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19893304-RR-14
| 19,893,304 | 23,100,625 |
RR
| 14 |
2201-03-17 16:06:00
|
2201-03-17 16:46:00
|
INDICATION: ___ hx HIV p/w with ___ edema, orthopnea, exertional dyspnea. No
hx CHF. // pulmonary edema? cardiomegaly?
TECHNIQUE: Frontal and lateral views of the chest.
COMPARISON: None.
FINDINGS:
There are small bilateral pleural effusions, larger on the left, with
associated atelectasis. Superiorly, the lungs are clear. There is
enlargement of the cardiac silhouette with a configuration raising concern for
underlying pericardial effusion. No acute osseous abnormalities.
IMPRESSION:
Bilateral pleural effusions. Enlargement of the cardiac silhouette with a
configuration raising concern for underlying pericardial effusion.
|
19893454-RR-31
| 19,893,454 | 24,535,949 |
RR
| 31 |
2163-05-16 01:32:00
|
2163-05-16 03:21:00
|
HISTORY: ___ female status post Roux-en-Y gastric bypass and recent
gastrojejunal anastomosis revision for marginal ulcer, now with severe left
upper quadrant pain and clinical concern for abdominal wall hernia.
TECHNIQUE: Axial CT images through the abdomen were acquired after
administration of intravenous and oral contrast. Coronal and sagittal
reformatted images were reviewed.
COMPARISON: None available.
FINDINGS:
The lung bases demonstrate minimal dependent atelectasis without pleural
effusion. No acute abnormalities are detected in the liver, spleen, pancreas,
adrenal glands, kidneys, or visualized portions of the colon. Few colonic
diverticula do not demonstrate evidence for acute inflammation. Note is made
of a splenule. The patient is status post cholecystectomy and surgical clips
are seen in the gallbladder fossa. Contrast is seen within the gastric pouch
without evidence for gastrogastric fistula. The gastrojejunal and
jejunal-jejunal anastomoses appear patent with oral contrast seen in the
colon.
There is substantial fat stranding of the anterior abdominal wall subcutaneous
fat with mild omental stranding deep to the incision site at the level of the
stomach. No fluid collection is seen. No free intraperitoneal air, ascites,
or extravasated contrast is seen. There is no evidence for abdominal wall
hernia.
No concerning lytic or sclerotic osseous lesions are detected.
IMPRESSION:
Substantial superficial subcutaneous fat stranding of the upper anterior
abdominal wall with mild omental stranding deep to the incision site at the
level of the stomach. No evidence for intestinal perforation or abdominal
wall hernia.
|
19894339-RR-14
| 19,894,339 | 25,032,928 |
RR
| 14 |
2158-06-02 02:08:00
|
2158-06-02 04:04:00
|
EXAMINATION: CT of the abdomen and pelvis
INDICATION: ___ with likely malignancy of your labs and ultrasound,
presenting with worsening abdominal pain. No previous CT imaging. Ultrasound
done at ___. NO_PO contrast// Malignancy, ascites, obstruction
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired
through the abdomen following intravenous contrast administration with split
bolus technique. Oral contrast was not administered.Coronal and sagittal
reformations were performed and reviewed on PACS.
DOSE: Total DLP (Body) = 839 mGy-cm.
COMPARISON: None.
FINDINGS:
LOWER CHEST: Visualized lung fields demonstrate bilateral pleural effusions,
small to moderate on the left, trace on the right, associated with bibasilar
atelectasis.
ABDOMEN: Moderate volume ascites is noted with extensive omental caking
consistent with peritoneal carcinomatosis. There is peritoneal nodularity
most notably in the deep pelvis.
HEPATOBILIARY: There are multiple hepatic hypodense lesions which are poorly
defined and highly concerning for metastatic disease. The largest of these
resides within segment 6 measuring approximately 5.3 x 5.9 x 5.0 cm. Main
portal vein is patent. The gallbladder is unremarkable. Common bile duct is
nondilated. Perihepatic ascites is moderate in volume.
PANCREAS: A pancreatic tail lesion is highly concerning for primary
malignancy, measuring 3.0 x 2.4 cm (02:33). There is no pancreatic ductal
dilatation.
SPLEEN: The spleen is normal. A tiny hypodensity within the mid body of the
spleen on series 2, image 29 is of doubtful clinical significance. The
splenic vein is occluded and there are numerous perisplenic and perigastric
collateral vessels.
ADRENALS: Adrenals are normal.
URINARY: Bilateral simple cysts measuring up to 1.8 cm in the upper pole of
the right kidney are noted. Otherwise, the kidneys are of normal and
symmetric size with normal nephrogram. There is no evidence of focal renal
lesions or hydronephrosis. There is no perinephric abnormality.
GASTROINTESTINAL: A moderate sized hiatal hernia is noted. The stomach is
decompressed. The duodenum appears normal. Small bowel loops demonstrate no
signs of ileus or obstruction. Colonic diverticulosis is notable. The
appendix is not clearly visualized though there are no secondary signs of
appendicitis. The sigmoid colon appears slightly thickened likely due to
chronic diverticulosis. An adjacent loculated fluid collection likely
reflects peritoneal carcinomatosis though clinical correlation is advised as a
possibility of complicated diverticulosis is impossible to exclude though no
air is seen within this collection.
PELVIS: Peritoneal thickening in the deep pelvis is consistent with peritoneal
carcinomatosis with large volume of ascites tracking into the pelvis. The
uterus is not well visualized. No definite adnexal mass is seen. The urinary
bladder is only partially distended appearing normal. There is no pelvic
sidewall or inguinal adenopathy.
LYMPH NODES: There is an abnormal lymph node at the porta hepatis best seen on
series 2, image 30 measuring 14 mm in short axis. Omental nodularity and
peritoneal nodularity is consistent with peritoneal carcinomatosis. No
retroperitoneal or pelvic sidewall adenopathy. No inguinal adenopathy. No
peripancreatic adenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease
is noted. Chronic splenic vein thrombosis likely due to malignant encasement
by pancreatic tail lesion. No additional evidence for vascular encasement.
BONES: Multilevel degenerative changes without evidence of worrisome osseous
lesions or acute fracture. The patient is status post right total hip
arthroplasty.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. Peritoneal carcinomatosis with moderate to large volume ascites, multiple
liver lesions concerning for metastatic disease, and a concerning lesion
within the pancreatic tail, suspicious for a primary pancreatic malignancy.
2. Extensive colonic diverticulosis. Given loculated fluid adjacent to the
sigmoid colon, impossible to exclude complicated diverticulitis. In the
absence of recent focal pain in the left lower quadrant findings are more
likely indicative of peritoneal carcinomatosis. Please correlate clinically
peer
3. Bilateral pleural effusions, left greater than right..
|
19894339-RR-15
| 19,894,339 | 25,032,928 |
RR
| 15 |
2158-06-03 10:32:00
|
2158-06-03 18:20:00
|
EXAMINATION: Ultrasound-guided targeted liver biopsy and therapeutic
paracentesis
INDICATION: ___ year old woman with abd pain, distention and new ascites.
Elevated tumor markers.// biopsy of met cancer (unknown primary)
COMPARISON: Multiple prior examinations, most recent from ___
OPERATORS: Dr. ___, radiology trainee and Dr. ___
radiologist. Dr. ___ supervised the trainee during the key
components of the procedure and reviewed and agrees with the trainee's
findings.
FINDINGS:
Limited preprocedure grayscale and Doppler ultrasound imaging of the liver was
performed. The lesion for biopsy was identified in segment VI. A suitable
approach for targeted liver biopsy was determined.
Limited grayscale ultrasound imaging of the abdomen demonstrated a small
amount of ascites.
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.
Under ultrasound guidance, an entrance site was selected for both the
paracentesis as well as the targeted biopsy and the skin was prepped and
draped in the usual sterile fashion. 1% lidocaine was instilled for local
anesthesia.
A 5 ___ catheter was advanced into the largest fluid pocket in the right
lower quadrant and 1.5 L of serosanguinous fluid were removed.
During the drainage of this 1.5 L, under real-time ultrasound guidance, two,
18-gauge core biopsy samples were obtained.
The skin was then cleaned and a dry sterile dressing was applied. There were
no immediate complications.
SEDATION: Moderate sedation was provided by administering 50 mcg fentanyl
throughout the total intra-service time of 22 minutes during which patient's
hemodynamic parameters were continuously monitored by an independent trained
radiology nurse.
IMPRESSION:
1. Uncomplicated 18-gauge targeted liver biopsy x 2, with specimen sent to
pathology.
2. Technically successful ultrasound-guided therapeutic paracentesis.
|
19894339-RR-16
| 19,894,339 | 25,032,928 |
RR
| 16 |
2158-06-04 13:33:00
|
2158-06-04 15:58:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old woman with new ascites concerning for pancreatic vs
ovarian vs GI malignancy, tachypneic over past two days.// worsening pleural
effusions or other pulmonary pathology to explain SOB worsening pleural
effusions or other pulmonary pathology to explain SOB
IMPRESSION:
Compared to chest radiographs ___. Small left pleural effusion
is unchanged. Left basal atelectasis has increased. No pneumothorax. Right
lung clear. No right pleural abnormality. Heart size normal.
|
19894339-RR-17
| 19,894,339 | 25,032,928 |
RR
| 17 |
2158-06-05 15:28:00
|
2158-06-05 16:20:00
|
EXAMINATION: US ABD LIMIT, SINGLE ORGAN
INDICATION: ___ woman was referred for admission yesterday toexpedite
workup for newly diagnosed multiple hepatic tumors and ascites shown on
abdominal ultrasound ___// therapeutic paracentesis
TECHNIQUE: Limited gray scale ultrasound images were obtained of the 4
quadrants of the abdomen
COMPARISON: Prior ultrasound-guided procedure from ___
FINDINGS:
Limited grayscale ultrasound images were obtained of the 4 quadrants of the
abdomen.
There was minimal ascites in the right lower quadrant. No fluid pocket safe
for drainage was identified.
IMPRESSION:
Minimal ascites in the right lower quadrant without fluid pocket identified
which is safe for drainage.
|
19894425-RR-18
| 19,894,425 | 26,275,322 |
RR
| 18 |
2200-01-23 19:47:00
|
2200-01-23 20:06:00
|
EXAMINATION: CHEST (AP AND LATERAL)
INDICATION: History: ___ with confusion, falls
TECHNIQUE: Upright AP and lateral views of the chest
COMPARISON: None.
FINDINGS:
Lung volumes are low. This accentuates the size of the cardiac silhouette
which appears at least mildly enlarged. The aorta is tortuous. The mediastinal
and hilar contours are otherwise unremarkable. There is no pulmonary edema.
Minimal streaky opacity in the left lower lobe likely reflects atelectasis. No
pleural effusion or pneumothorax is identified. Mild degenerative changes are
seen throughout the thoracic spine.
IMPRESSION:
Low lung volumes with left lower lobe atelectasis.
|
19894425-RR-19
| 19,894,425 | 26,275,322 |
RR
| 19 |
2200-01-23 20:16:00
|
2200-01-23 20:55:00
|
EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ with confusion, right weakness. Assess for bleeding, stroke
TECHNIQUE: Contiguous axial images images of the brain were obtained without
contrast. Coronal and sagittal as well as thin bone-algorithm reconstructed
images were obtained.
DOSE: DLP: 1226.4 mGy-cm
CTDI: 55.53 mGy
COMPARISON: None.
FINDINGS:
There is a large right mildly hyperdense extra-axial fluid collection with a
biconcave appearance measuring up to 2.7 cm within the left frontal region and
1.9 cm within the left parietal region. The extra-axial collection
demonstrates subtle shading consistent with subacute hemorrhage. There is
associated effacement of the left lateral ventricle as well as 4 mm rightwards
shift of midline structures. An additional 0.5 cm left frontoparietal subdural
hematoma is acute. No acute large territorial infarction, edema, or mass.
No osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and
middle ear cavities are clear. The orbits are unremarkable. Vascular
calcifications within cavernous portions of bilateral internal carotid
arteries is noted.
IMPRESSION:
1. Acute small left frontoparietal subdural hematoma measuring 0.5 cm in
maximal width.
2. Large left frontoparietal subdural hematoma with evidence of subacute on
chronic hemorrhage and 4 mm rightwards shift of midline structures.
3. No fracture.
|
19894425-RR-20
| 19,894,425 | 26,275,322 |
RR
| 20 |
2200-01-23 22:20:00
|
2200-01-23 22:35:00
|
EXAMINATION: GLENO-HUMERAL SHOULDER (W/ Y VIEW) RIGHT
INDICATION: History: ___ with right shoulder pain
TECHNIQUE: Right shoulder, three views.
COMPARISON: None available.
FINDINGS:
No fracture or dislocation is detected involving the glenohumeral or AC joint.
Mild acromioclavicular joint degenerative changes noted. No suspicious lytic
or sclerotic lesion is identified. No periarticular calcification or
radiopaque foreign body is seen. The visualized right lung demonstrates
atelectatic changes.
IMPRESSION:
No evidence of fracture or dislocation.
|
19894425-RR-21
| 19,894,425 | 26,275,322 |
RR
| 21 |
2200-01-24 20:00:00
|
2200-01-24 20:30:00
|
EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ female status post left craniotomy for subdural
hematoma evacuation. Evaluate for residual hematoma and mass effect.
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: 53.16 mGy
COMPARISON: Noncontrast head CT ___.
FINDINGS:
Postsurgical changes from left frontal craniotomy and subdural hematoma
evacuation. Along the left frontal convexity, there remains approximately 22
mm of subdural fluid with some postoperative hemorrhage and pneumocephalus,
previous subdural hemorrhage measured roughly 25 mm in maximal thickness.
There remains a similar degree of localized mass effect with effacement of the
involved sulci and some effacement of the left lateral ventricle. Movement in
the right to left midline shift, now measuring approximately 5 mm, previously
measuring approximately 8 mm. High right frontal acute subdural hematoma
appears unchanged, again measuring approximately 4 mm in maximal thickness,
superimposed upon a more chronic appearing component. There is no evidence of
large territory infarction, new intracranial hemorrhage, edema, or mass. The
ventricles and sulci are grossly stable in size and configuration.
No osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and
middle ear cavities are clear. The orbits are unremarkable.
IMPRESSION:
1. Postsurgical changes related to patient's interval left frontal craniotomy
and subdural hematoma evacuation, now with approximately 22 mm fluid
collection with small amount of blood and pneumocephalus.
2. Mass effect has mildly improved with interval decrease of rightward midline
shift compared to prior exam.
3. Stable right frontal mixed density subdural hematoma.
4. No new hemorrhage.
|
19894425-RR-22
| 19,894,425 | 26,275,322 |
RR
| 22 |
2200-01-26 02:25:00
|
2200-01-26 02:44:00
|
EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ year old woman with left subdural hematoma s/p evacuation.
Evaluate for interval bleeding or increased edema.
