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|---|---|---|---|---|---|---|---|
19903484-RR-9
| 19,903,484 | 21,511,003 |
RR
| 9 |
2128-08-26 14:56:00
|
2128-08-26 16:18:00
|
EXAMINATION: Left wrist radiographs, three views.
INDICATION: Status post motor vehicle accident with left wrist pain.
COMPARISON: None available.
FINDINGS:
There is no evidence of fracture, dislocation or lysis. Alignment appears
normal. Joint spaces appear preserved in with. Intravenous catheter visible.
IMPRESSION:
No evidence of fracture or dislocation.
|
19904083-RR-13
| 19,904,083 | 21,331,630 |
RR
| 13 |
2167-02-19 18:30:00
|
2167-02-19 19:50:00
|
INDICATION: Evaluation of patient with vomiting and abnormal LFTs.
COMPARISON: None available.
FINDINGS: The liver is enlarged, but the echotexture is normal. There are no
focal liver lesions. There is no intra- or extra-hepatic biliary dilatation
with the common bile duct measuring 2 mm. The portal vein is patent with
hepatopetal flow. Imaged intrahepatic IVC is unremarkable. The gallbladder is
normal with no evidence of gallstones. The visualized spleen is normal
measuring 10.9 cm. The pancreas and aorta are not clearly visualized due to
overlying bowel gas. The right kidney measures 12.0 cm and the left kidney
measures 13.5 cm. Bilateral kidneys are normal with no evidence of
hydronephrosis or stones.
IMPRESSION: Hepatomegaly. No focal hepatic lesions. Normal gallbladder with
no gallstones.
|
19904083-RR-14
| 19,904,083 | 21,331,630 |
RR
| 14 |
2167-02-19 19:07:00
|
2167-02-19 20:06:00
|
HISTORY: Elevated blood sugars.
TECHNIQUE: PA and lateral views of the chest.
COMPARISON: None.
FINDINGS:
The cardiac, mediastinal and hilar contours are normal. The lungs are clear
and the pulmonary vascularity is normal. No pleural effusion or pneumothorax
is present. There is marked gaseous distention of the stomach. No acute
osseous abnormality is seen.
IMPRESSION:
No acute cardiopulmonary abnormality.
|
19904101-RR-13
| 19,904,101 | 23,626,019 |
RR
| 13 |
2131-04-24 16:47:00
|
2131-04-24 18:05:00
|
EXAMINATION: FOOT AP,LAT AND OBL LEFT
INDICATION: ___ year old woman s/p L foot debridement// post op eval
TECHNIQUE: 3 portable views of the left foot were obtained
COMPARISON: ___
FINDINGS:
Postsurgical changes relating to recent debridement and amputation of the
second right at the level of the metatarsal neck. There may be a small
erosion at the base of the first proximal phalanx. The bones are diffusely
osteopenic. There is soft tissue swelling present around the forefoot.
IMPRESSION:
Expected postoperative changes as described above. Possible tiny erosion at
the base of the left first proximal phalanx concerning for osteomyelitis.
|
19904101-RR-14
| 19,904,101 | 23,626,019 |
RR
| 14 |
2131-04-28 13:00:00
|
2131-04-28 22:51:00
|
INDICATION: ___ year old woman s/p further ___ metatarsal resection, wound
closure// Post op eval
COMPARISON: Radiographs from ___
IMPRESSION:
There has been resection of the distal aspect of the second metatarsal shaft.
The bony margins appear sharp. There is soft tissue swelling and gas
consistent the recent surgery.
|
19904101-RR-15
| 19,904,101 | 23,626,019 |
RR
| 15 |
2131-04-29 21:41:00
|
2131-04-29 22:55:00
|
EXAMINATION: Right hip radiographs, two views, and pelvis radiograph, single
AP view.
INDICATION: Type 2 diabetes a necrotic left second toe lesions status post
amputation in debridement. Now status post fall onto right hip.
COMPARISON: None available.
FINDINGS:
There is no evidence of fracture, dislocation or lysis. Hip joint spaces
appear preserved in with.
IMPRESSION:
No fracture identified.
|
19904101-RR-16
| 19,904,101 | 23,626,019 |
RR
| 16 |
2131-04-30 09:39:00
|
2131-04-30 10:19:00
|
EXAMINATION: DX CHEST PORTABLE PICC LINE PLACEMENT
INDICATION: ___ year old woman with picc// r picc 43cm ping iv ___ Contact
name: ping, ___: ___
IMPRESSION:
No previous images. There has been placement of right subclavian PICC line
that is somewhat difficult to follow over the vertebral bodies. However, the
tip appears to be in the mid to lower SVC.
Cardiac silhouette is within normal limits and there is no vascular
congestion, pleural effusion, or acute focal pneumonia.
|
19904365-RR-21
| 19,904,365 | 26,365,597 |
RR
| 21 |
2145-05-13 03:25:00
|
2145-05-13 05:47:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: History: ___ with ? pna // ? pna
TECHNIQUE: Chest PA and lateral
COMPARISON: None available.
FINDINGS:
The lungs are clear. The pulmonary vasculature is unremarkable. No pleural
abnormalities. The cardiomediastinal silhouette is unremarkable. No acute
osseous abnormalities.
IMPRESSION:
No pneumonia.
|
19904800-RR-15
| 19,904,800 | 27,949,623 |
RR
| 15 |
2207-05-11 14:00:00
|
2207-05-11 14:14:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ with syncope // Pneumonia? cardiomegaly?
TECHNIQUE: Chest PA and lateral
COMPARISON:
CTA chest dated ___.
FINDINGS:
PA and lateral views the chest provided. Increased opacity projecting over
the lower lungs on the frontal view likely reflects known breast implants.
There is prominence of the mediastinum most notably along the right
peritracheal stripe which is compatible with no lymphadenopathy. Lungs are
clear. No large effusion or pneumothorax. Heart size is normal. Bony
structures are intact.
IMPRESSION:
As above.
|
19904800-RR-16
| 19,904,800 | 27,949,623 |
RR
| 16 |
2207-05-13 13:29:00
|
2207-05-13 16:25:00
|
EXAMINATION: CT ABD AND PELVIS WITH CONTRAST
INDICATION: ___ year old man with extensive lymphadenopathy and B-symptoms,
biopsy c/w DLBCL >> FCC. Staging exam.
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired
through the abdomen and pelvis following intravenous contrast administration
with split bolus technique. IV Contrast: 130 mL Omnipaque.
Coronal and sagittal reformations were performed and reviewed on PACS.
Oral contrast was administered.
DOSE: Total DLP (Body) = 401 mGy-cm.
COMPARISON: CTA chest of ___ and CT interventional procedure of
___.
FINDINGS:
LOWER CHEST: There is mild dependent bibasilar atelectasis without pleural
effusion. Bilateral breast implants are partially visualized.
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.
Sub cm hypodensity in the left lower renal pole is too small to characterize,
but statistically likely a cyst. 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.
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, mesenteric, or pelvic
lymphadenopathy by CT size criteria. There is a 2.0 x 1.4 cm right inguinal
lymph node (5:98).
VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease
is noted.
BONES: A 2.2 x 1.4 cm hemagnioma is identified in the L1 vertebral body. No
significant degenerative changes are present.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. 2.0 x 1.4 cm enlarged right inguinal lymph node.
2. 2.2 x 1.4 cm hemangioma in the L1 vertebral body.
3. No evidence of mesenteric, retroperitoneal or pelvic sidewall
lymphadenopathy by CT size criteria.
|
19904800-RR-20
| 19,904,800 | 26,949,881 |
RR
| 20 |
2207-06-18 13:36:00
|
2207-06-18 14:37:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ with B cell lymphoma with fevers, cough diarrhea for 1 week.
COMPARISON: Prior exam from ___. Prior CT from ___.
FINDINGS:
PA and lateral views of the chest provided. Overlying EKG leads are present.
Bilateral breast implants are noted. Lungs are clear. No pleural effusion or
pneumothorax. Cardiomediastinal silhouette appears normal. Bony structures
are intact.
IMPRESSION:
No acute findings. No pneumonia. Of note, mediastinal widening has improved
as compared with chest radiograph from ___.
|
19904800-RR-21
| 19,904,800 | 26,949,881 |
RR
| 21 |
2207-06-22 15:10:00
|
2207-06-22 18:14:00
|
INDICATION: ___ year old man with Lymphoma C 85.90 leave accessed if
appointment is confirmed please call pt ___!! pt is transgender // please
place single chest port for pt being treated after placement thanks ___
COMPARISON: ___
TECHNIQUE: OPERATORS: Dr. ___, Interventional Radiology Fellow and Dr.
___, attending radiologist performed the procedure. Dr. ___
___ personally supervised the trainee during the key components of the
procedure and has reviewed and agrees with the trainee's findings.
ANESTHESIA: Moderate sedation was provided by administrating divided doses of
100 mcg of fentanyl and 5 mg of midazolam throughout the total intra-service
time of 30 minutes during which the patient's hemodynamic parameters were
continuously monitored by an independent trained radiology nurse. 1% lidocaine
was injected in the skin and subcutaneous tissues overlying the access site.
MEDICATIONS: Fentanyl, Versed, cefazolin
CONTRAST: None
FLUOROSCOPY TIME AND DOSE: 0.1 min, 10 mGy
PROCEDURE
1. Right internal jugular approach chest single lumen Port-a-cath placement
PROCEDURE DETAILS: Following the explanation of the risks, benefits and
alternatives to the procedure, written informed consent was obtained from the
patient. The patient was then brought to the angiography suite and placed
supine on the exam table. A pre-procedure time-out was performed per ___
protocol. The upper chest was prepped and draped in the usual sterile fashion.
Under continuous ultrasound guidance, the patent right internal jugular vein
was compressible and accessed using a micropuncture needle. Permanent
ultrasound images were obtained before and after intravenous access, which
confirmed vein patency. Subsequently a Nitinol wire was passed into the right
atrium using fluoroscopic guidance. The needle was exchanged for a
micropuncture sheath. The Nitinol wire was removed and a short ___ wire was
advanced to make appropriate measurements for catheter length. The ___ wire
was then passed distally into the IVC.
Next, attention was turned towards creation of a subcutaneous pocket over the
upper anterior chest wall. After instilling superficial and deeper local
anesthesia using lidocaine mixed with epinephrine, a 2.5 cm transverse
incision was made and a subcutaneous pocket was created by using blunt
dissection. The single lumen port was then connected to the catheter. The
catheter was tunneled from the subcutaneous pocket towards the venotomy site
from where it was brought out using a tunneling device. The port was then
connected to the catheter and checks were made for any leakage by accessing
the diaphragm using a non-coring ___ needle. No leaks were found.
The port was then placed in the subcutaneous pocket and secured with ___
prolene sutures on either side. The venotomy tract was dilated using the
introducer of the peel-away sheath supplied. Following this, the peel-away
sheath was placed over the ___ wire through which the port was threaded into
the right side of the heart with the tip in the right atrium. The sheath was
then peeled away.
The subcutaneous pocket was closed in layers with ___ interrupted and ___
subcuticular continuous Vicryl sutures. ___ subcuticular Vicryl sutures and
Steri-strips were used to close the venotomy incision site. Steri-Strips were
applied over the sutures. Final spot fluoroscopic image demonstrating good
alignment of the catheter and no kinking. The tip is in the right atrium.
The port was accessed using a non coring ___ needle and could be aspirated
and flushed easily. Sterile dressings were applied. The patient tolerated the
procedure well without immediate complication. The port was left accessed as
requested.
FINDINGS:
Patent right internal jugular vein. Final fluoroscopic image showing port with
catheter tip terminating in the right atrium.
IMPRESSION:
Successful placement of a single lumen chest power Port-a-cath via the right
internal jugular venous approach. The tip of the catheter terminates in the
right atrium. The catheter is ready for use.
|
19904800-RR-24
| 19,904,800 | 28,410,318 |
RR
| 24 |
2207-07-02 10:23:00
|
2207-07-02 12:46:00
|
EXAMINATION: CT ABD AND PELVIS WITH CONTRAST
INDICATION: ___ year old M->F transgender named ___ with DLBCL with
night sweats worsening axillary and clavicular lymphadenopathy with known
mediastinal adenopathy compressing not invading pulm aa //
worsening/progression of disease
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired
through the abdomen and pelvis following intravenous contrast administration
with split bolus technique.
IV Contrast: 130 mL Omnipaque.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Total DLP (Body) = 548 mGy-cm.
COMPARISON: CT of the abdomen pelvis dated ___.
FINDINGS:
LOWER CHEST: Please refer to separate report of CT chest performed on the same
day for description of the thoracic findings.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There
is 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. The appendix is not visualized.
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. No atherosclerotic disease is
noted.
BONES: Several lucent lesions with thick sclerotic rims and associated
cortical thickening are present, including within the manubrium (9:38), L1
vertebral body extending into the left pedicle (5:28), bilateral iliac bones
(5:68, 69), and within the left superior pubic ramus (5:86).
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. No evidence of lymphadenopathy within the abdomen or pelvis.
2. Several lucent lesions with a thick sclerotic rim and associated cortical
thickening are present, as described above. Given the patient's history of
malignancy, these lesions are concerning for osseous involvement, although the
level of activity of these lesions cannot be assessed. Several of these
lesions would be amenable to biopsy.
3. Please see separate chest CT report for details of intrathoracic findings.
NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on
the ___ ___ at 12:27 ___, 5 minutes after discovery of the
findings.
|
19904800-RR-25
| 19,904,800 | 28,410,318 |
RR
| 25 |
2207-07-02 10:23:00
|
2207-07-02 12:14:00
|
EXAMINATION: Chest CT
INDICATION: Known mediastinal adenopathy
TECHNIQUE: MDCT of the chest was obtained from thoracic inlet to upper
abdomen. Axial images were reviewed in conjunction with coronal and sagittal
reformats
COMPARISON: ___
FINDINGS:
Bilateral breast implants are in place. Substantial axillary lymphadenopathy
has resolved. Mediastinal lymphadenopathy has substantially improved in the
interim, for example prevascular lymph nodes has decreased in size from 4.4 x
2.5 cm to 2.8 x 0.7 cm.
Heart size is normal. There is no pericardial pleural effusion. Image
portion of the upper abdomen will be reviewed separately in corresponding
report will be issued.
Airways are patent to the subsegmental level bilaterally. Apical bulla on the
right, series 5, image 7 is unchanged. Centri lobular nodules in the upper
lobes are most likely consistent with respiratory bronchiolitis. Bibasal
areas of atelectasis are present. No discrete nodules seen.
There are no lytic or sclerotic lesions worrisome for infection or neoplasm.
IMPRESSION:
Substantial improvement in the mediastinal lymphadenopathy an resolution of
the bilateral axillary lymphadenopathy.
Minimal apical emphysema.
Status post bilateral breast implants.
Port-A-Cath catheter tip terminates at the proximal right atrium.
Suspected respiratory bronchiolitis.
|
19904800-RR-32
| 19,904,800 | 27,675,246 |
RR
| 32 |
2207-08-05 15:23:00
|
2207-08-05 15:33:00
|
INDICATION: ___ with DLBCL on R-CHOP with N/V/F/D // evidence of pneumonia
TECHNIQUE: PA and lateral views of the chest.
COMPARISON: ___.
