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19881575-RR-49
| 19,881,575 | 29,284,557 |
RR
| 49 |
2124-06-09 16:59:00
|
2124-06-09 17:29:00
|
INDICATION: ___ year old woman here with presyncope. Has h/o recurrent large
bowel obstruction and is s/o colectomy. Baseline dementia, unclear if has
pain// bowel obstruction
TECHNIQUE: Supine abdominal radiograph was obtained.
COMPARISON: ___
FINDINGS:
There are no abnormally dilated loops of large or small bowel. The sigmoid is
noted to be redundant. Stool and gas are seen within the ascending and
descending colon.
Supine assessment limits detection for free air; there is no gross
pneumoperitoneum.
Osseous structures are notable for degenerative changes in the lumbar spine
and mild degenerative changes of both hips.
There are no unexplained soft tissue calcifications or radiopaque foreign
bodies.
IMPRESSION:
Nonspecific, nonobstructive bowel gas pattern.
|
19881575-RR-50
| 19,881,575 | 29,284,557 |
RR
| 50 |
2124-06-09 23:03:00
|
2124-06-10 03:06:00
|
EXAMINATION: CT abdomen and pelvis
INDICATION: ___ year old woman with ___ and ___ 4 severe hydronephrosis on R
kidney ultrasound// r/o obstruction
TECHNIQUE: Multidetector CT images of the abdomen and pelvis were acquired
without intravenous contrast. Non-contrast scan has several limitations in
detecting vascular and parenchymal organ abnormalities, including tumor
detection.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 4.1 s, 53.7 cm; CTDIvol = 5.4 mGy (Body) DLP = 290.8
mGy-cm.
Total DLP (Body) = 291 mGy-cm.
COMPARISON: CT abdomen pelvis dated ___ and ___.
FINDINGS:
LOWER CHEST: There are trace bilateral pleural effusions. No focal
consolidation. No pericardial effusion.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout.
There is no evidence of hepatic mass within the limitations of an unenhanced
scan. There is no evidence of intrahepatic or extrahepatic biliary
dilatation. The gallbladder is not visualized, likely collapsed.
PANCREAS: There is moderate diffuse atrophy of the pancreas. There is no main
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: There is severe right hydronephrosis to the level of the
ureteropelvic junction, without obstructing stone or mass identified. There
is no left hydronephrosis. There is no evidence of focal renal lesions within
the limitations of an unenhanced scan. There is no nephrolithiasis. There is
no perinephric abnormality.
GASTROINTESTINAL: The stomach is dilated and filled with oral contrast and
air. Small bowel loops are normal in caliber. The patient has history of
sigmoid volvulus, and is status post resection of the rectosigmoid with left
colorectal anastomosis on ___. The rectum is dilated up to 9.1 cm
with moderate amount of layering fluid. The distal colon is dilated with
abrupt transition point and twist in the midline upper pelvis (series 2,
images 54-57), concerning for recurrent volvulus. Findings appear less severe
compared to prior episode from ___. No pneumatosis, free air, or
ascites. The appendix is not visualized.
PELVIS: The urinary bladder is decompressed with a Foley in place. There is
no free fluid in the pelvis.
REPRODUCTIVE ORGANS: The uterus is unremarkable. No adnexal mass.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease
is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
Severe degenerative changes of the thoracolumbar spine are unchanged with
grade 1 anterolisthesis of L4 on L5.
SOFT TISSUES: There is diffuse anasarca.
IMPRESSION:
1. Dilated distal colon with abrupt transition and twist in the midline upper
pelvis, concerning for recurrent volvulus, although less severe compared to
prior episode from ___. No pneumatosis or free air.
2. Severe right hydronephrosis of unclear etiology to the level of the
ureteropelvic junction, of unclear etiology.
3. Trace bilateral pleural effusions.
|
19881575-RR-51
| 19,881,575 | 29,284,557 |
RR
| 51 |
2124-06-10 17:04:00
|
2124-06-10 18:10:00
|
INDICATION: ___ year old woman with acute on chronic volvulus// Evidence of
volvulus?
TECHNIQUE: Portable supine abdominal radiograph was obtained.
COMPARISON: Abdominal radiographs ___. CT abdomen and pelvis ___.
FINDINGS:
Study is slightly limited as part of the left side of the abdomen is excluded
outside of the field of view.
The air filled loops of sigmoid colon are minimally improved compared to CT ___ and there is not colonic dilation as the largest loop only
measures 4.6 cm. There has been passage of oral contrast throughout the colon
and into the rectum. There are no abnormally dilated loops of small bowel.
There is no evidence of free intraperitoneal air although study is limited by
supine positioning..
No acute osseous abnormalities are identified.
There are no unexplained soft tissue calcifications or radiopaque foreign
bodies.
IMPRESSION:
Passage of oral contrast from CT into the rectum indicates that there is not
obstruction at this time. No dilated loops of bowel.
|
19881575-RR-53
| 19,881,575 | 29,284,557 |
RR
| 53 |
2124-06-15 11:26:00
|
2124-06-15 11:47:00
|
EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ year old woman with new AMS and hypotension// Stroke?
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 18.0 s, 19.2 cm; CTDIvol = 47.0 mGy (Head) DLP =
903.1 mGy-cm.
2) Sequenced Acquisition 2.0 s, 4.3 cm; CTDIvol = 47.0 mGy (Head) DLP =
200.7 mGy-cm.
Total DLP (Head) = 1,104 mGy-cm.
COMPARISON: CT head ___. Brain MRI ___..
FINDINGS:
There is no evidence of infarction, hemorrhage, edema, or mass. Mild brain
parenchymal atrophy. Findings consistent with mild chronic small vessel
ischemic changes.
There is no evidence of fracture. Mild paranasal sinus disease. Otherwise,
the visualized portion of the paranasal sinuses, mastoid air cells, and middle
ear cavities are clear. The visualized portion of the orbits are
unremarkable. Degenerative changes spine. Additional nasal polyp the
superior right nasal cavity.
IMPRESSION:
No acute findings.
|
19881629-RR-10
| 19,881,629 | 28,055,087 |
RR
| 10 |
2157-05-29 03:41:00
|
2157-05-29 05:35:00
|
HISTORY: ___ male found down with GCS of 3, intubated in the field.
Numerous fractures seen on CT of the head.
TECHNIQUE: Axial helical MDCT images were obtained through the facial bones
without the use of intravenous contrast. Reformatted coronal and sagittal
images were also reviewed.
DLP: 607.0 mGy-cm.
CTDIvol: 25.9 mGy.
FINDINGS: As seen on the non-contrast CT of the head, there is extensive
overlying soft tissue swelling and intracranial hemorrhage about a left
frontal bone fracture, which extends into the temporal bone, with diastasis of
the coronal suture (2:4). The fractre xtends around the vertex and into the
right frontal bone and right temporal bone (2:24). A bony fragment along the
greater wing of the left sphenoid bone (2:48) is minimally displaced. The
fracture on the right extends into the greater wing of the sphenoid, with an
anteriorly displaced fracture fragment (2:44) measuring approximately 8 mm.
The fracture on the right extends into the squamous portion of the temporal
bone (2:59). A right zygomatic arch fracture (2:65) is also noted.
Fractures through the lateral wall of the right sphenoid sinus (2:52) are
associated with hemorrhage in the bilateral sphenoid sinuses, as well as
locules of intracranial air about the left posterior clinoid process and right
anterior clinoid process (2:49). Fractures through the anterior wall of the
right maxillary sinus (2:55, 2:59), with associated opacification of the right
sphenoid sinus with blood products.
There is a tiny non-displaced fracture in the right lamina papyracea
(601B:76), with a subjacent locule of air, and small intraorbital hematoma
(601B:80) which measures approximately 4 mm. A non-displaced fracture through
the anterior orbital floor is also noted (601B:50), with no evidence of
herniation of intraorbital fat or entrapment of the extraocular muscles.
There is no evidence of proptosis. The globes are intact. A locule of air is
noted in the intraconal fat on the right (601B:78).
The nasopharynx and oropharynx is fluid filled, likely related to intubation
and above-described fractures. An air-fluid level is noted in the left
maxillary sinus (2:66). The temporomandibular joints appear well articulated.
The bilateral mastoid air cells and middle ear cavities are clear. The nasal
septum is midline.
IMPRESSION:
1. Extensive facial and sinus fractures, as described above, with a small
retro-orbital right hematoma, and no evidence of globe injury or proptosis.
2. Intracranial pathology is better characterized on concurrently obtained
non-contrast CT of the head.
Final attending comment: also noted is a fracture through the petrous carotid
canal on the left( (2,67), consider further evaluation with CTA to exclude
carotid injury.
|
19881629-RR-11
| 19,881,629 | 28,055,087 |
RR
| 11 |
2157-05-29 07:17:00
|
2157-05-29 13:00:00
|
EXAMINATION: CHEST (PORTABLE AP)CHEST (PORTABLE AP)i
INDICATION: ___ year old man with SDH/EDH s/p decompression // Check ETT
placement
COMPARISON: No prior chest imaging available
IMPRESSION:
ET tube in standard placement. Nasogastric tube passes into the stomach and
out of view. Lungs are grossly clear, cardiomediastinal silhouette and pleural
surface is normal.
|
19881629-RR-12
| 19,881,629 | 28,055,087 |
RR
| 12 |
2157-05-29 08:05:00
|
2157-05-29 13:39:00
|
EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ year old man with ___/EDH s/p craniectomy // ? adequate
resolution of SDH/EDH
TECHNIQUE: Routine unenhanced head CT was performed and viewed in brain,
intermediate and bone windows. Coronal and sagittal reformats were also
performed.
DOSE: DLP: 936 mGy-cm
CTDI: 54 mGy
COMPARISON: Same day CT head at 03:16 and CT face at 03:39.
FINDINGS:
Patient is status post left craniectomy with evacuation of extra-axial
hemorrhage. There are expected postoperative changes with pneumocephalus and
minimal residual extra-axial blood. Midline shift is improved now measuring 7
mm, previously 10 mm. The suprasellar cistern is slightly better visualized
suggesting improvement in uncal herniation. The quadrigeminal plate cistern is
also better seen. There is persistent but improved effacement of the left
lateral ventricle.
Small focus of extra-axial hemorrhage along the right inferior anterior
temporal lobe is minimally redistributed but similar in total size (3:15).
Subcentimeter intraparenchymal contusions in the right frontal parietal lobe
near the vertex are unchanged. There is no evidence of large territorial
infarction.
Facial, calvarial and skullbase fractures are redemonstrated but better
characterized on recent maxillofacial CT. There is persistent opacification of
the sphenoid, posterior ethmoidal and right maxillary sinuses. The mastoid air
cells and middle ear cavities are clear. A few foci of gas underlying the
right temporalis muscle re- demonstrated.
IMPRESSION:
1. Decrease in midline shift and uncal herniation status post left craniectomy
with evacuation of extra-axial hemorrhage.
2. Small right temporal extra-axial hemorrhage and several subcentimeter
intraparenchymal contusions near the vertex are also stable.
3. Facial, skull base and calvarial fractures are redemonstrated.
|
19881629-RR-13
| 19,881,629 | 28,055,087 |
RR
| 13 |
2157-05-29 14:14:00
|
2157-05-29 15:34:00
|
EXAMINATION: CTA HEAD AND CTA NECK
INDICATION: ___ year old man with facial trauma // ? dissection
TECHNIQUE: Contiguous axial images were obtained through the brain without
contrast material. Subsequently, rapid axial imaging was performed from the
aortic arch through the brain during infusion of Omnipaque intravenous
contrast material. Images were processed on a separate workstation with
display of curved reformats, 3D volume redendered images, and maximum
intensity projection images.
DOSE: DLP: ___ MGy-cm;
COMPARISON: Head CT dated ___.
FINDINGS:
NONCONTRAST CT HEAD: There is no pertinent change since the same day study at
07:56. Patient status post left craniectomy. Minimal residual extra-axial
hemorrhage along the left hemisphere and associated postoperative
pneumocephalus is re-demonstrated. 7 mm shift rightward shift of midline
stable. Opacification of the sphenoid, posterior ethmoid and right maxillary
sinuses are unchanged. The mastoid air cells and middle ear cavities are
clear. Orogastric and endotracheal tubes are in place.
CTA HEAD: Equivocal hypodense linear focus traversing the petrous portion of
the left internal carotid artery (3:267) adjacent to a fracture in the petrous
apex. While most likely artifactual, dissection cannot be completely
excluded and MRA of the head with axial T1 fat sat images is recommended.
IMPRESSION:
1. Patient status post left craniectomy. Minimal residual extra-axial
hemorrhage along the left hemisphere and associated postoperative
pneumocephalus is re- demonstrated. 7 mm shift rightward shift of midline
stable.
2. Equivocal hypodense linear focus traversing the petrous portion of the left
internal carotid artery (3:267) adjacent to a fracture in the petrous apex.
While most likely artifactual, dissection cannot be completely excluded and
MRA of the head with axial T1 fat sat images is recommended.
|
19881629-RR-14
| 19,881,629 | 28,055,087 |
RR
| 14 |
2157-05-29 15:52:00
|
2157-05-30 20:28:00
|
HISTORY: Right hand bruising, to assess for fracture.
FINDINGS: There is an old healed fracture of the mid shaft of the fifth
metacarpal. No evidence of acute fracture or dislocation.
|
19881629-RR-15
| 19,881,629 | 28,055,087 |
RR
| 15 |
2157-05-29 12:05:00
|
2157-05-29 13:09:00
|
EXAMINATION: CHEST PORT. LINE PLACEMENT
INDICATION: ___ year old man with TBI // left subclavian TLC insertion
Contact name: ___: ___
COMPARISON: ___, 07:44
IMPRESSION:
As compared to the previous radiograph, the patient has received a new left
subclavian line. The course of the line is unremarkable, the tip of the line
projects over the upper to mid SVC. There is no evidence of complications,
notably no pneumothorax. The nasogastric tube, the endotracheal tube, are
both in correct position. Unchanged normal appearance of the lung parenchyma.
|
19881629-RR-16
| 19,881,629 | 28,055,087 |
RR
| 16 |
2157-05-30 05:45:00
|
2157-05-30 13:03:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with head trauma, intubated // ? pna
COMPARISON: Chest x-ray dated ___
FINDINGS:
An ET tube is present, tip approximately 2.2 cm above the Carina. A left
subclavian central line is present, tip over distal SVC. No pneumothorax is
detected.
Cardiomediastinal silhouette is unchanged although it appears slightly
prominent this may be accentuated by technique and positioning. There is
minimal atelectasis at both bases, slightly more pronounced. No frank
consolidation or effusion is identified. No CHF.
IMPRESSION:
As above.
|
19881629-RR-17
| 19,881,629 | 28,055,087 |
RR
| 17 |
2157-05-30 08:44:00
|
2157-05-30 10:33:00
|
INDICATION: Traumatic brain injury requiring evacuation. The patient now not
following commands. Evaluation for new increased hemorrhage.
TECHNIQUE: Contiguous axial images were obtained through the brain without IV
contrast. Coronal, sagittal, thin section bone reconstruction algorithm
images were prepared.
CTDIvol: 52.22 mGy.
DLP: 1003.42 mGy-cm.
COMPARISON: Multiple prior NECTs of the head from ___ at 3:16 a.m. to
2:20 p.m.
FINDINGS: Again noted is a left frontoparietal craniectomy with decreased
pneumocephalus compared to priors. There is still a small amount of
subarachnoid hemorrhage including a focus in the left quadrigeminal cistern
(2:11). Edema throughout the left cerebral hemisphere is unchanged and there
is 2-mm rightward shift of midline structures (2:14). There is no evidence of
uncal herniation. There is no new focus of hemorrhage. The patient now has a
surgical device traversing the right posterior frontal bone (601B:33).
Opacification of the sphenoid, posterior ethmoid and right maxillary sinuses
are unchanged. The mastoid air cells and middle ear cavities are clear.
Again noted are calvarial fractures extending along the right parietal bone
into the coronal suture. Fracture also extends into the right sphenoid bone.
Again noted also is a fracture through the anterior wall of the right
maxillary sinus.
IMPRESSION:
1. No new focus of hemorrhage. Stable 2-mm rightward shift of midline
structures and improving uncal herniation.
2. Stable small focus of subarachnoid hemorrhage in the quadrigeminal
cistern.