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 mGy-cm
CTDI: 54 mGy
COMPARISON: CT from ___
FINDINGS:
Compared to the prior head CT from ___, there has been decrease in size
of the left frontotemporal subdural hematoma with similar degree of hyperdense
components along the superior aspect. Maximal thickness is 15 mm, previously
18 mm. There is no evidence of new hemorrhage or infarction. There is a
moderate mass effect upon the adjacent left frontal and temporal lobes, and 3
mm of rightward shift of the midline structures, previously 5 mm. The basal
cisterns are patent.
Craniotomy changes in the left frontal bone and soft tissues are similar to
the prior exam. Motion artifact limits evaluation of the paranasal sinuses.
IMPRESSION:
1. Slightly decreased size of left frontotemporal subdural hematoma with
similar degree of hyperdense components as on the prior CT, and no evidence of
new hemorrhage.
2. Slight decrease in rightward shift of midline structures.
|
19894443-RR-43
| 19,894,443 | 20,566,241 |
RR
| 43 |
2203-12-05 12:13:00
|
2203-12-05 17:09:00
|
STUDY: AP chest ___.
CLINICAL HISTORY: ___ man with lower back pain. With desaturations.
FINDINGS: Comparison is made to prior radiographs from ___.
Heart size is within normal limits. There is minimal atelectasis at the left
lung base. There is no focal consolidation, pleural effusions or signs for
acute pulmonary edema. No pneumothoraces are identified.
|
19894538-RR-10
| 19,894,538 | 25,496,571 |
RR
| 10 |
2131-06-18 19:19:00
|
2131-06-18 20:16:00
|
EXAMINATION: CHEST (SINGLE VIEW)
INDICATION: ___ with fall// r/o PNA
TECHNIQUE: Single frontal view of the chest
COMPARISON: None.
FINDINGS:
Cardiac size is normal. The lungs are clear. There is no pneumothorax or
pleural effusion.
IMPRESSION:
No evidence of pneumonia.
|
19894538-RR-11
| 19,894,538 | 25,496,571 |
RR
| 11 |
2131-06-18 19:13:00
|
2131-06-18 20:03:00
|
EXAMINATION: PELVIS AP ___ VIEWS
INDICATION: ___ with fall// A/p pelvis to r/o fx, r/o bleed, fracture
TECHNIQUE: Single frontal view of the pelvis.
COMPARISON: None. Correlation since same day right femur films.
FINDINGS:
There is a fracture through the right femoral neck as described previously.
Pubic symphysis and SI joints are preserved. Mild degenerative changes of the
lower lumbar spine noted.
IMPRESSION:
Right femoral neck fracture.
|
19894538-RR-14
| 19,894,538 | 25,496,571 |
RR
| 14 |
2131-06-19 12:18:00
|
2131-06-19 13:03:00
|
EXAMINATION: HIP 1 VIEW ___
INDICATION: RIGHT TOTAL HIP
IMPRESSION:
Frontal view of the right hip.
Right femoral prosthesis in place. No evidence of loosening. No dislocation.
|
19894538-RR-8
| 19,894,538 | 25,496,571 |
RR
| 8 |
2131-06-18 18:07:00
|
2131-06-18 19:58:00
|
EXAMINATION: FEMUR (AP AND LAT) RIGHT
INDICATION: ___ with fall// r/o fx
TECHNIQUE: Frontal and cross-table lateral views of the right femur.
COMPARISON: None.
FINDINGS:
There is an acute fracture through the right femoral neck. There is some
degree of impaction with foreshortening of the neck. No visualized
angulation. No additional fractures.
IMPRESSION:
Right femoral neck fracture. No evidence of right hip dislocation.
|
19894538-RR-9
| 19,894,538 | 25,496,571 |
RR
| 9 |
2131-06-18 18:09:00
|
2131-06-18 19:51:00
|
EXAMINATION: DX KNEE AND TIB/FIB
INDICATION: ___ with fall// r/o fx
TECHNIQUE: Frontal and cross-table lateral views of the right knee and right
tibia/fibula.
COMPARISON: None.
FINDINGS:
No fracture or dislocation is seen. Severe degenerative changes including
tricompartmental calcaneal spurring and lateral compartment narrowing noted.
There is a small knee joint effusion. Limited views of the right ankle
demonstrate no gross abnormalities. There is normal osseous mineralization.
No suspicious lytic or sclerotic lesions are identified.
IMPRESSION:
No fracture or dislocation. Severe degenerative changes of the knee.
|
19895232-RR-70
| 19,895,232 | 24,250,280 |
RR
| 70 |
2169-11-08 05:19:00
|
2169-11-08 05:29:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: History: ___ with cp // cp
TECHNIQUE: Chest PA and lateral views.
COMPARISON: Multiple priors, most recently dated ___.
FINDINGS:
The heart is mildly enlarged. There is atherosclerotic calcification
involving the aortic arch. There is a loop recorder visualized in the left
chest wall. There is mild pulmonary vascular congestion. There is right lung
base opacification which may represent atelectasis. However pneumonia cannot
be excluded.
IMPRESSION:
1. Stable cardiomegaly with mild pulmonary vascular congestion.
2. Right lung base opacification which may represent atelectasis. However
superimposed pneumonia cannot be excluded.
|
19895232-RR-71
| 19,895,232 | 24,250,280 |
RR
| 71 |
2169-11-08 02:55:00
|
2169-11-08 03:54:00
|
EXAMINATION: CT ABD AND PELVIS WITH CONTRAST
INDICATION: NO_PO contrast; History: ___ with epigastric painNO_PO contrast
// Epigastric pain
TECHNIQUE: Single phase contrast: MDCT axial images were acquired through the
abdomen and pelvis following intravenous contrast administration.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Stationary Acquisition 5.0 s, 0.5 cm; CTDIvol = 24.1 mGy (Body) DLP =
12.0 mGy-cm.
2) Spiral Acquisition 5.7 s, 44.6 cm; CTDIvol = 10.9 mGy (Body) DLP = 487.0
mGy-cm.
Total DLP (Body) = 499 mGy-cm.
COMPARISON: CTA chest dated ___. PET-CT dated ___.
FINDINGS:
LOWER CHEST: There is dense coronary artery calcification. There is no
pericardial effusion. There is chronic-appearing right lung base
consolidation with associated mild bronchiectasis, which appears overall
improved comparison to the CT from ___. There is right lung base
pleural calcification. There is mild left lung base atelectasis.
ABDOMEN:
HEPATOBILIARY: There is a subcentimeter low-attenuation lesion in the right
hepatic lobe, too small to characterize. There is no evidence of intrahepatic
or extrahepatic biliary dilatation. The gallbladder is distended and grossly
unremarkable.
PANCREAS: The pancreas is grossly unremarkable. There is no peripancreatic
stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
There is no evidence of solid renal lesions or hydronephrosis. There is no
perinephric abnormality.
GASTROINTESTINAL: There is significant wall thickening of the pylorus and
proximal duodenum which may be secondary to pyloric/duodenum ulcer disease
versus infection (series 2, image 21). Small bowel loops demonstrate normal
caliber, wall thickness, and enhancement throughout. The colon and rectum are
within normal limits. The appendix is not visualized.
PELVIS: The urinary bladder is significantly distended and grossly
unremarkable. There is no free fluid in the pelvis.
REPRODUCTIVE ORGANS: The uterus is grossly unremarkable. There is a 8.0 x 5.2
x 6.5 cm cystic lesion likely arising from the right adnexal region, new since
the PET-CT from ___.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Moderate to severe
atherosclerotic disease is noted. There is significant proximal celiac trunk
and SMA stenosis with patent distal branch.
BONES: There is grade 1 anterolisthesis of L3 on L4 with bilateral pars defect
unchanged from previous study. There is moderate degenerative changes of the
thoracolumbar spine. There is mild dextroscoliosis of the lumbar spine.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. Wall thickening of the pylorus and proximal duodenum which could reflect
inflammation from ulcer disease or infection. No focal fluid collection or
perforation.
2. A 8.0 x 5.2 x 6.5 cm right pelvic cystic lesion likely rising from the
right ovary is new since ___. OBGYN consult and further evaluation with
nonurgent pelvic MRI are recommended.
3. Interval improvement of chronic right lower lobe consolidation since the ___ examination, with mild bronchiectasis.
|
19895232-RR-72
| 19,895,232 | 24,250,280 |
RR
| 72 |
2169-11-08 10:38:00
|
2169-11-08 11:33:00
|
EXAMINATION: VENOUS DUP EXT LOWER(MAP OR DVT) RIGHT
INDICATION: Ms. ___ is an ___ yo F with history of CAD s/p stent, HFpEF,
PAD, HTN, afib s/p ablation, and CKD who presents to the ED with
chest/midepigastric pain. // asymmetric right ___ swelling
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the right lower extremity veins.
COMPARISON: Lower extremity ultrasound dated ___
FINDINGS:
There is normal compressibility, color flow, and spectral doppler of the right
common femoral, femoral, and popliteal veins. Normal color flow is
demonstrated in the posterior tibial and peroneal veins.
There is normal respiratory variation in the common femoral veins bilaterally.
Redemonstrated is a 1.8 x 0.7 x 1.2 ___ cyst.
There is subcutaneous edema in the calf.
IMPRESSION:
1. No evidence of deep venous thrombosis in the right lower extremity veins.
2. Redemonstration of a small ___ cyst.
|
19895419-RR-10
| 19,895,419 | 20,204,854 |
RR
| 10 |
2127-03-01 11:49:00
|
2127-03-01 11:56:00
|
EXAMINATION: CHEST (AP AND LAT)
INDICATION: History: ___ with hx of CHF, c/o CP*** WARNING *** Multiple
patients with same last name! // PNA? Chest path?
TECHNIQUE: Chest AP and lateral
COMPARISON: None.
FINDINGS:
Lung volumes are low. Cardiac silhouette size is accentuated as result of low
lung volumes appearing borderline enlarged. Mediastinal and hilar contours
are unremarkable. Pulmonary vasculature is normal. Bibasilar patchy
opacities likely reflect areas of atelectasis. No pleural effusion or
pneumothorax. No acute osseous abnormalities. Mild degenerative changes of
the thoracic spine and right glenohumeral joint.
IMPRESSION:
Low lung volumes with probable bibasilar atelectasis.
|
19895419-RR-11
| 19,895,419 | 20,204,854 |
RR
| 11 |
2127-03-02 14:37:00
|
2127-03-02 19:48:00
|
EXAMINATION: Cervical spine radiographs, three views.
INDICATION: History of chronic pain status post spine surgery with worsening
pain and weakness.
COMPARISON: No prior relevant prior study is available.
FINDINGS:
Patient is status post posterior fusion from C2 through C 5 with bilateral
rods and pedicle screws on the right in C2, C4, and C5, and on the left from
C2 through C5. Laminectomies were also performed at least from C3 through C5.
No substantial lucency about the screws. No spondylolisthesis. C1-C2 fusion
is possible at the atlanto dens interface. The C2 through C5 vertebral bodies
appear show bony fusion. The C5-C6 interspace is mild to moderately narrowed
with medium-size anterior osteophytes. The C6-C7 interspace is moderately
narrowed with medium-size anterior osteophytes. There are also moderate
uncovertebral joint degenerative changes at C5-C6 and C6-C7 including
sclerosis and spurring. Neural foramina are not well assessed but probably
narrowed on 1 or both sides at C2-C3. Lateral view does not demonstrate
substantially open foramina from C3-C4 through C6-C7 so substantial narrowings
are possible. Bones appear demineralized. No evidence of fracture,
dislocation or lysis.
IMPRESSION:
Postsurgical and degenerative changes as described above. Degree of central
stenosis, if any, is difficult to assess. Limited visualization of neural
foramina, which are potentially narrowed. No evidence of acute abnormality.
RECOMMENDATION(S): Oblique views may be helpful to assess further if needed
clinically.
|
19895419-RR-12
| 19,895,419 | 20,204,854 |
RR
| 12 |
2127-03-05 13:49:00
|
2127-03-05 15:11:00
|
EXAMINATION: CTA HEAD AND CTA NECK Q16 CT NECK
INDICATION: ___ male with a history of diabetes, COPD,
congestiveheart failure, chronic lower extremity pain, and
schizophreniapresenting with chief complaint of general body pain, admitted
for NSTEMI which was subsequently ruled out now pending placement. New onset
vertigo with R eye blurry vision. // ?Vertebrobasilar insufficiency
TECHNIQUE: Contiguous MDCT axial images were obtained through the brain
without contrast material. Subsequently, helically acquired rapid axial
imaging was performed from the aortic arch through the brain during the
infusion of intravenous contrast material. Three-dimensional angiographic
volume rendered, curved reformatted and segmented images were generated on a
dedicated workstation. This report is based on interpretation of all of these
images.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 5.0 s, 20.0 cm; CTDIvol = 46.7 mGy (Head) DLP =
934.7 mGy-cm.
2) Spiral Acquisition 4.8 s, 38.0 cm; CTDIvol = 13.3 mGy (Body) DLP = 504.0
mGy-cm.
3) Stationary Acquisition 0.5 s, 0.5 cm; CTDIvol = 3.0 mGy (Body) DLP = 1.5
mGy-cm.
4) Stationary Acquisition 4.5 s, 0.5 cm; CTDIvol = 26.8 mGy (Body) DLP =
13.4 mGy-cm.
Total DLP (Body) = 519 mGy-cm.
Total DLP (Head) = 935 mGy-cm.
COMPARISON: None available.
FINDINGS:
CT HEAD WITHOUT CONTRAST:
There is no evidence of acute territorial infarction,hemorrhage,edema,ormass.
The ventricles and sulci are normal in size and configuration.
There is mucosal thickening involving the right frontal and anterior right
ethmoid air cells. Otherwise, the paranasal sinuses,mastoid air cells,and
middle ear cavities are clear. The visualized portion of the orbits are
normal.
CTA HEAD:
There are moderate nonocclusive atherosclerotic calcifications at the
bilateral carotid siphons.
The vessels of the circle of ___ and their principal intracranial branches
appear normal without stenosis, occlusion, or aneurysm. The dural venous
sinuses are patent.
CTA NECK:
There is a common origin of the left common carotid artery and right
subclavian artery, a normal anatomical variant. The bilateral carotid and
vertebral artery origins are patent.
There is no evidence of internal carotid stenosis on either side by NASCET
criteria.
The patient is left vertebral artery dominant, with an asymmetrically small
right vertebral artery terminating as the right ___. There is calcified
atherosclerotic plaque at the left vertebral artery V3/V4 junction without
significant stenosis. Otherwise, the carotidandvertebral arteries and their
major branches appear normal with no evidence of stenosis or occlusion.
OTHER:
The visualized portion of the lungs demonstrate no focal consolidation or
sizable pleural effusion. The visualized portion of the thyroid gland is
within normal limits. Scattered subcentimeter short axis bilateral cervical
lymph nodes are noted, which may be reactive. Posterior spinal fusion
hardware is noted from C2 through C5 with osseous fusion across these levels.
