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|---|---|---|---|---|---|---|---|
19887262-RR-13
| 19,887,262 | 27,243,050 |
RR
| 13 |
2176-05-23 10:26:00
|
2176-05-23 15:11:00
|
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// NGT placement?
TECHNIQUE: Chest PA and lateral
COMPARISON: Multiple prior chest radiographs, most recent dated ___.
FINDINGS:
The enteric tube is seen coursing below the left hemidiaphragm; however, the
tip is not visualized due to contrast in the stomach. Low lung volumes. New
left lower lobe consolidation, concerning for pneumonia versus atelectasis.
Unchanged linear right-sided opacity, likely due to scaring versus platelike
atelectasis. Atherosclerotic calcifications seen in the aortic arch.
IMPRESSION:
1. Enteric tube has been readjusted and courses below the left hemidiaphragm.
However, the distal tip is obscured by contrast within the stomach.
2. New left lower lobe consolidation, concerning for pneumonia versus
atelectasis.
NOTIFICATION: The findings were discussed with ___, M.D. by ___
___, M.D. on the telephone on ___ at 3:06 pm, 15 minutes after
discovery of the findings.
|
19887262-RR-14
| 19,887,262 | 27,243,050 |
RR
| 14 |
2176-05-23 15:47:00
|
2176-05-23 17:16:00
|
INDICATION: ___ y/o F w/ SBO, gastroview placed down NGT// evaluate contrast
transit through bowel to evaluate for resolution of SBO- please obtain at
16:00 today ___
TECHNIQUE: Portable supine abdominal radiograph was obtained.
COMPARISON: No prior radiographs available for comparisons. CT abdomen
pelvis dated ___.
FINDINGS:
Dilated small bowel loops with contrast. Contrast is now seen within the
colon.
Within the limitations of a supine only assessment, there is no free
intraperitoneal air.
Osseous structures are unremarkable. IVC filter seen projecting over the mid
abdomen. Enteric tube with tip in the stomach.
IMPRESSION:
Contrast extends from dilated small bowel into colon.
|
19887262-RR-16
| 19,887,262 | 27,243,050 |
RR
| 16 |
2176-05-25 16:42:00
|
2176-05-25 18:53:00
|
EXAMINATION: SHOULDER (AP, NEUTRAL AND AXILLARY) TRAUMA RIGHT
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// Shoulder
mobility issues. Rotator cuff? Please get AP, Lateral, and axillary views.
Shoulder mobility issues. Rotator cuff? Please get AP, Lateral, and axillary
views.
TECHNIQUE: Three views of the right shoulder were obtained
COMPARISON: None
FINDINGS:
There is no fracture or dislocation involving the glenohumeral or AC joint.
There are moderate degenerative changes of the acromioclavicular and
glenohumeral joints. No suspicious lytic or sclerotic lesions are identified.
No periarticular calcification or radio-opaque foreign body is seen.
IMPRESSION:
No acute osseous injury of the right shoulder. Moderate degenerative changes
of the acromioclavicular and glenohumeral joints..
|
19887349-RR-10
| 19,887,349 | 26,179,448 |
RR
| 10 |
2176-05-06 11:37:00
|
2176-05-06 12:16:00
|
EXAMINATION: DX CHEST PORTABLE PICC LINE PLACEMENT
INDICATION: ___ year old woman with new R PICC// 46 cm R basilic SL PICC-
___ ___ Contact name: ___: ___ cm R basilic SL PICC-
___ ___
IMPRESSION:
Right PICC line tip is at the level of lower SVC. Heart size and mediastinum
are stable. Lungs are clear. There is no pleural effusion or pneumothorax.
|
19887349-RR-9
| 19,887,349 | 26,179,448 |
RR
| 9 |
2176-05-02 21:46:00
|
2176-05-02 22:19:00
|
EXAMINATION: CT pelvis with contrast
INDICATION: ___ s/p vulvar procedure ___, now with purulent drainage//
?vulvar abscess, PLEASE extend imaging through entirety of vulva
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired
through the pelvis following intravenous contrast administration with split
bolus technique. Oral contrast was not administered. Coronal and sagittal
reformations were performed and reviewed on PACS.
DOSE: Total DLP (Body) = 406 mGy-cm.
COMPARISON: None.
FINDINGS:
The patient is post-operative day 9 from anterior and right radical
hemi-vulvectomy.
There is a 4.1 x 2.3 cm area of fluid and multiple foci of gas without a
definite rim, concerning for phlegmon or developing abscess in the
subcutaneous space inferior to the mons pubis and superior to the right labia.
A small foci of gas in the bladder is likely secondary to prior intervention.
Otherwise, the urinary bladder and distal ureters are unremarkable. There is
no free fluid in the pelvis.
There is diverticulosis without evidence of diverticulitis.
REPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease
is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
There is a small fat containing umbilical hernia.
IMPRESSION:
1. The patient is post-operative day 9 from anterior and right radical
hemi-vulvectomy.
2. 4.1 x 2.3 cm area of fluid and multiple foci of gas without a definite rim,
concerning for phlegmon or developing abscess in the subcutaneous space
inferior to the mons pubis and superior to the right labia. This does not
represent a drainable fluid collection.
|
19887608-RR-10
| 19,887,608 | 20,888,673 |
RR
| 10 |
2140-09-02 09:43:00
|
2140-09-02 10:21:00
|
INDICATION: ___ with L fem neck fx on OSH CT// eval L fem neck fx;
associated injuries
TECHNIQUE: AP view of pelvis. AP lateral views of the proximal distal left
femur.
COMPARISON: Torso CT performed at an outside institution from earlier the
same day.
FINDINGS:
There is an acute impacted left femoral neck fracture. Distal femur is
displaced proximally. Femoral head remains anatomically aligned with the
acetabulum. Bones are demineralized. No additional fractures identified.
Pubic symphysis and SI joints are preserved. Moderate degenerative changes
noted at the right hip. Distally, the left femur intact. Excreted contrast
is noted within the bladder.
IMPRESSION:
Acute left femoral neck fracture. No additional fractures.
|
19887608-RR-11
| 19,887,608 | 20,888,673 |
RR
| 11 |
2140-09-02 16:32:00
|
2140-09-02 17:15:00
|
EXAMINATION: HIP 1 VIEW
TECHNIQUE: Single portable view of the left hip was obtained
COMPARISON: ___ from earlier in the day
FINDINGS:
The patient is status post left hip hemiarthroplasty with a proximal cerclage
wire. There is no evidence of acute hardware related complications or
periprostatic fracture. Contrast opacifies the bladder. Subcutaneous
emphysema is compatible with recent surgery.
IMPRESSION:
Left hip hemiarthroplasty, in overall anatomic alignment.
|
19887608-RR-12
| 19,887,608 | 20,888,673 |
RR
| 12 |
2140-09-03 11:45:00
|
2140-09-03 14:54:00
|
INDICATION: ___ year old woman with hypoxia// ? pulm edema
COMPARISON: CT scan from ___
IMPRESSION:
Heart size is within normal limits. There is minimal atelectasis at the lung
bases. There is no overt pulmonary edema, large pleural effusions, or
pneumothoraces.
|
19887608-RR-13
| 19,887,608 | 20,888,673 |
RR
| 13 |
2140-09-03 17:17:00
|
2140-09-03 19:01:00
|
EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ year old woman with AMS// ? head bleed
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: DLP: 829 mGy-cm
COMPARISON: CT head from ___
FINDINGS:
There is no evidence of acute infarction,hemorrhage,edema, or mass.
Subcortical and periventricular white matter hypodensities are nonspecific,
likely the sequelae of chronic small vessel ischemic disease. 2
There is no evidence of fracture. There is mild mucosal thickening of the
ethmoid air cells and bilateral maxillary sinuses. The visualized portion of
the remaining paranasal sinuses, mastoid air cells, and middle ear cavities
are clear. The visualized portion of the orbits show right lens replacement.
IMPRESSION:
1. No acute intracranial process.
|
19887608-RR-14
| 19,887,608 | 20,888,673 |
RR
| 14 |
2140-09-03 18:04:00
|
2140-09-03 19:49:00
|
INDICATION: ___ year old woman with cough, sob// r/o pna
TECHNIQUE: AP portable chest radiograph
COMPARISON: ___ from earlier in the day
FINDINGS:
Opacities in both lower lungs may reflect atelectasis and/or consolidation. A
small left pleural effusion is also present. No pneumothorax. There is mild
pulmonary vascular congestion. The size of the cardiac silhouette is within
normal limits.
IMPRESSION:
Bibasilar opacities, left greater than right may reflect atelectasis and/or
consolidation. A small left pleural effusion is also present.
|
19887608-RR-15
| 19,887,608 | 20,888,673 |
RR
| 15 |
2140-09-04 08:56:00
|
2140-09-04 12:12:00
|
INDICATION: ___ with altered mental status// pneumonia?
COMPARISON: Radiographs from ___
IMPRESSION:
Heart size is upper limits of normal. There has been worsening of the left
lower lobe consolidation suspicious for pneumonia. There is also a small
left-sided pleural effusion. Patchy opacity at the right base is more
consistent with atelectasis and is stable.
|
19887608-RR-16
| 19,887,608 | 20,888,673 |
RR
| 16 |
2140-09-14 10:43:00
|
2140-09-14 14:05:00
|
EXAMINATION: HIP (UNILAT 2 VIEW) W/PELVIS (1 VIEW) LEFT
INDICATION: ___ year old woman with left hip fracture s/p arthroplasty// s/p
arthroplasty
TECHNIQUE: Frontal view radiograph of the pelvis with additional frontal and
frog-leg lateral views of the left hip.
COMPARISON: Multiple prior radiographs, most recent dated ___.
FINDINGS:
Patient is status post left hip hemiarthroplasty and cerclage wire placement
for a prior femoral neck fracture. Positioning of the prosthesis is anatomic.
Surgical staples seen. There is no fracture or dislocation. Mild degenerative
changes seen in the right hip. Moderate degenerative changes seen in the
lumbar spine. There is no suspicious lytic or sclerotic lesion. There is no
soft tissue calcification or radio-opaque foreign body.
IMPRESSION:
1. No evidence of hardware related complications.
2. Mild degenerative changes of the right hip and moderate degenerative
changes of the lumbar spine.
|
19887933-RR-49
| 19,887,933 | 28,099,240 |
RR
| 49 |
2128-12-20 02:07:00
|
2128-12-20 06:41:00
|
HISTORY: Hepatitis C cirrhosis with fevers. Rule out pneumonia.
COMPARISON: Prior chest radiograph from ___.
TECHNIQUE: PA and lateral chest radiographs.
FINDINGS:
The cardiomediastinal and hilar contours are within normal limits. Lung
volumes are decreased. There is an area of increased opacity at the left lung
base. There is also fluid accumulating in the left major fissure. There is
no pneumothorax.
IMPRESSION:
Increased density at the left lung base concerning for pneumonia with fluid
layering in the left major fissure.
Short interval followup is recommended upon completion of treatment to
document resolution.
|
19887933-RR-50
| 19,887,933 | 28,099,240 |
RR
| 50 |
2128-12-20 14:32:00
|
2128-12-20 21:01:00
|
INDICATION: Increased abdominal distention, abdominal pain, and fever in a
patient with decompensated liver cirrhosis. Evaluate for portal vein
thrombosis, cholecystitis, or other acute process. Mark site for
paracentesis.
COMPARISON: Ultrasound from ___.
FINDINGS: The liver is small in size and nodular in contour, consistent with
cirrhosis. There is no focal liver lesion. There is no intrahepatic or
extrahepatic bile duct dilation. The gallbladder is collapsed. The pancreas
is not well seen. The spleen is enlarged, measuring 16.0 cm. There is
moderate ascites. The imaged portion of the abdominal aorta is unremarkable.
The main portal vein features hepatopetal flow with appropriate velocity.
However, there is reversal of flow in the right and left portal veins. The
umbilical vein is patent. The hepatic veins and IVC are normal.
IMPRESSION:
1. Cirrhosis with sequelae of chronic portal venous hypertension.
2. Reversal of flow in the portal vein branches
3. Moderate ascites. An amenable spot was marked by the radiology resident
in the left flank for paracentesis.
4. Splenomegaly.
|
19887933-RR-51
| 19,887,933 | 28,099,240 |
RR
| 51 |
2128-12-22 09:59:00
|
2128-12-22 11:50:00
|
HISTORY: ___ male with HCV and ETOH cirrhosis with abdominal pain and
distention with fever. Assess for spontaneous bacterial peritonitis.
PROCEDURE: Diagnostic and therapeutic paracentesis.
COMPARISON: Liver/gallbladder ultrasound, ___.
PROCEDURE: Initial four-quadrant ultrasound demonstrates large amount of
intra-abdominal free fluid consistent with ascites. Written informed consent
is in chart. The left lower quadrant was selected given largest pocket of
free fluid. Preprocedure timeout was performed using three patient
identifiers. The skin was prepped and draped in usual sterile fashion.
Approximately, 10 cc of buffered 1% lidocaine was infiltrated into skin and
subcutaneous tissue for local anesthesia. A 5 ___ ___ catheter was passed
into the peritoneum. Subsequently, a 20 cc syringe was attached for
diagnostic fluid. Subsequently, a catheter was attached to the ___ catheter
and wall suction and two liters of clear yellow serous fluid was drained.
There were no immediate complications. The patient was transferred back to
the floor. Dr. ___, the attending radiologist was present during
the procedure.
IMPRESSION: Technically successful diagnostic and therapeutic paracentesis
with 2 liters of clear light yellow serous fluid removed.
|
19887933-RR-52
| 19,887,933 | 28,099,240 |
RR
| 52 |
2128-12-23 16:12:00
|
2128-12-24 13:50:00
|
HISTORY: ___ male with alcoholic cirrhosis and melena with normal EGD
and incomplete colonoscopy. Evaluate for colon mass and source of bleed.