FINDINGS:
Right chest wall port is again seen with catheter tip in the upper SVC. The
lungs are clear. There is no consolidation, effusion, or edema. The
cardiomediastinal silhouette is within normal limits. No acute osseous
abnormalities.
IMPRESSION:
No acute cardiopulmonary process.
|
19904800-RR-33
| 19,904,800 | 27,675,246 |
RR
| 33 |
2207-08-08 17:17:00
|
2207-08-08 17:34:00
|
EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ year old woman with lymphoma on chemo with persistent RUQ
pain. Assess main portal vein.
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: CT abdomen/pelvis ___.
FINDINGS:
LIVER: The hepatic parenchyma appears within normal limits. The contour of the
liver is smooth. There is no focal liver mass. The main portal vein is patent
with hepatopetal flow. There is no ascites.
BILE DUCTS: There is no intrahepatic biliary dilation. The CBD measures 5 mm.
GALLBLADDER: There is no evidence of stones or gallbladder wall thickening.
PANCREAS: Head, body and tail of the pancreas are within normal limits,
without masses or pancreatic ductal dilatation.
SPLEEN: Normal echogenicity, measuring 11 cm.
KIDNEYS: The kidneys are grossly unremarkable bilaterally with preserved
corticomedullary differentiation. There is no evidence of masses, stones, or
hydronephrosis in the kidneys.
RETROPERITONEUM: Visualized portions of aorta and IVC are within normal
limits.
IMPRESSION:
Normal abdominal ultrasound. Specifically, normal gallbladder and patent main
portal vein.
|
19904800-RR-36
| 19,904,800 | 29,926,865 |
RR
| 36 |
2207-09-07 12:30:00
|
2207-09-07 13:03:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ with diffuse large B cell lymphoma presenting with fevers,
cough
COMPARISON: Prior study ___
FINDINGS:
PA and lateral views of the chest provided. Right chest wall Port-A-Cath
again seen with catheter tip extending into the upper SVC. Lungs are clear.
No signs of pneumonia or edema. No pleural effusion or pneumothorax.
Cardiomediastinal silhouette appears normal. Bony structures are intact.
IMPRESSION:
No acute findings. Port-A-Cath appropriately positioned.
|
19904800-RR-37
| 19,904,800 | 29,926,865 |
RR
| 37 |
2207-09-07 12:38:00
|
2207-09-07 13:24:00
|
EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ with lymphoma on chemo with dull headache // eval acute
process
TECHNIQUE: Routine unenhanced head CT was performed and viewed in brain,
intermediate and bone windows. Coronal and sagittal reformats were also
performed.
DOSE: Total DLP (Head) = 903 mGy-cm.
COMPARISON: ___
FINDINGS:
There is no intra-axial or extra-axial hemorrhage, edema, shift of normally
midline structures, or evidence of acute major vascular territorial
infarction. Ventricles and sulci are normal in overall size and configuration.
The imaged paranasal sinuses are clear. Mastoid air cells and middle ear
cavities are well aerated. The bony calvarium is intact.
IMPRESSION:
No acute intracranial process.
|
19904800-RR-46
| 19,904,800 | 22,014,497 |
RR
| 46 |
2207-10-02 03:37:00
|
2207-10-02 06:56:00
|
EXAMINATION: Chest radiograph
INDICATION: ___ woman presenting with with weakness, recent pna, off
abx. Evaluate for pneumonia.
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest radiograph dated ___.
FINDINGS:
No significant interval change. Right Port-A-Cath tip ends in the mid SVC.
The lungs are well-expanded and clear. No focal consolidation, effusion,
edema, or pneumothorax. The heart size is normal. Mediastinal and hilar
contours are unchanged. No acute osseous abnormality.
IMPRESSION:
No pneumonia.
|
19905277-RR-88
| 19,905,277 | 29,787,558 |
RR
| 88 |
2164-08-02 04:50:00
|
2164-08-02 09:07:00
|
EXAMINATION: MRI PELVIS
INDICATION: ___ year old man with concern for prostatitis, continuing symptoms
despite 1 week of antibiotic treatment. Prostate abscess?
TECHNIQUE: Multiplanar T1 and T2 weighted images were acquired on a 3.0 T
magnet.
Intravenous contrast: 9 mL Gadavist.
COMPARISON MR urogram ___. CT abdomen and pelvis ___.
FINDINGS:
The prostate gland measures 6.0 x 6.6 x 6.7 cm (AP x SI x TV), yielding a
calculated volume of 139 cc. The central gland is enlarged and shows a
heterogenous swirled and whorled appearance with well defined nodules,
indicative of BPH.
There is no evidence of focal abscess within the prostate gland.
Seminal vesicles are grossly normal.
No overt pelvic lymphadenopathy.
There is mild circumferential thickening and trabeculation of the urinary
bladder wall, likely on a background of chronic outlet obstruction.
Visualized bowel is unremarkable.
No marrow replacing process.
IMPRESSION:
Background BPH and prostatic enlargement, with urinary bladder wall thickening
compatible with features of chronic outlet obstruction. No focal prostate
abscess is identified on today's study.
|
19905277-RR-89
| 19,905,277 | 29,787,558 |
RR
| 89 |
2164-08-02 15:26:00
|
2164-08-02 17:20:00
|
INDICATION: ___ year old man with reported ongoing constipation // eval stool
burden per ID
TECHNIQUE: Portable supine abdominal radiograph was obtained.
COMPARISON: CT of the abdomen from ___
FINDINGS:
There are no abnormally dilated loops of large or small bowel. Mild colonic
stool burden.
There is no free intraperitoneal air.
Osseous structures are unremarkable.
There are no unexplained soft tissue calcifications or radiopaque foreign
bodies.
IMPRESSION:
Nonobstructive bowel gas pattern with mild colonic stool burden.
|
19905351-RR-18
| 19,905,351 | 29,354,118 |
RR
| 18 |
2115-11-30 03:35:00
|
2115-11-30 05:31:00
|
EXAMINATION: MR HEAD W/O CONTRAST ___ MR HEAD
INDICATION: ___ year old man with cognitive changes// eval for any acute
intracranial process
TECHNIQUE: Sagittal and axial T1 weighted imaging were performed. After
administration of mL of Gadavist intravenous contrast, axial imaging was
performed with gradient echo, FLAIR, diffusion, and T1 technique. Sagittal
MPRAGE imaging was performed and re-formatted in axial and coronal
orientations.
COMPARISON: None.
FINDINGS:
There is no evidence of hemorrhage, edema, masses, mass effect, midline shift
or infarction. The ventricles and sulci are normal in caliber and
configuration. There is no abnormal enhancement after contrast
administration.
There is a heterogenous T1 and T2 hyperintense ovoid lesion in the
inferoposterior aspect of the sphenoid sinus measuring 20 x 24 x 17 mm (TV by
AP by CC) which does not show restricted diffusion. There is mild enhancement
of the anterior wall of this lesion measuring less than 2 mm in diameter as
well as possibly mild linear enhancement in the mid to posterior aspect of the
lesion. There is no evidence of bone destruction. These findings are typical
of a mucous retention cyst containing inspissated secretions.
The pituitary gland is normal. The adjacent internal carotid arteries are
patent.
Pneumatized left pterygoid bone.
There is no evidence of cerebral hemorrhage, edema, midline shift or
infarction. The ventricles and sulci are normal in caliber and
configuration.
IMPRESSION:
1. Sphenoid sinus mucous retention cyst.
2. The study is otherwise normal.
RECOMMENDATION(S): Correlation with CT paranasal sinuses/base of skull for
better evaluation of the sphenoid sinus and clivus (exclude bony destruction)
|
19905351-RR-19
| 19,905,351 | 29,354,118 |
RR
| 19 |
2115-11-30 09:47:00
|
2115-11-30 10:19:00
|
EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ year old man with sellar mass// please perform CT scan of the
skull base for neurosurgical planning
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast. Coronal and sagittal reformations as well as bone algorithm
reconstructions were provided and reviewed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 16.0 s, 16.0 cm; CTDIvol = 50.2 mGy (Head) DLP =
802.7 mGy-cm.
2) Sequenced Acquisition 2.0 s, 2.0 cm; CTDIvol = 50.2 mGy (Head) DLP =
100.3 mGy-cm.
Total DLP (Head) = 903 mGy-cm.
COMPARISON: MR head dated ___ at 09:48.
FINDINGS:
There is ___ evidence of infarction, hemorrhage, edema, or mass. The
ventricles and sulci are mildly prominent in size but otherwise normal in
configuration.
There is ___ evidence of fracture. There is a mucous retention cyst in the
left sphenoid sinus, corresponding to the lesion seen on recent MR. ___ is
___ surrounding osseous destruction. The remaining paranasal sinuses, mastoid
air cells, and middle ear cavities are clear. The visualized portion of the
orbits are unremarkable.
IMPRESSION:
1. ___ acute intracranial process.
2. Mucous retention cyst in the left sphenoid sinus, corresponding to the
lesion seen on recent MR. ___ osseous destruction.
3. Findings suggestive mild atrophy, advanced for age.
|
19905556-RR-28
| 19,905,556 | 27,307,539 |
RR
| 28 |
2166-12-24 15:22:00
|
2166-12-24 16:25:00
|
HISTORY: Right lower extremity pain, swelling, edema. Rule out DVT.
COMPARISON: None available.
TECHNIQUE: Grayscale, color and spectral Doppler evaluation was performed of
the right lower extremity veins.
FINDINGS:
There is normal compressibility, flow and augmentation of the right common
femoral, proximal femoral, mid femoral, distal femoral and popliteal veins.
Normal color flow is demonstrated in the posterior tibial and peroneal veins.
There is normal respiratory variation of the common femoral veins bilaterally.
A 3.2 cm lymph node is seen in the right groin.
IMPRESSION: No evidence of deep vein thrombosis in the right lower extremity.
|
19905556-RR-29
| 19,905,556 | 27,307,539 |
RR
| 29 |
2166-12-29 14:37:00
|
2166-12-29 18:08:00
|
HISTORY: Acute on chronic low back pain, rule out fracture/displacement.
COMPARISON: None available.
FINDINGS:
Lumbosacral spine, 4 views.
There are 5 non-rib-bearing vertebral bodies. There are mild degenerative
changes of lower lumbar facets. Lumbar lordosis is preserved. Vertebral body
and disc heights are preserved. No fracture or subluxation is identified. No
focal lytic or sclerotic lesion is seen. Sacroiliac joints are unremarkable.
Surgical clips overlie the right iliac crest.
IMPRESSION:
No acute fracture or dislocation. Mild lower lumbar facet arthropathy.
Findings were communicated with ___ telephone at 16:20 on ___.
|
19905556-RR-33
| 19,905,556 | 26,911,900 |
RR
| 33 |
2169-04-20 15:24:00
|
2169-04-20 15:43:00
|
INDICATION: History: ___ with chronic right lower extremity wounds with
purulent drainage.
TECHNIQUE: Two views of the right tibia and fibula
COMPARISON: None.
FINDINGS:
No acute fracture or focal lytic or sclerotic osseous abnormality is
identified. No cortical destruction or periosteal new bone formation is
visualized. Imaged aspect of the right knee and right ankle demonstrate no
gross dislocation. There is diffuse soft tissue swelling without radiopaque
foreign body or subcutaneous gas.
IMPRESSION:
No radiographic evidence for osteomyelitis. Diffuse soft tissue swelling.
|
19905556-RR-34
| 19,905,556 | 26,911,900 |
RR
| 34 |
2169-04-21 11:11:00
|
2169-04-21 11:59:00
|
EXAMINATION: VENOUS DUP EXT UNI (MAP/DVT) RIGHT
INDICATION: ___ year old woman with RLE cellulitis // Evaluate for DVT
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the right lower extremity veins.
COMPARISON: Lower extremity DVT examination from ___.
FINDINGS:
Extremely limited examination secondary to patient's known right lower
extremity cellulitis. There is normal compressibility, flow and augmentation
of the rightcommon femoral, femoral, and popliteal veins. Normal color flow is
demonstrated in the posterior tibial and peroneal veins.
There is normal respiratory variation in the common femoral veins bilaterally.
IMPRESSION:
Extremely limited examination secondary to patient's known right lower
extremity cellulitis. No evidence of deep venous thrombosis in the rightlower
extremity veins.
|
19905556-RR-43
| 19,905,556 | 27,689,540 |
RR
| 43 |
2170-11-09 05:57:00
|
2170-11-09 06:30:00
|
EXAMINATION: DX BILATERAL KNEES
INDICATION: History: ___ with obesity, fall, foot/knee pain// eval for knee
dislocation, foot fracture
TECHNIQUE: Frontal and cross-table lateral views of both knees
COMPARISON: Right tib-fib radiographs from ___
FINDINGS:
Evaluation is limited by overlying soft tissue positioning. No fracture,
dislocation, or joint effusion is detected in either knee. No suspicious
lytic or sclerotic lesion is identified. No soft tissue calcification or
radio-opaque foreign body is detected. Mild tricompartmental spurring seen in
both knees consistent with mild degenerative changes.
IMPRESSION:
No fracture or dislocation.
|
19905556-RR-44
| 19,905,556 | 27,689,540 |
RR
| 44 |
2170-11-09 05:57:00
|
2170-11-09 06:39:00
|
EXAMINATION: FOOT AP,LAT AND OBL BILATERAL
INDICATION: History: ___ with obesity, fall, foot/knee pain// eval for knee
dislocation, foot fracture
TECHNIQUE: Non-weightbearing frontal, oblique, and lateral view radiographs
of the right foot and non weight-bearing frontal and lateral views of the left
foot were obtained
COMPARISON: None
FINDINGS:
No acute fractures or dislocation are seen. There are no significant
degenerative changes. Bilateral hallux valgus is mild. No radiopaque foreign
body.
IMPRESSION:
No fracture or dislocation.
|
19905556-RR-45
| 19,905,556 | 27,689,540 |
RR
| 45 |
2170-11-16 11:24:00
|
2170-11-16 16:30:00
|
EXAMINATION: ___ DUP EXTEXT BIL (MAP/DVT)
INDICATION: ___ year old obese female w/recent fall with decreased sensation
in LLE and calf pain in LLE and RLE, reports swelling in LLE// assess for DVT
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the left lower extremity veins.
COMPARISON: ___ bilateral lower extremity Doppler ultrasound
FINDINGS:
There is normal compressibility, flow, and augmentation of the left common
femoral, femoral, and popliteal veins. Normal color flow and compressibility
are demonstrated in the tibial and peroneal veins.
There is normal respiratory variation in the common femoral veins bilaterally.
IMPRESSION:
No evidence of deep venous thrombosis in the left lower extremity veins.
|
19905556-RR-46
| 19,905,556 | 27,689,540 |
RR
| 46 |
2170-11-17 13:55:00
|
2170-11-17 16:32:00
|
EXAMINATION: HIP (UNILAT 2 VIEW) W/PELVIS (1 VIEW) LEFT
INDICATION: ___ year old woman with recent fall and left hip pain// evaluate
for fracture
TECHNIQUE: Pelvis single view, left hip two views
COMPARISON: CT ___
FINDINGS:
Degenerative arthritis lower lumbar spine. Degenerative changes bilateral
hips, more prominent in the left hip, with joint space narrowing, similar
compared with ___. surgical clips low abdomen. No evidence of
fracture.
IMPRESSION:
No evidence of fracture.