There are moderate degenerative changes of the visualized spine.
IMPRESSION:
1. Head CT: No acute intracranial pathology.
2. Head CTA: Moderate nonocclusive atherosclerotic calcifications at the
bilateral carotid siphons. Patent circle of ___ without evidence of
stenosis,occlusion,or aneurysm.
3. Neck CTA: Patent bilateral cervical carotid and vertebral arteries without
evidence of stenosis, occlusion, or dissection.
|
19895419-RR-13
| 19,895,419 | 20,204,854 |
RR
| 13 |
2127-03-09 05:23:00
|
2127-03-09 13:04:00
|
EXAMINATION: MR ___ SPINE W/O CONTRAST ___ MR SPINE
INDICATION: ___ year old man with ___ weakness // ? spinal stenosis ?
spinal stenosis
TECHNIQUE: Sagittal imaging was performed with T2, T1, and STIR technique,
followed by axial T2 imaging.
COMPARISON: None available.
FINDINGS:
Images are degraded by motion artifact. Within these confines:
There is 4 mm retrolisthesis of L5 on S1, likely degenerative in nature.
Otherwise, lumbar spine alignment is normal. Vertebral body signal
intensities appear normal, with the exception of the L5-S1 endplates which
demonstrates Schmorl's nodes as well as type 1 degenerative ___ endplate
changes. There is intervertebral disc space narrowing at T12-L1, L3-L4 and
L5-S1. The spinal cord appears normal in caliber and configuration,
terminating as the conus medullaris at the L1-L2 level. There is bunching of
the cauda equina nerve roots from the L1 through L3-L4 level.
T12-L1: Evaluation is limited secondary to lack of axial imaging at this
level. There is a small diffuse disc bulge with mild right and no significant
left neural foraminal narrowing.
L1-L2: There is no significant disc bulge, spinal canal or neural foraminal
narrowing.
L2-L3: There is a small disc bulge without significant spinal canal stenosis
but with moderate bilateral neural foraminal narrowing.
L3-L4: There is a large diffuse disc bulge with thickening of the ligamentum
flavum and bilateral facet osteophytes with bilateral facet joint effusions
resulting in severe spinal canal stenosis with impingement of the cauda equina
nerve roots as well as severe bilateral neural foraminal narrowing with
impingement of the exiting L3 nerve roots. There is bunching of the cauda
equina nerve roots above the level of L3-L4.
L4-L5: Diffuse disc bulge with ligamentum flavum thickening and bilateral
facet arthropathy resulting in mild spinal canal stenosis. There is severe
bilateral neural foraminal stenosis with impingement of the exiting L4 nerve
roots.
L5-S1: There is grade 1 retrolisthesis of L5 on S1 along with a disc bulge,
ligamentum flavum thickening and bilateral facet osteophytes. There is mild
spinal canal stenosis. There is severe bilateral neural foraminal stenosis
with impingement of the exiting L5 nerve roots.
IMPRESSION:
Images degraded by motion artifact. Within these confines:
1. Multilevel degenerative changes of the lumbar spine, most prominent at
L3-L4 where there is severe spinal canal stenosis.
2. There is severe bilateral neural foraminal narrowing from L3-L4 through
L5-S1.
PREVALENCE: Prevalence of lumbar degenerative disk disease in subjects
without low back pain:
Overall evidence of disk degeneration 91% (decreased T2 signal, height loss,
bulge)
T2 signal loss 83%
Disk height loss 58%
Disk protrusion 32%
Annular fissure 38%
Jarvik, et all. Spine ___ 26(10):1158-1166
Lumbar spinal stenosis prevalence- present in approximately 20% of
asymptomatic adults over ___ years old
___, et al, Spine Journal ___ 9 (7):545-550
These findings are so common in asymptomatic persons that they must be
interpreted with caution and in context of the clinical situation.
|
19895419-RR-14
| 19,895,419 | 20,204,854 |
RR
| 14 |
2127-03-09 05:23:00
|
2127-03-09 13:13:00
|
EXAMINATION: MR CERVICAL SPINE W/O CONTRAST ___ MR ___ SPINE
INDICATION: ___ year old man with weakness s/p cervical fusion surgery ___
// ? cervical spinal stenosis ? cervical spinal stenosis
TECHNIQUE: Sagittal imaging was performed with T2, T1, and STIR technique.
Axial images were not performed secondary to patient inability to tolerate the
exam. The exam was terminated prior to the administration of contrast.
COMPARISON: Cervical spine radiographs dated ___, CTA head and
neck dated ___
FINDINGS:
Please note that only sagittal images of the cervical spine were obtained, and
these images are significantly degraded by motion artifact, rendering this
exam essentially nondiagnostic.
The patient is status post C3-C5 posterior spinal fusion. There is mild
kyphosis , centered at C4-C5. Vertebral body and intervertebral disc signal
intensities are not well evaluated. Spinal cord signal intensity is not well
evaluated.
Degenerative changes encroach on the spinal canal without definite contact
with the spinal cord. The neural foramina are not well assessed on this study.
IMPRESSION:
Please note that only sagittal images of the cervical spine were obtained, and
these images are significantly degraded by motion artifact, rendering this
exam essentially nondiagnostic. Consider repeat MRI of the cervical spine,
possibly with sedation if clinically indicated.
Status post C3-C5 posterior spinal fusion. There is multilevel degenerative
changes. The neural foramina are not well evaluated.
|
19895419-RR-17
| 19,895,419 | 20,204,854 |
RR
| 17 |
2127-03-07 18:00:00
|
2127-03-07 18:33:00
|
EXAMINATION: Abdominal radiographs, two views.
INDICATION: Pre MR screening. Question hardware.
COMPARISON: No relevant prior study is available.
FINDINGS:
No unanticipated radiodense foreign body is found. Stomach is nondistended.
There are no dilated loops of large or small bowel. Quantity of stool
throughout the colon is moderately prominent. Stool and air are found
throughout most portions of the large bowel. No evidence of free air. Round
calcification in the left lower pelvis suggest phleboliths. Incompletely
characterized degenerative changes are present at the lumbosacral junction.
IMPRESSION:
No evidence of radiodense foreign body.
|
19895778-RR-5
| 19,895,778 | 25,751,002 |
RR
| 5 |
2116-09-22 02:36:00
|
2116-09-22 03:26:00
|
HISTORY: ___ female with chest pain. Evaluate for pneumonia.
COMPARISON: Same day chest CT.
FINDINGS:
Frontal and lateral views of the chest were obtained. Lung volumes are low,
exaggerating heart size. The cardiomediastinal contours are otherwise normal.
The lungs are clear. No focal consolidation, pleural effusion, or
pneumothorax. No radiopaque foreign body.
IMPRESSION:
No acute cardiopulmonary process.
See report of concurrent Chest CT for important findings not visible on
conventional CXR.
|
19895778-RR-6
| 19,895,778 | 25,751,002 |
RR
| 6 |
2116-09-22 02:28:00
|
2116-09-22 03:18:00
|
HISTORY: ___ female with acute onset of pleuritic chest pain.
Evaluate for pulmonary embolism.
COMPARISON: None.
TECHNIQUE: Multi detector CT images were obtained through the chest in
arterial phase after administration of 100 cc of IV Omnipaque contrast. Axial
images were interpreted in conjunction with coronal, sagittal, right oblique
MIP and left oblique MIP reformats.
FINDINGS:
CHEST CTA: The thoracic aorta is normal caliber without evidence of aneurysm
or dissection. The main, lobar, segmental, and subsegmental pulmonary
arteries are well opacified without filling defect. The remainder of the
great vessels have a normal appearance.
CHEST: The thyroid is normal. Axillary, supraclavicular, mediastinal, and
hilar lymph nodes are not pathologically enlarged. The heart and mediastinum
are normal. The pericardium is intact without effusion.
2.0 x 1.9 x 2.1 cm intermediate density left paraspinal lesion adjacent to the
T7 vertebral body (2: 50) could represent a duplication cyst, bronchogenic
cyst, schwannoma, or lymphangioma, amongst other differentials.
Airways are patent to the subsegmental levels. The lungs are clear without
focal or diffuse abnormality. The pleura is intact without effusion. No
pneumothorax or pneumomediastinum.
The esophagus and visualized upper abdominal organs are unremarkable.
OSSEOUS STRUCTURES: Multilevel thoracolumbar degenerative changes are
moderate. No focal lytic or sclerotic lesion concerning for malignancy.
IMPRESSION:
1. No evidence of pulmonary embolism.
2. 2.1 cm intermediate density left paraspinal lesion at the level of T7, of
uncertain clinical significance. MRI could be obtained for further
evaluation.
|
19895786-RR-13
| 19,895,786 | 26,601,468 |
RR
| 13 |
2163-06-09 12:49:00
|
2163-06-09 15:16:00
|
INDICATION: TIA. Evaluate for intracranial hemorrhage.
TECHNIQUE: Contiguous axial images were obtained through the brain. Coronal
and sagittal reformations were obtained. No contrast was administered.
COMPARISONS: None.
FINDINGS: There is no evidence of hemorrhage, edema, shift of midline
structures, or major vascular territorial infarction. The ventricles and
sulci are prominent consistent, with age-related atrophy. No suspicious
osseous lesions are identified. The visualized paranasal sinuses, mastoid air
cells, and middle ear cavities are clear.
IMPRESSION: No acute intracranial abnormality.
|
19895786-RR-14
| 19,895,786 | 26,601,468 |
RR
| 14 |
2163-06-09 14:11:00
|
2163-06-09 15:47:00
|
CHEST RADIOGRAPHS
HISTORY: Altered mental status.
COMPARISONS: ___.
TECHNIQUE: Chest, PA and lateral.
FINDINGS: The heart is mildly enlarged. Moderate unfolding of the thoracic
aorta and calcification appear similar. This study shows a streaky opacity in
the left lower lung suggesting minor atelectasis or scarring. Otherwise, the
lungs appear clear. There are no pleural effusions or pneumothorax. Small
osteophytes are present along the mid thoracic spine. Surgical clips again
project over the right upper quadrant.
IMPRESSION: No evidence of acute disease.
|
19895786-RR-15
| 19,895,786 | 26,601,468 |
RR
| 15 |
2163-06-10 20:27:00
|
2163-06-11 10:08:00
|
EXAM: MRI brain and MRA head and neck.
CLINICAL INFORMATION: Patient with transient speech difficulty and right hand
clumsiness, evaluate for stroke.
TECHNIQUE: T1 sagittal and FLAIR T2 susceptibility and diffusion axial images
of the brain were acquired. 2D time-of-flight MRA of the neck vessels and 3D
time-of-flight MRA of the circle of ___ obtained.
FINDINGS: BRAIN MRI:
Diffusion images demonstrate no evidence of acute infarct in the left cerebral
hemisphere. Subtle signal abnormality within the right side of the brain stem
on series 902 image 12 appears to be artifactual. Subtle hyperintensities in
the periventricular white matter in the right hemisphere appear to be due to
T2 shine-through. Otherwise no definite territorial infarcts are seen. There
is moderate atrophy and moderate-to-severe changes of small vessel disease
identified. No midline shift or hydrocephalus seen. Suprasellar and
craniocervical regions are unremarkable.
IMPRESSION: No definite evidence of acute infarct. Severe changes of small
vessel disease and brain atrophy.
MRA NECK:
The neck MRA demonstrates normal flow in the carotid and vertebral arteries.
No stenosis or occlusion seen.
MRA HEAD:
The head MRA demonstrates normal flow signal in the arteries of anterior and
posterior circulation. Bilateral fetal posterior cerebral arteries with
consequent small basilar arteries identified. The left vertebral artery
appears to be ending in posterior inferior cerebellar artery.
IMPRESSION: No significant abnormalities on MRA of the head.
|
19895786-RR-16
| 19,895,786 | 29,062,800 |
RR
| 16 |
2163-09-13 18:38:00
|
2163-09-14 00:35:00
|
RIGHT KNEE FILMS, ___
HISTORY: ___ male with pain, question joint infection.
FINDINGS: AP, lateral, and oblique views of the left knee. No prior plain
film available for comparison.
Postoperative changes of left total knee arthroplasty are seen, which is in
anatomic alignment. Joint space is maintained. Subtle lucency seen at the
anterior apect of the intramedullary aspect of the tibial component is seen,
nonspecific but correlation with priors may be useful. There is no evidence
of fracture or definite hardware complication. Possible small suprapatellar
joint effusion is seen.
|
19895786-RR-17
| 19,895,786 | 29,062,800 |
RR
| 17 |
2163-09-16 08:45:00
|
2163-09-16 09:36:00
|
AP CHEST, 9:00 A.M., ___
HISTORY: New left PICC line.
IMPRESSION: AP chest compared to ___:
The tip of the wire in the new left PIC line is by report 5 mm back from the
tip of the catheter, which ends in the right atrium. As discussed with the IV
nurse, ___, if the system is withdrawn 4 cm it will end in the low SVC.
Small left pleural effusion is new since ___. Heart size is normal.
There is no pneumothorax. Band of atelectasis crossing the right hilus in to
the lower lobe is new as well. Lungs are otherwise grossly clear of any acute
abnormality, but the pattern of vasculature, particularly in the right upper
lobe suggests emphysema.
|
19895786-RR-18
| 19,895,786 | 29,062,800 |
RR
| 18 |
2163-09-17 17:26:00
|
2163-09-17 19:27:00
|
INDICATION: ___ male with history of TIAs and atrial fibrillation,
presents with dysarthria and supratherapeutic INR. Question acute stroke.
___.
TECHNIQUE: Contiguous non-contrast axial images were acquired through the
brain.
FINDINGS: There is no intracranial hemorrhage, mass effect, edema, or shift
of normally midline structures. The gray-white matter differentiation is
preserved. There are foci of discrete and confluent periventricular white
matter hypoattenuation, compatible with small vessel ischemic disease.
Ventricles and sulci are prominent, consistent with age-related involution.
Suprasellar and basilar cisterns are patent.
Paranasal sinuses and mastoid air cells are well aerated. Concave right
maxillary walls appear longstanding. Vascular calcifications are seen in the
cavernous carotid arteries. Globes and orbits are intact.
IMPRESSION:
1. No acute intracranial process such as hemorrhage or major vascular
territorial infarct. MRI is, however, more sensitive for early ischemic
disease if not contraindicated.
2. Age-related involution and small vessel ischemic disease.
|
19895786-RR-19
| 19,895,786 | 29,062,800 |
RR
| 19 |
2163-09-18 09:19:00
|
2163-09-18 12:37:00
|
LIVER ULTRASOUND AND LIVER DOPPLER
CLINICAL INDICATION: ___ male with cirrhosis. The history states
prior TIPS in ___ but TIPS were not performed until the ___. Previous
scan suggests the patient may have had a portocaval surgical shunt.
COMPARISON SCAN: ___.