3. Complex facial fractures, unchanged from multiple priors.
|
19881629-RR-18
| 19,881,629 | 28,055,087 |
RR
| 18 |
2157-05-31 09:27:00
|
2157-05-31 11:55:00
|
HISTORY: Trauma of unclear etiology with epidural and subdural hematoma
status post left craniectomy C5 spinous process fracture, frontotemporal skull
fractures, evaluate for interval change.
CHEST, SINGLE AP VIEW.
COMPARISON: Chest x-ray from ___ at 6:08 a.m.
An ET tube is present, the tip lies 2 cm above the carina, pointing towards
the right mainstem bronchus. An NG tube is present, tip extending beneath the
diaphragm. A left subclavian central line tip overlies the mid/distal SVC.
No pneumothorax is detected.
Compared with prior film, there is increased retrocardiac density, with
obscuration of left hemidiaphragm, consistent with left lower lobe collapse
and/or consolidation. Possibility of a small left effusion cannot be
excluded. Mild upper zone redistribution, without overt CHF. Aside from
minimal atelectasis in the right cardiophrenic region, which is probably
slightly worse, no focal infiltrate is seen on the right. No gross right
effusion.
IMPRESSION:
1. ET tube 2 cm above the carina, at the lower limits of the range of
positioning, pointing towards the right mainstem bronchus.
2. Developing left lower lobe collapse and/or consolidation. Possible small
left effusion.
3. Atelectasis in the right cardiophrenic region, which may be slightly
worse.
4. Upper zone redistribution, without overt CHF.
5. There is some prominence of the right hilum compared to the prior film, of
uncertain etiology or significance. Possibly due to vascular engorgement.
Attention to this area on followup films is requested.
|
19881629-RR-19
| 19,881,629 | 28,055,087 |
RR
| 19 |
2157-06-01 05:11:00
|
2157-06-01 10:01:00
|
PORTABLE CHEST ___
Compared to previous radiograph one day prior.
Exam is limited due to patient's difficulty cooperating with positional
requirements, and the extreme left apex has been excluded from the radiograph.
Support and monitoring devices are in standard position. Cardiomediastinal
contours are similar. Pulmonary vascular congestion is accompanied by
asymmetrical bilateral right perihilar and left infrahilar airspace opacities,
which could be due to edema, aspiration or infection. Left retrocardiac
atelectasis has substantially improved.
|
19881629-RR-20
| 19,881,629 | 28,055,087 |
RR
| 20 |
2157-06-01 09:16:00
|
2157-06-01 10:06:00
|
INDICATION: ___ year old man found down, GCS 3; left pupil fixed and dilated,
large left acute SDH with shift. Now no movement of the right arm. Assess for
interval change.
TECHNIQUE: Contiguous axial images were obtained through the brain without IV
contrast. Coronal, sagittal, thin section bone reconstruction algorithm
images were prepared.
CTDIvol: 52.66 mGy.
DLP: 933 mGy-cm.
COMPARISON: Multiple prior NECTs of the head from ___ at 3:16 a.m. to
2:20 p.m., and ___ at 8:44 am.
FINDINGS: Again noted is a left frontoparietal craniectomy with unchanged
herniation of the brain through the defect. Pneumocephalus has decreased.
Hyperdense blood products overlying the dura at the craniectomy site are not
significantly changed. Small parafalcine subdural hematoma is stable. Small
foci of subarachnoid blood in the left sulci and left quadrigeminal plate
cistern are not significantly changed. Minimal rightward shift of midline
structures has slightly decreased, but the ventricles remain effaced. Basal
cisterns are stable in size. There is no evidence of uncal herniation. Right
frontal ICP monitor is noted. Developing hypodensity in the inferolateral left
frontal lobe on image 3:18 is compatible with infarction or contusion.
Multiple bilateral calvarial and facial fractures are again seen. There is
persistent blood in the paranasal sinuses and new partial left mastoid air
cell opacification.
IMPRESSION:
1. Small developing hypodensity in the inferolateral left frontal lobe,
compatible with infarction or contusion.
2. Mild improvement in left hemispheric edema with slightly decreased shift
of midline structures. However, herniation of the brain through left
craniectomy defect and ventricular effacement persist.
3. Stable appearance of intracranial hemorrhage compared to one day earlier.
4. Bilateral calvarial and facial fractures are again noted.
|
19881629-RR-6
| 19,881,629 | 28,055,087 |
RR
| 6 |
2157-05-29 03:20:00
|
2157-05-29 05:42:00
|
HISTORY: ___ man found down with G-CSF of 3, intubated in the field.
COMPARISON: No prior imaging is available for comparison. This study is read
in conjunction with CT of the torso, dictated separately.
FINDINGS: Supine views of the chest and pelvis demonstrate an underlying
trauma board, as well as an endotracheal tube terminating 5.6 cm above the
carina. A left nipple piercing is also noted.
The lungs appear well expanded, with no pneumothorax or large pleural
effusion. The cardiomediastinal silhouette is unremarkable.
No pelvic fractures are identified.
IMPRESSION:
1. No acute cardiopulmonary process.
2. No pelvic fracture.
3. Endotracheal tube is in high position. Care should be taken to prevent
cranial migration.
|
19881629-RR-7
| 19,881,629 | 28,055,087 |
RR
| 7 |
2157-05-29 03:24:00
|
2157-05-29 05:26:00
|
HISTORY: ___ male found down, and intubated in field.
COMPARISON: None available.
TECHNIQUE: Contiguous axial MDCT images were obtained through the brain
without the administration of intravenous contrast. Reformatted coronal,
sagittal and thin slice bone images were reviewed.
DLP: 1003.4 mGy-cm.
CTDIvol: 53.9 mGy.
FINDINGS: Acute extra-axial hemorrhage is present along the left frontal
convexity, extending along the left temporal bone (2:24), likely subdural,
although an epidural component along the more anterior aspect cannot be
excluded. There appear to be mixed high-density blood products in the
anterior aspect of the hemorrhage (2:25), indicating active bleeding. Locules
of intracranial air are noted underneath a left frontal and left temporal bone
fracture (2:25, 2:19). The fracture extends from the left temporal bone, in a
coronal plane, causing diastasis of the coronal suture (2:32), and traversing
the right frontal and temporal bones as well (2:27, 3:34, 3:26).
There is mass effect from the previously described left-sided extra-axial
hemorrhage, with approximately 10 mm of rightward shift of the normally
midline structures (2:19), and effacement of the left lateral ventricle. The
suprasellar cisterns are also effaced, representing uncal herniation, with
diffuse brainstem hypodensity concerning for infarction. The fourth ventricle
and right lateral ventricle are normal in size. Scattered small areas of
intraparenchymal contusions are noted in the right frontal lobe, near the
vertex ___, 401B:43), as well as likely areas of intraparenchymal
contusion along the left frontal convexity (401B:39, 401B:38). A tiny amount
of subdural hemorrhage is noted along the right temporal bone, posterior to
the right orbit (2:15), with a locule of air subjacent to the previously
described fracture. Locules of air are also noted in the bilateral sphenoid
sinuses and suprasellar region (2:13). Facial fractures are better assessed
on concurrently obtained facial CT.
IMPRESSION:
1. Multicomponent acute intracranial hemorrhages, as described above, with
apparent active bleeding into a left frontal extra-axial hemorrhage with
associated subfalcine , uncal and trasntentorial herniation, as well as
diffuse brainstem hypodensity concerning for infarction.
2. Large skull fracture in a coronal plane extends through the bilateral
frontal and temporal bones, as described above, with associated extensive soft
tissue swelling, subcutaneous emphysema, and pneumocephalus.
3. Facial fractures are better assessed on concurrently obtained facial bone
CT.
The above findings were communicated to Dr. ___ resident) by Dr. ___
in person at 3:50 a.m., two minutes after discovery.
|
19881629-RR-8
| 19,881,629 | 28,055,087 |
RR
| 8 |
2157-05-29 03:25:00
|
2157-05-29 05:03:00
|
HISTORY: ___ male found down and intubated in field. Evaluation for
trauma.
COMPARISON: No prior imaging is available for comparison.
TECHNIQUE: Axial helical MDCT images were obtained from the skull base to the
top of the T3 level. Reformatted coronal and sagittal images were also
reviewed.
FINDINGS: A vertically oriented fracture through the spinous process of the
C5 vertebral body (2:63) extends toward the spinal canal, and does not clearly
involve the lamina or middle or anterior spinal columns. Significant
overlying soft tissue swelling is noted (602B:39) posteriorly. No other
cervical spine fractures are noted. The vertebral body heights and disc
spaces are maintained. An anterior osteophyte is noted along the superior
endplate of the C4 vertebral body. The cervical lordosis is preserved. The
prevertebral soft tissues are unremarkable. There is no lymphadenopathy. The
visualized lung apices are clear. Facial and cranial injuries are better
described on concurrently obtained CT of the head and CT of the facial bones,
reported separately.
IMPRESSION: Vertically oriented fracture through the C5 spinous process with
overlying posterior soft tissue swelling, as described above. The overall
alignment is maintained, and no other fractures are identified.
NOTIFICATION: The above findings were communicated to Dr. ___ (ACS
resident) by Dr. ___ in person at 3:52 a.m., immediately after discovery.
FINAL ATTENDING COMMENT:
There is linear high density along the surface of the cord at C2 and C3,
consider further evaluation with MRI.
|
19881629-RR-9
| 19,881,629 | 28,055,087 |
RR
| 9 |
2157-05-29 03:25:00
|
2157-05-29 05:40:00
|
HISTORY: ___ male found down and intubated in field.
COMPARISON: No prior imaging is available for comparison.
TECHNIQUE: Axial MDCT images were obtained through the torso after the
administration of intravenous contrast. Reformatted coronal and sagittal
images were also reviewed.
DLP: 886.1 mGy-cm.
FINDINGS:
CT THORAX WITH IV CONTRAST: The aorta and its main branch vessels are well
opacified, with no evidence of focal stenosis, occlusion, dissection, or
intramural hematoma. The intrathoracic aorta is of normal caliber throughout
its course. The central pulmonary arteries are of normal caliber and well
opacified, with no evidence of central pulmonary embolism. The heart is
normal in size. There is no pericardial effusion. The esophagus is
unremarkable. The thyroid gland is normal in appearance. There is no
supraclavicular, axillary, mediastinal or hilar lymphadenopathy.
The airways are patent to the subsegmental level. Subsegmental atelectasis is
noted dependently bilaterally. There is no pneumothorax. No pleural effusion
or focal consolidation is identified.
CT ABDOMEN: The liver enhances homogeneously, with no evidence of focal
lesions. Mild periportal edema is noted (2:56) in the right and left hepatic
lobes, presumably due to IV fluid bolus. The portal veins are patent. The
gallbladder is unremarkable. There is no intra- or extra-hepatic biliary
ductal dilatation. The pancreas, spleen, bilateral adrenal glands and
bilateral kidneys are normal in appearance. There is no intraperitoneal free
air or free fluid. The stomach is markedly distended with ingested material,
but the duodenum, and intra-abdominal loops of large and small bowel are
normal in course and caliber, with no evidence of wall thickening or
obstruction. There is no retroperitoneal or mesenteric lymphadenopathy. No
retroperitoneal hematoma or fluid collection is identified. The aorta and its
main branch vessels are well opacified, with a normal-caliber aorta
throughout, and a widely patent celiac axis, superior mesenteric and inferior
mesenteric artery.
CT PELVIS WITH IV CONTRAST: The rectum and sigmoid colon are normal in
appearance. The bladder and terminal ureters are unremarkable. There is no
pelvic free fluid. No pelvic sidewall or inguinal lymphadenopathy is noted.
OSSEOUS STRUCTURES: No fractures are identified. No lytic or blastic lesion
suspicious for malignancy is present.
IMPRESSION:
1. No acute solid organ, vascular, or hollow viscous injury in the chest,
abdomen or pelvis.
2. Mild periportal edema, presumably due to IV fluid resuscitation.
The above findings were communicated to Dr. ___ by Dr. ___ in
person at 3:55 a.m., immediately after discovery.
|
19881755-RR-10
| 19,881,755 | 26,848,473 |
RR
| 10 |
2155-09-19 07:42:00
|
2155-09-19 11:25:00
|
EXAMINATION: MR HEAD W AND W/O CONTRAST T___ MR HEAD
INDICATION: ___ year old man with history of epilepsy, schizophrenia, ETOH use
disorder (sober ___ years per collateral), depression (multiple suicide
attempts), chronic hyponatremia (baseline Na 128-129), hypothyroidism, HTN,
HLD, now with seizures, L focal slowing on EEG// eval for seizure focus.
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. Coronal oblique
T2 weighted 3D images were additionally acquired.
COMPARISON: None.
FINDINGS:
Study is moderately degraded by motion. Within these confines:
Multiple supratentorial nonenhancing T2 and FLAIR white matter lesions with no
definite associated restricted diffusion or increase susceptibility are noted.
There is no evidence of hemorrhage, edema, masses, mass effect, midline shift
or infarction. The ventricles and sulci are preserved in caliber and
configuration.
Within limits of study, there is no definite evidence of mass, or mass effect
in the medial temporal lobes including the region of the hippocampal heads.
There is no definite abnormal enhancement after contrast administration.
There is extensive mucosal thickening/submucosal edema and fluid opacifying
the left maxillary sinus, involving the left more than right ethmoid air
cells, with more mild sphenoid sinus mucosal thickening. The frontal sinus is
clear. There is mild right maxillary sinus mucosal thickening. Major
intracranial vascular flow voids are grossly preserved. Major dural venous
sinuses are grossly patent.
IMPRESSION:
1. Study is moderately degraded by motion.
2. No acute intracranial abnormality.
3. Nonenhancing supratentorial white matter lesions as described.
Differential considerations include sequela of prior trauma or infection,
history of migraine headaches, inflammatory or demyelinating process, and
microangiopathic changes.
4. Within limits of study, no definite evidence of enhancing intracranial
mass.
5. Extensive paranasal sinus disease, as described.
NOTIFICATION: The impression and recommendation above was entered by Dr.
___ on ___ at 11:57 into the Department of Radiology critical
communications system for direct communication to the referring provider.
|
19881755-RR-4
| 19,881,755 | 26,848,473 |
RR
| 4 |
2155-09-14 01:44:00
|
2155-09-14 02:08:00
|
INDICATION: History: ___ with intubation*** WARNING *** Multiple patients
with same last name!// ETT placement
TECHNIQUE: Portable frontal chest radiograph.
COMPARISON: None
FINDINGS:
The lung volumes are low. The cardiomediastinal silhouette is prominent,
likely secondary to low lung volume and portable nature of image acquisition.
There is no focal consolidation. There is no large pleural effusion.
The endotracheal tube tip terminates at mid trachea. The enteric tube tip
courses into the left upper quadrant, presumably within the stomach.
IMPRESSION:
1. Low lung volumes.
2. Endotracheal tube terminates at mid trachea.
|
19881755-RR-6
| 19,881,755 | 26,848,473 |
RR
| 6 |
2155-09-14 14:13:00
|
2155-09-14 16:25:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with ___ from group home w/ hx of schizophrenia,
epilepsy found unresponsive at group home with eye fluttering. not taken AED's
for the past ___ days. GTC's at OSH.// assess for ETT placement
IMPRESSION:
In comparison with the study of earlier in this date, the tip of the
endotracheal tube measures approximately 4.5 cm above the carina.
Cardiomediastinal silhouette is unchanged. Mild elevation of pulmonary venous
pressure.
|
19881755-RR-7
| 19,881,755 | 26,848,473 |
RR
| 7 |
2155-09-14 19:22:00
|
2155-09-14 21:23:00
|
EXAMINATION: Chest radiograph, portable AP upright.
INDICATION: History of schizophrenia and epilepsy, recently found
unresponsive.
COMPARISON: Earlier on the same day. An endotracheal tube terminates 3 cm
above the carina. An orogastric tube courses across the whole esophagus and
into the stomach, although its distal course is not imaged, lying below the
inferior margin of the film. Cardiac, mediastinal and hilar contours appear
stable. Lung volumes are low. Streaky opacities at each lung base are most
suggestive of minor atelectasis. Mild vascular congestion seems to have
decreased somewhat.
FINDINGS:
Orogastric tube passing into the stomach, its distal course not imaged.