Degenerative arthritis bilateral hips, greater on the left, similar to prior.
|
19905604-RR-12
| 19,905,604 | 28,930,379 |
RR
| 12 |
2176-05-10 11:07:00
|
2176-05-10 19:06:00
|
EXAMINATION: CT CHEST W/CONTRAST; CT ABD AND PELVIS WITH CONTRAST
INDICATION: ___ year old man with L frontoparietal edema c/f underlying mass//
Evaluate for primary mass.
TECHNIQUE: Axial images of the chest, abdomen and pelvis were obtain after IV
contrast administration in the portal venous phase by split bolus technique.
Multiplanar reformats were obtained.
DOSE: Total DLP (Body) = 847 mGy-cm.
COMPARISON: No priors.
FINDINGS:
CHEST:
PULMONARY ARTERIES/AORTA: Thoracic aorta is normal in caliber. Proximal
pulmonary arteries are patent.
NECK: Thyroid gland is unremarkable. There are no supraclavicular adenopathy.
AIRWAYS: Airways are clear with no endotracheal or endobronchial lesions.
MEDIASTINUM: There are no mediastinal or hilar adenopathy. There is no
cardiomegaly or pericardial effusion. There are marked coronary arterial
calcifications.
LUNGS: There is mild biapical scarring. There Re near atelectatic bands in
the right lower lobe and right middle lobe.
PLEURA: There is no pleural effusion, pneumothorax or pleural plaques.
ABDOMEN:
HEPATOBILIARY: There is normal hepatic enhancement with no suspicious mass
lesions. There is no biliary ductal dilatation. Gallbladder is unremarkable.
High-density material is noted layering within the gallbladder likely contrast
excretion. Portal vein and hepatic veins are patent.
PANCREAS: Pancreatic contours are unremarkable with no pancreatic ductal
dilatation or suspicious mass lesions.
SPLEEN: There is no splenomegaly.
ADRENALS: Adrenal glands are unremarkable.
URINARY:There is no hydronephrosis or nephrolithiasis. There is normal course
and caliber of bilateral ureters.
GASTROINTESTINAL: Stomach is under distended. Small bowel loops are normal in
caliber. Appendix is normal in appearance. There is moderate amount of stool
in the right hemicolon. The left hemicolon is decompressed. There are
scattered colonic diverticulosis without diverticulitis.
PERITONEUM: There is no free air free fluid. There is no peritoneal
stranding.
LYMPH NODES: There is no adenopathy.
VASCULAR: Abdominal aorta is normal in caliber with moderate atherosclerotic
disease. Intra-abdominal branches are patent.
PELVIS: Urinary bladder demonstrates mild wall thickening which can be
secondary to bladder outlet obstruction vs cystitis. There are central
prostatic calcifications. Rectum is unremarkable.
BONES:There is an anterior wedge deformities of L2 and L1, of chronic nature.
There are multilevel degenerative changes of the lumbar spine. There are no
acute or aggressive osseous lesions.
SOFT TISSUES: Soft tissues are unremarkable.
IMPRESSION:
1. There are no acute intrathoracic, intra-abdominal or intrapelvic
abnormalities.
2. No suspicious lung masses, intra-abdominal solid organ lesions, bowel wall
thickening or adenopathy to suggest as a primary neoplastic process. Osseous
structures are intact.
3. Right basal atelectasis.
4. Urinary bladder outlet obstruction vs cystitis.
RECOMMENDATION(S):
1.
|
19905604-RR-13
| 19,905,604 | 28,930,379 |
RR
| 13 |
2176-05-11 18:41:00
|
2176-05-11 19:00:00
|
EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ year old man with L temporal mass s/p craniotomy for tumor
resection// assess for hemorrhage post-op
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 10.0 s, 17.0 cm; CTDIvol = 48.8 mGy (Head) DLP =
829.0 mGy-cm.
Total DLP (Head) = 843 mGy-cm.
COMPARISON: ___ brain MRI
FINDINGS:
Status-post left frontotemporal craniotomy and temporal lobe mass resection.
Postsurgical changes include surgical hardware, a subcutaneous surgical drain,
subcutaneous emphysema, pneumocephalus, and a small amount of extra-axial
blood products. Few punctate foci of hyperattenuation in the left temporal
lobe probably reflect blood products within the resection cavity. No
significant mass-effect on the adjacent left lateral ventricle. Left
frontotemporal edema is essentially unchanged. No evidence of large
territorial infarction.
The visualized portion of the paranasal sinuses, mastoid air cells, and
middle ear cavities are clear. The visualized portion of the orbits are
unremarkable.
IMPRESSION:
Expected postoperative changes status-post left frontotemporal craniotomy and
left temporal lobe mass resection. No large intracranial hemorrhage.
|
19905604-RR-14
| 19,905,604 | 28,930,379 |
RR
| 14 |
2176-05-12 20:30:00
|
2176-05-13 10:15:00
|
EXAMINATION: MR HEAD W AND W/O CONTRAST T___ MR HEAD
INDICATION: ___ year old man with L temporal mass, s/p L craniotomy for tumor
resection// assess for residual
TECHNIQUE: Sagittal and axial T1 weighted imaging were performed. After
administration of Gadavist intravenous contrast, axial imaging was performed
with gradient echo, FLAIR, diffusion, and T1 technique. Sagittal MPRAGE
imaging was performed and re-formatted in axial and coronal orientations.
COMPARISON: MRI brain ___.
FINDINGS:
Study is moderately degraded by motion. Within these confines:
Status post left frontotemporal craniotomy for mass resection. A small amount
of intrinsic T1 hyperintense signal within the resection cavity is compatible
blood products. Along the posteromedial resection cavity minimal linear
enhancement is suggested (see 4, 11:14; 900:100). Thin peripheral diffusion
abnormality surrounding the resection cavity is also noted.
No change to slight decrease in FLAIR signal abnormality surrounding the
resection cavity with a similar degree of mass effect on the left lateral
ventricle. The ventricles are grossly stable in size and configuration.
The major intracranial vascular flow voids are maintained. The mastoid air
cells and orbits are grossly preserved. Minimal bilateral ethmoid air cell
maxillary sinus mucosal thickening is present.
IMPRESSION:
1. Study is moderately degraded by motion.
2. Status post left frontotemporal craniotomy for mass resection with
associated probable postsurgical changes as described.
3. Minimal linear nonspecific enhancement along post room medial surgical
cavity border. While finding may be postoperative in nature, residual tumor
is not excluded on the basis examination. Recommend attention on follow-up
imaging.
4. Prominent slow diffusion medial to the resection cavity which may represent
treatment related effects, with differential consideration of infarction.
5. Grossly stable parenchymal signal abnormality surrounding resection cavity
with mass effect on the left lateral ventricle.
NOTIFICATION: The findings were discussed with ___, N.P. by
___, M.D. on the telephone on ___ at 9:56 am, 30 minutes
after discovery of the findings.
The impression and recommendation above was entered by Dr. ___ on
___ at 11:54 into the Department of Radiology critical communications
system for direct communication to the referring provider.
|
19905604-RR-9
| 19,905,604 | 28,930,379 |
RR
| 9 |
2176-05-10 09:40:00
|
2176-05-10 13:40:00
|
EXAMINATION: MR HEAD W AND W/O CONTRAST T___ MR HEAD
INDICATION: ___ year old man with L frontoparietal edema// Evaluate for
lesion- please perform with MR WAND
TECHNIQUE: Sagittal and axial T1 weighted imaging were performed. After
administration of 9 mL of Gadavist intravenous contrast, axial imaging was
performed with gradient echo, FLAIR, diffusion, and T1 technique. Sagittal
MPRAGE imaging was performed and re-formatted in axial and coronal
orientations.
COMPARISON: CTA head ___
FINDINGS:
There is a 2.5 cm irregular peripherally enhancing lesion within the left
operculum and subinsular region. The mass and moderate associated vasogenic
edema result in mild narrowing of the left lateral ventricle, however no
midline shift. There are a few foci of low signal intensity on GRE (series
10, image 13) that may reflect a small amount of associated hemorrhage. No
other enhancing lesions are identified.
The ventricles, sulci, and cisterns otherwise appear normal. There is no
acute infarct. A few tiny foci of hyperintense signal on T2/FLAIR within the
subcortical and periventricular white matter are nonspecific. The major
vascular flow voids are preserved. Dural venous sinuses are patent. There is
mild mucosal thickening of the ethmoid air cells. The orbits are
unremarkable.
IMPRESSION:
1. 2.5 cm irregular peripheral enhancing mass with moderate associated
vasogenic edema within the left operculum and subinsular region, most likely a
metastatic lesion or glioblastoma. No other enhancing lesions are identified.
2. Additional findings as described above.
NOTIFICATION: The findings above were discussed with Dr. ___ by
Dr. ___ on ___ in person in the neuroradiology reading
room.
|
19905646-RR-23
| 19,905,646 | 23,539,856 |
RR
| 23 |
2161-07-22 18:40:00
|
2161-07-22 20:17:00
|
CHEST RADIOGRAPHS
HISTORY: Chest pain.
COMPARISONS: ___.
TECHNIQUE: Chest, PA and lateral.
FINDINGS: The patient is status post coronary artery bypass graft surgery.
The heart is normal in size. Coronary arteries appear calcified, possibly
with stents. The lungs appear clear. There are no pleural effusions or
pneumothorax. Small osteophytes are noted along the mid thoracic spine.
There has been no significant change.
IMPRESSION: No evidence of acute disease.
|
19906067-RR-151
| 19,906,067 | 24,552,279 |
RR
| 151 |
2132-06-16 08:26:00
|
2132-06-16 10:56:00
|
STUDY: Seven total views of the left femur and knee ___.
___.
INDICATION: Left femur pain.
FINDINGS: Mild atherosclerotic vascular calcifications. Interval removal of
skin staples. The hip joint is unremarkable. Prior ORIF of the femur with
retrograde intramedullary nail and interlocking screws. Prior left total knee
arthroplasty. All of the hardware is intact and unchanged in position. No
evidence for ___ lucency. Old screw tracks are seen within the
femur. Slight interval healing of the distal periprosthetic fracture as the
fracture lines are less distinct and there is more bony bridging. Unchanged
heterotopic ossification and cortical thickening. No new fracture. No
dislocation.
IMPRESSION:
1. No hardware complication.
2. Interval healing of distal femur periprosthetic fracture.
|
19906067-RR-152
| 19,906,067 | 24,552,279 |
RR
| 152 |
2132-06-16 22:26:00
|
2132-06-17 10:35:00
|
PA AND LATERAL CHEST, ___
HISTORY: Diastolic heart failure. Basal crackles.
IMPRESSION: AP chest compared to ___:
Moderate cardiomegaly is stable. Right lung is clear. Leftward mediastinal
shift is probably due to pleural restriction from chronic calcific pleuritis,
best seen on the lateral view, and reflected in chronic left lower lobe
atelectasis. No findings to suggest acute infection or cardiac
decompensation, although moderate cardiomegaly including left atrial
enlargement are both chronic.
|
19906067-RR-193
| 19,906,067 | 20,311,554 |
RR
| 193 |
2134-11-26 10:09:00
|
2134-11-26 11:20:00
|
EXAMINATION: ABDOMEN US (COMPLETE STUDY)
INDICATION: Portal hypertension and NASH cirrhosis presenting with acute
kidney injury and GI bleed. Evaluate for ascites, liver vasculature and
kidneys.
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: Abdominal ultrasound ___ and abdominal MRI ___.
FINDINGS:
ABDOMINAL ULTRASOUND: The liver is coarsened and heterogeneous in
echotexture, compatible with cirrhosis. There are no focal liver lesions
identified. The gallbladder is surgically absent. There is no intra or
extrahepatic biliary ductal dilation. The spleen is enlarged, measuring 15.6
cm, slightly increased from ___. There is trace ascites within the
lower abdomen.
Evaluation of the pancreas is limited by overlying bowel gas. The kidneys show
no hydronephrosis, nephrolithiasis or solid mass. Atrophy and cortical
thinning is similar to the prior MRI.
LIVER DOPPLER: The portal venous system is patent with normal hepatopetal
flow. The main hepatic artery shows normal acceleration and waveforms.
Expected respiratory variation is seen within the inferior vena cava and
hepatic veins.
IMPRESSION:
1. Cirrhosis with splenomegaly and trace lower abdominal ascites. 2. Patent
portal venous system. 3. Atrophic kidneys without hydronephrosis.
|
19906407-RR-155
| 19,906,407 | 21,285,940 |
RR
| 155 |
2193-04-08 01:25:00
|
2193-04-08 09:21:00
|
BILATERAL FOOT RADIOGRAPH DATED ___
CLINICAL INDICATION: ___ male with severe foot pain and swelling,
history of osteomyelitis status post multiple amputations.
COMPARISON: None available.
FINDINGS:
LEFT FOOT:
Amputation changes are noted at the second digit up to the mid portion of the
proximal second phalanx. Prominent plantar calcaneal heel spur. Osseous spur
at medial cuneiform. Calcified atherosclerotic vascular disease of the
dorsalis pedis and branch vessels. ___ fat pad is maintained. Lisfranc
interval is maintained. Remaining joint spaces in the left foot are
unremarkable. Soft tissue calcification is seen in the left leg
anteromedially at the level of the distal left tibia diaphysis on the frontal
and oblique projections. This could be vascular or dystrophic calcification.
RIGHT FOOT:
Frontal, lateral, and oblique radiographs of the right foot demonstrate
grossly maintained joint spaces. No definite acute fractures or dislocations.
Prominent plantar calcaneal heel spur. Atherosclerotic calcified vascular
disease involving the dorsalis pedis artery. Lisfranc interval is maintained.
Mild right dorsal foot soft tissue swelling.
IMPRESSION:
1. Amputation changes in the left foot extending to the mid portion of the
right second proximal phalanx.
2. Bilateral calcified atherosclerotic vascular disease in the feet.
3. No acute fractures.
4. Mild right dorsal foot soft tissue swelling.
|
19906407-RR-156
| 19,906,407 | 21,285,940 |
RR
| 156 |
2193-04-08 04:26:00
|
2193-04-08 10:20:00
|
INDICATION: Left internal jugular catheter placement.
TECHNIQUE: Portable AP chest radiograph.
COMPARISON: ___.
FINDINGS: A left internal jugular vein catheter terminates in left
brachiocephalic vein. There is no pneumothorax. There is no focal
consolidation or pleural effusion. The cardiomediastinal silhouette is within
normal limits.
IMPRESSION: Left IJ catheter terminates in left brachiocephalic vein. No
pneumothorax.
Findings were relayed by Dr. ___ to Dr. ___ by phone at
10:55 a.m. on ___.
|
19906407-RR-157
| 19,906,407 | 21,285,940 |
RR
| 157 |
2193-04-08 10:51:00
|
2193-04-08 11:48:00
|
INDICATION: ___ man with morbid obesity and right greater than left
lower extremity edema.
COMPARISON: Bilateral leg ultrasound, ___.
FINDINGS: Grayscale, color and Doppler images were obtained of the right
common femoral, femoral, popliteal and tibial veins. Normal flow, compression
and augmentation is seen in all of the vessels.
IMPRESSION: No evidence of deep vein thrombosis in the right leg.
|
19906444-RR-7
| 19,906,444 | 23,511,401 |
RR
| 7 |
2178-04-20 21:02:00
|
2178-04-20 22:20:00
|
HISTORY: ___ man with abdominal pain, nausea. Evaluation for
appendicitis.