The liver is coarse and heterogeneous in echotexture and relatively small in
size. No discrete liver lesions are identified. There are several
peribiliary cysts, and there are some areas which appear to suggest mild
intrahepatic bile duct dilatation. The gallbladder is normal in size with
several stones and some sludge noted. The spleen is normal in size at 11 cm,
and a 3.2 cm soft tissue mass is seen in the region of the pancreatic tail.
This has been previously noted on CT scan of ___ and is minimally
increased in size.
Both kidneys are small and somewhat atrophic appearing. The right kidney
measures 8.8 cm in length and the left kidney 8.4 cm. There is no
hydronephrosis, although there may be some calculi present in the right
kidney, nonobstructive.
Color flow and pulse Doppler waveform analysis was performed. The portal vein
appears to be occluded with markedly increased and tortuous hepatic arterial
flow noted both in the porta hepatis and well within the liver itself. The
hepatic veins are patent as is the inferior vena cava. There does appear to
be some flow in the splenic vein, but the portacaval anastomosis could not be
identified.
CONCLUSION:
1. Cirrhotic liver with apparent portal vein thrombosis and markedly
increased arterial blood supply. No focal liver masses are seen.
2. Several liver cysts, possibly peribiliary cysts as well as some mild
intrahepatic bile duct dilatation is noted.
3. Doppler shows portal vein thrombosis and patent hepatic veins and IVC.
4. Soft tissue mass in the region of the pancreatic tail, slightly increased
compared to CT of ___.
|
19895786-RR-20
| 19,895,786 | 29,062,800 |
RR
| 20 |
2163-09-21 11:10:00
|
2163-09-21 12:13:00
|
HISTORY: Left knee septic arthritis, washout ___, now worsening swelling and
hematocrit drop, question septic arthritis.
LEFT KNEE, THREE VIEWS.
A three-component knee prosthesis is in place. There appears to be a large
joint effusion as well as some surrounding soft tissue swelling. No fracture
or focal osteolysis is identified. Diffuse osteopenia present. Faint
vascular calcification noted.
Compared with ___, the degree of distension of the suprapatellar recess
appears greater.
|
19895786-RR-21
| 19,895,786 | 29,062,800 |
RR
| 21 |
2163-09-22 11:39:00
|
2163-09-22 13:31:00
|
INDICATION: Leukocytosis, shortness of breath.
TECHNIQUE: AP and lateral chest radiograph.
COMPARISONS: ___.
FINDINGS: The left PICC is barely visible but appears to be terminate in the
low SVC. There is mild cardiomegaly. Hyperexpansion and diaphragmatic
flattening suggests emphysema. Surgical clips are overlying the upper
abdomen. There is no focal consolidation or pneumothorax. There are small
bilateral pleural effusions. There is no pulmonary vascular congestion.
IMPRESSION: No evidence of pneumonia. Small bilateral pleural effusions.
|
19895786-RR-22
| 19,895,786 | 29,798,422 |
RR
| 22 |
2163-10-14 07:45:00
|
2163-10-14 10:38:00
|
INDICATION: Fall onto left hip. Evaluate for fracture.
COMPARISONS: Pelvic CT, ___.
FINDINGS: There is an impaction fracture of the left femoral neck. There is
no displacement of the fracture. There is no dislocation. No other fractures
are seen. The pubis symphysis is intact. The bowel gas pattern is
nonspecific.
IMPRESSION: Nondisplaced impaction fracture of the left femoral neck.
|
19895786-RR-23
| 19,895,786 | 29,798,422 |
RR
| 23 |
2163-10-14 07:06:00
|
2163-10-14 09:32:00
|
INDICATION: ___ male with fall and intracranial head injury.
COMPARISON: CT head without contrast ___.
TECHNIQUE: Contiguous axial images were obtained through the brain without
the administration of IV contrast. Multiplanar reformats were generated and
reviewed.
FINDINGS: There is no evidence of acute intracranial hemorrhage, discrete
masses, mass effect or shift of normally midline structures. The gray-white
matter differentiation is preserved. Foci of periventricular and subcortical
low-attenuating regions are consistent with sequelae of chronic small vessel
ischemic disease. Ventricles and sulci are prominent consistent with
age-related involutional changes. Bilateral mastoid air cells and paranasal
sinuses appear well aerated. Atherosclerotic calcifications are noted within
the cavernous carotid arteries. The globes and orbits are intact. There is no
evidence of acute fracture.
IMPRESSION:
No acute intracranial process. Age-related involutional changes.
|
19895786-RR-24
| 19,895,786 | 29,798,422 |
RR
| 24 |
2163-10-14 07:56:00
|
2163-10-14 09:40:00
|
INDICATION: New hip fracture. Preoperative evaluation.
COMPARISON: Chest radiograph ___.
FINDINGS: There is mild cardiomegaly, unchanged from the prior exam. The
mediastinal silhouette is normal. Since the prior radiograph, there is mild
vascular engorgement which is new since the prior exam, but there is no
evidence of pulmonary edema. There is no consolidation, pneumothorax, or
pleural effusion. A left PICC terminates in the low SVC and is in unchanged
position from the prior exam. The osseous structures are unremarkable.
Surgical clips are noted in the right upper quadrant.
IMPRESSION:
1. No acute cardiopulmonary process.
2. Stable mild cardiomegaly.
3. Mild vascular engorgement.
3. Left PICC terminating in the low SVC.
|
19895786-RR-25
| 19,895,786 | 29,798,422 |
RR
| 25 |
2163-10-14 19:25:00
|
2163-10-15 08:31:00
|
LEFT FEMUR AND KNEE RADIOGRAPHS FROM ___
CLINICAL INDICATION: ___ man with left femoral neck fracture, assess
for other abnormalities.
COMPARISON: Left hip radiographs from ___ and CT abdomen and
pelvis without contrast from ___.
FINDINGS: Frontal, lateral, and oblique radiographs of the left femur and knee
again demonstrate an impaction fracture involving the left femoral neck with
mild foreshortening. No displacement of the fracture in the interim. No
other acute fractures are identified. Pubic symphysis is within normal
limits. Calcified atherosclerotic vascular disease of the superficial femoral
artery. Changes of a prior left knee total arthroplasty with orthopedic
hardware in place and intact without signs of loosening or periorthopedic
hardware complication. Mild osteopenia of the distal femur and proximal tibia
and fibula.
IMPRESSION:
1. Grossly unchanged appearance of left femoral neck fracture with mild
foreshortening, but no displacement in the interim.
2. Changes of a prior left total knee arthroplasty with orthopedic hardware
in place and intact.
3. Calcified atherosclerotic vascular disease of the superficial femoral
artery.
|
19895786-RR-26
| 19,895,786 | 29,798,422 |
RR
| 26 |
2163-10-15 17:01:00
|
2163-10-15 19:40:00
|
HISTORY: Hemiarthroplasty.
Single AP view of the left hip obtained portably.
The patient is status post left hemiarthroplasty in overall anatomic alignment
on this single AP view. No periarticular fracture is detected. Subcutaneous
emphysema and staples are consistent with recent surgery.
|
19895786-RR-27
| 19,895,786 | 29,798,422 |
RR
| 27 |
2163-10-15 23:45:00
|
2163-10-16 11:11:00
|
AP CHEST, 11:58 P.M. ON ___
HISTORY: Difficult extubation after hip fracture repair.
IMPRESSION: AP chest compared to ___:
New opacification in both lower lungs is most likely atelectasis. Small
posteriorly collected pleural effusions would have a similar appearance.
Moderate cardiomegaly is unchanged. The upper lungs are entirely clear. I do
not see any evidence of cardiac decompensation. Left PIC line is traceable to
the low SVC but the tip is indistinct.
|
19895786-RR-28
| 19,895,786 | 29,798,422 |
RR
| 28 |
2163-10-21 08:12:00
|
2163-10-21 09:29:00
|
HISTORY: Fever.
FINDINGS: In comparison with the study of ___, there is increased
opacification at both bases with obscuration of the hemidiaphragms, consistent
with layering pleural effusions, more prominent on the right. Compressive
atelectasis is seen at both bases. Cardiac silhouette is at the upper limits
of normal in size or slightly enlarged. There may be mild pulmonary vascular
congestion.
Little change in the appearance of the PICC line.
|
19896361-RR-15
| 19,896,361 | 24,105,587 |
RR
| 15 |
2150-02-18 20:24:00
|
2150-02-18 22:04:00
|
INDICATION: ___ with CHF // Pulmonary edema
TECHNIQUE: PA and lateral views the chest.
COMPARISON: ___.
FINDINGS:
There is moderate enlargement of the cardiac silhouette as on prior. Lungs
are clear without consolidation, effusion, or edema. Hypertrophic changes
seen throughout the spine. No acute osseous abnormalities.
IMPRESSION:
Cardiomegaly without superimposed acute cardiopulmonary process.
|
19896442-RR-17
| 19,896,442 | 24,416,022 |
RR
| 17 |
2156-05-23 02:16:00
|
2156-05-23 03:22:00
|
HISTORY: ___ male with history of cholangitis and right upper
quadrant pain.
COMPARISON: None available.
TECHNIQUE: Transabdominal ultrasound examination of the right upper quadrant
was performed.
FINDINGS:
The liver demonstrates normal echotexture. The main portal vein is patent
with hepatopetal flow. There is no intra or extrahepatic biliary ductal
dilation. A 13 mm stone is seen in the gallbladder neck. The gallbladder is
full but not densely distended. There is no sonographic ___ sign.
Sludge layers in the gallbladder. Mild adenomyomatosis is seen in the
gallbladder wall.
IMPRESSION:
1. Stone in the gallbladder neck; full gallbladder which contains layering
sludge and is not tensely distended. No sonographic ___ sign, but this
may be limited if the patient has received pain medication.
2. No intra or extrahepatic biliary ductal dilation.
|
19897276-RR-20
| 19,897,276 | 28,994,803 |
RR
| 20 |
2176-04-09 08:06:00
|
2176-04-09 09:24:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with L SDH// preop preop
IMPRESSION:
Heart size is normal. Lungs are clear. There is no pleural effusion or
pneumothorax.
|
19897276-RR-21
| 19,897,276 | 28,994,803 |
RR
| 21 |
2176-04-10 14:58:00
|
2176-04-10 16:58:00
|
EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ year old woman s/p burr hole ___ evac. Please obtain at 3pm//
s/p SDH evac. Please obtain at 3pm
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast. Coronal and sagittal reformations as well as bone algorithm
reconstructions were provided and reviewed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 10.0 s, 17.0 cm; CTDIvol = 48.8 mGy (Head) DLP =
829.0 mGy-cm.
Total DLP (Head) = 844 mGy-cm.
COMPARISON: Reference MR head from ___ reference CT head from ___
FINDINGS:
Patient is status post left parietal burr hole placement with expected
postoperative pneumocephalus and subgaleal fat stranding. There is minimal
residual extra-axial density along the left cerebral convexity to suggest
residual subdural blood. There is minimal high density material along the
drainage catheter (series 603; image 10), which is suggestive of a tiny
component of acute blood. Drainage catheter traverses to the level of the
tentorium cerebelli. There has been interval decrease in right to left
midline shift, measuring 4 mm on today's exam, previously 8 mm. There is no
suggestion of large territorial infarction. Basal cisterns remain patent.
There is moderate mucosal thickening of the bilateral maxillary sinuses as
well as ethmoid air cells. There is mild mucosal thickening of the left
sphenoid sinus. Minimal mucosal thickening is noted within the left mastoid
air cells. Right mastoid air cells and middle ear cavities appear clear. The
visualized portion of the orbits are unremarkable.
IMPRESSION:
Patient is status post left parietal burr hole with drainage catheter
placement with expected postoperative pneumocephalus and minimal high density
material adjacent to the drainage catheter suggestive of tiny component of
acute blood. Interval decrease in right to left midline shift, measuring 4 mm
on today's exam, previously 8 mm. Basal cisterns remain patent.
|
19897276-RR-22
| 19,897,276 | 28,994,803 |
RR
| 22 |
2176-04-12 13:06:00
|
2176-04-12 14:34:00
|
EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ year old woman POD#2 L burr hole for ___ evacuation s/p
subdural drain removal. Evaluate post-drain pull.
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 4.0 s, 16.0 cm; CTDIvol = 46.7 mGy (Head) DLP =
747.3 mGy-cm.
Total DLP (Head) = 747 mGy-cm.
COMPARISON: Head CT ___.
FINDINGS:
The patient is status post subdural drain removal, with mild decrease in
postoperative pneumocephalus. Compared to the most recent prior study, small
hypodense subdural blood along the left cerebral convexity appears similar. A
linear hyperdensity, which previously tracked along the course of the drainage
catheter (02:18), suggestive of acute blood, is unchanged. No evidence of new
hemorrhage. Rightward shift of normally midline structures is unchanged. A
focal hypodensity adjacent to this blood is most compatible with an evolving
contusion. The basal cisterns are patent.
Moderate mucosal thickening of the bilateral maxillary sinuses and ethmoid air
cells is unchanged. Otherwise, the visualized portion of the paranasal
sinuses, mastoid air cells, and middle ear cavities are clear. The visualized
portion of the orbits are unremarkable.
IMPRESSION:
1. Interval removal of a left subdural drainage catheter, with persistent,
unchanged mass effect from the left subdural hematoma. No evidence of new
hemorrhage.
2. Unchanged acute blood along the left frontal lobe, previously adjacent to
the drainage catheter, with an adjacent evolving parenchymal contusion.
|
19897314-RR-47
| 19,897,314 | 27,325,591 |
RR
| 47 |
2203-01-31 09:41:00
|
2203-01-31 09:56:00
|
INDICATION: History: ___ with syncope, L shoulder pain// eval for
fx/dislocation
TECHNIQUE: THREE VIEWS OF THE LEFT SHOULDER
COMPARISON: ___
FINDINGS:
No acute fracture or dislocation is seen. Left acromioclavicular joint is
intact with mild degenerative change seen. The partially imaged left upper
outer hemithorax is grossly unremarkable.
IMPRESSION:
No acute fracture or dislocation of the left shoulder.
|
19897314-RR-48
| 19,897,314 | 27,325,591 |
RR
| 48 |
2203-01-31 09:41:00
|
2203-01-31 09:57:00
|
INDICATION: ___ year old woman with fall, distal L clavicle pain// fracture?
TECHNIQUE: Two views of the left clavicle
COMPARISON: None.
FINDINGS:
No acute fracture is seen. The left acromioclavicular joint is intact.
Partially imaged left lung apex is grossly unremarkable.
IMPRESSION:
No acute fracture seen.
|
19897675-RR-41
| 19,897,675 | 20,344,270 |
RR
| 41 |
2193-04-07 14:46:00
|
2193-04-07 18:05:00
|
HISTORY: Worsening psoriasis, joint pain, question erosions.
RIGHT HAND, THREE VIEWS. LEFT HAND, THREE VIEWS.