Endotracheal tube in position. Mild decrease in vascular congestion.
|
19881755-RR-8
| 19,881,755 | 26,848,473 |
RR
| 8 |
2155-09-15 16:24:00
|
2155-09-15 17:19:00
|
INDICATION: ___ year old man with new line// new right PICC 53 cm ___
___ Contact name: ___: ___
TECHNIQUE: Chest AP
COMPARISON: ___
IMPRESSION:
Support lines and tubes are in acceptable position. There is a small left
pleural effusion. Right-sided PICC line projects to the cavoatrial junction.
No pneumothorax is seen. The mediastinal silhouette is stable
|
19881755-RR-9
| 19,881,755 | 26,848,473 |
RR
| 9 |
2155-09-17 03:33:00
|
2155-09-17 09:33:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with ___ from group home w/ hx of schizophrenia,
epilepsy found unresponsive at group home with eye fluttering. not taken AED's
for the past ___ days. GTC's at OSH.// assess for pna assess for pna
IMPRESSION:
No prior chest radiographs available.
Cardiac silhouette is mildly enlarged but this may be a augmented by
mediastinal fat deposition. Pulmonary vasculature is only mildly engorged,
exaggerated by low lung volumes. No pulmonary edema, pneumonia, or
pneumothorax. Pleural effusions small on the left if any.
Right PIC line can be traced as far as the low SVC. Tip is indistinct.
|
19882137-RR-10
| 19,882,137 | 21,995,360 |
RR
| 10 |
2162-06-23 20:30:00
|
2162-06-23 22:56:00
|
EXAMINATION: Lumbar spine radiograph, single lateral intraoperative view.
INDICATION: Posterior L2 through L4 laminectomies.
COMPARISON: Preoperative MR from ___.
FINDINGS:
Single lateral intraoperative view depicts surgical instruments projecting
posterior to the L2 and L3 lumbar vertebral bodies vertebral bodies are
preserved in height. There is no spondylolisthesis
IMPRESSION:
Surgical elements posterior to the upper lumbar spine.
|
19882171-RR-70
| 19,882,171 | 27,855,058 |
RR
| 70 |
2156-12-05 09:09:00
|
2156-12-05 09:53:00
|
HISTORY: ___ female status post fall.
TECHNIQUE: Multi detector CT images were obtained through the brain without
the administration of intravenous contrast. Coronal, sagittal, and
thin-section bone algorithm images were acquired. DLP 1,002 mGy-cm.
COMPARISON: Nonenhanced head CT dated ___.
FINDINGS:
There is no acute hemorrhage, mass effect, or edema. No acute territorial
infarction is identified. The ventricles and sulci are slightly prominent but
age appropriate and reflect age related involutional changes. Scattered
periventricular white matter hypodensities are likely sequelae of chronic
small vessel ischemic disease, present on prior examinations and unchanged.
The basal cisterns are patent. Gray-white matter junction is preserved.
No fracture is identified. Visualized portions of the paranasal sinuses
demonstrate near complete opacification of the right frontal and right
maxillary sinuses with associated bony changes suggestive of a chronic
inflammatory process. There is mild mucosal thickening within the left
paranasal sinus. The remainder of the sinuses, mastoid air cells, and middle
ear cavities are clear. Bilateral carotid siphon caclifications are noted.
IMPRESSION:
1. No acute intracranial abnormality.
2. Periventricular white matter changes compatible with sequela of chronic
small vessel disease present on prior examinations and stable.
|
19882171-RR-71
| 19,882,171 | 27,855,058 |
RR
| 71 |
2156-12-05 09:10:00
|
2156-12-05 09:58:00
|
HISTORY: ___ year old female status post fall.
TECHNIQUE: Multi detector CT images were obtained from the skullbase through
the ___ thoracic level. Re-formatted images in sagittal and coronal axes were
obtained.
COMPARISON: CT-spine ___.
FINDINGS: Multi-level multifactorial degenerative changes are noted with
anterior osteophytes at multiple levels most prominently at the C5-C6 level.
There is mild indentation of the thecal sac at the C5-C6 level secondary to
disc bulge. No acute fracture is identified. There is no abnormal cerveical
alignment. There is no prevertebral soft tissue swelling. Vascular
calcifications are identified within the vertebral arteries bilaterally. The
thyroid gland appears enlarged with calcifications, stable since examination
dated ___.
IMPRESSION:
1. Multi-level degenerative changes with mild disc disease, most prominently
at the C5-C6 level. No evidence of cervical malalignment or fracture.
2. Enlarged thyroid gland with calcifications, present on prior examination
dated ___ and stable. Clinical correlation is recommended and a non
urgent ultrasound can be performed as needed.
|
19882171-RR-72
| 19,882,171 | 27,855,058 |
RR
| 72 |
2156-12-05 09:56:00
|
2156-12-05 12:36:00
|
HISTORY: ___ female status post fall.
COMPARISON: Chest radiograph dated ___.
FINDINGS: AP supine radiograph of the chest demonstrate low lung volumes with
prominent interstitial markings compatible with pulmonary mild pulmonary
edema. The heart appears enlarged overall unchanged in size when compared to
examination dated ___. The hilar and mediastinal silhouettes are
stable in appearance. Patient is status post median sternotomy and aortic
valve repair. The lungs are without a focal opacity. There is no left-sided
pleural effusion. A possible small right-sided pleural effusion as evidenced
by obscuration of the right hemidiaphragm. There is a fracture through the
lateral aspect of the ___ right rib. No pneumothorax is identified.
IMPRESSION:
1. Cardiomegaly, stable in appearance since prior examination dated ___.
2. Mild interstitial pulmonary edema.
2. Right 8th rib fracture with small left sided pleural effusion. No
pneumothorax.
|
19882171-RR-73
| 19,882,171 | 27,855,058 |
RR
| 73 |
2156-12-05 09:55:00
|
2156-12-05 11:35:00
|
HISTORY: ___ female status post fall.
COMPARISON: None available.
FINDINGS: Three views of the left wrist were obtained. Significant
degenerative changes are identified at the ___ CMC joint. No fracture is
identified. There is no dislocation seen. The carpals appear in normal
alignment. The distal radioulnar joint appears unremarkable. Vascular
calcifications are identified. There are no radiopaque foreign bodies. There
is significant soft tissue swelling about the distal wrist along the dorsal
and medial aspect.
IMPRESSION: No fracture or dislocation identified. Significant degenerative
changes about the ___ CMC joint. Soft tissue swelling about the distal wrist
along the dorsal and medial aspect.
|
19882171-RR-75
| 19,882,171 | 27,855,058 |
RR
| 75 |
2156-12-05 09:56:00
|
2156-12-05 12:21:00
|
HISTORY: ___ female with hip pain.
COMPARISON: CT torso dated ___.
FINDINGS: One AP view of the pelvis as well as two additional views of the
right and left femur demonstrates no acute fracture or dislocation. Moderate
degenerative changes are identified within bilateral hip joints with
osteophytosis and subchondral sclerosis. Joint space, however, appears
relatively preserved. Extensive vascular calcifications are identified within
the arteries of the proximal thigh. Significant degenerative changes within
the lower lumbar spine are noted. There is a nonobstructive bowel gas
pattern. Surgical clips project over the left hemipelvis.
IMPRESSION:
1. Significant degenerative changes within the lower lumbar spine, similar in
appearance when compared to prior examination dated ___.
2. Moderate degenerative changes about bilateral hip joints.
3. No acute fracture or dislocation.
|
19882347-RR-18
| 19,882,347 | 26,838,579 |
RR
| 18 |
2170-07-16 03:57:00
|
2170-07-16 07:00:00
|
INDICATION: IBS and cramping abdominal pain, vomiting, no flatus. Evaluate
for SBO.
COMPARISON: None available.
TECHNIQUE: MDCT images were obtained through the abdomen and pelvis with IV
and oral contrast. Coronal and sagittal reformations were performed.
Total DLP is 344 mGy-cm. CTDIvol is 18 mGy.
FINDINGS: There is bibasilar atelectasis. The visualized heart and
pericardium are unremarkable.
The liver enhances homogeneously and there are no focal hepatic lesions.
Gallbladder is normal. The pancreas is normal. The spleen is normal. The
adrenal glands are normal. There is a 1.9 cm cyst in the right kidney. There
is a 1.8 cm cyst in the left kidney. Other subcentimeter hypodensities in the
kidneys are too small to characterize. The stomach is distended. There is a
small bowel obstruction with dilated small bowel up to a 3 cm, fecalization of
the small bowel with a transition point in the mid lower abdomen (602B, 44).
There is ascites in the right upper quadrant, which is nonspecific but can be
seen in ischemia. There is no hyperenhancing or unenhancing bowel walls or
bowel wall thickening. No evidence of pneumatosis. No portal venous gas is
seen. Of note the third portion of the duodenum does not cross the midline
and this can be seen in congenital malrotation. There is a small amount of
ascites also seen in the left paracolic gutter. The colon is unremarkable and
decompressed. There is no retroperitoneal or mesenteric lymphadenopathy. No
free air.
PELVIS: The rectum is normal. The uterus is not well seen. The bladder is
normal. There is no pelvic or inguinal lymphadenopathy. No inguinal hernias
are identified.
The aorta is normal in caliber.
BONES: There are no suspicious bony abnormalities.
IMPRESSION:
1. Findings consistent with high grade small bowel obstruction with the
transition point in the mid lower anterior abdomen. There is small amount of
ascites in the right upper quadrant and left paracolic gutter, which is
nonspecific but can be seen in ischemia. No definite sign of ischemia.
2. Renal cysts.
|
19882347-RR-19
| 19,882,347 | 26,838,579 |
RR
| 19 |
2170-07-18 08:30:00
|
2170-07-18 10:29:00
|
HISTORY: ___ female with small bowel obstruction, worsening abdominal
pain, for pre-operative evaluation.
COMPARISON: None.
FINDINGS:
Portable semi-upright radiograph of the chest demonstrates tiny bibasilar
pleural effusions with adjacent atelectasis, right greater than left.
Cardiomediastinal and hilar contours are unremarkable. There is no
pneumothorax or consolidation. Nasogastric tube courses into the stomach and
out of the field of view.
IMPRESSION: Tiny bibasilar pleural effusions with adjacent atelectasis, right
greater than left.
|
19882852-RR-15
| 19,882,852 | 26,983,593 |
RR
| 15 |
2184-07-24 06:28:00
|
2184-07-24 07:04:00
|
EXAMINATION: Left tibia, fibula and ankle radiographs.
INDICATION: ___ with pain and swelling. Evaluate for fracture.
TECHNIQUE: Multiple views of the tibia, fibula and ankle of the left.
COMPARISON: Radiographs from ___.
FINDINGS:
There is comminuted fracture of the distal tibial diaphysis, with slight
lateral angulation of the distal fracture fragment, unchanged. There is
medial and slightly superior displacement of the medial butterfly fracture
fragment. There is a comminuted fracture of the distal fibula with slight
lateral angulation of the distal fibular head at the level of the syndesmosis,
unchanged from prior exam. However, the distal tibiofibular articulation
appears to be intact. There is no evidence of intra-articular extension of
the fracture. The ankle mortise is grossly preserved. No osteochondral
lesion is seen in the tibial plafond. Subcutaneous swelling is seen over the
medial and lateral malleoli.
Cortical irregularity of the distal metaphysis of the femur is likely related
to prior trauma. No significant knee joint effusion is seen. Mild
degenerative changes are seen.
IMPRESSION:
Comminuted fracture of the distal tibia and fibula, grossly unchanged from
prior exam.
|
19882852-RR-16
| 19,882,852 | 26,983,593 |
RR
| 16 |
2184-07-25 08:02:00
|
2184-07-25 11:50:00
|
EXAMINATION: TIB/FIB (AP AND LAT) LEFT
INDICATION: LEFT TIB FX.ORIF
IMPRESSION:
Fluoroscopic images show placement of an intramedullary rod about a fracture
of the lower shaft of the tibia. Adjacent fibular fracture is seen. For
information can be gathered from the operative report.
|
19882955-RR-24
| 19,882,955 | 22,092,141 |
RR
| 24 |
2194-09-03 19:50:00
|
2194-09-03 20:32:00
|
INDICATION: ___ with AMS, tachycardia// AMS, r/o bleed or mass effect
TECHNIQUE: AP and lateral views the chest.
COMPARISON: None.
FINDINGS:
There is opacity at the right lung base, some of which appears linear
suggesting atelectasis. Elsewhere, lungs are clear. Cardiomediastinal
silhouette is within normal limits. No acute osseous abnormalities.
IMPRESSION:
Right basilar consolidation, in part due to atelectasis though infection would
be possible in the proper clinical setting.
|
19882955-RR-25
| 19,882,955 | 22,092,141 |
RR
| 25 |
2194-09-03 20:01:00
|
2194-09-03 20:37:00
|
EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ with history of alcohol use presenting for evaluation of
confusion and possible visual hallucinations.
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: 803 mGy-cm
COMPARISON: None.
FINDINGS:
The study is mildly degraded by motion.
There is no evidence of acute major vascular territorial
infarction,hemorrhage,edema, or mass. The ventricles and sulci are normal in
size and configuration.
There is no evidence of fracture. The visualized portion of the paranasal
sinuses, mastoid air cells, and middle ear cavities are clear. The visualized
portion of the orbits are unremarkable.
IMPRESSION:
No acute intracranial process identified, within the confines of this mildly
motion limited study.
|
19882955-RR-27
| 19,882,955 | 22,092,141 |
RR
| 27 |
2194-09-05 03:43:00
|
2194-09-05 09:40:00
|
INDICATION: ___ year old woman with delirium tremens// ? pneumonia
COMPARISON: Radiographs from ___
IMPRESSION:
Heart size is prominent. There is a persistent opacity at the right base
which may represent atelectasis or developing infiltrate. There are no
pneumothoraces.
|
19882955-RR-28
| 19,882,955 | 22,092,141 |
RR
| 28 |
2194-09-06 08:05:00
|
2194-09-06 11:58:00
|
EXAMINATION: VASCULAR/EXTREMITY ULTRASOUND
INDICATION: ___ year old woman with bilateral leg swelling in the ICU.
portable study// assess for DVT in both legs
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.
|
19882955-RR-29
| 19,882,955 | 22,092,141 |
RR
| 29 |
2194-09-06 14:43:00
|
2194-09-06 15:19:00
|
EXAMINATION: ANKLE (AP, MORTISE AND LAT) LEFT
INDICATION: Left ankle swelling. Evaluate for fracture or injury
TECHNIQUE: Left ankle, four views.
COMPARISON: Left foot radiograph ___.
FINDINGS:
There is soft tissue swelling overlying the medial malleolus. No fracture or
dislocations are seen. There is a tiny posterior calcaneal enthesophyte.
There is a possible small os trigonum. There are no significant degenerative
changes. The mortise is congruent. The tibial talar joint space is preserved
and no talar dome osteochondral lesion is identified. No suspicious lytic or
sclerotic lesion is identified. No soft tissue calcification or radiopaque
foreign body is identified.
IMPRESSION:
Soft tissue swelling overlying the medial malleolus without underlying
fracture or dislocation.
|
19882955-RR-30
| 19,882,955 | 22,092,141 |
RR
| 30 |
2194-09-07 04:38:00
|
2194-09-07 11:36:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with alchohol withdrawal, new fevers and body
aches// interval changes interval changes
IMPRESSION:
Heart size and mediastinum are enlarged but similar to ___. Right
basal atelectasis has progressed. There is mild vascular congestion but no
overt pulmonary edema. There is no pneumothorax.
|
19882955-RR-31
| 19,882,955 | 22,092,141 |
RR
| 31 |
2194-09-10 13:33:00
|
2194-09-10 16:21:00
|
EXAMINATION: MR ___ SPINE W/O CONTRAST ___ MR SPINE
INDICATION: ___ year old woman with ___ weakness, h/o L sciatica// focal
neurologic weakness of left leg, R hip flexor focal neurologic weakness
of left leg, R hip flexor
TECHNIQUE: Sagittal imaging was performed with T2, T1, and STIR technique.
Exam was not completed due to patient discomfort.
COMPARISON: None.
FINDINGS:
T1 images are significantly motion degraded. The exam was not completed due
to patient discomfort and no axial images were obtained.