COMPARISON: None available.
TECHNIQUE: Axial MDCT images were obtained through the abdomen and pelvis
after the administration of intravenous and oral contrast. Reformatted
coronal and sagittal images were also reviewed.
DLP: 315.9 mGy-cm.
FINDINGS:
CT ABDOMEN:
The bases of the lungs are clear. There is no pericardial effusion.
The liver enhances homogeneously, with no evidence of focal lesions. The
portal vein is patent. A type 1 choledochal cyst is noted, measuring 4.6 x
4.2 x 6.5 cm (TRV x AP x CC), best seen on (series 2, image 23 and series 601,
image 16). Otherwise, there is no pancreatic ductal dilatation or
intrahepatic ductal dilatation. The pancreas is unremarkable. The
gallbladder itself is normal in appearance, and thin-walled, with no evidence
of gallstones or gallbladder wall thickening. The spleen, bilateral adrenal
glands, bilateral kidneys, stomach and intra-abdominal loops of large and
small bowel are normal in appearance. The kidneys demonstrate symmetric
nephrograms and excretion of contrast, with no evidence of obstruction or
hydronephrosis. Enteric contrast is seen to the level of the sigmoid. There
is no retroperitoneal or mesenteric lymphadenopathy. No intraperitoneal free
air or free fluid is identified.
CT PELVIS: The pelvic loops of large and small bowel are normal in
appearance. Although the appendix is not definitely visualized, no secondary
signs of appendicitis are seen. Trace simple free fluid is noted in the
pelvis (2:64). The bladder and terminal ureters are unremarkable. The
prostate is normal. There is no pelvic sidewall or inguinal lymphadenopathy.
OSSEOUS STRUCTURES: No lytic or blastic lesion suspicious for malignancy is
identified.
IMPRESSION:
1. No acute pathology in the abdomen or pelvis.
2. Choledochal cyst most likely type I without intraluminal stone seen or
surrounding inflammation. MRCP would further evaluate. No cholelithiasis or
cholecystitis is present, although ultrasound is more sensitive.
|
19906444-RR-8
| 19,906,444 | 23,511,401 |
RR
| 8 |
2178-04-21 13:04:00
|
2178-04-21 15:46:00
|
INDICATION: Evaluation of patient with epigastric pain, elevated liver
enzymes, and elevated lipase, for further characterization.
TECHNIQUE: Multiplanar multisequence MRCP was performed on 1.5 Tesla magnet
before and after the administration of 7 cc of Gadavist.
COMPARISON: CT abdomen and pelvis from ___.
FINDINGS:
MRCP WITH AND WITHOUT CONTRAST:
At the junction of the left hepatic duct, right anterior hepatic duct, right
posterior hepatic duct there is bulbous dilatation of the origin of the common
hepatic duct to 2.0 cm (TV) x 1.0 cm (AP) x 1.3 cm (CC) which is continuous
with a common bile duct bulbous dilatation to 6.5 cm (TV) x 3.1 cm (AP) x 6.6
cm (CC). These findings are suggestive of a bilobed choledochal cyst, type
IV. Within the common bile duct portion of this bilobed choledochal cyst,
there is a 3.8 cm (TV) x 1.7 cm (AP) x 3.7 cm (CC) lesion which is hypoinense
to liver and pancreas on T1-weighted imaging, hyperintense on T2-weighted
imaging, and demonstrating enhancement as well as restricted diffusion, and
suggestive of a malignancy, likely cholangiocarcinoma. This mass has a broad
attachment to the posterior wall of the common bile duct with irregularity of
the posterior aspect of the common bile duct which are concerning for invasion
through the wall. At the junction of the IVC and left renal vein, no clear fat
plane is identified between this mass within the posterior aspect of the
common bile duct and the left renal vein. A non-enhancing focus is noted in
this mass and likely representative of necrosis (1003:76).
The intrapancreatic portion of the common bile duct appears within normal
limits and the pancreatic duct is not clearly identified on this study. The
liver is otherwise within normal limits. There is conventional hepatic
arterial anatomy. The splenic, super mesenteric, main portal, and right and
left portal veins are patent.
The cystic duct inserts into the common bile duct portion of the choledochal
cyst. The gallbladder, pancreas, spleen, stomach, bilateral kidneys, bilateral
adrenal glands are within normal limits. There is no significant free fluid.
There is no mesenteric or retroperitoneal lymphadenopathy. Bone marrow signal
is within normal limits.
IMPRESSION:
Bilobed choledochal cyst involving the common hepatic duct and the proximal
common bile duct to the level of the pancreas. Within the common bile duct
choledochal cyst is a 3.8 cm enhancing mass with restricted diffusion that is
highly concerning for cholangiocarcinoma. This mass has a broad attachment to
the posterior wall of the common bile duct with irregularity of the posterior
aspect of the common bile duct, which is concerning for invasion into and
through the wall; particularly at the junction of the IVC and left renal vein
where no clear fat plane is identified between this mass within the posterior
aspect of the common bile duct and the left renal vein. No lymphadenopathy or
other lesions.
No intrahepatic bile duct dilation with the tiny right and left hepatic ducts
inserting into the dilated CHD. Normal cystic duct caliber and normal
appearance of the gallbladder.
These findings were discussed by Dr. ___ with Dr. ___ telephone at
the time of discovery at 3:40 pm on ___.
|
19906564-RR-10
| 19,906,564 | 24,594,046 |
RR
| 10 |
2124-09-14 19:32:00
|
2124-09-14 20:46:00
|
EXAMINATION: KNEE (2 VIEWS) LEFT
INDICATION: ___ year old man s/p left knee hardware removal/placement abx
spacer// eval
TECHNIQUE: AP and lateral portable views of the left knee were obtained
COMPARISON: ___
IMPRESSION:
There has been interval removal of the left knee prosthesis and placement of
an antibiotic spacer. There is no evidence of an acute fracture.
|
19906564-RR-11
| 19,906,564 | 24,594,046 |
RR
| 11 |
2124-09-18 10:11:00
|
2124-09-18 11:21:00
|
EXAMINATION: CHEST PORT. LINE PLACEMENT
INDICATION: ___ year old man with new 47 SL PICC left side// picc tip location
Contact name: ___: ___
TECHNIQUE: Portable frontal chest radiograph.
COMPARISON: Multiple plain film radiographs of the chest, most recent dated
___.
FINDINGS:
The cardiomediastinal silhouette is unchanged since prior study, the heart is
enlarged but stable in size. There is no pulmonary edema, no effusions, no
pneumothorax or focal consolidation. There has been interval placement of a
left-sided PICC line with its tip in the distal SVC.
IMPRESSION:
Left PICC line is seen with its tip in the distal SVC.
|
19906564-RR-7
| 19,906,564 | 24,594,046 |
RR
| 7 |
2124-09-06 04:00:00
|
2124-09-06 08:33:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with sepsis and new O2 requirement iso IVF
resuscitation. Also likely undiagnosed COPD, OSA// pulmonary edema/congestion,
PNA?
IMPRESSION:
No previous images. There is enlargement of the cardiac silhouette without
vascular congestion, pleural effusion, or acute focal pneumonia.
|
19906564-RR-8
| 19,906,564 | 24,594,046 |
RR
| 8 |
2124-09-06 21:02:00
|
2124-09-06 22:24:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with new R IJ CVL placement// ___ year old man
with new R IJ CVL placement, please confirm line placement
TECHNIQUE: AP radiograph of the chest.
COMPARISON: Chest radiograph ___.
IMPRESSION:
There is a right internal jugular central venous catheter, which terminates in
the lower superior vena cava. There are low lung volumes. There is no focal
consolidation, pleural effusion or pneumothorax. The cardiomediastinal
silhouette is stable in appearance. No acute osseous abnormalities are
identified.
|
19906564-RR-9
| 19,906,564 | 24,594,046 |
RR
| 9 |
2124-09-10 13:43:00
|
2124-09-10 14:59:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with L knee septic arthritis and AFib with RVR,
recently admitted to TSICU now on the floor.// Consolidation or focal
abnormalities- decreased lung sounds on left with bilateral crackles
TECHNIQUE: Chest AP film
COMPARISON: ___
FINDINGS:
In comparison to the study completed on ___, improved pulmonary
edema. The right IJ catheter has also been removed. Cardiomegaly . Lungs are
well expanded. Bilateral pleural effusion, left greater than right with
compressive atelectasis. No evidence of focal consolidation or pneumothorax.
IMPRESSION:
1. Improved pulmonary edema.
2. Bilateral pleural effusions, left greater than right, with bibasilar
atelectasis.
|
19906572-RR-10
| 19,906,572 | 29,750,360 |
RR
| 10 |
2135-08-14 08:29:00
|
2135-08-14 15:32:00
|
EXAMINATION: PORTABLE ABDOMEN
INDICATION: ___ with PSH of hepaticojejunostomy presenting with painless
jaundice for the last week s/p exlap, lysis of adhesions, HJ revision, R SO//
CT with PO study yesterday, please eval for progression of contrast
TECHNIQUE: Abdomen single view
COMPARISON: CT ___, CT ___
FINDINGS:
Since ___, contrast is now present in the ascending and transverse
colon, rectum. Again seen are dilated loops of bowel in the central and right
abdomen, stable since prior, measuring 13 cm in diameter. Surgical clips
abdomen. Segmental elevation of the right hemidiaphragm stable. Surgical
clips. Degenerative changes spine.
IMPRESSION:
Stable dilatation of bowel loops in the mid abdomen, may be postsurgical or
from obstruction.
Contrast is now within nondilated colon.
|
19906572-RR-11
| 19,906,572 | 29,750,360 |
RR
| 11 |
2135-08-15 22:15:00
|
2135-08-16 05:35:00
|
INDICATION: ___ year old woman with ___ with PSH of hepaticojejunostomy
presenting with painless jaundice for the last week s/p exlap, lysis of
adhesions, HJ revision, R SO now w/ vomiting// interval change from prior
x-ray, r/o any new obstruction
TECHNIQUE: Portable supine abdominal radiograph was obtained.
COMPARISON: Abdominal radiograph from ___
FINDINGS:
Mild interval increase in dilated loops of small bowel in the mid abdomen and
right upper quadrant when compared to prior study, measuring up to 14 cm. The
diaphragm is not imaged limiting evaluation of the upper abdomen. Contrast
persists in the sigmoid colon and rectum. Assessment for free intraperitoneal
air is limited on supine radiographs.
Osseous structures are notable for multilevel degenerative changes of the
lumbar spine.
Skin staples are seen overlying the abdomen just right of midline. Surgical
clips are seen in the upper abdomen.
IMPRESSION:
1. Mild interval increase in significant gaseous distention in mid abdominal
and right upper quadrant loops of small bowel.
2. Assessment of the upper abdomen and diaphragm is limited on this study due
to technical considerations.
|
19906572-RR-12
| 19,906,572 | 29,750,360 |
RR
| 12 |
2135-08-23 08:14:00
|
2135-08-23 09:31:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ with PSH of hepaticojejunostomy presenting with painless
jaundice for the last week s/p exlap, lysis of adhesions, HJ revision, R
oophorectomy// eval for pneumonia
IMPRESSION:
In comparison with the study of ___, the nasogastric tube is been
removed. The left subclavian PICC line is stable.
Continued low lung volumes with bibasilar atelectatic changes and probable
small pleural effusions. The right hemidiaphragmatic contour remains
elevated.
Although node definite focal consolidation is appreciated, the low volumes and
pulmonary changes make it difficult to unequivocally exclude superimposed
pneumonia in the appropriate clinical setting, especially in the absence of a
lateral view.
|
19906572-RR-13
| 19,906,572 | 29,750,360 |
RR
| 13 |
2135-08-23 10:46:00
|
2135-08-23 13:38:00
|
INDICATION: ___ year old woman with concern for biliary obstruction// IV
contrast only
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired
through the abdomen and pelvis following intravenous contrast administration
with split bolus technique.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 4.1 s, 65.7 cm; CTDIvol = 20.4 mGy (Body) DLP =
1,337.6 mGy-cm.
2) Stationary Acquisition 5.6 s, 0.5 cm; CTDIvol = 30.7 mGy (Body) DLP =
15.4 mGy-cm.
Total DLP (Body) = 1,353 mGy-cm.
COMPARISON: CT abdomen pelvis on ___
FINDINGS:
LOWER CHEST: There is bibasilar atelectasis, left worse than right. There is
no evidence of pleural effusion. There is a normal heart size with trace
pericardial effusion. A catheter is seen terminating in the cavoatrial
junction.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.
Patient is status post hepaticojejunostomy with pneumobilia demonstrated as
expected. There is no evidence of focal lesions. There is persistent
intrahepatic biliary dilatation, similar to preoperative CT from ___. The gallbladder is surgically absent.
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 stable well-defined hypoattenuating lesion in the spleen
with central calcified septations measuring approximately 1.9 cm. Spleen is
enlarged measuring approximately 13 cm but demonstrates normal attenuation
throughout. A coil is once again demonstrated in the superior aspect of the
spleen.
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: Patient is status post hepaticojejunostomy. The biliary
limb is again markedly dilated extending from the J-J anastomosis to the
perihepatic small-bowel loops. The stomach, duodenum and efferent limb are
decompressed. The bowel loops distal to the new site of anastomosis are also
decompressed. Overall, the bowel pattern appears very similar to
postoperative CT from ___. Diverticulosis of the sigmoid colon is
noted, without evidence of wall thickening and fat stranding. The appendix is
normal.
REPRODUCTIVE ORGANS:
Patient is status post right salpingo-oophorectomy with bilateral fluid
collections as described below. A Foley catheter is visualized within the
bladder.
In the area of the right adnexal surgical bed status post a complex cyst
removal is a 3.6 x 3.9 cm fluid collection. In addition in the left adnexa
there is a newly developed 4.3 x 3.5 cm fluid collection likely representing a
postoperative seroma (2:94).
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.
Multilevel degenerative changes of the visualized thoracolumbar spine are
noted.
SOFT TISSUES: There is diffuse subcutaneous edema consistent with anasarca.
Skin staples are noted in the midline of the abdominal wall. There is trace
subcutaneous emphysema near the site of surgical incision, decreased from
prior exam.
IMPRESSION:
1. Patient is status post hepaticojejunostomy and entero-enteric anastomotic
revision with persistent dilation of the biliary limb extending from the site
of anastomosis to the perihepatic loops.
2. Status post right salpingo-oophorectomy with a 4.0 cm fluid collection
right adnexa and 4.3 cm fluid collection in the left adnexa.
3. Bibasilar atelectasis, left worse than right with trace pericardial
effusion.
|
19906572-RR-14
| 19,906,572 | 29,750,360 |
RR
| 14 |
2135-08-24 08:13:00
|
2135-08-24 09:51:00
|
INDICATION: ___ year old woman s/p hepaticojejunostomy with new fluid
collection in abdomen requiring ___ drainage// intra abdominal abscess
requiring drainage
COMPARISON: CT from the day prior
PROCEDURE: Ultrasound-guided drainage of a left abdominal collection.
OPERATORS: Dr. ___ trainee and Dr. ___ radiologist.
Dr. ___ supervised the trainee during the key components of the
procedure and reviewed and agree with the trainee's findings.