TECHNIQUE: Multi detector scanning is performed from the diaphragm to the
pubic symphysis following the rectal insifflation of CO2 in the supine and RPO
positions. Intravenous contrast was additionally administered.
DLP: 482.56 mGy-cm
COMPARISON: CT abdomen and pelvis dated ___.
FINDINGS:
CT Colonography: There is adequate distention of the cecum, ascending colon,
and transverse colon to the splenic flexure, rectum and distal sigmoid colon
between the supine upright scan. The patient was unable to retain sufficient
volume of gas for successful insufflation of the descending colon. There is a
small amount of residual stool and fluid seen throughout the colon, which does
not interfere with interpretation. There are no mass lesions or polyps
larger than 1cm in the portion of the colon which is insufflated. There are
no diverticulosis.
CT ABDOMEN:
Heart and Lungs: There is a simple fluid is seen in the mjor fissure on the
left. The visualized portion of the heart and pericardium are normal. There
is no pericardial effusions.
Liver: The liver is nodular and shrunken, consistent with known diagnosis of
cirrhosis. No focal lesions are seen. The portal and hepatic veins are
patent. There is no intra or extrahepatic biliary ductal dilatation. The
umbilical vein is recannulized and more dilated as compared to ___. There is
a moderate amount of simple ascites seen throughout the abdomen surrounding
the liver, spleen, and tracking into the pelvis.
Gallbladder: The gallbladder is decompressed and contains multiple calcified
gallstones. There is no common bile duct dilatation.
Spleen: There is splenomegaly.
Adrenals: The adrenal glands are normal in size and shape.
Pancreas: The pancreas enhances homogeneously without peripancreatic fat
stranding or ductal dilatation.
Kidneys: The kidneys are normal in size and display symmetric nephrograms and
contrast excretion. The ureters are normal in caliber along their course to
the bladder. There are no concerning mass lesions in the kidneys. There are
no perinephric abnormalities seen.
Bowel: There is a small hiatal hernia is seen. The stomach is under
distended, but grossly normal. The small bowel does not show abnormal
dilitation. Colon findings are reported above.
Lymph nodes: There are no pathologically enlarged retroperitoneal or
mesenteric lymph nodes by CT size criteria.
Vessels: There is aneurysmal dilatation of the abdominal aorta. The aorta
and major branches are patent. There are multiple splenic, gastric, and
para-umbilical varices seen. Additionally, the large recannalized umbilical
vein is pressing on and indenting the mid-transverse colon anteriorly. No
evidence of active extravasation of contrast to account for melena.
Pelvis: The bladder is relatively well distended and unremarkable. There is
ascites seen tracking into the pelvis. There are no pathologically enlarged
pelvic sidewall or inguinal lymph nodes by CT size criteria.
Osseous structures and soft tissues: There is no hernia seen. There are no
concerning lytic or sclerotic lesions seen in the visualized osseous
structures.
IMPRESSION:
1. There is adequate distention of the cecum, ascending colon, and transverse
colon to the splenic flexure, rectum and distal sigmoid colon between the
supine upright scan. The patient was unable to retain sufficient volume of
gas for successful insufflation of the descending colon. There are no mass
lesions or polyps larger than 1 cm in the portion of the colon which is
insufflated.
2. The large and dilated recannalized umbilical vein is pressing on and
indenting the mid-transverse colon anteriorly.
3. There are multiple splenic, gastric, and para-umbilical varices seen.
4. No evidence of active extravasation of contrast to account for melena.
|
19887933-RR-53
| 19,887,933 | 28,099,240 |
RR
| 53 |
2128-12-25 11:20:00
|
2128-12-25 11:58:00
|
HISTORY: New right PICC.
COMPARISON: ___.
FINDINGS: Frontal radiograph of the chest shows a new right PICC with the tip
of the catheter at the cavoatrial junction. No pneumothorax is seen.
Otherwise, there is continued left basilar opacity, and the cardiac and
mediastinal contours are unchanged.
IMPRESSION: New right PICC with tip at the cavoatrial junction.
|
19887950-RR-18
| 19,887,950 | 26,297,591 |
RR
| 18 |
2162-05-11 19:24:00
|
2162-05-11 20:55:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with SBO s/p NGT insertion// assess NG tube
position
TECHNIQUE: AP portable chest radiograph
COMPARISON: None
FINDINGS:
The tip of the feeding tube extends to the stomach. There is no focal
consolidation, pleural effusion or pneumothorax identified. The size of the
cardiomediastinal silhouette is within normal limits.
IMPRESSION:
The tip of the nasogastric tube extends to the stomach.
|
19887950-RR-19
| 19,887,950 | 26,297,591 |
RR
| 19 |
2162-05-12 02:13:00
|
2162-05-12 12:04:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ S/P EXLAP, SBR, PORT SITE HERNIA REPAIR// ?POSITION OF NGT
?POSITION OF NGT
IMPRESSION:
Compared to chest radiograph on ___.
Lung volumes are much lower making it difficult to exclude minimal pulmonary
edema.
Heart size is normal. No pleural abnormality.
Endotracheal tube cannulates the orifice of the right main bronchus and should
be withdrawn 3.5 cm. Nasogastric drainage tube is coiled in the stomach.
NOTIFICATION: The findings were discussed with ___
, M.D. by ___, M.D. on the telephone on ___ at 9:34 am, 5
minutes after discovery of the findings.
|
19887950-RR-20
| 19,887,950 | 26,297,591 |
RR
| 20 |
2162-05-12 13:37:00
|
2162-05-12 15:55:00
|
EXAMINATION: CHEST PORT. LINE PLACEMENT
INDICATION: ___ year old woman with IJ placement// eval IJ line Contact
name: ___: ___
TECHNIQUE: Portable chest radiograph
COMPARISON: ___
FINDINGS:
New right-sided IJ line with tip terminating at the cavoatrial junction. ET
tube is pulled back and is now 2 cm above the carina. Enteric tube is seen to
descend below the diaphragm but the tip is not visualized on the margins of
this exam. Stable cardiomegaly. There is no pneumothorax. Bibasilar
atelectasis is noted.
IMPRESSION:
1. New right-sided IJ with tip at the cavoatrial junction. No complications,
including no pneumothorax.
2. ET tube intervally pulled back and is now 2 cm above the carina.
|
19887950-RR-21
| 19,887,950 | 26,297,591 |
RR
| 21 |
2162-05-13 05:23:00
|
2162-05-13 08:44:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with ETT// eval ETT
TECHNIQUE: Chest AP view
COMPARISON: ___
IMPRESSION:
Lungs are low volume with worsening pulmonary edema. Support lines and tubes
are unchanged. Cardiomediastinal silhouette is stable. Bilateral effusions
left greater than right are unchanged. No pneumothorax is seen
|
19887950-RR-23
| 19,887,950 | 26,297,591 |
RR
| 23 |
2162-05-14 05:00:00
|
2162-05-14 10:00:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ with fibroids and menorrhagia s/p TLH-BS ___ p/w SBO
with TP in a right-sided port site hernia// ETT placement
IMPRESSION:
In comparison with study of ___, a the monitoring and support devices
are unchanged. Again there are extremely low lung volumes. Extensive
bilateral pulmonary opacifications again are consistent with pulmonary edema.
However, in the appropriate clinical setting, superimposed
aspiration/pneumonia would have to be seriously considered.
Hazy opacification of the left hemithorax with obscuration of the
hemidiaphragm is consistent with substantial layering pleural effusion.
|
19887950-RR-24
| 19,887,950 | 26,297,591 |
RR
| 24 |
2162-05-15 05:16:00
|
2162-05-15 10:28:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ with fibroids and menorrhagia s/p TLH-BS ___ p/w SBO
with TP in a right-sided port site hernia// ETT placement, eval for pulm edema
or pna
TECHNIQUE: Portable chest radiograph
COMPARISON: ___
FINDINGS:
The ET tube is stable in terminates 3 cm above the carina. Right-sided IJ
terminates at the lower SVC. An NG tube is seen to descend below the
diaphragm and the tip terminates within the stomach. There is again low lung
volumes. There are diffuse bilateral airspace opacities consistent with
severe pulmonary edema that appears to be mildly improved compared to
yesterday's study. Superimposed aspiration or pneumonia would be difficult to
exclude. Mild improvement of left-sided effusion and atelectasis.
IMPRESSION:
There is still severe pulmonary edema that is mildly decreased compared to
yesterday's study. Cannot exclude pneumonia in the appropriate clinical
setting.
|
19887950-RR-25
| 19,887,950 | 26,297,591 |
RR
| 25 |
2162-05-14 21:16:00
|
2162-05-14 22:26:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with SBO s/p SBR, intubated, increasing PEEP,
worsening PaO2// Increasing PEEP, worsening PaO2, please evaluate ?process,
thanks.
TECHNIQUE: AP portable chest radiograph
COMPARISON: ___ from earlier in the day
FINDINGS:
The supporting lines and tubes are unchanged. There are low bilateral lung
volumes with diffuse bilateral airspace opacities consistent with severe
pulmonary edema. Superimposed aspiration/pneumonia would be hard to exclude.
Layering pleural effusion on the left is unchanged.
IMPRESSION:
No significant interval change since the radiograph performed earlier today.
|
19887950-RR-26
| 19,887,950 | 26,297,591 |
RR
| 26 |
2162-05-16 05:20:00
|
2162-05-16 10:25:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with ETT// eval ETT
TECHNIQUE: Portable chest radiograph
COMPARISON: ___
FINDINGS:
ET tube terminates 3 cm above the carina. Right-sided IJ catheter is in
stable positioning. Feeding tube is seen to terminate within the stomach
however appears to be slightly pulled back compared to yesterday and the side
port is not visualized. There is redemonstration of low lung volumes. There
is no pneumothorax. There is mild improvement of extensive pulmonary edema.
IMPRESSION:
1. Mild improvement of extensive pulmonary edema.
2. NG tube is slightly pulled back and the side port is not seen and may be
above the gastroesophageal junction.
|
19887950-RR-27
| 19,887,950 | 26,297,591 |
RR
| 27 |
2162-05-15 12:55:00
|
2162-05-15 13:48:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with OG tube// eval OG tube placement
IMPRESSION:
In comparison with the earlier study of this date, the orogastric tube is been
pushed forward so that it coils in the fundus of the stomach. The side-port
is clearly beyond the esophagogastric junction.
Little overall change in the appearance of the heart and lungs.
|
19887950-RR-28
| 19,887,950 | 26,297,591 |
RR
| 28 |
2162-05-17 05:43:00
|
2162-05-17 10:23:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ with fibroids and menorrhagia s/p TLH-BS ___ p/w SBO
with TP in a right-sided port site hernia// location of NG tube?
TECHNIQUE: Chest PA
COMPARISON: ___
FINDINGS:
ET tube terminates 2.5 cm above the carina.
Right-sided IJ catheter is in stable position.
Enteric tube terminates in the stomach and EKG leads overlie the chest wall.
The lung volumes are low with improved pulmonary edema.
Small bilateral pleural effusions.
Cardiomediastinal silhouette is unchanged.
Visualized bones appear unremarkable.
IMPRESSION:
Persistent but improved mild pulmonary edema with low lung volumes. Small
bilateral pleural effusions.
Lines and tubes as above. The enteric tube is likely pushed back in position
and now terminates appropriately with the side-port in the stomach.
|
19887950-RR-29
| 19,887,950 | 26,297,591 |
RR
| 29 |
2162-05-18 05:11:00
|
2162-05-18 11:41:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with pulmonary edema// interval change?
TECHNIQUE: Chest AP portable
COMPARISON: ___ the ET tube tip is 2 cm above the carina. The
nasogastric tube is coursing below the left hemidiaphragm with the tip
projecting likely in the stomach.
Right internal jugular central venous line tip overlies the distal SVC.
There are bilateral diffuse airspace opacities, slightly worse since prior
examination. The lung volumes remain low. There is no pneumothorax. The
cardiomediastinal silhouette is unchanged.
FINDINGS:
Worsening bilateral airspace opacities.
|
19887950-RR-30
| 19,887,950 | 26,297,591 |
RR
| 30 |
2162-05-18 13:14:00
|
2162-05-18 15:22:00
|
EXAMINATION: CT abdomen and pelvis without contrast
INDICATION: ___ with fibroids and menorrhagia s/p TLH-BS ___ p/w SBO
with TP in a right-sided port site ___ OR OSH- ___ OR-Dx
laparoscopy reduction of port site hernia-> exlap, SBR, open abd with
___ OR- exlap, abd washout, small intestine anastomosis, abd
closure// *PLEASE GIVE PO CONTRAST* please evaluate for intraabdominal process
for recurrent high fever
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: Dose data not available at time of reporting
COMPARISON: Outside CT from ___.
FINDINGS:
LOWER CHEST: There is diffuse bilateral airspace consolidation involving
primarily the visualized left upper lobe and lingula, but also the lower
lobes. There is bibasal atelectasis and a small left pleural effusion.
ABDOMEN:
HEPATOBILIARY: Liver is diffusely hypoattenuating in keeping 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 at least moderately distended but there are no
evident pericholecystic inflammatory changes.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions within the limitations of an unenhanced scan. There is no
peripancreatic stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
punctate calcified granuloma.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size. There is no evidence
of focal renal lesions within the limitations of an unenhanced scan. There is
no hydronephrosis. There is no nephrolithiasis. There is no perinephric
abnormality.
GASTROINTESTINAL: Oral contrast has passed to the mid small bowel. Caliber of
small bowel loops has decreased relative to the previous study, and a few
remain mildly dilated at up to 3.5 cm. Overall, there is no convincing
evidence of a high-grade obstruction.
There is small to moderate volume ascites, with prominent locule in the
perisplenic region. There appears to be extension of the locule into the
chest by the diaphragmatic hiatus. There is suboptimal evaluation for rim
enhancing abscess on noncontrast CT.
PELVIS: There is a Foley catheter in the bladder.
REPRODUCTIVE ORGANS: Status post hysterectomy. No adnexal masses are seen.
