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19899950-RR-7
| 19,899,950 | 26,110,742 |
RR
| 7 |
2174-07-19 19:38:00
|
2174-07-20 22:07:00
|
INDICATION: First-onset seizure, history of large pituitary adenoma status
post resection, to evaluate for cause.
COMPARISON: CT head ___.
TECHNIQUE: MR of the brain and pituitary without and with IV contrast.
FINDINGS:
There is a focal area of altered signal intensity in the left frontal lobe,
with T1 hypo and T2 hyperintense appearance in the center surrounded by
hypointense signal and negative susceptibility within, likely related to old
blood products. There is no abnormal enhancement noted within except for
minimal rim enhancement.
No foci of abnormal enhancement are noted elsewhere to suggest a mass lesion.
There are a few small foci of slightly increased DWI signal in the right
parietal lobe (series 1402, image 20, 22), which are too small to be
accurately characterized and may represent tiny infarcts. However, these are
not well seen on the ADC sequence.
A few small scattered FLAIR-hyperintense foci are noted, non-specific in
appearance. There is increased signal intensity, diffusely to a mild extent
in the mastoid air cells on both sides. There is moderate mucosal thickening
with fluid in the ethmoid air cells and sphenoid sinuses. The portal mucosal
thickening and retention cysts are noted in the maxillary sinuses on both
sides.
The patient is status post surgery, in the sella.
Areas of increased T1 signal are noted, in the floor of the sella as well as
in the suprasellar location and anterior to the sella likely related to the
prior procedure/fat packing.
On the post-contrast images, there is a slightly heterogeneously enhancing
pituitary gland with enlargement noted. There is possible mild extension of
the tumor into the cavernous sinus on the right side. However, study is
somewhat limited due to the orientation of the images.
The infundibulum is not well seen. Part of the optic chiasm is seen.
IMPRESSION:
1. Focal area of altered signal intensity in the left frontal lobe with very
minimal peripheral enhancement and extensive foci of negative susceptibility
within, likely relates to an area of prior blood products. No abnormal
vessels noted adjacent. Correlate with history for prior trauma.
2. Two small foci of increased DWI signal in right parietal lobe-
acute-subacute tiny infarcts- attention on f/u.
2. Pan-paranasal sinus disease involving the ethmoid and sphenoid sinuses
predominantly and mild in the mastoid air cells on both sides.
3. Post-surgical changes in the sella, along with an enlarged pituitary
gland, with slight heterogeneous enhancement. This may represent
residual/recurrent adenoma.
Comparison with prior studies can be helpful to assess interval change.
Otherwise, consider followup in a few weeks/months to assess
stability/progression. There is possible mild extension of the tumor into the
cavernous sinus on the right side. However, study is somewhat limited due to
the orientation of the images.
|
19899950-RR-8
| 19,899,950 | 26,110,742 |
RR
| 8 |
2174-07-21 11:01:00
|
2174-07-21 14:53:00
|
LUMBAR PUNCTURE
HISTORY: Multiple attempts for lumbar puncture by the referring clinician
were unsuccessful. The patient is referred for fluoroscopic-guided lumbar
puncture.
Informed consent was obtained after explaining the risks, indications, and
alternative management to the patient's wife.
The patient was brought to the fluoroscopic suite and placed on the
fluoroscopic table in prone position. Access to lumbar subarachnoid space was
obtained with a 22-gauge spinal needle under local anesthesia, using 1%
lidocaine with aseptic precautions. Approximately 14 cc of CSF was collected.
The patient tolerated the procedure well without any complications and the
patient was sent to the MICU with post-procedure orders.
Access was obtained at the level of L3-4.
IMPRESSION: Successful fluoro-guided lumbar puncture. Samples were sent for
laboratory analysis as requested by the referring physician.
|
19900111-RR-21
| 19,900,111 | 25,876,146 |
RR
| 21 |
2198-07-01 11:17:00
|
2198-07-01 11:34:00
|
INDICATION: Chest pain.
COMPARISON: ___.
TECHNIQUE: PA and lateral views of the chest.
FINDINGS: The heart size is normal. The aorta remains unfolded. The
mediastinal and hilar contours are unremarkable. Lungs remain hyperinflated.
There is no focal consolidation, pleural effusion or pneumothorax. There are
mild degenerative changes of the imaged thoracolumbar spine. Retained oral
contrast is seen within colonic loops of bowel in the left hemi-abdomen.
IMPRESSION: No acute cardiopulmonary abnormality.
|
19900111-RR-22
| 19,900,111 | 25,876,146 |
RR
| 22 |
2198-07-02 08:44:00
|
2198-07-02 13:50:00
|
HISTORY: ___ woman with worsening dysphagia.
COMPARISON: Video oropharyngeal swallow date ___, video oropharyngeal
swallow ___
TECHNIQUE: Oral pharyngeal swallowing video fluoroscopy was performed in
conjunction with speech and swallow division. Multiple consistencies of
barium were administered.
FINDINGS:
Laryngeal penetration occurred with thin, nectar thick, and pureed
consistency. There was aspiration with thin and nectar thick liquids as a
result of pooling of residue in the piriform sinus which spilled over into the
airway.
IMPRESSION:
Laryngeal penetration with thin, nectar thick and puree consistencies. Mild
aspiration with thin liquids and nectar thick liquids.
|
19900111-RR-23
| 19,900,111 | 25,876,146 |
RR
| 23 |
2198-07-03 16:44:00
|
2198-07-03 19:17:00
|
HISTORY: Progressive dysphagia with suspicion for paraneoplastic process.
TECHNIQUE: Volumetric CT imaging was performed through the abdomen and pelvis
before and after the administration of 130 mL Omnipaque nonionic intravenous
contrast. Post contrast imaging was obtained in the portal venous and delayed
phases. Post processing performed in the coronal and sagittal planes.
COMPARISON: None.
FINDINGS:
Abdomen: The lung bases are clear. There is an ill defined 1.9 x 1.1 cm
lesion in segment 7 of the liver with peripheral enhancement and small central
areas of hypoenhancement. This fills in on delayed imaging and is favored to
represent a hemangioma. No other focal liver lesions are seen. The gall
bladder is distended with stones. There is a trace amount of inflammatory
change noted just posterior to the gall bladder. There is no evidence of
intra or extrahepatic biliary ductal dilation. The spleen, pancreas, and
adrenal glands are normal. There are subcentimeter hypodensities in both
kidneys which are too small to characterize. The small bowel and proximal
large bowel are with normal limits. There is no other signfican mesenteric or
retroperitoneal lymphadenopathy. The abdominal vasculature is widely patent.
There is an age indeterminant compression deformity of the L4 vertebral body.
The osseous structures are otherwise unremarkable.
Pelvis: The pelvic organs are within normal limits. There is no evidence of
pelvic mass or free fluid. The distal large bowel and recturm are normal.
There is no significant pelvic or inguinal lymphadenopathy. The osseous
structures are unremarkable.
IMPRESSION:
1. No clear evidence to suggest malignancy in the abdomen or pelvis.
2. Distended gall bladder filled with stones. Trace inflammatory change
immediately posterior to the GB. These findings raise concern for but are not
entirely diagnostic of acute cholecystitis. If patient has abnormal LFT's or
right upper quadrant tenderness, further evaluation with ultrasound is
recommended.
Findings discussed with Dr. ___ at 11:44 AM on ___.
|
19900111-RR-25
| 19,900,111 | 25,876,146 |
RR
| 25 |
2198-07-03 16:45:00
|
2198-07-04 10:01:00
|
INDICATION: History of progressive dysphagia with suspicion for
paraneoplastic process. Rule out malignancy.
COMPARISONS: Chest radiograph from ___ and ___.
TECHNIQUE: ___ MDCT images were obtained through the chest after the
administration of IV contrast. Multiplanar reformatted images in coronal and
sagittal axis were generated and reviewed.
FINDINGS:
There is a 3.2-cm (TRV) x 4.1-cm (AP) x 4.7-cm (CC) heterogeneous mass in the
region of the left lobe of the thyroid (3;8), which laterally displaces the
left carotid from the larynx. The mass is may invade the cricoid cartilage,
and extends to and is inseparable from the upper surface of the innominate
artery, and the left subclavian artery. Superiorly, there is thickening of the
supraglottic airway. The mass also appears to compress may invade the
cricopharyngeus and upper esophagus.
There is no axillary, hilar, supraclavicular, or mediastinal lymphadenopathy.
The heart size is normal. The pericardium is intact without evidence of an
effusion. Note is made of mild atherosclerotic coronary calcifications. The
airways are patent to the subsegmental levels.
There is mild biapical scarring. Multiple nodules are identified in the right
lung, measuring up to 5-mm in the right upper lobe (5;75;98). There is no
pleural effusion or pneumothorax.
For evaluation of the subdiaphragmatic structures, please refer to the
dedicated report of the abdomen and pelvis.
OSSEOUS STRUCTURES: No lytic or blastic lesion concerning for malignancy is
identified.
IMPRESSION:
1. 3.2-cm (TRV) x 4.1-cm (AP) x 4.7-cm (CC) heterogeneous mass in the region
of the left lobe of the thyroid (3;8), which laterally displaces the left
carotid from the larynx, and may invade the cricoid cartilage,
cricopharyngeus, upper esophagus, innominate and left subclavian arteries.
NOTE: This could be secondary to thyroid cancer, however this mass is highly
concerning for a squamous cell carcinoma. A dedicated neck CT is recommended
for further evaluation.
2. Multiple nodules in the right lung measuring up to 5-mm. Given that the
neck mass is highly suspicious for malignancy, a 6-month follow up is
recommended to assess for stability of the nodules.
Updated findings were discussed with Dr. ___ at 1:17 pm on ___ by Dr.
___ by telephone on the day of the exam.
|
19900111-RR-26
| 19,900,111 | 25,876,146 |
RR
| 26 |
2198-07-04 10:10:00
|
2198-07-04 11:20:00
|
HISTORY: ___ lady with paraneoplastic neuromuscular problem requiring
plasmapheresis.
TECHNIQUE: The patient was placed supine on the fluoroscopy table. The right
side of the neck was prepped and draped in a standard sterile fashion. A
preprocedure timeout was performed per institutional policy. After local
anesthesia with 5 mL of lidocaine 1%, access was gained into the right
internal jugular vein under ultrasound guidance, using a 21-gauge needle.
Hard copies of ultrasound images were stored before and after obtaining venous
access to document venous patency. The needle access was followed by
placement of a micropuncture sheath. A ___ wire was advanced under
fluoroscopic guidance through the micropuncture sheath and parked in the
inferior vena cava. The micropuncture sheath was removed and the tract was
dilated to 14 ___. Then, under fluoroscopic guidance, a 14 ___
triple-lumen pheresis catheter was placed through the internal jugular vein
access with tip in the superior vena cava. The catheter was flushed,
heplocked, and secured to the skin with ___ silk sutures. A sterile dressing
was applied. A final chest fluoroscopic spot image was obtained, documenting
adequate catheter position.
COMPLICATIONS: There were no immediate complications.
IMPRESSION: Successful placement of a temporary triple-lumen pheresis
catheter via the right internal jugular vein with tip in the superior vena
cava. The catheter is ready to use.
|
19900111-RR-27
| 19,900,111 | 25,876,146 |
RR
| 27 |
2198-07-04 17:04:00
|
2198-07-04 22:25:00
|
INDICATION: Neck mass identified on CT torso. Further characterization
needed.
TECHNIQUE: MDCT images were obtained from the skull base to the
aortopulmonary window after the administration of intravenous contrast.
Coronal and sagittal reformations were prepared. CTDIvol 44mGy, DLP 573 mGy-cm
COMPARISON: CT torso, ___.
FINDINGS: Again demonstrated is a heterogeneous mass arising adjacent to, and
perhaps from the left lobe of the thyroid measuring 4.5 x 2.5 cm and
displacing the trachea to the right (2:71). There is no cervical
lymphadenopathy. The major vessels of the neck are patent. There is no
exophytic mucosal or submucosal lesion in the visualized aerodigestive tract.
The salivary glands are normal. Subcutaneous air in the right supraclavicular
fossa is presumably from placement of a right-sided internal jugular catheter.
The visualized lungs are clear. There is no mediastinal lymphadenopathy. The
left vertebral artery arises directly from the aortic arch.
Allowing for helical acquisition, reconstruction algorithm, section thickness,
the included portions of the brain are normal. The circle of ___ and its
major branch vessels are patent. The globes are intact. Note is made of
bilateral lens replacements. The visualized paranasal sinuses, mastoid air
cells, and middle ear cavities are clear.
OSSEOUS STRUCTURES: There are mild changes of cervical spin degenerative disk
disease, with osteophytes encroaching on the spinal canal at C5-6 and ___. No
other osseous abnormalities are seen.
IMPRESSION: 4.6 cm mass adjacent to or arising from the left lobe of the
thyroid. Further characterization with ultrasound can be considered, but
ultimately biopsy would be required for definitive diagnosis. No cervical
lymphadenopathy.
|
19900111-RR-28
| 19,900,111 | 25,876,146 |
RR
| 28 |
2198-07-05 12:49:00
|
2198-07-05 14:16:00
|
HISTORY: Rapidly enlarging left neck mass with associated dysphagia.
Paraneoplastic process also being considered as cause for dysphagia.
COMPARISON: CT neck ___.
OPERATORS: Dr. ___ attending, and Dr. ___ imaging
fellow.
PROCEDURE:
The procedure, including risks, benefits and alternatives were explained to
the patient, and after detailed discussion, informed written consent was
obtained from the patient. A time-out was performed prior to the procedure
using 3 unique patient identifies according to the ___ protocol with the
interpreter present.
A limited ultrasound was performed demonstrating a heterogeneous solid mass in
the expected location of the left thyroid gland. The skin and probe were
prepped with alcohol antiseptic, and the skin and subcutaneous tissues at the
target site were infiltrated with 2cc of 1% lidocaine.
Ultrasound guided fine needle aspiration of the left thyroid mass was
performed with a 25 gauge needle. Three fine needle aspirates were obtained,
and placed in Cytolyte for evaluation by cytology.
There were no immediate postprocedural complications. The patient tolerated
the procedure well.
The attending Dr. ___ was present throughout the procedure.
FINDINGS:
There is a mass replacing the left lobe of the thyroid gland that is solid and
heterogeneous in appearance with lobulated borders. The mass measures
approximately 3.5 x 3.6 x 4.7 cm and demonstrate punctate echogenic foci that
may represent microcalcification. The margins of the lesion with the strap
muscles are indistinct.