Alignment appears normal. There is significant ___ type 2 endplate changes
of the superior endplate of T12, with prominent Schmorl's node.. Vertebral
body and intervertebral disc heights and signals are otherwise within normal
limits.
There is mild congenital narrowing of the lumbar spinal canal. There is no
evidence of disc protrusions. Multilevel facet degenerative changes.
Diffuse disc bulge contributes to mild central canal narrowing at T11-T12.
There is mild-to-moderate bilateral T10-T11, T11-T12 foraminal narrowing.
Mild bilateral L4-5, L5-S1 foraminal narrowing.
Spinal cord appears normal in configuration, caliber, and signal intensity.
There is left greater than right fluid signal within facet joints of L4-L5
and of the posterior elements more so on the right, may be reactive, consider
inflammatory or infectious process, including septic arthritis.
symmetric edema of the paraspinal muscles from the L2-L5 levels and
prevertebral edema extending from the L4 to S2 which may be reactive or
inflammatory. No definite evidence of fluid collection.. There is no
evidence of discitis or osteomyelitis. There is no evidence of epidural
collection.
IMPRESSION:
1. Motion limited, incomplete exam secondary to patient discomfort.
2. Edema within bilateral L4-5 facet joints, and posterior elements, more
prominent on the right. Differential considerations include reactive change,
inflammatory arthritis, septic arthritis.
3. Edema of the paravertebral muscles and prevertebral fluid in the lower
lumbar and sacral spine may be reactive or inflammatory.
4. No evidence of discitis, osteomyelitis, epidural collection, or fracture.
5. Mild congenital spinal canal narrowing, and degenerative changes, as above.
|
19882955-RR-32
| 19,882,955 | 22,092,141 |
RR
| 32 |
2194-09-12 13:33:00
|
2194-09-12 14:16:00
|
EXAMINATION: FOOT AP,LAT AND OBL LEFT
INDICATION: ___ year old woman with ETOH use disorder, CKD III with forefoot
tenderness causing difficulty with walking.// Is there fracture vs
arthropathy/gout at forefoot?
|
19882958-RR-10
| 19,882,958 | 29,628,147 |
RR
| 10 |
2182-08-29 18:49:00
|
2182-08-29 19:20:00
|
INDICATION: History: ___ with right CVL placed// evaluate for line placement
TECHNIQUE: AP portable chest radiograph
COMPARISON: None available
FINDINGS:
The tip of a right internal jugular central venous catheter projects over the
lower SVC.
There is no focal consolidation, pleural effusion or pneumothorax identified.
The size of the cardiomediastinal silhouette is within normal limits. Left
posterior seventh rib fracture is likely subacute to chronic.
IMPRESSION:
The tip of a right internal jugular central venous catheter projects over the
low SVC. No pneumothorax.
|
19883311-RR-103
| 19,883,311 | 27,934,870 |
RR
| 103 |
2146-01-23 15:17:00
|
2146-01-23 15:39:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old woman with dyspnea cough // dyspnea
TECHNIQUE: Chest PA and lateral
COMPARISON: CT chest ___.
FINDINGS:
New airspace opacification in the left upper lobe is most consistent with
pneumonia. Previously seen airspace opacity projecting over the right midlung
region has resolved in comparison to the CT chest dated ___.
Nodular opacity in the AP window may reflect a lymph node. No large pleural
effusion, pneumothorax or pulmonary edema. Cardiomediastinal silhouette is
unremarkable. Patient is status post median sternotomy. No acute osseous
abnormality appreciated.
IMPRESSION:
Left upper lobe pneumonia.
RECOMMENDATION(S): Post treatment radiograph is recommended in ___ weeks to
document resolution.
|
19883311-RR-105
| 19,883,311 | 27,934,870 |
RR
| 105 |
2146-01-25 22:51:00
|
2146-01-25 23:42:00
|
EXAMINATION: CT ABD AND PELVIS W/O CONTRAST
INDICATION: ___ year old woman with history of CAD s/p CABG, dCHF, HTN, HLD,
IDDMII, asthma, here with pneumonia, with course complicated by uncontrolled
diabetes, now with new abdominal pain and elevated lactate // cause for new
abdominal pain with elevated lactate
TECHNIQUE: Multidetector CT images of the abdomen and pelvis were acquired
without intravenous contrast. Non-contrast scan has several limitations in
detecting vascular and parenchymal organ abnormalities, including tumor
detection.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 7.8 s, 50.9 cm; CTDIvol = 12.5 mGy (Body) DLP = 630.0
mGy-cm.
Total DLP (Body) = 630 mGy-cm.
COMPARISON: CT abdomen pelvis ___
FINDINGS:
LOWER CHEST: Visualized lung fields demonstrate linear bibasilar and left
rounded atelectasis. There is a trace left pleural effusion. There is no
evidence of pericardial effusion. Mediastinal clips are noted.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates diffuse hypoattenuation, consistent with
steatosis. 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 medial limb of the right adrenal gland appears thickened. There
is a 1.4 cm indeterminate left adrenal nodule, most likely representing an
adenoma.
URINARY: The kidneys are of normal and symmetric size. There is no suspicious
renal lesions within the limitations of an unenhanced scan. There is no
hydronephrosis. There is no nephrolithiasis. There is no perinephric
abnormality.
GASTROINTESTINAL: There is a small Bochdalek's hernia (3:18). There is a
small to moderate hiatal hernia; otherwise, the stomach is unremarkable.
Small bowel loops demonstrate normal caliber and wall thickness throughout.
There is mild diverticulosis; otherwise, the colon and rectum are within
normal limits.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: The uterus and bilateral adnexae are grossly within
normal limits. Air is noted within the vaginal canal.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is a hooked appearance to the celiac trunk, nonspecific.
There is no abdominal aortic aneurysm. No atherosclerotic disease is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
Partially visualized sternal wires appear intact.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. Diffuse hepatic hypoattenuation consistent with steatosis. Steatohepatitis
or more advanced forms of hepatic disease cannot be excluded.
2. Slightly hooked appearance of the celiac trunk is nonspecific in the
absence of intravenous contrast. Median arcuate ligament syndrome could be
considered in the appropriate clinical presentation.
3. Indeterminate 1.4 cm left adrenal nodule which probably represents an
adenoma. If there is no history of malignancy, this is probably benign.
Follow up dedicated adrenal CT or MR in 12 months could be considered. If
there is a history of malignancy, a dedicated adrenal CT is recommended.
Recommendations based on ___ ACR guidelines:
___
4. Small to moderate hiatal hernia. Small Bochdalek's hernia.
|
19883311-RR-106
| 19,883,311 | 23,262,610 |
RR
| 106 |
2146-02-17 01:11:00
|
2146-02-17 03:56:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: History: ___ with chest pain, recent pneumonia // Worsening
pneumonia, pneumothorax?
COMPARISON: Chest radiograph from ___.
FINDINGS:
PA and lateral views of the chest provided.
Redemonstrated is a left upper lobe airspace opacification demonstrating
decreased density and enlargement compared to prior. The right lung is clear.
There is no effusion, or pneumothorax. There are no signs of congestion or
edema. The cardiomediastinal silhouette is normal. No evidence of displaced
fracture. Sternotomy wires are intact.
IMPRESSION:
Worsening left upper lobe pneumonia.
|
19883387-RR-28
| 19,883,387 | 25,729,919 |
RR
| 28 |
2136-12-12 18:53:00
|
2136-12-12 19:44:00
|
INDICATION: ___ female with left calf erythema, swelling, and pain.
___.
LEFT LOWER EXTREMITY ULTRASOUND: There is normal compressibility, flow, and
augmentation in the bilateral common femoral and left greater saphenous,
superficial and deep femoral, and popliteal veins. Color flow is also noted
in the posterior tibial and peroneal veins.
Diffuse subcutaneous edema is present, most severe in the distal calf and
ankle, without drainable collection seen. Note is made of a 7-mm reactive
left inguinal lymph node with fatty hilum.
IMPRESSION: No evidence of left lower extremity DVT. Subcutaneous edema.
|
19883978-RR-16
| 19,883,978 | 23,565,279 |
RR
| 16 |
2141-06-05 06:49:00
|
2141-06-05 07:36:00
|
INDICATION: NO_PO contrast; History: ___ with abd tenderness, sudden onset,
no prior surgeriesNO_PO contrast// acute surgical 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) Stationary Acquisition 5.5 s, 0.5 cm; CTDIvol = 26.5 mGy (Body) DLP =
13.2 mGy-cm.
2) Spiral Acquisition 6.5 s, 51.1 cm; CTDIvol = 21.9 mGy (Body) DLP =
1,118.0 mGy-cm.
Total DLP (Body) = 1,131 mGy-cm.
COMPARISON: None.
FINDINGS:
LOWER CHEST: There is minimal bibasilar atelectases. There is no evidence of
pleural or pericardial effusion.
ABDOMEN:
HEPATOBILIARY: There are multiple subcentimeter nonenhancing hypodensities
throughout the right and left hepatic lobes which are too small to
characterize on CT but likely represent hepatic cysts/biliary hamartomas. No
suspicious focal liver lesions. The liver otherwise demonstrates homogenous
attenuation throughout. There is no evidence of intrahepatic or extrahepatic
biliary dilatation. The gallbladder is within normal limits.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
The few subcentimeter hypodensities within the bilateral kidneys are too small
to characterize but likely simple renal cysts. There is no evidence of
susoicious focal renal lesions or hydronephrosis. There is no perinephric
abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Within the mid abdomen are
dilated fluid-filled loops of small bowel (measuring 2.8 cm in maximum
diameter). At least 2 transition points are visualized. The transition point
within the mid anterior abdomen (2:41, 602:44,) is followed by decompressed
distal small bowel loops. A second transition point visualized within the
right lower quadrant (2: 57) is also noted. There is no evidence of a closed
loop obstruction. There is no evidence of wall ischemia or free air. The
large bowel loops and rectum are unremarkable. The appendix is normal.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is
trace free fluid in the pelvis.
REPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease
is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: An umbilical hernia containing fat is noted.
IMPRESSION:
1. Mechanical multifocal small-bowel obstruction without evidence of bowel
wall ischemia on this scan, no perforation or portal venous gas. If there is
a past history of abdominal surgeries, this may reflect obstruction secondary
to adhesions.
2. Normal appendix, scattered hepatic cysts/biliary hamartomas and a small fat
containing umbilical hernia noted.
NOTIFICATION: The findings were discussed with ___, M.D. by ___
___, M.D. on the telephone on ___ at 7:31 am, 1 minutes after
discovery of the findings.
|
19883978-RR-18
| 19,883,978 | 23,565,279 |
RR
| 18 |
2141-06-06 17:15:00
|
2141-06-06 17:42:00
|
INDICATION: ___ w/ no PSHx here w/ periumbilical pain, c/f early SBO on CT
A/P// KUB 8 hrs after gastrografin administration, per protocol. at 1700pm
TECHNIQUE: Supine abdominal radiograph was obtained.
COMPARISON: CT scan from earlier in the day
FINDINGS:
Re-demonstrated are dilated loops of small bowel measuring up to 4.5 cm,
increased since prior. A large amount of stool is still seen within the
ascending colon. The enteric contrast material is still predominantly located
within the stomach.
Supine assessment limits detection for free air; there is no gross
pneumoperitoneum.
Osseous structures are unremarkable.
There are no unexplained soft tissue calcifications or radiopaque foreign
bodies.
IMPRESSION:
Small-bowel obstruction, with increased distension of the small bowel loops
measuring up to 4.5 cm in the left abdomen. The oral contrast material is
still within the stomach.
|
19883978-RR-19
| 19,883,978 | 23,565,279 |
RR
| 19 |
2141-06-07 05:04:00
|
2141-06-07 17:35:00
|
INDICATION: ___ w/ no PSHx here w/ periumbilical pain, c/f early SBO on CT
A/P// Gastrograffin protocol
TECHNIQUE: Supine and upright abdominal radiographs were obtained.
COMPARISON: Prior abdominal radiographs ___.
FINDINGS:
Multiple dilated loops of small bowel are again demonstrated with air-fluid
levels. Air is seen within the colon. Previously administered Gastrografin
is within the stomach, duodenum and probably the jejunum. Contrast overlying
the left flank is uncertain in location. No definite extension of contrast to
the colon.
There is a relative paucity of contrast overall compared to prior, the
differential includes passage of the contrast or aspiration of contrast
through the enteric tube. There is a moderate stool burden within the
ascending colon.
There is no free intraperitoneal air.
Osseous structures are unremarkable.
Enteric tube terminates appropriately within the body of the stomach.
IMPRESSION:
Administered Gastrografin seen likely reaching jejunum, with persistent
dilated loops of small which is concerning for a partial small bowel
obstruction.
|
19883978-RR-20
| 19,883,978 | 23,565,279 |
RR
| 20 |
2141-06-07 18:02:00
|
2141-06-07 19:44:00
|
INDICATION: ___ year old man with small bowel obstruction symptoms now s/p NG
tube placement and oral contrast administration.// KUB. Progression of oral
contrast. compare to prior study. Please obtain ___ at 1800.
TECHNIQUE: Supine and upright abdominal radiographs were obtained.
COMPARISON: ___
FINDINGS:
The tip of the feeding tube projects over the stomach. A small amount of
enteric material projects over the stomach as well as over a mid abdominal
small bowel loop. Small bowel loops measure up to 5.4 cm, not significantly
changed since prior. Stool and gas is seen within the colon and rectum.
Several differential air-fluid levels are noted.
There is no free intraperitoneal air.
Osseous structures are unremarkable.
There are no unexplained soft tissue calcifications or radiopaque foreign
bodies.
IMPRESSION:
Unchanged dilated small bowel loops with air-fluid levels again suggestive of
a partial obstruction. Contrast material has advanced and reaches mid jejunal
loops.
|
19883978-RR-21
| 19,883,978 | 23,565,279 |
RR
| 21 |
2141-06-13 14:52:00
|
2141-06-13 16:37:00
|
INDICATION: ___ year old man POD5 ex lap and lysis of adhesive band now w/
distention, pain// eval for ileus
TECHNIQUE: Portable supine abdominal radiograph was obtained.
COMPARISON: Prior abdominal radiograph ___.
FINDINGS:
Multiple dilated loops of small bowel measure up to 3.4 cm, mildly improved
from prior.
Supine assessment limits detection for free air; there is no gross
pneumoperitoneum.
Osseous structures are unremarkable.
There are no unexplained soft tissue calcifications or radiopaque foreign
bodies.
IMPRESSION:
Mild improvement in multiple dilated small-bowel loops which likely represents
ileus.
|
19883978-RR-22
| 19,883,978 | 23,565,279 |
RR
| 22 |
2141-06-15 21:22:00
|
2141-06-15 22:08:00
|
INDICATION: ___ year old man with sbo s/p ex lap and lysis of adhesive band//
emesis after clears; KUB to assess
TECHNIQUE: Supine portable abdominal x-ray
COMPARISON: Abdominal x-ray ___
FINDINGS:
There are multiple mildly dilated loops of small bowel, similar to previous.
Air seen within the rectum.
Please note the free air cannot be excluded on a supine radiograph.
Osseous structures are unremarkable.
There are no unexplained soft tissue calcifications or radiopaque foreign
bodies.
IMPRESSION:
Multiple dilated loops of small bowel, similar to previous.
|
19883978-RR-23
| 19,883,978 | 23,565,279 |
RR
| 23 |
2141-06-16 16:17:00
|
2141-06-16 17:00:00
|
EXAMINATION: CT abdomen pelvis with contrast.
INDICATION: ___ y/o M POD8 ex-lap LOA with ongoing ileus, N/V, and WBC bump to
13.7 this am// eval for obstruction, leak, abscess
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) Spiral Acquisition 4.4 s, 57.7 cm; CTDIvol = 17.3 mGy (Body) DLP = 999.6
mGy-cm.
2) Stationary Acquisition 0.6 s, 0.5 cm; CTDIvol = 3.4 mGy (Body) DLP = 1.7
mGy-cm.
3) Stationary Acquisition 9.6 s, 0.5 cm; CTDIvol = 53.7 mGy (Body) DLP =
26.8 mGy-cm.
Total DLP (Body) = 1,028 mGy-cm.