LYMPH NODES: There a few mildly prominent mesenteric nodes, the largest
measuring 11 mm. These are likely reactive. There is no pelvic or inguinal
lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: There are postsurgical changes in the lower abdominal wall.
There is diffuse subcutaneous edema. There is no drainable Fluid collection
seen. There is been interval resolution of the ovoid collection in the Left
anterior abdominal wall musculature.
IMPRESSION:
1. Bilateral airspace consolidation has been further evaluated on radiographs
from today and is concerning for multifocal infection.
2. Moderate to small volume simple Fluid ascites, including prominent a
loculation in the perisplenic region, possibly related to recent surgery.
Suboptimal evaluation for rim enhancing abscess without IV contrast.
3. Interval improvement of small bowel dilation.
|
19887950-RR-31
| 19,887,950 | 26,297,591 |
RR
| 31 |
2162-05-19 05:40:00
|
2162-05-19 09:58:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with intubation, bilateral fluid overload//
eval ARDS
TECHNIQUE: Portable AP radiograph of the chest.
COMPARISON: Radiograph of the chest performed 23 hours prior.
FINDINGS:
Mild-to-moderate cardiomegaly is unchanged compared to the prior exam. The ET
tube terminates approximately 25 mm above the carina. A enteric tube extends
below the diaphragm with the tip likely within the body the stomach.
Right-sided IJ line terminates within the mid to lower SVC. Pulmonary
vascular congestion is unchanged. Diffuse bilateral moderate to severe
airspace opacities are persistent. No evidence of pneumothorax.
IMPRESSION:
Overall, stable appearance of the bilateral airspace opacities compared to the
exam performed 23 hours prior.
|
19887950-RR-32
| 19,887,950 | 26,297,591 |
RR
| 32 |
2162-05-19 09:24:00
|
2162-05-19 12:09:00
|
EXAMINATION: RENAL U.S.
INDICATION: ___ female with fibroids and menorrhagia status post
TLH-BS ___ presenting with small bowel obstruction with tenderness to
palpation in a right-sided port site hernia. Now with increasing creatinine.
Evaluate for acute process.
TECHNIQUE: Grey scale and color Doppler ultrasound images of the kidneys were
obtained.
COMPARISON: CT abdomen pelvis performed ___.
FINDINGS:
There is a suggestion of a duplex collecting system in the right kidney, a
normal variant. There is no hydronephrosis, stones, or masses bilaterally.
Normal cortical echogenicity and corticomedullary differentiation are seen
bilaterally.
Right kidney: 11.5 cm
Left kidney: 11.9 cm
The bladder is only minimally distended with Foley catheter in place and can
not be fully assessed on the current study.
IMPRESSION:
Normal renal ultrasound.
|
19887950-RR-33
| 19,887,950 | 26,297,591 |
RR
| 33 |
2162-05-20 05:32:00
|
2162-05-20 09:12:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ with fibroids and menorrhagia s/p TLH-BS ___ p/w SBO
with TP in a right-sided port site hernia// eval for pna, fluid overload, ETT
placement eval for pna, fluid overload, ETT placement
IMPRESSION:
Comparison to ___. The tip of the endotracheal tube projects 25
mm above the carina. All other monitoring and support devices are also in
correct position. Minimally increased lung volumes. The extent and severity
of the extensive diffuse bilateral parenchymal opacities is stable. No
pleural effusions. Borderline size of the cardiac silhouette.
|
19887950-RR-34
| 19,887,950 | 26,297,591 |
RR
| 34 |
2162-05-21 05:39:00
|
2162-05-21 09:13:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with hypoxic respiratory failure// interval
change interval change
IMPRESSION:
Stable correct position of the monitoring and support devices. Stable
moderate pulmonary edema. No pleural effusions. Retrocardiac atelectasis but
no evidence of pneumonia.
|
19887950-RR-35
| 19,887,950 | 26,297,591 |
RR
| 35 |
2162-05-22 04:44:00
|
2162-05-22 10:28:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ with fibroids and menorrhagia s/p TLH-BS ___ p/w SBO
with TP in a right-sided port site hernia// eval for fluid overload, pna
eval for fluid overload, pna
IMPRESSION:
Comparison to ___. The pre-existing parenchymal opacities have
slightly increased, which is in part caused by the decreased lung volumes.
Moderate cardiomegaly persists. No pleural effusions. No pneumothorax. The
monitoring and support devices are in stable correct position.
|
19887950-RR-36
| 19,887,950 | 26,297,591 |
RR
| 36 |
2162-05-23 05:24:00
|
2162-05-23 10:01:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with mild ARDS, intubated.// are her lung field
improving?
TECHNIQUE: Portable supine radiograph of the chest.
COMPARISON: Radiograph of the chest performed 1 day prior.
FINDINGS:
The endotracheal tube terminates approximately 11 mm above the carina and is
low lying. Mild pulmonary vascular congestion and mild pulmonary edema
appears overall unchanged compared to the prior exam. Increased opacities are
seen overlying the right hemithorax. A enteric tube extends below the
diaphragm with the tip within the body of stomach. Right-sided IJ catheter
terminates at the level of the mid SVC. There is no evidence of pneumothorax.
IMPRESSION:
-Stable mild pulmonary vascular congestion and mild pulmonary edema.
-Interval increase in opacities overlying the right hemithorax, could be seen
in setting of worsening aspiration/infection.
-Low lying endotracheal tube terminating approximately 11 mm above the carina
and must be retracted.
NOTIFICATION: The findings were discussed with Dr. ___. by ___
___, M.D. on the telephone on ___ at 9:58 am, 2 minutes after
discovery of the findings.
|
19887950-RR-37
| 19,887,950 | 26,297,591 |
RR
| 37 |
2162-05-24 05:32:00
|
2162-05-24 10:00:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ with fibroids and menorrhagia s/p TLH-BS ___ p/w SBO
with TP in a right-sided port site hernia// f/u pulm edema, fluid overload
TECHNIQUE: Frontal chest
COMPARISON: ___
FINDINGS:
There is a new percutaneous drain in the left upper abdomen. No change in
patchy bilateral airspace opacities. The heart cannot be measured with
certainty although is unchanged. The ETT is 2 cm above the carina, as on
prior. The right IJ is in the distal SVC. The enteric tube ends in the mid
stomach. No pneumothorax. Small left pleural effusion is unchanged.
IMPRESSION:
Redemonstration of diffuse airspace opacities. New percutaneous drain in the
left upper quadrant. ETT remains 2 cm above the carina. No additional
interval change.
|
19887950-RR-38
| 19,887,950 | 26,297,591 |
RR
| 38 |
2162-05-23 17:33:00
|
2162-05-23 19:22:00
|
EXAMINATION: CT GUIDED DRAINAGE PERISPLENIC COLLECTION.
INDICATION: ___ with fibroids and menorrhagia s/p TLH-BS ___ p/w SBO
with TP in a right-sided port site hernia// perisplenic fluid collection
drainage.
COMPARISON: ___.
PROCEDURE: CT-guided drainage of PERISPLENIC collection.
OPERATORS: Dr. ___, radiology fellow and Dr. ___, attending
radiologist. Dr. ___ supervised the trainee during the key
components of the procedure and reviewed and agrees 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 CT scan table. Limited
preprocedure CT scan was performed to localize the collection. Based on the
CT findings an appropriate skin entry site for the drain placement was chosen.
The site was marked. Local anesthesia was administered with 1% Lidocaine
solution.
Using intermittent CT fluoroscopic guidance, an ___ Exodus pigtail
catheter was placed into the collection using trocar technique. The trocar
was removed and the pigtail was deployed. The position of the pigtail was
confirmed within the collection via CT fluoroscopy.
Approximately 100 cc of cloudy yellow fluid was aspirated with a sample sent
for microbiology evaluation. The catheter was secured by a Flexitrack. The
catheter was attached to bag. Sterile dressing was applied.
The procedure was tolerated well, and there were no immediate post-procedural
complications.
DOSE: Acquisition sequence:
1) Spiral Acquisition 8.6 s, 26.3 cm; CTDIvol = 11.3 mGy (Body) DLP = 282.8
mGy-cm.
Total DLP (Body) = 293 mGy-cm.
SEDATION: Moderate sedation was provided by administering divided doses
during which patient's hemodynamic parameters were continuously monitored by
an independent trained radiology nurse.
FINDINGS:
Preprocedure imaging re-demonstrates perisplenic fluid collection.
IMPRESSION:
Successful CT-guided placement of an ___ pigtail catheter into the
collection. Samples were sent for microbiology evaluation.
|
19887950-RR-39
| 19,887,950 | 26,297,591 |
RR
| 39 |
2162-05-25 15:22:00
|
2162-05-25 17:14:00
|
EXAMINATION: CHEST PORT. LINE PLACEMENT
INDICATION: ___ year old woman with newly placed left PICC 40 cm// new PICC
Contact name: ___: ___
TECHNIQUE: AP portable chest radiograph
COMPARISON: ___
FINDINGS:
The tip of the left PICC line projects over the distal SVC. A right internal
jugular central catheter tip projects over the mid SVC. A catheter projects
over the left hemidiaphragm and an enteric tube extends to the stomach.
There are low bilateral lung volumes with unchanged patchy bilateral airspace
opacities. The size of the cardiac silhouette is unchanged.
IMPRESSION:
The tip of a left PICC line projects over the distal SVC. No pneumothorax.
Persisting patchy airspace opacities.
|
19887950-RR-40
| 19,887,950 | 26,297,591 |
RR
| 40 |
2162-05-26 04:32:00
|
2162-05-26 11:06:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with pulm edema and tachypnea// is her pulm
edema improved.
TECHNIQUE: Chest AP
COMPARISON: Comparison to multiple prior radiograph studies dated from ___ to ___.
FINDINGS:
Lung volumes are decreased. Cardiomediastinal silhouette appears unchanged.
There are increased interstitial opacities bilaterally, concerning for
worsening pulmonary edema. Unchanged patchy parenchymal opacities overlying
the right hemithorax. No pneumothorax. Left PICC line is in stable position
with tip terminating in the mid SVC. Left pigtail catheter is in unchanged
position. Interval removal of the enteric tube and right IJ central line.
IMPRESSION:
Interval increased moderate to severe pulmonary edema.
|
19887950-RR-41
| 19,887,950 | 26,297,591 |
RR
| 41 |
2162-05-27 05:14:00
|
2162-05-27 09:08:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ with fibroids and menorrhagia s/p TLH-BS ___ p/w SBO
with TP in a right-sided port site hernia.// eval interval changes eval
interval changes
IMPRESSION:
Compared to chest radiographs ___ through ___.
Severe widespread infiltrative pulmonary abnormality is probably combination
of multifocal pneumonia and pulmonary edema, has worsened generally since
___, stable since ___. Pleural effusions small if any. Heart
size indeterminate. No pneumothorax.
Left PIC line ends in low SVC. Pigtail drainage catheter projects over the
left diaphragmatic region but cannot be localized on a single frontal view.
|
19887950-RR-42
| 19,887,950 | 26,297,591 |
RR
| 42 |
2162-05-28 04:43:00
|
2162-05-28 09:54:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ with fibroids and menorrhagia s/p TLH-BS ___ p/w SBO
with TP in a right-sided port site hernia now s/p diagnostic lap converted to
exlap, reduction of port site hernia, SBR, bowel left in discontinuity, open
abd with abethera placement, hypotensive requiring pressor// interval change
interval change
IMPRESSION:
Comparison to ___. Low lung volumes persist. The extent and
severity of the pre-existing opacities has minimally decreased but the
opacities are still clearly present. Borderline size of the cardiac
silhouette no pleural effusions. Stable correct position of the left PICC
line.
|
19887950-RR-43
| 19,887,950 | 26,297,591 |
RR
| 43 |
2162-05-29 17:33:00
|
2162-05-29 18:17:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ y/o F w/ leukocytosis// evaluate for pneumonia
TECHNIQUE: AP portable chest radiograph
COMPARISON: ___
FINDINGS:
The tip of a left PICC line projects over the mid SVC.
There are low bilateral lung volumes with interval decrease in extent of
diffuse bilateral airspace opacities. No pleural effusion or pneumothorax.
The size and appearance of the cardiomediastinal silhouette is unchanged.
IMPRESSION:
Interval decrease in extent of diffuse bilateral parenchymal opacities.
|
19887950-RR-44
| 19,887,950 | 26,297,591 |
RR
| 44 |
2162-05-29 20:55:00
|
2162-05-29 22:29:00
|
INDICATION: ___ s/p TAH/BSO ___ (fibroids) p/w SBO w TP in port site
hernia s/p lap->open exploration, hernia repair, SBR (for jejunal perf) left
in discontinuity now s/p SB-SB anastomosis closure// Worsening clinical
status, increasing WBC. Interval assessment. Please give ORAL AND IV CONTRAST.
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 4.2 s, 55.2 cm; CTDIvol = 16.1 mGy (Body) DLP = 885.0
mGy-cm.
2) Stationary Acquisition 0.6 s, 0.5 cm; CTDIvol = 3.4 mGy (Body) DLP = 1.7
mGy-cm.
3) Stationary Acquisition 6.0 s, 0.5 cm; CTDIvol = 33.6 mGy (Body) DLP =
16.8 mGy-cm.
Total DLP (Body) = 904 mGy-cm.
COMPARISON: Prior CT abdomen done ___
FINDINGS:
LOWER CHEST: Bilateral lower lung zone airspace opacification is concerning
for multifocal pneumonia, which appears fairly similar compared to prior
imaging. Left-sided pleural effusion is small and also similar compared to
prior. No 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: Pigtail catheter in situ in the perisplenic collection with the
collection being decreased in size compared to prior imaging.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The left kidney demonstrates delayed enhancement compared to the
right. Small wedge-shaped peripheral hypodensity in the medial upper pole of
the left kidney (series 601, image 43) may represent a small infarct. The
left renal artery and vein appears grossly patent. No hydronephrosis there is
no perinephric abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. No extravasation
of oral contrast from the small bowel. The oral contrast has not reached the
large bowel. The colon and rectum are within normal limits. The appendix is
not visualized. There is a large left abdominal/paracolic gutter collection
extending from the left upper quadrant inferiorly to the lower anterior left
abdomen with crude measurements in the coronal plane of 60 x ___ mm. It
appears organized/walled-off and is increased in size compared to prior.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: The patient is status post hysterectomy and BSO.
