,566 | 27,287,770 |
RR
| 17 |
2171-01-14 17:41:00
|
2171-01-14 18:00:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: History: ___ with sick sinus syndrome status post PPM, mitral
regurgitation presents with chest heaviness // evaluate for pulmonary edema
TECHNIQUE: PA and lateral views of the chest provided.
COMPARISON: Chest radiographs dated ___.
FINDINGS:
Lung volumes are well inflated. A left-sided pacing device with dual leads
follow the expected course to the right atrium and ventricle, respectively.
No focal consolidation or pneumothorax. Blunting of the left costophrenic
angle may be due to a small pleural effusion or chronic pleural thickening.
No large effusion on the right. There is no central vascular congestion or
pulmonary edema. Diffuse interstitial opacification extending to the
periphery bilaterally is unchanged since prior study and likely reflects a
chronic interstitial process. There is stable mild parenchymal scarring at
the right lung base. Unchanged tortuosity of the thoracic aorta is re-
demonstrated with atherosclerotic calcifications. Otherwise, mediastinal and
hilar contours are unchanged. Heart size normal.
IMPRESSION:
1. No pulmonary edema.
2. Possible trace left pleural effusion versus pleural thickening. No large
effusion on the right.
3. Similar mild diffuse interstitial opacities, suggestive of a chronic
interstitial process.
|
19881566-RR-19
| 19,881,566 | 29,352,254 |
RR
| 19 |
2171-09-20 12:01:00
|
2171-09-20 12:38:00
|
INDICATION: ___ woman with cough and fever. Rule out pneumonia.
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest x-ray from ___
FINDINGS:
There are bibasilar opacities, new since the prior study, concerning for
pneumonia. There is background prominent interstitial markings suggestive of
chronic interstitial process. There is also some central vascular congestion
without overt edema. Blunting of the right costophrenic angle is noted,
compatible with small pleural effusion. There is no pneumothorax. A left
chest pacemaker and leads are in unchanged positions. The heart size is
top-normal.
IMPRESSION:
1. New bibasilar opacities concerning for pneumonia.
2. Small right pleural effusion and central vascular congestion.
2. Background prominent interstitial markings suggestive of chronic
interstitial disease.
|
19881566-RR-20
| 19,881,566 | 29,352,254 |
RR
| 20 |
2171-09-21 13:58:00
|
2171-09-21 14:51:00
|
EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ year old woman with elevated LFT's, thrombocytopenia//
Cirrhosis? assessment of RUQ morphology
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: None.
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. Trace right pleural effusion is
noted
BILE DUCTS: There is no intrahepatic biliary dilation. The CHD measures 5 mm.
GALLBLADDER: The patient is status post cholecystectomy.
PANCREAS: The head and body of the pancreas are within normal limits. The tail
of the pancreas is not visualized due to the presence of gas.
SPLEEN: Normal echogenicity, measuring 8.5 cm.
KIDNEYS: Limited views of the right kidney show no hydronephrosis.
RETROPERITONEUM: The visualized portions of aorta and IVC are within normal
limits.
IMPRESSION:
Status post cholecystectomy. No evidence of intrahepatic or extrahepatic
biliary dilation.
|
19881575-RR-13
| 19,881,575 | 20,683,496 |
RR
| 13 |
2121-04-11 13:35:00
|
2121-04-11 14:10:00
|
INDICATION: ___ with syncope, R sided crackles on exam // eval ? edema,
infiltrate
TECHNIQUE: PA and lateral views of the chest.
COMPARISON: ___.
FINDINGS:
The lungs are clear without focal consolidation, effusion, or edema. The
cardiomediastinal silhouette is within normal limits. Atherosclerotic
calcifications are noted at the arch. No acute osseous abnormalities.
IMPRESSION:
No acute cardiopulmonary process.
|
19881575-RR-24
| 19,881,575 | 29,105,834 |
RR
| 24 |
2122-04-27 14:24:00
|
2122-04-27 15:09:00
|
EXAMINATION:
Chest: Frontal and lateral views
INDICATION: History: ___ with s/p fall, unclear head strike // eval for fx,
pna, ich
TECHNIQUE: Chest: Frontal and Lateral
COMPARISON: ___
FINDINGS:
Cardiac and mediastinal silhouettes are stable. No focal consolidation is
seen. There is no pleural effusion or evidence of pneumothorax. No displaced
fracture is identified. Gaseous distention of loops of bowel is partially
imaged. Evidence of DISH is seen along the thoracic spine.
IMPRESSION:
No acute intrathoracic process. Gaseous distention of loops of bowel
partially imaged and not well assessed on this study.
|
19881575-RR-25
| 19,881,575 | 29,105,834 |
RR
| 25 |
2122-04-27 13:58:00
|
2122-04-27 15:33:00
|
EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ with s/p fall, unclear head strike. Evaluate for
intracranial hemorrhage.
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast. Coronal and sagittal reformations as well as bone algorithm
reconstructions were provided and reviewed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 18.0 s, 18.3 cm; CTDIvol = 49.4 mGy (Head) DLP =
903.1 mGy-cm.
Total DLP (Head) = 903 mGy-cm.