RIGHT HAND: Mild changes of osteoarthritis. No findings conclusive for
psoriatic arthritis. No erosions detected. Degenerative narrowing at the
radioscaphoid joint is noted. There is probable ulnar positive variance.
LEFT HAND: An IV is in place. Allowing for this, there are mild changes of
osteoarthritis. There is a cyst in the radial styloid and probable narrowing
of the radioscaphoid articulation. Background osteoarthritis noted. No
findings conclusive for psoriatic arthritis. Of note, on the lateral view of
the left hand, there is prominent soft tissue swelling along the dorsum of the
wrist in this patient with an IV in place. Clinical correlation is requested.
IMPRESSION:
1. Soft tissue swelling along the dorsum of the left hand in this patient
with an IV in place. Clinical correlation is requested.
2. Bilateral osteoarthritis.
3. No findings conclusive for psoriatic arthritis.
|
19897771-RR-41
| 19,897,771 | 29,112,374 |
RR
| 41 |
2189-08-12 12:54:00
|
2189-08-12 15:29:00
|
EXAMINATION: HIP NAILING IN OR W/FILMS AND FLUORO RIGHT IN O.R.
INDICATION: Right-sided hip fracture.
TECHNIQUE: AP and lateral spot fluoroscopic images of the right hip were
obtained in the OR without radiologist present.
63.1 seconds of flouro time recorded on the requisition.
COMPARISON: Prior hip and femur radiographs of ___.
FINDINGS:
Fluoroscopic images demonstrate interval placement of gamma nail construct.
Right hip alignment is significantly improved from initial injury. See
separate OR report for further details.
IMPRESSION:
Intraoperative placement of gamma nail construct under fluoroscopy.
|
19897771-RR-44
| 19,897,771 | 29,112,374 |
RR
| 44 |
2189-08-14 13:27:00
|
2189-08-14 13:52:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old woman with heart disease // structural heart
disease?
COMPARISON: ___
IMPRESSION:
The lung volumes are normal. Moderate scoliosis with subsequent asymmetry of
the ribcage. This scoliosis is appears to be the explanation for the slight
leftward deviation of the trachea. The lateral radiograph only shows minimal
bilateral pleural effusions, restricted to the posterior portions of the
costophrenic sinuses. Moderate cardiomegaly with tortuosity of the thoracic
aorta. No pulmonary edema. No pneumonia.
|
19897794-RR-127
| 19,897,794 | 25,666,387 |
RR
| 127 |
2176-01-23 11:40:00
|
2176-01-23 13:52:00
|
INDICATION: ___ female with recurrent frequent UTIs. Evaluate for
nephrolithiasis.
COMPARISONS: None available.
TECHNIQUE: Axial helical MDCT images were obtained from the bases of the
lungs to the pubic symphysis without administration of IV contrast. Coronal
and sagittal reformations were generated.
FINDINGS: The bases of the lungs are clear. The heart and pericardium are
unremarkable with the exception of coronary artery calcifications. A tunneled
dialysis catheter is seen ending at the the right atrium or the thoracic
portion of the IVC. There is a small hiatal hernia.
The liver is homogeneous, without focal lesions. There are small dependent
calcified stones in the gallbladder but no evidence of pericholecystic fluid
collection or wall thickening. The pancreas is within normal limits without
peripancreatic stranding or fluid collection. The spleen is homogeneous and
there is no splenomegaly. A small splenule is noted (2:22). The kidneys are
atrophic. There is no evidence of nephrolithiasis. Small calcifications in
the interpolar region of both kidneys represent vascular calcifications. The
right kidney demonstrates a 1-cm hyperdense lesion in the interpolar region
(2:35) which likely represents hemorrhage or proteinaceous cyst. Exophytic
low sensity 9mm lesion seen off the lower pole of the right kidney,
potentially a cytst. No other focal lesions are present. There is no
pelvicaliceal or ureteral dilatation. The adrenal glands are unremarkable.
The stomach, duodenum, small bowel, and colon are within normal limits without
evidence of wall thickening. The appendix is visualized and is normal. There
are multiple sigmoid diverticula but no diverticulitis. The rectum is
unremarkable.
There is extensive calcification of the abdominal arterial tree, but detailed
assessment of the vascular structures is limited in this non-contrast study.
There is no lymph node enlargement. There is no evidence of abdominal free
air or ascites.
PELVIC CT: Air in the urinary bladder is compatible with recent
catheterization. Apparent mild wall thickening of the bladder may relate to
underdistention, but given history of UTIs, correlate with urinalysis. There
are multiple phleboliths. There are no pelvic wall or inguinal
lymphadenopathies. The uterus and adnexa are not clearly visualized.
No suspicious osseous lesions. Ther eis grade one anterolisthesis of L4 on L5
and L5 on S1.
IMPRESSION:
1. No evidence of nephrolithiasis.
2. 1-cm hyperdense lesion in the interpolar region of the right kidney likely
represents a small hemorrhagic cyst; could be confirmed on ultrasound.
3. Extensive abdominal vascular calcifications.
4. Hiatal hernia.
5. Cholelithiasis.
6. Air in the urinary bladder is compatible with recent catheterization; if
none, correlate with urinalysis to exclude infection. Bladder relatively
collapsed. Apparent mild wall thickening of the bladder may relate to
underdistention, but given history of UTIs, correlate with urinalysis.
|
19897794-RR-129
| 19,897,794 | 29,765,983 |
RR
| 129 |
2176-05-07 05:59:00
|
2176-05-07 06:36:00
|
INDICATION: ___ female with CHF exacerbation.
___
CHEST, AP UPRIGHT: Dialysis catheter has been removed. Changes of coronary
artery bypass grafting, with median sternotomy and mediastinal clips. Mild
cardiomegaly and central vascular congestion persist. Mild interstitial edema
has developed.
IMPRESSION: Mild pulmonary edema.
|
19897794-RR-130
| 19,897,794 | 29,849,146 |
RR
| 130 |
2176-07-13 00:21:00
|
2176-07-13 05:13:00
|
INDICATION: ___ with CHF.
TECHNIQUE: Single frontal radiograph of the chest was obtained.
COMPARISON: Radiograph from ___. CT of the abdomen and pelvis from
___.
FINDINGS:
There is moderate pulmonary edema and small bilateral pleural effusions.
There is no pneumothorax. Calcifications of the aortic arch are seen.
IMPRESSION: Moderate pulmonary edema.
|
19897794-RR-131
| 19,897,794 | 29,849,146 |
RR
| 131 |
2176-07-14 15:26:00
|
2176-07-14 18:20:00
|
CLINICAL HISTORY: End-stage renal disease, on dialysis, hypoxemia.
CHEST:
COMPARISON FILM: ___.
Compared to the prior chest x-ray, there has been considerable clearing of the
pulmonary edema present at this time. Upper zone re-distribution persists.
The heart remains enlarged.
IMPRESSION: Improving pulmonary edema.
|
19897837-RR-21
| 19,897,837 | 27,376,452 |
RR
| 21 |
2170-02-05 13:34:00
|
2170-02-05 15:11:00
|
INDICATION: History: ___ with fever// Eval PNA
COMPARISON: ___
IMPRESSION:
There are slightly low lung volumes. Heart size is upper limits of normal.
There is some tortuosity of thoracic aorta, unchanged. There are patchy
bibasilar opacities at the lung bases medially which may represent early
infiltrate or atelectasis. Follow-up to resolution is recommended. There are
no pneumothoraces or large pleural effusions. Bilateral humeral heads
articulate with the acromion consistent with rotator cuff rupture.
|
19897837-RR-22
| 19,897,837 | 27,376,452 |
RR
| 22 |
2170-02-06 13:17:00
|
2170-02-06 14:18:00
|
INDICATION: ___ year old man with cellulitis over left ankle, spreading
despite ABX with bony tenderness.// Please be sure to get area outlined with
marker
COMPARISON: None
IMPRESSION:
No acute fractures or dislocations are seen. There are mild degenerative
changes of the superior talonavicular joint. Ankle mortise is preserved.
There are no osteochondral lesions.There are vascular calcifications. There
is an inferior calcaneal spur.
|
19897837-RR-23
| 19,897,837 | 27,376,452 |
RR
| 23 |
2170-02-08 13:23:00
|
2170-02-08 15:20:00
|
EXAMINATION: RENAL U.S.
INDICATION: ___ year old man with new ___, Cr 2.9 > 3.4// With doppler please.
Looking at renal vascular flow, size and health of kidneys, rule out
obstruction
TECHNIQUE: Grey scale and color Doppler ultrasound images of the kidneys were
obtained.
COMPARISON: None.
FINDINGS:
Note is made that this is a limited study due to the patient's limited ability
to hold his breath.
There is no hydronephrosis, stones, or masses bilaterally. Cortical thinning
is seen bilaterally in the kidneys consistent with chronic parenchymal
disease.
Right kidney: 8.9 cm
Left kidney: 10.5 cm
DOPPLER EXAMINATION: Doppler examination is also limited by the patient's
inability to hold his breath. Arterial waveforms with sharp upstrokes are
seen in the main renal artery bilaterally. Peak systolic flow in the right
main renal artery measures 25 centimeters/second and within the left kidney
measures 12 centimeters/second. The renal vein is patent bilaterally.
Resistive indices of the intraparenchymal arteries in the right kidney measure
between 0.75 and 0.78 and within the left kidney measure between 0.71 and
0.84.
The bladder is moderately well distended and normal in appearance.
IMPRESSION:
1. The right kidney is somewhat smaller than the left kidney. Bilateral
cortical thinning noted consistent with chronic parenchymal disease.
2. Limited Doppler examination however there is no sonographic evidence of
renal artery stenosis.
|
19898116-RR-3
| 19,898,116 | 22,663,876 |
RR
| 3 |
2127-05-08 17:22:00
|
2127-05-08 18:00:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man admitted to NeuroICU with left parietal stroke.//
Admission CXR.
TECHNIQUE: AP portable chest radiograph
COMPARISON: None
FINDINGS:
There is no focal consolidation, pleural effusion or pneumothorax identified.
The size of the cardiac silhouette is mildly enlarged. Sternotomy wires are
intact.
IMPRESSION:
No acute cardiopulmonary abnormality.
|
19898116-RR-4
| 19,898,116 | 22,663,876 |
RR
| 4 |
2127-05-09 09:33:00
|
2127-05-09 11:38:00
|
EXAMINATION: MR HEAD W/O CONTRAST ___ MR HEAD
INDICATION: ___ year old man with left parietal/temporal stroke on noncontrast
CT, presents with right sided weakness/sensory changes and word finding
difficulties. Stroke evaluation.
TECHNIQUE: Sagittal T1 weighted imaging was performed. Axial imaging was
performed with gradient echo, FLAIR, diffusion, and T2 technique were then
obtained.
COMPARISON CTA head and neck performed and noncontrast head CT performed at
outside ___ on ___.
FINDINGS:
There is a large left MCA territory acute to early subacute infarction much of
the left parietal lobe, superior left temporal lobe, insula, and inferior/post
left frontal lobe.
There are small foci of acute to early subacute infarcts with identical signal
characteristics in the anterior right cingulate gyrus (right ACA territory),
right superior frontal gyrus on images ___ (MCA territory) and in the
right centrum semiovale white matter (4:26, 24, 23, 22).
No evidence of blood products. No significant mass effect. Specifically, no
compression of the ventricles or basal cisterns, and no shift of midline
structures.
Loss of the bilateral internal carotid of flow voids with distal supraclinoid
reconstitution corresponds to non opacification seen on the prior CTA head.
There is mild-to-moderate mucosal thickening and mucous retention cysts in the
right maxillary sinus. There is mild mucosal thickening in the left
maxillary, left frontal, and sphenoid sinuses. There is moderate bilateral
anterior ethmoid and mild bilateral posterior ethmoid air cell opacification.
There is mild partial opacification of the right mastoid air cells.
IMPRESSION:
1. Multifocal acute to early subacute infarctions, moderately large in the
left MCA territory, small in the anterior right cingulate gyrus in the right
ACA territory, punctate in the right superior frontal gyrus in the MCA
territory, and multiple punctate small acute to early subacute infarcts in the
right centrum semiovale.
2. No evidence for blood products. No significant mass effect.
3. Occlusion of bilateral internal carotid arteries is again seen with distal
supraclinoid reconstitution, better assessed on the ___ CTA.
|
19898586-RR-35
| 19,898,586 | 25,476,976 |
RR
| 35 |
2160-12-27 11:07:00
|
2160-12-27 14:00:00
|
INDICATION: ___ man with history of CBD stricture and right upper
quadrant pain and fever, evaluate for stone or dilatation.
COMPARISON: MRCP on ___, ultrasound on ___ and CT
abdomen and pelvis on ___.
FINDINGS: There is left intrahepatic biliary duct dilatation that is similar
compared to CT done two days ago. A more posterior focal cystic dilatation
may represent a chronically thrombosed left portal vein or a focal area of
biliary dilatation. There are a few hyperechoic areas in the left lobe that
may represent pneumobilia. The right lobe of the liver is notable for partial
lobectomy. There is no evidence of focal hepatic abscess.The visualized
portions of the right kidney are unremarkable. Right kidney measures 12 cm.
The main portal vein is patent with hepatopetal flow. The common bile duct is
not dilated and measures 4 mm. The left kidney measures 13 cm. The spleen
measures 9.8 cm.
IMPRESSION: Left intrahepatic biliary duct dilatation that is unchanged
compared to CT two days ago. A more focal cystic dilatation more posteriorly
either represents an area of intrahepatic biliary duct dilatation or
previously seen/chronic thrombosed left portal vein branch. If clinically
indicated, MRI can be done for better detail. There are a few scattered
hyperechoic foci that may represent pneumobilia.
|
19898586-RR-36
| 19,898,586 | 25,476,976 |
RR
| 36 |
2160-12-27 20:19:00
|
2160-12-28 08:53:00
|
INDICATION: Leukocytosis and left lower lobe crackles. Concern for
pneumonia.
COMPARISON: None.
FINDINGS: PA and lateral chest radiographs demonstrate bibasilar opacities
right greater than left. The aorta is tortuous. The cardiomediastinal
silhouette is otherwise normal.
IMPRESSION: Bibasilar opacities, larger on the right are likely atelectasis.
In the proper clinical setting, this can represent pneumonia.
|
19898586-RR-37
| 19,898,586 | 25,476,976 |
RR
| 37 |
2160-12-28 11:59:00
|
2160-12-28 18:31:00
|
MRI LIVER
INDICATION: History of hepatic resection for right hepatic duct stricture
___ secondary to stones, presents with abdominal pain.
COMPARISON: MRCP ___ and ultrasound abdomen ___.
TECHNIQUE: Multiplanar T1- and T2-weighted imaging were acquired on a 1.5
Tesla magnet including dynamic 3D imaging obtained prior to, during, and after
the uneventful intravenous administration of 7 cc of Gadovist.