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: Midline ventral abdominal incision defect is noted.
IMPRESSION:
1. There is an organized/walled-off collection in the left abdomen which is
increased in size compared to prior. This collection is amenable to
percutaneous drainage.
2. There is no extravasation of oral contrast from the small bowel.
3. Pigtail catheter is seen in the perisplenic collection, this collection is
decreased in size compared to prior imaging.
4. Hypoenhancement of the left kidney compared to the right with associated
small peripheral wedge-shaped hypodensity (suspected infarct) suggests left
renal vascular compromise. The left renal artery and vein appears grossly
patent. No hydronephrosis. Nephrology/urology consult advised
5. Bilateral lower lung zone airspace opacification/pneumonia with small
left-sided pleural effusion appears fairly similar compared to prior.
NOTIFICATION: The findings were discussed by Dr. ___ with
Dr. ___ on the telephoneon ___ at 10:27 pm, 10 minutes after
discovery of the findings.
|
19887950-RR-45
| 19,887,950 | 26,297,591 |
RR
| 45 |
2162-05-30 08:28:00
|
2162-05-30 10:05:00
|
EXAMINATION: US RENAL ARTERY DOPPLER
INDICATION: ___ year old woman with renal wedge shaped infarction CT scan//
Evaluation of renal vasculature
TECHNIQUE: Grey scale, color and spectral Doppler ultrasound images of the
kidneys were obtained.
COMPARISON: CT abdomen and pelvis ___.
FINDINGS:
There is no hydronephrosis, stones, or masses bilaterally. Normal cortical
echogenicity and corticomedullary differentiation are seen bilaterally.
Right kidney: 11.6 cm
Left kidney: 12.7 cm
Renal Doppler: Intrarenal arteries show normal waveforms with sharp systolic
peaks and continuous antegrade diastolic flow. The resistive indices of the
right intra renal arteries range from 0.77-0.83. The resistive indices on the
left range from 0.77-0.8. Overall, detailed evaluation of the resistive
indices was somewhat limited. Bilaterally, the main renal arteries are patent
with normal waveforms. The peak systolic velocity on the right is 128
centimeters/second. The peak systolic velocity on the left is 77
centimeters/second. Main renal veins are patent bilaterally with normal
waveforms.
The bladder is moderately well distended and normal in appearance.
IMPRESSION:
Normal bilateral resistive indices and no evidence of renal artery stenosis.
Findings of left renal infarct and hypoperfusion are better assessed by the
prior CT examination.
|
19887950-RR-46
| 19,887,950 | 26,297,591 |
RR
| 46 |
2162-05-30 16:25:00
|
2162-05-30 18:44:00
|
EXAMINATION: CT-GUIDED DRAINAGE
INDICATION: ___ s/p TAH/BSO ___ (fibroids) p/w SBO w TP in port site
hernia s/p lap->open exploration, hernia repair, SBR (for jejunal perf) left
in discontinuity now s/p SB-SB anastomosis closure.// large left
abdominal/paracolic gutter collection extending from the left upper quadrant
inferiorly to the lower anterior left abdomen with crude measurements in the
coronal plane of 60 x ___ mm
COMPARISON: Correlation with CT abdomen and pelvis from ___.
PROCEDURE: CT-guided drainage of left anterior intraperitoneal collection.
OPERATORS: Dr. ___, radiology trainee and Dr. ___, attending
radiologist. Dr. ___ supervised the trainee during the key
components of the procedure and reviewed and agrees 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 CT scan table. Limited
preprocedure CT scan was performed to localize the collection. Based on the
CT findings an appropriate skin entry site for the drain placement was chosen.
The site was marked. Local anesthesia was administered with 1% Lidocaine
solution.
Using intermittent CT fluoroscopic guidance, an 18-G ___ needle was
inserted into the collection. A sample of fluid was aspirated, confirming
needle position within the collection. 0.038 ___ wire was placed through
the needle and needle was removed. This was followed by placement of a
___ Exodus pigtail catheter into the collection. The stiffener and the
wire were removed. The pigtail was deployed. The position of the pigtail was
confirmed within the collection via CT fluoroscopy.
Approximately 250 cc of purulent fluid was aspirated with a sample sent for
microbiology evaluation. The catheter was secured by a StatLock. The catheter
was attached to suction bulb. Sterile dressing was applied.
Limited post drainage scan showed near complete resolution of the main
collection. There was a residual smaller component superiorly, lateral to the
splenic flexure of colon. This was accessed with an 18 gauge ___ needle
and an additional 30 cc purulent fluid was aspirated. No drain was placed at
this location.
The procedure was tolerated well, and there were no immediate post-procedural
complications.
DOSE: Dose information not available at time of reporting.
SEDATION: Moderate sedation was provided by administering divided doses of 2
mg Versed and 150 mcg fentanyl throughout the total intra-service time of 35
minutes during which patient's hemodynamic parameters were continuously
monitored by an independent trained radiology nurse.
FINDINGS:
1. On scout images of the abdomen and pelvis, a multilobulated Fluid
collection was present in the left anterior abdomen, similar in size and
configuration to this CT from yesterday.
2. Catheter positioned was satisfactory. Purulent fluid was aspirated. The
major portion of the collection was essentially resolved post aspiration and
the catheter was left in place. There was minimal residual fluid in the
superior component of the collection post aspiration, which is most likely
communicating with the more inferior components of the collection and with the
catheter.
ADDITIONAL FINDINGS ON PRE-PROCEDURE SCOUT IMAGES:
The field of view covers from the lung bases to the mid pelvis. There is a
pigtail drain in the left perisplenic region in stable position, with
unchanged appearance of small residual collection here. No new collections
are demonstrated. There are postsurgical changes in the abdomen and the
anterior abdominal wall. Note is also made of a stable small left pleural
effusion with associated basal atelectasis, as well as stable patchy bilateral
airspace consolidation at the lung bases. Findings related to the left kidney
described on the previous CT are not demonstrated on the present unenhanced
scan. There is no significant free-fluid.
IMPRESSION:
Successful CT-guided placement of a ___ pigtail catheter into the left
intra-abdominal collection, with aspiration of a total of 280 cc purulent
fluid. Samples were sent for microbiology evaluation.
|
19887950-RR-47
| 19,887,950 | 26,297,591 |
RR
| 47 |
2162-06-02 18:08:00
|
2162-06-02 19:32:00
|
EXAMINATION:
CT angiography of the abdomen and pelvis.
INDICATION: ___ y/o female; uterine fibroids s/p TLH-BS on ___
readmittedwith abd pain/distension on ___ SBO on CT scan; small
bowelperforation; underwent ex-lap with decompression, jejunal resection;
repair incarceratedhernia ___ followed by abdominal washout, small
intestineanastomosis and abdominal closure on ___ with findings of
aperisplenic fluid collection s/p drainage ___ with polymicrobialgrowth.//
pelvic vein thrombus?
TECHNIQUE: Following acquisition of a noncontrast scan of the abdomen and
pelvis, multidetector CT images of the abdomen and pelvis were obtained with
intravenous contrast in delayed phase. Sagittal and coronal reformations are
included.
DOSE: Acquisition sequence:
1) Spiral Acquisition 3.4 s, 54.7 cm; CTDIvol = 3.3 mGy (Body) DLP = 177.7
mGy-cm.
2) Spiral Acquisition 4.1 s, 54.7 cm; CTDIvol = 13.1 mGy (Body) DLP = 715.4
mGy-cm.
Total DLP (Body) = 893 mGy-cm.
COMPARISON: Recent CT of the abdomen and pelvis from ___.
FINDINGS:
At each lung base, multifocal consolidations are unchanged consistent with
multifocal pneumonia. A right posterior basilar pulmonary nodule measures up
to 6 mm (03:22) without short-term change. An organized left-sided pleural
effusion with loculation and partial rim measures up to 68 x 27 mm, previously
up to 74 x 35 mm, mildly decreased. Calcified granulomas are again found in
the left hilum.
No focal liver lesions are identified. Hypoattenuating enlarged liver is
consistent with steatosis. There is no biliary dilatation. Gallbladder
appears normal. Pancreas appears normal. Spleen is normal in size. Splenic
cyst appears unchanged. Adrenals are unremarkable. Right kidney appears
normal. The left again shows a delayed attenuated nephrogram wall with mild
wall thickening along the upper ureter but only minimal dilatation of the
upper ureter. Small defect along the medial left upper pole appears
unchanged.There is no hydro nephrosis. Distal left is not dilated and
difficult to follow.
The stomach is unremarkable. The proximal jejunum again shows mild wall
thickening, which can probably be attributed to peritoneal inflammation.
Small bowel small bowel anastomosis can be seen in the epigastric region.
Large bowel appears normal.
Patient is status post hysterectomy. Adnexa appear normal. Bladder is
unremarkable. There is no lymphadenopathy. There is no free air or ascites.
Systemic veins including pelvic veins are well opacified for review. There is
no evidence for venous thrombosis. Separate origins for the splenic and
common hepatic arteries is a normal variant. Arterial structures are
otherwise unremarkable.
A pigtail catheter terminates in a rim enhancing left subphrenic collection
that has increased in size. It is irregular in shape but the main part
measures up to 74 x 64 mm in axial dimension. Previously whole collection
appeared is a thin crescent and measured only up to 16 mm in width.
Subphrenic collection measures up to 44 mm in height, previously only 10 mm.
In the left lower quadrant, a second percutaneous pigtail catheter terminates
in a nearly collapsed collection. Previously, before drainage, that
collection had measured over 10 cm in length. Residual rim enhancing
collection at the site now measures only up to 49 x 11 mm in axial ___,
nearly collapsed.
There is air enhancement and stranding in the incision site in the midline
which is nonspecific.
There are no suspicious bone lesions. Vertebral body heights and interspaces
appear preserved in height.
IMPRESSION:
1. Increase in size of left subphrenic rim enhancing collection, despite
presence of in situ pigtail catheter. Correlation with catheter output is
recommended. Second more inferior pigtail catheter lies in a nearly collapsed
collection immediately deep to the abdominal wall in the left lower quadrant.
2. No significant change in multifocal consolidations at each lung base most
consistent with pneumonia. Slight decrease in persistent loculated, semi
organized left pleural collection. Empyema is not excluded.
3. Persistent attenuated delayed nephrogram of the left kidney. Despite the
lack of substantial hydroureteronephrosis, possibility of some degree of
obstruction should be considered. It may be appropriate to consider urology
consultation, if needed clinically, in addition to correlation with laboratory
data.
4. Hepatic steatosis.
5. No short-term change in 6 mm nodule in the right lower lobe. If there are
risk factors such as smoking, strong family history of pulmonary malignancy,
or occupational exposure, follow-up CT could be considered in one year.
6. No evidence of deep vein thrombosis.
|
19888315-RR-21
| 19,888,315 | 28,965,100 |
RR
| 21 |
2201-03-22 16:08:00
|
2201-03-22 16:33:00
|
EXAMINATION: CTA HEAD AND NECK WITH PERFUSION
INDICATION: ___ with aphasia, negative noncontrast CT at ___. Evaluate
for acute thrombosis.
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. CT perfusion studies also performed. Three-dimensional
angiographic volume rendered, curved reformatted and segmented images were
generated. This report is based on interpretation of all of these images.
DOSE: DLP: 3754.96 mGy-cm; CTDI: 367.04 mGy
COMPARISON: CTA head and neck of ___.
FINDINGS:
HEAD CT:
Multiple chronic infarcts are again seen, including the right thalamus,
caudate, and left carina radiata/lentiform nucleus/external capsule, the
latter with associated ex vacuo enlargement of the anterior body of the left
lateral ventricle. There also confluent areas of low density in the
subcortical, deep, and periventricular white matter of the cerebral
hemispheres, nonspecific but the sequela of chronic microangiopathy. There is
no acute intracranial hemorrhage and no evidence for an acute major vascular
territorial infarct. There is stable global cerebral volume loss with
associated prominence of the ventricles and sulci.
No suspicious blastic or lytic osseous lesions. Moderate mucosal thickening
of the maxillary sinuses as well as partial opacification of the ethmoid air
cells and milder mucosal thickening of the frontal and sphenoid sinuses are
identified. The mastoid air cells middle ear cavities are well pneumatized
and clear.
CT PERFUSION:
Nondiagnostic secondary to technical factors.
NECK CTA:
There is common origin of the right brachiocephalic and left common carotid
arteries. The carotid and vertebral arteries and their major branches are
patent with no evidence of stenoses. There is mild atherosclerotic
calcification of the bilateral carotid bifurcations without cervical internal
carotid stenosis by NASCET criteria. There is a retropharyngeal course of the
left common and cervical internal carotid arteries.
HEAD CTA:
Atherosclerotic calcification of the bilateral cavernous and supra clinoid
ICAs is noted without evidence for flow-limiting stenosis. Anterior and
middle cerebral arteries are patent. The right vertebral artery is diminutive
distal to the ___ with a calcification at the mid V4 segment and
apparent chronic occlusion of the distal V4 segment. The left vertebral
artery is dominant. There is no flow-limiting stenosis elsewhere in the
posterior circulation. There is fetal origin of the right PCA. There is no
evidence for an aneurysm.
OTHER:
There is bronchiectasis and bronchial wall thickening in the visualized upper
lungs bilaterally, with a bronchial thickening apparently new compared to
___, which may be infectious or an fine. The upper lobe
demonstrates a calcified granuloma and there are multiple calcified
mediastinal lymph nodes, compatible with prior granulomatous disease.
