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19890665-RR-9
| 19,890,665 | 20,028,733 |
RR
| 9 |
2118-10-12 01:35:00
|
2118-10-12 03:14:00
|
CLINICAL INDICATION: Right upper quadrant pain of two week's duration.
Evaluation for cholecystitis, cholelithiasis and hepatobiliary disease.
TECHNIQUE: Grayscale and color Doppler ultrasound evaluation of the abdomen.
COMPARISON: None.
FINDINGS: The liver is normal in echotexture without focal lesions. The
pancreas is homogeneous in echotexture and without evidence of pancreatic duct
dilation. There is no evidence of intrahepatic or extrahepatic biliary duct
dilation. The common bile duct measures 4 mm. The common bile duct is seen
extending from its origin to the pancreatic head and contains no stones. The
gallbladder is unremarkable without evidence of wall thickening or stones.
The visualized portions of the aorta and IVC appear normal. The portal vein
is patent and demonstrates normal hepatopetal flow. The pancreas appears
normal.
IMPRESSION: No evidence of cholecystitis, cholelithiasis or
choledocholithiasis. Normal right upper quadrant ultrasound.
|
19890770-RR-10
| 19,890,770 | 27,645,357 |
RR
| 10 |
2185-08-05 13:35:00
|
2185-08-05 14:32:00
|
INDICATION: Right shoulder pain after motor vehicle collision.
COMPARISON: CT torso from earlier the same day.
RIGHT SHOULDER, THREE VIEWS: Known fracture of the right scapula adjacent to
the base of the coracoid as seen on the prior CT is again visualized. Known
fractures of the right fourth, fifth, and sixth lateral ribs are also not well
visualized on the current radiograph. No other fracture or dislocation is
seen. The glenohumeral and acromioclavicular joints appear preserved. No
suspicious lytic or sclerotic osseous abnormality is seen. The visualized
right lung appears grossly clear.
IMPRESSION: Known minimally displaced fracture of the right scapula is
redemonstrated. Known right fourth, fifth, and sixth ribs are better seen on
prior CT. No dislocation.
|
19890770-RR-12
| 19,890,770 | 27,645,357 |
RR
| 12 |
2185-08-06 11:59:00
|
2185-08-06 17:12:00
|
HISTORY: Rib fractures and scapular fractures, to assess for pneumothorax.
FINDINGS: No previous images. The heart is normal in size and lungs are
clear without vascular congestion or pleural effusion. Elevation of the right
clavicle with respect to the acromion is consistent with separation. No
definite pneumothorax.
|
19890770-RR-4
| 19,890,770 | 27,645,357 |
RR
| 4 |
2185-08-05 12:39:00
|
2185-08-05 13:50:00
|
INDICATION: Trauma.
COMPARISON: None.
SUPINE AP VIEW OF THE CHEST: Overlying trauma board limits evaluation. There
are low lung volumes. The heart size is normal. There is crowding of the
bronchovascular structures. The mediastinal contours are within normal limits
without evidence of widening. There are likely patchy opacities in the lung
bases reflective of atelectasis. No large pleural effusion or pneumothorax is
present. Multiple radiopaque densities are seen projecting over the left
upper quadrant of the abdomen as well as the left hemithorax, which could
represent retained foreign bodies or be external to the patient. No grossly
displaced rib fractures are noted.
IMPRESSION: Probable bibasilar atelectasis. Multiple radiopaque foreign
bodies projecting over the left upper abdomen and left hemithorax, which could
represent retained foreign bodies or be external to the patient, and clinical
correlation is advised.
|
19890770-RR-5
| 19,890,770 | 27,645,357 |
RR
| 5 |
2185-08-05 12:52:00
|
2185-08-05 14:57:00
|
INDICATION: Motor vehicle collision.
TECHNIQUE: Contiguous axial images were obtained through the brain. Coronal
and sagittal reformats were obtained. No contrast was administered.
COMPARISON: None.
FINDINGS: There is no evidence of intracranial hemorrhage, edema, mass, mass
effect, or territorial infarction. The ventricles and sulci are normal in
size and configuration. There are fractures of the medial and lateral right
orbital walls as well as the right orbital floor, better characterized on
concurrent CT of the sinus. There is blood in the right maxillary and right
anterior ethmoid cells. There is mild mucosal thickening in the right
sphenoid sinus. The mastoid air cells and middle ear cavities are clear.
There are two subgaleal scalp hematomas in the left parietal region as well as
a soft tissue laceration in the right parietal scalp, superior to the pinna.
IMPRESSION:
1. Two left parietal subgaleal scalp hematomas and a small right parietal
soft tissue laceration.
2. No acute intracranial hemorrhage or mass effect.
3. Fractures of the right orbit better characterized on concurrent CT of the
sinus.
The case was discussed by Dr. ___ with Dr. ___ in person at
approximately 1:30 p.m. on ___.
|
19890770-RR-6
| 19,890,770 | 27,645,357 |
RR
| 6 |
2185-08-05 12:53:00
|
2185-08-05 15:57:00
|
INDICATION: Motor vehicle collision.
TECHNIQUE: Helical 2.5 mm axial images were obtained from the skull base
through the T2 level. Coronal and sagittal reformations were obtained. No
contrast was administered.
COMPARISON: None.
FINDINGS: There is no acute fracture or malalignment of the cervical spine.
There is no prevertebral soft tissue edema. The craniocervical junction is
intact.
There is no cervical lymphadenopathy. The thyroid gland is unremarkable.
There are paraseptal emphysematous changes in the visualized portions of the
lung apices.
IMPRESSION: No fracture or subluxation of the cervical spine.
Case was discussed by Dr. ___ with Dr. ___ in person at
approximately 1:30 p.m. on ___.
|
19890770-RR-7
| 19,890,770 | 27,645,357 |
RR
| 7 |
2185-08-05 12:53:00
|
2185-08-05 15:05:00
|
INDICATION: Motor vehicle collision.
TECHNIQUE: MDCT images were obtained from the thoracic outlet to the pelvic
outlet after the administration of intravenous contrast. Coronal and sagittal
reformations were obtained.
COMPARISONS: None.
CT OF THE CHEST: There is mild bibasilar atelectasis as well as paraseptal
emphysematous changes of the lung apices. No focal consolidation or pleural
effusion is noted. The thyroid gland is unremarkable. There is no
supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. The great
vessels are unremarkable. The airways are patent to the subsegmental level.
Minimal soft tissue density within the anterior mediastinum is compatible with
residual thymic tissue.
CT OF THE ABDOMEN: There is a 5-mm hypodensity in segment VII of the liver
too small to characterize (2:45). The liver otherwise enhances homogenously.
The hepatic and portal veins are patent. The gallbladder, pancreas, spleen,
and adrenal glands are unremarkable. The kidneys enhance and excrete contrast
symmetrically without evidence of hydronephrosis. The stomach and small bowel
are unremarkable. There is no mesenteric or retroperitoneal lymphadenopathy.
There is no free air or free fluid.
CT OF THE PELVIS: A 3.5 cm right adnexal cyst is noted with trace free fluid
in the anterior pelvis. These findings most likely represent a physiologic
cyst. The appendix is unremarkable. The colon, rectum, uterus, and left
adnexa are unremarkable. A foley catheter is noted in the bladder.
OSSEOUS STRUCTURES: There is a fracture of the right scapula near the base of
the coracoid process with mild distraction of the fracture fragment. There
are non-displaced fractures of the lateral aspects of the right fourth, fifth
and sixth ribs.
IMPRESSION:
1. Fracture of the right scapula with mild distraction near the base of the
coracoid process.
2. Non-displaced fractures of the lateral aspects of the right fourth, fifth
and sixth ribs.
3. No acute traumatic injury in the abdomen or pelvis.
The case was discussed in person by Dr. ___ with Dr. ___ at
approximately 1:40 p.m. on ___.
|
19890770-RR-8
| 19,890,770 | 27,645,357 |
RR
| 8 |
2185-08-05 12:54:00
|
2185-08-05 15:04:00
|
INDICATION: Motor vehicle collision.
TECHNIQUE: Helical axial images were obtained from the skull base through the
mandible. Coronal and sagittal reformations were obtained. No contrast was
administered.
COMPARISON: None.
FINDINGS: There are mildly displaced fractures of the medial, lateral, and
inferior right orbital walls (2:25,40);(400A:50). There is blood in the right
maxillary sinus and right anterior ethmoid air cells. There is no herniation
or entrapment of the inferior rectus muscle through the inferior wall fracture
defect. There is mild soft tissue swelling in the right infraorbital soft
tissues. The globes are intact. The nasopharyngeal soft tissues are
unremarkable. There is no deviation of the nasal septum. There is no
mandibular fracture or dislocation of the temporomandibular joints.
IMPRESSION:
Minimally displaced fractures of the right medial, lateral and inferior
orbital walls without herniation or entrapment of the inferior rectus muscle.
Globes intact. Small amount of blood in the right anterior ethmoid air cells
and right maxillary sinus.
The case was discussed by Dr. ___ with Dr. ___ in person at 1:40
p.m. on ___.
|
19890770-RR-9
| 19,890,770 | 27,645,357 |
RR
| 9 |
2185-08-05 13:35:00
|
2185-08-05 14:51:00
|
INDICATION: Motor vehicle collision with bilateral hip pain.
COMPARISON: CT torso obtained earlier in the same day.
AP VIEW OF THE PELVIS, TWO VIEWS OF EACH FEMUR: No fracture or dislocation is
identified. Hips and sacroiliac joints are preserved. There is no diastasis
of the pubic symphysis or sacroiliac joints. Contrast from recent CT is seen
within the bladder, which contains a Foley catheter. No suspicious lytic or
sclerotic osseous abnormalities are present. There are no radiopaque foreign
bodies.
IMPRESSION: No acute fracture or dislocation.
|
19890784-RR-166
| 19,890,784 | 21,503,447 |
RR
| 166 |
2131-08-07 20:32:00
|
2131-08-08 09:38:00
|
EXAMINATION: MR FOOT ___ CONTRAST RIGHT
INDICATION: ___ year old woman with right heel ulcer c/f calcaneal
osteomyelitis // ?osteomyelitis of calcaneous (hind foot)MRI with contrast
TECHNIQUE: Imaging performed at 1.5 Tesla using the extremity coil. Routine
protocol. Pre and post contrast imaging was performed before and after
administration of 8 cc of intravenous Gadavist gadolinium contrast material.
Subtraction images were also generated.
COMPARISON: Right foot radiographs dated ___
FINDINGS:
There is a large ulcer along the postero plantar aspect of the heel,
associated with a large fluid-filled defect in the subcutaneous fat. This
extends to the surface of the posterior and posteroinferior calcaneus near the
origin of the plantar fascia. Small inferior calcaneal spur is present.
There is mild edema and enhancement in the sub cortical bone along the
posterior and posteroinferior calcaneus extending into the small plantar
calcaneal enthesophyte. Only very small area (approximately 6 mm) of
corresponding low T1 signal is present (05:17). No cortical erosion is
identified.
The origin of the plantar fascia is thickened, measuring up to 7 mm in
superoinferior diameter, consistent with degenerative change. Horizontal
linear high T2 signal laterally (06:16) could reflect reactive edema or
intrasubstance tear in the proximal portion of the lateral band of the plantar
fascia.
A small amount of marrow edema in the body of the calcaneus adjacent to the
critical angle of Gissane (06:17) likely represents unrelated reactive
changes. Marrow edema in the midfoot is compatible with midfoot
osteoarthritis (___).
There is trace joint fluid in the subtalar joint, without frank joint
effusion.
Tendons about the ankle are intact, with note made of mild degenerative signal
in the posterior tibialis tendon and trace tenosynovitis about the anterior
posterior tibialis, flexor digitorum, and peroneal tendons. There is diffuse
edema most of the visualized muscles, with atrophy severe atrophy of the of
adductor digiti minimi muscle.
Sinus tarsi fat is preserved.
There is diffuse subcutaneous edema and enhancement. Enhancement of
subcutaneous edema has been described as a sign of cellulitis. No focal
abscess identified.
IMPRESSION:
Large ulcer and subcutaneous soft tissue defect along the posteroinferior
aspect of the heel, with the ulcer extending to the surface of the calcaneus.
Trace edema and enhancement in the subcortical bone along the posteroinferior
calcaneus. This is non-specific and is most suggestive of reactive changes,
secondary to adjoining soft tissue inflammation/infection. Within this area,
a tiny (6 mm) marrow focus adjacent to the inferior calcaneal spur
demonstrates low T1 signal and the possibility of a tiny focus of
osteomyelitis in this location cannot be entirely excluded. No other evidence
of osteomyelitis.
Degenerative change, edema, and thickening of the proximal plantar fascia.
The possibility of an intra substance tear in the proximal portion of the
lateral band of the plantar fascia cannot be excluded. Severe atrophy of the
abductor digiti minimi muscle is noted.
Extensive subcutaneous soft tissue edema with enhancement. The differential
includes cellulitis. No focal abscess identified.
Midfoot osteoarthritis.
Diffuse non-specific muscle edema.
Mild posterior tibialis tendinosis and trace tenosynovitis of several tendons.
No tendon tear.
|
19890784-RR-167
| 19,890,784 | 21,503,447 |
RR
| 167 |
2131-08-04 13:04:00
|
2131-08-04 13:57:00
|
EXAMINATION: ___ DUP EXTEXT BIL (MAP/DVT)
INDICATION: ___ year old woman with ulcers. Evaluate for deep vein thrombosis
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the bilateral lower extremity veins.
COMPARISON: CT abdomen and pelvis from ___.
FINDINGS:
There is normal compressibility, flow, and augmentation of the bilateral
common femoral, femoral, and popliteal veins. Normal color flow is
demonstrated in the left posterior tibial and peroneal veins and right
posterior tibial veins. The right peroneal veins could not be seen.
There is normal respiratory variation in the common femoral veins bilaterally.
No evidence of medial popliteal fossa (___) cyst.
There is a 2.9 x 2.2 x 0.8 cm hypoechoic collection along the distal left
anterior thigh, likely a hematoma. Along the lateral distal left thigh, there
is a heterogeneous hypoechoic 4.4 x 4.7 x 2.2 cm collection likely a hematoma.
No internal color flow is seen in either of these collections.
IMPRESSION:
1. No evidence of deep venous thrombosis in the right or left lower extremity
veins, though the right peroneal veins could not be well visualized.
2. Two hypoechoic collections along the distal left anterior thigh and distal
left lateral thigh measuring up to 4.7 cm, likely hematomas.
|
19890784-RR-168
| 19,890,784 | 21,503,447 |
RR
| 168 |
2131-08-06 15:37:00
|
2131-08-06 17:21:00
|
EXAMINATION: Ultrasound-guided aspiration.
INDICATION: ___ year old woman with L thigh collection // ? infection
COMPARISON: ___.
PROCEDURE: Ultrasound-guided aspiration of the left lateral thigh collection.
OPERATORS: Dr. ___ radiology fellow and Dr. ___
radiologist, who personally 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 stated allergy to IV lidocaine which causes headache. She
confirmed no allergy to subcutaneous lidocaine.
The patient was placed in a supine position on the US scan table. Limited
preprocedure ultrasound was performed to localize the collection. Based on
the ultrasound findings an appropriate skin entry site for the aspiration was
chosen over the left lateral thigh collection. The site was marked. Local
anesthesia was administered with 1% Lidocaine solution.