TECHNIQUE: The risks, benefits, and alternatives of the procedure were
explained to the patient. After a detailed discussion, informed written
consent was obtained. A pre-procedure timeout using three patient identifiers
was performed per ___ protocol.
The patient was placed in a supine position on the US scan table. Limited
preprocedure ultrasound was performed to localize the collection. Based on
the ultrasound findings an appropriate skin entry site for the drain placement
was chosen. The site was marked. Local anesthesia was administered with 1%
Lidocaine solution.
Using continuous sonographic guidance, ___ Exodus drainage catheter was
advanced via trocar technique into the collection. A sample of fluid was
aspirated, confirming catheter position within the collection. The pigtail
was deployed. The position of the pigtail was confirmed within the collection
via ultrasound.
Approximately 350 cc of serosanguineous fluid was drained with a sample sent
for microbiology evaluation. The catheter was secured by a StatLock. The
catheter was attached to bag. Sterile dressing was applied. Sample was sent
for microbiology.
The procedure was tolerated well, and there were no immediate post-procedural
complications.
SEDATION: Lidocaine local anesthesia only.
FINDINGS:
Preprocedure ultrasound re-demonstrates a large fluid collection just beneath
the peritoneal lining in the abdomen. Minimal complexity noted.
Postprocedure images demonstrate appropriate positioning of the pigtail
catheter in the collection.
IMPRESSION:
Successful US-guided placement of ___ pigtail catheter into the
collection. Samples was sent for microbiology evaluation.
|
19906572-RR-15
| 19,906,572 | 29,750,360 |
RR
| 15 |
2135-08-26 08:19:00
|
2135-08-26 12:29:00
|
INDICATION: ___ year old woman with ?biliary reflux vs dilation// ?assess for
anastomatic stricture
COMPARISON: CT abdomen/pelvis from ___ and ___.
TECHNIQUE: OPERATORS: Dr. ___, Radiology resident and Dr. ___
___, attending radiologist performed the procedure. Dr. ___
___ supervised the trainee during the key components of the procedure
and has reviewed and agrees with the trainee's findings.
ANESTHESIA: General anesthesia was administered by the anesthesiology
department.
MEDICATIONS: 10 cc 0.5% bupivacaine. Also see the general anesthesia record.
CONTRAST: 50 ml of Optiray contrast.
FLUOROSCOPY TIME AND DOSE: 18.2 min, 269 mGy
PROCEDURE:
1. Transabdominal ultrasound.
2. Ultrasound guided left percutaneous transhepatic bile duct access.
3. Left cholangiogram.
4. Pull-back cholangiogram beginning at the anastomosed jejunum.
5. Balloon dilation of the stenosed hepaticojejunal anastomosis to 10 mm.
6. ___ left biliary drain.
PROCEDURE DETAILS:
Following the discussion of the risks, benefits, and alternatives to the
procedure, written informed consent was obtained from the patient. The patient
was then brought to the angiography suite and placed supine on the exam table.
A pre-procedure time-out was performed per ___ protocol. The right abdomen
was prepped and draped in the usual sterile fashion.
Under ultrasound guidance, a 21G Cook needle was advanced into leftbiliary
system. Images of the access were stored on PACS. Once return of bilious fluid
was identified, a Nitinol wire was advanced under fluoroscopic guidance into
the common bile duct. A skin ___ was made over the needle and the needle was
removed over the wire. An Accustick set was advanced over the wire and the
inner stiffener was withdrawn. A contrast injection was performed to confirm
biliary anatomy, also demonstrating dilated bile ducts. A sample was removed
for culture. The headliner wire was exchanged for a Glidewire which was
advanced into the hepatobiliary limb using a Kumpe catheter. A 7 ___ sheath
was advanced over the wire into the biliary system. The glidewire was
exchanged for an Amplatz wire. A pull-back cholangiogram was performed to
deleniate the anatomy. A 10 mm x 4 cm balloon was advanced over the wire and
used to dilated the narrowed HJ anastomosis. The catheters and sheath were
removed. A ___ internal external biliary catheter was advanced, the wire and
inner stiffener were removed and the pigtail was formed. Contrast injection
confirmed appropriate position. The catheter was flushed with saline, secured
with stay sutures to the skin and sterile dressings were applied. The
catheter was attached to a bag.
The patient tolerated the procedure well. There were no immediate
complications.
FINDINGS:
1. Dilated biliary system filled with purulent/stool-like material, which was
sent for culture.
2. Severe hepaticojejunostomy anastomotic stricture, which was dilated to 10
mm.
3. Marked distention of the hepatobiliary limb with relative stasis of
contrast. Outflow of contrast to the jejunojejunostomy was not observed.
Further investigation may be performed once the bowel is more decompressed.
4. 10 ___ PTBD in appropriate final position.
IMPRESSION:
1. Dilated biliary system with purulent/stool-like material, sent for culture.
2. Hepaticojejunostomy anastomotic stricture.
3. Successful placement of a left ___ internal-external biliary drain.
|
19906572-RR-16
| 19,906,572 | 29,750,360 |
RR
| 16 |
2135-08-29 11:46:00
|
2135-08-29 16:01:00
|
INDICATION: ___ year old woman with cholangitis and occluded drain. Please
upsize PTBD size
COMPARISON: PTC from ___
TECHNIQUE: OPERATORS: Dr. ___ resident and Dr. ___,
___ radiologist performed the procedure. Dr. ___
supervised the trainee during the key components of the procedure and has
reviewed and agrees with the trainee's findings.
ANESTHESIA: Moderate sedation was provided by administrating divided doses of
75 mcg of fentanyl and 1 mg of midazolam throughout the total intra-service
time of 20 minutes during which the patient's hemodynamic parameters were
continuously monitored by an independent trained radiology nurse. 1% lidocaine
was injected in the skin and subcutaneous tissues overlying the access site
MEDICATIONS: None
CONTRAST: 40 ml of Optiray contrast.
FLUOROSCOPY TIME AND DOSE: 4.4 min, 95 mGy
PROCEDURE:
1. Over-the-wire pull back cholangiogram through existing left-sided 10 ___
percutaneous transhepatic biliary drainage access.
2. Exchange of the existing percutaneous trans-hepatic biliary drainage
catheter with a new left-sided 12 ___ PTBD catheter.
PROCEDURE DETAILS: Following the discussion of the risks, benefits and
alternatives to the procedure, written informed consent was obtained from the
patient. The patient was then brought to the angiography suite and placed
supine on the exam table. A pre-procedure time-out was performed per ___
protocol. The mid abdomen was prepped and draped in the usual sterile fashion.
Initial scout images showed biliary drain in the appropriate position. The
left tube was injected with dilute contrast. The images were stored on PACS.
Following the subcutaneous injection of 1% lidocaine and instillation of
lidocaine jelly into the skin site, the left catheter was cut and ___
wire was advanced through the catheter into the duodenum. A pull back
cholangiogram was then performed with findings as outlined below. The catheter
was removed over the wire and a 12 ___ percutaneous trans hepatic biliary
drainage catheter was advanced into the duodenum. Side holes were positioned
above and below the level of obstruction to facilitate internal drainage. The
wire and inner stiffener were removed, the catheter was flushed, the loop was
formed, the catheter was attached to a bag and sterile dressings were applied.
The patient tolerated the procedure well and there were no immediate
post-procedure complications.
FINDINGS:
1. Left 10 ___ percutaneous transhepatic biliary drainage catheter
presented occluded distally..
2. Cholangiogram showing severe intrahepatic biliary dilation and narrowing at
the bilioenteric anastomosis.
3. Successful up size of 10 ___ percutaneous transhepatic biliary drainage
catheter with a new 12 ___ percutaneous transhepatic biliary drainage
catheter.
IMPRESSION:
Successful up size of existing percutaneous transhepatic biliary drainage
catheter with a new 12 ___ biliary drainage catheter.
RECOMMENDATION(S): Recommend 10 cc sterile saline flushing of the catheter
___ times per day to prevent clogging.
|
19906572-RR-17
| 19,906,572 | 29,750,360 |
RR
| 17 |
2135-09-02 11:23:00
|
2135-09-02 12:17:00
|
EXAMINATION: DX CHEST PORTABLE PICC LINE PLACEMENT
INDICATION: ___ year old woman with new picc// R picc 48cm Contact name:
sal, ___: ___ R picc 48cm
IMPRESSION:
Comparison to ___. The left PICC line was removed. A new right PICC
line has been placed. The course of the line is unremarkable, the tip
projects over the mid SVC. No complications, notably no pneumothorax.
|
19906572-RR-18
| 19,906,572 | 29,750,360 |
RR
| 18 |
2135-09-05 13:54:00
|
2135-09-05 16:35:00
|
INDICATION: ___ year old woman with with history of hepaticojejunostomy status
post HJ and JJ revision with hyperbilirubinemia status post L PTBD.
COMPARISON: Biliary catheter exchange dated ___
TECHNIQUE: OPERATORS: Dr. ___ and Dr.
___ radiologist performed the procedure. Dr. ___
supervised the trainee during the key components of the procedure and has
reviewed and agrees with the trainee's findings.
ANESTHESIA: Moderate sedation was provided by administrating divided doses of
25 mcg of fentanyl and 0.5 mg of midazolam throughout the total intra-service
time of 34 minutes during which the patient's hemodynamic parameters were
continuously monitored by an independent trained radiology nurse. 1% lidocaine
was injected in the skin and subcutaneous tissues overlying the access site
MEDICATIONS: As above.
CONTRAST: 90 ml of Optiray contrast.
FLUOROSCOPY TIME AND DOSE: 5.8 min, 62 mGy
PROCEDURE:
1. Noncontrast abdominal cone beam CT with attention to the biliary system and
biliary limb
2. Over-the-wire cholangiogram through existing left percutaneous transhepatic
biliary drainage access.
3. Bowelogram
4. Exchange of the existing percutaneous trans-hepatic biliary drainage
catheter with a new ___ F PTBD catheter.
PROCEDURE DETAILS: Following the discussion of the risks, benefits and
alternatives to the procedure, written informed consent was obtained from the
patient. The patient was then brought to the angiography suite and placed
supine on the exam table. A pre-procedure time-out was performed per ___
protocol. The left abdomen and tube site were prepped and draped in the usual
sterile fashion.
Scout images showed biliary drain in the appropriate position. An unenhanced
cone beam CT of the abdomen was performed.
The left biliary tube was then injected with dilute contrast. The images were
stored on PACS.
Following the subcutaneous injection of 1% lidocaine and instillation of
lidocaine jelly into the skin site, the left catheter was cut and ___
wire was advanced through the catheter into the jejunal biliary limb. The
catheter was removed and a ___ x 25 cm bright tip sheath was advanced over the
wire. An over-the-wire pull back cholangiogram was then performed.
A straight flush catheter was advanced through the sheath side-x-side to the
___ wire into the jejunal biliary limb. Next, we attempted to aspirate
the jejunal limb contents. Then, we injected approximately 60 mL of contrast
to perform a bowelogram of the biliary jejunal limb. The catheter and sheath
were then removed.
A new 12 ___ percutaneous trans hepatic biliary drainage catheter was
advanced into the jejunum biliary limb. Side holes were positioned above and
below the HJ anastomosis to facilitate internal drainage. The wire and inner
stiffener were removed, the catheter was flushed, the loop was formed, the
catheter was attached to a bag and sterile dressings were applied.
The patient tolerated the procedure well and there were no immediate
post-procedure complications.
FINDINGS:
1. Abdominal cone beam CT with attention to the bile ducts and small bowel
identified a severely distended jejunal biliary limb. The bile duct drain was
in appropriate position.
2. Over-the-wire pull-back cholangiogram identified brisk antegrade biliary
flow through the HJ anastomosis with no evidence of stenosis. As seen on the
cone beam CT, the jejunal biliary limb was severely distended with fluid.
3. Attempted bowelogram was performed which showed antegrade flow to a bulbous
jejunal loop. A bowel stenosis was not identified
4. Appropriate final position of new ___ percutaneous transhepatic biliary
drain.
IMPRESSION:
Successful exchange of existing occluded percutaneous transhepatic biliary
drainage catheter with a new ___ catheter. There is no evidence of HJ
anastomotic stenosis noting brisk antegrade flow. The jejunal biliary limb is
severely distended with fluid suggestive of outflow stenosis or partial
obstruction.
|
19906572-RR-3
| 19,906,572 | 29,750,360 |
RR
| 3 |
2135-08-06 20:13:00
|
2135-08-06 21:11:00
|
EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: History: ___ with new onset painless jaundice// evaluate for
biliary dilation, portal vein thrombosis. Reported history of
hepaticojejunostomy ___ years ago at ___.
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: None.
FINDINGS:
LIVER: The hepatic parenchyma appears within normal limits. The contour of the
liver is smooth. There is no focal liver mass. The main portal vein is patent
with hepatopetal flow. There is no ascites. There are prominent tortuous
vessels in the porta hepatis which may represent varices.
BILE DUCTS: There is mild intrahepatic biliary dilatation and pneumobilia.
Common bile duct was not visualized.
GALLBLADDER: The patient is status post cholecystectomy.
PANCREAS: The pancreas is not well visualized, largely obscured by overlying
bowel gas.
SPLEEN: Spleen is enlarged measuring 15.0 cm. There is a lobulated anechoic
lesion with internal septations but no internal vascularity in the spleen
measuring 2.0 x 1.4 x 1.5 cm.
KIDNEYS: Limited views of the right kidney show no hydronephrosis.
RETROPERITONEUM: The visualized portions of aorta and IVC are within normal
limits.
IMPRESSION:
1. Mild intrahepatic biliary dilatation with pneumobilia and nonvisualization
of the common bile duct. Findings may be related to prior reported
hepaticojejunostomy, but if there is concern for biliary obstruction, MRCP
should be considered for further assessment.
2. Patent portal vein.
3. Prominent tortuous vessels in the porta hepatis which may represent
varices.
4. Splenomegaly with septated cyst.
RECOMMENDATION(S): Consider MRCP for further assessment if there is concern
for biliary obstruction.
|
19906572-RR-4
| 19,906,572 | 29,750,360 |
RR
| 4 |
2135-08-06 22:26:00
|
2135-08-06 23:31:00
|
EXAMINATION: CT abdomen pelvis
INDICATION: +PO contrast; History: ___ with painless
jaundice//Intra-abdominal mass
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 inadvertently not administered due to a protocol error.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Stationary Acquisition 7.5 s, 0.5 cm; CTDIvol = 36.1 mGy (Body) DLP =
18.1 mGy-cm.
2) Spiral Acquisition 5.8 s, 63.9 cm; CTDIvol = 17.0 mGy (Body) DLP =
1,083.0 mGy-cm.
Total DLP (Body) = 1,101 mGy-cm.
COMPARISON: Liver gallbladder ultrasound ___.
FINDINGS:
LOWER CHEST: There is subsegmental atelectasis in the right lower lobe. There
is no pleural effusion. Heart size is normal with a trace pericardial
effusion.
ABDOMEN:
HEPATOBILIARY: The right lobe of the liver appears atrophic. No concerning
hepatic mass is present. Patient is status post hepaticojejunostomy with
pneumobilia demonstrated. There is also moderate intrahepatic biliary
dilatation with the common bile duct not visualized. The gallbladder is
surgically absent.
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 well-defined hypoattenuating lesion in the spleen with
central calcified septations measuring 1.9 x 1.1 cm (02:34). Spleen is
enlarged measuring up to 13.6 cm.