Palatine and left lingual tonsilliths are identified. There is mass effect on
the posterior aspect of the left pharynx secondary to retropharyngeal course
of the left common and internal carotid arteries. There is no evidence for an
exophytic mucosal mass.
Severe multilevel cervical spondylosis resulting in spinal canal narrowing and
neural foraminal narrowing is identified, previously assessed by MRI on ___.
IMPRESSION:
1. No evidence for acute intracranial abnormalities on noncontrast head CT.
Nondiagnostic CT perfusion study due to technical factors.
2. Multiple chronic infarcts are again seen in the right thalamus, left
caudate, and left lentiform nucleus/corona radiata/external capsule.
3. No flow-limiting arterial stenosis in the neck.
4. Unchanged atherosclerotic occlusion of the distal V4 segment of the non
dominant right vertebral artery.
5. Bronchiectasis in the visualized upper lungs with apparent new bronchial
wall thickening compared to ___, which may represent superimposed
infectious/inflammatory process versus technical differences. Clinical
correlation is recommended.
6. Severe cervical spinal stenosis, previously assessed by MRI in ___.
RECOMMENDATION(S): MRI would be more sensitive for an acute infarction, if
clinically warranted.
|
19888315-RR-23
| 19,888,315 | 28,965,100 |
RR
| 23 |
2201-03-24 20:56:00
|
2201-03-25 11:07:00
|
EXAMINATION: MR HEAD W AND W/O CONTRAST
INDICATION: ___ year old man with episodic global aphasia. Seizure protocol
please. // Seizure protocol please!
TECHNIQUE: Axial susceptibility and diffusion axial images of the brain
acquired. Sagittal 3D FLAIR images were obtained. Coronal fast inversion
recovery images were acquired. Coronal post there is generalized parenchymal
volume loss with commensurate enlargement of the ventricles, sulci, and
cisterns. Gadolinium MPRAGE images were obtained with axial and sagittal
reformats.
COMPARISON: CTA head ___
FINDINGS:
There is a 6 mm focus of slowed diffusion with corresponding FLAIR signal
abnormality in the left temporal lobe along the sylvian fissure, consistent
with an acute infarct (series 402, image 20 and series 300b, image 47). No
additional acute infarcts are identified. There are numerous chronic infarcts
of the coronal radiata, bilateral basal ganglia, and bilateral thalami. There
are numerous patchy and confluent foci of FLAIR hyperintensity in the
subcortical, deep, and periventricular white matter, consistent with severe
chronic microangiopathy. There may be hemosiderin associated with some of
these old infarcts. There is focal ex vacuo dilatation of the left lateral
ventricle adjacent to old infarcts. There is moderate generalized chronic
volume loss with commensurate prominence of the ventricles, sulci, and
cisterns. There is a cavum septum pellucidum et vergae, a developmental
variant.
The V4 segment of the right vertebral artery is occluded, as seen CTA from ___. The major intracranial vessels otherwise demonstrate normal
patency.
Coronal high-resolution images asymmetric enlargement of the right temporal
horn relative to the left, although the hippocampi by appear normal in
morphology and signal. There is no evidence of migration abnormality
identified.
IMPRESSION:
1. Small 6 mm acute to subacute infarct of the left temporal lobe. No
associated mass effect.
2. Numerous chronic infarcts of the cerebral white matter, bilateral basal
ganglia, and thalami. Severe chronic microangiopathy.
3. Moderate generalized parenchymal volume loss.
4. Asymmetric enlargement of the right temporal horn, although this appears to
be due to adjacent temporal lobe volume loss rather than specifically volume
loss of the right hippocampus.
5. Occlusion of the V4 segment of the right vertebral artery, unchanged from
CTA on ___.
|
19888347-RR-12
| 19,888,347 | 25,162,606 |
RR
| 12 |
2147-02-13 21:57:00
|
2147-02-13 23:21:00
|
EXAMINATION: MRCP
INDICATION: ___ with Hx SSD, Hx biliary ductal dilation, progressing since
___, unclear etiology; splenic infarcts also noted, chronic // intrahepatic
biliary ductal dilation
TECHNIQUE: T1- and T2-weighted multiplanar images of the abdomen were
acquired in a 1.5 T magnet.
Intravenous contrast: 7 mL Gadavist.
Oral contrast: 1 cc of Gadavist mixed with 50 cc of water was administered
for oral contrast.
COMPARISON: Outside CT chest on ___
FINDINGS:
Exam is somewhat degraded by motion.
Lower thorax: The lung bases are grossly clear.
Liver: The liver is enlarged and demonstrates diffuse severe hypoattenuation
less than the paraspinal muscles compatible with severe are no overload. No
suspicious focal liver lesion identified.
Biliary: There is no significant intrahepatic biliary duct dilatation. The
common bile duct is dilated at 8 mm and either numerous adjacent adherent tiny
stones or the larger stone measuring up to approximately 9 mm (3:21). The
gallbladder contains numerous tiny stones. No gallbladder wall thickening.
Pancreas: There is diffuse drop in signal on inphase imaging compared with out
of phase imaging compared with iron deposition in the pancreas. No focal
pancreatic lesion. No duct dilatation.
Spleen: Spleen is enlarged up to 20 cm. The splenic parenchyma is diffusely
hypoattenuating less than the paraspinal muscles, compatible with severe iron
deposition. There are numerous rounded lesions within the spleen measuring up
to 3.9 cm which have varying T2 signal characteristics and enhancement
(1302:89). No evidence of splenic infarct.
Adrenals: There is drop in signal on inphase imaging compared with out of
phase imaging compatible with iron deposition. No focal adrenal lesion.
Kidneys: The kidneys enhance and excrete symmetrically without suspicious
lesions or hydronephrosis.
Bowel: Partially imaged loops of small and large bowel are unremarkable.
There is no wall thickening, adjacent inflammatory change, or abnormal
enhancement. There is no evidence of stricture or obstruction.
Vasculature: Abdominal aorta is normal in caliber and major branch vessels are
patent. The portal vein, splenic vein and SMV are patent.
Lymph nodes: There are numerous prominent periportal, aortocaval, and
periaortic lymph nodes which are severely hypoattenuating, compatible with
iron deposition (6:44).
Osseous/Soft Tissue: There is diffuse severe hypoattenuation of the bone
marrow compatible with iron deposition. No focal osseous lesions.
IMPRESSION:
1. Evidence of severe iron deposition in the liver, spleen bone marrow,
pancreas, and adrenals, likely due to chronic transfusions in the setting of
sickle cell disease.
2. Splenomegaly, measuring up to 20 cm, with numerous rounded lesions within
the spleen measuring up to 3.9 cm which are of differing T2 signal
hyperintensities and enhancement, possibly representing focal areas of
extramedullary hematopoiesis. No evidence of splenic infarct.
3. Numerous prominent periportal, aortocaval, and periaortic lymph nodes in
the upper abdomen with severe hypoattenuation compatible with iron deposition,
the may be a form of extramedullary hematopoiesis.
4. Cholelithiasis without evidence of acute cholecystitis.
5. Dilation of the common bile duct up to 8 mm with either multiple adjacent
tiny adherent stones or a larger stone measuring up to 9 mm within the distal
common bile duct. No significant intrahepatic biliary duct dilatation.
|
19888426-RR-24
| 19,888,426 | 27,937,540 |
RR
| 24 |
2150-03-15 21:14:00
|
2150-03-15 21:54:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: History: ___ with hypertensive emergency, HA, CP// CT head:
?bleed, CXR: edema
COMPARISON: Chest CT from ___
FINDINGS:
PA and lateral views of the chest provided. Lungs are clear. Volumes are
low.
There is no focal consolidation, effusion, or pneumothorax. There are no
signs of congestion or edema. The cardiomediastinal silhouette is normal.
Imaged osseous structures are intact. No free air below the right
hemidiaphragm is seen.
IMPRESSION:
No acute intrathoracic process.
|
19888426-RR-25
| 19,888,426 | 27,937,540 |
RR
| 25 |
2150-03-15 20:48:00
|
2150-03-15 21:49:00
|
EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ with hypertensive emergency, HA, CP// CT head: ?bleed, CXR:
edema
TECHNIQUE: Routine unenhanced head CT was performed and viewed in brain,
intermediate and bone windows. Coronal and sagittal reformats were also
performed.
DOSE: Total DLP (Head) = 803 mGy-cm.
COMPARISON: None.
FINDINGS:
There is no intra-axial or extra-axial hemorrhage, edema, shift of normally
midline structures, or evidence of acute major vascular territorial
infarction. Prominence of ventricles and sulci likely reflect age related
involutional changes. Complete opacification of the bilateral maxillary
sinuses which contain hyperdense material, possibly representing blood
products, inspissated secretions, difficult to exclude fungal colonization.
Mild opacification of the right ethmoidal air cells and right frontal sinus.
Mastoid air cells are clear as are the middle ear cavities. The bony
calvarium is intact.
IMPRESSION:
1. No acute intracranial process.
2. Complete opacification of the maxillary sinuses which contain hyperdense
material, differential includes blood products, inspissated material versus
fungal colonization.
|
19889187-RR-45
| 19,889,187 | 24,863,608 |
RR
| 45 |
2129-01-09 10:55:00
|
2129-01-09 13:27:00
|
EXAMINATION: Carotid Doppler Ultrasound
INDICATION: Ms. ___ is a ___ with a PMH of COPD, HTN, PMR presenting with
acute Type B aortic dissection.// Eval for wall thickening
TECHNIQUE: Real-time grayscale, color, and spectral Doppler ultrasound
imaging of the carotid arteries was obtained.
COMPARISON: None.
FINDINGS:
RIGHT:
The right carotid vasculature has mild atherosclerotic plaque.
The peak systolic velocity in the right common carotid artery is 86 cm/s.
The peak systolic velocities in the proximal, mid, and distal right internal
carotid artery are 73 cm/s, 57 cm/s, and 77 cm/s respectively. The peak end
diastolic velocity in the right internal carotid artery is 21 cm/sec.
The ICA/CCA ratio is 0.89.
The external carotid artery has peak systolic velocity of104 cm/s.
The vertebral artery is patent with antegrade flow.
LEFT:
The left carotid vasculature has mild atherosclerotic plaque.
The peak systolic velocity in the left common carotid artery is 107 cm/s.
The peak systolic velocities in the proximal, mid, and distal left internal
carotid artery are 62 cm/s, 89 cm/s, and 76 cm/s respectively. The peak end
diastolic velocity in the left internal carotid artery is 21 cm/sec.
The ICA/CCA ratio is 0.82.
The external carotid artery has peak systolic velocity of 94 cm/s.
The vertebral artery is patent with antegrade flow.
IMPRESSION:
Less than 40% stenosis of the internal carotid arteries bilaterally.
|
19889187-RR-46
| 19,889,187 | 24,863,608 |
RR
| 46 |
2129-01-12 10:58:00
|
2129-01-12 17:10:00
|
EXAMINATION: CTA TORSO
INDICATION: ___ with acute Type B aortic dissection at admission. This is
repeat CTA prior her d/c// ___ with acute Type B aortic dissection at
admission. This is repeat CTA prior her d/c
TECHNIQUE: Abdomen and pelvis CTA: Non-contrast and multiphasic post-contrast
images were acquired through the abdomen and pelvis.
Oral contrast was not administered.
MIP reconstructions were performed on independent workstation and reviewed on
PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 4.4 s, 58.2 cm; CTDIvol = 14.4 mGy (Body) DLP = 837.5
mGy-cm.
2) Stationary Acquisition 0.6 s, 0.5 cm; CTDIvol = 2.7 mGy (Body) DLP = 1.3
mGy-cm.
3) Stationary Acquisition 6.0 s, 0.5 cm; CTDIvol = 26.8 mGy (Body) DLP =
13.4 mGy-cm.
Total DLP (Body) = 852 mGy-cm.
COMPARISON: Prior torso CTA from ___.
FINDINGS:
VASCULAR:
Redemonstration of an intramural hematoma beginning just distal to the takeoff
of the left subclavian artery extending into the distal descending thoracic
aorta. A large penetrating atherosclerotic ulcer in the most distal portion
of the descending thoracic aorta is also unchanged (2:67). Mild to moderate
atherosclerotic burden in the aorta and iliac arteries. There is no
aneurysmal dilatation or dissection of the abdominal aorta.
Mild coronary atherosclerotic disease noted as well as in the origin of the
celiac artery, superior mesenteric artery and both renal arteries.
CHEST:
NECK, THORACIC INLET, AXILLAE AND CHEST WALL:
The thyroid is not imaged. No enlarged lymph nodes in either axilla or
thoracic inlet. No abnormalities on the chest wall. No atherosclerotic
calcifications in the head and neck arteries.
HEART:
The heart is normal in size and shape. No pericardial effusion. The pulmonary
arteries are normal in caliber throughout. No incidental filling defects are
noted in the main pulmonary artery and its immediate segmental branches.
MEDIASTINUM AND HILA:
The esophagus is unremarkable. Small mediastinal lymph nodes, none
pathologically enlarged by CT size criteria. No hilar lymphadenopathy.
PLEURA:
Small left pleural effusion. No pleural effusion to the right. Mild
bilateral apical scarring.
LUNGS:
The airways are patent to the subsegmental levels. No bronchial wall
thickening, bronchiectasis or mucus plugging. No suspicious lung nodules or
masses. Partial compressive atelectasis in the left lower lobe. Mild
centrilobular and paraseptal emphysema..
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,
without stones or gallbladder wall thickening.
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.
Redemonstration of large simple cysts to the left measuring up to 3.1 cm
(2:98). There is a tiny nonobstructing calculus in the lower pole the right
kidney (603:39). There are no urothelial lesions in the kidneys or ureters.
There is no perinephric abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness and enhancement throughout. Colon and rectum
are within normal limits. There is no evidence of mesenteric lymphadenopathy.
RETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.