Using continuous sonographic guidance, a 16 gauge needle was introduced into
the fluid collection which appeared heterogeneous an echogenic, consistent
with hematoma. 5 cc of sanguinous fluid was aspirated and sent for culture.
No further fluid could be aspirated as the remaining fluid represents clots/
evolved hematoma. Sterile dressing was applied.
The procedure was tolerated well, and there were no immediate post-procedural
complications.
SEDATION: None.
FINDINGS:
Left lateral thigh hematoma.
Aspiration of 5 cc sanguinous fluid from the left lateral thigh hematoma.
IMPRESSION:
Left lateral thigh hematoma with removal of 5 cc sanguinous fluid, sent to
microbiology.
|
19890872-RR-15
| 19,890,872 | 21,308,291 |
RR
| 15 |
2190-07-16 08:15:00
|
2190-07-16 10:08:00
|
HISTORY: ___ female with dyspnea. Evaluate for fluid overload.
COMPARISON: Reference chest radiograph from outside hospital obtained same
day six hours prior.
FINDINGS: Single portable upright frontal chest radiograph demonstrates
bilateral interstitial markings with cephalization of vessels and central
vascular engorgement. Obscuration of bilateral diaphragmatic angles may
represent bilateral small pleural effusions, although a component of
atelectasis or a consolidation cannot be excluded. There is no pneumothorax.
Heart size is enlarged. Visualized osseous structures are without acute
abnormality.
IMPRESSION: Vascular congestion and interstitial markings compatible with
interstitial edema. Obscuration of bilateral costophrenic angles compatible
with pleural effusions, although component of atelectasis or focal
consolidation cannot be excluded.
|
19890872-RR-16
| 19,890,872 | 21,308,291 |
RR
| 16 |
2190-07-19 12:33:00
|
2190-07-19 13:33:00
|
___
Department of Radiology
Standard Report- Carotid Series Complete
Reason: ___ year old woman with AS, pre op AVR
Findings: Duplex evaluation was performed of bilateral carotid arteries. On
the right there is mild heterogeneous plaque in the ICA. On the left there is
mild heterogeneous plaque in the ICA.
On the right systolic/end diastolic velocities of the ICA proximal, mid and
distal respectively are 78/18, 92/27, 80/24 cm/sec. CCA peak systolic velocity
is 50 cm/sec. ECA peak systolic velocity is 45 cm/sec. The ICA/CCA ratio is
1.1. These findings are consistent with <40% stenosis.
On the left systolic/end diastolic velocities of the ICA proximal, mid and
distal respectively are 52/14, 99/28, 65/13 cm/sec. CCA peak systolic velocity
is 52 cm/sec. ECA peak systolic velocity is 50 cm/sec. The ICA/CCA ratio is
1.9. These findings are consistent with <40% stenosis.
There is right antegrade vertebral artery flow.
There is left antegrade vertebral artery flow.
Impression: Right ICA with <40% stenosis.
Left ICA with <40% stenosis.
|
19890872-RR-17
| 19,890,872 | 21,308,291 |
RR
| 17 |
2190-07-20 09:37:00
|
2190-07-20 11:05:00
|
INDICATION: ___ year old woman with AS, pre-op // acute process Surg:
___ (AVR)
TECHNIQUE: Chest PA and lateral
COMPARISON: ___
FINDINGS:
Moderate cardiomegaly is stable. Pulmonary edema has almost completely
resolved. There is no pneumothorax or pleural effusion. Elevation of the left
hemi diaphragm is unchanged from ___. There are minimal degenerative
changes in the thoracic spine
IMPRESSION:
Resolved pulmonary edema.
There is residual minimal vascular congestion
Stable cardiomegaly
|
19890943-RR-31
| 19,890,943 | 21,035,868 |
RR
| 31 |
2186-08-12 09:21:00
|
2186-08-12 10:01:00
|
HISTORY: CHF and prior pericardial effusion now reported persistent cough,
increased shortness of breath and decreased breath sounds with desaturation to
80% with exercise.
TECHNIQUE: AP and lateral chest radiograph, 2 views.
COMPARISON: ___ through ___.
FINDINGS:
There has been interval development of a large left pleural effusion with
associated compressive atelectasis which shifts the cardiac silhouette to the
right and shifts the left hemidiaphragm downward. Cardiac silhouette cannot
be accurately gauged due to obliteration of the left cardiac border by the
large effusion. The right lung is clear. There is no pneumothorax. No
distracted bony injury is identified.
IMPRESSION:
Interval development of a large left pleural effusion. If there is history of
recent trauma, hemothorax should be considered. Other causes include
infection or malignancy and malignancy, but the latter is less likely given
the short interval time of development.
Results were discussed over the telephone with Dr. ___ by ___
___ at 9:40 on ___ at time of initial review.
|
19890943-RR-32
| 19,890,943 | 21,035,868 |
RR
| 32 |
2186-08-13 10:59:00
|
2186-08-13 13:43:00
|
HISTORY: Left-sided pleural effusion status post thoracentesis.
TECHNIQUE: Portable frontal chest radiograph.
COMPARISON: ___ 9:26.
FINDINGS:
There has been significant interval improvement in large left effusion with a
small amount of remnant fluid and associated compressive atelectasis as well
as a linear streak of atelectasis in the lingula. Remainder of the lungs is
clear. There is no pneumothorax. Cardiomediastinal silhouette and hilar
contours are normal.
IMPRESSION:
Small remnant left pleural effusion status post thoracentesis without evidence
of pneumothorax.
|
19890943-RR-33
| 19,890,943 | 21,035,868 |
RR
| 33 |
2186-08-13 12:34:00
|
2186-08-13 14:48:00
|
CT of the Thorax
INDICATION: Left pleural effusion that was drained, followup. History of
pericardial effusion, admitted for left pleural effusion status post
thoracocentesis. Evaluation for cause of pleural effusion.
COMPARISON: CTA of the chest from ___.
TECHNIQUE: Volumetric CT acquisitions over the entire thorax in inspiration,
no administration of intravenous contrast material, multiplanar
reconstructions.
FINDINGS: No incidental thyroid findings. No supraclavicular,
infraclavicular, or axillary lymphadenopathy. No enlarged lymph nodes in the
anterior and middle mediastinum. All visible lymph nodes are normal to
borderline in size. In the anterior mediastinum (2, 19), a small thymic
remnant is seen. No lymphadenopathy in the subcarinal region and in the
posterior mediastinum. Minimal coronary calcifications. No pericardial
effusion. Normal appearance of the large mediastinal vessels. Solitary
minimally enlarged lymph node in the anterior aspect of the subdiaphragmatic
fat (2, 45).
The thoracic spine shows moderate degenerative changes, but no evidence of
osteodestructive lung lesions. The appearance of the ribs is unremarkable,
normal appearance of the sternum.
At a non-ideally deep inspiration, the lung volumes remain low and the
attenuation of the lung parenchyma is increased. There are scattered areas of
air trapping; their extent does not exceed the physiological level. The
airways are patent; there is no evidence of airway wall thickening or
endobronchial lesions. Mild scars of non-characteristic appearance in the
dorsolateral aspect of the left lung, in particular the left upper and lower
lobe. However, no evidence of other focal or diffuse pathology is seen.
The main finding is the volume loss in the left lower lobe. This volume loss
is associated to a relatively large area of subpleural atelectasis, that
displays characteristics of rounded atelectasis on the sagittal
reconstructions (401B, 41). There is a minimal left pleural effusion and
minimal fluid accumulation in the minor fissure. However, no evidence of
pleural thickening or other pathological changes is seen that could likely
explain the origin of the pleural effusion.
Other than the atelectatic changes and the associated increase in density and
volume loss, the left lower lobe displays no parenchymal abnormalities.
IMPRESSION: Obviously chronic mild-to-moderate left pleural effusion with
rounded atelectasis in the left lower lobe. No evidence of parenchymal or
pleural pathology that could explain the origin of the effusion.
Incomplete inspiration and non-characteristic appearance of the remaining
lung, including non-characteristic areas of scarring in the subpleural parts
of the left upper lobe.
Small thymic remnant. Minimal coronary calcifications. No enlarged hilar and
mediastinal lymph nodes. Borderline size of the heart without evidence of
fluid overload.
|
19890943-RR-34
| 19,890,943 | 21,035,868 |
RR
| 34 |
2186-08-14 09:29:00
|
2186-08-14 13:04:00
|
HISTORY: Pericarditis, pericardial effusion and pleural effusion.
TECHNIQUE: PA and lateral chest radiograph, 2 views.
COMPARISON: ___ through ___.
FINDINGS:
Cardiomediastinal silhouette and hilar contours are unchanged from immediate
prior exam. The left moderate to large pleural effusion is slightly increased
in size with associated atelectasis and either fluid tracking up the left
major fissure or bandlike atelectasis present in the left mid lung. The right
lung is clear. There is no pneumothorax.
IMPRESSION:
Stable cardiac silhouette. Increasing left moderate to large pleural effusion
with associated atelectasis.
|
19890966-RR-29
| 19,890,966 | 24,100,578 |
RR
| 29 |
2136-11-05 09:08:00
|
2136-11-05 09:29:00
|
INDICATION: ___ with left sided numbness.Of note, the history provided for
prior outside imaging states "Right-sided numbness and tingling"
TECHNIQUE: Contiguous axial MDCT images were obtained through the brain
without administration of IV contrast. Reformatted coronal, sagittal, and
thin section bone algorithm reconstructed images were generated.
DOSE: DLP: 891.93 mGy-cm
COMPARISON: ___. Noncontrast head CT and brain MRI, as well as
imaging of other body parts, from ___
___.
FINDINGS:
There is no acute intracranial hemorrhage, edema, mass effect, loss of gray/
white matter differentiation, or pathologic extra-axial collection.
Ventricles and sulci are mildly prominent due to mild cerebral atrophy. A
linear focus of low density in the right lentiform nucleus corresponds to a
prominent perivascular space on the prior MRI. Small foci of low density in
bilateral corona radiata and periventricular white matter, similar to the
prior MRI, are likely sequela of chronic small vessel ischemic disease in a
patient of this age.
Irregular deformity of the medial right orbital wall is likely related to a
chronic fracture. There is mild mucosal thickening in the right anterior
ethmoid air cells. Some of left middle and posterior ethmoid air cells are
opacified, and others contain polypoid mucosal thickening. There is mild
mucosal thickening in bilateral sphenoid sinuses. There is a small mucous
retention cyst in the right maxillary sinus. Walls of bilateral maxillary
sinuses are thickened and sclerotic, suggesting sequela of chronic
inflammation. Right mastoid air cells are well aerated. Left mastoid tip air
cells are minimally opacified.
IMPRESSION:
No evidence for acute intracranial abnormalities. Supratentorial white matter
hypodensities are nonspecific, but compatible with sequela of chronic small
vessel ischemic disease, demyelination, or inflammation. Please correlate
clinically. MRI with intravenous contrast may be of value, if clinically
warranted.
|
19890966-RR-30
| 19,890,966 | 24,100,578 |
RR
| 30 |
2136-11-05 10:54:00
|
2136-11-05 11:06:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: History: ___ with left sided numbness. Evaluate for infection.
TECHNIQUE: Chest PA and lateral
COMPARISON: Outside hospital chest radiograph dated ___
FINDINGS:
The lungs are clear.The cardiac, hilar and mediastinal contours are normal.No
pleural abnormality is seen.
IMPRESSION:
No acute cardiopulmonary process.
|
19890966-RR-31
| 19,890,966 | 24,100,578 |
RR
| 31 |
2136-11-05 16:30:00
|
2136-11-06 12:14:00
|
EXAMINATION: MRI AND MRA BRAIN AND MRA NECK
INDICATION: ___ year old woman with hx left thalamic stroke, now new left
sided sensory loss // ?right thalamic stroke
TECHNIQUE: Three dimensional time of flight MR arteriography was performed
through the brain with MIP reconstructions. Dynamic MRA of the neck was
performed during administration of 15cc of Multihance intravenous contrast. A
MRI of the brain was performed without intravenous contrast.
COMPARISON: No prior MRI is available. Prior head CT dated ___.
FINDINGS:
MRI Brain: There is no evidence of acute hemorrhage, edema, mass effect or
acute infarction. Ventricles and sulci are normal in caliber and
configuration.
There are prior infarctions noted in the left thalamus and in the right
coronal radiata. There are scattered foci of T2/FLAIR signal hyperintensity in
the periventricular, subcortical, and deep white matter. There are tiny foci
of susceptibility artifact in the left temporal lobe and right caudate which
may represent tiny regions of chronic micro hemorrhage versus foci of
mineralization.
Vascular flow voids are preserved.
The orbits are unremarkable. There is mucosal thickening within the ethmoid
air cells and bilateral maxillary sinuses.
There is a small amount of fluid again noted in the left mastoid air cells.
MRA brain: The intracranial vertebral and internal carotid arteries and their
major branches appear normal without evidence of focal flow-limiting stenosis,
occlusion.
A tiny outpouching is noted at the left middle cerebral artery division,
measuring approximately 2-3 mm, series 13, image 86 ; series 1301, image 10
which can represent a small saccular aneurysm or related to the branching
point.
.
No prior studies are available to assess for interval change.
MRA neck: The common, internal and external carotid arteries and vertebral
arteries appear patent.
There is no evidence of focal flow-limiting stenosis. The origins of the
great vessels, subclavian arteries included appear patent bilaterally.
Cervical spine inadequately assessed as not targeted.
IMPRESSION:
1. No evidence of new acute infarction. Prior infarctions in the left
thalamus and right coronal radiata.
2. T2/FLAIR signal hyperintensity in the periventricular, subcortical, and
deep white matter which is nonspecific but may be seen in the setting of
chronic small vessel ischemic disease.
3. Patent major intra and extracranial arteries, without focal flow-limiting
stenosis or occlusion.
4. A small 2-3 mm saccular outpouching at the left middle cerebral artery
division
(Se 1301, im 8), can represent a tiny aneurysm or related to the branching
point.
No prior studies available.
Correlation with CT angiogram of the head can be considered for better
assessment and interventional neuroradiology consult after CTA to decide on
management
|
19890966-RR-32
| 19,890,966 | 21,589,441 |
RR
| 32 |
2136-12-29 11:29:00
|
2136-12-29 12:46:00
|
EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ with left sided weakness
TECHNIQUE: Contiguous axial MDCT images were obtained through the brain
without the administration of IV contrast. Reformatted coronal, sagittal and
thin section bone algorithm-reconstructed images were then generated.
DOSE: CTDIvol: 52 mGy
DLP: 892 mGy-cm
COMPARISON: CT head without contrast ___
FINDINGS:
There is no evidence of acute intracranial hemorrhage, edema, mass effect, or
large territorial infarction.
Prominent ventricles and sulci suggest age-related involutional changes or
atrophy. The basal cisterns appear patent and there is preservation of
gray-white matter differentiation.
There is a right lamina papyracea deformity, compatible with an old fracture.
There is mild mucosal thickening of the ethmoid, sphenoid and maxillary
sinuses compatible with ongoing inflammation. The mastoid air cells, and
middle ear cavities are clear.
Atherosclerotic mural calcification of the vertebral and cavernous carotid
arteries is noted.