The right thyroid appears atrophic.
No regional adenopathy was demonstrated.
IMPRESSION:
Ultrasound guided left thyroid mass FNA. Concerning sonographic features of
the mass as described. Cytology results are pending.
|
19900111-RR-30
| 19,900,111 | 25,876,146 |
RR
| 30 |
2198-07-07 10:52:00
|
2198-07-07 11:52:00
|
HISTORY: This lesion progressive head pain. Question intracranial mass.
TECHNIQUE: Axial helical MDCT images were obtained through the brain without
administration of IV contrast. Multiplanar reformatted images in coronal and
sagittal axes and thin-section bone algorithm reconstructed images were
acquired.
DLP: 934 mGycm
COMPARISON: None available
FINDINGS:
There is no evidence of hemorrhage, edema, mass effect or acute large vascular
territory infarction. Prominent ventricles and sulci suggest age-related
atrophy. Periventricular white matter hypodensities are consistent with
chronic small vessel ischemic disease. The basal cisterns appear patent and
there is preservation of gray-white differentiation.
No fracture is identified. The visualized paranasal sinuses, mastoid air
cells and middle ear cavities are clear. Atherosclerotic mural calcification
of the internal carotid arteries is noted. The globes are unremarkable.
IMPRESSION:
No acute intracranial process.
|
19900111-RR-31
| 19,900,111 | 25,876,146 |
RR
| 31 |
2198-07-07 16:58:00
|
2198-07-08 17:28:00
|
HISTORY: New subclavian line, eval placement.
COMPARISON: ___.
FINDINGS: Frontal and lateral chest radiographs were obtained.
A right subclavian line terminates in the mid SVC. There is no evidence of
complication or pneumothorax. The lungs are fully expanded and clear. The
cardiomediastinal silhouette, hilar contours, and pleural surfaces are normal.
There is no pleural effusion.
IMPRESSION: Right subclavian line terminates in the mid SVC without evidence
of complication.
|
19900111-RR-36
| 19,900,111 | 25,876,146 |
RR
| 36 |
2198-07-15 13:05:00
|
2198-07-15 13:42:00
|
INDICATION: Leukocytosis. PEG tube placed on ___.
COMPARISON: Chest radiographs from 12, ___. PET-CT, ___.
FINDINGS: PA and lateral chest radiographs. Pneumoperitoneum below both
hemidiaphragms was present on PET-CT from three days prior. This is most
likely from the patient's PEG tube placement. The HD dialysis catheter has
been removed. There is no focal consolidation, pleural effusion, or
pneumothorax. The lungs are expanded but clear. The cardiomediastinal
silhouette is normal.
IMPRESSION:
1. Pneumoperitoneum is likely post-procedural from PEG tube placement on ___.
2. No pneumonia.
Findings were discussed by Dr. ___ with Dr. ___ by phone
at 1:29 p.m. (2 minutes after discovery) on ___.
|
19900626-RR-19
| 19,900,626 | 21,246,742 |
RR
| 19 |
2152-04-24 15:30:00
|
2152-04-24 18:23:00
|
CHEST, TWO VIEWS: ___
HISTORY: ___ male with liver failure.
COMPARISON: None.
FINDINGS: PA and lateral views of the chest. Relatively low lung volumes
seen with linear bibasilar opacities, potentially due to atelectasis.
Superiorly, the lungs are clear. There is no effusion. The cardiomediastinal
silhouette is within normal limits. Median sternotomy wires are noted. No
acute osseous abnormality is identified.
IMPRESSION: Low lung volumes with streaky bibasilar opacities, most likely
atelectasis. Otherwise, no acute cardiopulmonary process.
|
19900626-RR-20
| 19,900,626 | 21,246,742 |
RR
| 20 |
2152-04-24 21:33:00
|
2152-04-24 22:35:00
|
INDICATION: Decompensated cirrhosis. Evaluate for thrombus or hepatic
lesions with Doppler.
COMPARISON: No prior studies available for comparison.
FINDINGS: The liver is nodular, shrunken and with a coarse heterogeneous
echotexture consistent with provided history of cirrhosis. An 8-mm right
hepatic lobe granuloma is incidentally noted as well as several cysts within
the left hepatic lobe. No concerning liver lesions identified. There is no
intra- or extra-hepatic biliary ductal dilatation with the common bile duct
measuring 5 mm. The gallbladder has been resected. The midline including
pancreas, portal confluence and splenic vein is obscured by bowel gas. The
spleen is enlarged measuring 16 cm. Moderate four-quadrant ascites present.
Doppler assessment of the hepatic and portal veins demonstrate patency. Flow
within the main and right portal veins is hepatopetal; however, flow is slowed
and reversed in the patent left portal vein. The umbilical vein is not patent.
IMPRESSION:
1. Cirrhotic liver without focal concerning lesion. Sequela of portal
hypertension including splenomegaly and moderate four-quadrant ascites.
2. Doppler assessment demonstrates patency of all visualized veins with slow
reversed flow in the left portal vein. Please note midline including portal
confluence and splenic vein is obscured by bowel gas.
|
19900626-RR-21
| 19,900,626 | 21,246,742 |
RR
| 21 |
2152-04-25 15:27:00
|
2152-04-25 16:38:00
|
EXAMINATION: Ultrasound-guided paracentesis.
INDICATION: ___ year old man with cirrhosis pw ascites // Therapeutic
paracentesis
TECHNIQUE: Ultrasound guided diagnostic and therapeutic paracentesis
COMPARISON: Comparison is made to abdominal ultrasound dated ___.
FINDINGS:
Limited grayscale ultrasound imaging of the abdomen demonstrated a moderate
amount ofascites. 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 1.9 L of clear, straw-coloredfluid was removed.
The patient tolerated the procedure well without immediate complication.
Estimated blood loss was minimal.
Dr. ___ attending radiologist, was present throughout the critical
portions of the procedure.
IMPRESSION:
Uneventful diagnostic and therapeutic paracentesis yielding 1.9 L of clear,
straw-colored ascitic fluid.
|
19900689-RR-15
| 19,900,689 | 26,824,053 |
RR
| 15 |
2189-06-10 22:12:00
|
2189-06-10 22:49:00
|
EXAMINATION: Chest radiograph, AP view.
INDICATION: Trauma.
COMPARISON: None available.
FINDINGS:
Heart is normal in size. Mediastinal and hilar contours appear within normal
limits. There is no pneumothorax. Subcutaneous emphysema overlying the left
lateral chest. Patchy nonspecific opacities at the left lung base.
Subpulmonic effusions are difficult to exclude. No definite fracture.
IMPRESSION:
Nonspecific patchy opacities at the left lung base. Left-sided subcutaneous
emphysema.
|
19900689-RR-16
| 19,900,689 | 26,824,053 |
RR
| 16 |
2189-06-10 22:25:00
|
2189-06-10 23:21:00
|
EXAMINATION: CTA NECK WANDW/OC AND RECONS Q25 CT NECK
INDICATION: History: ___ with trauama*** WARNING *** Multiple patients with
same last name!// r/o trauama
TECHNIQUE: Rapid axial imaging was performed from the aortic arch through the
skull base during infusion of Omnipaque intravenous contrast material.
Three-dimensional angiographic volume rendered, curved reformatted and
segmented images were generated. This report is based on interpretation of all
of these images.
DOSE: Acquisition sequence:
1) Stationary Acquisition 4.0 s, 0.5 cm; CTDIvol = 43.6 mGy (Head) DLP =
21.8 mGy-cm.
2) Spiral Acquisition 4.3 s, 33.5 cm; CTDIvol = 35.2 mGy (Head) DLP =
1,181.7 mGy-cm.
Total DLP (Head) = 1,203 mGy-cm.
COMPARISON: None.
FINDINGS:
No fracture identified. Normal spinal alignment.
The carotidandvertebral arteries and their major branches are patent with no
evidence of stenoses. No evidence for dissection is seen.
There is no internal carotid artery stenosis by NASCET criteria
There is left subpectoral gas extending superiorly along the left scalene and
sternocleidomastoid muscles, tracking around the left vertebral artery at the
C5 level. There is gas within the adjacent left epidural space. Gas is also
seen tracking within the left posterior cervical neck muscles and left
trapezius muscle.
There is a shallow left apical pneumothorax. There is a small left
hemothorax.
IMPRESSION:
-The carotidandvertebral arteries and their major branches are patent with no
evidence of stenoses or dissection.
- No fracture identified. Normal spinal alignment.
-Shallow left apical pneumothorax.
-Subcutaneous emphysema overlying the left lateral chest wall extending
superiorly along the left scalene and sternocleidomastoid muscles. Gas is
noted around the left vertebral artery at the level of C5 and in the adjacent
the left epidural space.
|
19900689-RR-17
| 19,900,689 | 26,824,053 |
RR
| 17 |
2189-06-10 22:26:00
|
2189-06-10 23:36:00
|
EXAMINATION: CTA torso
INDICATION: History: ___ with stab wound*** WARNING *** Multiple patients
with same last name!// extent of injuries
TECHNIQUE: Axial multidetector CT images were obtained through the thorax
after the uneventful administration of intravenous contrast in the arterial
phase. Then, imaging was obtained through the abdomen and pelvis in the
portal venous phase. Reformatted coronal and sagittal images through the
chest, abdomen, and pelvis, and oblique maximal intensity projection images of
the chest were submitted to PACS and reviewed.
DOSE: Acquisition sequence:
1) Spiral Acquisition 9.2 s, 72.6 cm; CTDIvol = 22.2 mGy (Body) DLP =
1,607.4 mGy-cm.
Total DLP (Body) = 1,607 mGy-cm.
COMPARISON: None.
FINDINGS:
CHEST:
HEART AND VASCULATURE: Limited evaluation of the pulmonary vasculature;
pulmonary vasculature is well opacified to the segmental level without filling
defect to indicate a pulmonary embolus. The thoracic aorta is normal in
caliber without evidence of dissection or intramural hematoma. The heart,
pericardium, and great vessels are within normal limits. No pericardial
effusion is seen.
AXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar
lymphadenopathy is present. No mediastinal mass.
PLEURAL SPACES: Small left apical pneumothorax (02:23). Small left hemo
thorax (2:81).
LUNGS/AIRWAYS: Bibasilar atelectasis, left greater than right. Very small
subpleural nodule in the right middle lobe measuring 3 mm (2:79) is doubtful
in significance. Left lung laceration (02:56). The airways are patent to the
level of the lobar bronchi bilaterally.
BASE OF NECK: Please see separate CTA neck.
ABDOMEN:
HEPATOBILIARY: Hypodense liver is consistent with fatty infiltration. No
focal liver lesions are identified. There is no evidence of focal lesions.
There is no evidence of intrahepatic or extrahepatic biliary dilatation. The
gallbladder is within normal limits.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
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. There is no free intraperitoneal fluid or
free air.
PELVIS:
The urinary bladder and distal ureters are unremarkable. There is no free
fluid in the pelvis.
REPRODUCTIVE ORGANS: The reproductive organs are unremarkable.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm.
BONES AND SOFT TISSUES: Locules of gas track along the left posterior shoulder
at site of known stab wounds. Locules of gas also track along the left
anterior chest wall at additional stab wound site where there is also a
displaced fracture of the anterior left fifth rib (605:127). Locules of gas
tract along the right anterior abdominal wall at site of stab wound without
specific CT evidence of intra-abdominal entry.
IMPRESSION:
1. Left lateral chest wall stab wound site with associated lung laceration
(02:56), small left pneumothorax (02:23), and small left hemothorax (2:81), as
well as mildly displaced complete anterior left fifth rib fracture (605:127)
at entry.
2. Locules of gas track along the right anterior abdominal wall at site of
stab wound without CT evidence of intra-abdominal entry.
3. Please see separate CTA neck for neck findings.
NOTIFICATION: The findings were discussed with trauma surgery team by ___
___, M.D. in person on ___ at 11:00 pm.
|
19900689-RR-18
| 19,900,689 | 26,824,053 |
RR
| 18 |
2189-06-11 00:43:00
|
2189-06-11 08:38:00
|
EXAMINATION: CHEST (PORTABLE AP) ___
INDICATION: PERFORM AT 1AM. ___ year old man with trauma, L PTX/hemothorax//
PERFORM AT 1AM. assess for interval change- L PTX/hemothorax PERFORM AT
1AM. assess for interval change- L PTX/hemothorax
IMPRESSION:
Compared to chest radiographs ___.
Mild pulmonary edema is new. Heterogeneous opacification persists at the left
lung base but has not worsened, consistent with stable contusion or
aspiration. There has been no change since the chest CT 2 hours earlier to
suggest an increase in either small left pneumothorax or a small left pleural
effusion. One separated rib fracture is clear, anterior left fifth, with
adjacent subcutaneous emphysema, unchanged.
|
19900689-RR-19
| 19,900,689 | 26,824,053 |
RR
| 19 |
2189-06-11 05:38:00
|
2189-06-11 10:29:00
|
EXAMINATION: CHEST (PORTABLE AP) ___
INDICATION: ___ year old man with stab wound x6 with L ptx and hemothorax//
please eval for interval change please eval for interval change
IMPRESSION:
Compared to chest radiographs ___ and ___ at 00:55.
Moderate left pneumothorax is substantially larger. Left pleural effusion IS
small if any. Left basal consolidation is more pronounced, perhaps
atelectasis from displacement by the larger pneumothorax. Right basal
atelectasis is mild, reflecting ipsilateral mediastinal shift.
NOTIFICATION: The findings were discussed with ___, by ___,
M.D. on the telephone at 10:20, IMMEDIATELY following discovery of the
findings.
|
19900689-RR-20
| 19,900,689 | 26,824,053 |
RR
| 20 |
2189-06-11 11:31:00
|
2189-06-11 12:28:00
|
EXAMINATION: CHEST (PORTABLE AP) ___
INDICATION: ___ year old man with left ptx s/p pigtail placement// pigtail
location and ptx. pigtail location and ptx.
IMPRESSION:
Compared to chest radiographs ___ and ___.