FINDINGS:
The imaged lung bases are clear. Incidental note is made of a small hiatal
hernia.
There has been a previous right hepatic resection. There is unremarkable
hepatic parenchymal signal intensity. A simple hepatic cyst is identified
within segment VIII of the liver measuring 9 mm (series 6, image 10)and within
segment ___ measuring 10 mm (series 6, image 21), and are unchanged when
compared to prior imaging. They are hyperintense relative to hepatic
parenchyma on T2-weighted imaging and do not demonstrate enhancement
post-contrast.
Again within segment III of the liver, there are dilated intrahepatic bile
ducts seen with a focal region of narrowing noted at the origin of the left
hepatic duct, overall unchanged when compared to prior MRCP from ___.
No mass is identified centrally at the porta hepatis to account for these
findings.
Note is made of prior cholecystectomy.
The common bile duct is slightly more prominent when compared to prior imaging
and measures up to 9 mm, previously 7 mm. There are multiple filling defects
noted within the distal common bile duct (series 7, image 22 and series 8,
image 1), concerning for small common bile duct stones at the ampulla.
Following contrast administration, there is heterogeneous perfusion noted
within segment II of the liver secondary to chronic thrombosis of the left
anterior branch of the portal vein (series 1101, image 65). The remainder of
the visualized right posterior and main portal veins, however, are patent.
There is conventional hepatic arterial anatomy.
Visualized portions of the spleen, pancreas, adrenal glands, and kidneys are
unremarkable. There are no retroperitoneal masses or adenopathy. There are
no abnormally dilated or thickened small or large bowel loops in visualized
abdomen. There is no free fluid.
Bone marrow signal is normal and there are no osseous lesions.
IMPRESSION:
1. Numerous tiny filling defects are noted within the distal common bile duct
concerning for stones. The common bile duct diameter has slightly increased in
size when compared to prior imaging and today measures 9 mm, previously 7 mm
in ___.
2. Stable appearance to the dilated intrahepatic biliary tree in the left
lobe of the liver likely secondary to focal narrowing of the origin of the
left hepatic duct which is unchanged when compared to prior MRCP from ___.
3. Thrombosed left anterior branch of the portal vein which is chronic and
unchanged when compared to prior imaging, with associated perfusion anomaly
within segment II of the liver. The visualized remainder of the right and
main portal vein are patent.
Findings were discussed with Dr. ___ ___ by Dr.
___ on ___ at 5:15 p.m.
|
19898586-RR-38
| 19,898,586 | 25,476,976 |
RR
| 38 |
2160-12-29 00:45:00
|
2160-12-29 10:38:00
|
STUDY: AP chest, ___.
CLINICAL HISTORY: ___ male with fevers and choledocholithiasis,
tachycardia and cough. Assess for pneumonia.
FINDINGS: The heart size has left ventricular prominence. There are no signs
for overt pulmonary edema. There are some hazy densities at the left base
likely representing atelectasis as opposed to focal infiltrates. No
pneumothoraces are identified. Bony structures demonstrate old healed
fractures of the left lateral clavicle and degenerative changes of the left
glenohumeral joint.
|
19898586-RR-41
| 19,898,586 | 28,045,483 |
RR
| 41 |
2161-07-14 20:38:00
|
2161-07-14 22:35:00
|
HISTORY: ___ male with epigastric abdominal pain.
COMPARISON: CT abdomen and pelvis from ___ and MR of the abdomen
from ___
TECHNIQUE: MDCT-acquired axial images from the lung bases to the pubic
symphysis were displayed with 5 mm slice thickness. Intravenous contrast was
administered. Coronal and sagittal reformations were prepared.
CT ABDOMEN WITH INTRAVENOUS CONTRAST: Dependent ground-glass opacities in the
lung bases are likely due to atelectasis. There is no pleural effusion. The
heart appears mildly enlarged, though there is no pericardial effusion.
The patient is status post right hepatic resection secondary to right hepatic
biliary duct stricture secondary to stones. The postoperative appearance of
the liver appears similar to recent prior examinations. A 10 mm hypodensity
within segment VIII of the liver is unchanged and was characterized as a
simple cyst on prior MRI (2:11). No suspicious hepatic lesion is identified.
The main portal vein and right posterior and anterior branches remain patent.
Chronic thrombus within a branch of the left anterior portal vein appears
slightly improved since most recent prior from ___ (2:20). No
perfusion heterogeneity of the liver is evident. Intrahepatic biliary ductal
dilatation predominantly within the left lobe of the liver appears similar to
prior. A focally dilated duct near the porta hepatis appears slightly larger,
now measuring 11 mm as compared to 9 mm on previous CT (2:21). The common
bile duct remains prominent measuring 8 mm. There is gradual distal tapering
of the common bile duct without clear obstructing lesion. The patient is
status post cholecystectomy. The spleen, pancreas, and adrenal glands are
normal. There is symmetric enhancement and excretion from both kidneys
without suspicious focal lesion or hydronephrosis. Numerous too small to
characterize hypodensities within both kidneys appear similar to prior
examination and likely represent cysts. The abdominal aorta and its branch
vessels demonstrate moderate atherosclerotic calcifications, though are
grossly patent. A small hiatal hernia is unchanged from prior. The stomach
and small bowel are normal in caliber and configuration without evidence of
obstruction or inflammation. The appendix is well visualized and appears
normal. Left para-aortic retroperitoneal lymphadenopathy is unchanged dating
back to ___. No new mesenteric or retroperitoneal lymphadenopathy is
identified.
CT PELVIS WITH INTRAVENOUS CONTRAST: There are scattered sigmoid diverticula,
though no acute diverticulitis. The bladder is markedly distended, though
appears normal. The patient is status post prostatectomy. Seminal vesicles
are not clearly visualized. There is no pelvic free fluid. No pathologically
enlarged pelvic or inguinal lymph nodes are identified. The patient is likely
status post bilateral inguinal hernia repairs.
BONES AND SOFT TISSUES: No bone destructive lesion or acute fracture is
identified. Multilevel degenerative changes of the lower lumbar spine appear
unchanged in severity compared to recent prior examination, most pronounced at
the L4-L5 level.
IMPRESSION:
1. Chronic thrombus within a branch of the left anterior portal vein,
slightly improved since prior study from ___.
2. Unchanged post right hepatectomy changes. No suspicious hepatic lesion.
3. Persistent left-predominant intrahepatic biliary ductal dilatation.
4. Unchanged 8 mm common bile duct without clear obstructing lesion.
5. Unchanged small hiatal hernia. No bowel obstruction or inflammation.
6. Normal appendix.
7. Stable para-aortic retroperitoneal lymphadenopathy
|
19898586-RR-42
| 19,898,586 | 28,045,483 |
RR
| 42 |
2161-07-14 22:16:00
|
2161-07-14 22:25:00
|
HISTORY: Fever.
TECHNIQUE: PA and lateral views of the chest.
COMPARISON: ___.
FINDINGS:
The heart size is normal. The aorta is tortuous. The mediastinal and hilar
contours are otherwise unchanged, and no pulmonary vascular congestion is
present. Except for mild bibasilar atelectasis, the lungs are clear without
focal consolidation. No pleural effusion or pneumothorax is identified.
Diffuse demineralization of the osseous structures is re- demonstrated.
Degenerative changes of both glenohumeral joints are partially imaged.
IMPRESSION:
Mild bibasilar atelectasis. No focal consolidation to indicate pneumonia.
|
19898601-RR-48
| 19,898,601 | 23,343,457 |
RR
| 48 |
2153-02-11 16:27:00
|
2153-02-11 17:23:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: History: ___ with dysphagia // Retained food or pills in
esophagus?
TECHNIQUE: Chest PA and lateral
COMPARISON: None.
FINDINGS:
Heart size is normal. The mediastinal and hilar contours are normal. The
pulmonary vasculature is normal. Lungs are clear. No pleural effusion or
pneumothorax is seen. There are no acute osseous abnormalities. No radiopaque
foreign bodies are identified.
IMPRESSION:
No acute cardiopulmonary abnormality. No radiopaque foreign bodies are
visualized.
|
19898644-RR-69
| 19,898,644 | 24,332,969 |
RR
| 69 |
2137-08-03 16:08:00
|
2137-08-03 16:38:00
|
INDICATION: ___ year old woman with advanced ovarian malignancy w/ ascites
presenting with SOB// assess for pleural effusions, r/o PNA vs pulm edema
TECHNIQUE: AP and lateral views of the chest.
COMPARISON: Chest x-ray from ___. Chest CT from ___.
FINDINGS:
Persistent small to moderate right pleural effusion is noted. Linear right
midlung opacity may be due to small amount of fluid within the fissure. There
are low lung volumes. There is no superimposed confluent consolidation. Mild
cardiac enlargement and tortuosity of the thoracic aorta again noted. No
acute osseous abnormalities.
IMPRESSION:
Small to moderate right pleural effusion.
|
19898644-RR-70
| 19,898,644 | 24,332,969 |
RR
| 70 |
2137-08-04 09:16:00
|
2137-08-04 14:35:00
|
EXAMINATION: Paracentesis
INDICATION: ___ year old woman with metastatic ovarian cancer p/w abdominal
pain/distension.// Please perform therapeutic paracentesis. Please consider
placement of abdominal pleurex.
TECHNIQUE: Ultrasound guided therapeutic paracentesis
COMPARISON: CT abdomen and pelvis on ___
FINDINGS:
Limited grayscale ultrasound imaging of the abdomen demonstrated a large
amount of ascites. A suitable target in the deepest pocket in the right lower
quadrant was selected for paracentesis.
PROCEDURE: The procedure, risks, benefits and alternatives were discussed
with the patient and written informed consent was obtained.
A preprocedure time-out was performed discussing the planned procedure,
confirming the patient's identity with 3 identifiers, and reviewing a
checklist per ___ protocol.
Under ultrasound guidance, an entrance site was selected and the skin was
prepped and draped in the usual sterile fashion. 1% lidocaine was instilled
for local anesthesia.
A 5 ___ catheter was advanced into the largest fluid pocket in the right
lower quadrant and 3.5 L of clear, straw-colored fluid were removed.
The patient tolerated the procedure well without immediate complication.
Estimated blood loss was minimal.
Dr. ___ supervised the trainee during the key
components of the procedure and reviewed and agrees with the trainee's
findings.
IMPRESSION:
1. Technically successful ultrasound guided therapeutic paracentesis.
2. 3.5 L of fluid were removed.
|
19898805-RR-13
| 19,898,805 | 28,419,294 |
RR
| 13 |
2120-02-27 09:42:00
|
2120-02-27 10:23:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: History: ___ with 3 episodes of syncope, ?seizure in past 3 days,
also w/ rsr' on EKG // eval for underlying cause of syncope/?seizure eval
for underlying cause of syncope/?seizure
IMPRESSION:
No comparison. The lung volumes are normal. Normal size of the cardiac
silhouette. Normal hilar and mediastinal contours. No pneumonia, no
pulmonary edema. No pleural effusions. No pneumothorax.
|
19898805-RR-14
| 19,898,805 | 28,419,294 |
RR
| 14 |
2120-02-27 14:02:00
|
2120-02-27 15:08:00
|
EXAMINATION: CT HEAD W/O CONTRAST Q111
INDICATION: History: ___ with 3 episodes of syncope, ?seizure in past 3 days,
also w/ rsr' on EKG // eval for underlying cause of syncope/?seizure
TECHNIQUE: Multidetector CT images of the head were obtained without
intravenous contrast. Sagittal and coronal reformations were also performed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 16.0 s, 16.1 cm; CTDIvol = 50.0 mGy (Head) DLP =
802.7 mGy-cm.
Total DLP (Head) = 803 mGy-cm.
COMPARISON: None available.
FINDINGS:
There is no evidence of intracranial hemorrhage. No mass effect,
hydrocephalus or shift of normally midline structures. Ventricles, cisterns
and sulci appear within normal limits. Gray-white matter distinction appears
preserved in with. Surrounding soft tissue structures appear normal. There
is no evidence of fracture or bone destruction. Visualized paranasal sinuses
and mastoid air cells appear clear.
IMPRESSION:
No evidence of acute intracranial process.
|
19898813-RR-13
| 19,898,813 | 29,500,226 |
RR
| 13 |
2154-03-18 00:38:00
|
2154-03-18 07:59:00
|
EXAMINATION: ELBOW (AP, LAT AND OBLIQUE) LEFT
INDICATION: History: ___ with L elbow pain with CBC c/f malignancy*** WARNING
*** Multiple patients with same last name!// eval for fracture or lesion.
TECHNIQUE: Frontal, lateral, and oblique views of the Left elbow
COMPARISON: None.
FINDINGS:
No acute fractures or dislocations are seen. There are moderate degenerative
changes in the left elbow with osteophytes of the lateral and medial
epicondyles and mild joint space narrowing. A prominent olecranon spur is
noted. There is a small left elbow joint effusion. No soft tissue
calcifications or radiopaque foreign bodies are detected.
IMPRESSION:
1. No evidence of fracture or dislocation in the left elbow.
2. Moderate degenerative changes in the left elbow. Small left elbow joint
effusion.
3. Spurs about the medial and lateral epicondyle and of the olecranon.
|
19898813-RR-14
| 19,898,813 | 29,500,226 |
RR
| 14 |
2154-03-18 08:11:00
|
2154-03-18 09:38:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old man with elbow swelling, ? septic arthritis// pre-op
TECHNIQUE: Chest PA and lateral
COMPARISON: None.
FINDINGS:
Limited evaluation of the lateral chest radiograph due to low lung volumes.
Heart size is mildly enlarged. The mediastinal and hilar contours are
unremarkable normal. The pulmonary vasculature is normal. Mild patchy
opacities in the lung bases may reflect atelectasis. No focal consolidation.
No pleural effusion or pneumothorax is seen. There are no acute osseous
abnormalities.
IMPRESSION:
Somewhat limited lateral view due to low lung volumes. Patchy opacities in
lung bases may reflect atelectasis. Infection is not excluded in the correct
clinical setting.
|
19898813-RR-15
| 19,898,813 | 29,500,226 |
RR
| 15 |
2154-03-19 00:33:00
|
2154-03-19 09:52:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old man with blood disorder with night sweats, cough,
weight loss.// Please evaluate for lung pathology.
TECHNIQUE: Chest PA and lateral
COMPARISON: Plain film radiograph of the chest dated ___ .
FINDINGS:
Compared to prior radiograph, the lungs are well expanded. There is unchanged
cardiomegaly, and the mediastinal contour is unchanged. The aorta is
tortuous. There is no evidence of pulmonary edema, pneumothorax or pleural
effusion. Improved right lower lobe opacities with mild residual
opacification.
IMPRESSION:
Improved right lower lobe opacities with mild residual opacification.
|
19898828-RR-14
| 19,898,828 | 22,869,649 |
RR
| 14 |
2148-10-19 12:15:00
|
2148-10-19 13:17:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: History: ___ with DKA// eval for PNA eval for PNA
IMPRESSION:
No prior chest radiographs are available.