The globes are unremarkable.
IMPRESSION:
No evidence of acute intracranial process.
|
19890966-RR-33
| 19,890,966 | 21,589,441 |
RR
| 33 |
2136-12-29 13:06:00
|
2136-12-29 13:49:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: History: ___ with cough
TECHNIQUE: Chest PA and lateral
COMPARISON: ___
FINDINGS:
Cardiac silhouette size is normal. Mediastinal and hilar contours are
unchanged. Pulmonary vasculature is normal. Lungs are clear. No pleural
effusion or pneumothorax is present. No acute osseous abnormalities are
visualized.
IMPRESSION:
No acute cardiopulmonary abnormality.
|
19890966-RR-34
| 19,890,966 | 21,589,441 |
RR
| 34 |
2136-12-30 08:45:00
|
2136-12-30 12:05:00
|
INDICATION: ___ year old prior smoker w/ HTN and recent left thalamic infarct
in ___ p/w left hemibody sensory loss that is worse than what she
experienced in ___ when MRI was negative for acute stroke. // eval for
right thalamic or other acute infarct
TECHNIQUE: Multiplanar MR sequences were acquired on a 1.5 Tesla magnet
through the brain without administration of IV contrast.
COMPARISON: Head CT of ___. Brain MRI of ___.
FINDINGS:
There is no evidence of hemorrhage, edema, mass effect, mass, or acute
territorial infarction. The ventricles and sulci are stable in size and
configuration. Chronic lacunes involving the left thalamus and right coronal
radiata are unchanged. Scattered FLAIR hyperintensities in the periventricular
and subcortical white matter are consistent with chronic small vessel ischemic
disease. The major intracranial flow voids are preserved. There is mild
mucosal thickening of the maxillary sinuses and ethmoid air cells.
IMPRESSION:
No acute intracranial process. No evidence of acute infarction or hemorrhage.
Chronic left thalamic and right coronal radiata unchanged.
|
19890966-RR-35
| 19,890,966 | 21,589,441 |
RR
| 35 |
2136-12-30 08:45:00
|
2136-12-30 12:17:00
|
INDICATION: ___ year old woman with upper motor neuron findings on left //
?cervical spondylosis
TECHNIQUE: Multiplanar MR sequences were acquired through the cervical spine
on a 1.5 Tesla magnet without administration of IV contrast.
COMPARISON: None.
FINDINGS:
Cervical spine vertebral body labeling is provided on image 2:8. Cervical
vertebral body heights are maintained and there is no evidence of fracture.
The bone marrow signal is unremarkable. The signal and caliber of the cervical
spinal cord is normal. The included posterior fossa is unremarkable. No
prevertebral or paraspinal soft tissue abnormality is identified.
At C2-3, there is no significant abnormality.
At C3-4, there is mild anterolisthesis of C3 on C4 with uncovering of the disc
and right uncovertebral hypertrophy. These result in mild right neural foramen
narrowing.
At C4-5, there is right uncovertebral hypertrophy with resultant mild right
neural foramen narrowing.
At C5-6, there is a small disc bulge and uncovertebral hypertrophy with mild
right neural foramen narrowing.
At C6-7 and C7- T1, there is no significant abnormality.
IMPRESSION:
Mild cervical spine degenerative changes, as described above, with mild right
neural foramen narrowing at C3-4, C4-5, and C5-6. No evidence of spinal canal
stenosis or abnormal cord signal.
|
19891107-RR-12
| 19,891,107 | 26,303,115 |
RR
| 12 |
2131-06-22 21:02:00
|
2131-06-22 22:54:00
|
HISTORY: ___ male with back pain and fever. Evaluate for abscess.
TECHNIQUE: Total spine MRI is obtained without intravenous contrast utilizing
the following sequences: Sagittal T2, sagittal STIR, sagittal T1, and axial
T2. The patient did not want intravenous contrast material.
COMPARISON: No prior studies available for comparison.
FINDINGS:
Cervical spine:
The vertebral body heights are preserved. There is loss of normal disc signal
at multiple levels due to degenerative disc disease.
There are mild disc bulges of the cervical spine, worst at the C6-C7 level
where there is mild spinal canal narrowing.
The posterior fossa is unremarkable. The cervical cord is normal in signal
intensity and morphology.
Thoracic spine:
The vertebral body heights are preserved. The bone marrow signal is
unremarkable
There are mild disc bulges at the T5-T6, T6-T7, T11-T12 levels resulting in
mild spinal canal narrowing. There is no significant neural foraminal
narrowing.
The thoracic cord is normal in signal intensity and morphology.
Lumbar spine:
The vertebral body heights are preserved. Within the L2 and L3 vertebral
bodies there is heterogeneously T1 and T2 hyperintense lesions that are
relatively hypointense on the STIR images suggestive of hemangiomas. There
are short pedicles throughout the lumbar spine suggestive of congenital spinal
stenosis
There is loss of normal disc signal at multiple levels due to degenerative
changes. The conus medullaris is normal in morphology and terminates at the
T12-L1 level.
At the L3-L4 and L4-L5 levels, there is soft tissue and interspinous
ligamentous STIR hyperintensity. There is also fluid within the facet joints
at L4-L5 bilaterally. Findings could relate to degenerate changes and possible
ligamentous injury, however without intravenous contrast difficult to exclude
an infectious process. There is no definite fluid collection identified.
At the T12-L1 level, there is mild disc bulge, facet osteophytes with
ligamentum flavum thickening without significant spinal canal or neural
foraminal narrowing.
At the L1-L2 level, there is mild disc bulge, and facet osteophytes resulting
in mild bilateral neural foraminal narrowing.
At L2-L3 level, there is a disc bulge, facet aspect ilium and flavum
thickening resulting in mild spinal canal, subarticular zone and neural
foraminal narrowing.
At the L3-L4 level, there is disc bulge, facet osteophytes and ligamentum
flavum thickening resulting in moderate spinal canal, narrowing left greater
than right subarticular zone, and mild bilateral neural foraminal narrowing.
At the L4-L5 level, there is disc bulge, facet osteophytes and ligamentum
flavum thickening, and along with short pedicles results in severe spinal
canal, moderate left and mild right neural foraminal narrowing.
At the L5-S1 level, there is disc bulge, and facet osteophytes resulting in
mild no severe left and mild right neural foraminal narrowing. There is no
significant spinal canal narrowing.
IMPRESSION:
Study limited due to lack of intravenous contrast, but there is no evidence
abscess. There is soft tissue and interspinous ligamentous STIR
hyperintensity at L3-L4, and L4-L5 levels. There is also fluid within the
bilateral L4-L5 facet joints. Findings could relate to degenerate changes and
possible ligamentous injury, however without intravenous contrast difficult to
completely exclude an infectious process. There is no definite fluid
collection identified. There is no evidence of discitis osteomyelitis. To
address the ongoing concern of possible infection, we recommend a repeat study
that includes post contrast T1 weighted imaging only. There is no need to
repeat the T2 or STIR imaging.
Lumbar spondylosis, worst at the L4-L5 level where there is a severe spinal
canal narrowing. Also multilevel lumbar spine neural foraminal narrowing as
described above.
Mild cervical and thoracic spondylosis as described above.
|
19891107-RR-13
| 19,891,107 | 26,303,115 |
RR
| 13 |
2131-06-23 21:10:00
|
2131-06-24 11:07:00
|
STUDY: AP chest, ___.
CLINICAL HISTORY: ___ man with morbid obesity with femurs and back
pain. Evaluate for pneumonia.
FINDINGS: The heart size is upper limits of normal. There is mild prominence
of interstitial markings without overt pulmonary edema. No definite
consolidation is seen. There are no pneumothoraces. Bony structures are
grossly intact.
|
19891107-RR-14
| 19,891,107 | 26,303,115 |
RR
| 14 |
2131-06-23 12:03:00
|
2131-06-23 15:01:00
|
INDICATION: Possible thoracic aortic aneurysm with suboptimal imaging at an
outside hospital. Presenting with chronic back pain.
COMPARISONS: CT of the torso with contrast from ___, obtained at
___.
TECHNIQUE: Contiguous axial MDCT images were obtained through the chest,
abdomen and pelvis after the administration of IV contrast per the long
dissection protocol. Sagittal and coronal reformatted images were obtained
and reviewed.
DLP TOTAL: ___ mGy-cm.
FINDINGS:
CTA: The exam is somewhat limited by cardiac motion and body habitus, though
the thoracic aorta is normal in course and caliber without evidence of
dissection. The area of question in the descending thoracic aorta that was
previously identified at an outside study scan demonstrates improved
opacification and there is no evidence of dissection. Mild atherosclerotic
calcifications are noted at the aortic arch. The abdominal aorta is normal in
caliber without evidence of an abdominal aortic aneurysm or dissection. There
are mild atherosclerotic calcifications of the abdominal aorta, though no
significant stenosis at the takeoff of the major vessels. Incidentally noted
are a replaced left hepatic artery and an accessory right renal artery. The
bilateral common iliac arteries are normal in course and caliber.
CHEST: The imaged portions of the thyroid gland are normal. There is no
axillary, mediastinal, or hilar lymphadenopathy. The heart is normal in size.
There is no pericardial effusion. The main pulmonary artery trunk is normal
in diameter. This CT is not timed to evaluate the pulmonary arteries, though
there is no large central filling defect.
The airways are patent to the subsegmental levels. Incidentally noted is a
small tracheal diverticulum just superior to the carina (2, 34). The lungs
are clear without nodule or consolidation. There is no pleural effusion or
pneumothorax. Minimal bibasilar atelectasis is present.
ABDOMEN: The liver is normal in shape and contour without focal hepatic
lesions. There is no intra- or extra-hepatic biliary duct dilation. The
gallbladder, spleen, pancreas, adrenal glands, and kidneys are normal. There
are no renal masses. There is no hydronephrosis or pyelonephritis.
The stomach and small bowel are unremarkable. There are no focal inflammatory
changes or evidence of obstruction. There is no free air or free fluid.
There is no mesenteric or periportal lymphadenopathy. Multiple small
retroperitoneal lymph nodes are present, though none meet criteria for
pathologic enlargement.
PELVIS: The large bowel is normal without focal inflammatory changes or
evidence of mass. The appendix is normal. Bladder and prostate are
unremarkable. Small pelvic sidewall lymph nodes are present, though none meet
criteria for pathologic enlargement. There is no pelvic or inguinal
lymphadenopathy. There is no free fluid in the pelvis.
OSSEOUS STRUCTURES: There is increased trabeculation of the right acetabulum
(2, 46), which may represent a small focus of pagetoid-like bone. The osseous
structures are otherwise unremarkable. There are no concerning lytic or
sclerotic osseous lesions. No fracture is identified. Mild degenerative
changes are noted throughout the spine.
IMPRESSION:
No evidence of aortic dissection, aortic aneurysm, or acute aortic pathology.
Results were discussed with Dr. ___ resident) at 2:00 p.m. on
___ via telephone by Dr. ___ at the time the findings were discovered.
|
19891107-RR-15
| 19,891,107 | 26,303,115 |
RR
| 15 |
2131-06-26 21:39:00
|
2131-06-27 09:13:00
|
HISTORY: ___ man with neck pain and bacteremia and concern for
osteomyelitis or epidural abscess.
TECHNIQUE: Sagittal T2 and sagittal STIR images of the cervical, thoracic and
lumbar spines were obtained. Following the administration of intravenous
contrast, sagittal T1 and axial T1 weighted images were obtained.
COMPARISON: MRI total spine without contrast ___.
FINDINGS:
There is no abnormal enhancement within the cervical spine.
Fluid signal is present in the region of the interspinous ligament at L3-L4
and L4- L5. In addition, at the level of L4 -L5, there are two small rim
enhancing collections in the paraspinal soft tissues adjacent to the L5
spinous process with enhancement extending into the left L5 lamina, left L4-5
facet joint, and into the left aspect of the spinal canal. The largest
paraspinal soft tissue collection measures 20 mm in maximal dimension. A small
collection within the spinal canal adjacent to the left L5 lamina measures 10
x 12 mm. An additional small collection in the left anterior aspect of the
spinal canal at the level of L4 measures 9 x 9 mm. In addition, there is
irregular linear enhancement surrounding the lumbar thecal sac and extending
superiorly to the mid thoracic spine.
Spinal alignment, vertebral body heights and disc spaces and multi level
degenerative changes are as described on the previous exam.
IMPRESSION:
Abnormal enhancement surrounding involving the left L5 lamina, spinous process
and facet joint with extension into the left aspect of the spinal canal where
there are two small epidural collections. Abnormal enhancement surrounds the
lumbar thecal sac and extends superiorly to the mid thoracic spine. This may
represent infectious or inflammatory myositis with small paraspinal abscesses
and an epidural component.
Findings communicated to Dr. ___ fellow, via telephone at 12:00
pm on ___, at the time of discovery.
|
19891107-RR-16
| 19,891,107 | 26,303,115 |
RR
| 16 |
2131-06-23 21:09:00
|
2131-06-24 07:57:00
|
STUDY: Right knee, ___.
CLINICAL HISTORY: ___ male with bacteremia, history of IV drug use,
concern for osteomyelitis and septic joint.
FINDINGS: There is a right total knee arthroplasty. There are no signs for
hardware-related complications. No periprosthetic lucencies or fractures are
seen. There is no bony destruction. There is soft tissue swelling about the
knee. Lateral view is suboptimal for evaluation of joint effusion.
|
19891107-RR-17
| 19,891,107 | 26,303,115 |
RR
| 17 |
2131-06-25 15:56:00
|
2131-06-25 17:09:00
|
STUDY: AP chest, ___.
CLINICAL HISTORY: ___ man with bacteremia, back pain and hypoxia.
FINDINGS: Comparison is made to previous study from ___.
There is prominence of the pulmonary interstitial markings, consistent with
pulmonary edema, which is moderate in severity. Heart size is enlarged.
There are no pneumothoraces. No focal consolidation is present.
|
19891107-RR-19
| 19,891,107 | 26,303,115 |
RR
| 19 |
2131-06-26 21:39:00
|
2131-06-27 11:32:00
|
MRI EXAMINATION OF THE LEFT HIP WITH AND WITHOUT GADOLINIUM CONTRAST
CLINICAL INDICATION: ___ male with remote history of intravenous drug
use with chronic back pain and MSSA bacteremia, evaluate for infection.
TECHNIQUE: MRI examination of the left hip was performed with and without
gadolinium contrast in the following sequences: Coronal T1 pelvis, coronal
STIR pelvis, axial T1 left hip, axial T2 left hip, axial STIR left hip and
post-contrast sequences.
COMPARISON: None.
FINDINGS:
There are degenerative changes of both hips, left greater than right, with
cartilage thinning, spurring, and os acetabulae, but no joint effusion or
findings suggestive of septic arthritis. Subchondral edema along the left
lateral femoral head is nonspecific, but more likely relates to degenerative
change (5:13). No other marrow edema is seen about left hip.
There is abnormal bone marrow edema along the right medial acetabulum
extending into the right inferior pubic ramus with surrounding soft tissue
edema and associated enhancement (5:22 and 15:20). T1 signal in this area is
predominantly hyperintense with thickened trabeculae. This is no intense low
signal T1 to suggest osteomyelitis. This corresponds to an area of thickened
trabeculae and ? slightly thickened cortex on the ___ CT scan (series 3,
im 496 of that exam).