Small left pneumothorax has decreased substantially following insertion of a
basal pigtail pleural drainage catheter. Left basal consolidation is
nevertheless more pronounced now than it was earlier in the day, presumably
worsening atelectasis. Left pleural effusion minimal if any. Heart size
normal. Right lung grossly clear.
|
19900689-RR-22
| 19,900,689 | 26,824,053 |
RR
| 22 |
2189-06-12 07:19:00
|
2189-06-12 11:33:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man s/p stab wounds x6 with L 5th rib fx, s/p L
pigtail placement for PTX (___)// Reassess L pigtail placement, ?size PTX.
Please obtain CXR on ___ at 7:00 Reassess L pigtail placement, ?size PTX.
Please obtain CXR on ___ at 7:00
IMPRESSION:
Left pigtail catheter is in place. There is left apical pneumothorax, small.
Heart size and mediastinum are stable. Left retrocardiac atelectasis is
unchanged. Right lung is overall clear.
|
19900689-RR-23
| 19,900,689 | 26,824,053 |
RR
| 23 |
2189-06-12 07:27:00
|
2189-06-12 13:46:00
|
EXAMINATION: HAND (PA,LAT AND OBLIQUE) RIGHT
INDICATION: ___ year old man s/p assault with bruising to R ___ digit//
?Fracture
TECHNIQUE: Frontal, oblique, and lateral view radiographs of the right hand
COMPARISON: No prior images available for comparisons.
FINDINGS:
There is sclerosis and irregularity about the body of the scaphoid, concerning
for likely old nondisplaced fracture. Mildly displaced fracture of the dorsal
base of the distal fifth phalanx with mild flexion deformity, concerning for
mallet finger. Dystrophic calcification near the TFC and another seen on the
volar aspect of the wrist on the lateral view, which may be the sequelae of
prior trauma. There are no significant degenerative changes. No bone erosion
or periostitis is identified.
IMPRESSION:
Mildly displaced fracture of the dorsal base of the distal fifth phalanx with
mild flexion deformity, concerning for mallet finger.
Likely chronic changes related to waist fracture of the scaphoid. Recommend
correlation for pain in the anatomic snuffbox and considering dedicated views
of the wrist.
NOTIFICATION: The findings were relayed to ___, M.D. by ___
___, M.D. on the telephone on ___ at 11:34 am, 5 minutes after
discovery of the findings.
|
19900689-RR-24
| 19,900,689 | 26,824,053 |
RR
| 24 |
2189-06-13 09:10:00
|
2189-06-13 13:20:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old man with left PTX// CT to waterseal, eval for
interval change. Pls get film at 7am on ___
TECHNIQUE: Chest PA and lateral
COMPARISON: Multiple chest radiographs, most recent from ___.
FINDINGS:
In comparison with the prior study a small apical 1.5 cm pneumothorax is
demonstrated. The pigtail drainage catheter is stable in position. Stable
appearance of the left lower lobe atelectasis. No pleural effusion.
Cardiomediastinal silhouette is unchanged.
IMPRESSION:
Apical 1.5 cm pneumothorax. Stable position of the left drainage pigtail
catheter.
NOTIFICATION:
1. The findings were discussed with ___, M.D. by ___
___, M.D. on the telephone on ___ at 1:18 pm, 10 minutes after
discovery of the findings.
|
19900689-RR-25
| 19,900,689 | 26,824,053 |
RR
| 25 |
2189-06-13 09:10:00
|
2189-06-13 10:41:00
|
INDICATION: ___ y/o M s/p assault with right wrist pain// r/o fx. Can get film
when pt is down getting CXR at 7am
COMPARISON: Compared to radiographs of the right hand from yesterday.
IMPRESSION:
There is again seen osseous irregularity and spurring about the scaphoid waist
suggestive of prior old injury. However, please correlate with any history of
prior trauma and acute pain. On the lateral view, there is a well corticated
density along the volar aspect of the wrist joint and another calcific density
dorsal to the capitate. Small dystrophic calcification is seen superior to
the expected location the TFCC on the AP view. There are mild degenerative
changes of the first CMC joint with minimal joint space narrowing spurring.No
definite acute fractures or dislocations are seen.
|
19900689-RR-26
| 19,900,689 | 26,824,053 |
RR
| 26 |
2189-06-12 20:25:00
|
2189-06-12 21:04:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with sob s/p rib fractures and stab wounds//
?interval change
TECHNIQUE: AP portable chest radiograph
COMPARISON: ___ from earlier in the day
IMPRESSION:
There has been interval repositioning of the left pleural pigtail catheter.
No discrete pneumothorax is identified. Retrocardiac atelectasis is unchanged.
No large pleural effusion. The size of the cardiac silhouette is within normal
limits. Unchanged cortical irregularity of the distal right clavicle at the
acromioclavicular joint.
|
19900689-RR-27
| 19,900,689 | 26,824,053 |
RR
| 27 |
2189-06-13 15:32:00
|
2189-06-13 15:48:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with L 5th rib fracture, s/p L pigtail placement
with 4 hr clamp trial.// Please obtain CXR after 4 hr clamp trial. ?Increase
PTX
TECHNIQUE: Chest AP
COMPARISON: ___
IMPRESSION:
Left-sided pigtail catheter is unchanged. There is a small left apical
pneumothorax. Lungs are low volume with bibasilar atelectasis.
Cardiomediastinal silhouette is stable. There is subsegmental atelectasis in
the right lower lobe.
|
19900689-RR-28
| 19,900,689 | 26,824,053 |
RR
| 28 |
2189-06-14 04:57:00
|
2189-06-14 09:36:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with L 5th rib fx, s/p L pigtail placement,
clamped overnight. ?interval change in pneumothorax.// ?PTX after overnight
clamp trial. Please obtain CXR on ___ at 5:00. ?PTX after overnight clamp
trial. Please obtain CXR on ___ at 5:00.
IMPRESSION:
Comparison to ___. The left pleural pigtail catheter is in
stable position. The left pneumothorax has minimally decreased. There is no
evidence of tension. Stable retrocardiac atelectasis. No pleural effusions.
No pulmonary edema. No pneumonia.
|
19900867-RR-47
| 19,900,867 | 25,731,044 |
RR
| 47 |
2166-11-04 02:15:00
|
2166-11-04 02:49:00
|
EXAMINATION: FEMUR (AP AND LAT) LEFT
INDICATION: History: ___ with left hip fx, had recurrent fall out of bed//
eval ich; eval knee injury
TECHNIQUE: Frontal, lateral and cross-table lateral views of the right knee
were obtained.
COMPARISON: Multiple prior knee radiographs, most recently ___.
Hip radiograph dated ___.
FINDINGS:
A single view of the left hip again demonstrates foreshortening of the left
femoral neck, consistent with femoral neck fracture. Brachy therapy seeds are
again noted overlying the lower pelvis. Moderate degenerative change at the
left hip joint is again noted.
No additional fracture or dislocation is seen. Depression of the anterior
surface of the patella is likely chronic and related to the prior patellar
fracture. Re-demonstrated are cerclage wires and pins in the patella. There
is a fracture through one of the superior cerclage wire loops, similar to
prior. Re-demonstrated is mild degenerative change along the medial
compartment as evidenced by tiny osteophytes. There is no knee joint
effusion. There is normal osseous mineralization. No suspicious lytic or
sclerotic lesions are identified. Note is made of a fabella posteriorly.
IMPRESSION:
1. Re-demonstrated is foreshortening of the left femoral neck, consistent
with a femoral neck fracture.
2. There are new fractures within the cerclage wires since the ___
study with irregularity of the anterior aspect of the patella on the lateral
view. Please correlate with patellar pain to exclude an acute on chronic
patellar fracture.
|
19900867-RR-48
| 19,900,867 | 25,731,044 |
RR
| 48 |
2166-11-04 02:31:00
|
2166-11-04 03:12:00
|
EXAMINATION: CT HEAD W/O CONTRAST.
INDICATION: History: ___ with left hip fx, had recurrent fall out of bed//
eval ich; eval knee injury.
TECHNIQUE: Contiguous axial images from skullbase to vertex were obtained
without intravenous contrast. Coronal and sagittal reformations and bone
algorithms reconstructions were also performed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 9.0 s, 18.0 cm; CTDIvol = 50.2 mGy (Head) DLP =
903.1 mGy-cm.
2) Sequenced Acquisition 4.0 s, 8.0 cm; CTDIvol = 50.2 mGy (Head) DLP =
401.4 mGy-cm.
Total DLP (Head) = 1,304 mGy-cm.
COMPARISON: Head CT dated ___ at 22:11.
FINDINGS:
The examination is partially limited due to patient motion, within this
limitation, grossly there is no evidence of acute territorial infarction,
intracranial hemorrhage, edema, or mass effect. The ventricles and sulci are
prominent keeping with age-related involutional change. Moderate
periventricular and subcortical white matter hypodensities are nonspecific,
but likely represent sequela of chronic ischemic microvascular disease.
No acute fractures are seen. Re-demonstrated is a small subgaleal hematoma
overlying the left frontal bone measuring up to 7 mm in thickness (03:47).
There is new soft tissue swelling overlying the right frontal bone measuring
up to 5 mm in thickness. A small amount of subcutaneous gas likely reflects
known laceration. Aside from mild mucosal thickening in the bilateral ethmoid
air cells, the paranasal sinuses, mastoid air cells, and middle ear cavities
are clear. The orbits are unremarkable.
IMPRESSION:
1. There is a new small subgaleal hematoma overlying the right frontal bone.
2. Re-demonstrated is a small hematoma overlying the left frontal bone with
an overlying laceration, and subcutaneous emphysema.
3. No acute intracranial hemorrhage or fracture.
|
19900867-RR-50
| 19,900,867 | 25,731,044 |
RR
| 50 |
2166-11-04 06:24:00
|
2166-11-04 06:41:00
|
EXAMINATION: GLENO-HUMERAL SHOULDER (W/ Y VIEW) RIGHT
INDICATION: History: ___ with R shoulder pain s/p fall// eval fx
TECHNIQUE: AP and Y-view of the right shoulder were obtained.
COMPARISON: None
FINDINGS:
There is no fracture or dislocation involving the glenohumeral or AC joint.
There are mild degenerative changes in the right acromioclavicular joint. No
suspicious lytic or sclerotic lesions are identified. No periarticular
calcification or radio-opaque foreign body is seen. The visualized portion of
the lungs are clear,
IMPRESSION:
1. No acute fracture.
2. Mild degenerative disease in the acromioclavicular joint.
|
19900867-RR-51
| 19,900,867 | 25,731,044 |
RR
| 51 |
2166-11-04 19:09:00
|
2166-11-04 23:02:00
|
EXAMINATION: Left hip radiograph, single AP portable view, intraoperative.
INDICATION: Immediately status post left hip hemiarthroplasty.
COMPARISON: Prior study from ___.
FINDINGS:
Patient is immediately status post left hip hemiarthroplasty. Hardware
appears intact. Brachy therapy seeds again project along the lower central
pelvis.
IMPRESSION:
Anticipated postoperative appearance immediately status post left hip
hemiarthroplasty.
|
19900961-RR-25
| 19,900,961 | 24,410,305 |
RR
| 25 |
2154-02-09 15:00:00
|
2154-02-09 16:10:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with NSTEMI requiring CABG ___// preop eval for
CABG ___ Surg: ___ (CABG) preop eval for CABG ___
IMPRESSION:
Heart size and mediastinum are stable. Lungs are clear. There is no pleural
effusion. There is no pneumothorax.
|
19900961-RR-26
| 19,900,961 | 24,410,305 |
RR
| 26 |
2154-02-11 15:38:00
|
2154-02-11 16:48:00
|
EXAMINATION: CHEST PORT. LINE PLACEMENT
INDICATION: ___ year old man s/p CABG// FAST TRACK EARLY EXTUBATION CARDIAC
SURGERY Contact name: ___: ___
COMPARISON: Chest radiographs from ___ through ___
FINDINGS:
Supine portable AP view of the chest provided.
The ET tube tip is approximately 5.5 cm above the carina. The right IJ
central venous catheter tip ends in the mid SVC. Mediastinal drains are in
place. Left chest tube is in place. Nasogastric tube tip is in stomach.
Median sternotomy wires are intact. Surgical staples are visible in the
anterior chest, consistent with recent CABG. The heart size and mediastinum
are stable. There is increased pulmonary vascular congestion, although this
is expected postoperatively. The lungs are otherwise clear. There is no
pleural effusion or pneumothorax.
IMPRESSION:
1. Lines, tubes and drains are in appropriate positions.
2. Increased pulmonary vascular engorgement, however this is within normal
limits postoperatively.
|
19900961-RR-27
| 19,900,961 | 24,410,305 |
RR
| 27 |
2154-02-12 12:12:00
|
2154-02-12 15:35:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with s/p CABG- CTs d/c'd// evaluate for
pneumothorax
COMPARISON: Chest radiographs from ___ through ___
FINDINGS:
Portable AP view of the chest provided.
The endotracheal tube, left chest tube, nasogastric tube and mediastinal
drains have been removed. The right IJ central venous catheter tip ends in
the mid SVC. Median sternotomy wires and mediastinal clips consistent with
recent CABG are intact and aligned. Lung volumes are low bilaterally
following extubation. There is increased bibasilar atelectasis. The heart
size and mediastinum are mildly enlarged, although this is normal
postoperatively. No pleural effusion or pneumothorax.
IMPRESSION:
1. No pneumothorax.
2. Increased bibasilar atelectasis with low lung volumes following
extubation.
3. Expected postoperative changes.
|
19900961-RR-28
| 19,900,961 | 24,410,305 |
RR
| 28 |
2154-02-15 10:29:00
|
2154-02-15 11:29:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old man with s/p CABG// eval postop changes
IMPRESSION:
In comparison with the study of ___, the right IJ catheter tip remains at
the level of the carina. Bibasilar opacifications again are consistent with
atelectatic changes. There may be a small right pleural effusion.
No evidence of pneumothorax.
|
19900981-RR-22
| 19,900,981 | 26,885,641 |
RR
| 22 |
2167-06-03 00:02:00
|
2167-06-03 10:47:00
|
INDICATION: Chest pain and shortness of breath. Evaluate for PE. The
patient has history of sickle cell disease.
COMPARISON: None.
TECHNIQUE: Contiguous helical MDCT images were obtained through the chest
after administration of 100 cc of Omnipaque IV contrast. Multiplanar axial,
coronal, sagittal and maximum intensity projection oblique images were
generated.
TOTAL BODY DLP: 149 mGy-cm.