PELVIS: The urinary bladder and distal ureters are unremarkable. A ring
pessary is in-situ (2:178). There is no evidence of pelvic or inguinal
lymphadenopathy. There is no free fluid in the pelvis.
REPRODUCTIVE ORGANS: The uterus is not visualized.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
Mild thoracolumbar spondylosis. S shaped scoliosis of the thoracolumbar
spine. Prior surgery to the right hip. Severe degenerative changes in the
right hip.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. Stable appearance of a type B acute intramural hematoma and a penetrating
atherosclerotic ulcer involving the descending thoracic aorta, unchanged since
___.
2. Tiny nonobstructing calculus in the lower pole the right kidney.
|
19889247-RR-28
| 19,889,247 | 22,579,998 |
RR
| 28 |
2166-09-20 08:41:00
|
2166-09-20 09:36:00
|
HISTORY: COPD, now with cough and shortness of breath.
TECHNIQUE: Frontal and lateral chest radiographs.
COMPARISON: Comparison is made to chest radiographs and CT torso dated ___.
FINDINGS: The lungs are noted to be hyperinflated, compatible with the
patient's known chronic obstructive pulmonary disease. There is no evidence
of focal consolidation, pleural effusion, pneumothorax, or pulmonary edema.
The previously described multiple sub-4 mm right upper lobe pulmonary nodules
are not well visualized on this examination. The cardiomediastinal silhouette
is stable. No acute bony abnormality is detected.
IMPRESSION:
1. No acute cardiopulmonary process.
2. COPD.
|
19889247-RR-29
| 19,889,247 | 22,579,998 |
RR
| 29 |
2166-09-20 10:53:00
|
2166-09-20 11:44:00
|
HISTORY: Shortness breath and cough. Evaluate for pulmonary embolism.
TECHNIQUE: Axial helical MDCT images were obtained from the suprasternal
notch to the upper abdomen without contrast and low-dose radiation at first,
followed by an early arterial phase scanning after the administration of 100
cc of Omnipaque. Multiplanar reformatted images in coronal and sagittal axes
were generated. Oblique MIPS were prepared in an independent work station.
DLP: 304.12
COMPARISON: Comparison is made to CT torso dated ___.
FINDINGS:
CT THORAX: The airways are patent to the subsegmental level. There is no
mediastinal, hilar, or axillary lymph node enlargement by CT size criteria.
Diffuse coronary calcifications are seen. Heart, pericardium, and great
vessels are within normal limits. No hiatal hernia or any other esophageal
abnormality is present.
Lung windows redemonstrate multiple pulmonary nodules within the right upper
lobe measuring up to 4 mm (3:38, 39, 64, and 88), all of which are stable in
size as compared to the most recent prior examination. Regions of nonspecific
ground-glass airspace opacification are noted within the right apex and mid
left lower lobe (3:147), and may represent an area of infection versus
inflammation. Diffuse bronchial wall thickening and mucous plugging is
compatible with an inflammatory airway process. No pleural effusion or
pneumothorax is present.
CTA THORAX: The aorta and main thoracic vessels are well opacified. The
aorta contains diffuse atherosclerotic calcifications and demonstrates normal
caliber throughout the thorax without intramural hematoma or dissection. The
pulmonary arteries are opacified to the segmental level. There is no filling
defect to suggest pulmonary embolism.
BONES: No focal osseous lesions concerning for malignancy are seen.
Although this study is not designed for assessment of intra-abdominal
structures, limited views demonstrate mild thickening of the bilateral adrenal
glands, stable since the prior examination. The visualized solid organs and
stomach are otherwise unremarkable.
IMPRESSION:
1. No evidence of pulmonary embolism.
2. Regions of nonspecific ground-glass opacity with the RUL and LLL, which
may reflect infection.
3. Diffuse bronchial wall thickening and bilateral mucous plugging. Findings
likely represent an inflammatory airway process such as COPD or asthma.
4. Multiple sub-4 mm right upper lobe pulmonary nodules, stable as compared
to the prior examination. No further follow up is required for these nodules.
|
19889659-RR-10
| 19,889,659 | 29,856,140 |
RR
| 10 |
2130-06-13 06:44:00
|
2130-06-13 08:00:00
|
INDICATION: History: ___ with chest pain // presence of infiltrate, ptx
TECHNIQUE: Chest PA and lateral
COMPARISON: None
FINDINGS:
Cardiomediastinal silhouette is within normal limits. Lungs are clear. There
is no pleural effusion or pneumothorax.
IMPRESSION:
No acute intrathoracic process.
|
19889659-RR-11
| 19,889,659 | 29,856,140 |
RR
| 11 |
2130-06-13 11:47:00
|
2130-06-13 14:18:00
|
EXAMINATION: CT abdomen and pelvis
INDICATION: NO_PO contrast; History: ___ with hx Crohn's, pain in lower
abdomen w/ tendernessNO_PO contrast // eval for acute abdominal process, most
tender in lower abdomen just inferior to umbilicus
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 6.5 s, 0.5 cm; CTDIvol = 31.3 mGy (Body) DLP =
15.6 mGy-cm.
2) Spiral Acquisition 4.8 s, 52.0 cm; CTDIvol = 16.7 mGy (Body) DLP = 867.1
mGy-cm.
Total DLP (Body) = 883 mGy-cm.
COMPARISON: CT abdomen and pelvis with contrast from ___.
FINDINGS:
LOWER CHEST: Mild bibasilar atelectasis noted. Otherwise, the visualized lung
fields are within normal limits. There is no evidence of pleural or
pericardial effusion.
ABDOMEN:
HEPATOBILIARY: A 1.8 cm hemangioma is again seen in the right liver lobe.
Otherwise, the liver 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.
There is no evidence of focal renal lesions or hydronephrosis. There is no
perinephric abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. The colon and
rectum are within normal limits. The appendix is normal.
PELVIS: The urinary bladder is not fully distended but appears thin-walled.
Very trace pelvic free fluid is within physiologic range.
REPRODUCTIVE ORGANS: There is a 2 cm right ovarian corpus luteum. Multiple
uterine fibroids are seen, a dominant intramural fibroid measures on the order
of 2.6 cm seen in the uterine fundus. There is also an additional 5 right
that appears to extend/involve the endometrial cavity, likely a submucosal
fibroid. The left ovary appears grossly 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: Sclerosis along the bilateral sacroiliac joints is re- demonstrated,
consistent with bilateral sacroiliitis.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. No bowel obstruction or bowel wall thickening. No findings to suggest an
acute Crohn's flare. Normal appendix.
2. Fibroid uterus, similar in appearance to prior. One fibroid appears to
involve the endometrial cavity (submucosal) versus less likely representing a
polyp; stable in appearance since ___. Findings could be further
assessed on outpatient pelvic ultrasound if clinical symptoms referable to
this.
3. Right corpus luteum.
4. Again seen bilateral sacroiliitis.
|
19889659-RR-12
| 19,889,659 | 29,856,140 |
RR
| 12 |
2130-06-14 14:35:00
|
2130-06-14 16:30:00
|
EXAMINATION: PELVIS, NON-OBSTETRIC
INDICATION: ___ year old woman with hypogastric abdominal pain and history of
submucosal fibroids. // abnormality? large fibroid?
TECHNIQUE: Grayscale and Doppler ultrasound images of the pelvis were
obtained with transabdominal approach followed by transvaginal approach for
further delineation of uterine anatomy.
COMPARISON: CT abdomen ___
FINDINGS:
The uterus is retroverted. The uterus is enlarged measuring 9.3 x 5.2 x 5.7
cm. There are multiple masses consistent with fibroids. The largest fibroid is
located in the fundus on the right and measures 2.5 x 2.9 x 2.4 cm, similar to
recent CT. The endometrium is distorted by fibroids, but where seen measures 4
mm.
The ovaries are normal. There is a trace amount of free fluid.
IMPRESSION:
Fibroid uterus with normal ovaries.
|
19889659-RR-9
| 19,889,659 | 29,856,140 |
RR
| 9 |
2130-06-13 06:44:00
|
2130-06-13 09:20:00
|
INDICATION: History: ___ with Crohn's presenting with abdominal pain, back
pain // presence of bowel dilation, toxic megacolon
TECHNIQUE: Supine and upright abdominal radiographs were obtained.
COMPARISON: None.
FINDINGS:
There are no abnormally dilated loops of large or small bowel.
There is no free intraperitoneal air.
Osseous structures are unremarkable.
There are no unexplained soft tissue calcifications or radiopaque foreign
bodies.
IMPRESSION:
Nonobstructive bowel gas pattern.
|
19889694-RR-149
| 19,889,694 | 28,067,210 |
RR
| 149 |
2171-03-28 15:34:00
|
2171-03-28 15:55:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ with pleuritic chest pain// eval for PNA or PTX
COMPARISON: ___
FINDINGS:
PA and lateral views of the chest provided. Suture material is noted in the
right midlung as on prior. The lungs are clear bilaterally. No focal
consolidation, large effusion, pneumothorax. Cardiomediastinal silhouette is
stable. Bony structures are intact. No free air below the right
hemidiaphragm.
IMPRESSION:
No acute findings in the chest.
|
19889694-RR-150
| 19,889,694 | 28,067,210 |
RR
| 150 |
2171-03-28 20:59:00
|
2171-03-28 21:50:00
|
EXAMINATION: BILAT LOWER EXT VEINS
INDICATION: ___ year old woman with leg pain, history of DVTs, pleuritic
chest pain, allergy to contrast// r/o DVT
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the bilateral lower extremity veins.
COMPARISON: None.
FINDINGS:
There is normal compressibility, flow, and augmentation of the bilateral
common femoral, femoral, and popliteal veins. Normal color flow and
compressibility are demonstrated in the posterior tibial and peroneal veins.
There is normal respiratory variation in the common femoral veins bilaterally.
No evidence of medial popliteal fossa (___) cyst.
IMPRESSION:
No evidence of deep venous thrombosis in the right or left lower extremity
veins.
|
19889694-RR-162
| 19,889,694 | 26,986,243 |
RR
| 162 |
2172-06-11 02:34:00
|
2172-06-11 04:14:00
|
EXAMINATION: UNILAT LOWER EXT VEINS LEFT
INDICATION: History: ___ with hx DVT p/w chest pain, c/f dvt/PE // DVT?
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the bilateral lower extremity veins.
COMPARISON: Pelvic MRI ___, lower extremity ultrasound ___.
FINDINGS:
There is normal compressibility, color flow, and spectral doppler of the left
common femoral, femoral, and popliteal veins. Normal color flow and
compressibility are demonstrated in the posterior tibial and peroneal veins.
As seen previously, there is dampening of the venous waveform of the right
common femoral vein, which may reflect proximal venous thrombosis. Otherwise,
the left common femoral, femoral, and popliteal veins are patent with normal
compressibility. Assessment of the right posterior tibial and peroneal veins
is limited due to technique.
Additional imaging was performed over the patient's site of pain on the
posterior right calf over the area of scar, which revealed partially occlusive
thrombus in a superficial vein.
No evidence of medial popliteal fossa (___) cyst.
IMPRESSION:
1. No evidence of deep venous thrombosis in the right or left lower extremity
veins. Limited assessment of the right posterior tibial and peroneal veins.
2. Dampening of the right common femoral vein waveform may reflect persistence
of proximal deep vein thrombosis.
3. Partially occlusive superficial venous thrombophlebitis in the right
posterior calf at the site of pain.
|
19889694-RR-163
| 19,889,694 | 26,986,243 |
RR
| 163 |
2172-06-11 08:02:00
|
2172-06-11 08:59:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with lupus c/b lupus nephritis s/p renal
transplant ___, DVT,( now offanticoagulation since ___ and presenting
with pleuritic chest pain and SOB and c/f PE // CXR for V/Q scan
IMPRESSION:
In comparison with the study of ___, there again is globular enlargement
of the cardiac silhouette. Scatter radiation related to the size of the
patient somewhat obscures detail, but no appreciable vascular congestion is
seen. No pleural effusion or acute focal pneumonia.
|
19890030-RR-10
| 19,890,030 | 26,070,834 |
RR
| 10 |
2178-08-29 07:06:00
|
2178-08-29 09:59:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with SOB. // Interval change from X-ray on
___
COMPARISON: ___
IMPRESSION:
As compared to the previous radiograph, the signs indicative of interstitial
lung edema have substantially improved. There is a new retrocardiac
atelectasis. No pleural effusions. Borderline size of the cardiac silhouette
persists. Unchanged position of the monitoring and support devices.
|
19890030-RR-12
| 19,890,030 | 26,070,834 |
RR
| 12 |
2178-08-30 02:36:00
|
2178-08-30 11:22:00
|
REASON FOR EXAMINATION: Stress cardiomyopathy and increased work of
breathing.
Portable AP radiograph of the chest was reviewed in comparison to ___.
There is interval development of moderate-to-severe interstitial pulmonary
edema with some element of alveolar edema and bilateral pleural effusions,
substantial progression as compared to the prior study. The patient was
subsequently intubated as demonstrated on the subsequent chest radiograph.
|
19890030-RR-13
| 19,890,030 | 26,070,834 |
RR
| 13 |
2178-08-30 05:15:00
|
2178-08-30 11:20:00
|
REASON FOR EXAMINATION: Cardiomyopathy and increased work of breathing after
intubation and left internal jugular line placement.
Portable AP radiograph of the chest was reviewed in comparison to prior study
obtained the same day earlier.
The NG tube tip is currently 3.6 cm above the carina. The NG tube tip is in
the stomach. The left internal jugular line tip is at the level of mid SVC.
Heart size and mediastinum are unchanged including cardiomegaly but there is
interval progression of pulmonary edema and interval increase in pleural
effusion.
|
19890030-RR-15
| 19,890,030 | 26,070,834 |
RR
| 15 |
2178-08-30 21:00:00
|
2178-08-31 09:43:00
|
HISTORY: Cardiomyopathy and fever.