Bone marrow signal intensity within the remainder of the pelvis girdle and
proximal femora is within normal limits with the exception of scattered
probable intraosseous hemangiomas versus focal medullary fat in the sacrum and
iliac bones. One focus also has a thin uniform rim of marrow edema, which is
somewhat atypical, but nonspecific (5:17).
Of note, there is edema surrounding the left L5 nerves anteriorly (8:1), with
edema about the left facet joint and in the left transverse process ___
5:15). This corresponds to the area of abnormality identified on the ___
lspine mri, though the epidural component is less well visualized on this
study. In addition, there is edema within the lower lumbar spine paraspinal
musculature bilaterally (8:1 and 8:2).
A Foley catheter is present within the bladder. Note is made of some
simple-appearing free fluid in the pelvis, an atypical finding in a male of
this age.
IMPRESSION:
1. Bone marrow edema along the right medial acetabulum extending to the right
inferior pubic ramus with surrounding soft tissue edema. This area does not
have marked low T1 signal and there are thickened trabecula in this region.
The differential diagnosis includes intraosseous vascular malformation such an
as intraosseous hemangioma, atypical Paget's disease, or atypical
osteomyelitis. The presence of thickened trabeculae is more suggestive of a
chronic process and an intraosseous hemangioma is therefore considered most
likely. However, clinical correlation to assess for any localized symptoms and
follow-up imaging of this area to confirm stability is recommended.
2. Degenerative change within the left > right hips, without evidence of
septic arthrits. Small focus of nonspecific edema in left femoral head is more
likely related to osteoarthritis than osteomyelitis.
3. Edema within the lower lumbar spine paraspinal musculature with edema
surrounding the left lower L5 nerve root, concerning for infection. Please
see report of lspine MRI obtained the same day.
Findings were discussed by Dr ___ by phone with the house officer covering
for Dr ___ (? ___ on ___. Findings in item #1 with
follow-up imaging recommendations were submitted to the critical results
dashboard.
|
19891107-RR-20
| 19,891,107 | 26,303,115 |
RR
| 20 |
2131-06-27 09:24:00
|
2131-06-27 11:33:00
|
CHEST RADIOGRAPH
INDICATION: Bacteremia, epidural abscess, evaluation after intubation.
COMPARISON: ___.
FINDINGS: As compared to the previous radiograph, the patient has been
intubated. The tip of the endotracheal tube projects 4.7 cm above the carina.
There is no evidence of complications, notably no pneumothorax.
The size of the cardiac silhouette continues to be moderately enlarged, there
is minimal fluid overload but no overt pulmonary edema. Retrocardiac
atelectasis with air bronchograms, but no evidence of pneumonia.
|
19891107-RR-21
| 19,891,107 | 26,303,115 |
RR
| 21 |
2131-06-27 16:37:00
|
2131-06-28 10:52:00
|
SINGLE FRONTAL VIEW OF THE CHEST
REASON FOR EXAM: Assess NG tube.
Comparison is made with prior study performed the same day earlier in the
morning.
ET tube is in a standard position. The tip is 4.5 cm above the carina. NG
tube tip is in the distal stomach. There are lower lung volumes. No other
acute interval changes.
|
19891107-RR-22
| 19,891,107 | 26,303,115 |
RR
| 22 |
2131-06-28 12:52:00
|
2131-06-28 14:23:00
|
HISTORY: ___ year old man with MSSA bacteremia with L5 paraspinal fluid.
Please drain paraspinal fluid collection at L5.
COMPARISON: Compared to lumbar spine MRI dated ___.
TECHNIQUE: Consent could not be obtained from the patient as he was
intubated. No family members available for informed consent. Referring
service deemed the procedure to be a medical necessity and the aspiration was
performed. The preprocedure time out was performed confirming the patient
identity, labs and relevant history.
Under fluoroscopic guidance and after the administration of 1% lidocaine for
local anesthesia the small collection adjacent to the L5 spinous processes was
accessed using a 18 gauge, 20cm Franseen needle. Approximately 4 cc of
purulent material was aspirated and sent to the laboratory for analysis.
FINDINGS:
Under are fluoroscopic guidance the L5 paraspinal collection was accessed with
a 18 gauge, 20 cm Franseen needle. Approximately 4 cc of purulent material
was aspirated and sent to the laboratory for analysis.
IMPRESSION:
Successful aspiration of 4 cc of purulent material adjacent to the L5 spinous
process and sent to the laboratory for analysis. Patient tolerated the
procedure without complications.
|
19891107-RR-23
| 19,891,107 | 26,303,115 |
RR
| 23 |
2131-06-30 09:26:00
|
2131-06-30 14:04:00
|
CHEST RADIOGRAPH
INDICATION: PICC line placement.
COMPARISON: ___.
FINDINGS: As compared to the previous radiograph, the patient has received a
new PICC line. The line appears to project over the right atrium and should
be pulled back by approximately 4-5 cm. The other monitoring and support
devices are in constant position. The lung volumes have increased, the signs
indicative of pulmonary edema have slightly decreased in severity. Moderate
cardiomegaly persists. Retrocardiac atelectasis is unchanged.
|
19891107-RR-24
| 19,891,107 | 26,303,115 |
RR
| 24 |
2131-06-30 11:15:00
|
2131-06-30 16:01:00
|
HISTORY: PICC line placement.
TECHNIQUE: Single, AP, portable view of the chest was obtained.
COMPARISON: Comparison made to radiographs dated ___.
FINDINGS:
There has been interval placement of a right-sided PICC line, the tip of which
is seen extending into the right atrium, roughly 8 cm beyond the cavoatrial
junction. An endotracheal tube is noted, terminating approximately 6 cm above
the carina. There is a nasogastric tube is traceable through the lower
esophagus, although the tip is not visible. Within the lung parenchyma, there
is a dense consolidation noted within the left upper lung and lingula,
concerning for potential aspiration pneumonia. There is a probable small
left-sided pleural effusion. The right lung is grossly clear. The heart size
cannot be adequately assessed on this examination. Mediastinal contours are
normal.
IMPRESSION:
1. Right-sided PICC line with the tip in the right atrium. If desired to
place the tip at the cavoatrial junction, the line should be withdrawn by 8
cm.
2. Left upper and mid lung consolidation, concerning for potential aspiration
pneumonia.
Findings were conveyed by Dr. ___ to ___ at 2:06pm on ___ via
telephone, 5 minutes after discovery.
|
19891107-RR-25
| 19,891,107 | 26,303,115 |
RR
| 25 |
2131-06-30 14:34:00
|
2131-06-30 16:32:00
|
HISTORY: Status post right PICC line and bilateral.
TECHNIQUE: Single, AP, portable view of the chest was obtained.
COMPARISON: Comparison is made to radiographs dated ___.
FINDINGS:
The right-sided PICC line is now identified with the tip extending to the
level of the carina. The endotracheal tube is again noted to terminate
approximately 6 cm above the level of the carina. The nasogastric tube can be
traced to the level of the lower esophagus, after which point it is no longer
visualized. There has been an interval improvement in the aeration of the
left hip upper and mid lung, suggestive of an atelectatic process. Stable,
small left-sided pleural effusion. The right lung remains unremarkable in
appearance. There is mild to moderate cardiomegaly noted. Mediastinal
contours are stable.
IMPRESSION:
1. Right-sided PICC line, now seen terminating at the level of the carina.
2. Interval improvement in the previously identified left upper and mid lung
opacity, suggesting that this was an atelectatic process.
|
19891107-RR-26
| 19,891,107 | 26,303,115 |
RR
| 26 |
2131-07-01 21:23:00
|
2131-07-02 09:57:00
|
HISTORY: Patient with bacteremia and paraspinal abscess for further
evaluation.
TECHNIQUE: T1, T2 and inversion recovery sagittal and T2 axial images of the
lumbar spine were obtained before gadolinium. T1 sagittal and axial images of
the lumbar spine were acquired following gadolinium.
COMPARISON: Comparison was made with the previous MRI of ___.
FINDINGS:
There continues to be increased signal identified within the posterior soft
tissues. There is also diffuse and enhancement seen in the epidural space in
the lumbar spine extending from L2-L5 and sacral level. The epidural
enhancement appears to have increased from the prior study. In addition,
there is increase in size of the epidural abscess seen which now extends from
L2-L4 level anterior to the thecal sac. There is also a small epidural fluid
collection seen posterior to the L5 vertebra. There has been interval
postoperative changes identified at L4-5 level with diffuse enhancement of the
muscles and a fluid collection within the soft tissues which has slightly
increased in size and could be postoperative in nature but could also be due
to abscess.
Multilevel degenerative changes are seen as described previously. The distal
spinal cord shows normal signal intensity. There is a well-defined area of
increased T1 signal seen in the posterior soft tissues in the upper lumbar
region which demonstrates low signal on inversion recovery images. This could
be secondary to a lipoma.
IMPRESSION:
Increase in size of the epidural abscess and epidural enhancement since the
previous study. Postoperative changes are seen but there continues to be a
small amount of fluid collection in the posterior soft tissues at that level
with increased fluid in the f left acet joints at L4-5 level. Other findings
as described above.
Telephone notification to Dr. ___ by Dr ___ at 09:45 on ___, 5 min after the study.
|
19891107-RR-27
| 19,891,107 | 26,303,115 |
RR
| 27 |
2131-07-02 13:29:00
|
2131-07-02 17:16:00
|
PORTABLE CHEST ___ WITH COMPARISON ___ RADIOGRAPH
FINDINGS: Support and monitoring devices are in standard position, and
cardiomediastinal contours are stable. Worsening left lower lobe and new
patchy right lower lobe opacities, which may represent atelectasis, aspiration
or developing pneumonia. Slight improvement in linear juxtahilar opacities
likely due to atelectasis.
|
19891107-RR-28
| 19,891,107 | 26,303,115 |
RR
| 28 |
2131-07-04 07:08:00
|
2131-07-04 14:43:00
|
HISTORY: Bacteremia.
FINDINGS: In comparison with the study of ___, the monitoring and support
devices remain in place. There are lower lung volumes. Continued decrease in
the patchy opacifications bilaterally, suggesting clearing atelectasis or
aspiration. Dense streak of atelectasis is seen at the left base.
|
19891107-RR-29
| 19,891,107 | 26,303,115 |
RR
| 29 |
2131-07-03 10:20:00
|
2131-07-03 11:11:00
|
PORTABLE CHEST ___
COMPARISON: ___ radiograph.
FINDINGS: Support and monitoring devices are unchanged in position, and
cardiomediastinal contours are stable. Rapid improvement of bibasilar
opacities nearly resolved on the right with residual patchy and linear
opacities on the left. Such rapid improvement favors atelectasis or
aspiration over an infectious pneumonia. Small left pleural effusion is again
demonstrated, but there is no evidence of a pneumothorax.
|
19891107-RR-30
| 19,891,107 | 26,303,115 |
RR
| 30 |
2131-07-04 17:31:00
|
2131-07-05 10:36:00
|
REASON FOR EXAMINATION: Evaluation of the patient after central venous line
placement.
Portable AP radiograph of the chest was reviewed in comparison to ___, obtained at 07:22 a.m.
The ET tube tip is 6.5 cm above the carina. Left internal jugular line tip is
at the low SVC. Right PICC line tip is at the level of low SVC as well.
Heart size is enlarged and unchanged since the prior study. Bibasilar
opacities appear to be slightly more prominent than on the prior examination.
The ET tube tip is 7 cm above the carina. The NG tube passes below the
diaphragm, most likely with its tip not clearly included in the field of view.
|
19891107-RR-31
| 19,891,107 | 26,303,115 |
RR
| 31 |
2131-07-05 04:11:00
|
2131-07-05 11:15:00
|
REASON FOR EXAMINATION: Evaluation of the patient intubated for respiratory
failure with MSSA bacteremia.
Portable AP radiograph of the chest was reviewed in comparison to ___ obtained at 5:37 p.m.
The ET tube tip is approximately 6.3 cm above the carina. The left internal
jugular line tip is at the level of low SVC. Right PICC line tip is at the
level of superior SVC. Heart size and mediastinum are grossly unchanged and
there are bibasal areas of atelectasis. No pneumothorax is seen and no overt
pulmonary edema is demonstrated.
|
19891107-RR-32
| 19,891,107 | 26,303,115 |
RR
| 32 |
2131-07-05 14:31:00
|
2131-07-06 10:36:00
|
CHEST RADIOGRAPH
INDICATION: Status post endotracheal tube advancement, evaluation.
COMPARISON: ___.
FINDINGS: As compared to the previous radiograph, the endotracheal tube has
been advanced. The tube currently projects 4 cm above the carina, instead of
6 cm on the previous image. The other monitoring and support devices are
unchanged. Unchanged appearance of the cardiac silhouette and of the lung
parenchyma. No evidence of complications.
|
19891107-RR-33
| 19,891,107 | 26,303,115 |
RR
| 33 |
2131-07-06 03:06:00
|
2131-07-06 10:33:00
|
CHEST RADIOGRAPH
INDICATION: Bacteremia
COMPARISON: ___.
FINDINGS: As compared to the previous radiograph, there is no relevant
change. The monitoring and support devices including the endotracheal tube,
are in unchanged position. Unchanged mild-to-moderate pulmonary edema and
moderate cardiomegaly, with retrocardiac atelectasis. The presence of a
minimal left pleural effusion cannot be excluded. No other new parenchymal
opacities, notably none suggesting pneumonia.
|
19891107-RR-34
| 19,891,107 | 26,303,115 |
RR
| 34 |
2131-07-07 02:27:00
|
2131-07-07 08:59:00
|
PORTABLE CHEST ___
COMPARISON: Radiograph of one day earlier.
FINDINGS: Support and monitoring devices are in standard position, and
cardiomediastinal contours are stable allowing for marked rightward patient
rotation. Pulmonary vascular congestion is accompanied by resolving edema and
improving bibasilar lung opacities.
|
19891107-RR-35
| 19,891,107 | 26,303,115 |
RR
| 35 |
2131-07-09 11:07:00
|
2131-07-09 13:18:00
|
HISTORY: Morbidly obese with epidural abscess status post laminectomy now
with right lower extremity tenderness. Evaluate for deep vein thrombosis.
TECHNIQUE: Duplex Doppler examination was performed on the lower extremities.
COMPARISON: None.
FINDINGS: On the right, the exam was limited by body habitus and patient
tenderness. There is normal flow and augmentation seen within the right
common femoral, superficial femoral and popliteal veins. Normal flow was
noted within the calf veins.
On the left, there is normal compression and augmentation in the left common
femoral and superficial femoral veins. A nonocclusive thrombus is noted
within the popliteal vein. The peroneal veins are not visualized, and
extension into these vessels cannot be excluded. There is normal flow noted
within the posterior tibial veins.
Normal respiratory phasicity is seen in the common femoral veins bilaterally.
IMPRESSION:
1. Left popliteal deep vein thrombosis. The left peroneal veins were not
visualized and extension into these vessels cannot be excluded.
2. Limited evaluation of the right lower extremity, however, no right deep
vein thrombosis was visualized.