Lungs are fully expanded and clear. Cardiomediastinal and hilar silhouettes
and pleural margins are normal.
|
19899101-RR-34
| 19,899,101 | 23,568,631 |
RR
| 34 |
2126-10-26 01:32:00
|
2126-10-26 06:16:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ with chest pain and sob ? pneumothorax.
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest x-ray ___.
FINDINGS:
The cardiomediastinal silhouettes are within normal limits. The bilateral hila
are unremarkable. The lungs are clear. There is no pulmonary vascular
congestion. There is a right apical pneumothorax measuring approximately 1.8
cm in largest extent. There is no left pneumothorax. There is no pleural
effusion.
IMPRESSION:
Small right apical pneumothorax measuring 1.8 cm in largest extent.
|
19899101-RR-35
| 19,899,101 | 23,568,631 |
RR
| 35 |
2126-10-26 09:22:00
|
2126-10-26 10:19:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: History: ___ with spontaneous pneumothorax. admitting to thoracic
// Enlargement of pneumothorax?
TECHNIQUE: Chest PA and lateral
COMPARISON: ___ at 01:37
FINDINGS:
Small right apical pneumothorax measuring up to 2.3 cm in greatest extent has
slightly increased in size compared to the previous study. Remainder of the
lungs are clear. The cardiac, mediastinal and hilar contours are unchanged,
and no leftward shift of mediastinal structures is present. There is no
pleural effusion. No acute osseous abnormality is visualized.
IMPRESSION:
Small right apical pneumothorax, minimally increased in size compared to the
previous study.
|
19899101-RR-36
| 19,899,101 | 23,568,631 |
RR
| 36 |
2126-10-27 19:13:00
|
2126-10-28 10:39:00
|
INDICATION: ___ year old man with R spontaneous ptx now s/p RVATS mxn/chemical
pleuradesis // ptx, effusion
COMPARISON: Compared to radiographs from ___
IMPRESSION:
Right-sided chest tubes have been placed. No pneumothoraces are seen. There
is volume loss on the right. Heart size is within normal limits. There are no
focal consolidation or pleural effusions.
|
19899101-RR-38
| 19,899,101 | 23,568,631 |
RR
| 38 |
2126-10-29 21:18:00
|
2126-10-30 08:05:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old man s/p VATS RUL blebectomy, mechanical and chemical
pleurodesis, now s/p chest tube removal // ?PTX s/p chest tube removal
?PTX s/p chest tube removal
IMPRESSION:
As compared to ___, the right-sided chest tubes have been removed.
There is presence of a 1 cm circumferential hydropneumothorax. No evidence of
tension. Normal size of the heart. Unchanged appearance of the left lung.
|
19899194-RR-88
| 19,899,194 | 27,175,397 |
RR
| 88 |
2156-02-16 13:34:00
|
2156-02-16 15:26:00
|
INDICATION: ___ with presyncope, hx of CHF and a-fib, evaluate for
pulmonary edema or PNA // ___ with presyncope, hx of CHF and a-fib, evaluate
for pulmonary edema or PNA
TECHNIQUE: Single portable view of the chest.
COMPARISON: ___.
FINDINGS:
Left chest wall dual lead pacing device is noted, partially obscuring the left
lung. The lungs were seen are clear without consolidation, effusion, or
edema. The cardiomediastinal silhouette is within normal limits. Median
sternotomy wires are intact. Orthopedic hardware noted in the right humeral
head.
IMPRESSION:
No acute cardiopulmonary process.
|
19899252-RR-23
| 19,899,252 | 27,406,381 |
RR
| 23 |
2112-04-11 17:33:00
|
2112-04-11 18:52:00
|
INDICATION: Knee pain and effusion, evaluate for evidence of injury.
COMPARISON: None.
FINDINGS: Four views of the left knee are provided. There is no evidence of
fracture or dislocation. Tricompartmental osteoarthritis is seen including
space narrowing particularly at the medial tibiofemoral joint, and osteophyte
formation. Calcification of the meniscus is also noted, compatible with CPPD
arthropathy. No suspicious lytic or sclerotic lesion is seen. Extensive
vascular calcifications are noted. There is no large joint effusion. There
is no radiopaque foreign body.
IMPRESSION:
1. Moderate tricompartmental osteoarthritis.
2. CPPD arthropathy.
3. No acute fracture or dislocation.
4. Extensive vascular calcifications.
|
19899324-RR-19
| 19,899,324 | 26,170,092 |
RR
| 19 |
2166-10-05 15:02:00
|
2166-10-05 15:43:00
|
INDICATION: ___ with no known medical history recently moved from ___,
paraplegic presenting complaining of lower abdominal pain radiating to back
and legs. Patient tachycardia.
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired
through the abdomen and pelvis following intravenous contrast administration
with split bolus technique. IV Contrast: 130 mL Omnipaque.
Coronal and sagittal reformations were performed and reviewed on PACS.
Oral contrast was not administered.
DOSE: This study involved 4 CT acquisition phases with dose indices as
follows:
1) CT Localizer Radiograph
2) CT Localizer Radiograph
3) Stationary Acquisition 5.5 s, 0.5 cm; CTDIvol = 26.5 mGy (Body) DLP =
13.2 mGy-cm.
4) Spiral Acquisition 4.8 s, 52.5 cm; CTDIvol = 16.8 mGy (Body) DLP = 881.7
mGy-cm.
Total DLP (Body) = 895 mGy-cm.
COMPARISON: None.
FINDINGS:
LOWER CHEST: Visualized lung fields are within normal limits aside from
dependent atelectasis. There is no evidence of pleural or pericardial
effusion.
ABDOMEN:
HEPATOBILIARY: A peripheral wedge-shaped hyperenhancing area in the right lobe
of the liver most likely reflects with a transient hepatic attenuation
difference. There is no evidence of intrahepatic or extrahepatic biliary
dilatation. The gallbladder is within normal limits.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
There is no evidence of focal renal lesions or hydronephrosis. There is no
perinephric abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. The colon and
rectum are within normal limits. The appendix is normal.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: Large amount of simple fluid is seen distending the
vagina. The uterus is unremarkable in appearance. A corpus luteum is present
in the left ovary.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease
is noted.
BONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or
acute fracture. A small fat containing umbilical hernia is present.
IMPRESSION:
1. Large amount of simple fluid distending the vagina. Correlation with
direct pelvic exam is recommended.
2. No other acute abdominal process.
|
19899324-RR-20
| 19,899,324 | 26,170,092 |
RR
| 20 |
2166-10-06 11:50:00
|
2166-10-06 18:03:00
|
EXAMINATION: MR ___ WAND W/O CONTRAST ___ MR ___ SPINE
INDICATION: ___ year old woman with ___ years of idiopathic paraplegia and
diminished sensation in legs // Please eval for acute or chronic spinal cord
changes
TECHNIQUE: Sagittal imaging was performed with T2, T1, and STIR technique.
Axial T2 imaging was performed. After the uneventful administration of 12 mL
of Gadavist contrast agent, additional axial and sagittal T1 images were
obtained.
COMPARISON: None.
FINDINGS:
Cervical spine:
Numbering of the cervical spine is provided on series 8, image 7.
Alignment of the cervical spine is normal. There is no evidence of infection.
Vertebral body heights are preserved. Vertebral body and intervertebral disc
signal intensity appear normal. There is a 4.3 x 1.1 cm (CC x AP) extradural
mass within the dorsal spinal canal extending from C7 through T3 (series 18,
image 9) that partially encases the cervical cord (27:9) and causes severe
cord compression at this level. There is homogeneous enhancement, but
notably, enhances less compared to the surrounding meninges (18:7). Increased
STIR signal within the cord at these levels suggests cord edema/contusion
(Series 11, Image 8). The mass extends into, and obliterates the left neural
foramen at C7-T1 and T1-T2. Additional degenerative changes are as follows:
At C2-C3, there is no spinal canal or neural foraminal narrowing.
At C3-C4, there is a right paracentral protrusion (9:12) that indents the
thecal sac, without spinal canal or neuroforaminal narrowing.
C4-C5, there is a disc bulge that results in mild spinal canal narrowing. No
neural foraminal narrowing at this level.
At C5-C6, and C6-C7, there is disc bulging that indents the ventral thecal
sac, without significant spinal canal or neural foraminal narrowing.
At C7-T1, there is cord compression resulting in cord edema/contusion from the
mass described above.
Thoracic spine:
Numbering of the thoracic spine is provided on series 11, image 9.
Alignment of the thoracic spine is normal. There is no evidence of infection.
Vertebral body heights are preserved. Vertebral body and intervertebral disc
signal intensity appear normal. As noted in the cervical spine section above,
there is severe compression with edema/contusion in the lower thoracic spine
extending through the superior aspect of T3 as a result of the dorsal
extradural mass. Vertebral body and intervertebral disc signal intensity
appear normal. Between T3-T12, there is no spinal canal or neuroforaminal
narrowing.
Lumbar spine:
Numbering of the lumbar spine is provided on series 12, image 11.
Alignment of the lumbar spine is normal. There is no evidence of infection or
neoplasm. Vertebral body heights are preserved, and marrow signal intensity
appears normal. There is disc desiccation at L5-S1. Remaining intervertebral
discs demonstrate normal signal.
At T12-L1 and L1-L2, there is no spinal canal or neuroforaminal narrowing.
At L2-L3, there is mild ligamentum flavum hypertrophy without significant
spinal canal or neuroforaminal narrowing.
At L3-L4 and L4-L5, there is disc bulging and facet joint arthropathy, without
significant spinal canal or neural foraminal narrowing.
At L5-S1, there is disc bulging with a superimposed central protrusion that
indents the thecal sac without significant spinal canal narrowing. Bilateral
neuroforaminal narrowing is mild at this level.
IMPRESSION:
1. 4.3 x 1.1cm homogeneously enhancing extradural spinal canal mass extending
from C7-T3, causing severe cord compression and cord edema/contusion at these
levels. There is also extension into and obliteration of the left C7-T1 and
T1-T2 neural foramens. Its appearance, including partial encasement of the
cord, heavily favors lymphoma or leukemia. Meningioma is also on the
differential, although somewhat atypical in this case given less avid
enhancement compared to the surrounding meninges. Neuroblastoma is unlikely in
this age group.
2. Mild degenerative changes in the cervical and lumbar spine, most prominent
at L5-S1 where there is disc bulging/superimposed central protrusion without
critical spinal canal narrowing at this level.
NOTIFICATION: Preliminary findings were telephoned to Dr. ___ by ___
___ on ___ at 12:59PM, at time of discovery.
|
19899324-RR-21
| 19,899,324 | 26,170,092 |
RR
| 21 |
2166-10-07 16:20:00
|
2166-10-07 22:51:00
|
EXAMINATION: CT CHEST W/CONTRAST
INDICATION: ___ ___ speaker who immigrated to ___ 1 month ago with
___ year hx of progressive ideopathic paraplegia, who presents for further
evaluation; has a history of abd pain that is worse with spasm. // lymphoma
vs other infiltrative mass. Cord compression; r/o evidence of lymphadenopathy
in chest
TECHNIQUE: Multi detector helical scanning of the chest was coordinated with
intravenous infusion of nonionic iodinated contrast agent and reconstructed as
5 and 1.25 mm thick axial, 2.5 mm thick coronal and parasagittal, and 8 mm MIP
axial images. All images were reviewed.
DOSAGE: TOTAL DLP 370.0mGy-cm
COMPARISON: THERE NO PRIOR CHEST CT SCANS FOR COMPARISON.
FINDINGS:
Supraclavicular nodes are not enlarged. Axillary nodes range up in diameter
up to 8 and 9 mm on the left, 03:12, 17, 19.
Excluding the breasts which require mammography for evaluation, there are no
soft tissue abnormalities in the chest wall suspicious for malignancy. This
study is not designed for subdiaphragmatic diagnosis, recently assessed by CT
of the abdomen and pelvis on ___, reported separately.
Atherosclerotic calcification is not apparent in the head and neck vessels or
coronaries. Thyroid is unremarkable. Aorta, pulmonary arteries and cardiac
chambers are normal size. Mediastinal and hilar lymph nodes are not enlarged
and there is no adenopathy in the internal mammary, retrocrural, or
diaphragmatic stations. Minimal pleural effusions layer posteriorly, not
clinically significant. There is no pericardial abnormality. Hiatus hernia is
small.
There are no focal pulmonary abnormalities. Mild heterogeneity in the
background density of the left lower lobe could be due to scattered areas of
atelectasis or, less likely, air trapping.
There are no bone abnormalities in the chest cage suspicious for malignancy or
infection. The extradural in the cervicothoracic spine is better demonstrated
on the MR of that area, ___, reported separately.
IMPRESSION:
Minimal bilateral pleural effusion, probably not clinically significant. No
adenopathy or other evidence of intrathoracic malignancy.
Cervicothoracic extradural spinal mass, better demonstrated on MR, ___,
reported separately.
|
19899324-RR-22
| 19,899,324 | 26,170,092 |
RR
| 22 |
2166-10-08 11:37:00
|
2166-10-08 17:15:00
|
EXAMINATION: MR PITUITARY ___ CONTRAST T9118 MR ___
INDICATION: ___ ___ speaker who immigrated to US 1 month ago with
___ year hx of progressive idiopathic paraplegia, who presents for further
evaluation; has a history of abd pain that is worse with spasm. // Pituitary
mass vs other infiltration
TECHNIQUE: Sagittal and coronal T1 weighted imaging were performed along with
coronal T2 imaging. Sagittal and coronal T1 weighted imaging were repeated
after the uneventful intravenous administration of 12 mL of Gadavist contrast.
COMPARISON: None.
FINDINGS:
Images of the pituitary appear normal. The signal intensity appears normal
before and after contrast administration. No masses are identified. The
suprasellar cistern and cavernous sinuses appear and normal. The limited
portion of the brain included on this study appears normal.
IMPRESSION:
Normal pituitary.
|
19899324-RR-23
| 19,899,324 | 26,170,092 |
RR
| 23 |
2166-10-07 16:21:00
|
2166-10-07 18:23:00
|
EXAMINATION: CT C-SPINE W/O CONTRAST Q311 CT SPINE
INDICATION: ___ year old woman with spastic paraplegia, found to have 1x4cm
mass from C7 to T3, concerning for meningioma vs lymphoma. Ortho spine to
perform decompression/biopsy // C-spine bony reconstruction for decompression
planning C-spine bony reconstruction for decompression planning
TECHNIQUE: Non-contrast helical multidetector CT was performed. Axial image
data was collimated to display separate 2.5 mm soft tissue and bone algorithm
axial images. Coronal and sagittal reformations were then constructed.
DOSE: This study involved 3 CT acquisition phases with dose indices as
follows:
1) CT Localizer Radiograph
2) CT Localizer Radiograph
3) Spiral Acquisition 13.6 s, 20.8 cm; CTDIvol = 29.0 mGy (Body) DLP =
565.1 mGy-cm.