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: Patient is status post hepaticojejunostomy. The biliary
limb appears circular in configuration with 2 anastomoses noted to a bowel
loop in the left upper quadrant, and is diffusely dilated with fluid and air.
Distal to the jejunojejunostomy (602:62), the small bowel (efferent limb) is
relatively decompressed and normal in appearance. The stomach, duodenum, and
proximal jejunum proximal to the jejunojejunostomy appear relatively
decompressed and unremarkable. There is colonic diverticulosis without
evidence of diverticulitis. Rectum is normal.
PELVIS: The bladder is distended. There is no free fluid in the pelvis.
REPRODUCTIVE ORGANS: There is a right adnexal cystic lesion measuring 9.3 x
7.8 cm (2:89) with several somewhat thickened and irregular septations within
it, which displaces the uterus to the left. The uterus and left 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: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. Status post hepaticojejunostomy with marked dilatation of the biliary limb
with fluid and air. Of note, the biliary limb appears to be circular in
configuration with 2 anastomoses noted to a bowel loop in the left upper
quadrant. The stomach, duodenum, and proximal jejunum leading to the
jejunostomy as well as the small bowel loops distal to the jejunojejunostomy
(efferent limb) appear relatively decompressed. Findings are concerning for
afferent loop syndrome secondary to narrowing at the jejunojejunostomy leading
to the efferent limb.
2. Mild intrahepatic biliary dilatation may be due to dilatation and
obstruction of the biliary limb. Pneumobilia is expected post
hepaticojejunostomy.
3. Complex right adnexal cystic lesion measuring 9.3 x 7.3 cm with apparent
thickened irregular septations, suspicious for a cystic epithelial ovarian
neoplasm. Pelvic ultrasound is recommended for further delineation.
4. Right lobe of the liver is atrophic.
5. Splenomegaly with cystic lesion containing calcified septations, possibly a
posttraumatic cyst.
RECOMMENDATION(S): Pelvic ultrasound for improved assessment of the right
adnexal cystic lesion.
|
19906572-RR-5
| 19,906,572 | 29,750,360 |
RR
| 5 |
2135-08-07 20:31:00
|
2135-08-07 21:15:00
|
EXAMINATION: PELVIS, NON-OBSTETRIC
INDICATION: ___ year old woman status post hepaticojejunostomy with Roux limb
obstruction and incidental finding of right adnexal mass, will have
exploratory lap tomorrow// Per OBGyn would like to have ultrasound of this
mass to better characterize the mass before surgery
TECHNIQUE: Grayscale ultrasound images of the pelvis were obtained with
transabdominal approach followed by transvaginal approach for further
delineation of uterine and ovarian anatomy.
COMPARISON: CT from ___
FINDINGS:
The uterus is retroflexed and measures 5.6 x 2.7 x 3.5 cm. The uterus appears
normal. The endometrium is poorly visualized.
There is a multi-septated complex cystic mass in the right adnexa measuring
7.3 x 8.4 x 7.5 cm with multiple thick, irregular, and nodular septations.
Echogenic debris is seen within several of the cystic components. No definite
internal vascularity is seen within this mass. The left ovary is not seen.
There is no free fluid.
IMPRESSION:
7.3 x 8.4 x 7.5 cm complex cystic mass in the right adnexa with thick,
irregular, and nodular septations. While no definite internal vascularity is
seen within this cystic mass, findings are concerning for a malignant ovarian
epithelial neoplasm and surgical evaluation is recommended.
|
19906572-RR-6
| 19,906,572 | 29,750,360 |
RR
| 6 |
2135-08-09 04:59:00
|
2135-08-09 09:44:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman s/p new biliary anastomosis, increasing WBC//
?infiltrate
TECHNIQUE: Single frontal view of the chest
COMPARISON: None
IMPRESSION:
NG tube tip isin the stomach. Mild cardiomegaly is accentuated by the
projection . The right hemidiaphragm is elevated. There are minimal
bibasilar atelectasis right greater than left. There is no pneumothorax or
pleural effusion
|
19906572-RR-8
| 19,906,572 | 29,750,360 |
RR
| 8 |
2135-08-10 10:20:00
|
2135-08-10 13:38:00
|
EXAMINATION: DX CHEST PORTABLE PICC LINE PLACEMENT
INDICATION: ___ year old woman with new line// new left PICC 44 cm ___
___ Contact name: ___: ___
IMPRESSION:
In comparison with study of ___, there is an placement of a left
subclavian PICC line that extends to about the level of the cavoatrial
junction.
Lower lung volumes with atelectatic changes at the bases. Continued elevation
of the right hemidiaphragmatic contour.
|
19906572-RR-9
| 19,906,572 | 29,750,360 |
RR
| 9 |
2135-08-12 15:29:00
|
2135-08-12 18:05:00
|
EXAMINATION: CT of the abdomen and pelvis
INDICATION: ___ y/o F POD ___ s/p exploratory laparotomy, LOA, JJ ___, R
SO, Tbili still elevated but downtrending// reassess dilated biliary limb,
assess flow of PO contrast via anastomosis- please use PO contrast only
TECHNIQUE: Multidetector CT images of the abdomen and pelvis were acquired
without intravenous contrast. Non-contrast scan has several limitations in
detecting vascular and parenchymal organ abnormalities, including tumor
detection.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 16.6 s, 57.1 cm; CTDIvol = 18.4 mGy (Body) DLP =
1,025.4 mGy-cm.
Total DLP (Body) = 1,040 mGy-cm.
COMPARISON: CT of the abdomen and pelvis from ___.
FINDINGS:
LOWER CHEST: There are new small bilateral pleural effusions with passive
atelectasis in both lower lobes.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout.
Pneumobilia is no longer seen. Absence of IV contrast limits the evaluation
for intrahepatic biliary ductal dilatation, however there is probable
persistent mild intrahepatic biliary ductal dilatation. The gallbladder is
surgically absent.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions within the limitations of an unenhanced scan. There is no
pancreatic ductal dilatation. There is no peripancreatic stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions. A coil is again noted within the superior aspect
of the spleen.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size. There is no
hydronephrosis. There is no nephrolithiasis. There is no perinephric
abnormality.
GASTROINTESTINAL: The patient is status post hepaticojejunostomy. The biliary
limb is again noted to be markedly dilated. Of note, there is oral contrast
beyond the jejuno-jejunal anastomosis, reaching the ileum. The stomach,
duodenum, the proximal jejunum and the efferent limb are decompressed.
Colonic diverticulosis is again noted in the sigmoid and descending colon.
There is new small amount of ascites. There is trace pneumoperitoneum.
PELVIS: The patient is status post right salpingo-oophorectomy, with
postsurgical changes noted in the area. Small amount of gas within the
bladder is likely related to prior instrumentation.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm.
BONES: Mild degenerative changes are again noted within the lower lumbar
spine.
SOFT TISSUES: Small subcutaneous emphysema along with stranding along the
anterior abdominal wall in keeping with postsurgical changes. Skin staples
are noted in the midline of the abdominal wall.
IMPRESSION:
1. Status post hepaticojejunostomy with similar appearance of the markedly
dilated biliary conduit. It is uncertain whether this represents chronically
dilated biliary conduit since a revision has been recently performed or if
this is secondary to obstruction. Of note, oral contrast passes beyond the
jejuno-jejunal anastomosis and reaches the ileum.
2. New small volume ascites is likely related to recent surgery.
3. Pneumobilia is no longer seen with persistent mild intrahepatic biliary
ductal dilatation, raising concern for obstruction at level of the
hepaticojejunostomy.
4. Status post right salpingo-oophorectomy.
5. Small bilateral pleural effusions with atelectasis in both lower lobes.
NOTIFICATION: The impression and recommendation above was entered by Dr.
___ on ___ at 18:04 into the Department of Radiology
critical communications system for direct communication to the referring
provider.
|
19906623-RR-12
| 19,906,623 | 20,871,993 |
RR
| 12 |
2141-04-30 01:32:00
|
2141-04-30 03:06:00
|
EXAMINATION: MRI ORBITS AND BRAIN WANDW/O CONTRAST T714 MR ___
INDICATION: ___ year old man with headache, left blurry vision ptosis,
photophobia, fever.
TECHNIQUE: Sagittal and axial T1 weighted imaging were performed. After
administration of 9 mL of Gadavist intravenous contrast, axial imaging was
performed with gradient echo, FLAIR, diffusion, and T1 technique. Sagittal
MPRAGE imaging was performed and re-formatted in axial and coronal
orientations. Orbit images acquired at 3 mm slice thickness. Precontrast
sequences included axial and coronal T1, coronal STIR. Postcontrast sequences
included axial and coronal T1 with fat saturation.
COMPARISON: Outside MR head ___, CTA head ___
FINDINGS:
MRI BRAIN: There is no evidence of infarction or edema. There is no enhancing
mass or abnormal enhancement. The ventricles are normal in size. There is no
midline shift. The dural venous sinuses appear patent on post-contrast MP
rage images. There is opacification of the right maxillary sinus with
probable mucosal retention cyst. There is an additional anterior small
enhancing mucosal retention cyst (17:5) there is mild mucosal thickening of
the left frontal, bilateral ethmoid air cells.
MRI ORBITS: There is faint enhancement surrounding the left optic nerve
(15:13). The apparent asymmetric size of the optic nerves is likely related
to differences in course of the optic nerves. There is no enlargement of the
left optic nerve. There is no orbital abscess. The globes and extraocular
muscles appear unremarkable. The preseptal soft tissues appear unremarkable.
IMPRESSION:
1. Faint enhancement surrounding the left optic nerve, which is normal in
size. Finding is nonspecific, but given the clinical presentation, finding
may be related to infectious or inflammatory process, suggest perineuritis.
No evidence of orbital abscess. Clinical correlation and attention on
follow-up imaging is recommended, as clinically warranted.
2. Right maxillary sinus mucosal retention cysts or polyps.
NOTIFICATION: The findings were discussed with ___, M.D. by ___
___, M.D. on the telephone on ___ at 11:28 am, 2 minutes after
discovery of the findings.
|
19906885-RR-41
| 19,906,885 | 21,216,663 |
RR
| 41 |
2146-06-26 12:36:00
|
2146-06-26 17:02:00
|
EXAMINATION: CT ABD AND PELVIS W AND W/O CONTRAST, ADDL SECTIONS
INDICATION: ___ year old woman with Filling the endometrial cavity there is a
heterogenous mass, concerning for endometrial cancer. Other possibilities
include a molar pregnancy or hydropic degeneration of a missed abortion. //
further evaluation of endometrial mass
TECHNIQUE: MDCT axial images were acquired through abdomen without contrast
initially, followed by scanning through the abdomen and pelvis following
intravenous contrast administration with split bolus technique. 3 min delayed
images were also obtained through the abdomen and pelvis.
Coronal and sagittal reformations were performed and submitted to PACS for
review.
Oral contrast was administered.
DOSE: DLP: 2321 mGy-cm
COMPARISON: Comparison is made to pelvic ultrasound from ___.
FINDINGS:
LOWER CHEST:
The bases of the lungs are clear, with the exception of some minimal scarring
or atelectasis anteriorly (3:5). There is no pleural or pericardial effusion.
ABDOMEN:
GENERAL: There is no intra-abdominal free air or free fluid.
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There
is no evidence of focal lesions. There is no evidence of intrahepatic or
extrahepatic biliary dilatation. The gallbladder is within normal limits,
without stones or gallbladder wall thickening.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The left kidney has a duplicated collecting system, with no evidence
of hydronephrosis of either the upper or lower pole moieties (05:49, 601b:37).
A 1.9 cm hyperdense exophytic cyst is noted along the lower pole of the left
kidney, an demonstrates no enhancement on portal venous or 3 min delayed phase
imaging (601b:34). A small parapelvic cyst is noted on the right (05:24).
GASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness
and enhancement throughout. Colon and rectum are within normal limits.
Appendix contains air, has normal caliber without evidence of fat stranding.
RETROPERITONEUM: There is no evidence of retroperitoneal and mesenteric
lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. There is no calcium burden in
the abdominal aorta and great abdominal arteries.
PELVIS:
A markedly enlarged uterus is filled with hemorrhagic material, and
demonstrates marked eccentric endometrial thickening along the left lateral
aspect (___), with evidence of post postcontrast enhancement and
extravasation of contrast into the fluid-filled endometrial cavity, compatible
with active hemorrhage. Multiple heterogeneously enhancing fibroids are also
noted, better characterized on recent prior pelvic ultrasound. The ovaries are
within normal limits, with a corpus luteum on the right (601b:29), and a
dominant follicle on the left (5:62).
BONES AND SOFT TISSUES:
No osseous lesion worrisome for malignancy is identified. A very small fat
containing umbilical hernia is present (05:53).
IMPRESSION:
1. Markedly enlarged uterus with asymmetric nodular thickening of the
endometrium and marked expansion of the cavity with blood products and
significant active hemorrhage. This constellation of findings, taken together
with markedly elevated beta HCG, is highly concerning for molar pregnancy.
2. No metastatic disease or lymphadenopathy is identified in the abdomen or
pelvis.
INCIDENTAL FINDINGS:
1. Uterine fibroids and ovaries are better characterized on recent prior
pelvic ultrasound.
2. Bilateral renal cysts and duplicated left renal collecting system.
NOTIFICATION: The findings were discussed via telephone by Dr. ___ with
___ Qui___ (ordering provider) on ___ at 4:43 ___, 5 minutes
after discovery of the findings.
|
19906885-RR-43
| 19,906,885 | 21,216,663 |
RR
| 43 |
2146-06-27 10:02:00
|
2146-06-27 11:47:00
|
INDICATION: Molar pregnancy. Pre operative chest radiograph
COMPARISON: CT examination from ___.
FINDINGS:
The heart size is normal. The hilar and mediastinal contours are within normal
limits. There is no pneumothorax, focal consolidation, or pleural effusion.
IMPRESSION:
No acute intrathoracic process.
TECHNIQUE: Frontal and lateral chest radiographs.
|
19906916-RR-31
| 19,906,916 | 26,067,035 |
RR
| 31 |
2157-12-13 17:10:00
|
2157-12-13 17:29:00
|
INDICATION: ___ with pre-syncope // R/O acute process
TECHNIQUE: PA and lateral views of the chest.
COMPARISON: ___.
FINDINGS:
The lungs are clear. The cardiomediastinal silhouette is within normal
limits. No acute osseous abnormalities.
IMPRESSION:
No acute cardiopulmonary process.
|
19906916-RR-32
| 19,906,916 | 26,067,035 |
RR
| 32 |
2157-12-15 09:38:00
|
2157-12-15 14:54:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old woman with SSS s/p dual chamber PPM. // Assess lead
placement and r/o PTx.
TECHNIQUE: PA and lateral chest radiographs.
COMPARISON: Multiple prior chest radiographs most recent dated ___
FINDINGS:
There has been interval placement of a transvenous dual lead pacemaker. The
these appear to be in appropriate position. No pneumothorax seen. No pleural
effusion or consolidation seen. Air-filled bowel loops are seen under the
diaphragm consistent with Chilaiditi syndrome. No free air under the
diaphragm.
IMPRESSION:
No acute cardiopulmonary process seen.
|
19906947-RR-57
| 19,906,947 | 29,264,555 |
RR
| 57 |
2179-08-07 13:30:00
|
2179-08-07 14:50:00
|
EXAMINATION: CT ABD AND PELVIS WITH CONTRAST
INDICATION: ___ woman with abdominal pain and hypotension after
undergoing screening colonoscopy earlier today.