FINDINGS: There is no supraclavicular, axillary, or mediastinal
lymphadenopathy. A borderline 1 cm right hilar lymph node is of unclear
clinical significance. The heart is mildly enlarged, but without pericardial
effusion. The aorta and main pulmonary arteries are normal in caliber. There
are no appreciable atherosclerotic calcifications of the coronary arteries.
There is no pleural effusion or pneumothorax. There is mild bibasilar
atelectasis. 7 mm irregular opacity in the right upper lobe may reflect
scarring. There is an indeterminant 9 mm ground-glass opacity in the lingula
(3:125). The airways are patent to the subsegmental level.
CTA CHEST: The aorta and great vessels are normally opacified. The pulmonary
arteries are opacified to the subsegmental level without evidence of pulmonary
embolism.
OSSEOUS STRUCTURES: H-shaped appearance of the vertebrae is compatible with
known sickle cell disease.
This study is not designed for evaluation of the subdiaphragmatic structures;
however, the spleen is shrunken to 2.9 x 1.1 cm and compatible with
auto-infarction.
IMPRESSION:
1. No evidence of pulmonary embolism.
2. Mild cardiomegaly.
3. 9 mm ground-glass opacity in the lingula should be followed up in six
months.
4. H-shaped vertebrae and auto infarction of the spleen compatible with known
sickle cell disease.
|
19900981-RR-30
| 19,900,981 | 25,189,471 |
RR
| 30 |
2167-11-19 00:38:00
|
2167-11-19 01:02:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ with ?pna // pna?
TECHNIQUE: Portable AP view of the chest.
COMPARISON: Chest radiographs from ___ through ___
FINDINGS:
Heart size is enlarged. The mediastinal and hilar contours are normal. The
pulmonary vasculature is minimally engorged. Lung volumes are slightly low
which accentuate bronchovascular markings. Given that, there is subtle opacity
at the base of the right lung which could represent atelectasis or infection
in the appropriate clinical setting. No pleural effusion or pneumothorax is
seen. The is made of some sclerosis in the left humeral head.
IMPRESSION:
Slightly low lung volumes. Subtle opacity at the base of the right lung could
represent atelectasis however infection should be considered in the
appropriate clinical setting. Recommend followup chest radiograph for further
evaluation if clinically indicated.
|
19900981-RR-31
| 19,900,981 | 25,189,471 |
RR
| 31 |
2167-11-19 17:42:00
|
2167-11-19 17:59:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old man with sickle cell disease with chest pain, now
improving. Opacity on portable CXR. consolidation vs atelectasis //
?consolidation vs atelectasis
COMPARISON: ___
IMPRESSION:
As compared to the previous radiograph, a pre-existing bilateral parenchymal
opacities at the lung bases have incompletely resolved. Minimal remnant
opacities are still visualized. No pleural effusions. No pulmonary edema.
Moderate cardiomegaly persists.
|
19900981-RR-32
| 19,900,981 | 27,544,733 |
RR
| 32 |
2167-12-20 00:53:00
|
2167-12-20 01:56:00
|
EXAMINATION: Chest radiograph
INDICATION: History of sickle cell presenting with chest pain and fever.
TECHNIQUE: Chest PA and lateral
COMPARISON: ___.
FINDINGS:
Moderate cardiomegaly is unchanged. Cardiomediastinal silhouette and hilar
contours are otherwise normal. Subtly increased opacity compared to prior at
the left lung base adjacent to the heart border with the posterior basal
lateral correlate. Lungs are otherwise clear. Pleural surfaces are clear
without effusion or pneumothorax.
IMPRESSION:
Subtly increased density at the posterior left lung base suspicious for
pneumonia versus acute chest syndrome.
|
19900981-RR-35
| 19,900,981 | 22,537,206 |
RR
| 35 |
2168-02-06 04:00:00
|
2168-02-06 07:20:00
|
EXAMINATION: Chest radiograph
INDICATION: Sickle cell with chest pain. Assess for acute cardiopulmonary
process.
COMPARISON: Chest radiograph from ___.
FINDINGS:
Frontal and lateral chest radiograph demonstrate hypoinflated lungs with
crowding of vasculature and left lower lobe atelectasis. Small right pleural
effusion is noted. No left pleural effusion. Stable mild cardiomegaly.
Mediastinal contour and hila are unremarkable.
Limited assessment of the upper abdomen is within normal limits. Persistent H
shaped vertebrae is consistent with known history of sickle cell disease.
IMPRESSION:
1. Small right pleural effusion.
2. No pneumonia.
NOTIFICATION: The findings were discussed by Dr. ___ with Dr.
___ on the telephone on ___ at 8:10 AM.
|
19900981-RR-36
| 19,900,981 | 22,537,206 |
RR
| 36 |
2168-02-06 11:42:00
|
2168-02-06 12:58:00
|
EXAMINATION: CHEST CTA
INDICATION: A ___ man with chest pain, evaluate for pulmonary
embolism.
TECHNIQUE: Axial helical MDCT images were obtained from the suprasternal
notch to the upper abdomen in early arterial phase scanning after the
administration of 100 cc of Omnipaque.
Reformatted coronal, sagittal, thin slice axial images, and oblique maximal
intensity projection images were submitted to PACS and reviewed.
DLP: 216.25 mGy-cm.
COMPARISON: CTA chest ___.
FINDINGS:
CTA THORAX: The main thoracic vessels are well-opacified. The aorta
demonstrates normal caliber without evidence of intramural hematoma or
dissection. The aortic arch branches are normal in appearance. The main,
right, and left pulmonary arteries are well-opacified. There is no evidence of
lobar, segmental, or subsegmental intraluminal filling defect. No
arteriovenous malformation is detected.
CT OF THE THORAX: The airways are patent to subsegmental levels.
Well-demarcated anterior mediastinal soft tissue density may represent thymic
hyperplasia, and is unchanged since ___. There is moderate to severe
cardiomegaly, with biventricular enlargement. There is no pericardial
effusion. There is no mediastinal, hilar, axillary, or supraclavicular
lymphadenopathy. The esophagus is normal without evidence of hiatus hernia.
Ill-defined nodular opacities in the right middle and lower lobe could
represent a very early pneumonia. Streaky opacities at the lung bases are
compatible with dependent atelectasis. The remainder of the lungs are clear.
There are right greater than left small bilateral layering simple pleural
effusions.
Although this study is not designed for assessment of intra-abdominal
structures, the visualized solid organs and the stomach are unremarkable.
OSSEOUS STRUCTURES: The imaged thoracic vertebral bodies demonstrate normal
alignment. H-shaped vertebral bodies are compatible with known sickle cell
disease, unchanged from prior exam. There is no evidence of fracture. There
are no concerning osteolytic or osteosclerotic lesions identified.
IMPRESSION:
1. No evidence of pulmonary embolism.
2. Ill-defined nodular opacities within the right middle and lower lobes may
represent early pneumonia.
3. Moderate to severe cardiomegaly.
4. Small right greater than left layering simple pleural effusions.
5. Anterior mediastinal soft tissue may represent thymic hyperplasia,
unchanged since prior exam.
|
19900981-RR-52
| 19,900,981 | 25,012,902 |
RR
| 52 |
2169-09-14 14:18:00
|
2169-09-14 14:47:00
|
EXAMINATION:
Chest: Frontal and lateral views
INDICATION: History: ___ with hx sickle cell, hypoxia // ? infectious
process
TECHNIQUE: Chest: Frontal and Lateral
COMPARISON: ___
FINDINGS:
Cardiac and mediastinal silhouettes are stable with the cardiac silhouette
mildly enlarged. No focal consolidation is seen. There is no large pleural
effusion although trace pleural effusions are difficult to exclude. No
evidence of pneumothorax is seen. No overt pulmonary edema.
IMPRESSION:
No large pleural effusion, but possible trace pleural effusions. No definite
focal consolidation.
|
19900981-RR-54
| 19,900,981 | 22,451,108 |
RR
| 54 |
2169-10-21 04:03:00
|
2169-10-21 07:42:00
|
INDICATION: ___ with sickle cell disease and chest pain. // evaluate for
vascular congestion
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest radiograph from ___.
FINDINGS:
Lung volumes are low. The lungs are grossly clear. Mediastinum and hila are
normal. There is moderate cardiomegaly, stable from ___. There is no
pneumothorax. Small left pleural effusion is associated with adjacent
atelectasis
IMPRESSION:
Stable moderate cardiomegaly without evidence of pulmonary edema.
|
19900981-RR-55
| 19,900,981 | 22,451,108 |
RR
| 55 |
2169-10-21 05:07:00
|
2169-10-21 05:53:00
|
EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ with sickle cell crisis, headache // evaluate for stroke
TECHNIQUE: Contiguous axial images from skullbase to vertex were obtained
without intravenous contrast. Coronal and sagittal reformations and bone
algorithms reconstructions were also performed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 18.0 s, 18.3 cm; CTDIvol = 49.3 mGy (Head) DLP =
903.1 mGy-cm.
Total DLP (Head) = 903 mGy-cm.
COMPARISON: None.
FINDINGS:
There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles
and sulci are normal in size and configuration.
No acute fracture. The disc thickening of the posterior wall of the right
maxillary sinus and mild expansion of the calvarial diploic space are
compatible with the history sickle cell disease. Mucosal thickening of the
right sphenoid and ethmoid sinuses. The remaining paranasal sinuses, mastoid
air cells, and middle ear cavities are clear. The orbits are unremarkable.
IMPRESSION:
1. No evidence of hemorrhage or infarct.
2. Osseous findings compatible the history of sickle cell disease.
|
19900981-RR-56
| 19,900,981 | 22,451,108 |
RR
| 56 |
2169-10-24 17:19:00
|
2169-10-24 17:46:00
|
EXAMINATION: DX THORACIC AND LUMBAR SPINES
INDICATION: ___ M with PMH of sickle cell disease complicated by sickling
crises including NSTEMI x2, priaprism, presented with recurrence of low back
pain, likely secondary to vasooclusive crisis from underlying sickle cell
disease. // back pain, ? fracture
TECHNIQUE: Thoracic, lumbar spine, two views each.
COMPARISON: ___
FINDINGS:
Stable chronic changes of sickle cell disease. Bilateral femoral head AVN,
stable. No new compression fractures. Surgical clips right upper quadrant.
Large volume stool in the colon. Stable calcifications right pelvis.
Increased heart size, improved since prior.
IMPRESSION:
No radiographic evidence of interval fracture
|
19900981-RR-58
| 19,900,981 | 25,565,157 |
RR
| 58 |
2169-10-29 09:29:00
|
2169-10-29 10:08:00
|
INDICATION: ___ with elevated wbc. fever // eval for pna
TECHNIQUE: Single portable view of the chest.
COMPARISON: ___.
FINDINGS:
There is faint retrocardiac opacity focally silhouetting the hemidiaphragm.
Elsewhere, the lungs are grossly clear. The cardiac silhouette is top-normal.
No acute osseous abnormalities. Increased sclerosis at the bilateral humeral
heads is likely due to avascular necrosis. H-shaped vertebral bodies are
again noted. Surgical clips in the right upper quadrant suggest prior
cholecystectomy.
IMPRESSION:
Very slight retrocardiac opacity which is potentially atelectasis. If
persistent clinical concern, consider PA and lateral for further
characterization.
|
19900981-RR-59
| 19,900,981 | 25,565,157 |
RR
| 59 |
2169-10-29 12:20:00
|
2169-10-29 13:43:00
|
INDICATION: ___ with abd pain, wbc 25 // eval for abscess, infection
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired
through the abdomen and pelvis following intravenous contrast administration
with split bolus technique.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Stationary Acquisition 6.0 s, 0.5 cm; CTDIvol = 28.9 mGy (Body) DLP =
14.4 mGy-cm.
2) Spiral Acquisition 4.4 s, 48.0 cm; CTDIvol = 5.9 mGy (Body) DLP = 284.3
mGy-cm.
Total DLP (Body) = 299 mGy-cm.
COMPARISON: CTA chest ___
FINDINGS:
LOWER CHEST: There is mild right basilar atelectasis. Mild
peribronchovascular opacity in the left lower lobe could represent atelectasis
or early infection. There is trace left pleural effusion. No pericardial
effusion.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There is no evidence of focal lesions. There is no evidence of intrahepatic
or extrahepatic biliary dilatation. The gallbladder is surgically absent.
Nonspecific calcifications in the right abdomen and pelvis (02:36 and 67) are
indeterminate. There is no prior imaging available to establish chronicity.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: There is a small calcified spleen in the left upper quadrant,
compatible with auto infarction.
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 suspicious renal lesions or hydronephrosis. Ovoid
hypodensities in the kidneys bilaterally likely represent simple cysts. There
is no perinephric abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. There is
significant wall edema of the distal transverse and proximal descending colon.
The colon and rectum are otherwise 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: 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.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
Bone marrow changes with increased sclerosis are likely due to prior infarcts.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. Wall thickening of the colon in the region of the splenic flexure, a
watershed area, is concerning for colitis. While ischemic colitis would be
unusual in a patient of this age, sickle cell disease makes this a
possibility. Infectious causes for colitis are also possible.
2. Mild peribronchovascular opacity in the left lower lobe could represent
atelectasis or early infection.
|
19900981-RR-66
| 19,900,981 | 24,317,150 |
RR
| 66 |
2171-05-26 02:07:00
|
2171-05-26 02:43:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: History: ___ with pain// ?acute chest
COMPARISON: Multiple prior chest radiographs with the most recent dated ___
FINDINGS:
PA and lateral views of the chest provided.
There is no focal consolidation, effusion, or pneumothorax. The
cardiomediastinal silhouette is unchanged with moderate cardiomegaly.
Multilevel chronic thoracic spine deformity is re-demonstrated and may relate
to known history of sickle cell disease.
IMPRESSION:
1. No acute intrathoracic process.
2. Stable moderate cardiomegaly.
|
19900981-RR-67
| 19,900,981 | 24,317,150 |
RR
| 67 |
2171-05-26 11:22:00
|
2171-05-26 11:42:00
|
INDICATION: ___ year old man with picc// r dl picc 41cm iv ping ___
Contact name: ping, ___: ___
COMPARISON: Radiographs from ___
IMPRESSION:
There is a new right-sided PICC line with distal tip in the proximal right
atrium/cavoatrial junction. Heart size is within normal limits. There is
minimal bibasilar atelectasis. There are no pneumothoraces.
|
19900981-RR-68
| 19,900,981 | 24,317,150 |
RR
| 68 |
2171-05-27 03:45:00
|
2171-05-27 09:48:00
|
INDICATION: ___ year old man with acute sickle cell pain crisis.// Evaluate
for interval change, acute chest syndrome.