COMPARISON: Prior CT abdomen and pelvis ___
FINDINGS:
LOWER CHEST: There are new small pleural effusions, the right larger than the
left, and overlying atelectatic collapse.
ABDOMEN:
HEPATOBILIARY: There is new trace perihepatic fluid, likely postoperative in
nature. d The liver demonstrates homogenous attenuation throughout. Multiple
subcentimeter hypodensities within both hepatic lobes are again demonstrated,
and appear unchanged from ___. There is no evidence of focal
lesions. The common bile duct is more prominent than on prior, measuring up
to 7 mm (601:28). The gallbladder is within normal limits.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: There is new trace perisplenic fluid, likely postoperative in nature.
The spleen shows normal size and attenuation throughout, without evidence of
focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
Subcentimeter hypodensities within the cortex of the left kidney are too small
to characterize but likely represent simple renal cysts and are unchanged from
prior. There is no evidence of focal renal lesions or hydronephrosis. There
is no perinephric abnormality.
GASTROINTESTINAL: An enteric tube terminates within the body of the stomach.
There is diffuse small bowel dilatation up to 4.6 cm with multiple air-fluid
levels. Fluid is seen within the colon. No intra-abdominal abscess or
phlegmonous changes are noted.
PELVIS: The urinary bladder and distal ureters are unremarkable. Free fluid
in the pelvis may be postoperative in nature.
REPRODUCTIVE ORGANS: The prostate and seminal vesicles are unremarkable.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease
is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: Increased general anasarca is noted of the subcutaneous tissues.
A midline laparotomy wound demonstrates soft tissue swelling without definite
fluid collection.
IMPRESSION:
1. Mild diffuse dilatation of small bowel with few air-fluid levels with air
and fluid within the colon likely representing a mild postoperative ileus. No
frank areas of transition to suggest a recurrence small-bowel obstruction. No
evidence for intra-abdominal phlegmonous collection or abscess.
2. New small bilateral pleural effusions with overlying atelectatic collapse.
3. Small volume free pelvic fluid is likely postoperative.
|
19883978-RR-24
| 19,883,978 | 23,565,279 |
RR
| 24 |
2141-06-18 22:27:00
|
2141-06-19 14:15:00
|
INDICATION: ___ w/ no PSHx p/w SBO now s/p ex lap and lysis of adhesive
band.// KUB 8 hours after gastrografin administration @ 2200. please check
whith nurse for accurate timing
TECHNIQUE: AP standing and supine views of the abdomen and pelvis
COMPARISON: CT dated ___
FINDINGS:
An enteric catheter is placed with the tip in the left upper quadrant, likely
within the stomach.
There is no definite evidence of free air in the abdomen.
There are multiple mildly dilated loops of small bowel throughout the abdomen
and pelvis demonstrating few air-fluid levels. Areas of apparent bowel wall
thickening is noted in the right mid abdomen which may be due to juxtaposition
of adjacent loops of small bowel. There is no evidence of pneumatosis. Large
bowel contains gas and is not significantly distended. Oral contrast is noted
in the rectum.
IMPRESSION:
Normal passage of oral contrast into the rectum. Dilated loops of small bowel
as described may be secondary to postoperative ileus or partial obstruction.
|
19884061-RR-17
| 19,884,061 | 22,201,399 |
RR
| 17 |
2147-05-06 22:30:00
|
2147-05-06 22:51:00
|
EXAMINATION: CT CHEST W/CONTRAST
INDICATION: ___ year old man with metastatic prostate cancer.// Evaluate lung
nodules.
TECHNIQUE: Multi detector helical scanning of the chest was coordinated with
intravenous infusion of nonionic iodinated contrast agent and reconstructed as
5 and 1.25 mm thick axial, 2.5 mm thick coronal and parasagittal, and 8 mm MIP
axial images. All images were reviewed.
DOSE: Acquisition sequence:
1) Spiral Acquisition 9.7 s, 37.4 cm; CTDIvol = 7.5 mGy (Body) DLP = 275.2
mGy-cm.
Total DLP (Body) = 289 mGy-cm.
COMPARISON: There are no prior chest CT scans for comparison.
FINDINGS:
Small right axillary lymph nodes are numerous, but no lymph nodes in the
supraclavicular or axillary stations are pathologically enlarged and there is
no soft tissue abnormality in the chest wall suspicious for malignancy. This
study is not there are no thyroid lesions warranting further imaging
evaluation. Atherosclerotic calcification is not apparent head neck vessels
or coronary arteries. Aorta and pulmonary arteries and cardiac chambers are
normal size. Pericardium is physiologic.
There is no appreciable pleural effusion. Lower esophagus is appropriate for
subdiaphragmatic diagnosis, but shows no adrenal mass mild to moderate
distension of the esophagus at multiple levels suggests that the esophagus is
patulous and may have a motility disorder, but there is no appreciable
retention of food material.
Other than a solitary 11 mm left hilar lymph node, 5:152, mediastinal and
hilar lymph nodes are not enlarged.
Soft tissue pleural thickening of the right posterior costal pleural surface,
extending into the right major fissure, 5:112 is contiguous with one of many
blastic metastases, presumably local pleural tumor invasion. There is a
second probable pleural deposit long the right diaphragmatic pleural surface,
5:296, and other very small regions, along the right anterior and left lateral
costal pleural surfaces, 5:316.
There are no lung nodules or evidence of active infection. Small collection
of aspirated barium is present at the left lung base.
Despite extensive blastic metastases throughout the chest cage, there is no
pathologic or compression fracture.
IMPRESSION:
Multiple small pleural tumor deposits related to local invasion of extensive
blastic metastases throughout the chest cage. No appreciable pleural
effusion.
No lung lesions.
Solitary borderline enlarged left hilar lymph node, significance
indeterminate.
|
19884061-RR-18
| 19,884,061 | 22,201,399 |
RR
| 18 |
2147-05-06 21:28:00
|
2147-05-07 11:01:00
|
EXAMINATION: MR ___ AND W/O CONTRAST ___ MR SPINE
INDICATION: ___ man with history of metastatic prostate cancer.
Evaluate for progression of lumbar metastatic disease.
TECHNIQUE: Sagittal imaging was performed with T2, T1, and STIR technique,
followed by axial T2 imaging. This was followed by sagittal and axial T1
images obtained after the uneventful intravenous administration of 7 mL of
___ contrast agent.
COMPARISON: ___, outside hospital contrast lumbar spine MR.
___:
Study is moderately degraded by motion.
S shaped scoliosis of the thoracolumbar spine is again noted. Extensive,
prominently T1 and T2 hypointense bone marrow replacing sclerotic metastatic
lesions seen throughout all visualized osseous structures, appear grossly
unchanged compared to the outside hospital examination from ___.
Vertebral body heights are grossly preserved. There remains posterior extra
cortical soft tissue extension into the anterior epidural space at S1 and S2,
measuring up to 48 x 9 mm (02:11). The enhancing soft tissue extends into the
bilateral S1-S2 neural foramina, partially encasing the exiting bilateral S1
nerve roots. Additionally, enhancing epidural soft tissue displaces the
traversing bilateral S2 nerve roots, with possible compression, greater on the
right. Epidural soft tissue extension produces mild spinal canal narrowing at
these levels. There is also anterior presacral enhancing soft tissue
extension along the S1 and S2 vertebral bodies, measuring up to 46 x 6 mm
(09:11), also appearing unchanged. Grossly stable sacral probable Tarlov
cysts are again noted.
There is loss of T2 signal of the intervertebral discs, a manifestation of
degenerative disc disease.
The terminal spinal cord is preserved in signal and caliber. The conus
medullaris terminates at the T12-L1 level. There is no abnormal focus of
intrathecal enhancement.
At T12-L1, there is no significant spinal canal or neural foraminal narrowing.
At L1-L2, there is mild disc bulge without significant spinal canal or neural
foraminal narrowing.
At L2-L3, there is minimal disc bulge without significant spinal canal or
neural foraminal narrowing.
At L3-L4, there is minimal disc bulge without significant spinal canal or
neural foraminal narrowing.
At L4-L5, there is minimal disc bulge without significant spinal canal
narrowing. Facet and endplate osteophytes produce mild right neural foraminal
narrowing. The left neural foramen is patent.
At L5-S1, there is mild disc bulge without significant spinal canal narrowing.
Endplate osteophytes produce mild right neural foraminal narrowing. There is
a 10 mm mildly enhancing nodule within the left neural foramen, adjacent to
the nerve root, representing extra cortical soft tissue extension of tumor,
producing mild-to-moderate neural foraminal narrowing. This appears
contiguous with the anterior epidural involvement within the upper sacrum.
Additional sclerotic metastases are noted throughout the imaged iliac bones
and sacrum.
Degree of degenerative change appears similar to the ___
examination.
IMPRESSION:
1. Study is moderately degraded by motion.
2. Diffuse sclerotic osseous metastatic disease, all visualized osseous
structures, grossly unchanged since ___.
3. No evidence of pathologic fracture.
4. Unchanged anterior presacral and anterior epidural soft tissue extension of
enhancing tumor, grossly unchanged, with anterior epidural soft tissue
component mildly narrowing the spinal canal, encasing the bilateral exiting S1
nerve roots through the neural foramina with possible compression, also
displacing the traversing S2 nerve roots with possible compression, with
additional minimal extension into the left L5-S1 neural foramen.
5. Multilevel lumbar spondylosis, as described, grossly unchanged since ___. No definite moderate to severe spinal canal or neural foraminal
narrowing.
|
19884061-RR-80
| 19,884,061 | 25,671,112 |
RR
| 80 |
2148-12-07 15:20:00
|
2148-12-07 16:10:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with pleural effusion s/p B/L chest tube//
pleural effusion s/p chest tube pleural effusion s/p chest tube
IMPRESSION:
Heart size and mediastinum are stable. Right PICC line tip is at the level of
mid SVC. Multiple bone metastasis are re-demonstrated.
Left pigtail catheter and right pigtail catheter are in place. There is
substantial decrease in the right pleural effusion and left pleural effusion
as well. There is no pneumothorax
|
19884207-RR-27
| 19,884,207 | 25,299,236 |
RR
| 27 |
2125-02-20 13:09:00
|
2125-02-20 13:25:00
|
EXAMINATION:
Chest: Frontal and lateral views
INDICATION: History: ___ with sob, leg swelling// eval for infiltrate, fluid
overload
TECHNIQUE: Chest: Frontal and Lateral
COMPARISON: ___
FINDINGS:
Cardiac and mediastinal silhouettes are stable. There is slight blunting of
the costophrenic angles which could be due to trace pleural effusions. There
is mild pulmonary vascular congestion. No definite focal consolidation is
seen. There is no pneumothorax.
IMPRESSION:
Small bilateral pleural effusions and mild pulmonary vascular congestion.
|
19884707-RR-15
| 19,884,707 | 22,223,949 |
RR
| 15 |
2119-03-02 17:48:00
|
2119-03-02 18:08:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: History: ___ with fever// eval for pna
TECHNIQUE: Chest PA and lateral
COMPARISON: None.
FINDINGS:
Heart size is mildly enlarged. The mediastinal and hilar contours are normal.
The pulmonary vasculature is normal. Irregular focal opacity projecting over
the left first rib anteriorly may reflect overlapping shadows though
underlying nodular parenchymal opacity is not excluded. The lungs are
otherwise clear. No pleural effusion or pneumothorax is seen. There are no
acute osseous abnormalities.
IMPRESSION:
1. No radiographic evidence for pneumonia.
2. Irregular focal opacity projecting over the left first rib anteriorly could
reflect a confluence of shadows, though a nodular parenchymal opacity is not
excluded. Shallow oblique images are recommended to further determine if this
finding is artifactual.
|
19884707-RR-16
| 19,884,707 | 22,223,949 |
RR
| 16 |
2119-03-02 20:23:00
|
2119-03-02 22:02:00
|
EXAMINATION: CT abdomen and pelvis with intravenous contrast
INDICATION: ___ female with fever and elevated liver enzymes.
Evaluate for cholangitis or liver abscess.
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: Total DLP (Body) = 540 mGy-cm.
COMPARISON: None.
FINDINGS:
LOWER CHEST: Visualized lung fields are within normal limits. There is no
evidence of pleural or pericardial effusion.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There is no evidence of focal lesions. There is no evidence of intrahepatic
or extrahepatic biliary dilatation. The gallbladder is within normal limits.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
A 6 mm hypodensity in the lower pole of the right kidney (05:40) and 4 mm
hypodensity in the interpolar left kidney are too small to characterize.
There is no hydronephrosis or perinephric abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. The colon and
rectum are within normal limits. The appendix is normal.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: There is an involuting left corpus luteum cyst (5:62).
Right adnexa is unremarkable. The uterus is unremarkable.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease
is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. No acute abnormality in the abdomen or pelvis. Specifically, no hepatic
abscess or cholangitis. The gallbladder is unremarkable and there is no
evidence of biliary dilatation.
2. Normal appendix. No evidence of bowel obstruction.
|
19884707-RR-17
| 19,884,707 | 22,223,949 |
RR
| 17 |
2119-03-03 08:33:00
|
2119-03-03 13:32:00
|
EXAMINATION: CHEST (BOTH OBLIQUES ONLY)
INDICATION: ___ year old woman with fever and rash// Shallow oblique views to
assess whether a finding in the left upper lung field on 2v was artifiactual
or not. Shallow oblique views to assess whether a finding in the left
upper lung field on 2v was artifiactual or not.
IMPRESSION:
Compared to chest radiographs ___.
Oblique views show that the small region of sclerosis, proximal left first rib
should not be mistaken for a lung lesion.
Lungs clear. Heart size top-normal. No pleural abnormality or evidence of
central adenopathy.
|
19884729-RR-15
| 19,884,729 | 26,888,271 |
RR
| 15 |
2158-08-21 18:44:00
|
2158-08-21 21:24:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ with chest pain // eval for acute process
COMPARISON: ___
FINDINGS:
AP portable upright view of the chest. Overlying EKG leads are present. The
heart is markedly enlarged. Hila are congested and there is mild pulmonary
edema. No large effusions. No pneumothorax. No convincing evidence for
pneumonia. Bony structures are intact. Mediastinal contour is normal. No
free air is seen below the right hemidiaphragm.
IMPRESSION:
Cardiomegaly, congestion and mild edema.
|
19884788-RR-23
| 19,884,788 | 20,657,679 |
RR
| 23 |
2183-04-06 16:39:00
|
2183-04-06 17:58:00
|
CLINICAL INDICATION: thrown off house with known L2 burst fracture and head
strike. Evaluate for hemorrhage and fracture.
TECHNIQUE: Multidetector CT scan through the brain was performed without IV
contrast. Reformatted images were provided.
DLP: 891.93 mGy-cm. CTDI VOLUME: 50.93 mGy.
COMPARISON: None.
FINDINGS: There is no acute intracranial hemorrhage, edema, mass, mass effect
or acute large vascular territorial infarction. The ventricles and sulci are
normal in size and configuration. There is preservation of gray-white matter
differentiation. The basal cisterns are patent.
No acute fracture is identified. The paranasal sinuses and mastoid air cells
are clear.
IMPRESSION: No acute intracranial process.
|
19884788-RR-24
| 19,884,788 | 20,657,679 |
RR
| 24 |
2183-04-06 16:39:00
|
2183-04-06 18:09:00
|
CLINICAL INDICATION: Thrown off house with known L2 burst fracture and head
strike. Evaluate for hemorrhage and fracture.
TECHNIQUE: Multidetector CT scan through the cervical spine was performed
without intravenous contrast. Reformatted images were provided.
DLP: 926.98 mGy-cm. CTDI VOLUME: 29.53 mGy.
COMPARISON: None.
FINDINGS: There is no acute fracture. There are mild multilevel degenerative
changes including narrowing of the C6-C7 and C7-T1 intervertebral disc spaces.
There is minimal anterolisthesis of C4 over C5 of indeterminate age. There is
no prevertebral soft tissue swelling. Clips in the region of the thyroid
likely represent prior thyroid surgery. The lung apices are clear.
IMPRESSION: No acute fracture. Degenerative changes. Minimal
anterolisthesis of C4 over C5 of indeterminate age
|
19884788-RR-25
| 19,884,788 | 20,657,679 |
RR
| 25 |
2183-04-06 20:50:00
|
2183-04-06 21:22:00
|
HISTORY: L2 spine fracture, preop evaluation.