COMPARISON: CT head of ___ and MR head of ___.
FINDINGS:
There is no evidence of infarction, hemorrhage, edema, or mass. There is
prominence of the ventricles and sulci suggestive of involutional changes. An
8 mm pineal cyst is unchanged (602b:42).
There is no evidence of acute fracture. A small subgaleal hematoma underlies
the right frontal scalp (3:44). The previously described oblong soft tissue
density in the right nasal cavity with remottling of the adjacent bone,
measuring 1.4 x 0.7 cm (601b:22), has not changed since the prior study.
There is mucosal thickening in the bilateral maxillary sinuses. The
visualized portion of the remaining paranasal sinuses and middle ear cavities
are clear. There is underpneumatization of the bilateral mastoid air cells,
as seen on the prior study. The visualized portion of the orbits are
unremarkable.
IMPRESSION:
1. No acute intracranial hemorrhage.
2. Small right frontal subgaleal hematoma without underlying fracture.
3. Small focal polypoid lesion in the right nasal cavity is unchanged since
___.
|
19881575-RR-26
| 19,881,575 | 29,105,834 |
RR
| 26 |
2122-04-27 13:59:00
|
2122-04-27 15:28:00
|
EXAMINATION: CT C-SPINE W/O CONTRAST
INDICATION: ___ with s/p fall, unclear head strike. Evaluate for cervical
spinal fracture.
TECHNIQUE: Non-contrast helical multidetector CT was performed. Soft tissue
and bone algorithm images were generated. Coronal and sagittal reformations
were then constructed.
DOSE: Acquisition sequence:
1) Spiral Acquisition 5.7 s, 22.3 cm; CTDIvol = 37.1 mGy (Body) DLP = 828.5
mGy-cm.
Total DLP (Body) = 828 mGy-cm.
COMPARISON: Cervical spine CT of ___.
FINDINGS:
Alignment is normal. No fractures are identified. There is no prevertebral
soft tissue swelling.
Severe degenerate changes of the cervical spine are most pronounced at C5
through C7, where there is complete loss of disc space. Spinal canal
narrowing is present at multiple levels, most severe at C6-C7, as described on
the prior study. There is no evidence of infection or neoplasm.
Biapical pleural parenchymal scarring with right upper lobe bronchiectasis is
unchanged since the prior study. The imaged thyroid is normal.
IMPRESSION:
1. No evidence of fracture or malalignment.
2. Severe multilevel degenerative changes with severe spinal canal narrowing
and multiple levels of severe neural foraminal narrowing are similar in
appearance since ___.
|
19881575-RR-27
| 19,881,575 | 29,105,834 |
RR
| 27 |
2122-04-27 15:42:00
|
2122-04-27 16:38:00
|
EXAMINATION: CT L-SPINE W/O CONTRAST
INDICATION: ___ with L1 tenderness to palpation after a fall. Evaluate
for fracture.
TECHNIQUE: Non-contrast helical multidetector CT was performed. Soft tissue
and bone algorithm images were generated. Coronal and sagittal reformations
were then constructed.
DOSE: Acquisition sequence:
1) Spiral Acquisition 6.8 s, 26.6 cm; CTDIvol = 32.0 mGy (Body) DLP = 850.5
mGy-cm.
Total DLP (Body) = 850 mGy-cm.
COMPARISON: Lumbar spinal radiograph of ___.
FINDINGS:
There is grade 1 anterolisthesis of L4 on L5.No acute lumbar spinal fracture
detected.Severe degenerative changes of the lumbar spine are most pronounced
at L4-L5, where there is endplate sclerosis, severe disc space narrowing, and
osteophytosis. There is a large posterior disc bulge causing moderate central
canal narrowing at L3-L4. There is no prevertebral soft tissue swelling.
Incidental note is made of a large amount of hyperdense stool in the colon.
IMPRESSION:
1. No evidence of acute lumbar spinal fracture.
2. Grade 1 anterolisthesis of L4 on L5.
3. Severe degenerative changes of the lumbar spine, most pronounced at L3-L4
and L4-L5. At L3-L4, there is a large posterior disc bulge causing moderate
central canal narrowing.
|
19881575-RR-43
| 19,881,575 | 22,455,619 |
RR
| 43 |
2123-11-08 20:40:00
|
2123-11-08 21:04:00
|
EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ year old woman with elevated transaminases, nausea, ams//
unclear reason for liver enzyme elevation
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: None.
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 trace perihepatic ascites.
BILE DUCTS: There is no intrahepatic biliary dilation. The CHD measures 8 mm.
GALLBLADDER: There is no evidence of stones or gallbladder wall thickening.
PANCREAS: The pancreas is not well visualized, largely obscured by overlying
bowel gas.
SPLEEN: Normal echogenicity, measuring 8.5 cm.
KIDNEYS: Limited views of the right kidney show no hydronephrosis.
RETROPERITONEUM: The visualized portions of aorta and IVC are within normal
limits.