COMPARISON: Radiographs from ___
IMPRESSION:
There is a right-sided PICC line with the distal tip at the cavoatrial
junction. Heart size is prominent but stable. There are no focal
consolidations, pleural effusion, or pulmonary edema. There are no
pneumothoraces.
|
19900981-RR-69
| 19,900,981 | 24,317,150 |
RR
| 69 |
2171-05-28 05:07:00
|
2171-05-28 09:42:00
|
INDICATION: ___ year old man with sickle cell disease, pain crisis.// Evaluate
for acute chest syndrome.
TECHNIQUE: Portable AP radiograph of the chest.
COMPARISON: Radiograph of the chest performed 1 day prior
FINDINGS:
Moderate cardiomegaly is unchanged compared to the prior exam. Hilar and
mediastinal contours are stable. There appears to be subtle increased opacity
at the right lung base. There is no large pleural effusion or pneumothorax.
Visualized osseous structures are grossly unremarkable.
IMPRESSION:
Subtle increase in opacity seen at the right lung base, which could be
secondary to an infectious process.
|
19900981-RR-70
| 19,900,981 | 24,317,150 |
RR
| 70 |
2171-05-28 23:39:00
|
2171-05-29 07:57:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with sickle cell, c/f acute chest syndrome.//
?any infiltrations?
IMPRESSION:
In comparison with the study ___, the there is little change.
Continued enlargement of the cardiac silhouette with indistinctness of
pulmonary vessels consistent with elevated pulmonary venous pressure.
Retrocardiac opacification with obscuration of the hemidiaphragm is consistent
with substantial volume loss in the left lower lobe and probable pleural
effusion. There is probably also a small effusion at the right base.
Although no focal consolidation is identified, given the changes described
above would be extremely difficult to exclude superimposed
aspiration/pneumonia in the appropriate clinical setting, especially in the
absence of a lateral view.
|
19900981-RR-71
| 19,900,981 | 24,317,150 |
RR
| 71 |
2171-05-29 23:02:00
|
2171-05-30 01:37:00
|
EXAMINATION: CTA CHEST
INDICATION: Mr. ___ is a ___ year old gentleman with SCD (not on
hydroxyurea) c/b NSTEMI, priapism and frequent pain crises who presented to
the ED with low and mid back pain consistent with acute pain crisis now with
chest pain and hypoxemia// Rule out PE and evaluate for lobar infiltrate that
would suggest acute chest pain sx
TECHNIQUE: Axial multidetector CT images were obtained through the thorax
after the uneventful administration of intravenous contrast.
Reformatted coronal, sagittal, thin slice axial images, and oblique maximal
intensity projection images were submitted to PACS and reviewed.
DOSE: Acquisition sequence:
1) Spiral Acquisition 2.0 s, 26.9 cm; CTDIvol = 5.4 mGy (Body) DLP = 146.0
mGy-cm.
2) Stationary Acquisition 0.6 s, 0.5 cm; CTDIvol = 3.0 mGy (Body) DLP = 1.5
mGy-cm.
3) Stationary Acquisition 1.8 s, 0.5 cm; CTDIvol = 9.1 mGy (Body) DLP = 4.5
mGy-cm.
Total DLP (Body) = 152 mGy-cm.
COMPARISON: CT dated ___
FINDINGS:
HEART/VASCULATURE:
Assessment of the pulmonary vasculature is partially degraded by motion
artifact. The pulmonary arteries are well opacified to the segmental level
with no evidence of filling defect within the main, right, left, lobar or
segmental pulmonary arteries. Subsegmental arteries are inadequately
assessed. The main and right pulmonary arteries are normal in caliber.
The aorta and its major branch vessels are patent, with no evidence of
stenosis, occlusion, dissection, or aneurysmal formation. No other acute
aortic abnormality or significant aortic atherosclerosis evident.
There is moderate global cardiomegaly. There is no evidence of right
ventricular strain. There is no pericardial effusion.
AIRWAYS/LUNGS:
The airways are patent to the subsegmental level.
Lung apices are excluded from the field of view. There is opacification of
the lung parenchyma in the of lower lobes bilaterally which demonstrate
adequate enhancement. There is small bilateral pleural effusions.
MEDIASTINUM/LYMPH NODES:
No mediastinal, or hilar lymphadenopathy. No other mediastinal abnormality.
BONES/CHEST WALL:
Note is again made of H-shaped vertebral bodies and patchy sclerosis
throughout the vertebra, sternum and bilateral ribs in keeping with history of
sickle cell disease. There is no destructive bone lesion.
UPPER ABDOMEN:
Limited images of the upper abdomen demonstrates hepatomegaly and absence of
the spleen consistent with sickle cell disease.
IMPRESSION:
1. No evidence of pulmonary embolism in the main, right, left, lobar or
segmental pulmonary arteries.
2. Small bilateral pleural effusions.
3. Opacification of the lung parenchyma in the lower lobes may be secondary to
compressive atelectasis although acute chest syndrome cannot be excluded.
4. Global cardiomegaly, bony sclerosis, H-shaped vertebral bodies and absence
of the spleen consistent with sequela of sickle cell disease.
|
19900981-RR-72
| 19,900,981 | 24,317,150 |
RR
| 72 |
2171-06-01 10:28:00
|
2171-06-01 11:54:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: Mr. ___ is a ___ year old gentleman with SCD (not on hydroxyurea
given personal preference) c/b NSTEMI, priapism and frequent pain crises who
presented to the ED with low and mid back pain consistent with acute pain
crisis requiring ICU admission for SVT to 160s and Ketamine gtt. Called out
to floor ___ overnight, now with pleuritic chest pain diagnosed with acute
chest of moderate severity.// Worsening chest pain. Assess interval
COMPARISON: Chest radiograph ___.
FINDINGS:
PA and lateral views of the chest provided.
Right-sided PICC terminates overlying the superior cavoatrial junction. Right
lower lobe consolidation is worse as compared to chest CT head ___.
Small bilateral pleural effusions are mildly increased in size.. Mild
cardiomegaly is unchanged.
IMPRESSION:
1. Right lower lobe opacity appears worse as compared to chest CT ___
and could represent atelectasis or infection
2. Small bilateral pleural effusions are increased in size.
|
19901190-RR-14
| 19,901,190 | 22,988,121 |
RR
| 14 |
2147-02-20 20:29:00
|
2147-02-20 21:45:00
|
HISTORY: ___ female with bloody diarrhea.
COMPARISON: None available
TECHNIQUE: Axial helical MDCT images were obtained from the lung bases to the
pubic symphysis after administration of IV and oral contrast. Coronal and
sagittal reformations were generated.
DLP: 916 mGy-cm
FINDINGS:
The lung bases are clear and the visualized heart and pericardium are
unremarkable.
CT ABDOMEN: There is concentric wall thickening of the descending colon from
the splenic flexure to the proximal sigmoid with mild pericolonic stranding
compatible with colitis. Some diverticuli are seen but there is no evidence of
diverticulitis. There is no fluid collection or intra-abdominal free air to
suggest perforation. No pneumatosis intestinalis is seen.
The liver enhances homogeneously, without focal lesions or intrahepatic
biliary duct dilatation. The gallbladder is unremarkable and the portal vein
is patent. The pancreas, spleen, adrenal glands are within normal limits.
The kidneys show symmetric nephrograms and excretion of contrast. A single sub
cm hypodensity in the right kidney is too small to characterize but likely a
simple cyst. There is no solid focal renal lesion or hydronephrosis
bilaterally.
The small bowel is within normal limits without evidence of wall thickening or
dilatation to suggest obstruction. The appendix is visualized and is not
inflamed. The aorta and its main branches are patent and nonaneurysmal.
There is no mesenteric or retroperitoneal lymph node enlargement by CT size
criteria. There is no ascites, abdominal free air or abdominal wall hernia.
CT PELVIS: The urinary bladder and ureters are unremarkable. There is no
pelvic wall or inguinal lymphadenopathy. No pelvic free fluid is observed.
OSSEOUS STRUCTURES: There are no lytic or blastic lesions concerning for
malignancy.
IMPRESSION:
Colitis involving primarily the descending colon and proximal sigmoid colon,
likely infectious or inflammatory in etiology. Ischemic colitis is much less
likely given the extent of inflammation.
Changes to the wet read were communicated to Dr ___ by Dr ___ on
___ at 10:55 pm via telephone.
|
19901288-RR-20
| 19,901,288 | 24,808,650 |
RR
| 20 |
2139-01-10 16:43:00
|
2139-01-10 17:30:00
|
EXAMINATION: Chest x-ray
INDICATION: preop// preop Surg: ___ (knee washout)
TECHNIQUE: Series of 2 portable chest x-ray
COMPARISON: Previous chest x-ray from ___
FINDINGS:
Previous chest x-ray from ___ there is no focal infiltrate or
effusion. The cardiac silhouette and mediastinal structures are within normal
limits. The trachea is midline and both hemidiaphragms are well rounded.
IMPRESSION:
No focal consolidation.
|
19901288-RR-22
| 19,901,288 | 24,808,650 |
RR
| 22 |
2139-01-12 15:01:00
|
2139-01-12 15:47:00
|
EXAMINATION: DX CHEST PORTABLE PICC LINE PLACEMENT
INDICATION: ___ year old man with new R PICC// R SL Power PICC 45cm ___
___ Contact name: ___: ___
IMPRESSION:
In comparison with study of ___, there has been placement of right
subclavian PICC line that extends to the midportion of the SVC.
Continued enlargement of the cardiac silhouette. The pulmonary markings are
less distinct, raising the possibility of increasing pulmonary vascular
congestion. No evidence of acute focal pneumonia.
|
19901341-RR-32
| 19,901,341 | 24,456,392 |
RR
| 32 |
2166-10-27 18:01:00
|
2166-10-27 19:43:00
|
HISTORY: ___ female with fall last week with subdural hematoma, right
parietal fracture with reported changes in mental status. Evaluate for acute
component of subdural hematoma.
TECHNIQUE: Contiguous axial MDCT images were obtained through the brain
without the use of IV contrast material. Reformatted coronal and sagittal and
thin section bone algorithm reconstructed images were obtained.
COMPARISONS: None available.
FINDINGS: There is also an intraparenchymal area of hemorrhage with
surrounding edema, which could represent a hemorrhagic contusion, within the
left temporal lobe (2:11,601b:42). There is a fluid-fluid level along the
posterior aspecte of the extensive intraparenchymal hematom. There is also a
small subdural hematoma seen along the left tentorium (60___:74). There is
also subarachnoid blood with a small component of subdural hematoma seen along
the left frontal convexity (2:12, 602b:55).
There is no evidence of shift of midline structures, and there is preservation
of normal gray-white matter differentiation. The ventricles and sulci are
appropriate in size for age. The basal cisterns appear patent.
No fracture is identified. Mild fluid is seen within the left maxillary sinus
(3:1) and the other visualized paranasal sinuses and mastoid air cells are
unremarkable. Soft tissue irregularity is seen along the right frontoparietal
region (3:43). The globes are unremarkable.
IMPRESSION:
1. Intraparenchymal hemorrhage with surrounding edema is seen within the left
temporal lobe. This could represent hemorrhagic contusion in the appropriate
clinical context. However, an underlying mass lesion cannot be excluded if
clinical history does not corroborate mechanism of injury.
2. Small amount of subdural hematoma with subarachnoid hemorrhage seen along
the left frontal convexity. Subdural hematoma seen also along the left
tentorium. No evidence of mass effect.
The possibility of coagulopathy should also be considered clinically;
sometimes a fluid-fluid level, such as seen in the temporal lobe on this study
can be seen with very recent or ongoing bleeding, or in the setting of
coagulopathy. Correlation with prior studies is recommended and with
mechanism and any potential risk factors for coagulopathy.
The final report was discussed with Dr. ___ on ___ at 6 pm.
|
19901341-RR-69
| 19,901,341 | 23,906,609 |
RR
| 69 |
2169-08-06 10:31:00
|
2169-08-06 11:52:00
|
EXAMINATION: CT urogram
INDICATION: ___ with left flank pain, history of CKD, kidney stones,
malnutrition, family history of Lynch syndrome.
TECHNIQUE: Multidetector CT through the abdomen pelvis performed without
contrast. Patient scanned in the supine position with multiplanar
reformations provided.
DOSE: Total DLP (Body) = 169 mGy-cm.
COMPARISON: Renal ultrasound from ___ as well as a CT abdomen
pelvis from ___.
FINDINGS:
LOWER CHEST: Lung bases are hyperinflated and clear.
ABDOMEN: The unenhanced appearance of the liver, spleen, and both adrenals is
normal. Multiple parenchymal calcifications are noted within the uncinate
process of the pancreas. Calcified portacaval lymph nodes noted. Bilateral
kidney stones are noted, measuring up to 17 mm on the right and 11 mm on the
left. In addition, note is again made of medullary nephrocalcinosis. No
hydronephrosis or hydroureter is seen. No definite stone is seen along the
course of either ureter. A punctate calcific density in the region of the
left UVJ on series 2, image 65 appears more suggestive of a phlebolith given
its appearance on the sagittal reformats.
The stomach and duodenum appear normal. There is no free air or free fluid.
No definite adenopathy is seen. There is calcification along the abdominal
aorta which is moderate without aneurysmal dilation. No retroperitoneal
hematoma.
PELVIS: Loops of small bowel demonstrate no signs of ileus or obstruction. A
candidate for a normal appendix is seen on series 601b, image 21. Fecal
loading is notable in the rectum. Otherwise the colon is unremarkable. The
uterus is atrophic. No adnexal mass is seen. Urinary bladder is partially
distended appearing normal. No pelvic sidewall or inguinal adenopathy.
BONES: No worrisome bony lesion. Bones appears diffusely demineralized.
There is subtle contour abnormality and sclerosis involving the mid sacrum,
seen on series 602b, image 31, new from prior though appears healed, likely
representing an interval injury. Bilateral L5 pars defects noted without
associated listhesis. Chronic bilateral rib deformities noted.
SOFT TISSUES: Cachectic appearance of the soft tissues of the body wall is
consistent with known history of anorexia.