TECHNIQUE: AP supine portable view of the chest.
COMPARISON: None.
FINDINGS:
There is mild elevation of the right hemidiaphragm. No focal consolidation is
seen. No pleural effusion or definite pneumothorax. The cardiac and
mediastinal silhouettes are unremarkable.
IMPRESSION:
No acute cardiopulmonary process seen.
|
19884788-RR-26
| 19,884,788 | 20,657,679 |
RR
| 26 |
2183-04-07 02:39:00
|
2183-04-07 12:59:00
|
MR EXAMINATION OF LUMBAR ___ WITHOUT CONTRAST, ___
HISTORY: ___ female with L2 burst fracture; ? injury to the spinal
cord (sic) or posterior elements.
TECHNIQUE: Routine ___ non-enhanced MR examination, comprising sagittal
STIR FSE sequence.
FINDINGS: The study is compared with the "___" NECT, obtained roughly 15.5
hours earlier.
Corresponding to the findings on that study is the acute burst compression
fracture of L2 vertebra, which demonstrates extensive bone marrow edema
throughout its body. The involvement of the right pedicle, suggested on the
OSH MDCT, is difficult to assess on this examination, though the bone marrow
edema extends to its base. There is roughly 40% loss of height of this
vertebra, centrally, with no angular kyphosis or other alignment abnormality.
As on the CT, there is marked retropulsion of its dorsal cortex. The superior
retropulsed fragment is eccentric to the right, and measures up to 9.5 mm
(AP), and the more inferior retropulsed fragment is eccentric to the left and
measures 7 mm (AP). As on the CT, there is no definite significant associated
epidural hematoma. The retropulsed fragment results in significant stenosis
of the spinal canal, which measures up to only 8 mm in AP dimension; in
particular, both subarticular zones are narrowed, with mass effect upon both
traversing L3 nerve roots; however, there is also crowding of the remaining
cauda equina nerve roots with loss of the normal CSF-signal within the thecal
sac. Despite the retropulsion, there is no significant neural foraminal
stenosis or exiting L2 neural impingement.
No other acute compression or significant focal bone marrow edema is seen,
with only mild ___ 1 change involving the left lateral aspect of the L3
inferior and L4 superior endplates, associated degeneration of the intervening
disc. There is evidence of right hemilaminotomy. Perhaps related to this is
markedly asymmetric facet arthrosis at this level, with marked degenerative
hypertrophy of the left facet joiint and a prominent synovial effusion with
fluid-filled gap of 6.5 mm; no right facet effusion is seen.
There is degeneration of the L4-5 disc with moderate bulging and superimposed
left foraminal extrusion which, with facet arthrosis narrows this subarticular
zone and neural foramen, likely impinging upon the left traversing L5 and
exiting L4 nerve roots at these sites.
There is marked degeneration of the L5-S1 disc with ___ types 2 and 3 change
in adjacent vertebral endplates. There is mild posterior bulging, narrowing
the subarticular zones without definite traversing S1 neural impingement.
The distal spinal cord is normal in caliber and intrinsic signal intensity, as
is the conus medullaris, which is normal in morphology and terminates at the
mid-L1 level. Incidentally noted are prominent subperineurial (Tarlov) cysts
involving the S2 foramina, left significantly larger than right, measuring up
to 2.4 cm (CC) and significantly remodeling that sacral segment, which
demonstrates no bone marrow edema.
The evaluation of the overlying soft tissues is limited by the lack of
intravenous contrast and imaging field of view; however, there is patchy fatty
atrophy of the paraspinal multifidus muscles, particularly at the L5 and S1
levels.
IMPRESSION:
1. Extensively comminuted burst fracture of the L2 vertebral body, with
marked retropulsion of its dorsal cortex and resultant canal stenosis,
crowding of the cauda equina nerve roots and impingement upon the traversing
L3 nerve roots, bilaterally.
2. The involvement of the right pedicle, suggested on the OSH MDCT, is
difficult to assess on this examination, though there is bone marrow edema at
its base.
2. L3-4: Markedly asymmetric left facet arthrosis with prominent synovial
effusion, status post apparent right hemilaminotomy.
3. L4-5: Multifactorial left subarticular zone and neural foraminal stenosis
with corresponding neural impingement.
4. L5-S1: Degenerative disc disease, with no definite neural impingement.
COMMENT: An attempt was made to reach Dr. ___
fellow), via textpage, at 1130H, ___, without success; the findings were
then discussed with Ms. ___, NP (Orthopedic ___ service), via
telephone, at 1205H on the same date.
|
19884788-RR-27
| 19,884,788 | 20,657,679 |
RR
| 27 |
2183-04-10 08:33:00
|
2183-04-10 12:53:00
|
INDICATION: Intraoperative fluoroscopic images for posterior spinal fusion..
COMPARISON: L-spine radiograph ___.
TECHNIQUE 10 intraoperative fluoroscopic images were obtained.
FINDINGS:
Intraoperative fluoroscopic images were obtained without a radiologist
present. Images show subsequent steps in posterior spinal fusion from T12-
L4. For details, please refer to the operative note in OMR.
Total fluoroscopic time: 39 seconds.
IMPRESSION:
Status post posterior spinal fusion from T12 through L4, please refer to the
operative note for more detail.
|
19884866-RR-37
| 19,884,866 | 25,495,735 |
RR
| 37 |
2159-01-27 16:17:00
|
2159-01-27 16:34:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: History: ___ with chest pain// acute process?
TECHNIQUE: Chest PA and lateral
COMPARISON: CTA chest ___ at 16:11, chest radiograph ___
FINDINGS:
Heart size is mildly enlarged, unchanged. The mediastinal and hilar contours
are similar with the thoracic aorta appearing tortuous. 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.
|
19884866-RR-38
| 19,884,866 | 25,495,735 |
RR
| 38 |
2159-01-27 16:02:00
|
2159-01-27 16:35:00
|
EXAMINATION: CTA CHEST WITH CONTRAST
INDICATION: History: ___ with 2d history chest pain that radiates to back
b/l. Evaluation for dissection
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 2.6 s, 34.2 cm; CTDIvol = 13.3 mGy (Body) DLP = 453.3
mGy-cm.
2) Stationary Acquisition 0.6 s, 0.5 cm; CTDIvol = 3.3 mGy (Body) DLP = 1.7
mGy-cm.
3) Stationary Acquisition 4.8 s, 0.5 cm; CTDIvol = 26.5 mGy (Body) DLP =
13.2 mGy-cm.
Total DLP (Body) = 468 mGy-cm.
COMPARISON: Comparison to CTA chest from ___.
FINDINGS:
HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the
subsegmental level without filling defect to indicate a pulmonary embolus. The
thoracic aorta is normal in caliber without evidence of dissection or
intramural hematoma. There is moderate to severe diffuse atherosclerotic
calcification and mural plaques along the aortic arch and descending thoracic
aorta. Moderate atherosclerotic narrowing involving the proximal left
subclavian artery. Moderate calcification at the origin of the celiac trunk
and SMA. The heart is mildly enlarged with diffuse coronary artery
calcifications. Pericardium and remaining 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: Mild opacification at the left lung base is likely compatible
with atelectasis. Lungs are otherwise clear without masses or areas of
parenchymal opacification. The airways are patent to the level of the
segmental bronchi bilaterally. Diffuse airway wall thickening is present.
BASE OF NECK: Visualized portions of the base of the neck show no abnormality.
ABDOMEN: Included portion of the upper abdomen is unremarkable. Patulous
esophagus and moderate-sized hiatal hernia are noted. There is severe
narrowing of the celiac artery and moderate to severe narrowing of the
proximal SMA.
BONES: No suspicious osseous abnormality is seen.? There is no acute fracture.
IMPRESSION:
1. No evidence of pulmonary embolism or acute aortic abnormality.
2. Patulous esophagus with moderate hiatal hernia.
3. Moderate to severe atherosclerotic disease.
4. Diffuse airway wall thickening suggests chronic bronchitis.
|
19884866-RR-39
| 19,884,866 | 25,495,735 |
RR
| 39 |
2159-01-31 08:37:00
|
2159-01-31 11:30:00
|
EXAMINATION: Chest PA and lateral
INDICATION: ___ year old man with pAF, SSS, s/p PPM// Lead position
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest PA and lateral ___
FINDINGS:
In comparison the previous film, there has been interval placement of a left
chest wall pacing device with leads terminating in the right atrium and right
ventricle. There is no pneumothorax. Cardiomediastinal silhouette is normal
and stable in appearance. There is a moderately sized mediastinal fat
collection. There is no pulmonary edema or pleural effusions. There is left
basilar atelectasis. There is no focal consolidation consistent with
pneumonia.
IMPRESSION:
1. Interval placement of a left chest wall transvenous pacemaker with leads
terminating in the right atrium and right ventricle. No pulmonary edema,
mediastinal widening, pleural effusion or pneumothorax.
|
19885694-RR-36
| 19,885,694 | 26,958,770 |
RR
| 36 |
2198-02-24 14:45:00
|
2198-02-24 15:58:00
|
EXAMINATION: COMPLETE GU U.S. (BLADDER AND RENAL)
INDICATION: ___ hx dementia, BPH, hypothyroid who presentswith altered mental
status, foul smelling urine and darker urine, found to have increased WBCs and
RBCs in urine with CT scan suggesting blood in bladder. Please assess for
blood clots and/or other source of bleeding in the GU tract. // Eval for
blood clots in bladder, mass in bladder
TECHNIQUE: Grey scale and color Doppler ultrasound images of the kidneys and
bladder were obtained.
COMPARISON: None.
FINDINGS:
There is no hydronephrosis, stones, or masses bilaterally. Normal cortical
echogenicity and corticomedullary differentiation are seen bilaterally. There
are bilateral peripelvic renal cysts, also visualized on the CT from ___.
Right kidney: 11.2 cm
Left kidney: 10.7 cm
The bladder contains a small amount of mobile echogenic material. Only a left
ureteral jet could be visualized.
Prevoid volume of the bladder is 170.0 cm3.
The patient could not void.
IMPRESSION:
No focal renal or bladder mass identified. Small amount of echogenic mobile
material within the bladder could represent blood or debris. No underlying
cause for hematuria identified.
|
19885694-RR-37
| 19,885,694 | 26,958,770 |
RR
| 37 |
2198-02-25 10:48:00
|
2198-02-25 12:07:00
|
EXAMINATION: UNILAT LOWER EXT VEINS RIGHT
INDICATION: ___ year old man with RLE edema greater than left, please r/o DVT
// DVT?
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the right lower extremity veins.
COMPARISON: None.
FINDINGS:
There is normal compressibility, color flow, and spectral doppler 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.
|
19885694-RR-38
| 19,885,694 | 26,958,770 |
RR
| 38 |
2198-02-25 17:30:00
|
2198-02-25 20:11:00
|
EXAMINATION: KNEE (2 VIEWS) RIGHT
INDICATION: ___ year old man with worsening R knee pain after a fall, please
assess for fracture // Fracture?
TECHNIQUE: AP and cross-table lateral views of the right knee were obtained
COMPARISON: No recent priors are available for comparison
FINDINGS:
No fracture or dislocation is seen. There is severe degenerative changes over
the lateral compartment and mild to moderate degenerative changes over the
medial and patellofemoral compartments. Fragmented osteophytes are noted to
arise from the lateral femoral condyle and lateral tibial plateau. There is
no knee joint effusion. There is normal osseous mineralization. Vascular
calcification is present.
IMPRESSION:
No acute fracture. Severe degenerative changes of the lateral femorotibial
compartment.
|
19885726-RR-7
| 19,885,726 | 29,902,732 |
RR
| 7 |
2118-12-13 14:39:00
|
2118-12-13 15:35:00
|
EXAMINATION: Ultrasound-guided aspiration
INDICATION: ___ year old woman with ILD who presents with LUQ pain and is
found to have a large hepatic cyst compressing the stomach. // please drain
hepatic cyst compressing stomach
COMPARISON: Send reference was made to a CT of the abdomen and pelvis
performed on ___ at an outside hospital.
PROCEDURE: Ultrasound-guided aspiration of a large left hepatic cyst.
OPERATORS: Dr. ___, radiology fellow and Dr. ___ , attending
radiologist. Dr. ___ personally supervised the trainee during the
key components of the procedure and reviewed and agree with the trainee's
findings.
TECHNIQUE: The risks, benefits, and alternatives of the procedure were
explained to the patient. After a detailed discussion, informed written
consent was obtained. A pre-procedure timeout using three patient identifiers
was performed per ___ protocol.
The patient was placed in a supine position on the US scan table. Limited
preprocedure ultrasound was performed to localize the collection. Based on
the ultrasound findings an appropriate skin entry site for the aspiration was
chosen. The site was marked. Local anesthesia was administered with 1%
Lidocaine solution.
Using continuous sonographic guidance, 5 ___ catheter was inserted
into the collection. A sample of fluid was aspirated, confirming needle
position within the collection. Approximately 350 cc of dark non purulent
fluid was drained with a sample sent for microbiology and cytology evaluation.
Sterile dressing was applied.
The procedure was tolerated well, and there were no immediate post-procedural
complications.
SEDATION: Moderate sedation was not administered. The patient received
intravenous fentanyl.
FINDINGS:
Corresponding to the large left hepatic cyst seen on prior CT, there is a 9.4
cm anechoic structure within the left hepatic lobe with internal nonvascular
septations. Post aspiration imaging demonstrates collapse of the cavity.
IMPRESSION:
Successful ultrasound-guided aspiration of a 9.4 cm left hepatic cyst with
collapse of the cavity on post aspiration imaging. 350 cc of dark non
purulent fluid was aspirated with a sample sent for microbiology and cytology
evaluation.
|
19885929-RR-31
| 19,885,929 | 24,702,155 |
RR
| 31 |
2138-12-26 09:20:00
|
2138-12-26 10:37:00
|
INDICATION: ___ with abdominal pain NO_PO contrast // Eval for colitis
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired
through the abdomen and pelvis following intravenous contrast administration
with split bolus technique. IV Contrast: 130 mL Omnipaque.
Coronal and sagittal reformations were performed and reviewed on PACS.
Oral contrast was not administered.
DOSE: Total DLP (Body) = 877 mGy-cm.
COMPARISON: Pelvis ultrasound ___
FINDINGS:
LOWER CHEST: Visualized lung fields are within normal limits. There is no
evidence of pleural or pericardial effusion.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There is no evidence of focal lesions. There is no evidence of intrahepatic
or extrahepatic biliary dilatation. The gallbladder is within normal limits.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
Left upper pole ovoid hypodensity is too small to characterize. 1.4 cm right
interpolar hypodensity is incompletely characterized. There is no
hydronephrosis. There is no perinephric abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. The colon and
rectum are within normal limits. The appendix is normal.
PELVIS: The urinary bladder and distal ureters are unremarkable. Trace free
fluid in the pelvis is nonspecific.
REPRODUCTIVE ORGANS: Multiple uterine fibroids are again seen.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease
is noted. There is a circumaortic left renal vein.
BONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or
acute fracture. There is grade 1 anterolisthesis of L4 on L5. There is
minimal retrolisthesis of L5 on S1. There is mild disc height loss with vacuum
disc phenomenon at L5-S1. The abdominal and pelvic wall is within normal
limits.
IMPRESSION:
1. No evidence of colitis.
2. Right renal hypodensity is small, but measuring Hounsfield units greater
than that typically seen for a a simple cyst.
RECOMMENDATION(S): Followup nonurgent renal ultrasound to evaluate right
kidney hypodensity.
NOTIFICATION: The recommendation for nonurgent renal ultrasound was discussed
by Dr. ___ with Dr. ___ on the telephone on ___ at
approximately 18:00.
|
19885929-RR-32
| 19,885,929 | 24,702,155 |
RR
| 32 |
2138-12-27 14:57:00
|
2138-12-27 17:51:00
|
EXAMINATION: CT SINUS/MANDIBLE/MAXILLOFACIAL W/ CONTRAST Q1217 CT HEADSINUS
INDICATION: ___ year old woman with fever and maxilary sinus tenderness, with
poor dentition and tooth pain // Sinusitis, dental abscess?
TECHNIQUE: Axial images were acquired through the paranasal sinuses. Bone
and soft tissue reconstructed images were generated. Coronal reformatted
images were then produced.