These findings were discussed with Dr. ___ by Dr. ___ at 13:12 on ___ by telephone at the time of discovery.
|
19891107-RR-36
| 19,891,107 | 26,303,115 |
RR
| 36 |
2131-07-10 12:25:00
|
2131-07-10 15:26:00
|
REASON FOR EXAMINATION: Shortness of breath and Klebsiella in the sputum,
assessment for ventilation-acquired pneumonia.
AP radiograph of the chest was reviewed in comparison to ___.
The patient was extubated in the meantime interval with removal of the NG
tube. The right PICC line tip is at the level of mid SVC. Heart size and
mediastinum are stable. There is interval improvement of bibasilar
consolidations with no evidence of new consolidation to suggest interval
development of ventilation-acquired pneumonia.
|
19891253-RR-150
| 19,891,253 | 26,307,811 |
RR
| 150 |
2199-10-09 18:41:00
|
2199-10-09 22:12:00
|
INDICATION: Patient with relapsing-remitting multiple sclerosis, who now
presents with nausea, vomiting and diarrhea.
COMPARISONS: ___.
TECHNIQUE: MDCT-acquired contiguous images through the abdomen and pelvis was
obtained with intravenous contrast at 5 mm slice thickness. Coronally and
sagittally reformatted images are provided.
FINDINGS: Imaged lung bases are clear without pleural effusion. Heart size is
normal without pericardial effusion. Patient is status post bilateral
mastectomies and bladder reconstruction.
CT ABDOMEN: Evaluation of abdominal organs is limited due to extensive streak
artifact generated by metallic hardware. The liver enhances homogeneously.
Focal hypodensities in segment VII are too small to characterize and likely
represent cysts or hamartomas (2:12, 2:15). An additional hypodensity in left
hepatic lobe is also seen (2:17), stable. The hepatic vasculature appears
patent. The gallbladder is incompletely distended. There is no gallbladder
wall edema or pericholecystic fluid collection to suggest acute inflammation.
The spleen is unremarkable. The pancreas enhances homogeneously without
ductal dilatation or peripancreatic fluid collection. The CBD measures 5 mm.
The adrenal glands are unremarkable. The kidneys enhance and excrete
symmetrically without hydronephrosis or renal masses. There is no evidence
of small-bowel obstruction. Imaged intra-abdominal aorta appears normal in
caliber. Multiple surgical clips are seen within the retroperitoneum.
CT OF THE PELVIS: The patient is status post bladder reconstruction, which is
markedly distended. The bladder, rectum and sigmoid colon is unremarkable.
There is no free air or free fluid within the pelvis. There is no pelvic or
inguinal lymphadenopathy.
OSSEOUS STRUCTURES: Spinal fusion hardware is in place, which appears intact.
There is severe rotatory levoscoliosis of the thoracolumbar spine.
IMPRESSION:
1. Markedly distended bladder. Patient is status post bladder augmentation.
In this patient with history of nephrogenic metaplasia, continued f/u
recommendations per Urology.
2. Limited evaluation of intra-abdominal organs due to extensive streak
artifact generated by metallic hardware. Within this limitation, no evidence
of acute intra-abdominal process.
3. Focal hepatic hypodensities, too small to characterize, likely cysts or
hamartomas.
|
19891253-RR-151
| 19,891,253 | 26,307,811 |
RR
| 151 |
2199-10-10 13:47:00
|
2199-10-10 14:46:00
|
INDICATION: Mild pancreatitis on CT equivocal for cholelithiasis. Please
evaluate for cholelithiasis.
COMPARISON: ___ abdominal CT.
TECHNIQUE: Upper quadrant ultrasound.
FINDINGS: Hepatic echotexture is within normal limits. There is no intra- or
extra-hepatic biliary ductal dilation. The common hepatic duct measures 2 mm.
No focal liver lesions are identified. The gallbladder is nondistended and
contains a single shadowing, mobile gallstone. There is no evidence of
gallbladder wall edema or pericholecystic fluid. Portal vein is patent with
flow in the appropriate direction. Imaged portion of pancreas appears within
normal limits with portions of the pancreatic head and tail obscured by
overlying bowel gas. The spleen measures 9.1 cm. A small splenule is seen at
the splenic hilum.
IMPRESSION:
1. Cholelithiasis without sonographic evidence of cholecystitis. No biliary
dilation.
2. Otherwise, unremarkable abdominal ultrasound.
|
19891253-RR-152
| 19,891,253 | 26,307,811 |
RR
| 152 |
2199-10-15 15:52:00
|
2199-10-16 10:11:00
|
HISTORY: Abdominal pain. Question pancreatitis.
COMPARISON: MRCP dated ___.
TECHNIQUE: Coronal and axial T2 and axial T1-weighted sequences were
performed on a 1.5 Tesla magnet without intravenous contrast.
FINDINGS:
The pancreatic duct is of normal caliber. No side branches are visualized.
The 2 mm cystic lesion that was identified within the pancreas on the previous
MRI is not identified on the current study. Normal signal is identified
within the pancreatic parenchyma on the pre-contrast T1-weighted sequence.
There is signal loss within the liver between the T1-weighted in-phase and
out-of-phase sequences (fat fraction = 9%). There are multiple subcentimeter
T2 hyperintense cystic lesions within the liver which likely represent biliary
hamartomas and are unchanged since previous. The liver is otherwise
unremarkable on this non-contrast examination. No intra or extrahepatic duct
dilatation. The common bile duct measures 6 mm in diameter. A solitary
gallstone is noted within the gallbladder. The gallbladder is otherwise
unremarkable.
There are subcentimeter T2 hyperintense cystic lesions within the left kidney,
consistent with simple cysts. The kidneys are otherwise unremarkable. The
adrenals and spleen are within normal limits. The visualized small and large
bowel is unremarkable. No retroperitoneal or mesenteric adenopathy. The lung
bases are clear. The patient is status post spinal fusion with scoliosis of
the lower thoracic and upper lumbar spine convex to the left. No destructive
osseous lesions.
IMPRESSION:
1. Pancreas appears within normal limits without ductal abnormalities or
complications from prior or acute pancreatitis.
2. Mild hepatic steatosis.
3. Cholelithiasis.
|
19891253-RR-154
| 19,891,253 | 25,786,771 |
RR
| 154 |
2199-11-26 17:02:00
|
2199-11-26 17:31:00
|
HISTORY: Fall out of wheelchair with severe right hip pain.
TECHNIQUE: AP view of the pelvis, 2 views of the right hip.
COMPARISON: ___.
FINDINGS:
Right subcapital femoral neck fracture is demonstrated with proximal and
lateral displacement of the dominant distal fracture fragment by at least one
shaft width. Additionally, the distal fracture fragment is also rotated. No
dislocation is demonstrated. There is no diastasis of the pubic symphysis or
sacroiliac joints. Hardware within the lower lumbosacral spine is unchanged
without complications. There are moderate degenerative changes of both hips
with joint space narrowing. Sclerotic focus within the left intertrochanteric
region of the left femoral neck is unchanged compatible with a bone island.
IMPRESSION:
Displaced fracture of the right femoral neck.
|
19891253-RR-155
| 19,891,253 | 25,786,771 |
RR
| 155 |
2199-11-26 18:53:00
|
2199-11-26 19:48:00
|
HISTORY: Right femoral neck fracture. Perform traction view.
TECHNIQUE: Single AP view of the right hip with traction.
COMPARISON: ___ at 17:05.
FINDINGS:
Re- demonstrated is a right subcapital femoral neck fracture. The degree of
displacement of the distal fracture fragment has improved, now appearing only
minimally medially displaced. Additionally, the distal fracture fragment no
longer appears rotated. No dislocation is identified.
IMPRESSION:
Interval improvement in alignment of the right femoral neck fracture.
|
19891253-RR-156
| 19,891,253 | 25,786,771 |
RR
| 156 |
2199-11-26 19:08:00
|
2199-11-26 19:44:00
|
HISTORY: Right knee pain.
TECHNIQUE: 3 views of the right knee.
COMPARISON: ___.
FINDINGS:
There is no acute fracture or dislocation is present. A joint effusion is not
identified. No suspicious lytic or sclerotic osseous abnormalities are
visualized. There are no soft tissue calcifications. Mild medial joint space
narrowing is unchanged.
IMPRESSION:
No acute fracture or dislocation.
|
19891253-RR-157
| 19,891,253 | 25,786,771 |
RR
| 157 |
2199-11-27 15:45:00
|
2199-11-28 09:24:00
|
STUDY: Single intraoperative radiograph of the right hip ___.
COMPARISON: ___.
INDICATION: Right total hip arthroplasty.
FINDINGS AND IMPRESSION: Single AP view of the right hip. Status post
hemiarthroplasty. The hardware appears intact. No definite fracture or
dislocation on this single view. Please see operative report for further
details.
|
19891464-RR-18
| 19,891,464 | 26,947,998 |
RR
| 18 |
2121-10-05 10:32:00
|
2121-10-05 12:46:00
|
INDICATION: The patient with history of bilateral inguinal hernia, status
post repair, who now presents with left inguinal mass, which is not reducible
on exam.
COMPARISONS: None available.
TECHNIQUE: MDCT-acquired contiguous images through the abdomen and pelvis
were obtained with intravenous contrast at 5-mm slice thickness. Coronally
and sagittally reformatted images were displayed.
FINDINGS:
CT OF THE ABDOMEN: Bibasilar dependent atelectasis is noted. Otherwise, the
imaged lung bases are clear. The heart is normal in size without pericardial
effusion. Aortic valve and coronary artery calcifications are noted.
The liver enhances homogeneously without focal lesions. There is no evidence
of intrahepatic or extrahepatic biliary ductal dilatation. Focal hypodensity
in segment VI (2:32) is too small to characterize and likely represents a cyst
or hematoma. No suspicious hepatic lesion is seen. The hepatic vasculature
is patent. The gallbladder is incompletely distended. There is no
gallbladder wall thickening or pericholecystic fluid collection to suggest
acute inflammation. The spleen is unremarkable. The pancreas enhances
homogeneously without ductal dilatation or peripancreatic fluid collection.
The adrenal glands are normal. Kidneys enhance and excrete contrast
symmetrically without evidence of hydronephrosis or renal masses.
Small and large bowel loops are normal in caliber without evidence of bowel
wall thickening or obstruction. No pathologically enlarged mesenteric or
retroperitoneal lymph nodes are seen. There is no free air or free fluid
within the abdomen. The intra-abdominal aorta and its branches are notable
for calcified atherosclerotic disease without associated aneurysmal changes.
CT OF THE PELVIS: The bladder and rectum are unremarkable. The prostate
gland is enlarged measuring 5.7 x 4. 5 cm internal calcification. There is a
left inguinal hernia containing a short loop of the sigmoid colon. The bowel
wall enhancement is maintained. Surrounding fat stranding is noted. There is
no fluid present in hernia sac. There is no right inguinal hernia. The
sigmoid colon is otherwise unremarkable. There are no pathologically enlarged
pelvic or inguinal lymph nodes. Surgical clips are seen in the scrotum
bilaterally. No free air or free fluid within the pelvis.
OSSEOUS STRUCTURES: No suspicious lytic or sclerotic lesions are seen.
IMPRESSION:
1. Left inguinal hernia contains a small segment of the sigmoid colon. There
is surrounding fat stranding. The bowel wall enchancement is maintained.
There is no fluid within the hernia sac.
2. Focal hepatic hypodensity, too small to characterize, likely a cyst or
hematoma.
|
19891610-RR-23
| 19,891,610 | 27,974,538 |
RR
| 23 |
2160-04-11 16:43:00
|
2160-04-11 18:47:00
|
EXAMINATION:
Chest: Frontal and lateral views
INDICATION: History: ___ with fevers, confusion // pls eval for PNA
TECHNIQUE: Chest: Frontal and Lateral
COMPARISON: None.
FINDINGS:
There is thoracic scoliosis. The left hilar/mediastinal calcified nodes
likely relate to prior granulomatous disease. The cardiac silhouette is
top-normal to mildly enlarged. The aorta is tortuous. No focal consolidation
is seen. There is no pleural effusion or pneumothorax.
IMPRESSION:
No acute cardiopulmonary process.
|
19891610-RR-24
| 19,891,610 | 27,974,538 |
RR
| 24 |
2160-04-11 16:29:00
|
2160-04-11 17:07:00
|
EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ with confusion on lovenox. Assess for subdural hematoma.
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
Coronal and sagittal as well as thin bone-algorithm reconstructed images were
obtained.
DOSE: DLP: 891.93 mGy-cm
CTDI: 52.22 mGy
COMPARISON: CT orbit ___.
FINDINGS:
Bilateral acute on chronic subdural hematoma, right greater than left, which
extension along the frontoparietal convexity bilaterally. These measure 1.3
cm (02:17) on the right and 0.6 cm (02:16) on the left in maximal width.
There is 3 mm leftwards shift of normally midline structures. Mild effacement
of the right sided sulci in comparison to the left is noted. No
intraparenchymal hemorrhage. No subarachnoid hemorrhage. There is no
evidence of infarction, edema or mass. Prominence of the ventricles and sulci
are consistent with age-related cortical volume loss. Periventricular,
subcortical and deep white matter hypodensities are likely sequelae of chronic
small vessel ischemic disease.
No osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and
middle ear cavities are clear. Calcification of bilateral cavernous portions
of internal carotid arteries are noted. Soft tissue density within bilateral
external auditory canals is most consistent with cerumen.
IMPRESSION:
1. Bilateral acute on chronic subdural hematomas, right greater than left,
with 3 mm leftwards shift of normally midline structures and mild effacement
of the sulci, right greater than left.
2. No intraparenchymal hemorrhage.
3. Chronic changes as described above.
|
19891610-RR-25
| 19,891,610 | 27,974,538 |
RR
| 25 |
2160-04-12 08:43:00
|
2160-04-12 11:33:00
|
EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ year old man with bilateral acute on chronic SDH // interval
change, complete prior to 8am ___
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
Coronal and sagittal as well as thin bone-algorithm reconstructed images were
obtained.
DOSE: DLP: 54 mGy-cm
CTDI: 1014 mGy
COMPARISON: Head CT from ___.
FINDINGS:
Again seen are bilateral acute on chronic subdural hemorrhage, right greater
than left, not significantly changed from prior study from a day ago. 3 mm
leftward shift of midline structures is stable. No new hemorrhage or
infarction are seen. The ventricles and sulci are unchanged in size and
configuration.
No osseous abnormalities seen. Limited evaluation of the paranasal sinuses,
mastoid air cells, and middle ear cavities appear clear. The orbits are
unremarkable.
IMPRESSION:
Stable acute on chronic bilateral subdural hemorrhage. No new hemorrhage or
infarction.
|
19891610-RR-41
| 19,891,610 | 24,903,155 |
RR
| 41 |
2161-03-09 12:25:00
|
2161-03-09 12:57:00
|
EXAMINATION: UNILAT UP EXT VEINS US LEFT
INDICATION: History: ___ with LUE swelling // DVT
TECHNIQUE: Grey scale and Doppler evaluation was performed on the left upper
extremity veins.
COMPARISON: None.
FINDINGS:
There is normal flow with respiratory variation in the left subclavian vein.
The left internal jugular and axillary veins are patent, show normal color
flow and compressibility. The left brachial, basilic, and cephalic veins are
patent, compressible and show normal color flow and augmentation.
There is significant subcutaneous edema overlying the left forearm.