TECHNIQUE: MDCT acquired axial images of the abdomen and pelvis were obtained
after administration of 130 mL Omnipaque intravenous contrast. Enteric
contrast was not given. Coronal and sagittal reformats prepared and reviewed.
DOSE: DLP: 430.73 mGy-cm.
COMPARISON: CT from ___.
FINDINGS:
CHEST:
There is left lower lobe atelectasis, a small hiatal hernia, and trace,
physiologic pericardial effusion.
ABDOMEN:
The liver enhances homogeneously, without concerning focal lesion. There is
a sub cm hypodensity in the right lobe of the liver which is too small to
characterize but stable from ___ (2:6). The gallbladder and biliary tree are
normal. The pancreas is normal, without focal lesion or duct dilation. The
spleen is normal in size, without focal lesion. The adrenal glands are normal.
The kidneys enhance normally and excrete contrast briskly. There are no solid
renal lesions or hydronephrosis.
There is cecal mural edema with minimal adjacent mesenteric fat stranding and
simple fluid (___). Otherwise, the small bowel and remainder large bowel
are normal in caliber.
There is no intra- or retroperitoneal lymphadenopathy. There is no ascites,
fluid collection, or pneumoperitoneum. The abdominal aorta is normal caliber,
with patent main branches. The portal vein and IVC are patent.
PELVIS:
The urinary bladder is without wall thickening or mass. The rectum is
unremarkable. There is no free fluid. There is no pelvic or inguinal
lymphadenopathy. There are multiple uterine fibroids with coarse
calcifications, likely in the process of involution, with areas of hypodensity
which may reflect degeneration. Rounded hypodensities in the region of the
cervix may relate to nabothian cysts. There is no adnexal abnormality.
BONES AND SOFT TISSUES:
There is no acute fracture. There is severe scoliosis of the spine with
associated degenerative change.
IMPRESSION:
1. Cecal wall edema and small amount of adjacent simple fluid and fat
stranding at the site of patient's reported polypectomy, most c onsistent with
postpolypectomy electrocautery syndrome. No evidence of perforation.
2. Multiple uterine fibroids, some of which may be degenerating.Rounded
hypodensities in the region of the cervix may relate to nabothian cysts.
Findings could be confirmed on nonurgent pelvic ultrasound.
|
19907026-RR-52
| 19,907,026 | 25,632,267 |
RR
| 52 |
2163-05-20 12:40:00
|
2163-05-20 13:45:00
|
EXAMINATION: CHEST RADIOGRAPH ___
INDICATION: History: ___ with worsening SOB, known CHF // eval heart and
lungs
TECHNIQUE: Chest PA and lateral
COMPARISON: Comparison is made to radiographs of the chest from ___ and ___.
FINDINGS:
Assessment is limited by underpenetration secondary to patient's body habitus.
The heart is markedly enlarged, but unchanged compared to the prior studies,
which may reflect cardiomegaly or a pericardial effusion. Clinical
correlation is advised. The lung volumes are somewhat low, with bibasilar
atelectasis, and pulmonary vascular congestion with peribronchial cuffing,
suggesting mild pulmonary edema. Aorta is unfolded. There is no pneumothorax
or large pleural effusion. Multi level degenerative changes are again seen in
the thoracic spine.
IMPRESSION:
1. Stable marked cardiomegaly.
2. Mild pulmonary edema and bibasilar atelectasis.
|
19907026-RR-53
| 19,907,026 | 25,632,267 |
RR
| 53 |
2163-05-20 20:03:00
|
2163-05-20 20:44:00
|
EXAMINATION: BILAT LOWER EXT VEINS
INDICATION: ___ year old woman with new onset dyspnea and right calf pain.
Rule out DVT, especially in right lower extremity.
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the bilateral lower extremity veins.
COMPARISON: Lower extremity ultrasound from ___.
FINDINGS:
There is normal compressibility, flow and augmentation of the bilateral common
femoral, superficial femoral, and popliteal veins. Normal color flow and
compressibility are demonstrated in the posterior tibial and peroneal veins.
There is normal respiratory variation in the common femoral veins bilaterally.
No evidence of medial popliteal fossa (___) cyst.
IMPRESSION:
No evidence of deep venous thrombosis in the bilateral lower extremity veins.
|
19907026-RR-56
| 19,907,026 | 28,499,285 |
RR
| 56 |
2164-05-02 02:48:00
|
2164-05-02 11:15:00
|
EXAMINATION: DX TIB/FIB AND ANKLE/FOOT
INDICATION: History: ___ with s/p fall onto her knees. Morbidly obese,
substantial pain on palpation of knees // fracture? fracture?
TECHNIQUE: Left ankle, three views, left foot, two views, left tibia and
fibula, two views
COMPARISON: Left knee radiograph from ___.
FINDINGS:
There is a spiral - shaped minimally displaced fracture of the distal tibia.
The distal fragment is mildly medially displaced. There is no evidence of
dislocation. The mortise is congruent on this non stress view. The tibial
talar joint space is preserved and no talar dome osteochondral lesion is
identified.
Visualized portions of the knee demonstrates severe degenerative changes of
the medial compartment, characterized by joint space narrowing and spur
formation, progressed since prior examination. Note is also made of
chondrocalcinosis.
No suspicious lytic or sclerotic lesion is identified.
IMPRESSION:
Spiral mildly displaced fracture of the distal tibia.
|
19907026-RR-57
| 19,907,026 | 28,499,285 |
RR
| 57 |
2164-05-02 03:05:00
|
2164-05-02 11:09:00
|
EXAMINATION: TIB/FIB (AP AND LAT) RIGHT
INDICATION: History: ___ with fall onto legs // eval for fx eval for
fx
TECHNIQUE: Right tibia and fibula, two views. Right foot, 2 views.
COMPARISON: Prior right knee radiographs from ___.
FINDINGS:
Right tibia and fibula: There is no evidence of acute fracture or
dislocation. Visualized portions of the knee demonstrate moderate to severe
tricompartmental degenerative changes, characterized by joint space narrowing
and spur formation. No suspicious lytic, sclerotic lesion, or periosteal new
bone formation is detected. No radio opaque foreign body is detected.
Right foot: no evidence of fracture dislocation. The ankle mortise is
preserved. Mild tarsometatarsal degenerative changes, talonavicular
degenerative changes and plantar calcaneal spur.
IMPRESSION:
No acute fracture. Degenerative changes as above.
|
19907026-RR-58
| 19,907,026 | 28,499,285 |
RR
| 58 |
2164-05-02 03:19:00
|
2164-05-02 09:28:00
|
EXAMINATION: CHEST RADIOGRAPH
INDICATION: History: ___ with s/p fall // Please eval for pna Please
eval for pna
TECHNIQUE: Frontal chest radiograph.
COMPARISON: Chest radiograph from ___ and ___.
FINDINGS:
Evaluation is limited due to under penetration secondary to patient's body
habitus. The heart is markedly enlarged and stable. Clearly there is
vascular engorgement, with possible mild pulmonary edema. Although no focal
consolidation is identified, given limited examination, pneumonia cannot be
entirely excluded. No large pleural effusion or pneumothorax identified.
IMPRESSION:
1. Stable marked cardiomegaly.
2. Limited evaluation secondary to patient's body habitus. There is clear
vascular engorgement with possible mild pulmonary edema.
3. Although no focal consolidation is identified, given limited examination,
pneumonia cannot be entirely excluded.
|
19907026-RR-59
| 19,907,026 | 28,499,285 |
RR
| 59 |
2164-05-02 05:50:00
|
2164-05-02 11:17:00
|
EXAMINATION: ANKLE (AP, MORTISE AND LAT) LEFT
INDICATION: History: ___ with s/p reduction of LLE // Eval post reduction
Eval post reduction
TECHNIQUE: Left ankle, two views.
COMPARISON: Prior radiographs from the same day.
FINDINGS:
As compared to prior examination, there has been interval improvement in
anatomic alignment of the known distal fracture of the tibia. Fracture lines
are still appreciated. No additional new fractures identified.
IMPRESSION:
Status post reduction of known fracture of the distal tibia, with interval
improvement in anatomic alignment.
|
19907026-RR-63
| 19,907,026 | 28,499,285 |
RR
| 63 |
2164-05-03 14:03:00
|
2164-05-03 14:39:00
|
EXAMINATION: DX TIB/FIB AND ANKLE
INDICATION: ___ year old woman with tib fib fx // ___ year old woman with tib
fib fx ___ year old woman with tib fib fx
IMPRESSION:
In comparison with the study of ___, the cast again greatly obscures the
appearance of the oblique fracture of the distal tibia. Fracture lines are
well seen.
|
19907026-RR-64
| 19,907,026 | 28,499,285 |
RR
| 64 |
2164-05-05 00:37:00
|
2164-05-05 07:47:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with new ___, unclear if ___ to hypervolemia
// r/o pulm edema, chf worsening r/o pulm edema, chf worsening
IMPRESSION:
In comparison with the study of ___, there are slightly lower lung
volumes. Again there is substantial enlargement of the cardiac silhouette
with much worsening pulmonary edema. Probable layering effusions with
compressive basilar atelectasis bilaterally.
Scatter radiation related to the size of the patient somewhat obscures detail.
|
19907026-RR-66
| 19,907,026 | 24,069,513 |
RR
| 66 |
2165-05-15 15:50:00
|
2165-05-15 16:32:00
|
EXAMINATION: BILATERAL LOWER EXTREMITY ULTRASOUND
INDICATION: Chest pain, shortness of breath and right heart strain. Evaluate
for DVT.
TECHNIQUE: Bilateral lower extremity venous ultrasound
COMPARISON: ___
FINDINGS:
Grayscale, color, and spectral doppler imaging was obtained of the right and
left common femoral, femoral, and popliteal veins. Examination is limited by
reduced acoustic penetration due to body habitus. Normal flow,
compressibility, augmentation, and waveforms are demonstrated (compression
views were not obtained of the distal superficial femoral or popliteal veins
bilaterally due to limited visualization on grayscale images). No intraluminal
thrombus is identified. Color flow is demonstrated in limited views of the
posterior tibial and peroneal veins. There is normal respiratory variation in
both common femoral veins. A ___ cyst is seen on the left measuring 4.6 x
1.1 x 2.0 cm.
IMPRESSION:
Limited examination due to reduced acoustic penetration related to body
habitus. No evidence of deep vein thrombosis in right or left lower
extremity, with limited views of distal superficial femoral, popliteal, and
calf veins.
|
19907026-RR-67
| 19,907,026 | 24,069,513 |
RR
| 67 |
2165-05-15 18:57:00
|
2165-05-15 19:46:00
|
INDICATION: ___ year old woman with PICC // Pt had a R PICC,55cm ___ ___
Contact name: ___: ___
COMPARISON: Radiographs from ___
IMPRESSION:
There is a right-sided PICC line with the distal lead tip at the cavoatrial
junction. Heart size is enlarged. There remains pulmonary vascular
congestion and likely small bilateral effusions. There are no pneumothoraces.
|
19907026-RR-68
| 19,907,026 | 24,069,513 |
RR
| 68 |
2165-05-16 09:32:00
|
2165-05-16 11:18:00
|
INDICATION: ___ year old woman with DM, HTN, AFIB, admitted with cellulitis.
// verify PICC placement
COMPARISON: Compared to radiographs from ___
IMPRESSION:
There is a right-sided PICC line with the distal lead tip at the cavoatrial
junction. Heart size is enlarged. There is atelectasis at the lung bases
There are no pneumothoraces.
|
19907138-RR-9
| 19,907,138 | 21,846,712 |
RR
| 9 |
2134-02-06 03:13:00
|
2134-02-06 04:24:00
|
INDICATION: ___ with left chest pain.
TECHNIQUE: Frontal and lateral radiographs of the chest were obtained.
COMPARISON: There are no prior studies for comparison available.
FINDINGS:
Faint opacity in the left upper lobe might represent possible early pneumonia
in the appropriate clinical setting. Follow-up CXR after antibiotic therapy
may be helpful. The cardiomediastinal silhouette and hila are normal. There is
no pleural effusion and no pneumothorax.
|
19907150-RR-14
| 19,907,150 | 26,334,868 |
RR
| 14 |
2167-08-29 01:34:00
|
2167-08-29 08:00:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: History: ___ with UGIB, hypoxia // Eval for acute process
TECHNIQUE: Chest PA and lateral
COMPARISON: None.
FINDINGS:
Heart size is at the upper limits of normal. The mediastinal and hilar
contours are normal. The pulmonary vasculature is normal. The upper lungs are
clear. No pleural effusion or pneumothorax is seen. There are no acute
osseous abnormalities. There are multiple remote left posterior rib
fractures.
IMPRESSION:
The upper lungs are clear. The lower lungs are not well evaluated. Recommend
oblique views for further evaluation.
|
19907150-RR-15
| 19,907,150 | 26,334,868 |
RR
| 15 |
2167-08-29 07:27:00
|
2167-08-29 08:44:00
|
EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ year old man with Hep C, hematemesis, ?cirrhosis, evaluate for
cirrhosis, ascites.
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: None.
FINDINGS:
Evaluation is markedly limited due to poor sonographic penetration related to
body habitus.
LIVER: The liver is diffusely echogenic. The contour of the liver is smooth.
There is no focal liver mass. The main portal vein is patent with hepatopetal
flow. There is no ascites.
BILE DUCTS: There is no intrahepatic biliary dilation. The CHD measures 5 mm.
GALLBLADDER: Cholelithiasis without gallbladder wall thickening.
PANCREAS: The pancreas is not well visualized, largely obscured by overlying
bowel gas.
SPLEEN: Normal echogenicity, measuring 12.9 cm.
KIDNEYS: The right kidney measures 9.8 cm. The left kidney measures 9.6 cm.
There is no suspicious focal renal lesion, nephrolithiasis, or hydronephrosis.
Simple renal cysts are seen bilaterally measuring up to 1.1 cm.
RETROPERITONEUM: The visualized portions of aorta and IVC are within normal
limits.
IMPRESSION:
Markedly limited study due to poor sonographic penetration related to body
habitus. Limited assessment for cirrhosis and focal liver lesions. Patent
main portal vein, no ascites, borderline splenomegaly.
RECOMMENDATION(S): Consider MRI or CT of liver for more complete evaluation.
|
19907150-RR-16
| 19,907,150 | 26,334,868 |
RR
| 16 |
2167-08-29 12:18:00
|
2167-08-29 17:40:00
|
EXAMINATION: CHEST PORT. LINE PLACEMENT
INDICATION: ___ year old man with hep C with hematemesis. s/p intubation for
EGD. // ET tube placement? Contact name: ___: ___ ET tube
placement?
IMPRESSION:
There to chest radiographs new ___.
Endotracheal tube tip is between 3 and 4 cm from the carina.
New bibasilar consolidation could be pneumonia or, given the history provided
of hemoptysis, pulmonary hemorrhage. Small left pleural effusion is new. No
pneumothorax. Heart size top-normal.
|
19907150-RR-17
| 19,907,150 | 26,334,868 |
RR
| 17 |
2167-08-29 15:38:00
|
2167-08-29 16:25:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with hep C with hematemesis. s/p intubation for
EGD // Evaluate placement of OG tube
TECHNIQUE: Chest single view
COMPARISON: ___ 12:31
FINDINGS:
Enteric tube tip is below diaphragm, not included on the radiograph.