DOSE: This study involved 3 CT acquisition phases with dose indices as
follows:
1) CT Localizer Radiograph
2) CT Localizer Radiograph
3) Spiral Acquisition 2.7 s, 21.4 cm; CTDIvol = 25.8 mGy (Head) DLP = 553.3
mGy-cm.
Total DLP (Head) = 553 mGy-cm.
COMPARISON: Comparison is made MRA of the brain from ___.
FINDINGS:
Dense opacification of the right aspect of the sphenoid sinus, with a areas of
calcification (03:35), and adjacent reactive osseous thickening implies
chronic inflammatory disease. Mild mucosal thickening of the ethmoid air
cells is also noted. The frontal and bilateral maxillary sinuses are mostly
clear, with a very thin layer of mucosal thickening in the left maxillary
sinus (03:57). The middle ear cavities and mastoid air cells are clear
bilaterally. The ostiomeatal units are patent. The cribriform plates are
intact. There is no nasal septal defect. The nasal septum is midline. The
anterior clinoid processes are not pneumatized. The lamina papyracea are
intact. The sphenoid sinus septum is midline.
A periapical lucency is noted about the left lateral maxillary incisor ___
#10) (602 B:99). Dental caries are also noted in multiple mandibular teeth on
the left. Multiple prominent level IA, IB, and bilateral IIA lymph nodes are
noted, likely reactive. Level IIA nodes measure up to 0.9 x 1.5 cm on the
right (3:87), and 1.5 x 1.6 cm on the left (3:85).
IMPRESSION:
1. Periapical lucency about the left lateral maxillary incisor, and multiple
dental caries, for which dedicated dental examination is recommended.
2. Chronic inflammatory changes of the sphenoid sinus on the right, the
possibility of fungal colonization is a consideration.
3. Prominent submental, submandibular, and cervical lymph nodes are likely
reactive.
|
19885929-RR-34
| 19,885,929 | 24,702,155 |
RR
| 34 |
2138-12-31 10:15:00
|
2138-12-31 11:00:00
|
EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ year old woman p/w leukopenia, unexplained transaminitis, RUQ
tenderness // liver size/heterogeneity?
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: CT abdomen pelvis ___
FINDINGS:
LIVER: The hepatic parenchyma appears within normal limits. The contour of the
liver is smooth. There is no focal liver mass. The main portal vein is patent
with hepatopetal flow. There is no ascites.
BILE DUCTS: There is no intrahepatic biliary dilation. The CBD measures 5 mm.
GALLBLADDER: Large gallbladder stone measuring up to 3.8 cm in size. The
gallbladder wall appears normal. No pericholecystic fluid.
PANCREAS: Imaged portion of the pancreas appears within normal limits, without
masses or pancreatic ductal dilation, with portions of the pancreatic tail
obscured by overlying bowel gas.
SPLEEN: Normal echogenicity, measuring 8.4 cm.
KIDNEYS: The right kidney measures 10.3 cm. The left kidney measures 9.7 cm.
Normal cortical echogenicity and corticomedullary differentiation is seen
bilaterally. There is no evidence of masses, stones, or hydronephrosis in the
kidneys.
RETROPERITONEUM: Visualized portions of aorta and IVC are within normal
limits.
IMPRESSION:
Large gallbladder stone without evidence of cholecystitis.
|
19886408-RR-14
| 19,886,408 | 28,518,899 |
RR
| 14 |
2114-12-22 09:41:00
|
2114-12-22 12:02:00
|
INDICATION: ___ with intubated, transfer// verify ETT placement
TECHNIQUE: Single portable view of the chest.
COMPARISON: None.
FINDINGS:
Endotracheal tube tip is 4.6 cm from the carina. Enteric tube passes below
the diaphragm with tip in the gastric body. Lung volumes are low but the
lungs are clear. Cardiomediastinal silhouette is within normal limits. No
acute osseous abnormalities.
IMPRESSION:
Endotracheal and enteric tubes appropriately positioned.
|
19886408-RR-16
| 19,886,408 | 28,518,899 |
RR
| 16 |
2114-12-22 11:30:00
|
2114-12-22 12:50:00
|
EXAMINATION: MR HEAD W AND W/O CONTRAST T___ MR HEAD
INDICATION: History: ___ with seizures and mass// eval left fronto-parietal
mass
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: None.
FINDINGS:
2.0 cm x 1.6 cm x 1.6 cm peripherally enhancing round mass is identified in
the left very posterior temporal lobe. Inhomogeneous T2 signal is seen
centrally, with few thin enhancing septations. Thin rim of enhancement along
the periphery of the lesion, with small areas of associated nodularity, and
linear subtle mildly restricted diffusion of the enhancing component.
Appearance is not consistent with abscess, or late cerebritis, diffusion
weighted images, T2 weighted images and extent of surrounding edema with
different appearance.
Mild surrounding nonenhancing T2 signal abnormality. No internal blood
products. 0.5 cm satellite enhancing nodule along the superolateral margin of
the lesion. Findings likely represent primary glioma, less likely metastasis.
Given complete ring of enhancement and some thickened nodular enhancement
along the periphery, local mild mass-effect, findings not typical for
tumefactive demyelination.
Mild local mass effect. There is no midline shift or mass effect on the
ventricles. 3 mm focus of hypoenhancement right inferior pituitary gland,
suggestive of microadenoma, clinically correlate coronal image 74. There is
no evidence of hemorrhage or infarction. Mild paranasal sinus disease.
IMPRESSION:
1. 2.0 cm posterior left temporal gyrus mass, worrisome for primary high-grade
glioma, less likely metastasis. Appearance not consistent with abscess.
|
19886408-RR-17
| 19,886,408 | 28,518,899 |
RR
| 17 |
2114-12-22 20:48:00
|
2114-12-22 22:33:00
|
LIMITED CT
Patient had an episode of nasal pruritis and stuffiness after test bolus (30
cc) of contrast was administered. Patient was examined by ___, MD
and ___ decision was made to abort the current study and repeat tomorrow with
premedication protocol.
Only a lateral scout image was obtained.
|
19886408-RR-19
| 19,886,408 | 28,518,899 |
RR
| 19 |
2114-12-23 14:04:00
|
2114-12-23 16:42:00
|
EXAMINATION: CT scan of the abdomen and pelvis with contrast
INDICATION: ___ year old woman with new brain lesion, r/o metastatic lesion.
She a ? reaction to contrast, she will be premedicated prior to this imaging
with prednisone and Benadryl.// ___ year old woman with new brain lesion, r/o
metastatic lesion. She a ? reaction to contrast, she will be premedicated
prior to this imaging with prednisone and Benadryl.
TECHNIQUE: Oncology 3 phase: Multidetector CT of the abdomen and pelvis was
done as part of CT torso without and with IV contrast. Initially the abdomen
was scanned without IV contrast. Subsequently a single bolus of IV contrast
was injected and the abdomen and pelvis were scanned in the portal venous
phase, followed by a scan of the abdomen in equilibrium (3-min delay) phase.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 9.4 s, 36.2 cm; CTDIvol = 8.3 mGy (Body) DLP = 284.9
mGy-cm.
2) Stationary Acquisition 0.5 s, 1.0 cm; CTDIvol = 1.2 mGy (Body) DLP = 1.2
mGy-cm.
3) Stationary Acquisition 6.0 s, 1.0 cm; CTDIvol = 13.9 mGy (Body) DLP =
13.9 mGy-cm.
4) Spiral Acquisition 17.5 s, 67.0 cm; CTDIvol = 11.8 mGy (Body) DLP =
773.6 mGy-cm.
5) Spiral Acquisition 9.6 s, 36.8 cm; CTDIvol = 8.2 mGy (Body) DLP = 288.5
mGy-cm.
Total DLP (Body) = 1,380 mGy-cm.
COMPARISON: None.
FINDINGS:
LOWER CHEST: Please refer to separate report of CT chest performed on the same
day for description of the thoracic findings.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There is a 7 mm hypodensity in segment V/VI of the liver (06:57), too small to
characterize. There is no evidence of intrahepatic or extrahepatic biliary
dilatation. There is a small amount of pneumobilia, to be correlated with a
history of sphincterotomy. The gallbladder is within normal limits.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
There is no evidence of focal renal lesions or hydronephrosis. Note is made
of a small right extrarenal pelvis. There is no perinephric abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. There is
inspissated oral contrast in the terminal ileum and ascending and transverse
colon. The colon and rectum are otherwise unremarkable.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: The uterus and bilateral adnexa are unremarkable.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease
is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. 7 mm hypodensity in segment V/VI of the liver, too small to characterize.
2. Otherwise no evidence of primary malignancy or metastatic disease in the
abdomen and pelvis.
3. Small amount of pneumobilia, to be correlated with a history of previous
sphincterotomy.
|
19886408-RR-20
| 19,886,408 | 28,518,899 |
RR
| 20 |
2114-12-23 14:06:00
|
2114-12-23 16:36:00
|
EXAMINATION: CT CHEST W/CONTRAST
INDICATION: Left temporal lobe mass on MRI of the brain. Evaluate for
primary malignancy.
TECHNIQUE: MDCT of the chest was performed with intravenous contrast.
Coronal and sagittal reformats were sent to PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 9.4 s, 36.2 cm; CTDIvol = 8.3 mGy (Body) DLP = 284.9
mGy-cm.
2) Stationary Acquisition 0.5 s, 1.0 cm; CTDIvol = 1.2 mGy (Body) DLP = 1.2
mGy-cm.
3) Stationary Acquisition 6.0 s, 1.0 cm; CTDIvol = 13.9 mGy (Body) DLP =
13.9 mGy-cm.
4) Spiral Acquisition 17.5 s, 67.0 cm; CTDIvol = 11.8 mGy (Body) DLP =
773.6 mGy-cm.
5) Spiral Acquisition 9.6 s, 36.8 cm; CTDIvol = 8.2 mGy (Body) DLP = 288.5
mGy-cm.
Total DLP (Body) = 1,380 mGy-cm.
** Note: This radiation dose report was copied from CLIP ___ (CT ABD AND
PELVIS W AND W/O CONTRAST, ADDL SECTIONS)
COMPARISON: None.
FINDINGS:
NECK, THORACIC INLET, AXILLAE, CHEST WALL: There is no supraclavicular or
axillary lymphadenopathy. The thyroid gland is unremarkable. Superficial
soft tissue structures of the chest wall are unremarkable.
UPPER ABDOMEN: Please see separate report for CT of the abdomen and pelvis
performed the same day.
MEDIASTINUM: There is no mediastinal mass or lymphadenopathy.
HILA: There is no hilar lymphadenopathy.
HEART and PERICARDIUM: The heart is normal in size. There is no pericardial
effusion.
PLEURA: There are no pleural effusions.
LUNG:
1. PARENCHYMA: There are subsegmental dependent atelectatic changes at both
lung bases. There is no pulmonary mass or nodules.
2. AIRWAYS: The airways are patent to the subsegmental level.
3. VESSELS: The thoracic aorta and main pulmonary artery are normal in
caliber.
CHEST CAGE: There are no suspicious bone lesions.
IMPRESSION:
No evidence of primary malignancy or metastatic disease in the chest.
|
19886408-RR-21
| 19,886,408 | 28,518,899 |
RR
| 21 |
2114-12-25 02:34:00
|
2114-12-25 09:19:00
|
EXAMINATION: MR HEAD W/ CONTRAST ___ MR HEAD
INDICATION: ___ year old woman with left parietal lesion// pre-op wand study
for crani/resection on ___
TECHNIQUE: After administration of Gadavist intravenous contrast, axial
imaging was performed with MPRAGE and T1 technique. Sagittal and coronal
orientation reformatted images of the MPRAGE acquisition was then produced. \
COMPARISON: MR head ___
FINDINGS:
The 2 cm peripherally enhancing irregular lesion within the posterior left
superior temporal gyrus and the 3 x 6 mm enhancing subcortical satellite
lesion (series 8, image 68) appear similar to the recent MR from ___. No new enhancing lesions are identified.
The ventricles, sulci, and cisterns appear stable. There is no midline shift.
The 3 mm focus with lower intensity on postcontrast T1 weighted images within
the adenohypophysis to the right of midline may reflect a pituitary
microadenoma, similar to the prior study.
There are a few paranasal sinus mucosal retention cysts.
IMPRESSION:
2 cm peripheral enhancing irregular lesion within the posterior left superior
temporal gyrus and small enhancing satellite nodule appear similar to the MR
from ___. These findings are most suspicious for a high-grade
glioma, with metastasis a much less likely consideration.
|
19886408-RR-22
| 19,886,408 | 28,518,899 |
RR
| 22 |
2114-12-26 20:40:00
|
2114-12-27 09:34:00
|
EXAMINATION: MR HEAD W AND W/O CONTRAST.
INDICATION: ___ year old woman s/p left craniotomy for tumor resection// s/p
tumor resection.
TECHNIQUE: MRI of the brain is performed and includes the following
sequences: sagittal T-weighted, axial fast spin echo T2-weighted,axial FLAIR,
axial diffusion weighted and axial gradient echo images. The T1 weighted
images were repeated after the administration of 8 ML of Gadavist intravenous
gadolinium contrast.
COMPARISON: Multiple prior brain MRI examinations dated ___ 18, prior head CT dated ___, reference head CT dated ___.
FINDINGS:
The patient is status post left temporal lobe mass resection, expected
postsurgical changes are seen consistent with frontal pneumocephalus, residual
blood products are seen at the surgical site in the temporal region with
high-signal intensity on T1 weighted images without contrast, after the
administration of gadolinium no significant change is noted in the surgical
bed, the previously seen satellite lesion is not clearly seen in the current
exam, please compare the image number 69, series 8 from ___ with the
current exam image 97 through 99, series 14. There is no evidence of
significant mass effect or shifting of the normally midline structures.
Susceptibility changes are visualized at the surgical cavity consistent with a
combination of residual air and blood products (image 12, series 10),
peripheral slow diffusion is noted towards the left inferior longitudinal
fascicle and and left periventricular atrium (image 15, series 4), however
there is no evidence of territorial infarction. No new areas of abnormal
enhancement are seen. The major vascular are vascular flow voids are present
and demonstrate normal distribution. The orbits are unremarkable, the
paranasal sinuses again demonstrate an unchanged mucous retention cyst on the
right maxillary sinus.
IMPRESSION:
1. Postsurgical changes identified in the left temporal lobe, the patient is
status post left temporal lobe mass resection, expected postsurgical changes
are seen consistent with frontal pneumocephalus and residual blood products at
the surgical site, after the administration of gadolinium contrast, there is
no evidence of significant enhancement at the surgical bed, however close
follow-up is recommended until complete resolution of the postsurgical blood
products.
2. Mild slow diffusion is noted surrounding the surgical bed with no evidence
of territorial infarction.
NOTIFICATION: The findings were discussed with ___, M.D. by
___, M.D. In person on ___ at 08:40 hours.
RECOMMENDATION(S): Postsurgical changes are visualized in the left temporal
lobe. Close follow-up with MRI of the head with and without contrast is
recommended to demonstrate evolution of the surgical blood products in the
left temporal surgical cavity.
|
19886408-RR-23
| 19,886,408 | 28,518,899 |
RR
| 23 |
2114-12-25 17:35:00
|
2114-12-25 19:27:00
|
EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ year old woman s/p left craniotomy for resection of tumor//
please perform by 1730
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 4.0 s, 16.0 cm; CTDIvol = 46.7 mGy (Head) DLP =
747.3 mGy-cm.
Total DLP (Head) = 747 mGy-cm.
COMPARISON: MRI head dated earlier same day. CT head from outside institution
dated ___.
FINDINGS:
The patient is status post left craniotomy for tumor resection, with expected
postoperative changes including pneumocephalus, most significant overlying the
frontal lobes bilaterally and within the resection site in the left temporal
lobe. There is a small hypodensity along the posterior aspect of the
resection bed with adjacent hyperdensity likely representing blood products,
as well as a small of subarachnoid blood, most consistent with postoperative
change. There is no evidence of infarction. No residual mass is seen,
however, MRI is more sensitive for the detection of intracranial masses. The
ventricles and sulci are normal in size and configuration.
Postoperative changes from recent left craniotomy. There is a mucous
retention cyst in the right maxillary sinus, similar to prior. The visualized
portion of the paranasal sinuses, mastoid air cells, and middle ear
cavitiesare otherwise clear. The visualized portion of the orbits are
unremarkable.