Pacemaker lead seen in left subclavian vein.
IMPRESSION:
Significant subcutaneous edema without the presence of DVT in the left upper
extremity.
|
19891610-RR-42
| 19,891,610 | 24,903,155 |
RR
| 42 |
2161-03-09 16:50:00
|
2161-03-09 17:44:00
|
EXAMINATION: CTV chest
INDICATION: Left upper extremity swelling with no DVT ultrasound. Evaluate
for central thrombus or mass occluding venous return.
TECHNIQUE: Axial multidetector CT images were obtained through the thorax
before and after the uneventful administration of intravenous contrast in the
venous phase. Reformatted coronal, sagittal, thin slice axial images, and
oblique maximal intensity projection images were submitted to PACS and
reviewed.
DOSE: Total DLP (Body) = 559 mGy-cm.
COMPARISON: CTA chest ___.
FINDINGS:
Bilateral thyroid nodules measure up to 7 mm in the left lobe and 7 mm in the
right lobe.
Heart is mildly enlarged without significant pericardial fluid. Left anterior
chest wall pacer is in place with unchanged position of the leads. There are
moderate atherosclerotic calcifications along a normal caliber abdominal
aorta. Main pulmonary artery is normal caliber and there is no central
embolus. There is no supraclavicular, axillary, hilar or mediastinal
lymphadenopathy by CT size criteria.
Bilateral internal jugular, axillary and subclavian veins are patent, with
evaluation of the left, minimally limited by pacer leads. SVC is patent.
There is no central venous thrombosis.
There are moderate to large bilateral pleural effusions with adjacent
compressive atelectasis, most prominent in the lung bases and in the lingula.
There is mild biapical scarring which appears similar to the prior
examination. Punctate calcified granuloma is noted in the lingula. Multiple
calcified mediastinal and left hilar lymph nodes are noted.
Imaged portion of the visualized upper abdomen is notable for moderate ascites
and bilateral renal hypodensities measuring up to 3.1 cm in the right upper
pole kidney as well as scattered sub cm hypodensities which are all
incompletely characterize, but likely to represent cysts.
Bones and soft tissues: There is no suspicious focal bone lesion. There are
changes from a healed impacted right humeral neck fracture. There is diffuse
superficial soft tissue stranding compatible with anasarca, though the left
arm soft tissues appear asymmetric to the right.
IMPRESSION:
1. Patent central veins in the chest, without evidence of central venous
thrombosis.
2. Moderate to large bilateral pleural effusions.
3. Sub cm bilateral thyroid nodules which require no further evaluation.
4. Anasarca and moderate ascites.
|
19891640-RR-10
| 19,891,640 | 26,718,333 |
RR
| 10 |
2151-12-28 09:56:00
|
2151-12-28 11:38:00
|
EXAMINATION: TIB/FIB (AP AND LAT) LEFT IN O.R.
INDICATION: LEFT TIB FX.ORIF
IMPRESSION:
Fluoroscopic images show placement of external fixation devices about fracture
of the proximal tibia. Further information can be gathered from the operative
report.
|
19891640-RR-11
| 19,891,640 | 26,718,333 |
RR
| 11 |
2151-12-28 17:09:00
|
2151-12-29 10:34:00
|
EXAMINATION: CT left knee without contrast
INDICATION: Preoperative planning for of left tibial plateau fracture repair.
TECHNIQUE: Axial helical multi detector CT images were acquired of the knee
without contrast. Multiplanar reformats were generated in the coronal and
sagittal planes.
DOSE: Acquisition sequence:
1) CT Localizer Radiograph
2) CT Localizer Radiograph
3) Spiral Acquisition 9.0 s, 20.8 cm; CTDIvol = 27.1 mGy (Body) DLP = 536.8
mGy-cm.
Total DLP (Body) = 544 mGy-cm.
COMPARISON: Left tibia/ fibula radiograph ___. Outside hospital
left knee radiograph ___.
FINDINGS:
There is a severely comminuted, mildly displaced 4 part bicondylar tibial
plateau fracture. In the medial plateau, there is maximal articular step-off
of 2 mm (603 08:24). In the lateral plateau, there is maximal articular
step-off of 8 mm (603 08:55). Tiny intraarticular fracture fragments are
noted in both the medial and lateral compartments. There is an additional
nondisplaced, mildly comminuted oblique fracture of the fibular head (603
08:59). No other fracture is identified.
There is a large associated lipohemarthrosis. There is prominent superficial
soft tissue swelling about the knee. Though soft tissue evaluation by CT is
limited, in the ACL and PCL appear to follow their usual course. Quadriceps
and patellar tendons are grossly intact. The distal patellar tendon insertion
appears preserved and uninvolved by the fracture. There is apparent laxity of
the medial collateral ligament though fibers are grossly intact. Noted. The
lateral collateral ligamentous complex is grossly unremarkable by CT.
IMPRESSION:
1. Severely comminuted, mildly displaced 4 part bicondylar tibial plateau
fracture, as described above.
2. Nondisplaced mildly comminuted oblique fracture of the fibular head.
3. Large associated lipohemarthrosis and soft tissue swelling about the knee.
s
|
19891640-RR-23
| 19,891,640 | 23,804,716 |
RR
| 23 |
2152-06-14 14:27:00
|
2152-06-14 18:24:00
|
EXAMINATION: DX FEMUR AND TIB/FIB
INDICATION: ___ female with fall last night and now acute left hip
fracture. Please evaluate for hardware placement and acute fracture status
post fall.
TECHNIQUE: Frontal and lateral radiographs of the left femur, knee, and tibia
and fibula were obtained.
COMPARISON: Pelvis CT from ___.
FINDINGS:
There is a minimally displaced subcapital left hip fracture, better delineated
on the recent pelvic CT. Ghost tracts are noted in the femur, and no acute
fracture is seen in the knee or left tibia and fibula. Left proximal tibial
surgical plates and screws appear similar to prior exam without evidence of
hardware failure or loosening. Ghost tracks are again noted in the
proximal-mid left tibia.
IMPRESSION:
1. Left femoral neck fracture, subcapital, as noted on the recent pelvis CT.
2. Stable appearance of the left tibial surgical hardware without evidence of
loosening or hardware failure.
|
19891640-RR-24
| 19,891,640 | 23,804,716 |
RR
| 24 |
2152-06-14 14:27:00
|
2152-06-14 16:05:00
|
INDICATION: ___ with left hip fracture, plan for OR tomorrow with
orthopedics // Pre-op CXR
TECHNIQUE: Single supine view of the chest.
COMPARISON: ___.
FINDINGS:
The lungs are well inflated and clear. Skin fold projects over the right lung
superolaterally. The cardiomediastinal silhouette is within normal limits.
No displaced fractures identified.
IMPRESSION:
No acute cardiopulmonary process.
|
19891640-RR-25
| 19,891,640 | 23,804,716 |
RR
| 25 |
2152-06-14 14:38:00
|
2152-06-14 18:01:00
|
EXAMINATION: CT PELVIS ORTHO W/O C
INDICATION: ___ woman with a history of asthma (treated with
fluticasone), now with a posttraumatic left hip fracture, presenting for
further evaluation due to concern for a pathological fracture.
TECHNIQUE: Multidetector CT images were obtained of the pelvis and extending
through the tibial plateaus bilaterally, without the administration of
intravenous contrast. Coronal and sagittal reformats were reviewed.
DOSE: Total DLP: ___ mGy-cm
COMPARISON: Outside facility pelvis/hip radiographs ___
FINDINGS:
There is an acute subcapital fracture on the left, as seen on the recent
radiograph performed earlier on the same date. This is associated with
impaction and varus angulation. No definite evidence of an underlying lesion
to suggest a pathological fracture. Faint ill-defined sclerosis in the
femoral neck may be due to fracture-related trabecular compression or a prior
medullary infarct. No other fractures are identified.
Note is made of crescentic areas of mild subchondral sclerosis separated from
normal bone by linear serpiginous areas of more dense sclerosis. Findings are
consistent with bilateral avascular necrosis. Slightly more inferiorly along
the inferior medial surface of the left femoral head, there is a surface
concavity/deformity (2:75, 400b:67), which appears to be separate from the
fovea capitis. This raises the possibility of subchondral collapse, although
notably its inferior location is atypical. Two ghost tracks are seen in the
left mid femoral shaft.
Limited evaluation of the knee joints reveals a small non-hemorrhagic effusion
on the left (2:242). There has been prior surgical fixation of a tibial
plateau fracture, without evidence of hardware loosening. Nonspecific
oval-shaped sclerosis along the posterior aspect of the medial femoral condyle
measures 1.6 x 0.8 cm (2:250).
Degenerative changes are noted in the lower lumbosacral spine, with
intervertebral disc space narrowing and vacuum disc phenomena at L5-S1. Mild
calcification projecting posterior to the L5-S1 intervertebral disc space is
likely due to disc pathology.
Imaged small and large bowel loops are normal in caliber. Bladder is mildly
distended. Uterus is grossly unremarkable, within the limitations of this
noncontrast CT. No adnexal masses are identified. No free fluid in the pelvis.
IMPRESSION:
1. Acute left subcapital fracture with impaction and varus angulation. No
definite evidence of an underlying lesion to suggest a pathological fracture.
However, note that subtle osseous lesions may be obscured by the fracture
itself.
2. Bilateral femoral head osteonecrosis. Non-specific concavity along the
inferior medial surface of the femoral head raises the possibility of
subchondral collapse, although its location is atypical.
3. 1.6 x 0.8 cm sclerotic focus along the posterior aspect of the medial
femoral condyle, non-aggressive in appearance, but of unclear clinical
significance.
4. Small left knee joint effusion.
s
NOTIFICATION: The findings were discussed with ___, M.D. by
___, M.D. on the telephone on ___ at 5:36 ___, 15 minutes after
discovery of the findings.
|
19891640-RR-26
| 19,891,640 | 23,804,716 |
RR
| 26 |
2152-06-16 10:06:00
|
2152-06-16 10:29:00
|
EXAMINATION: HIP 1 VIEW
INDICATION: LEFT TOTAL HIP REPL. FX
IMPRESSION:
In comparison with the study ___, there is an placement of a total hip
arthroplasty that appears well seated with standard postsurgical changes in
soft tissues. Further information can be gathered from the operative report.
|
19891717-RR-10
| 19,891,717 | 29,258,820 |
RR
| 10 |
2116-05-01 20:48:00
|
2116-05-02 01:08:00
|
INDICATION: ___ man struck by car, to evaluate for head injury.
COMPARISON: None available.
TECHNIQUE: MDCT helical images were acquired through the head without
intravenous contrast. Sagittal and coronal reformats were generated and
reviewed.
FINDINGS: There is a small right frontal subdural hematoma without
significant mass effect. No intraparenchymal hemorrhage or edema. The
ventricles and sulci are normal in caliber and configuration. The basal
cisterns are normal. There is soft tissue thickening and hematoma in the left
preseptal region. A dense round focus overlying the left preseptal region
(2:19) is likely debris on the skin. The globes are intact. Few locules of
gas and a small extraconal orbital hematoma are seen within right retrobulbar
space(2:19), without clear visualization of fracture. There is a
nondisplaced fracture of the right occipital condyle (3:6). The paranasal
sinuses and mastoid air cells are clear.
IMPRESSION:
1. Small right frontal subdural hematoma without mass effect.
2. Left preseptal hematoma. Few locules of gas and small left retroblbar
extraconal hematoma, without a visualized orbital fracture. Consider dedicated
facial bone CT to further assess.
3. Non-displaced right occipital condyle fracture.
|
19891717-RR-11
| 19,891,717 | 29,258,820 |
RR
| 11 |
2116-05-01 20:49:00
|
2116-05-02 01:10:00
|
INDICATION: ___ man struck by car.
COMPARISON: None available.
TECHNIQUE: MDCT helical images were acquired through the cervical spine
without intravenous contrast. Sagittal and coronal reformats were generated
and reviewed.
FINDINGS: As seen on head CT, there is a right occipital condyle nondisplaced
fracture, without associated hematoma. No acute cervical spine fracture or
malalignment is detected. The vertebral body heights, intervertebral disc
spaces are normal. The prevertebral soft tissues are normal. No significant
degenerative changes are seen. The imaged portion of the thyroid gland and
lung apices are unremarkable.
IMPRESSION:
1. No acute cervical spine fracture or malalignment.
2. Non-displaced right occipital condyle fracture, better assessed in the
head CT performed the same day.
|
19891717-RR-12
| 19,891,717 | 29,258,820 |
RR
| 12 |
2116-05-01 20:49:00
|
2116-05-02 01:18:00
|
INDICATION: ___ bicyclist struck by car.
COMPARISON: None available.
TECHNIQUE: MDCT helical images were acquired through the chest, abdomen, and
pelvis after the administration of 130 cc of Omnipaque intravenous contrast
with sagittal and coronal reformats were generated and reviewed.
CT OF THE CHEST WITH INTRAVENOUS CONTRAST: The major airways are patent to
subsegmental levels bilaterally. There is mild dependent atelectasis, without
pulmonary contusion or nodule. There is no pleural effusion or pneumothorax.
The heart and mediastinal great vessels are intact. Residual thymic tissue is
seen in the anterior mediastinum. Compression fracture of T7 and T8 vertebral
bodies are described below though there is associated perivertebral hematoma
at these levels.
CT OF THE ABDOMEN AND PELVIS WITH INTRAVENOUS CONTRAST: A 3.8 x 3.3 cm
hyper-enhancing lesion (similar to blood pool) centered within the right
hepatic lobe (2:54), with central area of hypoattenuation, most likely
represents a hemangioma. There is no biliary dilation. The gallbladder,
adrenal glands, spleen, and pancreas are normal. Both kidneys enhance and
excrete contrast symmetrically without evidence of acute trauma. The stomach,
small and large bowel are normal, without evidence of acute injury. No
significant retroperitoneal or mesenteric adenopathy is seen. The abdominal
aorta is normal in course and caliber.
CT OF THE PELVIS WITH INTRAVENOUS CONTRAST: The urinary bladder, prostate,
rectum, and sigmoid colon are normal. No pelvic lymphadenopathy or free fluid
is seen.
BONES AND SOFT TISSUES: Acute compression fractures of T7 and T8 vertebral
bodies, with associated paraspinal hematoma. No bony retropulsion into the
spinal canal. No obvious epidural hematoma at this level. Also seen is
nondisplaced fracture of the spinous process of T7 vertebral body (602B:36).
Known left distal clavicle fracture, better seen on the concurrent shoulder
radiograph is partly visualized in the initial scout views.
IMPRESSION:
1. Acute compression fractures of T7 and T8 vertebral bodies, with an
associated paraspinal hematoma. Nondisplaced T7 spinous process fracture.
Please refer to subsequent MRI thoracic spine for additional details.
2. No intrathoracic or abdominal visceral injury.
3. A 3.8 cm hyper-enhancing lesion in the right lobe of liver, likely
represents a hemangioma. (bedside US by Drs. ___ a
hyperechoic appearance of this lesion, also supporting a diagnosis of
hemangioma)
4. Distal left clavicle fracture, better assessed in the concurrent shoulder
radiographs.
|
19891717-RR-13
| 19,891,717 | 29,258,820 |
RR
| 13 |
2116-05-01 21:20:00
|
2116-05-01 22:38:00
|
LEFT SHOULDER RADIOGRAPH PERFORMED ON ___
COMPARISON: None.