IMPRESSION:
1. Bilateral nonobstructing kidney stones and evidence of medullary
nephrocalcinosis without hydronephrosis or obstructing ureteral stone.
2. Pancreatic calcification involving the uncinate process may reflect chronic
pancreatitis.
3. Osteopenia with healed sacral and lower rib fractures.
4. Atrophic body wall consistent with provided history of anorexia.
|
19901341-RR-70
| 19,901,341 | 23,906,609 |
RR
| 70 |
2169-08-07 15:53:00
|
2169-08-07 17:00:00
|
EXAMINATION: Chest radiograph
INDICATION: ___ year old woman with dophoff placement- part 1 of 2 //
confirmation of dophoff placement (step 1 of 2 step procedure)
TECHNIQUE: Portable semi upright view of the chest
COMPARISON: Chest radiograph from ___
FINDINGS:
A Dobhoff tube is seen terminating in the left-sided stomach. The lungs
appear grossly clear without evidence of focal consolidation. There is no
pulmonary edema, pneumothorax, or pleural effusion. The cardiomediastinal
silhouette hilar contours are unchanged.
IMPRESSION:
Dobhoff tube is seen terminating in the left-sided stomach.
|
19901341-RR-71
| 19,901,341 | 23,906,609 |
RR
| 71 |
2169-08-10 14:57:00
|
2169-08-10 16:03:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with anorexia, needs Dobhoff // Need a 2 step
CXR for Dobhoff placement. Thank you! Need a 2 step CXR for Dobhoff
placement. Thank you!
IMPRESSION:
In comparison with study of ___, the tip of the Dobhoff tube is in the
fundus of the stomach. Otherwise, little change and no evidence of acute
cardiopulmonary disease.
|
19901341-RR-72
| 19,901,341 | 23,906,609 |
RR
| 72 |
2169-08-13 08:59:00
|
2169-08-13 10:06:00
|
EXAMINATION: Chest radiograph
INDICATION: ___ year old woman with anorexia // assess positioning DHTube
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest radiograph from ___, ___, ___
FINDINGS:
A Dobhoff tube is seen terminating in the left-sided stomach. Surgical clips
are noted in the right upper quadrant. The lungs otherwise appear clear
without evidence of focal consolidation. There is no pulmonary edema,
pneumothorax, or pleural effusion. The cardiomediastinal silhouette and hilar
contours appear normal.
IMPRESSION:
Dobhoff tube is seen terminating in the left-sided stomach.
|
19901341-RR-73
| 19,901,341 | 23,906,609 |
RR
| 73 |
2169-08-22 13:21:00
|
2169-08-22 14:54:00
|
EXAMINATION: Chest radiograph
INDICATION: ___ year old woman with malnutrition // dobhoff tube placement
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest radiograph from ___
FINDINGS:
A Dobhoff tube is seen in the left stomach. The lungs appear clear without
focal consolidation. There is no pulmonary edema, pneumothorax, or pleural
effusion. The cardiomediastinal silhouette and hilar contours appear normal.
There is diffuse regular thickening of the small bowel loops in the visualized
upper abdomen, which can be seen in hypoproteinemia. There is paucity of soft
tissues/fat, possibly due to malnutrition.
IMPRESSION:
The Dobhoff tube is seen in the left stomach.
|
19901341-RR-74
| 19,901,341 | 23,906,609 |
RR
| 74 |
2169-08-25 12:59:00
|
2169-08-25 18:47:00
|
INDICATION: ___ year old woman with anorexia, bulimia w/ hx of laxative abuse;
here on eating disorder protocol; currently on bolus tube feeds; c/o abdominal
fullness, no BMs; abd exam is relatively benign, looking to assess stool
burden // ? evidence of severe constipation
TECHNIQUE: Supine abdominal radiographs were obtained.
COMPARISON: CT abdomen and pelvis performed ___.
FINDINGS:
A feeding tube is noted with tip projecting over the distal stomach. Stool is
noted in the colon. Stippled calcifications noted in the right upper quadrant
is consistent with pancreatic head calcifications seen on prior CT.
Assessment for intraperitoneal free air is limited given supine technique.
Osseous structures are unremarkable.
There are no unexplained soft tissue calcifications. Surgical clips in the
right upper quadrant.
Visualized lung bases are clear.
IMPRESSION:
Stool is noted in the colon.
|
19901341-RR-75
| 19,901,341 | 23,906,609 |
RR
| 75 |
2169-08-29 18:28:00
|
2169-08-29 19:35:00
|
INDICATION: ___ year old woman with anorexia. Just placed new dobhoff, last
was clogged.// ? dobhoff in place
TECHNIQUE: Portable supine abdominal radiograph was obtained.
COMPARISON: ___
FINDINGS:
There are no abnormally dilated loops of large or small bowel in the
visualized upper abdomen. The tip of the Dobhoff projects over the stomach.
The supine view precludes assessment for free intraperitoneal gas. Surgical
clips project over the right upper quadrant as do calcification consistent
with pancreatic head calcifications.
The osseous structures are unremarkable. No focal consolidation or pleural
effusion is identified within the lung.
IMPRESSION:
The tip of the Dobhoff projects over the stomach.
|
19901661-RR-15
| 19,901,661 | 29,337,046 |
RR
| 15 |
2179-04-10 14:47:00
|
2179-04-10 14:56:00
|
INDICATION: History: ___ with abdominal pain, ulcerative colitis
TECHNIQUE: Upright and supine AP views of the abdomen
COMPARISON: None.
FINDINGS:
The bowel gas pattern is normal. No dilated loops of small bowel, free
intraperitoneal air, or differential air-fluid levels are noted. No
pneumatosis is seen. There are no soft tissue calcifications. The osseous
structures are normal.
IMPRESSION:
No evidence of bowel obstruction or free intraperitoneal air.
|
19901866-RR-19
| 19,901,866 | 25,036,286 |
RR
| 19 |
2191-04-17 19:54:00
|
2191-04-17 21:49:00
|
HISTORY: ___ male with back and chest pain.
COMPARISON: None.
FINDINGS:
PA and lateral views of the chest. The lungs are clear of focal
consolidation. Cardiomediastinal silhouette is within normal limits. No
acute osseous abnormalities detected.
IMPRESSION:
No acute cardiopulmonary process.
|
19901866-RR-20
| 19,901,866 | 25,036,286 |
RR
| 20 |
2191-04-17 19:55:00
|
2191-04-17 21:31:00
|
HISTORY: Prior history of pulmonary embolus with current EKG findings
concerning for repeat PE.
COMPARISON: None available.
TECHNIQUE: Axial helical MDCT images were obtained of the chest after the
administration of IV contrast in the arterial phase. Multiplanar reformatted
images were generated in the coronal and sagittal planes as well as bilateral
maximum intensity projection oblique images.
DLP: 306.53 mGy-cm.
FINDINGS:
CT CHEST: The imaged portion of the thyroid is unremarkable in appearance.
Heart size is top normal without pericardial effusion. The thoracic aortic
arch is normal in caliber without aneurysm or dissection although tortuous.
Incidental note of bovine aortic arch anatomy and the left vertebral artery
arising directly from the aorta. The main pulmonary artery is normal in
caliber, and there is no pulmonary embolus to the segmental level. There is
no supraclavicular, axillary, hilar or mediastinal lymphadenopathy by CT size
criteria.
This study is not tailored for subdiaphragmatic diagnosis; however, the
visualized upper abdomen is grossly unremarkable.
The airways are patent to the subsegmental level. Bibasilar atelectasis is
small. Lungs are clear without nodule or focal consolidation. Pleural
surfaces are clear without effusion or pneumothorax.
OSSEOUS STRUCTURES: There are no focal blastic or lytic lesions in the
visualized osseous structures concerning for malignancy.
IMPRESSION: No acute aortic pathology or pulmonary embolus.
|
19901886-RR-18
| 19,901,886 | 27,911,354 |
RR
| 18 |
2148-06-09 01:19:00
|
2148-06-09 04:19:00
|
HISTORY: ___ male with dementia, s/p unwitnessed fall, transferred
from another hospital secondary to concern for a new focus of petechial
hemorrhage. Assess for interval change.
COMPARISON: Non-contrast head CT dated ___ from ___
___.
TECHNIQUE: ___ MDCT axial images of the brain were obtained without
intravenous contrast. Coronal and sagittal reformations were prepared.
NON-CONTRAST HEAD CT: There is a large area of encephalomalacia in the left
superior MCA territory, suggesting a prior infarction. The CT scan from ___
___ demonstrates a 4 mm hyperdense focus along the periphery of the
encephalomalacia, at the level of the parietal lobe, likely subdural in
location. On the current study, this focus is almost isodense to the brain
(2:20 and 601:55). There is no new hemorrhage. There is no pathologic
extraaxial collection. There is no mass effect or edema in the brain.
Extensive hypoattenuation in the subcortical, deep and periventricular white
matter of the cerebral hemispheres is likely sequela of chronic small vessel
ischemic disease. Severe enlargement of the ventricles and sulci is
consistent with advanced cerebral atrophy. Dense arterial calcifications are
noted.
There is no fracture. The visualized paranasal sinuses and mastoid air cells
are well aerated.
IMPRESSION: 4 mm focus of resolving blood products along the periphery of
encephalomalacia in the superior left MCA territory, likely subdural in
location. No new hemorrhage. No mass effect.
Findings discussed with Dr. ___ at 8:40 am on ___ by Dr. ___.
|
19901886-RR-19
| 19,901,886 | 27,911,354 |
RR
| 19 |
2148-06-09 08:50:00
|
2148-06-09 09:54:00
|
INDICATION: Evaluate for signs of pneumonia in patient with advanced dementia
and syncope.
COMPARISON: None available.
FINDINGS: PA and lateral radiographs of the chest are somewhat technically
limited, especially the lateral view. The lungs are clear and aside from
aortic tortuosity, the hilar and cardiomediastinal contours are normal. There
is no pneumothorax or pleural effusion, and the pulmonary vascularity is
normal, without edema. Median sternotomy cerclage wires are intact.
IMPRESSION: No evidence of pneumonia.
|
19902204-RR-19
| 19,902,204 | 29,874,966 |
RR
| 19 |
2156-09-15 06:40:00
|
2156-09-15 06:59:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: History: ___ with CHF and multiple prior pleural effusion//
assessment of effusion?
TECHNIQUE: Portable AP chest
COMPARISON: Chest radiograph from ___. Chest CT from ___.
FINDINGS:
Compared to ___, lung volumes are reduced. The cardiac silhouette
is enlarged. There is a large right pleural effusion, increased from prior.
A small left pleural effusion is again seen. There is volume loss at the
bases. There is pulmonary vascular redistribution.
IMPRESSION:
1. Large right and small left pleural effusions.
2. Compared to ___, increased cardiomegaly and increased right
effusion
|
19902204-RR-20
| 19,902,204 | 29,874,966 |
RR
| 20 |
2156-09-20 11:37:00
|
2156-09-20 12:53:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with CHF, bilat pleural effusions, s/p 10lb
diuresis, monitoring status of pulm edema and effusions.// ___ year old man
with CHF, bilat pleural effusions, s/p 10lb diuresis, monitoring status of
pulm edema and effusions. ___ year old man with CHF, bilat pleural
effusions, s/p 10lb diuresis, monitoring status of pulm edema and effusions.
IMPRESSION:
Comparison to ___. The extent of the right pleural effusion has
minimally decreased. Stable minimal left pleural effusion. Both the right
and the left lung basis show proportional areas of atelectasis. Moderate
cardiomegaly without pulmonary edema persists.
|
19902376-RR-26
| 19,902,376 | 29,059,273 |
RR
| 26 |
2127-09-13 14:56:00
|
2127-09-13 17:44:00
|
EXAMINATION: Abdominal radiograph
INDICATION: ___ year old woman with GIB s/p capsule endoscopy though record
seems stuck in stomach // Assess location of capsule
TECHNIQUE: Abdominal radiograph, supine and erect
COMPARISON: CT abdomen and pelvis ___
FINDINGS:
There is a mild left retrocardiac opacity, likely representing atelectasis. No
evidence of subdiaphragmatic free air. The bowel gas pattern is unremarkable,
with no evidence of obstruction. The endoscopy capsule is located in the
ascending colon. Suture lines are noted in the right lateral abdomen. An
intrauterine device is noted. No acute osseous abnormalities.
IMPRESSION:
Endoscopy capsule within the ascending colon.
|
19902511-RR-20
| 19,902,511 | 21,360,377 |
RR
| 20 |
2168-02-02 23:21:00
|
2168-02-03 08:48:00
|
BILATERAL TIBIA AND FIBULA RADIOGRAPHS
CLINICAL INDICATION: ___ male, status post fall.
TECHNIQUE: AP and lateral radiographs of bilateral lower legs were obtained.
COMPARISON: None.
FINDINGS:
RIGHT LOWER LEG: There is a highly comminuted fracture of the calcaneus.
This is best assessed on the same day CT. The ankle mortise is congruent.
There is a joint effusion posteriorly at the tibiotalar joint.
LEFT LOWER EXTREMITY: There is partial visualization of a posterior malleolar
fracture demonstrating mild posterior displacement. An obliquely oriented
distal fibular fracture is also seen. No fractures are seen within the
proximal tibia or fibula.
IMPRESSION:
1. Partial visualization of left posterior malleolar fracture and distal
fibular fracture.
2. Highly comminuted fracture of right calcaneus.
|
19902511-RR-21
| 19,902,511 | 21,360,377 |
RR
| 21 |
2168-02-02 23:21:00
|
2168-02-03 08:48:00
|
LEFT FOOT RADIOGRAPH
CLINICAL INDICATION: ___ male status post fall.
TECHNIQUE: AP, lateral, and oblique radiographs of the left foot were
obtained.
COMPARISON: None.
FINDINGS:
There is a fracture of the posterior malleolus with mild posterior
displacement of the fracture fragment. Additionally, there is fracture of the
distal fibula that is obliquely oriented. A transversely oriented fracture at
the base of the second metatarsal as well as the distal third metatarsal is
noted. There appears to be good alignment of the second metatarsal base upon
the middle cuneiform. Dorsal soft tissue swelling is present.
IMPRESSION: Posterior malleolar, distal fibular, second metatarsal base, and
third metatarsal neck fractures noted within the left foot with soft tissue
swelling. If there is clinical concern for a Lisfranc injury, weight bearing
views or MRI may be performed.