IMPRESSION:
Post-operative changes status post left craniotomy and resection of left
temporal tumor. Evaluation for residual tumor is limited and better evaluated
with MRI.
|
19886569-RR-23
| 19,886,569 | 26,818,429 |
RR
| 23 |
2131-02-23 20:52:00
|
2131-02-23 22:02:00
|
CHEST RADIOGRAPH PERFORMED ON ___.
___.
CLINICAL HISTORY: Seizure, assess aspiration.
FINDINGS: AP upright and lateral views of the chest are provided. The lung
volumes are low. The lungs appear clear without focal consolidation,
effusion, or pneumothorax. The heart and mediastinal contours are normal.
Bony structures are intact.
IMPRESSION: No acute intrathoracic process.
|
19886569-RR-29
| 19,886,569 | 26,866,665 |
RR
| 29 |
2131-09-15 05:22:00
|
2131-09-15 12:11:00
|
HISTORY: ___ woman with seizures.
TECHNIQUE: Multiplanar, multi sequence MRI of the head was performed before
and after intravenous gadolinium administration.
COMPARISON: MRI and MRA of the brain ___, MRI head with and
without contrast ___.
FINDINGS:
There is no evidence of an acute infarct, hemorrhage, midline shift, mass
effect, extra-axial fluid collections or hydrocephalus. The ventricles and
sulci are normal. There is no evidence of abnormal enhancement. There are no
structural abnormalities identified, including no evidence of cortical
dysplasia. The bilateral hippocampal formations are symmetric. The brainstem
and cerebellum are normal. The paranasal sinuses, orbits and soft tissues are
grossly unremarkable.
IMPRESSION:
No evidence of acute intracranial process, abnormal enhancement, hemorrhage or
structural abnormality.
|
19886573-RR-4
| 19,886,573 | 25,916,071 |
RR
| 4 |
2120-05-28 11:30:00
|
2120-05-28 11:56:00
|
HISTORY: Evaluate for pneumothorax or fracture after fall.
COMPARISON: None.
FINDINGS: There is bilateral lower lobe atelectasis. The lungs are otherwise
clear. Note is made of an azygos fissure. The hilar and cardiomediastinal
contours are normal. There is no pneumothorax or pleural effusion. Pulmonary
vascularity is normal. No displaced rib fracture is seen.
IMPRESSION: No evidence of pneumothorax or displaced rib fracture.
|
19886573-RR-5
| 19,886,573 | 25,916,071 |
RR
| 5 |
2120-05-28 11:46:00
|
2120-05-28 12:50:00
|
INDICATION: Fall with known splenic laceration and hemoperitoneum.
Evaluation for active extravasation.
TECHNIQUE: MDCT images were obtained from the lung bases to the lesser
trochanters after administration of intravenous contrast. Oral contrast had
already been given at an outside institution. Post-contrast images were
obtained in the early arterial and portal venous phases. Coronal and sagittal
reformations were prepared.
COMPARISON: CT of the abdomen and pelvis from ___ on ___ at 8:54.
CT ABDOMEN: There is no active extravasation. Again seen is hemoperitoneum
centered around the spleen with numerous lacerations. Free fluid extends
around the liver and into the pelvis, but overall is not significantly changed
in volume from CT from three hours prior. Note is made of a tiny 1.0 cm
accessory spleen. There is no liver laceration.
Oral contrast is seen throughout the colon without evidence of obstruction.
The hepatic and portal veins are patent. The major abdominal aortic branch
vessels are patent without significant stenosis with the exception of the left
renal artery. Note is made of some calcifications at the ostia of the left
renal artery. Numerous stones fill the gallbladder. The pancreas and
adrenals are normal. The kidneys enhance symmetrically and excrete contrast
without evidence of hydronephrosis or mass. 7-mm hypodensity arising from the
upper pole of right kidney is too small to characterize (2B:212). The IVC is
not flattened and the abdominal aorta is normal in caliber. There is no free
intraperitoneal air. The stomach and small bowel are unremarkable.
CT PELVIS: Sigmoid diverticulosis is seen without evidence of diverticulitis.
The urinary bladder and adnexa are normal. The uterus is absent. There is no
pelvic lymphadenopathy.
OSSEOUS STRUCTURES: Fractures of the ninth through twelfth ribs are again
demonstrated as are fractures of the left transverse processes of L2 and L3.
There is no fracture or malalignment of the thoracolumbar spine.
IMPRESSION:
1. Large multifocal splenic laceration with hemoperitoneum - much of the
outer spleen is essentially shattered altough with sparing of the hilum, but
no active extravasation identified. Perisplenic hemorrhage has a small to
moderate subcapsular component with adjacent suspected intraperitoneal
hematoma. Unchanged associated perihepatic and pelvic hemoperitoneum. No
liver laceration.
2. Fractures of the left ninth through twelfth ribs and left L2-L3 transverse
processes.
3. Cholelithiasis.
4. Sigmoid diverticulosis.
Preliminary findings were discussed by Dr. ___ with Dr. ___
___ at 12:06 p.m. on ___.
|
19886688-RR-28
| 19,886,688 | 20,633,117 |
RR
| 28 |
2126-12-26 13:54:00
|
2126-12-26 16:11:00
|
HISTORY: acute on chronic back pain.
FINDINGS: Lumbar spine, 2 views.
COMPARISON: none.
FINDINGS:
There are 5 nonrib bearing vertebral bodies. There is partial lumbarization
of S1. Vertebral body and disc heights are preserved. No fracture,
subluxation, or degenerative changes detected. No focal lytic or sclerotic
lesions identified. There is a nonobstructive bowel gas pattern with pills in
the stomach.
IMPRESSION:
Partial lumbarization of S1. No acute fracture or dislocation.
|
19886688-RR-29
| 19,886,688 | 20,633,117 |
RR
| 29 |
2126-12-27 14:57:00
|
2126-12-27 17:41:00
|
INDICATIONS: ___ male with right hip and leg pain.
Bilateral lower extremity ABIs, Doppler waveforms and PVRs were performed at
rest.
FINDINGS:
RIGHT: The right ABI is 1.15/1.19 at ___. Right-sided Doppler waveforms
are triphasic at all levels with normal PVRs.
LEFT: The left ABI is 1.14/1.26 at ___ respectively. Left-sided Doppler
waveforms are triphasic at all levels with normal PVRs.
IMPRESSION: No evidence of any peripheral vascular disease at rest in either
lower extremity.
|
19886772-RR-42
| 19,886,772 | 29,520,585 |
RR
| 42 |
2119-07-04 20:14:00
|
2119-07-04 20:42:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ with sepsis criteria// pna
COMPARISON: Chest CT from ___
FINDINGS:
PA and lateral views of the chest provided. Lungs are clear. 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. Partially visualized cervical fusion hardware noted in the lower neck.
IMPRESSION:
No acute intrathoracic process.
|
19886772-RR-43
| 19,886,772 | 29,520,585 |
RR
| 43 |
2119-07-06 10:52:00
|
2119-07-06 11:48:00
|
EXAMINATION: MR HEAD W AND W/O CONTRAST T9112 MR HEAD
INDICATION: ___ year old woman with prior viral meningitis, h.o dural leak,
chronic headache, who presents with acute on chronic headache and reports of
decreased hearing in her R.side// please eval for intracranial process and
signs of intracranial hypotension
TECHNIQUE: Sagittal and axial T1 weighted imaging were performed. After
administration of intravenous contrast, axial imaging was performed with
gradient echo, FLAIR, diffusion, and T1 technique. Sagittal MPRAGE imaging was
performed and re-formatted in axial and coronal orientations.
COMPARISON: MRI/MRA of the head and neck dated ___.
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 is no abnormal enhancement after contrast
administration.
A developmental venous anomaly is seen in the left cerebellar hemisphere.
The paranasal sinuses, mastoid air cells and middle ear cavities are clear.
The intraorbital contents are normal.
IMPRESSION:
1. No acute intracranial abnormality or evidence of intracranial hypotension.
|
19887057-RR-30
| 19,887,057 | 21,690,920 |
RR
| 30 |
2149-08-04 15:20:00
|
2149-08-04 16:12:00
|
INDICATION: ___ with stage IV Hodgkin lymphoma who fell on her pelvis 3d ago
and now has persistent pain// Evaluate for fracture or metastatic lesion
COMPARISON: Prior CT of the abdomen pelvis from ___.
FINDINGS:
AP view of the pelvis provided. The bony pelvic ring is intact and both hips
align anatomically. There is only minimal acetabular spurring. SI joints are
symmetric and normal. No worrisome bony lesion. Soft tissues are
unremarkable.
IMPRESSION:
Unremarkable.
|
19887057-RR-32
| 19,887,057 | 21,690,920 |
RR
| 32 |
2149-08-07 19:38:00
|
2149-08-08 09:41:00
|
EXAMINATION: MRI CERVICAL, THORACIC, AND LUMBAR PT22 MR SPINE
INDICATION: ___ year old woman with ___ PMH muscular
___ dz, stage IVHodgkin lymphoma on clinical trial,
in etiology, p/w diarrhea and recent fall, weakness. On neurology eval, found
to have increase in ___ weakness bilaterally. Hx of T4 tumor
infiltration.// Pt w lymphoma and new ___ proximal weakness...does she have
malignancy in spine causing sx?
TECHNIQUE: Sagittal imaging was performed with T2, T1, and STIR technique.
Axial T2 imaging was performed. Axial GRE images of the cervical spine were
performed. After the uneventful administration of Gadavist contrast agent,
additional axial and sagittal T1 images were obtained.
COMPARISON: None.
FINDINGS:
CERVICAL:
Cervical alignment is anatomic. Vertebral body heights are preserved. There
is no focal suspicious marrow lesion. Disc height and signal are maintained.
The visualized posterior fossa is grossly unremarkable.
There is no definite signal abnormality or enhancement of the cord itself.
Multiple ventral and dorsal nerve roots demonstrate thickening and abnormal
enhancement (for example, at C5-C6 (series 17, image 17).
C2-C3: A right central protrusion results in mild spinal canal narrowing,
minimally remodeling the ventral aspect of the cord. Uncovertebral facet
arthropathy results in mild bilateral neural foraminal narrowing.
C3-C4: No significant spinal canal or neural foraminal narrowing.
C4-C5: A left central protrusion with annular fissure minimally remodels the
left ventral aspect of the cord. There is no significant spinal canal or
neural foraminal narrowing.
C5-C6: There is a 4 mm right perineural cyst. There is no significant spinal
canal or neural foraminal narrowing.
C6-C7 and C7-T1: No significant spinal canal or neural foraminal narrowing.
The visualized prevertebral and paraspinal soft tissues are grossly
unremarkable.
THORACIC:
Thoracic alignment is anatomic. Vertebral body heights are preserved. There
is no focal suspicious marrow lesion. Specifically, there is no evidence of
bone marrow signal abnormality corresponding to the T4 vertebral body where
there is a history lymphomas involvement. There is no definitive cord signal
abnormality. As with the cervical spine, the dorsal and ventral nerve roots
are diffusely thickened demonstrating postcontrast enhancement.
There is no significant spinal canal or neural foraminal narrowing.
LUMBAR:
Lumbar alignment is anatomic. Vertebral body heights are preserved.
Suspicious marrow lesions identified. The conus medullaris terminates at the
L2 level, within expected limits.
There is diffuse thickening and enhancement of the cauda equina nerve roots as
well as the lumbar peripheral nerves within the foraminal and extraforaminal
regions.
No significant spinal canal or neural foraminal narrowing is identified,
allowing for mild degenerative changes.
OTHER: There is bilateral gravity dependent atelectasis of the lung bases,
which is more confluent at the right lung base raising the possibility for a
superimposed consolidation.
A 1.3 cm T2 hyperintense nonenhancing cystic lesion of the right superior
renal pole demonstrating a single nonenhancing septation is compatible with a
Bosniak 2 cyst. There are multiple nonenhancing T2 hypointense cystic lesions
in the left kidney measuring up to 1 cm, likely representing hemorrhagic
cysts.
IMPRESSION:
1. There is diffuse thickening and abnormal enhancement of the cervical and
thoracic ventral and dorsal nerve roots as well as of the cauda equina and
lumbar peripheral nerves. Overall the findings are compatible with given
history of ___. However, given the patient's history of stage
IV lymphoma, lymphomas involvement should be excluded.
2. No definite cord signal abnormality is identified. There is no evidence of
high-grade spinal canal or neural foraminal narrowing.
3. Multiple nonenhancing T2 hypointense cystic lesions in the left kidney
measuring up to 1 cm, likely representing hemorrhagic cysts. This could be
further evaluated with ultrasound.
4. Bilateral dependent atelectasis of the lung bases. Clinical correlation
for more confluent focus in the right lung base for superimposed
consolidation.
5. Additional findings as described above.
|
19887057-RR-33
| 19,887,057 | 21,690,920 |
RR
| 33 |
2149-08-08 17:16:00
|
2149-08-08 19:01:00
|
EXAMINATION: RENAL U.S.
INDICATION: ___ PMH muscular ___ dz, stage
IVHodgkin lymphoma on clinical trial, recent admission for diarrhea, p/w
diarrhea and recent fall, weakness, now receiving neuro w/u for new ___
proximal muscle weakness.// Multiple nonenhancing T2 hypointense cystic
lesions in the left kidney measuring up to 1 cm, likely representing
hemorrhagic cysts. Please eval further to determine if need bx? Thank you.
TECHNIQUE: Grey scale and color Doppler ultrasound images of the kidneys were
obtained.
COMPARISON: MRI of the spine dated ___. CT of the abdomen pelvis
dated ___.
FINDINGS:
The right kidney measures 10.2 cm. The left kidney measures 11.4 cm. There is
no hydronephrosis or stones bilaterally. Normal cortical echogenicity and
corticomedullary differentiation are seen bilaterally. In the upper pole of
the right kidney, there is a 1.6 x 1.1 x 1.6 cm mildly complicated cyst with
internal septation. No mass is seen in the left kidney.
The bladder is moderately well distended and normal in appearance.
IMPRESSION:
No cystic lesions are seen in the left kidney. Small septated cyst right
kidney.
RECOMMENDATION(S): Given the findings on recent spine MRI, MRI with renal
mass protocol can be performed for further evaluation.
|
19887262-RR-10
| 19,887,262 | 27,243,050 |
RR
| 10 |
2176-05-22 01:19:00
|
2176-05-22 10:31:00
|
EXAMINATION: AP portable radiograph of the chest
INDICATION: ___ w/ h/o dementia, Afib and DVT/PE (w/ IVC filter), on
Coumadin, p/w abd pain, n/v, txf from ___ w/ SBO and NSTEMI// NGT placement?
Acute process
COMPARISON: None available.
FINDINGS:
Evaluation is limited due to nonstandard positioning of the patient. There is
a nasogastric tube in place with the side port and tip below the diaphragm.
No pleural effusion or pneumothorax is seen. The left lung appears clear.
The right lung and mediastinum are difficult to evaluate due to the
nonstandard positioning. There are multiple dilated loops of bowel projecting
over the abdomen. There is an IVC filter projecting over the upper right
abdomen.
IMPRESSION:
Nonstandard positioning of the patient limiting evaluation. Repeat two view
chest radiograph when patient can tolerate.
|
19887262-RR-12
| 19,887,262 | 27,243,050 |
RR
| 12 |
2176-05-22 05:26:00
|
2176-05-22 12:39:00
|
INDICATION: ___ w/ h/o dementia, Afib and DVT/PE (w/ IVC filter), on
Coumadin, p/w abd pain, n/v, txf from ___ w/ SBO and NSTEMI// etiology of
resp status
COMPARISON: ___ at 01:30
FINDINGS:
The nasogastric tube appears to have been pulled up and now appears to be
curling in the distal esophagus. There is no pleural effusion or
pneumothorax. There is a widened appearance of the mediastinum, which could
be due to nonstandard positioning of the patient. There is linear opacity in
the right midlung. There is an IVC filter in place.
IMPRESSION:
The ET tube appears to be curling in the distal esophagus above the diaphragm.
The mediastinum appears widened.
NOTIFICATION: This was discussed with Dr. ___ at 12:38 on ___
by Dr. ___..
|
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