CLINICAL HISTORY: Left shoulder pain, cyclist hit by car, assess fracture.
FINDINGS: Four views of the left shoulder were provided. There is an acute
fracture involving the left distal clavicle with slight inferior displacement
of the distal fracture fragment. There is no extension of the fracture line
into the left acromioclavicular joint. The glenohumeral joint appears well
aligned. No additional fractures are seen.
IMPRESSION: Acute fracture involving the distal left clavicle with mild
inferior displacement.
|
19891717-RR-14
| 19,891,717 | 29,258,820 |
RR
| 14 |
2116-05-01 23:09:00
|
2116-05-02 04:25:00
|
INDICATION: ___ unhelmeted bicyclist struck, to rule out facial
fractures.
COMPARISON: CT of the head done earlier today at 20:38 hours.
TECHNIQUE: MDCT helical images were acquired through the facial bones,
without intravenous contrast. Sagittal and coronal reformats were generated
and reviewed.
FINDINGS: No definite facial bone fracture is appreciated in this study.
Again seen are small locules of gas within the posterior right orbit (2:47),
similar to the prior study. No obvious fracture is identified. Mild
preseptal edema/hematoma around the left orbit is noted. The globes are
intact. There is a small hematoma in an extraconal location along the
posterosuperior aspect of the orbit (400B:45) measuring approximately 2.0 x
0.6 cm. There is no significant mass effect on the intraocular muscles.
Mild mucosal thickening is seen in bilateral ethmoid sinuses and the frontal
recess. The maxillary sinuses are clear. There is mild deviation of the
nasal septum to the right.
IMPRESSION:
1. No acute definite facial bone fractures identified.
2. Small locules of gas and a small extraconal hematoma along the
posterosuperior aspect of the right orbit, may be related to a subtle
non-displaced fracture.
3. Left periorbital hematoma.
|
19891717-RR-15
| 19,891,717 | 29,258,820 |
RR
| 15 |
2116-05-02 00:52:00
|
2116-05-02 10:34:00
|
INDICATION: MVA, pedestrian struck, thoracic compression fractures on prior
CT torso, for further evaluation.
COMPARISON: Sagittal reformations of the CT abdomen done on ___.
TECHNIQUE: MR of the thoracic spine without contrast - sagittal T1, sagittal
T2, sagittal STIR, and axial T2.
FINDINGS:
The numbering used for the present study is shown on series 3, image 1, based
on counting from C2 downwards. There is mild dextroscoliosis as seen on the
localizing images.
There is loss of height of the T7 body, approximately 55-60% loss of height
anteriorly. There is a hypointense fracture line irregularity noted in the
upper portion of the T7 vertebral body corresponding with the CT appearance.
There is mild convex appearance of the posterior cortex with effacement of the
ventral CSF space. The previously noted spinous process fracture is difficult
to be identified on the present study; however, minimal edema is noted in the
spinous process and interspinous and suprasponous regions.
There is approximately 50% loss of height of the T8 vertebral body anteriorly
and ___ in the mid portion. Areas of marrow edema are also noted in the T7
and T8 vertebral bodies, extending into the parts of the pedicles.
Minimal edema is noted in the T9 vertebral body in a curvilinear manner.
In the T10 vertebral body, there is area of marrow edema noted in the superior
portion extending from anterior to the posterior aspects. A thin fracture
line is noted retrospectively on the CT image corresponding to this finding.
There is moderate amount of pre/paravertebral hyperintense areas related to
edema/blood products. Small anterior osteophytes are noted at T6-T7 level
along with a possible fracture fragment.
Mild displacement of the posterior longitudinal ligament and the anterior
longitudinal ligaments at T7 and T8 levels; the contour of the anterior
longitudinal ligament is not well seen in particular from T6-T8 levels and
associated edema/injury cannot be completely excluded.
There is effacement of the ventral CSF space. Assessment for cord herniation
is limited on the present study. Prominent posterior epidural fat is noted.
No obvious areas of increased signal intensity are noted in the imaged
portions of the thoracic cord.
At T5-T6 level, there is a small protrusion effacing the ventral CSF space and
indenting the cord. Minimal bulge/small protrusion is also noted at T9-T10
level.
IMPRESSION:
1. Compression fractures involving T7 and T8 vertebral bodies as described
above, approximately 55-60% anteriorly in T7 and approximately 50-55%
anteriorly in the T8 vertebral body. Previously noted spinous process
fracture of T7 is not adequately seen on the present study; however, there is
small amount of marrow edema in the spinous process and adjacent posterior
spinous soft tissues.
2. Marrow edema pattern in the T7, T8, and T10 vertebral bodies and minimal
in the T9 vertebral body, from marrow edema or contusion.
3. Small protrusion at T5-T6 level effacing the ventral CSF space.
4. Effacement of the CSF space at T6-T7 and T7-T8 levels, from T5-T10 levels
with prominent posterior epidural fat. Evaluation for cord herniation is
somewhat limited on the present study. Consider attention on followup.
5. Moderate amount and paravertebral soft tissue swelling from edema/blood
products. Mild displacement of the posterior longitudinal ligament and the
anterior longitudinal ligaments at T7 and T8 levels, with the contour of the
anterior longitudinal ligament is not well seen in particular at T6-T7 level
and associated edema/injury cannot be completely excluded.
6. Small protrusion at T5/6 and T9/10 levels.
|
19891717-RR-16
| 19,891,717 | 29,258,820 |
RR
| 16 |
2116-05-02 10:29:00
|
2116-05-02 15:18:00
|
INDICATION: ___ male status post trauma with head injury. Please
evaluate for evidence of evolving subdural hematoma.
COMPARISON: NECT on ___.
TECHNIQUE: Contiguous axial MDCT images were obtained through the head
without the administration of IV contrast.
FINDINGS: There is no evidence of hemorrhage, edema, mass, mass effect, or
infarction. Previously noted hyperdensity in the right frontal inner table is
not present in this exam and likely represented an imaging artifact. The
sulci and ventricles are normal in size and configuration. The basal cisterns
appear patent. The gray-white matter differentiation is preserved.
There is no evidence of fracture. A hematoma is noted in the superior aspect
of the right orbit with trapped gas, which is unchanged compared with prior
exam. The paranasal sinuses, mastoid air cells, and middle ear cavities are
clear. There has been interval improvement of the left preseptal soft tissue
swelling.
IMPRESSION:
1. No evidence of subdural hematoma.
2. Hematoma in the superior aspect of the right orbit with a few locules of
gas is stable compared with prior exam.
|
19891717-RR-9
| 19,891,717 | 29,258,820 |
RR
| 9 |
2116-05-01 20:37:00
|
2116-05-01 21:21:00
|
PORTABLE CHEST RADIOGRAPH PERFORMED ON ___
COMPARISON: None.
CLINICAL HISTORY: ___ man struck by car, assess for traumatic injury.
FINDINGS: Portable supine AP view of the chest was provided. Underlying
trauma board is in place. The lungs appear clear bilaterally. No supine sign
for pneumothorax. No large effusion. Cardiomediastinal silhouette appears
normal. No bony deformities are seen.
IMPRESSION: No acute findings.
|
19892176-RR-16
| 19,892,176 | 20,994,625 |
RR
| 16 |
2139-03-25 09:41:00
|
2139-03-25 10:17:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ with pancreatitis
TECHNIQUE: Chest AP and lateral
COMPARISON: Chest radiograph from ___.
FINDINGS:
The cardiomediastinal and hilar contours are normal. No focal consolidations
are seen. There is no pulmonary edema or pleural abnormality. No concerning
abnormality in the imaged upper abdomen.
New subcentimeter radiodensities project over the right lung apex and superior
and inferior to the distal left clavicle on AP view.
IMPRESSION:
1. No acute intrathoracic process.
2. New subcentimeter radiodensities project over the right lung apex and
superior and inferior to the distal left clavicle on AP view, which may be
external to the patient. Please correlate with physical exam.
|
19892176-RR-17
| 19,892,176 | 20,994,625 |
RR
| 17 |
2139-03-25 18:08:00
|
2139-03-25 20:48:00
|
EXAMINATION: MRCP
INDICATION: ___ year old woman with acute pancreatitis in the setting of an
unclear diagnosis of chronic pancreatitis// evaluate for structural evidence
of chronic pancreatitis vs. biliary disease
TECHNIQUE: T1- and T2-weighted multiplanar images of the abdomen were
acquired in a 1.5 T magnet.
Intravenous contrast: 6 mL Gadavist.
Oral contrast: 1 cc of Gadavist mixed with 50 cc of water was administered
for oral contrast.
COMPARISON: MRCP dated ___
FINDINGS:
Lower Thorax: The lung bases are clear with no pleural effusion.
Liver: The liver is normal in morphology. There are sub 5 mm T2 hyperintense
foci in the hepatic segment 4 (Series 4, images 16 and 14) which are too small
to adequately characterize likely representing cyst or biliary hamartoma.
There is no hepatic steatosis. The gallbladder is unremarkable.
Biliary: There is no intrahepatic or extrahepatic biliary ductal dilatation.
There is no filling defect or obstructive lesion noted.
Pancreas: Pancreas is normal with no focal lesion or pancreatic ductal
dilatation. There is no evidence of pancreatitis. Normal pancreatic
enhancement characteristics.
Spleen: The spleen is normal in size with no focal lesion.
Adrenal Glands: Adrenal glands are normal
Kidneys: The kidneys are normal without evidence of hydronephrosis.
Gastrointestinal Tract: The visualized small bowel and colon are normal in
caliber with no evidence of obstruction.
Lymph Nodes: There are no abnormal lymph nodes.
Vasculature: Incidental note is made of 2 left renal arteries.
Osseous and Soft Tissue Structures: There is no worrisome osseous lesion or
acute fracture.
IMPRESSION:
Normal appearing pancreas with no evidence of pancreatitis. No bile duct
dilatation or cholelithiasis.
|
19892539-RR-61
| 19,892,539 | 25,088,002 |
RR
| 61 |
2179-04-01 21:27:00
|
2179-04-01 23:29:00
|
CHEST RADIOGRAPH
HISTORY: Status post fall with angulated hip.
COMPARISONS: ___.
TECHNIQUE: Chest, AP supine.
FINDINGS: The patient is again status post coronary artery bypass graft
surgery and aortic valve replacement. A dual-lead pacemaker/ICD device
appears unchanged with leads terminating in the right atrium and ventricle,
respectively. The lungs appear clear. There are no pleural effusions or
pneumothorax. The lungs appear hyperinflated.
IMPRESSION: No evidence of acute disease.
|
19892539-RR-62
| 19,892,539 | 25,088,002 |
RR
| 62 |
2179-04-01 21:27:00
|
2179-04-01 23:32:00
|
RADIOGRAPHS OF THE RIGHT HIP AND PELVIS
HISTORY: Status post fall with angulated right hip.
COMPARISONS: Radiographs of the left hip and pelvis are available from
___.
TECHNIQUE: Right hip, two views, as well as AP pelvis.
FINDINGS: There is a complete intertrochanteric fracture on the right with
comminution including displaced avulsion of the lesser trochanter. There is
slight foreshortening and lateral displacement of the distal fragment. On the
left, there is a prior left total hip replacement, which appears unchanged
without evidence for hardware loosening. The bones appear demineralized.
Degenerative changes along the lower lumbar spine are incompletely
characterized. There are slight degenerative changes along the sacroiliac
joints and pubic symphysis. The right hip joint space is mildly narrowed with
prominent osteophytes. Vascular calcifications are widespread. The quantity
of stool within mid abdominal portions of the colon is moderately prominent.
IMPRESSION: Complete comminuted fracture through the right greater
trochanter.
|
19892539-RR-63
| 19,892,539 | 25,088,002 |
RR
| 63 |
2179-04-02 08:47:00
|
2179-04-04 09:21:00
|
RIGHT FEMUR FLUOROSCOPIC SPOT RADIOGRAPHS DATED ___
CLINICAL INDICATION: ORIF of hip fracture.
COMPARISON: Right hip radiographs from ___.
FINDINGS: Four total fluoroscopic operative spot radiographs demonstrate
interval changes of an ORIF with gamma nail and intramedullary rod fixating a
comminuted intertrochanteric fracture extending to the level of the right
greater trochanter. Grossly maintained anatomic alignment at the conclusion
of the procedure. Moderate degenerative changes of the right femoroacetabular
joint. A calcified atherosclerotic vascular disease at the expected location
of the distal superficial femoral artery. Incompletely seen changes of a
total knee arthroplasty.
IMPRESSION: ORIF of right intertrochanteric fracture extending through the
level of the right greater trochanter with gamma nail and intramedullary rod
with grossly maintained anatomic alignment at the conclusion of the procedure.
Please refer to operative report for further details.
|
19892539-RR-64
| 19,892,539 | 25,088,002 |
RR
| 64 |
2179-04-04 09:43:00
|
2179-04-04 12:10:00
|
INDICATION: ___ woman with new confusion, postop day 2 from right hip
surgery, rule out infarct or other intracranial process.
COMPARISON: MR head on ___.
TECHNIQUE: Contiguous axial images were obtained through the brain. No
contrast was administered.
FINDINGS: There is no evidence of hemorrhage, edema, mass, mass effect, or
acute vascular territorial infarction. There are confluent periventricular
and subcortical white matter hypodensities consistent with the sequelae of
chronic small vessel ischemic disease. The ventricles and sulci are mildly
prominent consistent with age-related involution. The visualized paranasal
sinuses and mastoid air cells are well aerated. No fractures are identified.
IMPRESSION:
1. No acute intracranial process.
2. Age-related involution and chronic small vessel ischemic disease.
|
19892539-RR-65
| 19,892,539 | 25,088,002 |
RR
| 65 |
2179-04-07 08:23:00
|
2179-04-07 11:07:00
|
INDICATION: ___ female with hypotension, tachycardia and
palpitations, here to evaluate for acute cardiopulmonary process.
COMPARISON: Chest radiograph, last performed on ___.
PORTABLE FRONTAL CHEST RADIOGRAPH: A left pectoral pacemaker with two leads
terminating in the right atrium and right ventricle is unchanged. The patient
is status post median sternotomy with multiple mediastinal surgical clips and
wires appearing intact. Biapical pleural thickening is unchanged. A tiny
nodule projecting at the left cardiophrenic angle may represent a vessel or a
calcified granuloma. The lungs are otherwise clear without focal
consolidation, pleural effusion or pneumothorax. No pulmonary vascular
congestion or edema is present. The cardiac silhouette is normal in size.
The mediastinal and hilar contours are stable with moderate tortuosity of the
thoracic aorta and calcified aortic knob.
IMPRESSION:
No acute cardiopulmonary process.
|
19892539-RR-67
| 19,892,539 | 25,088,002 |
RR
| 67 |
2179-04-08 07:13:00
|
2179-04-08 12:11:00
|
HISTORY: Postoperative with GI bleed and transfusion, to assess for CHF.
FINDINGS: In comparison with study of ___, there is little overall change.