These findings were communicated via telephone to Dr. ___ by Dr. ___ at
7:37 a.m. on ___.
|
19902511-RR-22
| 19,902,511 | 21,360,377 |
RR
| 22 |
2168-02-02 23:39:00
|
2168-02-03 08:35:00
|
INDICATION: Status post fall with calcaneal fracture, grade heel fracture on
right.
TECHNIQUE: Axial MDCT images were acquired through the right ankle and foot
without intravenous contrast. Coronal and sagittal reformats were produced
and reviewed.
COMPARISON: Right ankle radiographs, ___.
FINDINGS:
There is a comminuted fracture of the calcaneus. Three separate fracture
lines are identified passing into the posterior facet of the subtalar joint
consistent with ___ grade 4 fracture. The largest intra-articular gap
measures approximately 3 mm (500:13). In addition, there is a fracture line
extends to the base of the sustentaculum tali. There is a fracture of the
anterior process of the talus which extends into the calcaneocuboid
articulation. No additional fractures are seen. The ankle mortise is
congruent. There is a well-corticated bony fragment adjacent to the medial
malleolus (2:62), suggestive of an old avulsion injury. Incidental note is
made of an os trigonum and an accessory navicular bone. Mild diffuse
subcutaneous edema. No joint effusion can be appreciated. The fat in the
sinus tarsi is preserved. Visualized tendons about the ankle are unremarkable
in appearance. Specifically, no entrapped tendons seen.
IMPRESSION:
___ grade 4 fracture of the calcaneus with involvement of the posterior
and anterior facets of the calcaneus. A vertically oriented fracture extends
through the base of the sustentaculum tali.
|
19902511-RR-23
| 19,902,511 | 21,360,377 |
RR
| 23 |
2168-02-03 00:41:00
|
2168-02-03 08:48:00
|
LEFT ANKLE RADIOGRAPH
CLINICAL INDICATION: ___ male status post reduction of fractures.
TECHNIQUE: AP, lateral, and oblique radiographs of the left ankle were
obtained.
COMPARISON: Left foot radiography dated earlier the same day.
FINDINGS:
There has been placement of overlying cast which obscures fine bony detail.
Allowing for this, posterior malleolar and distal fibular fractures are again
noted. There is slight widening of the medial ankle mortise.
The fracture at the base of the second metatarsal is noted. Soft tissue
swelling is present.
IMPRESSION: Status post cast placement over left ankle with fracture lines at
the distal fibula and posterior malleolus. Slight widening of the medial
ankle mortise.
|
19902684-RR-23
| 19,902,684 | 23,141,738 |
RR
| 23 |
2148-11-23 00:04:00
|
2148-11-23 00:30:00
|
EXAMINATION: Chest radiograph
INDICATION: ___ with hypoxia, dyspnea// Eval for CHF
TECHNIQUE: AP frontal view of the chest
COMPARISON: None available
FINDINGS:
Lung volumes are low. There is moderate pulmonary edema. There is mild
cardiomegaly. There is a small bilateral pleural effusion. There is no
pneumothorax. There is no free air underneath the diaphragm.
IMPRESSION:
Moderate pulmonary edema and mild cardiomegaly.
|
19902684-RR-24
| 19,902,684 | 23,141,738 |
RR
| 24 |
2148-11-23 07:37:00
|
2148-11-23 08:37:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with shortness of breath// ?interval change in
pulmonary edema ?interval change in pulmonary edema
IMPRESSION:
Comparison to ___. Substantial decrease in severity of the
pre-existing pulmonary edema that is now mild to moderate in severity.
Moderate cardiomegaly. Low lung volumes persist. Mild bilateral basilar
atelectasis.
|
19902684-RR-25
| 19,902,684 | 23,141,738 |
RR
| 25 |
2148-11-25 15:46:00
|
2148-11-25 16:06:00
|
INDICATION: ___ year old woman with three vessel disease// CABG work up
TECHNIQUE: Chest PA and lateral
COMPARISON: ___
FINDINGS:
There is no focal consolidation, pleural effusion or pneumothorax identified.
Mild bibasilar atelectasis. Vascular redistribution without overt pulmonary
edema. The size of the cardiac silhouette is enlarged but unchanged.
IMPRESSION:
Mild bibasilar atelectasis.
|
19902687-RR-23
| 19,902,687 | 22,802,020 |
RR
| 23 |
2137-11-16 09:24:00
|
2137-11-16 12:11:00
|
EXAMINATION: CT abdomen pelvis with intravenous contrast
INDICATION: ___ female with history early gastric bypass and
abdominal pain. Evaluate for complication of bypass, colitis, or
diverticulitis.
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired
through the abdomen and pelvis following intravenous contrast administration
with split bolus technique.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Total DLP (Body) = 802 mGy-cm.
COMPARISON: CT abdomen and pelvis ___
FINDINGS:
LOWER CHEST: Visualized lung fields are within normal limits. There is no
evidence of pleural or pericardial effusion.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
There is no evidence of focal lesions. There is no evidence of intrahepatic
or extrahepatic biliary dilatation. The gallbladder is within normal limits.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
There is no evidence of focal renal lesions or hydronephrosis. There is no
perinephric abnormality.
GASTROINTESTINAL: Status post sleeve gastrectomy. Remnant stomach is
unremarkable. There is wall thickening and wall edema of nondilated distal
ileal loops and terminal ileum in the right lower quadrant (series 2:40).
There is no bowel obstruction. The colon and rectum are within normal limits.
Appendix not visualized.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: Intrauterine device is appropriately positioned. The
uterus and bilateral adnexa are otherwise unremarkable.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease
is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: Subcutaneous soft tissue densities in the bilateral gluteal
regions are unchanged from ___ likely from prior silicone
injections. Hernia mesh is noted beneath the anterior upper abdominal wall.
IMPRESSION:
1. Wall thickening and edema of distal ileal loops and terminal ileum in the
right lower quadrant, compatible with infectious or inflammatory enteritis.
No bowel obstruction.
2. Status post sleeve gastrectomy without evidence of complication.
|
19902687-RR-24
| 19,902,687 | 22,802,020 |
RR
| 24 |
2137-11-16 23:19:00
|
2137-11-17 10:18:00
|
EXAMINATION: Chest radiograph
INDICATION: ___ year old woman with gastroenteritis, hx gastric sleeve. Now
hypotensive. Hx cough over past several days.// Cardiopulmonary findings?
TECHNIQUE: Chest radiograph, AP portable technique
COMPARISON: No prior chest radiographs are available for comparison at the
time of dictation.
FINDINGS:
The lung volumes are low however they are clear without focal consolidation.
No pleural effusion or pneumothorax is seen. The cardiac and mediastinal
silhouettes are unremarkable. Two radiopaque densities are seen projecting
over the heart, which may be secondary to prior abdominal surgeries or
represent external structures and clinical correlation is recommended.
IMPRESSION:
No evidence of acute cardiopulmonary process.
|
19902791-RR-136
| 19,902,791 | 27,957,067 |
RR
| 136 |
2200-09-06 03:39:00
|
2200-09-06 05:30:00
|
EXAMINATION: UNILAT UP EXT VEINS US RIGHT
INDICATION: ___ year old woman with redness/swelling// RUE DVT?
TECHNIQUE: Grey scale and Doppler evaluation was performed on the right upper
extremity veins.
COMPARISON: Ultrasound ___
FINDINGS:
There is normal flow with respiratory variation in the bilateral subclavian
veins.
The right internal jugular, axillary, and brachial veins are patent, show
normal color flow, spectral doppler, and compressibility. The right basilic,
and cephalic veins are patent, compressible and show normal color flow.
IMPRESSION:
No evidence of deep vein thrombosis in the right upper extremity.
|
19903067-RR-7
| 19,903,067 | 28,945,206 |
RR
| 7 |
2165-03-14 21:06:00
|
2165-03-15 08:32:00
|
EXAMINATION: MR HEAD W AND W/O CONTRAST
INDICATION: ___ year old man with syncope, suspicious enhancing lesions on
BID-N CT // eval lesions, ?metastatic disease
TECHNIQUE: Multi sequence, multiplanar brain MRI was performed pre and post
intravenous administration of 6 cc of Gadavist. The following sequences were
utilized: Sagittal T1, axial T1, axial FLAIR, axial T2 GRE, axial T2, axial T2
trace, axial T1 post and sagittal MPRAGE post.
COMPARISON: Head CT dated ___.
FINDINGS:
Within the right frontal region there is a 0.8 x 1.9 cm extra-axial T2
hyperintense lesion with slow diffusion and homogeneous enhancement. Findings
likely represent a meningioma. There is no abnormal signal within the adjacent
brain. There are nonspecific periventricular and subcortical white matter
T2/FLAIR hyperintensities, likely reflecting sequela of chronic small vessel
ischemic disease. There is no infarct, hemorrhage or mass effect. The
ventricles, and sulci a are prominent indicative of mild parenchymal volume
loss.
The principal intracranial flow voids are present. There is mild ethmoid and
bilateral maxillary sinus mucosal thickening. There is a small amount of fluid
within the right mastoid air cells.
IMPRESSION:
There is 0.8 x 1.9 cm enhancing right frontal extra-axial mass most likely
representing a meningioma.
Nonspecific white matter abnormalities, likely sequela of chronic small vessel
ischemic disease.
|
19903067-RR-8
| 19,903,067 | 28,945,206 |
RR
| 8 |
2165-03-15 15:03:00
|
2165-03-15 16:26:00
|
EXAMINATION: CT Abdomen and Pelvis
INDICATION: ___ year old man with syncope, extra-axial soft tissue masses seen
on CT head/neck // r/o primary malignancy as source for suspected mets
TECHNIQUE: MDCT axial images were acquired through abdomen and pelvis
following intravenous administration of 130cc of Omnipaque. Coronal and
sagittal reformations were performed. Oral contrast was administered.
DOSE: DLP: 1076 mGy-cm.
COMPARISON: None.
FINDINGS:
CHEST: Please refer to separate report of CT chest performed on the same day
for description of the thoracic findings.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There
is no evidence of focal lesions. There is no evidence of intrahepatic or
extrahepatic biliary dilatation. The gallbladder is within normal limits,
without stones or gallbladder wall thickening.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The adrenals glands are unremarkable bilaterally.
KIDNEYS: The kidneys are of normal and symmetric size with normal nephrogram.
There is no evidence of stones or hydronephrosis. Multiple round hypodensities
are seen within the bilateral kidneys, the largest measuring 4.2 x 2.8 cm
within the left lower pole representing a cyst (3:65).
BOWEL: The stomach opacifies with oral contrast. The stomach is distended with
residual fluid and tapers at the second duodenum in the area of mesenteric
vessels. The small bowel opacifies with contrast without wall thickening or
evidence of obstruction. Large bowel contains stool without evidence for wall
thickening or obstruction. There is no abdominal free air free fluid.
RETROPERITONEUM: There is no evidence of retroperitoneal and mesenteric
lymphadenopathy.
VASCULAR: The abdominal aorta demonstrates severe atherosclerosis.
PELVIS:
The urinary bladder and distal ureters are unremarkable. There is no evidence
of pelvic or inguinal lymphadenopathy. There is no free fluid in the pelvis.
BONES AND SOFT TISSUES:
There is no evidence of worrisome lesions.
IMPRESSION:
No evidence of malignancy within the abdomen or pelvis.
|
19903067-RR-9
| 19,903,067 | 28,945,206 |
RR
| 9 |
2165-03-15 15:09:00
|
2165-03-15 17:47:00
|
CT CHEST
REASON FOR EXAM: Suspected mets on CT of the head.
TECHNIQUE: Multidetector CT through the chest was acquired after
administration of IV contrast. Images were displayed in axial, coronal and
sagittal reformations.
FINDINGS: The airways are patent to the subsegmental level.
There are no enlarged mediastinal, hilar or axillary lymph nodes. There are
dense calcifications in all coronary arteries and in the aortic valve.
Cardiac size is top normal. There is no pleural or pericardial effusion.
Please refer to the concurrent CT abdomen for complete description of the
intraabdominal findings.
Respiratory motion limits the evaluation of the lungs. Allowing for this
limitation, there are multiple centrilobular tiny nodules in the right upper
lobe. Some of them are located in the peribronchovascular distribution.
There are no large lung nodules or masses. There are tiny calcified granulomas
in the anterior right upper lobe.
IMPRESSION:
No evidence of large lung nodules or masses. Tiny punctate nodules in the
right upper lobe, some of them centrilobular and some of them in a
peribronchovascular distribution are non-specific and could have two different
etiologies, most likely inflammatory in origin. Given the clinical history
need follow-up in three months.
Dense coronary calcification and calcification of the aortic valve is of
unknown hemodynamic significance.
|
19903141-RR-53
| 19,903,141 | 24,421,078 |
RR
| 53 |
2172-11-03 16:03:00
|
2172-11-03 16:45:00
|
INDICATION: ___ female with asthma exacerbation and fever, evaluate
for infectious process.
COMPARISON: Chest radiograph from ___.
TWO VIEWS OF THE CHEST:
The lungs are low in volume and show a right middle lobe opacity. The cardiac
silhouette appears mildly enlarged, likely accentuated due to low lung
volumes. The mediastinal silhouette and hilar contours are normal. No
pleural effusion or pneumothorax is present. An anterior cervical fusion
device is noted to the cervical spine, unchanged.
IMPRESSION:
New right middle lobe opacity could be related to atelectasis in the setting
of lower low lung volumes or pneumonia. A repeat radiograph with a better
inspiratory effort could be obtained if clinically necessary.
|
19903197-RR-113
| 19,903,197 | 21,534,969 |
RR
| 113 |
2194-11-16 11:45:00
|
2194-11-16 13:08:00
|
INDICATION: ___ with s/p fall, c/o rib pain and sob// r/o fx and acute
process
TECHNIQUE: PA and lateral views the chest.
COMPARISON: Chest x-ray and chest CT from ___.
FINDINGS:
There is mild right basilar atelectasis abutting the hemidiaphragm. No
significant effusion. There is pulmonary vascular congestion without overt
edema. No consolidation worrisome for infection. Cardiomediastinal
silhouette and hilar contours are unchanged. No acute osseous abnormalities.