Endotracheal tube tip is 1.8 cm above carina. Stable cardiopulmonary
findings.
IMPRESSION:
Enteric tube tip is below diaphragm.
|
19907150-RR-18
| 19,907,150 | 26,334,868 |
RR
| 18 |
2167-08-30 15:16:00
|
2167-08-30 16:09:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with pneumonia // eval pulmonary findings
eval pulmonary findings
IMPRESSION:
Compared to chest radiographs ___.
Severe bibasilar consolidation continues to increase, probably pneumonia,
particularly aspiration, accompanied by increasing mild pulmonary edema.
Heart is moderately enlarged. Small pleural effusions are likely. No
pneumothorax.
ET tube in standard placement. Nasogastric drainage tube passes into the
stomach and out of view.
|
19907150-RR-19
| 19,907,150 | 26,334,868 |
RR
| 19 |
2167-08-31 04:07:00
|
2167-08-31 09:11:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with GI bleed, aspiration pneumonia s/p
intubation // interval change interval change
IMPRESSION:
Compared to chest radiographs ___ through ___.
Previous consolidation right lower lobe has improved. This may have been due
to acute aspiration atelectasis. Left lower lobe however remains densely
consolidated. Since mediastinal shift is equivocal, it is difficult to
distinguish atelectasis from pneumonia. Small left pleural effusion is
stable. Moderate cardiomegaly unchanged. No pneumothorax.
ET tube in standard placement. Nasogastric drainage tube passes into the
stomach and out of view.
|
19907150-RR-20
| 19,907,150 | 26,334,868 |
RR
| 20 |
2167-08-31 14:47:00
|
2167-08-31 15:10:00
|
EXAMINATION: CHEST PORT. LINE PLACEMENT
INDICATION: ___ year old man with new R PICC // R DL Power PICC 50cm ___
___ Contact name: ___: ___ R DL Power PICC 50cm ___
___
IMPRESSION:
ET tube tip is 5 cm above the carina. A right PICC line tip is at the level
of the proximal right atrium and should be pulled back 3 cm. Heart size is
enlarged, unchanged. Mediastinum is stable. Multifocal bilateral opacities
are unchanged. Small bilateral pleural effusion is unchanged. No
pneumothorax.
|
19907150-RR-21
| 19,907,150 | 26,334,868 |
RR
| 21 |
2167-09-01 15:01:00
|
2167-09-01 16:34:00
|
EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with pneumonia // ? progression of pulmonary
findings ? progression of pulmonary findings
IMPRESSION:
In comparison with the study of ___, the monitoring and support devices
are unchanged. Continued enlargement of the cardiac silhouette with some
element of elevated pulmonary venous pressure. The right hemidiaphragm is
quite sharply seen. On the left, there is silhouetting of the hemidiaphragm
consistent with pleural fluid and volume loss in the left lower lobe.
|
19907150-RR-22
| 19,907,150 | 26,334,868 |
RR
| 22 |
2167-09-02 04:37:00
|
2167-09-02 07:43:00
|
INDICATION: ___ year old man with pneumonia // ? progression of pulmonary
findings
TECHNIQUE: Portable AP view of the chest
COMPARISON: ___
IMPRESSION:
In comparison the prior radiograph, the left-sided PICC line, endotracheal
tube and elbow tube are in stable positions. Left lower lobe atelectasis and
underlying effusion or still present. Pulmonary edema is continuing to
resolve.
|
19907150-RR-23
| 19,907,150 | 26,334,868 |
RR
| 23 |
2167-09-03 04:43:00
|
2167-09-03 10:58:00
|
INDICATION: ___ year old man with pneumonia // interval eval of pulm edema
COMPARISON: ___.
IMPRESSION:
Support lines and tubes are unchanged in position. There is unchanged
cardiomegaly. There are opacities at the lung bases which may represent
developing pneumonia or aspiration. Follow-up to resolution is recommended.
There is slight pulmonary vascular congestion. There are no pneumothoraces.
|
19907150-RR-24
| 19,907,150 | 26,334,868 |
RR
| 24 |
2167-09-07 13:40:00
|
2167-09-07 15:57:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old man with recent VAP and ongoing hypoxia // ?Interval
change, new consolidation ?Interval change, new consolidation
IMPRESSION:
Compared to chest radiographs ___.
Heterogeneous opacification at the lung bases has improved, probably resolving
pneumonia. Cardiomediastinal silhouette is normal and there is no pleural
effusion. Pulmonary arteries are mildly enlarged suggesting elevated
pulmonary artery pressure. Healed left middle rib fractures are chronic.
This examination neither suggests nor excludes the diagnosis of acute
pulmonary embolism.
Right PIC line is been withdrawn to the origin of the right brachiocephalic
vein.
|
19907191-RR-70
| 19,907,191 | 21,112,927 |
RR
| 70 |
2154-07-14 15:15:00
|
2154-07-14 15:39:00
|
EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: History: ___ with colon cancer s/p recent neurosurgery p/w
altered mental status, dizziness// any metastasis or acute process?
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast. Coronal and sagittal reformations as well as bone algorithm
reconstructions were provided and reviewed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 16.0 s, 16.0 cm; CTDIvol = 50.2 mGy (Head) DLP =
802.7 mGy-cm.
Total DLP (Head) = 803 mGy-cm.
COMPARISON: CT head without contrast from ___.
FINDINGS:
Patient is status post right frontal craniotomy with resection changes seen in
the right frontal lobe. Suboccipital left craniotomy changes are also
unchanged.
There is redemonstration of numerous scattered hemorrhagic metastatic lesions
within the cerebral and cerebellar hemispheres. The largest lesion measures
approximately 1.7 x 2.1 cm in the left cerebellum, which appears mildly
enlarged compared to the prior study. There is again vasogenic surrounding
edema causing mass-effect in the posterior fossa and fourth ventricle.
Additionally, there is new vasogenic edema surrounding a 1.5 cm metastatic
lesion in the left parieto-occipital lobe, adjacent to the occipital horn of
the left lateral ventricle, not seen on the prior study from ___
(series 2: Image 13). Multiple other metastatic lesions also appear enlarged.
There is no evidence of acute major vascular territory infarction or new
hemorrhage. The ventricles and sulci are stable in size and configuration.
There is no midline shift.
Mild mucosal thickening is seen in the ethmoid air cells. Otherwise, the
remaining visualized portion of the paranasal sinuses, mastoid air cells, and
middle ear cavities are clear.
IMPRESSION:
1. There is interval increase in size of multiple scattered
hemorrhagic/hyperdense metastatic lesions since ___. For example,
the largest left cerebellar lesion is slightly enlarged with vasogenic edema
causing mass-effect in the posterior fossa and fourth ventricle. No evidence
of acute major vascular territory infarction or new hemorrhage.
2. The patient is status post right frontal craniotomy and suboccipital left
craniotomy with resection changes in the right frontal lobe.
|
19907318-RR-12
| 19,907,318 | 20,704,814 |
RR
| 12 |
2184-08-16 12:39:00
|
2184-08-16 15:39:00
|
HISTORY: ___ male with coronary artery disease and AFib, now with
nonspecific abdominal pain.
STUDY: AP portable upright chest radiograph.
COMPARISON: ___.
FINDINGS: The heart size is at the upper limits of normal, likely exaggerated
by technique. The mediastinal and hilar contours are unremarkable. The lungs
are clear. There is no pleural effusion or pneumothorax. Old left rib
fractures are seen in the area of metallic fragments. Numerous radiopaque
structures again project over the thorax, bilaterally, stable, question
shrapnel. There is no evidence of free air beneath the diaphragms.
IMPRESSION: No acute cardiopulmonary process.
|
19907318-RR-13
| 19,907,318 | 20,704,814 |
RR
| 13 |
2184-08-16 13:02:00
|
2184-08-16 18:58:00
|
INDICATION: One week's abdominal pain in patient with history of atrial
fibrillation, peripheral vascular disease, coronary artery disease. Evaluate
for mesenteric ischemia.
COMPARISON: None available.
TECHNIQUE: Contiguous axial images were obtained from the lung bases through
the pubic symphysis. Image acquisition was performed both before and the
after administration of IV contrast in the arterial and venous phases. No
p.o. contrast was given. Multiplanar reformation was performed.
FINDINGS:
LOWER CHEST:
The imaged lung bases feature minimal basilar atelectasis, but are otherwise
clear. There is no pleural effusion. There is focal thinning of the
myocardium at the cardiac apex with a calcification, suggestive of old
infarction (4B:205). There are coronary arterial atherosclerotic
calcifications present. There is no pericardial effusion. There is minimal
dilation of the right atrium.
ABDOMEN:
The liver enhances normally and contains no concerning focal lesions. The
patient is status post cholecystectomy. The inferior vena cava, portal vein,
splenic vein, superior and inferior mesenteric veins are patent.
There is subtle stranding of fat surrounding the pancreatic head. The body
and tail appear normal. There is no fluid collection. Borderline 1 cm
peripancreatic lymph node it seen (4:239). There is a 1.7 x 1.3 cm left
adrenal nodule (2:23). This mass is of fat density on non-contrast images,
and homogeneous in appearance, consistent with benign adrenal adenoma. The
right adrenal gland appears normal. There is a wedge-shaped hypodensity
within the spleen in the delayed phase, which may indicate an area of prior
infarction. The kidneys enhance normally and excrete contrast symmetrically.
There is a 2.3 x 2.0 cm simple cyst in the upper pole of the right kidney.
Another, 1.2 x 0.9 cm simple cyst is found in the lower pole of the right
kidney. A subcentimeter hypodensity in the mid pole of the left kidney is too
small to characterize by CT, however, also has the appearance of a simple
cyst. Cortical thinning seen at the posterior aspect of the right kidney,
likely scarring.
There is no intraperitoneal free air or fluid. The intra-abdominal loops of
small and large bowel appear normal, without dilation, wall thickening, or
abnormal enhancement. The abdominal aorta features extensive atherosclerotic
calcification, which extend into many of the main branches. There is no
aneurysmal dilation or dissection. There is focal narrowing of the celiac
trunk due to atherosclerotic disease (4B:246). There is mild stenosis of the
origin of the superior mesenteric artery caused by non-calcified plaque
(4B:251). Similarly, there is mild stenosis of the proximal superior
mesenteric artery (4B:260). The inferior mesenteric artery contains extensive
calcifications, but appears to be patent. There is no mesenteric arterial
occlusion seen.
PELVIS:
The pelvic loops of small and large bowel, rectum, and sigmoid colon are
normal. The appendix is not seen. The bladder, prostate, and seminal
vesicles appear normal. There is no pelvic free fluid. There is no
intraperitoneal or pelvic lymphadenopathy.
OSSEOUS STRUCTURES: There are no destructive lesions or acute fractures. Old
left ___ and 10th rib fractures seen. Chronic appearing deformity of the
right superior pubic ramus is also seen, may be sequela of prior trauma.
IMPRESSION:
1. Extensive peripheral vascular disease without evidence of mesenteric
arterial occlusion. There is no evidence of ischemic enteritis or colitis.
2. Focal fat stranding around the pancreatic head, in the setting of elevated
serum lipase, is consistent with mild acute pancreatitis.
3. Incidental findings as described above.
|
19907318-RR-17
| 19,907,318 | 22,468,325 |
RR
| 17 |
2191-06-07 14:54:00
|
2191-06-07 16:47:00
|
EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ male with abdominal pain.
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest radiograph performed ___.
FINDINGS:
Lungs are well aerated. Multiple metallic densities projecting over the left
and right chest are unchanged compared to multiple prior exams. No evidence
of focal consolidation. No pleural effusion or pneumothorax. The
cardiomediastinal silhouette is stable. Chronic left lateral rib deformities
are again noted.
IMPRESSION:
No acute intrathoracic process.
|
19907318-RR-18
| 19,907,318 | 22,468,325 |
RR
| 18 |
2191-06-07 17:44:00
|
2191-06-07 18:55:00
|
EXAMINATION: CT ABD AND PELVIS WITH CONTRAST
INDICATION: ___ male with abdominal pain.
TECHNIQUE: Single phase contrast: MDCT axial images were acquired through the
abdomen and pelvis following intravenous contrast administration. Oral
contrast was not administered. Coronal and sagittal reformations were
performed and reviewed on PACS.
DOSE: Total DLP (Body) = 1,106 mGy-cm.
COMPARISON: CT abdomen pelvis performed ___.
FINDINGS:
LOWER CHEST: Bibasilar atelectasis. No large pleural effusion or pericardial
effusion. Coronary artery calcifications are moderate.
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.
PANCREAS 1.1 x 1.5 cm hypodense cystic lesion the proximal pancreatic body
appears increased in size compared to ___ where it measured 0.6 x
0.7 cm (02:25). This is associated with soft tissue stranding about the
pancreatic head and body (for example 2:26, 601:23). No pancreatic ductal
dilatation is identified.
SPLEEN: The spleen shows normal size. Subtle peripheral hypodensity in the
spleen likely reflects prior infarct, age indeterminate but new from prior
exam.
ADRENALS: The right adrenal gland is normal in size and shape. A 1.3 x 1.3 cm
left adrenal nodule is unchanged compared to ___ and was previously
characterized as an adrenal adenoma (02:20).
URINARY: Mild right renal cortical scarring. Multiple bilateral renal cystic
structures measure up to 2.6 x 2.4 cm in the right upper pole kidney. There
is no evidence of focal renal lesions or hydronephrosis. There is no
perinephric abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. The colon and
rectum are within normal limits. The appendix is not visualized, however there
are no definite secondary signs of appendicitis.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic
disease is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. Mild focal soft tissue stranding surrounding the pancreatic head and body
may reflect a mild acute pancreatitis in the setting of elevated lipase.
2. 1.5 cm proximal pancreatic body cystic lesion may represent a pseudocyst
and appears slightly increased in size compared to ___. This may be
further evaluated with dedicated MRCP.
3. Small splenic hypodensity likely reflects an age-indeterminate infarct, new
compared to ___.
RECOMMENDATION(S): Nonemergent MRCP.
|
19907351-RR-16
| 19,907,351 | 22,349,990 |
RR
| 16 |
2158-06-04 14:27:00
|
2158-06-04 16:05:00
|
EXAMINATION: HIP NAILING IN OR W/FILMS AND FLUORO RIGHT
INDICATION: RT HIP FX.ORIF
IMPRESSION:
Images from the operating suite show placement of a fixation device about
fracture of the proximal right femur. Further information can be gathered
from the operative report.
|
19907351-RR-17
| 19,907,351 | 22,349,990 |
RR
| 17 |
2158-06-06 20:31:00
|
2158-06-06 21:01:00
|
INDICATION: ___ year old woman with new O2 oxygen requirement// Observe for
atelectasis or other lung abnormality
TECHNIQUE: Chest PA and lateral
COMPARISON: ___
FINDINGS:
Retrocardiac opacities may reflect atelectasis and/or pneumonia. The lateral
view suboptimal. There is no pleural effusion or pneumothorax. The size of
the cardiac silhouette is enlarged but unchanged. The bones are diffusely
demineralized.
IMPRESSION:
Retrocardiac opacities may reflect atelectasis and/or consolidation.
|
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