FINDINGS: In comparison with the study of ___, the monitoring and support
devices are essentially unchanged. Diffuse bilateral pulmonary opacification
is consistent with pulmonary edema in a patient with cardiomegaly and
bilateral pleural effusions with compressive atelectasis at the bases.
|
19890030-RR-16
| 19,890,030 | 26,070,834 |
RR
| 16 |
2178-09-01 07:46:00
|
2178-09-01 10:12:00
|
COMPARISON: ___.
FINDINGS: Support and monitoring devices are in standard position, and
cardiomediastinal contours are stable. Persistent pulmonary vascular
congestion accompanied by improving pulmonary edema and slight decrease in
size of bilateral pleural effusions.
|
19890030-RR-17
| 19,890,030 | 26,070,834 |
RR
| 17 |
2178-08-31 11:40:00
|
2178-08-31 12:00:00
|
EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: Agitation and confusion.
TECHNIQUE: Routine unenhanced head CT was performed and viewed in brain,
intermediate and bone windows.
DOSE: DLP: 891.93 mGy-cm
CTDI: 51.69 mGy
COMPARISON: None.
FINDINGS:
There is no acute intracranial hemorrhage edema, mass effect, or loss of gray/
white matter differentiation. The ventricles and sulci are normal in size and
configuration for age. Small foci of low density in the subcortical, deep,
and periventricular white matter of the cerebral hemispheres are nonspecific,
but likely sequela of mild chronic small vessel ischemic disease in a patient
of this age. Atherosclerotic calcifications are noted in bilateral carotid
siphons.
Visualized paranasal sinuses and mastoid air cells are clear. There is no
fracture.
IMPRESSION:
No evidence for acute intracranial abnormalities.
|
19890030-RR-18
| 19,890,030 | 26,070,834 |
RR
| 18 |
2178-08-31 12:37:00
|
2178-08-31 14:14:00
|
HISTORY: CHF versus pneumonia.
FINDINGS: In comparison with the study of ___, the monitoring and support
devices are essentially unchanged. Again, there are diffuse areas of
increased opacification bilaterally, consistent with pulmonary edema with
cardiomegaly and bilateral pleural effusions with compressive atelectasis at
the bases. In the appropriate clinical setting, supervening pneumonia would
have to be considered.
|
19890030-RR-19
| 19,890,030 | 26,070,834 |
RR
| 19 |
2178-09-02 07:20:00
|
2178-09-02 17:52:00
|
HISTORY: Volume status and signs of infection.
FINDINGS: In comparison with study of ___, the left IJ Swan-Ganz catheter
again extends well into the left pulmonary artery. This could be withdrawn a
few centimeters for standard positioning. Otherwise, little change in the
diffuse bilateral pulmonary opacifications.
|
19890030-RR-20
| 19,890,030 | 26,070,834 |
RR
| 20 |
2178-09-01 12:37:00
|
2178-09-01 16:15:00
|
PORTABLE CHEST, ___
COMPARISON: Chest x-ray from earlier the same date.
FINDINGS: On the first image of this serial radiographic study, a Swan-Ganz
catheter terminates in the right lower lobe, likely within a segmental branch
of the right lower lobe pulmonary vasculature, as communicated by telephone
with Dr. ___ at 2:37 p.m. on ___ by telephone at the time of
discovery. A second radiograph was obtained following repositioning of this
device, with tip now terminating in the left descending pulmonary artery just
below the left hilum. This could be withdrawn a few centimeters for standard
positioning. With the exception of Swan-Ganz catheter placement, there has
been minimal change to the appearance of the chest since the recent study
performed several hours earlier the same date.
|
19890030-RR-21
| 19,890,030 | 26,070,834 |
RR
| 21 |
2178-09-03 08:02:00
|
2178-09-03 11:09:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with stress cardiomyopathy // eval volume
status
COMPARISON: ___
IMPRESSION:
As compared to the previous radiograph, the interstitial component of the
pre-existing pulmonary edema has minimally decreased and the pleural effusions
have minimally increased in extent. Signs of pulmonary edema, however, are
still clearly present.
The monitoring and support devices, including the Swan-Ganz catheter, are in
unchanged correct position. No new focal parenchymal opacities. No
pneumothorax.
|
19890030-RR-22
| 19,890,030 | 26,070,834 |
RR
| 22 |
2178-09-04 07:58:00
|
2178-09-04 10:09:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with cardiogenic shock vs. septic shock
requiring intubation // compare to previous
COMPARISON: ___
IMPRESSION:
As compared to the previous radiograph, the patient has been extubated and the
nasogastric tube was removed. The lung volumes have slightly decreased. A
pleural effusion on the left is minimally increased and signs of mild to
moderate pulmonary edema are present in almost unchanged manner. No
pneumothorax. No new parenchymal opacities.
|
19890030-RR-23
| 19,890,030 | 26,070,834 |
RR
| 23 |
2178-09-06 17:21:00
|
2178-09-07 08:49:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with cardiomyopathy and cdiff with acute
desaturation and dyspnea // PE, pulmonary edema, vs aspiration PE,
pulmonary edema, vs aspiration
IMPRESSION:
In comparison with the study of ___, the Swan-Ganz catheter has been
removed. Continued enlargement of the cardiac silhouette with worsening
pulmonary edema. Little change in the degree of bilateral pleural effusions,
more prominent on the left.
|
19890030-RR-24
| 19,890,030 | 26,070,834 |
RR
| 24 |
2178-09-06 18:30:00
|
2178-09-07 08:31:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with HF. // Any change since last xray, resp
compromise. Any change since last xray, resp compromise.
IMPRESSION:
In comparison with the study of 1 hour previously, there is some worsening of
the pulmonary edema. Continued bilateral pleural effusions with compressive
atelectasis at the bases.
|
19890030-RR-26
| 19,890,030 | 26,070,834 |
RR
| 26 |
2178-09-07 14:48:00
|
2178-09-07 15:52:00
|
EXAMINATION: CHEST PORT. LINE PLACEMENT
INDICATION: ___ year old woman with respiratory failure and heart failure now
intubated with Swan Ganz catheter // ETT and PA catheter position Contact
name: ___: ___ ETT and PA catheter position
IMPRESSION:
In comparison with the study of ___, there is now an endotracheal tube in
place with the tip approximately 4.5 cm above the carina. Right IJ Swan-Ganz
catheter extends into the right pulmonary artery, several cm beyond the
mediastinal margin. Continued opacification at the left base is consistent
with volume loss in the left lower lobe. Little change in the degree of
pulmonary edema, given the better inspiration. Small bilateral pleural
effusions bilaterally.
|
19890030-RR-27
| 19,890,030 | 26,070,834 |
RR
| 27 |
2178-09-07 19:34:00
|
2178-09-07 21:15:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman s/p AVR. Please ___ at ___ with
abnormalities. // FAST TRACK EXTUBATION CARDIAC SURGERY, ?line placement, r/o
PTX/Effusion FAST TRACK EXTUBATION CARDIAC SURGERY, ?line placement, r/o
IMPRESSION:
In comparison with the earlier film of this date, the Swan-Ganz catheter tip
has been pulled back to the proximal portion of the right pulmonary artery.
Nasogastric tube extends into the stomach. Endotracheal tube is unchanged.
Bilateral chest tubes are in place without evidence of pneumothorax. Improved
aeration in the retrocardiac region with sharp demonstration of the
hemidiaphragm. Improvement in pulmonary vascular congestion.
|
19890030-RR-28
| 19,890,030 | 26,070,834 |
RR
| 28 |
2178-09-10 08:13:00
|
2178-09-10 08:56:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with s/p avr // s/p ct removal s/p ct
removal
IMPRESSION:
In comparison with the study of ___, the monitoring and support devices
have been removed with a right IJ sheath remaining in place. No evidence of
pneumothorax. The cardiac silhouette is enlarged and there is evidence of
retrocardiac opacification consistent with volume loss in the left lower lobe.
Mild atelectatic changes are seen on the right and there is blunting of both
costophrenic angles.
|
19890030-RR-29
| 19,890,030 | 26,070,834 |
RR
| 29 |
2178-09-10 16:27:00
|
2178-09-10 17:30:00
|
EXAMINATION: CHEST PORT. LINE PLACEMENT
INDICATION: ___ year old woman with PICC // Pt had a left picc,43cm ___
___ Contact name: ___: ___ Pt had a left picc,43cm ___
___
IMPRESSION:
In comparison with the earlier study of this day, there has been placement of
a left subclavian PICC line that extends into the jugular region. There is
increased opacification at the left base with obscuration of the
hemidiaphragm, consistent with volume loss in the left lower lobe and
associated pleural effusion. Less prominent atelectatic changes are seen at
the right base. There is continued enlargement of the cardiac silhouette with
evidence of pulmonary vascular congestion.
|
19890030-RR-30
| 19,890,030 | 26,070,834 |
RR
| 30 |
2178-09-10 19:21:00
|
2178-09-10 22:30:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with avr // check PICC line placement
(midline) check PICC line placement (midline)
IMPRESSION:
In comparison with the earlier study of this date, there has been placement of
a right PICC line that terminates in the left axilla. Otherwise little
change.
|
19890030-RR-31
| 19,890,030 | 26,070,834 |
RR
| 31 |
2178-09-11 13:26:00
|
2178-09-11 16:09:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ female status post emergent AVR.
TECHNIQUE: PA and lateral radiograph of a chest from ___.
COMPARISON: ___.
FINDINGS:
The right IJ central venous catheter has been removed. There is no
pneumothorax. Mild to moderate pulmonary edema has increased since the prior
exam. Small bilateral pleural effusions are unchanged. The patient is status
post median sternotomy with stable cardiomegaly. There is generalized
osteopenia.
IMPRESSION:
Interval worsening of pulmonary edema with stable small bilateral pleural
effusions.
Stable cardiomegaly.
|
19890030-RR-32
| 19,890,030 | 26,070,834 |
RR
| 32 |
2178-09-12 08:49:00
|
2178-09-12 10:46:00
|
INDICATION: ___ year old woman s/p emergent AVR // Please advance midline to
PICC position
COMPARISON: Chest radiograph ___
TECHNIQUE: OPERATORS: Dr. ___ radiology fellow) and
Dr. ___ radiology attending) performed the procedure.
The attending, Dr. ___ was present and supervising throughout the
procedure.
ANESTHESIA: 1% lidocaine was injected in the skin and subcutaneous tissues
overlying the access site.
MEDICATIONS: 1% lidocaine
CONTRAST: 0 ml of Optiray contrast.
FLUOROSCOPY TIME AND DOSE: 1.6 min, 3 mGy
PROCEDURE: 1. Repositioning of left PICC.
PROCEDURE DETAILS: Using sterile technique and local anesthesia, the existing
PICC line was aspirated and flushed and a Nitinol guidewire was introduced
into the superior vena cava (SVC). A peel-away sheath was then placed over a
guidewire. The guidewire was then advanced into the superior vena cava. A
double lumen PIC line measuring 40 cm in length was then placed through the
peel-away sheath with its tip positioned in the distal SVC under fluoroscopic
guidance. Position of the catheter was confirmed by a fluoroscopic spot film
of the chest. The peel-away sheath and guidewire were then removed. The
catheter was secured to the skin, flushed, and a sterile dressing applied.
The patient tolerated the procedure well. There were no immediate
complications.
FINDINGS:
1. Existing left arm approach midline with tip in the left arm replaced with a
new double lumen PIC line with tip in the low SVC.
IMPRESSION:
Successful placement of a 40 cm left arm approach double lumen PICC with tip
in the low SVC. The line is ready to use.
|
19890030-RR-5
| 19,890,030 | 26,070,834 |
RR
| 5 |
2178-08-28 00:00:00
|
2178-08-28 01:08:00
|
INDICATION: History: ___ with dyspnea // eval for infiltrate
TECHNIQUE: Single portable upright AP image of the chest.
COMPARISON: None.
FINDINGS:
The lungs are well expanded. Diffusely increased interstitial markings,
pulmonary vasculature engorgement, cardiomegaly, and small bilateral pleural
effusions are seen, consistent with moderate pulmonary edema. No focal
consolidation is seen. There is no pneumothorax.
IMPRESSION:
Moderate pulmonary edema with small bilateral pleural effusions.
|
19890030-RR-7
| 19,890,030 | 26,070,834 |
RR
| 7 |
2178-08-28 01:45:00
|
2178-08-28 03:48:00
|
INDICATION: History: ___ with sob // ? pecxr-? tube placement
TECHNIQUE: Single portable semi upright AP image of the chest.
COMPARISON: Comparison is made with chest radiographs from earlier the same
day, ___, and CTA chest from and the same day, ___.
FINDINGS:
An ET tube terminates 3 cm above the carina. And NG tube passes inferiorly off
the image in the expected region of the stomach.
The lungs are well expanded. Diffusely increased interstitial markings are
again seen, along with engorged pulmonary vasculature and cardiomegaly and
bilateral pleural effusions, consistent with moderate pulmonary edema.
Increased opacity at the left lung base compared to prior likely reflects
atelectasis. No focal consolidation is seen. There is no pneumothorax.
IMPRESSION:
1. ET tube terminates 3 cm above the carina.
2. Moderate pulmonary edema with bilateral pleural effusions.
|
19890030-RR-8
| 19,890,030 | 26,070,834 |
RR
| 8 |
2178-08-28 02:12:00
|
2178-08-28 02:59:00
|
EXAMINATION: CTA CHEST WANDW/O CANDRECONS, NON-CORONARY
INDICATION: History: ___ with sob // ? pecxr-? tube placement
TECHNIQUE: CTA imaging of the chest was performed after administration of
intravenous contrast. Multiplanar reformats were prepared and reviewed. MIP
images were generated and reviewed
DOSE: DLP: 216.98 mGy-cm
COMPARISON: Comparison is made with chest radiographs from earlier the same
day, ___.