No visualized rib fracture
IMPRESSION:
Right basilar atelectasis. No visualized fracture though if clinical concern,
consider dedicated rib series for more detailed evaluation.
|
19903197-RR-114
| 19,903,197 | 21,534,969 |
RR
| 114 |
2194-11-16 17:45:00
|
2194-11-16 19:01:00
|
INDICATION: ___ with fall, respirophasic R chest pain// eval for fracture
COMPARISON: Prior exam is dated ___
FINDINGS:
AP, lateral and oblique views of the right knee were provided. There is no
fracture or dislocation. Changes related to prior arthroplasty again noted
with prosthesis components aligning normally without signs of hardware
failure. No joint effusion is seen. Bones appear demineralized. Soft
tissues are unremarkable.
IMPRESSION:
Status post right knee arthroplasty. No fracture, dislocation or joint
effusion.
|
19903197-RR-115
| 19,903,197 | 21,534,969 |
RR
| 115 |
2194-11-16 17:25:00
|
2194-11-16 18:09:00
|
EXAMINATION: CTA CHEST WITH CONTRAST
INDICATION: ___ with fall, R rib pain, respirophasic chest pain// eval for
PE, rib fractures, PNA
TECHNIQUE: Axial multidetector CT images were obtained through the thorax
after the uneventful administration of intravenous contrast. Reformatted
coronal, sagittal, thin slice axial images, and oblique maximal intensity
projection images were submitted to PACS and reviewed.
DOSE: Total DLP (Body) = 398 mGy-cm.
COMPARISON: CT from ___
FINDINGS:
HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the
subsegmental level without filling defect to indicate a pulmonary embolus. The
thoracic aorta is normal in caliber without evidence of dissection or
intramural hematoma. The heart, pericardium, and great vessels are within
normal limits. No pericardial effusion is seen. The main pulmonary artery is
dilated, measuring 3.3 cm. The right pulmonary artery measures 3.0 cm. Mild
calcifications are noted at the aortic valve.
AXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar
lymphadenopathy is present. No mediastinal mass.
PLEURAL SPACES: Small amount of right dependent nonhemorrhagic pleural
effusion is new since ___. No pneumothorax.
LUNGS/AIRWAYS: Anterior segment of the right lower lobe consolidation is
increased since prior exam and demonstrate homogeneous attenuation, likely
atelectasis. Subcentimeter cyst in the left lower lobe is unchanged. Small
amount of consolidation in the lingula is likely atelectasis. Centrilobular
and paraseptal emphysema is noted in the bilateral upper lobes, right greater
than left. Mild peripheral septal thickening is likely due to pulmonary
edema. The airways are patent to the level of the segmental bronchi
bilaterally. There is diffuse thickening of the peribronchial wall right
greater than left.
BASE OF NECK: Visualized portions of the base of the neck show no abnormality.
ABDOMEN: Included portion of the upper abdomen is notable for nodular liver.
Calcification between the right and left lobe of the liver is unchanged from
prior exam and may be posttreatment changes. The spleen is enlarged,
measuring 14.4 cm. Trace perihepatic and perisplenic ascites are noted.
Portacaval lymph node measures up to 10 mm, likely reactive..
BONES: No suspicious osseous abnormality is seen. There are minimally
displaced fractures of the anterior right second, third and fourth ribs.
IMPRESSION:
1. Minimally displaced fractures of the anterior right second, third and
fourth ribs.
2. New small simple appearing right pleural effusion, compressive atelectasis
in the right lung base.
3. Mild interstitial pulmonary edema.
4. No acute pulmonary embolism.
5. Enlarged pulmonary artery, suggestive of pulmonary arterial hypertension.
6. Cirrhosis, partially visualized ascites and splenomegaly.
|
19903197-RR-116
| 19,903,197 | 21,534,969 |
RR
| 116 |
2194-11-17 14:17:00
|
2194-11-17 15:52:00
|
EXAMINATION: US ABD LIMIT, SINGLE ORGAN
INDICATION: ___ female with concern for spontaneous bacterial
peritonitis, please perform diagnostic paracentesis.
TECHNIQUE: Grayscale ultrasound images were obtained of the 4 quadrants of
the abdomen.
COMPARISON: CTA of the chest dated ___.
FINDINGS:
Extensive scanning throughout the abdomen was performed looking for an
accessible pocket of ascites. No pocket large enough for safe access was
identified. There is partially imaged massive splenomegaly, similar to prior
studies.
IMPRESSION:
No paracentesis could be performed as there was no pocket of ascites large
enough to access.
NOTIFICATION: The findings were discussed with ___, M.D. by ___
___, M.D. on the telephone on ___ at 3:15 pm, 3 minutes after
discovery of the findings.
|
19903197-RR-53
| 19,903,197 | 28,801,714 |
RR
| 53 |
2193-01-29 10:28:00
|
2193-01-29 23:30:00
|
INDICATION: ___ year old woman with HCV/cirrhosis - reported PV thrombosis not
on anticoagulation // eval RUQ, portal vasculature with dopplers
TECHNIQUE: Gray scale, color, and spectral Doppler evaluation of the abdomen
was performed.
COMPARISON: Abdomen ultrasound ___
FINDINGS:
Liver: The hepatic parenchyma is coarsened and nodular. There is an
isoechoic/mildly hypoechoic 2.3 x 1.9 x 2.9 cm mass in the left lobe. There
is no ascites.
Bile ducts: There is mild intrahepatic biliary ductal dilation. The common
hepatic duct measures 8 mm.
Gallbladder: The gallbladder appears within normal limits, without stones,
abnormal wall thickening, or edema.
Pancreas: The imaged portion of the pancreas appears within normal limits,
with portions of the pancreatic tail obscured by overlying bowel gas.
Spleen: The spleen demonstrates normal echotexture, and measures 18.3 cm.
Doppler evaluation:
The main portal vein is patent in the intrahepatic portion, with flow in the
appropriate direction.
Main portal vein velocity is 17 cm/sec.
Left and posterior right portal veins are patent, with antegrade flow.
The main hepatic artery is patent, with appropriate waveform.
Right, middle and left hepatic veins are patent, with appropriate waveforms.
Splenic vein and superior mesenteric vein are patent, with antegrade flow,
although there is partially occlusive thrombus in the SMV.
IMPRESSION:
1. Partially occlusive SMV thrombosis. The intrahepatic portion of the main
portal vein is patent, but the SMV thrombus could conceivably extend into the
extrahepatic portion of the portal vein, which is not fully visualized.
2. Cirrhotic liver and a 2.9 cm mass in the left lobe.
3. Mild intra and extrahepatic biliary ductal dilation.
4. Splenomegaly has worsened since prior.
RECOMMENDATION(S): The patient reports recent imaging and known liver
lesions. Comparison with these outside studies is recommended.
|
19903197-RR-55
| 19,903,197 | 28,801,714 |
RR
| 55 |
2193-01-30 15:29:00
|
2193-01-30 17:42:00
|
INDICATION: ___ yoF with hx of HCV cirrhosis and s/p HCC resection with new
lesion found on liver on US. // ___ yoF with hx of HCV cirrhosis and s/p HCC
resection with new lesion found on liver on US. Requesting Triphasic CT scan
to evaluate for HCC recurrence.
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired
through the abdomen and pelvis following intravenous contrast administration
with split bolus technique.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 3.1 s, 34.5 cm; CTDIvol = 2.6 mGy (Body) DLP = 90.7
mGy-cm.
2) Stationary Acquisition 5.0 s, 0.5 cm; CTDIvol = 24.1 mGy (Body) DLP =
12.0 mGy-cm.
3) Spiral Acquisition 2.7 s, 21.1 cm; CTDIvol = 9.0 mGy (Body) DLP = 189.9
mGy-cm.
4) Spiral Acquisition 4.2 s, 32.8 cm; CTDIvol = 9.6 mGy (Body) DLP = 315.8
mGy-cm.
5) Spiral Acquisition 2.7 s, 20.9 cm; CTDIvol = 10.5 mGy (Body) DLP = 219.8
mGy-cm.
Total DLP (Body) = 828 mGy-cm.
COMPARISON: None.
Ultrasound examination dated ___. CT examination dated ___
FINDINGS:
LOWER CHEST: Visualized lung fields are within normal limits. There is no
evidence of pleural or pericardial effusion.
ABDOMEN:
HEPATOBILIARY: The patient is status post liver resection. The majority of
the right lobe has been removed. There is a 0.7 cm arterially hyperenhancing
lesion in the dome of the liver and series 3A, ___ 14. This demonstrates a
suggestion of washout on the delayed images. . A 2.1 cm hyperenhancing lesion
on the arterial phase is seen in the left lateral segment on series 3A, ___
47. This demonstrates washout on delayed images and a triangular, I
geographic area of hyper enhancement in the lateral segment seen on 3D AA, ___
48 is isodense on delayed images and likely represents a perfusional
abnormality. There is a thrombus in the portal vein at the level of the
confluence best seen on series 6, ___ 56. It is nonocclusive, measuring 1.5
cm in diameter. There is central dilatation of the intrahepatic bile ducts.
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: Splenomegaly of 17.6 cm. The spleen shows normal attenuation
throughout, without evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in shape. The left
adrenal gland is diffusely thickened consistent with hyperplasia.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
Subcentimeter hypodense lesions in the kidneys are too small to characterize
but are most consistent with cysts. 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.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease
is noted. Extensive venous collaterals are noted in the left upper quadrant.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: There is an anterior abdominal wall hernia containing small
bowel. There is no evidence of obstruction.
IMPRESSION:
1. 2.1 cm liver lesion in the left lateral segment with imaging findings
consistent with hepatocellular carcinoma.
2. 0.1 cm lesion in the dome of the liver with imaging findings also
concerning for hepatocellular carcinoma
3. Nonocclusive thrombosis of the main portal vein
4. Moderate amount of ascites
5. Splenomegaly of 17.6 cm and venous collaterals in the left upper quadrant
as well as esophageal varices consistent with portal hypertension
6. Status post liver resection with the majority of the right lobe having been
removed.
7. Multiple ___ opacities at the lung bases consistent with
aspiration. More focal consolidation in the left lower lobe is concerning for
pneumonia
NOTIFICATION: The findings were discussed with ___, M.D. by ___
___, M.D. on the telephone on ___ at 5:40 ___, 5 minutes after
discovery of the findings.
|
19903197-RR-56
| 19,903,197 | 28,801,714 |
RR
| 56 |
2193-01-30 13:19:00
|
2193-01-30 15:48:00
|
EXAMINATION: Portable upright chest x-ray
INDICATION: ___ year old woman with PMH of COPD, IVDU, HCV, Cirrhosis (MELD 9)
complicated HCC s/p liver resection, mild shortness of breath and desaturation
on ambulation. // Please evaluate lungs for consolidation or pleural
effusion. Additionally, please evaluate cardiac silhouette for enlargement.
TECHNIQUE: Portable upright chest x-ray
COMPARISON: Comparison is made to chest x-rays dated from ___
through ___.
FINDINGS:
The cardiomediastinal silhouette is increased in size from ___ study which is
likely exaggerated by low lung volumes. The hilar silhouettes are normal.
There are no pleural effusions or pneumothorax. There is opacification of the
right lower lung which could represent pulmonary vascular congestion, though
given unilateral appearance and absence of pleural effusion raises the concern
of developing pneumonia. .
IMPRESSION:
Right lower lung opacification concerning for developing pneumonia.
|
19903197-RR-57
| 19,903,197 | 28,801,714 |
RR
| 57 |
2193-01-31 13:13:00
|
2193-01-31 14:05:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with HCV cirrhosis complicated by HCC. Now with
pneumonia and acute shortness of breath, nausea and vomiting. // Please
evaluate for worsening pneumonia vs. ?aspiration Please evaluate for
worsening pneumonia vs. ?aspiration
IMPRESSION:
Comparison to ___. The pre-existing bilateral basal parenchymal
opacities, right more than left, are substantially unchanged. No new
opacities. No pulmonary edema. Normal to borderline sized cardiac
silhouette. No larger pleural effusions.
|
19903312-RR-13
| 19,903,312 | 24,654,700 |
RR
| 13 |
2117-01-15 11:49:00
|
2117-01-15 12:14:00
|
INDICATION: ___ with pre-op for laminectomy// pna/chf
TECHNIQUE: PA and lateral views the chest.
COMPARISON: None.
FINDINGS:
The lungs are clear. There is no consolidation, effusion, or edema. The
cardiomediastinal silhouette is within normal limits.
IMPRESSION:
No acute cardiopulmonary process.
|
19903312-RR-14
| 19,903,312 | 24,654,700 |
RR
| 14 |
2117-01-16 11:24:00
|
2117-01-16 13:00:00
|
EXAMINATION: C-SPINE NON-TRAUMA ___ VIEWS IN O.R.
INDICATION: Intraoperative guidance during internal fixation of the cervical
spine
TECHNIQUE: Fluoroscopic guidance for intraoperative surgery.
COMPARISON: None
FINDINGS:
3 intraoperative images were acquired without a radiologist present.
Images show internal fixation of the cervical spine.
IMPRESSION:
Intraoperative images were obtained during internal fixation of cervical
spine.. Please refer to the operative note for details of the procedure.
|
19903312-RR-15
| 19,903,312 | 24,654,700 |
RR
| 15 |
2117-01-18 09:05:00
|
2117-01-18 10:16:00
|
EXAMINATION: C-SPINE NON-TRAUMA ___ VIEWS
INDICATION: ___ year old man with C Spine Stenosis// Postop C3-6 Fusion
Hardware Position
COMPARISON: Intraoperative fluoroscopic images ___, and cervical
spine MRI ___.
FINDINGS:
There remains instrumented posterior fusion between C3 and C6, and probable
drain projected posteriorly. There is minimal anterolisthesis of C4 on C5,
and retrolisthesis of C5 on C6. No hardware complications. Skin staples.
IMPRESSION:
Posterior fusion between C3 and C6, first postoperative baseline exam.
|
19903312-RR-16
| 19,903,312 | 24,654,700 |
RR
| 16 |
2117-01-20 10:16:00
|
2117-01-20 14:46:00
|
EXAMINATION: C-SPINE NON-TRAUMA ___ VIEWS
INDICATION: ___ year old man s/p C3-C6 lami fusion s/p JP drain removal//
Evaluate for drain retention
COMPARISON: Cervical spine radiograph ___.
FINDINGS:
There remains posterior fusion between C3-C6, no changes in alignment or
hardware complication. There remains postoperative soft tissue changes, and
skin staples. Drain removed.
IMPRESSION:
C3-C6 posterior fusion, drain removed.
|
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