Cardiac silhouette is mildly enlarged with pacemaker device in place. No
vascular congestion, pleural effusion, or acute focal pneumonia. There may be
mild atelectasis in the retrocardiac region.
|
19892539-RR-69
| 19,892,539 | 25,088,002 |
RR
| 69 |
2179-04-11 07:58:00
|
2179-04-11 10:47:00
|
CLINICAL INDICATION: ___ year old woman with recent ORIF ___ who has
recurrent GI bleed therefore anticoagulation contraindicated, ortho
recommended IVC filter.
RADIOLOGY: Dr. ___ (Fellow), Dr. ___
and Dr. ___ ( Attending) was present during the fellowship. The
attending was present and supervised the procedure throughout.
ANESTHESIA: Fentanyl 50 micro grams, Local, 1% lidocaine.
PROCEDURE: Informed consent for the procedure was obtained from the patient's
healthcare proxy (sister) after risks, benefits and potential complications of
the procedure had been discussed. The patient was placed on the angiographic
table in supine position and skin of the right inguinal region was prepped and
draped in sterile fashion. Timeout protocol was carried out prior to the
procedure according to the ___ policy.
After generous infiltration of subcutaneous soft tissues of the right inguinal
region by 1% lidocaine, a patent and fully compressible right common femoral
vein was punctured using 21-gauge micropuncture needle. Over a 0.018
guidewire, a 21-gauge micropuncture needle was exchanged for a 4 ___
micropuncture sheath followed by insertion of 0.035 ___ guidewire through
the 4 ___ micropuncture sheath into the inferior vena cava. Micropuncture
sheath was exchanged for a 4 ___ Omniflush catheter was inserted into the
left iliac vein. DSA IVC venogram was obtained.
IVC VENOGRAM FINDINGS: Conventional anatomy of the inferior vena cava is
demonstrated with confluence of the common femoral veins and no angiographic
evidence of duplication variant. Confluence of bilateral renal veins with
inferior vena cava was also readily visualized. No IVC thrombus seen.
The delivery sheath was introduced. Under fluoroscopic visualization,
Venatech filter was deployed in optimal position in the infrarenal inferior
vena cava.
Meticulous hemostasis was maintained throughout the procedure.
CONCLUSIONS:
1. Uncomplicated deployment of Venatech IVC filter into the infrarenal
inferior vena cava.
2. No angiographic evidence of IVC thrombosis or duplication variants.
|
19892763-RR-4
| 19,892,763 | 26,335,877 |
RR
| 4 |
2162-10-27 11:27:00
|
2162-10-27 11:50:00
|
EXAMINATION: Chest radiograph.
INDICATION: ___ man with chest pain.
TECHNIQUE: AP and lateral view the chest.
COMPARISON: Comparison is made to chest radiograph ___.
FINDINGS:
Cardiomediastinal silhouette is normal. There is no pleural effusion or
pneumothorax. There is no focal lung consolidation.
IMPRESSION:
No radiographic explanation for chest pain.
|
19892763-RR-5
| 19,892,763 | 26,335,877 |
RR
| 5 |
2162-10-31 15:22:00
|
2162-10-31 17:05:00
|
INDICATION: ___ year old man lives in shelters, uncontrolled diabetes. chest
x-ray to assess for TB // TB rule out
TECHNIQUE: Chest PA and lateral
COMPARISON: ___
FINDINGS:
Cardiomediastinal silhouette is normal. There is no pleural effusion or
pneumothorax. There is no focal lung consolidation.
IMPRESSION:
No acute cardiopulmonary process.
|
19892880-RR-17
| 19,892,880 | 28,860,858 |
RR
| 17 |
2177-01-11 16:27:00
|
2177-01-11 17:02:00
|
HISTORY: Right PICC placement.
COMPARISON: None.
FINDINGS:
A portable view of the chest shows a right PICC ending in the right atrium, it
can be pulled back 4.0 cm. There is no pneumothorax. The cardiomediastinal
and hilar contours are normal. The lungs are clear.
IMPRESSION:
Right PICC ends in the right atrium and can be pulled back 4.0 cm. No
pneumothorax.
Findings were discussed with ___ the IV nurse by Dr. ___ the
telephone on ___ at 16:55, 1 min after they were made.
|
19892936-RR-23
| 19,892,936 | 21,679,045 |
RR
| 23 |
2128-11-06 21:54:00
|
2128-11-06 23:13:00
|
INDICATION: ___ male status post cholecystectomy, now with abdominal
pain and elevated bilirubin and liver enzymes. Evaluate for evidence of CBD
stone or any other abnormality.
COMPARISON: ___ and CT torso from ___.
TECHNIQUE: Grayscale and color Doppler images of the right upper quadrant
were obtained.
FINDINGS: The liver is normal in echotexture, without focal lesions. There
is mild intrahepatic biliary duct dilatation. The common bile duct is also
dilated measuring 8 mm and increased in size from prior exam in ___ when it
measured 5 mm. The common bile duct can be followed to the pancreatic head
where it tspers and no stones are identified. The patient is status post
cholecystectomy. The portal vein is patent with hepatopetal flow. The
pancreatic head and neck are within normal limits, but the body and tail of
the pancreas cannot be visualized due to bowel gas artifact. Limited views of
the right kidney are unremarkable.
IMPRESSION: Extrahepatic and intrahepatic biliary duct dilatation without
choledocholithiasis seen sonographically. Consider correlation with MRCP/ERCP,
which are more sensitive.
|
19892936-RR-24
| 19,892,936 | 21,679,045 |
RR
| 24 |
2128-11-06 23:48:00
|
2128-11-07 08:18:00
|
HISTORY: Upper abdominal pain, to assess for free air.
FINDINGS: In comparison with the study of ___, there are lower lung
volumes that accentuate the transverse diameter of the heart. No evidence of
acute pneumonia, vascular congestion, or pleural effusion. Specifically,
there is no evidence of free intraperitoneal gas on this examination, though
it is unclear whether this truly represents an upright view. If there is
serious clinical thought for perforation, CT would be the next imaging
procedure.
|
19892976-RR-35
| 19,892,976 | 22,830,523 |
RR
| 35 |
2134-06-16 18:14:00
|
2134-06-16 18:28:00
|
EXAMINATION: ANKLE (AP, MORTISE AND LAT) RIGHT
INDICATION: ___ year old woman with right foot tenderness to palpation of
lateral malleolus// please obtain foot and ankle x-ray to assess for fracture
or other osseous abnormality please obtain foot and ankle x-ray to
assess for fracture or other osseous abnormality
TECHNIQUE: Right ankle, three views.
COMPARISON: None.
FINDINGS:
No fracture or dislocations are seen. There is a small posterior calcaneal
enthesophyte. There are no significant degenerative changes. The mortise is
congruent. The tibial talar joint space is preserved and no talar dome
osteochondral lesion is identified. No suspicious lytic or sclerotic lesion is
identified. No soft tissue calcification or radiopaque foreign body is
identified.
IMPRESSION:
Unremarkable right ankle radiographs.
|
19893075-RR-9
| 19,893,075 | 27,110,682 |
RR
| 9 |
2132-11-01 08:16:00
|
2132-11-01 11:30:00
|
EXAMINATION: COMPLETE GU U.S. (BLADDER AND RENAL)
INDICATION: ___ year old woman with pyelonephritis in setting of ___
s/p stent ___ now w/ persistent fevers // Please check position of left
stent and assess for renal abscess
TECHNIQUE: Grey scale and color Doppler ultrasound images of the kidneys were
obtained.
COMPARISON: None.
FINDINGS:
The right kidney measures 16.6 cm. The left kidney measures 15.7 cm. Tubular
structure in the upper pole of the left kidney likely represents stent which
is poorly visualized on the study. There is no hydronephrosis, stones, or
masses bilaterally. Normal cortical echogenicity and corticomedullary
differentiation are seen bilaterally.
The bladder is moderately well distended and normal in appearance. Distal end
of the nephroureteral stent is seen in appropriate position.
IMPRESSION:
Enlarged kidneys bilaterally. Left nephroureteral stent in appropriate
position. No abscess.
|
19893114-RR-37
| 19,893,114 | 23,619,610 |
RR
| 37 |
2183-10-30 12:18:00
|
2183-10-30 13:46:00
|
HISTORY: ___ female with urosepsis.
COMPARISON: ___.
FINDINGS:
PA and lateral views of the chest. The lungs are clear. The
cardiomediastinal silhouette is normal. No acute osseous abnormality is
detected. Surgical clips seen in the right upper quadrant.
IMPRESSION:
No acute cardiopulmonary process.
|
19893114-RR-38
| 19,893,114 | 23,619,610 |
RR
| 38 |
2183-10-30 12:44:00
|
2183-10-30 15:54:00
|
INDICATION: Status post renal transplant with recent UTI/pyelo, returning
with same complaints, evaluate for perinephric abscess.
COMPARISON: ___.
TECHNIQUE: Grayscale and color Doppler ultrasound examination of the
transplanted kidney was performed.
FINDINGS: Transplanted kidney is seen in the right lower quadrant measuring
13.8 cm. Corticomedullary architecture is normal. There is no
hydronephrosis. No stones are identified. The kidney demonstrates normal
vascularity on color flow; however, Doppler examination is not performed. No
perinephric fluid collection is identified. Partially distended bladder is
grossly unremarkable.
IMPRESSION:
1. No abnormality or significant change compared to the prior study.
2. No perinephric fluid collection.
|
19893114-RR-39
| 19,893,114 | 23,619,610 |
RR
| 39 |
2183-10-30 17:14:00
|
2183-10-30 19:57:00
|
INDICATION: ___ female with renal transplant coming with one day of
symptoms consistent with UTI/pyelonephritis after completing her course of
antibiotics. Evaluate for evidence of nidus of infection.
COMPARISON: Renal transplant ultrasound on ___ and renal ultrasound
on ___.
TECHNIQUE: Axial helical MDCT images were obtained from the lung bases to the
pubic symphysis after administration of IV and oral contrast. Coronal and
sagittal reformats were generated.
DLP: 643.85 mGy-cm.
FINDINGS: The lung bases are clear. The visualized heart and pericardium are
unremarkable. The liver enhances homogeneously. There is minimal
intrahepatic biliary duct dilatation which may be seen in patients status post
cholecystectomy as is the case in this patient. The portal vein is patent.
The pancreas, spleen, and adrenal glands are within normal limits. The native
kidneys are atrophic, compatible with known history of chronic kidney disease.
The transplant kidney is seen in the anterior right hemipelvis. There are
multiple areas of decreased contrast uptake, with loss of corticomedullary
differentiation as in image 2:54. Also in interpolar region of the kidney
there is a large triangular region of hypoenhancement extending to the cortex
which is also compatible with pyelonephritis. A 6 mm cyst is noted in the
posterior aspect of the interpolar region (2:65), too small to characterize
but likely benign. There is no evidence of hydronephrosis or nephrolithiasis.
The small and large bowel are unremarkable, without wall thickening or
dilatation to suggest obstruction. The appendix is seen and is not inflamed.
There is no retroperitoneal or mesenteric lymphadenopathy by CT size criteria.
The aorta is non-aneurysmal and the main intra-abdominal vessels are grossly
patent. There is no ascites, abdominal free air or abdominal wall hernia.
PELVIC CT: For description of the transplanted kidney, please refer to
abdomen section of this report. The urinary bladder is unremarkable. The
uterus and adnexa are within normal limits. A dropped surgical clip is noted
the cul-de-sac (2:69). The sigmoid and rectum are within normal limits. There
is no pelvic wall or inguinal lymphadenopathy. The origin of the arterial
supply of the transplanted kidney in the right common iliac artery is grossly
patent. No pelvic free fluid is identified.
OSSEOUS STRUCTURES: There are no lytic or blastic lesions concerning for
malignancy.
IMPRESSION:
1. Pyelonephreitis of the transplant kidney, no evidence for abscess
2. Mild intrahepatic biliary duct dilatation can be seen after
cholecystectomy, correlate with liver function tests
3. Atrophic native kidneys
|
19893114-RR-40
| 19,893,114 | 23,619,610 |
RR
| 40 |
2183-11-02 18:01:00
|
2183-11-03 08:33:00
|
HISTORY: PICC line.
FINDINGS: The left PICC line extends to the lower portion of the SVC. No
acute cardiopulmonary disease.
|
19893114-RR-55
| 19,893,114 | 26,301,121 |
RR
| 55 |
2188-06-09 00:34:00
|
2188-06-09 02:14:00
|
EXAMINATION:
Chest: Frontal and lateral views
INDICATION: History: ___ with hx transplant w/ UTI and high fevers. cough.
body aches// renal abscess? PNA?
TECHNIQUE: Chest: Frontal and Lateral
COMPARISON: Chest radiograph ___.
FINDINGS:
The lungs are clear without focal consolidation. No pleural effusion or
pneumothorax is seen. The cardiac and mediastinal silhouettes are
unremarkable.
IMPRESSION:
No acute cardiopulmonary process.
|
19893114-RR-56
| 19,893,114 | 26,301,121 |
RR
| 56 |
2188-06-09 00:48:00
|
2188-06-09 01:36:00
|
EXAMINATION: RENAL TRANSPLANT U.S.
INDICATION: History: ___ with hx transplant w/ UTI and high fevers. cough.
body aches// renal abscess? PNA?
TECHNIQUE: Grey scale as well as color and spectral Doppler ultrasound images
of the renal transplant were obtained.
COMPARISON: Renal ultrasound ___.
FINDINGS:
The right iliac fossa transplant renal morphology is normal. Specifically,
the cortex is of normal thickness and echogenicity, pyramids are normal, there
is no urothelial thickening, and renal sinus fat is normal. There is no
hydronephrosis and no perinephric fluid collection.
The resistive index of intrarenal arteries ranges from 0.62 to 0.67, within
the normal range. The main renal artery shows a normal waveform, with prompt
systolic upstroke and continuous antegrade diastolic flow, with peak systolic
velocity of 277 cm/S. Vascularity is symmetric throughout transplant. The
transplant renal vein is patent and shows normal waveform.
IMPRESSION:
1. Apparent interval increase in peak systolic velocity of the main renal
artery near the anastomosis, measuring up to 277 cm/S, concerning for
stenosis.
2. Normal intrarenal resistive indices similar to prior.
RECOMMENDATION(S): Consider short term repeat doppler exam or MRA/CTA
|
19893114-RR-62
| 19,893,114 | 24,569,129 |
RR
| 62 |
2190-04-23 21:39:00
|
2190-04-23 22:05:00
|
EXAMINATION: RENAL TRANSPLANT U.S.
INDICATION: History: ___ with renal tranplant, uti sx // evaluate renal
transplant
TECHNIQUE: Grey scale as well as color and spectral Doppler ultrasound images
of the renal transplant were obtained.
COMPARISON: Multiple priors, most recently transplant renal ultrasound ___
FINDINGS:
The right iliac fossa transplant renal morphology is normal. Specifically,
the cortex is of normal thickness and echogenicity, pyramids are normal, there
is no urothelial thickening, and renal sinus fat is normal. There is no
hydronephrosis and no perinephric fluid collection.
The resistive index of intrarenal arteries ranges from 0.64 to 0.7, within the
normal range. The main renal artery shows a normal waveform, with prompt
systolic upstroke and continuous antegrade diastolic flow, with peak systolic
velocity of 66.0 cm/s. Vascularity is symmetric throughout transplant. The
transplant renal vein is patent and shows normal waveform.
IMPRESSION:
Normal right iliac fossa renal transplant ultrasound.
|
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