FINDINGS:
CHEST CTA:
Pulmonary arterial vasculature is well-visualized to the subsegmental levels
bilaterally. No filling defects are identified to suggest the presence of
pulmonary embolism. The aorta is normal in caliber without evidence of
dissection or intramural hematoma. The great vessels are unremarkable.
CHEST:
There is diffuse pulmonary septal thickening, bilateral pleural effusions, and
cardiomegaly, consistent with moderate pulmonary edema. Compressive
atelectasis is seen in the bilateral lung bases. No definite focal
consolidation is seen. The airways are patent to the subsegmental levels
bilaterally. No pathologically enlarged axillary, mediastinal, or hilar lymph
nodes are identified.
The study is not tailored for subdiaphragmatic evaluation, but the visualized
intra-abdominal organs are unremarkable.
BONE WINDOWS: No focal lytic or sclerotic osseous lesion suspicious for
infection or malignancy is seen.
IMPRESSION:
1. No evidence of pulmonary embolism.
2. Moderate pulmonary edema with bilateral mild to moderate pleural effusions.
NOTIFICATION: Findings communicated to Dr. ___ at 3:57 a.m. on ___ by phone.
|
19890030-RR-9
| 19,890,030 | 26,070,834 |
RR
| 9 |
2178-08-28 03:34:00
|
2178-08-28 03:53:00
|
INDICATION: History: ___ with new right IJ central line // Eval new line
placement
TECHNIQUE: Single portable supine AP image of the chest.
COMPARISON: Comparison is made with chest radiographs from earlier the same
day, ___, and CTA chest from earlier the same day, ___.
FINDINGS:
A new right IJ central line terminates in the mid to low SVC. The ET tube and
NG tube are unchanged from prior exam.
The lungs are well expanded. Diffusely increased interstitial markings are
again noted in the lungs bilaterally, along with engorged pulmonary
vasculature, cardiomegaly, and bilateral pleural effusions, consistent with
moderate pulmonary edema, similar to prior exams. Opacity at the left lung
base is again noted, consistent with atelectasis. No focal consolidation is
seen and there is no pneumothorax.
IMPRESSION:
1. Right IJ central line terminates in the mid to low SVC.
2. Moderate pulmonary edema with bilateral pleural effusions.
|
19890202-RR-3
| 19,890,202 | 27,867,603 |
RR
| 3 |
2144-08-08 06:03:00
|
2144-08-08 06:44:00
|
EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ with catatonia, likely volitional/psychiatric, please
evaluate for intracranial process.
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast. Coronal and sagittal reformations as well as bone algorithm
reconstructions were provided and reviewed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 16.0 s, 16.0 cm; CTDIvol = 50.2 mGy (Head) DLP =
802.7 mGy-cm.
Total DLP (Head) = 803 mGy-cm.
COMPARISON: None.
FINDINGS:
Evaluation is limited by severe leftward tilt of the patient's head. There is
no evidence for acute hemorrhage, edema, mass effect, or loss of gray/ white
matter differentiation. Ventricles, sulci, and basal cisterns are normal in
size for age.
Visualized bones are unremarkable. 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 evidence for acute intracranial abnormalities.
|
19890202-RR-4
| 19,890,202 | 27,867,603 |
RR
| 4 |
2144-08-08 21:16:00
|
2144-08-09 10:32:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with fever, catatonia // eval for pna
eval for pna
IMPRESSION:
Heart size and mediastinum are stable. Lungs are clear. There is no pleural
effusion or pneumothorax.
|
19890202-RR-5
| 19,890,202 | 27,867,603 |
RR
| 5 |
2144-08-09 01:11:00
|
2144-08-09 03:16:00
|
EXAMINATION: MR HEAD W AND W/O CONTRAST T9112 MR HEAD
INDICATION: ___ year old woman with AMS in setting of viral prodrome. CSF
protein elevated // encephalitis?
TECHNIQUE: Axial diffusion, sagittal T1, axial T1, axial T2, and axial
gradient echo sequences performed
Following the uneventful intravenous administration of 6 cc Gadavist,
gadolinium base contrast, axial T1 and sagittal T1 sequences were performed.
COMPARISON: ___ head CT.
FINDINGS:
There is mild motion artifact requiring use of BLADE acquisition technique.
On the axial T2 and axial FLAIR sequences, there is questionable diffuse mild
thickening of the cortical gray matter with a mildly indistinct interface with
the underlying subcortical white matter. On corresponding axial T1 and
sagittal T1 sequences, the gray matter demonstrates normal thickness within
normal interface within the subcortical white matter.
Otherwise the parenchymal signal is unremarkable without infarct, hemorrhage,
mass, or mass effect. The ventricles and cortical sulci are normal in caliber
configuration. The extra-axial spaces are unremarkable. There is normal
dural venous sinus enhancement. The vascular flow voids are preserved.
The orbits, calvarium, and soft tissues are unremarkable. There is no
abnormal fluid signal within paranasal sinuses, mastoid air cells, or middle
ears.
IMPRESSION:
1. Mild motion artifact requiring use of BLADE acquisition technique.
2. Questionable diffuse mild thickening of the cortical gray matter and
indistinct gray-white interface seen only on the T2 and FLAIR sequences and
appearing normal on the correlate T1 sequences, therefore likely due to motion
and BLADE acquisition technique. Given the clinical setting, however an early
encephalitis is not entirely excluded. Consider follow-up imaging if
clinically warranted.
3. No acute infarct, hemorrhage, or mass.
RECOMMENDATION(S): Close follow-up with MRI of the brain with and without
contrast as clinically warranted is advised.
NOTIFICATION: The findings were discussed with ___, M.D. by ___,
M.D. on the telephone on ___ at 10:02 AM, 10 minutes after discovery of
the findings.
|
19890202-RR-6
| 19,890,202 | 27,867,603 |
RR
| 6 |
2144-08-11 13:11:00
|
2144-08-11 15:15:00
|
INDICATION: ___ year old woman with presumed encephalitis // eval for ovarian
teratoma
TECHNIQUE: Grayscale ultrasound images of the pelvis were obtained with
transabdominal approach followed by transvaginal approach for further
delineation of uterine and ovarian anatomy.
COMPARISON: None.
FINDINGS:
The uterus is anteverted and measures 6.3 x 3.1 x 4.1 cm cm. The endometrium
is homogenous and measures 3 mm.
The ovaries are normal. There is no free fluid.
IMPRESSION:
Normal pelvic ultrasound.
|
19890202-RR-7
| 19,890,202 | 27,867,603 |
RR
| 7 |
2144-08-11 18:13:00
|
2144-08-11 18:54:00
|
EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ year old woman with presumed encephalitis, now with acutely
elevated liver function tests. Evaluate for etiology of elevated LFTs
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: None.
FINDINGS:
LIVER: The hepatic parenchyma appears within normal limits. The contour of
the liver is smooth. There is no focal liver mass. The main portal vein is
patent with hepatopetal flow. There is no ascites.
BILE DUCTS: There is no intrahepatic biliary dilation. The CHD measures 3 mm.
GALLBLADDER: There is mild gallbladder thickening possible from liver
disease. The gallbladder is not frankly distended, and there is no evidence
of stones.
PANCREAS: The imaged portion of the pancreas appears within normal limits,
without masses or pancreatic ductal dilation, with portions of the pancreatic
body and tail obscured by overlying bowel gas.
SPLEEN: Normal echogenicity, measuring 10.1 cm.
KIDNEYS: The partial as imaged aspects of the right kidney are within normal
limits without evidence of stone, mass or hydronephrosis.
RETROPERITONEUM: The visualized portions of aorta and IVC are within normal
limits. There are partially imaged bilateral pleural effusions.
IMPRESSION:
1. Mild apparent gallbladder wall thickening may be due to third spacing or
underlying liver disease.
2. Partially imaged bilateral pleural effusions.
|
19890202-RR-8
| 19,890,202 | 27,867,603 |
RR
| 8 |
2144-08-13 14:19:00
|
2144-08-13 15:05:00
|
EXAMINATION:
DX CHEST PORTABLE PICC LINE PLACEMENT
INDICATION:
___ year old woman with new picc // R picc 43cm sal ___ Contact name: sal,
___: ___
TECHNIQUE: Chest single view
___
IMPRESSION:
There is a new right-sided PICC line with tip 2 cm below the cavoatrial
junction. The lungs are clear without infiltrate or effusion. There is no
pneumothorax.
|
19890361-RR-10
| 19,890,361 | 29,599,221 |
RR
| 10 |
2168-05-23 16:25:00
|
2168-05-23 17:06:00
|
HISTORY: Right upper extremity swelling.
COMPARISON: None.
FINDINGS: These findings refer to the right side. The internal jugular and
axillary veins are patent and compressible. There is normal flow void and
respiratory variation in bilateral subclavian veins. The brachial, basilic
and cephalic veins are patent and compressible and show normal color flow and
augmentation.
IMPRESSION: No evidence of deep venous thrombosis in the right upper
extremity.
|
19890361-RR-6
| 19,890,361 | 29,599,221 |
RR
| 6 |
2168-05-20 20:55:00
|
2168-05-20 23:54:00
|
HISTORY: ___ male with bilateral lower extremity erythema and pain.
COMPARISON: None.
FINDINGS:
Frontal and lateral views of the right femur. Frontal and lateral views of
the proximal distal right tibia and fibula. There is no acute fracture.
Tricompartmental degenerative changes are seen at the knee. There is no knee
joint effusion. There is soft tissue swelling seen in the calf without
subcutaneous gas or radiopaque foreign body. There is no focal region of
osteolysis. Plantar calcaneal spur is noted as well as degenerative changes
in the hindfoot.
IMPRESSION:
Soft tissue swelling without subcutaneous gas or underlying osseous
abnormality. Degenerative changes at the knee.
|
19890361-RR-7
| 19,890,361 | 29,599,221 |
RR
| 7 |
2168-05-20 20:55:00
|
2168-05-21 00:57:00
|
HISTORY: ___ male with bilateral lower extremity edema and pain.
Question subcutaneous air.
COMPARISON: None.
FINDINGS:
Frontal and lateral views of the proximal and distal left femur. Frontal and
lateral views of the left tibia and fibula.
There is no fracture or acute osseous abnormality. Degenerative changes seen
about the knee. Edema seen within the soft tissues of the calf without
subcutaneous gas or radiopaque foreign body.
IMPRESSION:
Soft tissue swelling of the calf without radiopaque foreign body or
subcutaneous gas.
|
19890361-RR-8
| 19,890,361 | 29,599,221 |
RR
| 8 |
2168-05-20 20:29:00
|
2168-05-20 21:24:00
|
HISTORY: ___ male with history of stroke, ___. Here with
altered mental status.
TECHNIQUE: Contiguous axial images obtained from skullbase to vertex without
intravenous contrast. Coronal and sagittal reformats were reviewed.
COMPARISON: None.
FINDINGS:
There is no acute intra-axial or extra-axial hemorrhage, mass, midline shift,
or territorial infarct. The gray-white matter differentiation is preserved.
There is prominence of the ventricles and sulci compatible with volume loss.
There is near-complete opacification of the left mastoid air cells and middle
ear. The right mastoids and included paranasal sinuses are essentially clear
the besides minimal mucosal thickening in the right maxillary sinus and
ethmoid air cells. There is minimal asymmetry in the nasopharynx with
fullness on the left.
IMPRESSION:
1. No acute intracranial process.
2. Given mild asymmetry in the nasopharynx with fullness on the left and
secondary left mastoid and middle ear opacification, direct visualization
should be performed to exclude underlying lesion.
|
19890361-RR-9
| 19,890,361 | 29,599,221 |
RR
| 9 |
2168-05-22 10:14:00
|
2168-05-22 11:59:00
|
HISTORY: Confusion and left lower extremity cellulitis, worsening atraumatic
shoulder pain with limited range of motion and tenderness to palpation.
RIGHT SHOULDER, THREE VIEWS.
Assessment of fine bony detail is moderately limited by overlying soft tissues
and underpenetration. Allowing for this, no fracture or dislocation is
detected involving the left shoulder. The AC joint is within normal
limits,except for possible tiny spurs. Similarly, the glenohumeral joint is
within normal limits, except for minimal spurring. No periarticular
calcification is identified. There is suggestion of vascular plethora in the
lung, but this could relate to lower inspiratory volumes.
IMPRESSION: X-ray examination of the right shoulder within normal limits,
except for minimal spurring about the AC and glenohumeral joints. Please see
comment.
|
19890665-RR-10
| 19,890,665 | 20,028,733 |
RR
| 10 |
2118-10-12 03:28:00
|
2118-10-12 04:36:00
|
CLINICAL INDICATION: Right upper quadrant pain. Evaluation for
nephrolithiasis.
TECHNIQUE: Multidetector CT scan through the abdomen and pelvis without the
administration of IV contrast. Coronal and sagittal reformatted images were
obtained.
DLP: 614.12 mGy-cm.
COMPARISON: Right upper quadrant ultrasound performed the same day.
FINDINGS: The lung bases are clear. The heart size is normal.
Without the administration of IV contrast, evaluation of the solid organs is
limited. The liver, gallbladder, pancreas, spleen, adrenal glands and kidneys
appear normal. There is no evidence of hydronephrosis or stones.
The small and large bowel are unremarkable without evidence of obstruction.
The appendix is visualized in the right lower quadrant and appears normal.
The bladder and uterus appear normal. There is no free air, free fluid or
lymphadenopathy.
OSSEOUS STRUCTURES: There are no concerning osteoblastic or osteolytic
lesions.
IMPRESSION: No renal stones or hydronephrosis. No other findings to explain
the patient's abdominal pain.
|
19890665-RR-11
| 19,890,665 | 20,028,733 |
RR
| 11 |
2118-10-12 04:05:00
|
2118-10-12 07:31:00
|
CLINICAL INDICATION: Nausea and epigastric discomfort. Evaluation for
pneumonia.
TECHNIQUE: Frontal and lateral views of the chest. Normal heart, lungs,
pleural and mediastinal surfaces.
IMPRESSION: Normal chest radiograph.
|
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