IMPRESSION:
Trace perihepatic ascites. Otherwise unremarkable abdominal ultrasound.
|
19881575-RR-46
| 19,881,575 | 22,455,619 |
RR
| 46 |
2123-11-13 16:41:00
|
2123-11-13 18:41:00
|
EXAMINATION: CT ABDOMEN/PELVIS WITH CONTRAST
INDICATION: ___ year old woman with dementia, HTN, HLD, admitted with syncopal
episodes as well as increasing gait instability, also with ongoing complaint
of nondescript abdominal pain// please evaluate for acute process
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were
acquired through the abdomen and pelvis following intravenous contrast
administration with split bolus technique.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 0.5 s, 0.4 cm; CTDIvol = 4.7 mGy (Body) DLP = 1.9
mGy-cm.
2) Stationary Acquisition 19.7 s, 0.2 cm; CTDIvol = 263.1 mGy (Body) DLP =
52.6 mGy-cm.
3) Spiral Acquisition 7.8 s, 50.4 cm; CTDIvol = 5.4 mGy (Body) DLP = 270.9
mGy-cm.
Total DLP (Body) = 325 mGy-cm.
COMPARISON: CT abdomen/pelvis ___.
FINDINGS:
LOWER CHEST: There are right greater than left basal atelectatic changes with
minimal pleural effusion.
HEPATOBILIARY: There is homogeneous hepatic enhancement with no suspicious
mass lesions. Portal vein is patent. Gallbladder is unremarkable. There is
no intrahepatic biliary ductal dilatation. Common bile duct is mildly
prominent in caliber tapers to the level of the ampulla and is unchanged in
appearance since ___.
PANCREAS: Atrophic changes are noted within the pancreas with no pancreatic
ductal dilatation.
SPLEEN: There is no splenomegaly.
ADRENALS: Adrenal glands are unremarkable.
URINARY:There is left greater than right renal cortical atrophy with multiple
areas of renal cortical scarring. There is interval development of mild
hydronephrosis, which can be secondary to distention of the urinary bladder..
GASTROINTESTINAL: Stomach is under distended. Proximal small bowel loops are
normal in caliber. The right hemicolon appears unremarkable. Transverse
colon is under distended. Note is made interval worsening of the distension
of descending colonic loops measuring up to 7.8 cm. There is notable
twisting/swirling of the sigmoid colon with the transition point along the
left pelvic inlet consistent with sigmoid volvulus. Given the appearance of
this patient's bowel loops since ___, this is probably acute on chronic or
intermittent in nature. There is new mild mesenteric stranding and edema.
PERITONEUM: There is no evidence of perforation.
LYMPH NODES: There is no adenopathy.
VASCULAR: Abdominal aorta is normal in caliber with moderate atherosclerotic
calcifications.
PELVIS: Urinary bladder is markedly distended. Uterus is unremarkable. There
are no adnexal mass lesions.
BONES:Degenerative changes of the lumbar spine are noted. There are no acute
osseous abnormalities.
SOFT TISSUES: Soft tissues are unremarkable.
IMPRESSION:
1. Findings of large bowel obstruction secondary to sigmoid volvulus.
Findings are likely acute on chronic or intermittent given the notable
distension of the bowel loops in ___. Evidence of mesenteric stranding and
edema. No evidence of perforation.
2. Mild bilateral hydronephrosis likely secondary to urinary bladder
distension.
NOTIFICATION: The findings were discussed with ___, M.D. by ___
___, M.D. on the telephone on ___ at 6:38 pm, 5 minutes after
discovery of the findings.
|
19881575-RR-47
| 19,881,575 | 22,455,619 |
RR
| 47 |
2123-11-15 07:25:00
|
2123-11-15 09:44:00
|
INDICATION: ___ year old woman with recent volvulus now s/p endoscopic
decompression, likely plan for OR// please assess for any recurrence of
volvulus
TECHNIQUE: Portable supine radiograph of the abdomen and pelvis.
COMPARISON: CT abdomen pelvis dated ___
FINDINGS:
A rectal tube is in place for colonic decompression. Gas is seen within
nondistended loops of large and small bowel. Residual oral contrast material
is also seen, mostly within the ascending colon. There is no secondary signs
of free air.
IMPRESSION:
Rectal tube is in place for colonic decompression. Gas is seen within
nondistended loops of large and small bowel.
|
19881575-RR-48
| 19,881,575 | 29,284,557 |
RR
| 48 |
2124-06-09 14:50:00
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2124-06-09 17:53:00
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EXAMINATION: RENAL U.S.
INDICATION: ___ year old woman with presyncope and ___, r/o
obstruction/pathology
TECHNIQUE: Grey scale and color Doppler ultrasound images of the kidneys were
obtained.
COMPARISON: Prior CT done ___
FINDINGS:
Right kidney: 10.5 cm. Severe grade 4 hydronephrosis.
Left kidney: 7 cm. No hydronephrosis.
The bladder is moderately well distended and normal in appearance.
IMPRESSION:
Severe grade 4 hydronephrosis of the right kidney.
Hypotrophic appearance of the left kidney. No hydronephrosis.
NOTIFICATION: The findings were discussed by Dr. ___ with
Dr. ___ on the ___ ___ at 4:06 pm, 10 minutes after
discovery of the findings.
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