Total DLP (Body) = 573 mGy-cm.
COMPARISON: MRI of the cervical, thoracic, and lumbar spine dated ___.
FINDINGS:
The previously described enhancing extradural spinal canal mass extending from
C7-T3 is essentially in visible on this CT scan and is better assessed on
recent MR of the spine.
There is no fracture or malalignment. Again seen is a right-sided disc
protrusion at C3-4 that encroaches on the spinal canal and contacts and
flattens the right anterior aspect of the spinal cord.
There appears to be mm calcific density in the midline of the spinal canal and
C7 that encroaches on the spinal cord. This is poorly seen on the CT but this
most likely represents the meningioma defined on the spinal MR ___
prevertebral soft tissues are unremarkable. The thyroid gland is normal. The
lung apices are clear.
IMPRESSION:
1. The previously described enhancing extradural spinal canal mass extending
from C7-T3 is essentially in visible on CT and is better assessed on recent MR
of the spine.
2. No osseous abnormality detected.
3. Degenerative disc disease with disc protrusion flattening the spinal cord
at C3-4.
|
19899324-RR-26
| 19,899,324 | 26,170,092 |
RR
| 26 |
2166-10-09 11:38:00
|
2166-10-09 16:37:00
|
EXAMINATION: CT T-SPINE W/O CONTRAST
INDICATION: ___ year old woman with extradural spinal lesion going to OR Today
for resection. // Please complete with localizer. Staples placed on skin in
thoracic spine, please use for localizer. Please complete prior to OR today.
Please complete with localizer. Staples placed on skin in th
TECHNIQUE: Non-contrast helical multidetector CT was performed. Axial image
data was collimated to display separate 2.5 mm soft tissue and bone algorithm
axial images. Coronal and sagittal reformations were then constructed.
DOSE: This study involved 3 CT acquisition phases with dose indices as
follows:
1) CT Localizer Radiograph
2) CT Localizer Radiograph
3) Spiral Acquisition 8.5 s, 33.5 cm; CTDIvol = 31.2 mGy (Body) DLP =
1,045.6 mGy-cm.
Total DLP (Body) = 1,046 mGy-cm.
COMPARISON: Comparison is made to the prior MRI of cervical, thoracic, lumbar
spine from ___.
FINDINGS:
There is severe spinal canal narrowing with spinal cord compression at the
T1-T2 vertebrae levels due to compression from a recently discovered
extradural mass. Mild scalloping is noted at the T1 vertebrae. As the mass
most extensively affects the cervical spine, bony changes from the mass can be
better seen on the CT C-spine from ___.
Alignment is normal. No fractures are identified. Schmorl's nodes are seen at
the T7 and T8 inferior endplates. There is no prevertebral soft tissue
swelling. There is no evidence of infection or neoplasm.
The visualized potions of the lungs appear clear. There is no evidence of
pleural effusions or consolidations.
Cutaneous staples are noted at the T4 vertebral level.
IMPRESSION:
1. Severe spinal canal narrowing with spinal cord compression at the T1-T2
vertebrae levels due to compression from recently discovered mass.
2. Mild scalloping of the T1 vertebrae.
3. Normal alignment and no evidence of fractures.
|
19899743-RR-10
| 19,899,743 | 22,200,044 |
RR
| 10 |
2123-04-28 18:39:00
|
2123-04-28 18:56:00
|
INDICATION: History: ___ with crush injury, bilateral lower extremity pain
TECHNIQUE: Bilateral tibia and fibula, two views each
COMPARISON: None.
FINDINGS:
On the right, no acute fracture is identified. Well corticated ossific
densities about the tibial tubercle are compatible with prior
___'s disease. No concerning lytic or sclerotic osseous
abnormality is visualized. Mild degenerative changes are noted in the right
knee. There is no right knee or ankle dislocation. No large right knee joint
effusion is seen. There are no radiopaque foreign bodies or soft tissue
calcifications.
On the left, no acute fracture is identified. Patient is status post ACL
repair with screws noted in the distal femur and proximal tibia. Well
corticated ossific densities adjacent to the tibial tubercle are compatible
with prior ___'s disease. The imaged left knee demonstrates
degenerative changes without dislocation. The imaged left ankle is grossly
unremarkable. No radiopaque foreign body is otherwise noted.
IMPRESSION:
No acute fracture in either tibia or fibula.
|
19899743-RR-11
| 19,899,743 | 22,200,044 |
RR
| 11 |
2123-04-28 20:35:00
|
2123-04-28 21:31:00
|
INDICATION: History: ___ with crush injury, pain in the lower extremities
TECHNIQUE: Bilateral femurs, two views each
COMPARISON: None.
FINDINGS:
LEFT FEMUR: No fracture is identified. The femoroacetabular joint is
preserved. Screws are noted within the distal femur and proximal tibia
compatible with prior ACL repair. There are mild degenerative changes noted
in the left knee. No knee joint effusion is identified. No concerning lytic
or sclerotic osseous abnormalities are detected. No radiopaque foreign body
or soft tissue calcification is present.
RIGHT FEMUR: No fracture is identified. Mild degenerative changes are seen
involving the right femoroacetabular joint. No concerning lytic or sclerotic
osseous abnormalities are present. Imaged right knee demonstrates mild
degenerative changes without effusion. Contrast is seen within the bladder
from recent CT examination.
IMPRESSION:
No fracture or dislocation.
|
19899743-RR-13
| 19,899,743 | 22,200,044 |
RR
| 13 |
2123-04-28 18:35:00
|
2123-04-28 19:54:00
|
EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: History: ___ with crush injury
TECHNIQUE: Routine unenhanced head CT was performed and viewed in brain,
intermediate and bone windows. Coronal and sagittal reformats were also
performed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 18.0 s, 18.8 cm; CTDIvol = 48.0 mGy (Head) DLP =
903.1 mGy-cm.
Total DLP (Head) = 903 mGy-cm.
COMPARISON: Same-day CT C-spine without contrast.
FINDINGS:
There is no acute large territorial infarction, hemorrhage, edema or mass.
Basal cisterns are patent and there is preservation gray-white matter
differentiation. Ventricles and sulci are normal in overall size and
configuration.
No fracture identified. Extracranial soft tissues are unremarkable. Mild
mucosal thickening within the right sphenoid sinus and mucosal small bilateral
maxillary mucous retention cysts are noted. There is minimal mucosal
thickening within the left maxillary sinus as well. The remaining imaged
paranasal sinuses, mastoid air cells and middle ear cavities are clear.
Otherwise portions of the orbits are unremarkable.
IMPRESSION:
No acute intracranial abnormalities.
|
19899743-RR-14
| 19,899,743 | 22,200,044 |
RR
| 14 |
2123-04-28 18:35:00
|
2123-04-28 20:07:00
|
EXAMINATION: CT C-SPINE W/O CONTRAST
INDICATION: History: ___ with crush injury
TECHNIQUE: Noncontrast CT cervical spine with axial, coronal, sagittal
reformations.
COMPARISON: Same-day CT head without contrast.
FINDINGS:
Moderate motion artifact somewhat limits evaluation of the cervical spine.
There is no acute fracture or malalignment in the cervical spine. Minimal
degenerative changes of the cervical spine are noted with mild intervertebral
disc space narrowing and small disc bulge at C4-C5 resulting in mild spinal
canal narrowing. There is minimal right neuroforaminal narrowing at C3-4 due
to uncovertebral hypertrophy. No prevertebral edema.
The aerodigestive tract appears patent. Lung apices are clear apart from
minimal scarring. Thyroid gland appears normal. There is no cervical
lymphadenopathy by CT size criteria.
IMPRESSION:
1. No acute fracture or malalignment of the cervical spine.
2. Mild degenerative changes with small disc bulge at C4-C5 resulting in mild
spinal canal narrowing.
|
19899743-RR-15
| 19,899,743 | 22,200,044 |
RR
| 15 |
2123-04-28 18:38:00
|
2123-04-28 20:27:00
|
EXAMINATION:
Trauma torso with contrast.
INDICATION: History: ___ with crush injury
TECHNIQUE: MDCT axial images were acquired through the chest, abdomen and
pelvis following intravenous contrast administration with split bolus
technique.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 9.3 s, 72.6 cm; CTDIvol = 23.7 mGy (Body) DLP =
1,724.3 mGy-cm.
Total DLP (Body) = 1,724 mGy-cm.
COMPARISON: None.
FINDINGS:
CHEST:
HEART AND VASCULATURE: The thoracic aorta is normal in caliber without
evidence of acute injury. The heart, pericardium, and great vessels are
within normal limits. No pericardial effusion is seen.
AXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar
lymphadenopathy is present. No mediastinal hematoma. Minimal residual thymic
tissue is seen in the anterior mediastinum.
PLEURAL SPACES: No pleural effusion or pneumothorax.
LUNGS/AIRWAYS: There is mild dependent atelectasis in the lung bases. 6 mm
right lower lobe perifissural nodule (03:56) and 8 mm right middle lobe
perifissural pulmonary nodule (03:54) are noted. Lungs are otherwise clear
without masses or areas of parenchymal opacification. The airways are patent
to the level of the segmental bronchi bilaterally.
BASE OF NECK: Visualized portions of the base of the neck show no abnormality.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There is no evidence of focal lesion or laceration. There is no evidence of
intrahepatic or extrahepatic biliary dilatation. The gallbladder is within
normal limits.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesion or laceration.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
There is no evidence of focal renal lesions or hydronephrosis. There is no
perinephric abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. The colon and
rectum are within normal limits. The appendix is normal. There is no
evidence of mesenteric injury.
There is no free fluid or free air in the abdomen.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: The prostate and seminal vesicles are unremarkable.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm or retroperitoneal hematoma.
No atherosclerotic disease is noted.
BONES: There is no acute fracture. No focal suspicious osseous abnormality.
SOFT TISSUES: Small fat-containing umbilical hernia.
IMPRESSION:
1. No acute intrathoracic or intra-abdominal injury identified.
2. 2 right perifissural lung nodules, likely reflect of subpleural lymph
nodes.
|
19899743-RR-9
| 19,899,743 | 22,200,044 |
RR
| 9 |
2123-04-28 18:04:00
|
2123-04-28 19:32:00
|
INDICATION: Crush injury.
TECHNIQUE: Supine AP view of the chest.
COMPARISON: None. Patient is currently listed as EU critical.
FINDINGS:
The left lateral chest is excluded from the field of view. Heart size is
normal. Mediastinal and hilar contours are unremarkable. The pulmonary
vasculature is normal. Imaged lungs are clear without focal consolidation.
No large right pleural effusion or pneumothorax is present. No displaced
fractures are evident. Multiple radiopaque densities project over the upper
chest, likely external to the patient, but clinical correlation is needed.
IMPRESSION:
1. Exclusion of the left lateral chest wall. Otherwise, no acute
cardiopulmonary abnormality.
2. Multiple radiopaque densities project over the upper chest, likely external
to the patient, but clinical correlation is needed.
|
19899950-RR-2
| 19,899,950 | 26,110,742 |
RR
| 2 |
2174-07-19 02:51:00
|
2174-07-20 01:07:00
|
INDICATION: ___ male with a question of ET tube and OG tube
placement.
COMPARISON: No relevant comparisons available.
ONE VIEW OF THE CHEST:
The lungs are low in volume and show bibasilar lower lobe opacities. The
cardiac silhouette is enlarged. There is cardiomegaly, with evidence of CHF.
No pleural effusion or pneumothorax is present.
An ET tube and NG tube are appropriate in position.
IMPRESSION:
1. Cardiomegaly and evidence of CHF. Bibasilar opacities could represent
atelectasis, sequelae for aspiration or pneumonia.
2. Appropriate siting of ET and NG tube.
|
19899950-RR-3
| 19,899,950 | 26,110,742 |
RR
| 3 |
2174-07-19 02:53:00
|
2174-07-19 04:55:00
|
INDICATION: ___ male with new-onset seizures, evaluate for
intracranial hemorrhage.
COMPARISON: No relevant comparisons available.
TECHNIQUE: MDCT images were acquired through the head without contrast. Bone
kernel reconstructions and multiplanar reformations were obtained and
reviewed.
FINDINGS:
No acute intracranial hemorrhage, large vascular territory infarct, shift of
midline structures or mass effect is present. The ventricles and sulci are
normal in size and configuration. The patient is status post a right
craniotomy. High-density lining the left frontal gray matter likely
represents cortical laminar necrosis. Visible paranasal sinuses and mastoid
air cells show diffuse polypoidal mucosal thickening in both maxillary sinuses
and within the ethmoidal air cells and frontal sinus . A moderate amount of
fluid is noted in the sphenoid air cells.
IMPRESSION:
No acute intracranial process.
NOTE ON ATTENDING REVIEW:
Hypodense area in the left frontal lobe with surrounding hyperdense rim
laterally - ( se 6, im 16)- consider follow up to exclude hemorrhage or
space-occupying lesion though these may represent evolving encephalomalacic
changes. No priors are available.
A small dense focus in the right frontal lobe laterally-? artifact/hemorrhage-
attention on followup ( se 6, im 17).
|
19899950-RR-5
| 19,899,950 | 26,110,742 |
RR
| 5 |
2174-07-19 04:12:00
|
2174-07-19 06:34:00
|
INDICATION: ___ male with attempted right subclavian central line.
Evaluate for pneumothorax.
COMPARISON: Chest radiograph from ___ at 3:00 a.m.
ONE VIEW OF THE CHEST:
No central line is seen. No ptx is detected on either side. An ET and NG tube
are again noted.
The cardiomediastinal silhouette is enlarged. There is mild vascular
plethora, but no overt CHF. A small right pleural effusion may be present.
Minimal atelectasis and/or scarring noted at the bases.
IMPRESSION:
No pneumothorax detected.
|
19899950-RR-6
| 19,899,950 | 26,110,742 |
RR
| 6 |
2174-07-20 03:56:00
|
2174-07-20 09:19:00
|
HISTORY: Evaluate ET tube placement.
TECHNOLOGIST'S NOTE: "No ET tube in place. Radiograph needed to assess
interval change."
CHEST, SINGLE AP PORTABLE VIEW.
Slightly rotated positioning. Compared with ___ at 5:35 a.m., the
cardiomediastinal silhouette is stable. There is more pronounced focal
opacity in the right midzone, in the perihilar area. This may reflect the
presence of atelectasis, but an early infiltrate is in the differential.
There is upper zone redistribution, but I doubt overt CHF. There is minimal
atelectasis at the left base peripherally, with increased retrocardiac
density, consistent with left lower lobe collapse and/or consolidation.
Suspect small amount of fluid at the right costophrenic angle, unchanged.
IMPRESSION:
1) More pronounced focal opacity in the right perihilar region -- ?
atelectasis or early pneumonic infiltrate. Otherwise, no significant change.
2) As noted, no ET tube is in place.
|
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